Assuming things around 1998 in the graph below were what most of us would have figured until recently was what normal should look like – by that I mean as we might have expected things to be – there has been a dramatic change since 1998. See Conspiracy of Silence. No one, until recently, would have expected teens to be collecting disability payments and the rate of disability in people under 35 to escalate to the point where it outstripped disability in middle age.
Something has happened. If the something began with the 18-30 year olds here, then it may have begun between 1990 and 2000. If it began with their parents and through their parents affects the now 18-30 year olds the key events might have been back around 1980 or earlier.
Abigail Shrier’s Bad Therapy puts trauma culture in the frame as a happening that is having catastrophic effects on children today in part because of the effects it has had on their parents and people of their parent’s generation working in bureaucracies who, likely with good intentions, but nevertheless misguidedly, are trying to put something in place that will mean the next generation of kids will be less traumatized than their parents. Those trying to put things right are folk, who think if we can set up a virtuous circle we can make a real difference for the better.
Trauma
World War I and II brought trauma into Western culture.
Nervous breakdowns among soldiers had been well described in the American Civil War. The Russians put something more clearly linked to traumatic shock on the map in 1904 when losing to the Japanese – a loss that likely contributed to the 1917 Revolution. But WW I really brought trauma to the fore as told in Stefanie Linden’s wonderful book They Called it Shellshock.
The word shellshock essentially rebranded hysteria, which up till WW I had been a disorder of women and people with weaker constitutions. A new name was needed because in WW I officers, no less than the working class men in trenches, were badly affected. Women in contrast were becoming surgeons and running hospitals back at home. The social order was shaken up. There was an uptick of births linked to WW I but not as dramatic as the increase 30 years later.
Shellshock helped make Freud’s reputation. Paradoxically, Freud came to the fore not because he believed trauma was a factor causing nervous problems but because his position was that trauma, whether War or Sexual Abuse in childhood, was irrelevant. People broke down in War or in Life, because they had pre-existing adjustment difficulties linked to poor prior management of their libidinous impulses. Current difficulties (trauma) played into the prior weakness. See Shipwreck in Maastricht.
This view excuses the powers that be from causing our nervous breakdowns. It stops us suing governments for drafting us into military or vaccine wars. It lays a basis for pointing to a pre-existing mendacity of women when they claim sexual abuse or rape.
Thinking on these lines was not unique to Freud. It played a growing part in industrial accidents and ‘mental trauma’ linked to these accidents in American legal cases from the creation of railroads in the 1850s onwards.
It shaped how the American military dealt with the question of military pensions after the Civil War – ultimately creating in the US what might be called the first single party payer health service anywhere in the world. It colored how Germany and Britain dealt with Shellshock after WW I.
For WW II the Americans screened men for psychological weakness and excluded them. This did nothing to eliminate the problems. The War and the post War nervous problems entrenched psychoanalytic thinking in the United States. The Europeans went to War armed with high dose barbiturates, which helped in many but not all cases.
Analysis came out of the War strengthened. This led to claims that it was obvious where the War had come from – the Germans were maladjusted. Democrat voting psychiatrists, unlike Republican voting doctors in general, knew what was wrong with Republican politicians like Goldwater and Reagan – they were latent homosexuals. In an era when Americans put a man on the moon, the shrinks figured it was within reach to prevent Wars by curing our neuroses.
Data on personality profiles showing that German concentration camp guards were more normal and less psychopathic than the American G.I.s who liberated the camps did nothing to change minds on this.
Vietnam
Then came Vietnam. Once again the Americans screened for prior nervous dispositions. Once again this didn’t solve the problems. US troops unquestionably saw grim things, but Vietnam also had an element of pointlessness or worse to it. Unlike WW I when both sides and WW II when the Allies at least mostly felt they were on the right side, it was not clear to all American troops in Vietnam they were on the right side. Apart from sheer terror or the prospect of imminent death, many of them had an element of moral injury not present to the same extent previously.
The returning veterans had problems that needed managing. Some of those doing the managing lobbied the committees put in place in 1976 to revise American psychiatry’s Diagnostic and Statistics Manual seeking to get Trauma included in what would be the 3rd Edition of the Diagnostic and Statistics Manual – DSM III.
This led to the creation of Post Traumatic Stress Disorder – PTSD. The original PTSD criteria stressed the need for prior traumatic events beyond the level of common adversity – events like War.
DSM III was published in 1980. It marked the swings of two pendulums within American psychiatry. One was a swing from psychoanalysis to what has since come to be called biological psychiatry – a term invented around this time which points to something quite different to clinical psychiatry, which most of the rest of the world, who had not become so Freudian, were practicing.
The second swing was from an analytic management of trauma, which downplayed it, to an insistence on the reality of trauma and its effects even in normal people. This swing led to an explosive wildfire growth of a trauma culture, where recovered memories of abuse on alien spaceships were taken seriously. Nobody was allowed to doubt anything that people who might have been traumatized said to them.
The stated goal of DSM III was to pull the psychiatric profession back from the craziness of viewing the entire United States as mentally ill to a medical model. When most of those now working in American mental health hear ‘medical model’ they hear pharmaceutical model. This is a long way from the original meaning of the word which tied diseases to bodily changes and enabled doctors to recognize it might not be a good idea to treat the condition with drugs etc.
The original medical model put an end to our use of drugs to get the balance of our humors right. Left to our own devices 200 years ago we were consuming lots of potions designed to balance humors in addition to enthusiastically bleeding and purging ourselves in a manner that resembled today’s polypharmacy pandemic..
Even though, DSM III had no talk about our lack of prior resilience being a factor in our current problems, the trauma-informed care that exploded onto the scene, no less than its twin, biological psychiatry, happily recreated the impression that everyone was mentally ill. And also cemented the location of these problems within us.
This happened because DSM III gloried in being an operational manual. This means it was stepping back from experts like Freud on the one side and Doctors on the other and said when you meet 5 of these 9 criteria for Major Depressive Disorder (MDD) or PTSD you have MDD or PTSD. It advised professionals applying the criteria to exercise judgement as to whether superficially meeting the criteria should be counted as the real thing – but professional judgement got swept aside when it was published.
Even more than the adoption of monetarism by Chile and Britain, DSM III marks the birth of neo-liberalism. Monetarism and neoliberalism are built as the DSM was (and is) on an operationalism. Forget about wise judgements about the state of the country or a patient, following the numbers is the only rational thing to do – so rational that the money follows people following the numbers.
One Dimensionality
But following the numbers is not a wise thing to do and we are now reaping the consequences of pursuing this rational folly.
As early as 1964, Herbert Marcuse worried that operationalism was creating one-dimensional humans. Republicans, and likely Abigail. without naming Marcuse, now blame him for the Trauma Culture and Woke Epidemic destroying the United States.
Marcuse died the year before DSM III came out and would almost certainly have found it horrific – whereas Michel Foucault likely thought it wonderful before he died shortly after. While Marcuse was worried about operationalism, both the Left and the Right were embracing this new form of rationality, none more so than Foucault, maybe the earliest neoliberal – long before Milton Friedman suggested we should let the numbers govern us – or at least govern Chile.
Another great symbol lies in the stated aim of DSM III to shift psychiatry back to the medical fold. At exactly the same time, the rest of medicine was moving in the direction DSM III was moving toward a new Holy Ground – operationalism. Pretty soon, whatever your problem, physical or mental, your doctor was going to be treating your numbers rather than treating you. Whether some doctors leaned left and others leaned right was irrelevant to the practice of neo-medicalism.
When the Americans failed to spot that the Germans might be more normal than they were, they missed the obvious conclusion that we are all capable of atrocities. In a similar manner, the new therapy culture failed to note the Vietnamese and even the victims of the Holocaust, although unquestionably suffering far more than the Americans and the Germans, with far more losses, were not as traumatized as their high powered enemies. The Vietnamese and the Jews were relentlessly high achieving rather than disability claimants or seeking medical input for their problems.
PTSD rapidly spread way beyond War to cover Rape and then Child Abuse. This did not seem unreasonable to me writing a history of Trauma in the early 1990s. The book was originally called Images of Uncertainty but the publisher insisted on Images of Trauma. The full text is on Samizdat and Here.
Rape is clearly violent and legitimately described as traumatic and may be linked to significant violence up to murder. It can be a weapon of war. Child abuse is usually less violent but the confusions linked to grooming are not insignificant and may also involve trafficking by gangs of men.
But by the early 1990s things were spinning out of control. Reasonable clinicians were believing stories about abuse on alien spaceships and hostile to anyone who didn’t. The failure to even think about attempting to disentangle fantasy from reality paved a road to hell.
After the Recovery Memory fiasco, trauma reinvented itself in the form of ACEs – adverse childhood experiences. No more alien spaceships, no need to distinguish fantasy from reality. If a person had a history of multiple relatively minor (compared to War or Rape) stressors in their childhood they were traumatized and this lead to all sorts of physical or mental problems, including things like Medically Unexplained Symptoms (MUS) and more recently Functional Neurological Disorder (FND).
With ACEs there is no one to blame and the problem to be fixed again lies within the person which is good for mental health business and increasingly school teachers.
There are all kinds of trauma these days like religious trauma syndrome. For Millennia we have recognized people have had spiritual crises that may involve thinking about leaving a faith (or a prior political tribe). This is part of being human. Now it’s an illness and a counsellor who might know nothing about life will offer to heal you.
On this basis adolescence should be redefined as an illness – but of course in practice it is rapidly becoming one.
It is much less threatening to the established order if you are dealing with your illness than tackling what you figure might be wrong with society. Being alive is traumatic but good news we can treat that.
What about the plummeting fertility rates, especially in this disabled generation? It will lead to a lack of troops for future Wars, which has been a major military concern – Welfare Conspiracy and Fertility and the Military. The military may not be concerned. In the near future, wars will be robot wars. Robots don’t get PTSD or moral qualms.
Moral Injury
Stefanie Linden’s new book is published this week. I haven’t read it but know that moral injury is on her radar.
Nobody hears about it today but WW I triggered a communist revolution in Germany stemming in part from the argument – this was a War against us not against the English. It was savagely put down. Germans welcomed the final solution for political stability put in place.
After WW II, there was little mention of the Holocaust. Was this post-traumatic amnesia or a matter of moral injury? The 1960s generation who didn’t carry this baggage started asking questions and turning to mass protest in 1968 and Red Brigade violence.
As with Vietnam, German views about what a moral universe might look like had been damaged. Is political dislocation disorder a matter for a health service? Should we have to invoke a medical illness to be heard? Will invoking a medical illness help us be heard? Why do we invoke a medical illness?
What a fine balance it is to invoke a medical illness while insisting any number of labels from ADHD, to neurodiversity and trans matters aren’t medical illnesses.
The graph above is Exhibit 1 in the case being mounted against a ‘Snowflake’ Generation. As Conspiracy of Silence and Bad Therapy hopefully make clear, while I think its ridiculous that smart people can use ADHD to get disability payments, I’m not part of the case against them. I’m pretty sure I and my generation would be acting the same way if operating in the system they are in.
But I do think locating social and political difficulties within people and managing (medicalising) them with therapy and drugs and disability payments is a disaster.
I see Greta Thunberg’s generation morally oppressed by global destruction. Current wars seem utterly senseless to me – and this is not because I couldn’t kill someone. The stripping of health and social care by Hedge Funds, facilitated by socialist parties, is evidence of a world gone mad. The Korean women – with other Asian women in hot pursuit – whose fertility levels have fallen to 0.5 because they see no point bringing a child, particularly a girl, into this world have a case. We have not valued women.
I can’t speak to these matters because I don’t know enough to have more than hunches or feelings. But there is something I know something about.
Colleagues universally tell me about a snowflake generation of medical trainees who are not like ‘us’. They can’t make decisions, can’t tolerate the uncertainty that is central to clinical practice and don’t feel cherished. I smile when I hear this; the only cherishing that went on that I can remember when I was trainee was among classmates.
But the word cherish turns up again in a Lancet editorial by Richard Horton this week who wonders what our generation has done to make life so miserable for today’s trainees and insists we must put it right.
For me this maps onto regular opinion pieces by Richard Smith, a former BMJ editor, complaining about fraud in health research. Smith published perhaps the most serious medical fraud ever – Lilly’s Beasley et al article. He knows exactly what he did and what he should now do but hasn’t got the backbone to do so.
Is this Sanctimoniousness the innocent looking tip of a moral iceberg?
For 30 years Horton and Smith and related Lancet and BMJ editors have been too scared to publish anything on the harms of prescription drugs – Vampire Medicines. They are only outdone in this by the New England Journal of Misinformation’s Drazen and Rubin. See Boston Strangler and Silencing Doctors, Silencing Safety (see footnote).
Medical journal editors are not the only one’s to blame. Presidents of Medical Associations in America and Royal Colleges in Britain and equivalent bodies in Europe share the blame. Dinesh Bhugra, a former President of the Royal College of Psychiatrists, who is campaigning for us to cherish trainees, along with Simon Wessely, Adrian James, Lade Smith and others clearly have an ability to turn a blind eye to the damage that rivals Nelson.
The combined lack of backbone of these (mostly) dudes has morally compromised medicine.
The message to the ‘snowflakes’ is we will discredit you if you even think about speaking out about the obvious. If you take a patient’s side, the system we have been party to creating will ensure you never work again. Talk about cherishing is gaslighting.
The upshot of all this is that Yoko and Vincent, the parents of Romain Schmitt, cannot get a single doctor in France to write a report about a drug disaster that a teenager with no medical training could get right. Not only can people not get decent medical care – I don’t mean stellar care, just decent would do – but they also cannot get justice.
It means that Rosie Tilli, injured so distinctively by a drug that no other medical condition could conceivably confound an interpretation of what has happened her, gets detained in a mental hospital for her crazy ideas – See Sex Death and the Royal College of Psychiatrists for this and a bunch of related issues.
It means the best material on what has gone wrong in healthcare comes from people who have no background in healthcare at all – Healthcare Gone Mad.
We are heading toward a cliff edge.
Footnote: For aficionados of these things the Silencing Doctors post above contains a collector’s item – a doctored photo of Kate Middleton.
I watched an interesting documentary on Netflix “The Program: Cons, Cults, and Kidnapping” – recommended.
But at one point a psycho-analyst corrects a “victim” by saying”No, not PTSD – you have CPTSD”
CPTSD – the C word is “Complex” – doesn’t have a code in the ICD-10 and the DSM-5 classification although ICD-11 has come on board
Features of CPSD include additional symptoms, including chronic and extensive issues with:
Emotion regulation.
Identity and sense of self.
Relationships.
The Wiki definition of “snowflake” is
Inflated sense of uniqueness
Unwarranted sense of entitlement
Overly emotional
Easily offended
Unable to deal with opposing opinions
Time for a diagnostic code for Snowflake I think
CPTSD is a horror – it means we can’t identify any significant trauma or failure to help you but we ain’t going to let you go and damage our income flow
CPTSD is like the Ptolemaic spheres where new ones got invoked the whole time rather than admit the original theory wasn’t right. There is a respectable way out of this which doesn’t mean saying our theory isn’t right which these posts will return to soon and its this – our theory isn’t right for this person
D
I should also add that I’m indebted to Annie Bevan for drawing my attention to the Horton Bhugra stuff mentioned. Just a few days ago she commented on last week’s Welfare State Conspiracy post and brought all of this to may attention – it was a light bulb moment for me – for which I need to thank Annie
David
Annie has been a massive source of information and encouragement to me as a commentator for many years now. Thanks also Annie.
Thanks very much, Susanne
Let’s examine…
My British-born Cousin was taken to Canada by his parents. They emigrated to Canada and ran a borstal for delinquent children. Mostly big-black. It was a tough job. My cousin volunteered to go Vietnam. He became a paramedic.
His parents, my aunt and uncle, retired to Florida. They lived in a mobile home in Daytona Beach.
On his way back to the US, he visited me in a full-office in London, at the Ministry of Agriculture, Fisheries and Foods. In full combat-gear, the garb, the boots, the cap, the decorations. The silence was deafening.
We often went to Florida on vacation, and it was my cousin who I adored and we hung-out together.
He was exciting. He splashed out on a new convertible and drove it in to the sea. We went to Disneyland in Orlando. At times, he wept. I was 17, what did I know.
As a war-veteran, he went in to the fire-service. He rose the ranks and became Chief Fire Officer, Daytona Beach. At 50, moving his lawn he dropped dead from a heart attack leaving his wife and 3 children. He got quite a lot press as a war-hero.
In 1970, my cousin wasn’t offered drugs or talking therapy. I saw the lived reality in the head of my cousin; the almost impossible adjustment to a new life that he himself worked through and pushed himself from unimaginable horrors to even new horrors in the fire-service.
When Simon Wessely promotes a book by Dinesh Bhugra, with a picture of a lighthouse on the front of it, I am somewhat sickened. A lighthouse is a beacon of hope for sailors. It is there to warn, to assist, to navigate.
Here is the book-cover for the new book by Dinesh Bhugra
https://twitter.com/dineshbhugra/status/1764923209038614906
dinesh bhugra reposted
Charlotte Summers
@charlot_summers
·
Mar 15
Challenge from @richardhorton1 about the current state of medical education. “Who will act?” he asks…. What have we done to medical students? – The Lancet
Get a load of it
https://twitter.com/dineshbhugra
Here is Richard Horton
What have we done to medical students?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2824%2900526-9/fulltext
Towards Shangri-La
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2824%2900464-1/fulltext
Trust is a complex idea. Miranda Fricker has pointed out that trustworthiness suggests two quite separate qualities—competence and sincerity. Our leaders across many domains of society, including medicine and science, often lack both. And when a category of actor—the political leader, multilateral bureaucrat, or scientist—is suspected of self-interest or deceit then society will not veer towards simple mistrust, but, as Anthony Giddens once argued, a persistent existential anxiety, angst, or dread. Some of my companions believed that human nature was composed of two elements—one more selfish, concerned with, above all else, yourself, your family, your community, your nation; while another was more altruistic and generous to others. Within this altruistic aspect of human nature lay reasons for hope. A good story to raise our expectations for the future, to be sure. But a fatal misreading of our pitifully and brutally unjust world today.
The Lancet’s Richard Horton:
‘We’re going to continue to see health as political’
Veteran editor says commercial success has given him the freedom to make controversial decisions
https://www.ft.com/content/33e41e46-0d5d-480b-ad08-009da434c52f
In an era of culture wars, Horton’s activism — on issues from global inequality and the Iraq war to the UK government’s immigration policy and pandemic response — is not universally popular, particularly with commentators on the political right. “Richard Horton is destroying The Lancet with politics,” claimed an article last year in online publication Unherd.
“The combined lack of backbone of these (mostly) dudes has morally compromised medicine.”
There you have it
Do you want a Lighthouse, a Political animal, or do you want The Moral Prerogative?
‘Competence and Sincerity’
Over to you,,,
In order to sort out what’s going on, a bit more information on that “Disability” graph would really help. What definition of “disability” was used? Or in other words: what were they measuring?
The graph says that in 2022, about 20% of people ages 24-30 were “disabled.” Did that mean that A) these people were receiving disability benefits? Unable to work full-time? Or did it simply mean B) they self-identified, when asked by a pollster, as “a person with a disability”? I find option B not too hard to believe – especially when it comes to mental and emotional problems, folks under 40 are more likely to think of themselves as having a chronic disease than someone over 40 in the same condition. But 20% of those young adults “on disability” and out of the workforce? I have a hard time imagining that.
What country or country do these figures come from – and do you have a source?
U.S. Census survey from 2021 reported that about 13% of non-institutionalized Americans reported having a disability. I think they used a stricter definition – the condition had to interfere with a major life activity like walking, memory/concentration, independent living, etc., although being employed did not exclude you from the count.
By age group, the percentage of “disabled Americans” were: 8% for ages 18-34; 12% for 35-64; 24% for 65-74; 46% for age 75 and up. In other words, the rates rose with age. Rates were higher in rural areas than urban, and five states scored 17% or higher: Oklahoma, Tennessee, West Virginia, Kentucky and Mississippi. All economically depressed parts of the South. Rising numbers of workers applying for public disability benefits (Social Security Disability or SSDI) have inspired much hand-wringing in recent years — overwhelmingly in the 40-64 age group. Rates of premature death in this same age group have risen sharply as well.
How does this picture compare with the UK, Ireland or other places?
Jo
The Data/graph and report on which its based are all linked in the previous post on Welfare State conspiracy. The graph points to disability benefit collection and in this age group its mental illness based – autism, depression and ADHD – along musculo-skeletal. It seems you just have to come along and say you have trouble bending your finger since Covid to get a musculo-skeletal benefit – there is strong encouragement on docs not to go hard on anyone.
Why? The Brits at the moment want to keep the unemployment figures low which they do by signing people off on disability but between unemployed and disability they have more people out of work than anyone else.
My point is add people collecting ‘pensions’ from the age f 18 to the collapsing fertility rate in this group and you have a recipe for economic collapse – which is increasingly on the radar for all sorts of politicians. In the UK its not going to be dealt with until after their election. But someone is going to have to get a grip on a range of issues.
David
Joanna – The source of the graphs is
https://www.resolutionfoundation.org/publications/weve-only-just-begun/
Data are from the Labour Force Survey by the UK Office of National Statistics.
https://www.ons.gov.uk/surveys/informationforhouseholdsandindividuals/householdandindividualsurveys/labourforcesurvey
The graph shows “Proportion of the working-age population that classify as disabled, by main health problem and single year of age: UK”
My interpretation is that this is “self-reported” health status – which is perhaps even more concerning?
Thanks for the links, Dr. P! While I haven’t been able to locate the exact chart reprinted above, I did find lots of others which referred to people “classified as disabled under the Equality Act of 2010.” I think that is the definition we are working with.
Being “classified as disabled” under the Act requires more than simply thinking of yourself as “having a disability.” You must have an impairment that is a) substantial; b) long-term and c) affects your ability to perform “normal day-to-day activities.”
But it does not mean you qualify for disability benefits (or any other specific benefit like a parking permit or a tax break). It’s somewhere in the middle, more like the U.S. Census definition. And just like the Americans with Disabilities Act over here, it is inevitably subjective – which means it’s also political. When government benefit programs and workers’ rights are up for debate, it stands to reason that one side will declare the current rules outrageously permissive, while the other side says they are cruelly restrictive or stingy.
So, we can be totally right to be concerned about that chart showing 21% of the 24-to-30 group “classified as disabled.” But we gotta realize that does not mean 21% are drawing a disability check. And we can’t automatically side with whichever team argues the problem is out of control, just because that appears to strengthen our own case for medication harms. Political teams on either side can be reckless with the facts, for reasons that have little or nothing to do with the medical system.
A little run on Wise-Owl James, host of Mad in America podcasts, and a little run on UK suicide expert, ‘film-buff’ and bird-man…
https://twitter.com/ProfLAppleby
“But I do think locating social and political difficulties within people and managing (medicalising) them with therapy and drugs and disability payments is a disaster.”
recovery&renewal reposted
James Moore
@jf_moore
·
5h
I notice ‘too many people on benefits’ criticisms being equated with ‘mental health diagnoses overused’. They are not the same, what the benefits critics are doing is denying suffering and harm. That’s not the same as asking if we are applying a medical lens to social issues.
James Moore
@jf_moore
·
5h
And for the record, being able to feed your kids is not a ‘benefit’ it’s surely a human right. There’s more than enough money to go round if the 1% werent engaged in a grotesque spectacle of competitive hoarding and excess.
Mark Horowitz
@markhoro
·
1h
well said James
louis appleby
@ProfLAppleby
By coincidence reports of rising poverty and rising mental ill-health both appeared yesterday.
But the cause for the latter was said to be “over-medicalisation”.
louis appleby
@ProfLAppleby
From stigma to “gone too far”.
Need to recognise a growing public narrative, that mental health is a card people play, a way of evading responsibility for work or crime.
Every govt wants to reduce welfare bill.
But rhetoric matters, it can’t be at the risk of renewing stigma.
https://twitter.com/ProfLAppleby/status/1771107135994073533
Families for Informed Consent for Antidepressants
@stopharmingus
·
3m
We also need to acknowledge that a proportion of people who have taken antidepressants as prescribed will experience severe and protracted withdrawal when they try to stop taking them.
The stigma here is multiplied by the denial and cover-up culture in the NHS.
Pro Flappelby on Oscars
‘I am secretly hoping #Barbie wins everything…
As a young neurologist, Sigmund Freud had patient after patient come to him, mostly women but some men as well, revealing they had been violated sexually as children, always beginning before the age of eight. he concluded (non unreasonably, IMHO) that their present-day problems had their roots in these early childhood violations, and he published three papers on the subject, all in the year 1895.
But then he did an about-face and proclaimed that these early childhood violations never happened at all. Rather, they were the product of “infantile fantasies.”
Now let’s take a moment to consider how bizarre Dr. Freud’s position becomes at this point, He always adamant that conditions like “hysteria” and “neurosis” were real diseases, no less so than smallpox (his comparison, not mine). Now he was saying, in effect, that these real diseases were caused by events that never happened,
Patrick
Thanks for this important comment. Images of Trauma covers this area for anyone who is interested but it was written just before the Recovered Memory Crisis came into the frame and made everything a lot more complex. Images of Trauma does not endorse the reality of trauma in all cases but what is now clear is fantasy can get mixed in the accounts people give. Clinicians should not be hostile but as the post next week will outline there is a need for both sides to establish what probably has happened rather than one side – either Freud or his patient getting to claim their version alone is the reality. They/We need to get a point complete outsiders are likely to agree is a reasonable interpretation – that said it has to be an interpretation that allows us to change out mind as new evidence comes into play.
I spent last night being quizzed about an early RxISK article about SSRI induced alcoholism. There was a commentary published with it that was pretty hostile – by Stefan Kruszewski – not much consensus between us and him but as the evidence has come in and the position we outlined is now endorsed in Canadian national guidelines one hopes he might agree that our claims that SSRIs can trigger alcoholism in some cases looks right in some cases – at least in the cases we reported on.
David
Patrick I’m currently reading The Guru, The Bagman and the Sceptic – marketed as a story of science, sex and psychoanalysis. by Seamus O’Mahony
There’s so much to be sickened by How Freud got away with it, and became one of the most influential men of modern times iIt s a lesson in itself -he even ‘analysed ‘his own daughter against her wishes for three years He was supported by a gaggle of supposed intelligent people with highly dubious characters but partly because of the position in society indulged themselves by characterising analysis as a science. It amounted to a cult where sexual and emotional abuse amongst them was brushed off with his incredible sometimes cocaine induced psychological rubbish His effect on so many of them was to commit suicide. There doesn’t seem to be one individual who stands alone like Freud these days but the collective harm done by groups influenced by him and his admirers is reflected int eh way the disgraced Tavistock allowed youngsters to be harmed by gender altering drugs. A few psychoanalysts who worked there did tried to speak out but most went along with it Too late for many of the youngsters. Yet another theory has taken hold in schools and so on is Bowlby ‘s Attachment theory. There is now a minute check list drawn p to characterise various types of attachment ‘disorders’ relating to ‘parenting’. When it’s blindingly obvious harmful experiences will have an effect this level of theorising amounts to yet another cult.Women are not overly keen on mostly men who haven’t actually brought up children or even worked with them , telling parents and carers how to raise their children. It’s another type of control with a another Freud , Mathew Freud type of propaganda to hide any critiscism of blaming. it’s time to stick their theories where – wherever they can do less harm.
‘Pretty soon, whatever your problem, physical or mental, your doctor was going to be treating your numbers rather than treating you. Whether some doctors leaned left and others leaned right was irrelevant to the practice of neo-medicalism.’
There’s another Marcusean construct that we can build back into the operationalism and one-dimensionality narrative that helps explain the ‘relational ‘ – or not – aspects of neo-medicalism. That political favourite – ALIENATION.
‘Marcuse understands alienation as anaesthetization— a deadening of the senses that makes repression and manipulation possible. ‘
https://www.bu.edu/wcp/Papers/Educ/EducReit.htm
Alienation, arguably, is the cultural mindset that enables our historically caring, holistic ‘family doctors’ to morph into time pressed, ‘EBM’ misprogrammed automatons, treating patients in atomised form as numbers on a screen. It’s also the cultural mindset that enables human beings, to disconnect from their instincts– and instead validate their existences through some parenting or sexual or psychiatric identity and performance manual. Alienation is short on insight and has no sense of irony either. It’s no fun – because it lacks whole human connection.
In a fairly recent piece of research (2018) – it was shown that the majority of clinicians (not unreasonably specialists working off referrals were even worse than primary care) failed to elicit their patient’s agenda – the patient’s own perceptions of their state of health and what mattered to them – interrupted after a median time of 11 seconds ( far less time than it apparently takes most of us to pee – 21 seconds). This was 2018 – with pressures on healthcare exacerbating, it would not be unreasonable to assume this situation has not improved.
https://link.springer.com/article/10.1007/s11606-018-4540-5
Dariusz Galasinski, who often has an original take on experience as a discourse analyst , half psychologist, half linguist, wrote a wonderful blog about the alienating experience of a medical consult ,trying to relate to a doctor whose primary connection, physical, emotional and intellectual, was with their computer:
‘And so, as I was perched on the edge of the chair, speaking to the side of the GP whose primary interest was in the computer screen, the whole layout suggested to me that I was a bystander. I was on the sideline. To make matters worse, I was making an effort to engage with the GP, twisting body uncomfortably, but the GP was offering me his cold shoulder as he continued to ‘talk’ to the computer. And that’s the main reason why I think that the side-desk layout is unhelpful. As clinicians repeat the mantra about the physical barrier and their bid to remove it, the new layout is, I think, even more about their power.’
https://dariuszgalasinski.com/2022/02/14/power-of-the-layout/
Ofc they’re not all automatons. Not all. Jonathan Tomlinson, whom you may know, is a GP in East London, working in an area of deprivation with a large immigrant population suffering much distress. He came to my attention on X when he announced, controversially at the time – that he was not a regular prescriber of antidepressants, because he found that if he saw patients on multiple occasions, their ‘depression’ or ‘anxiety’ had passed. As it would. As it does. He’s written some pretty compelling stuff – even rather moving – about, amongst other things, ‘being present’ for patients:
‘But to be fully present with another person calls for awareness of oneself,
and the other person, and of what is going on between the two in the here and now. Maintaining this kind of self-aware openness and curiosity under stress is extremely difficult.”
https://abetternhs.net/wp-content/uploads/2021/09/wp-1632927991740.pdf
He’s also an educator – but how much one – or a few enlightened bods like him, can reverse the HORROR (‘Apocalypse Now’) remains to be seen. The only thing I remember from physics’ lessons is – for every force there is always a counterforce. The cliff edge still remains…perilously close.
“This work has the potential to reshape and improve care for millions of people across the country.””
News item this evening, RCP and ADHD
https://www.bbc.co.uk/sounds/play/m001xwps
The Taskforce
https://www.england.nhs.uk/nhs-england-announces-formation-of-attention-deficit-hyperactivity-disorder-adhd-taskforce/
Royal College of Psychiatrists
@rcpsych
On @BBCRadio4 on this evening’s @BBCPM Programme Consultant Psychiatrist – Dr Ulrich Müller-Sedgwick – welcomes the establishment of a new @NHSEngland Taskforce into #ADHD Attention Deficit Hyperactivity Disorder
https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/03/30/rcpsych-welcomes-new-adhd-taskforce
NHS England, alongside Government, has announced that they will be launching a new attention deficit hyperactivity disorder (ADHD) taskforce to improve care for people living with the condition.
The new taskforce will bring together expertise from across a broad range of sectors, including the NHS, education and justice, to better understand the challenges affecting those with ADHD and help provide a joined up approach in response to concerns around rising demand.
Commenting on the news, Dr Ulrich Müller-Sedgwick, spokesperson for the Royal College of Psychiatrists, said:
“We welcome the commitment to a new ADHD taskforce, and fully support the ambition to bring together cross-sector expertise to better understand the challenges, and provide joined-up solutions, for people living with ADHD.
“ADHD is the most common mental health condition in children and up to 1 in 25 adults have ADHD. The demand for services is growing as people become more aware of the disorder. ADHD’s impacts are life-long, affecting lots of different brain functions, including learning, communication, movement, emotions and attention.
“Psychiatrists and other mental health professionals across the country are seeing record numbers of people coming forward in need of an ADHD assessment and support. It is good to see the NHS making this issue a top priority and exploring how services can best meet people’s needs, including the necessary resource to meet demand. However, we must ensure decisions about patient pathways are backed by better data and we support the work being done to develop a national ADHD data improvement plan.
“We are aware many people are struggling to access care due to long waiting lists, medication shortages and a lack of available services in various parts of the country. The work to provide detailed mapping of existing ADHD services, both within the NHS and independent sector providers, with the identification of best practice and innovation will be vital shared learning.
“People with ADHD often have a co-occurring mental illness, and so it is important they receive holistic care which addresses all their needs. Psychiatrists have a key role to play in creating solutions to these challenges, such as the development of better care pathways and training schemes. However, this will need to be supported by additional investment into the expansion of services and recruitment and retention of staff.
“The College is committed to working with the NHS and Government to take full advantage of this important opportunity. This work has the potential to reshape and improve care for millions of people across the country.”