Although the subjects covered here are the important issue, I have noticed on various sites, skepticism about my qualifications. “Anyone could sound off. Is he an expert?” Stuff like that.
Answer: 1) I do like to sound off as much as the next person. Maybe more. 2) No, I am not an “expert.” But that is only strike two. I freely acknowledge that without an academic appointment, and not exactly a house hold name, I have to “sell” the legitimacy of these articles.
Which is a problem. Heaping praise on myself goes against my upbringing. It’s embarrassing. But if it lures someone flying through the web to want to come in for a landing, the compliments I have gathered here will have served a purpose. Please note the variety of notable and thoughtful people who have found these articles valuable.
This still doesn’t qualify me as an “expert,” which is fine by me. The theme of many of these article is that, considering how much we still don’t understand, our steps forward should be tentative, investigative, not closed off by the chilling effects of authority, especially when they are paid and delivered by large pharmaceutical companies.
A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances. Scott Peck (The Road Less Traveled) described this article ”as one of the few superlative papers he had read in his career as a psychiatrist.” Psychologist, Lauren Slater (Prozac Diary) wrote to me that she had printed it up for everyone at the clinic where she then worked to study. On the google search term “psychiatric diagnosis” it was number 1 for four years. It was based on a talk given in 1999 as the featured speaker at the University Of Alabama’s Psychiatry Department’s Grand Rounds.
The strengths and weaknesses of DSM IV: How it clarifies, how it blinds psychiatrists to issues in need of investigation Many of the the same issues from earlier articles including cuttings and pastings from them, but this article specifically critiques DSM IV, pointing out misunderstandings of its proper usage. Not all of the misuse is innocent.
Pursuing Treatments That Are Not Evidence Based: How DSM IV clarifies, how it blinds psychiatrists to issues in need of investigation Very similar to the article above minus references to Freud. It is more exclusively focused on the shortsightedness of “evidence based medicine.” The editor of Medical Hypothesis, a journal devoted to challenges to dominant scientific paradigms, invited me to write this essay for them, where it appeared as an editorial . The print version is shorter than the web version.
As opposed to treatment strategies based on diagnoses, this article gives specific examples of medications used to address psychopathology that may, or may not, be listed as symptoms of a particular syndrome. It continues arguments made in earlier papers (see below) that 15 minute once a month med checks cannot be considered optimal treatment. It gives examples of sensible strategies that psychiatists can consider only when they know their patient well, increasingly a rarity.
Psychotherapy Perspectives in Medication Management: The Inadequacy of 15-min Med Checks as Standard Psychiatric Practice First appeared in the April 1999 Psychiatric Times This article resulted in the Grand Round invitation cited above
On the Banality of Positive Thinking Takes issue with the assumptions and practices of cognitive behavioral therapy. ( From Psychiatric Times July 2001) Group Therapy Perspective included this article in their mailing to the members of the Group Therapy Association. Not sure what the connection to group therapy is but some editor apparently thought it should be read by their members.
Mood Stabilizers and Mood Swings: In Search of a Definition An article challenging, the recent extraordinary overdiagnosis of bipolar disorder. (Psychiatric Times October 1999) James Phelps M.D. in the annotated references at his wonderful site described this article as “an important historical touchstone.” Recently, Allen Frances M.D. , chair of the DSM IV Task Force referred to one of DSM IV’s unintended consequences as “false epidemics“, a sudden increase in the diagnosis of autism, bipolar disorder and ADHD.
The Fear of Death. An argument with Freud, and a reconsideration of his ideas. It is an attempt to introduce the obvious into psychoanalytic theory, that the fear of death plays a seminal role in our psychology. Freud’s own strong fear of death was his most pressing neurotic symptom. It was the lurking monster in his most frightening and famous dream. He looks into his patient Dora’s throat and discovers a horrifying lesion that he had missed. Like the Pharoah questioning Joseph, he had to understand what that dream meant. It led him to write “The Interpretation of Dreams.” In a letter to Wilhelm Fleiss, he described the writing of this book as a need to work “to which every effort of thought has to be given and which gradually absorbs all other capacities and the ability to receive impressions– a sort of neoplastic substance that enters into one’s humanity and then replaces it. With me it is even more so. Work and earning are identical with me–so that I have become wholly carcinoma…my existence from now on is that of a neoplasm.” (Jones 1953)
It eventually became clear what his dream meant. The location of the lesion in the back of Dora’s throat was to be the exact spot that Freud’s throat cancer developed many years later. It eventually killed him. This dream may have been the stimulus for the birth of psychoanalysis, for his passion to make sense our most hidden motivations Yet, strangely, despite his own symptoms, Freud dismissed the fear of death as a major part of our psychology.
Clearly, he was wrong. The fear is constantly addressed, but in our inimitable fashion, sanitized and seen on a more positive note. For example religion; to get rid of the fear of death the Aztec’s practiced human sacrifice to appease the angry Gods. Century after century, Christians worried about their death, sometimes to the point of torment. They were pious (or resolved to follow that path) in order to assure immortality in heaven. In our time, virtuous behavior has been redefined (exercise, weight loss, lower cholesterol, and the most virtuous of all, “organic” food). The problem is, that while what constitutes piety can be modernized into secular language, the passion behind it reveals itself in the usual and necessary distortion in our thinking. And also as usual, whatever bargaining, compromising, and self deception is required, is easily accomplished by the mind, even if available solutions are clearly imperfect. Invariably faith, rather than common sense, or logic is required to sustain veracity. And as might be expected in religion, some people go over board. In its modern version some people become fanatical about the organic purity of their food. They become “glaat” kosher. Many become sanctimonious. Also, as has always been done, many do an inventory of their soul. Only in this case their virtues and vices are measured by whether or not they gave in to temptation and ate that slice of pizza, or whether they forgoed their morning workout. Whatever language we use, the fear of death insinuates itself into our consciousness, demanding solutions.
ADHD AND OTHER SINS OF OUR CHILDREN (SHORTER VERSION) a shortened version of an article that first appeared on the web ( below) This version is a chapter in “Rethinking ADHD: From Brain to Culture,” published in 2009 by Palgrave Macmillan.
ADHD and Other Sins of Our Children This is the original, far more lengthy article on ADHD. Among other things it includes a discussion of false scientific claims for the biological basis of ADHD which is not a part of the shorter version. It wanders quite a bit, (a self indulgent weakness) but the reader who sticks it through to the end will be rewarded with a good many insights about the nature of psychiatric knowledge and perspectives as well the extraordinarily important subject (to me!) growing up in Queens during the 50’s.
Bipolar Disorder in Children and Adolescents: a Caution Further concern about the overdiagnosis of bipolar disorder especially as it applies to children.
Summary of bipolar disorder article and additions since it was written Farmington Hills A/P (Cengage Learning) paid for permission to include this article in their (book? internet site?) “Perspective On Disease and Disorders-Mood Disorders”
After Lisa (the early chapters of the novel) A compelling case inspired me to want to write this novel. It is based on real events, the tragic consequences of our broken medical system on a good family.
Narcissism as a Function of Culture Anna Freud had this to say about this article: “I read immediately what you have written and found it very interesting and convincing… I have searched for the right words to describe the processes which underlie the young people’s attitudes, but I was not able to find them. I believe that you have done much better in this respect and I find myself fascinated by your elaborations…” She had it published in the 1977 yearly addition of the Psychoanalytic Study of the Child.
Naricissism and Social Disorder Yale Review 64:527-543 (1975)