#like i AGREE with being critical of psychiatry as an institution but you need to understand what it is youre even criticizing

[vexangle]

real annoyed by the attitude of "this clinical terminology sucks because i misinterpreted what it meant without looking into how it is defined in clinical literature and assumed i could just apply my colloquial understanding of the word and/or pop psych ideas to come up with my own definition for the term, they should have called it something else"

like have you tried maybe doing even a little bit of reading into the topic before revealing that you are talking out of your own ass. perhaps.

[sysmedsaresexist]

sysmedicalism is an objectively pro psych stance. The fact that you're identifying as it is extremely disturbing, as a DID SYSTEM that has been harmed by the medical institution.

This post is highly related to this post, and I hope you'll read both. This was written first.

Mod Quill here, automatically done with this entire conversation about the term sysmed. Let’s just break this down.

This blog is pysch-critical. Because we believe psychology is beneficial and we are. In therapy. For our psychological problems. I’m not sure where you thought we were anti-psych? No false advertising here. Mod Dude is quite literally on all sides of psych; patient, trained SSW, proud DSM-bootlicker, you name it. The other mods are in similar positions. We can acknowledge the flaws of the medical system while also acknowledging the need for it. If you can’t, then you’re not going to like us.

Sysmed, as a term, means basically nothing at this point. Yes, it had a definition. No, the definition is not agreed upon. Until the Holy Pro-Endo Prophet who invented the damn word comes down from the heavens and announces what it actually meant, I’m going to continue to be a little bitch about a word that’s hurt me (and you can ID with it all you want). Fun fact, I actually don’t agree with Mod Dude using the label sysmed — I think he’ll reach a point eventually where he drops it in favor for some other label, or maybe no labels. But I also cannot bring myself to give a single solitary shit about it. Why would I? The word has as much meaning now as half the labels I see in system spaces. It’s not a useful word. I have literally never understood the desire to cling to it when it’s not ever used usefully. When is the last time someone actually used the term to *properly* critique the associations of the systems who feel plurality is medical to those who feel gender identity is medical, a flawed argument in of itself?

Lastly, I’m so sorry that the constant correlation between “CDD Focused” and “Sysmed” has made me and many others accept that we (DID systems) are sysmeds to you all. I’ve been told countless times that my beliefs are “sysmedical,” despite those beliefs being things that have nothing to do with medicalizing plurality. Dude is far further on the medical spectrum than I am, and yet I’ve been called a sysmed more times than I can count. Traumascum, too. Because I’m a CDD system speaking up for CDD systems.

Look. Anon. I’m sorry for what you’ve faced. I’m sorry you’ve been hurt by the medical system. That sucks.

It’s also not our fault, and something some of us have also experienced. It’s bold of you to think you’re unique in those struggles.

I hope you can find healing outside of the psych system, and that you can recover on your own, or else one day perhaps find solace within a medical system. Who knows?

The fact is, this blog has always been psych critical, and will continue to be. And that shouldn’t matter because the thing about this blog is, it has been and always will be dedicated to focusing on CDD systems. If that bothers people, there’s a million other blogs out there. May I suggest pokemon-cards-hourly?

---

Everyone getting in on this.

Mod Dude, here, OG blog owner

To reiterate, I am on both sides-- patient and clinician in the psych field (NOT LICENSED).

I really just want to pop in and say something myself.

I am psych-critical, and I always have been. I have had some terrible doctors. Fatphobia, transphobia, homophobia, ableism abound, and a large population of uneducated people parading as doctors. I was sanctioned once by a doctor who didn't like that I was gay. Yes, in Canada. It took the threat of legal action to get me released, and then they tried to purge my file and say I had never been admitted.

I've had more amazing, wonderful doctors that have gone and above and beyond to help me than bad ones, though. I want to be one of those doctors. I want to change the landscape of psychiatry to be what it SHOULD BE, not what it is now.

The psych system is a necessary evil, and I have a very complicated relationship to it as, eventually, my father will need to be forcibly confined and treated for his disease. The world will be very lucky if he doesn't kill someone before then.

I don't think it will always be evil, though. I don't think every case is evil. I don't honestly think a system is capable of being evil, only the people within the system and using it to further their own gain.

I feel for anyone who has been abused in the system, or that has suffered because of it.

I see anti-psych as giving up. Rather than fight for change, it's rejected entirely for talking points that are already available and need to be improved within themselves anyways.

I have HOPE for the FUTURE of the psych system, and can acknowledge its many current flaws while simultaneously engaging with and promoting its positive aspects and work, and by encouraging more people to get into the field and specialize. Releasing the backlog and increasing the number of specialists with lived experience that actually care is step number 1. I want to reduce the fear of stigma of engaging with the system.

I support the medicalization and treatment of systems that WANT to engage with psychiatry (hence sysmed). I support systems that have no desire to engage for simple reasons, or for no reason at all. I equally support and care for those who have been so hurt by it that they can't engage anymore. Those are real people with real stories. I hope that the things I post can help those that can't engage directly.

It's not the full picture, though. Hence "critical".

I have never WANTED or TRIED to force medicalization on anyone, and I never will. I can understand that in some cases it's not so black and white. But this may not be the space for you. Good luck elsewhere, genuinely ❤️

Also I'm going to follow Pokémon hourly now.

[hestiasroom]

Dr. Jessica Taylor has always seemed off to me. I really used to gravitate toward some of her content, and agreed on her takes about the pathologizing of women's trauma in particular, but idk. You know when you get that feeling that beneath all of the bravado and confidence, someone is actually just a conspiracy theorist and a contrarian that basically just likes going against the grain? She gives me that sense. Like if it wasn't women and girls' trauma it would be some other topic that she would revel in being "against the grain" with. You can kind of see it with her COVID talk - which basically boils down to, "some UK politicians behaved very very badly and hypocritically, and lockdowns had negative consequences, and therefore all of the science behind covid, vaccines, and masks must all be false and it was actually just a plot for control, and the only people who are thinking critically are the people like me, and everyone who "followed the rules" just needs to have their "global awakening" (because apparently her point of view is the enlightened one, and the rest of us sheep are just waiting to evolve to her level)"? Yeah. It's not the "what" or the content of what she thinks (like, duh you have the right to question psychiatry, and covid policies etc. and would probably be better off if you did) but the how and why of it that makes me suspicious. It's the "maybe XYZ institution was wrong about ABC, therefore there was an intentional mastermind plot behind it all" narrative that gets to me and gives me pause. Again, I really, really, really agree with a massive majority of her takes on psychiatry in general. I don't think she's wrong. But nonetheless, I'm always trying to be critical not just of those I disagree with, but also with those I agree with, and she just never seems to pass the smell test for me. Who knows, I could be way off. But every time I come back to her, I really don't think I am off lol.

[exclamaquest]

hey read this if you're going to criticize psychiatry

This morning, I saw a post that looked, on the surface, to be a criticism of Western psychiatry. I agree that the field has severe problems, so I read the post. However, instead of actually criticizing psychiatry, the post just ended up being absurdly ableist. Here it is:

[ID: a post by user @taricharivularis that says "everytime there is discourse about "x psychiatric diagnosis is fake" or "x psychiatric diagnosis is real" i just feel like we are missing the point that all "psychiatric diagnoses" are socially legible expressions of distress and that psychiatry, as an institution, will abuse and detain those who express distress (especially those who occupy marginalized positions in society), and panicking about people adopting a fake diagnosis or whatever really sidesteps the actual problem: Western society medicalizes, individualizes, and carceralizes the experience of being distressed. from a scientific point of view, *no* psych diagnosis yet holds up as experimentally valid! instead of nitpicking diagnoses we could just accept that people have many different internal experiences and those with experiences too far outside the norm are often ostracized and abused under capitalism. the problem is lack of social support, living with intense violence and precarity, and lack of mechanism for collective grief and rage in many social networks :/" END ID]

I agree with some of what OP is saying here. The western psychiatric system is definitely incredibly screwed up and heavily biased in favor of overdiagnosis and medicalizing perfectly normal responses to stress incurred by life under capitalism. However, a lot of this is genuinely harmful misinformation and is also ableist.

To start off with, yes, the way psychiatry is practiced today is absolutely ableist at its worst. Things are overdiagnosed and underdiagnosed and treated poorly and professionals are biased and bigoted.

However, this does not undermine the field of psychiatry as a whole. It is, at its heart, an extension of the field of medicine (which is also rife with problems, but still necessary). Psychiatry is the diagnosis and treatment of disorders of the mind just like how podiatry is for feet and urology is for the urinary system. The mind is a part of the body as much as any other, and it needs medical care specialized to it and its different disorders.

The sentence "no psych diagnosis yet holds up as experimentally valid" is provably incorrect and adopting this idea as fact can do significant damage. In fact, studies have shown and continue to show the existence of unique structural differences in the brain that are indicative of and unique to Alzheimer's, depression (more studies), dissociative identity disorder, schizophrenia, autism, anxiety, and BPD, among others. Mental illnesses can disrupt the gut and digestive system, the nervous system, and even your heart. They are physical disorders.

The damage comes from the implication that mental disorders aren't real. There's two significant problems here that I'm going to address, but let's start with the notion that the real underlying problem . They are. Take, for example, me.

I have major depressive disorder. Because of this, I have the physical markers associated with it: Lesions in areas of my brain including my anterior cingulate cortex (which is associated with mood regulation) and my orbitofrontal cortex (which helps regulate responses to uncomfortable situations and executive function), decreased gray matter in my striatum (a part of the basal ganglia that when disrupted is associated with higher risk of suicidality), and a smaller hippocampus, which is associated with memory recall and the reward system (the part of your brain that goes "hey, job well done!" when you finish something you meant to.)

This severely impacts how I function daily. Yes, the situations under which I live make it worse: The pressure to perform "normalcy" to societal standards, the pressure to keep making money to survive in the capitalist hellscape that is life right now, etc etc etc. These do all impede my functioning in addition to my mental illnesses. Key word: in addition.

In a perfect society, I would still have days where I'm unable to get out of bed. I would still have problems functioning at the level of others. I would still have memory issues and poor executive functioning and episodes of anhedonia.

Even with all the supports I needed given to me, I would still be depressed.

It is a biological disorder that affects everything I do no matter where I am, who I'm with, or what environment I'm in. Without psychiatry, I would not have been diagnosed. I would have to wonder what was wrong with me without putting a name to it. Even in a community with no ableism, I would still notice I was having abnormal responses to things and that I was struggling to function, just like how if I lived in a society without the medicine needed to get glasses I would notice that I was unable to see things how I should.

Insinuating that diagnoses and medical disorders are not real and are only a production of the "lack of social support" and the society that we live in today erases the very real experiences of life with psychiatric disorders and is at its heart an ableist statement. You wouldn't say this to someone with a physical disability. Why would you say this about mental ones?

Secondly, saying that "panicking about people adopting a fake diagnosis or whatever really sidesteps the actual problem" is also incorrect. For instance, if someone fakes depression and then spreads misinformation (as fakers are wont to do) it is measurably harmful. With my depression, for instance, if someone claims they have depression and then says things like "...and yoga/kale smoothies/exercise/Jesus Christ ended up curing it!" (which I have seen before), that can send me (and other people with depression) spiraling.

It can also be harmful to the faker, too--even if they don't realize they're faking. The underlying issue could be different (for instance, mistaking symptoms of one disease for another) and that means that the treatment is different, too.

Compare it to someone claiming they have kidney stones when they really have an infection: The pain comes from two different sources, but is in the same area. The two sources need different treatment to be healed, and someone saying "you don't have x because you do not meet the criteria for x" is not ableism or bigotry or prejudice, but a statement of fact based on evidence. The person's lived experience of what they think is kidney stones does not matter because ultimately, while the pain is real, they do not have kidney stones.

If you made it this far, thanks for reading. I want to reiterate again that I'm not defending the individual injustices committed by people who are in the field of psychiatry--the field is rampant with ableism and bigotry. However, just like any other medical field, it has its merits and addresses serious physical problems and disorders that people have. Just because you can't see the physical manifestations of a disorder doesn't mean that they aren't there or that the disorder is a construct.

EDIT, FORGOT TO ADD: Self-diagnosing is perfectly fine if you meet the criteria. Informed self-diagnosis does NOT equal faking a disorder. Not everyone has access to reliable, adequate, and affordable mental health care.

[magz]

These are my most pertinent views: (long)

Pro-recovery, pro-autonomy, pro-harm reduction, anti-stigmatization, and anti-psychiatry. This does not mean I am anti-medication or anti-drugs, but that I am anti-medical abuse & against psychiatric and carceral institutions’ abuse of power. Try not to insult people for struggling to recover.

Pro-workers’ unions and worker’s rights, anti-capitalism.

Abolish police and abolish prisons. Police brutality and state violence is not the answer.

People’s value is not just in "intelligence" and physical ability and "usefulness" and "productivity". ALL disabled people matter.

Decriminalize sex work. Decriminalize drugs and drug users. Punishing and traumatizing the vulnerable and stigmatized, does not help them!

Fiction and media affect reality. This does not mean that “playing video games automatically makes you a serial killer”, however media depictions affect what you internalize. News, shows, books, games, videos, social media, etc.

Media consumption alone (including entertainment, theory, and social media) is not peak activism. You cannot consume your way into liberation, especially not the content from big corporations or white academia, as the only thing. There should be variety. Valid criticism is good.

I like to actually “chew” and question things, and criticism is my love language.

It is valuable to be careful what you normalize online. Including bigoted 4chan memes, digital blackface, positive & neutral depictions of inappropriate animal interactions and abuse, crossing reasonable personal boundaries publicly, posting memes of bystanders whose photo was taken without permission, etc.

Generally, people deserve to be treated well and helped to thrive on a community level, this includes children as best as you can.

Assimilationist and essentialist-focused methods for social progress will exclude the ones that do not fit in (example: “I’m not like other people in my group, I’m more respectable”). Even the nonconforming or multiply marginalized members of a community deserve respect and human rights.

You do not need dysphoria to be trans. The idea that you do, comes from transmisogynistic and medicalist origins (Sandy Stone’s “The Empire Strikes Back” explains part of this).

Gender and language can be decolonized. Bigotry and biases is often embedded in our language and common phrases, and it’s ok for people criticize it even if it’s “normal”.

You cannot truly be a trans-inclusive radical feminist. People should examine what radical feminist ideology and gender essentialist ideals they have internalized or taken as true, even if they think they haven’t.

People should unpack and confront their biases in general. We are always growing.

I personally at least try to avoid body shaming and stuff, it’s overly mean. It’s weird to make fun of someone for being fat, balding, “being ugly”, facial disability, or whatever else. Because that’s usually what’s happening when people do that. And I really don’t think people’s appearances is equal to people’s moralities and worth.

Pro-Palestine. Killing, oppressing, and displacing so many people can never be justified. Don’t be antisemitic, however. Decolonize Palestine.

Pro-landback movement, and decolonization in general. This includes questioning default ways of thinking, information, language, etc. Do mutual aid, helping community online and irl if possible. (Link is wikipedia)

I do not want to have a doomed mindset about the world. We all should do what we can.

Pro-heaux womanist (Links are thotscholar’s explanation. I do not fully agree with a few phrasings but it is good.)

[a-room-of-my-own]

Have you read "An Apology to JK Rowling" by Petra Bueskens on Areo? I'm pathetically grateful to read something so clever and well articulated on the subject after the amount of abuse JK has been subjected to

It's a great piece so here it is, thank you anon!

 Rowling recently published an eminently reasonable, heartfelt treatise, outlining why it is important to preserve the category of woman. There’s only one thing wrong with it: it assumes a rational interlocutor. Rowling outlines why the biological and legal category of sex is important: in sports, in rape crisis shelters, in prisons, in toilets and changing rooms, for lesbians who want to sleep with natal women only and at the level of reality in general. Rowling marshals her experiences as an androgynous girl, as a domestic violence and sexual assault survivor and as someone familiar with the emotional perils of social media, in ways that have resonated with many women (and men). Her writing is clear, unpretentious, thoughtful, moving, vulnerable and honest. At no point does she use exclusionary or hostile language or say that trans women do not exist, have no right to exist or that she wants to rob them of their rights. Her position is that natal women exist and have a right to limit access to their political and personal spaces. Period.

Of course, to assume that her missive would be engaged with in the spirit in which it was intended, is to make the mistake of imagining that the identitarian left is broadly committed to secular, rational discourse. It is not. Its activist component has transmogrified into a religious movement, which brooks no opposition and no discussion. You must agree with every tenet or else you’re a racist, sexist, transphobic bigot, etc. Because its followers are fanatics, Rowling is being subjected to an extraordinary level of abuse. There seems to be no cognitive dissonance among those who accuse her of insensitivity and then proceed to call her a cunt, bitch or hag and insist that they want to assault and even kill her (see this compilation of tweets on Medium). She has been accused of ruining childhoods. Some even claim that the actor Daniel Radcliffe wrote the Harry Potter books—reality has become optional for some of these identitarians. Rowling’s age, menstrual status and vagina come in for particularly nasty attention and many trans women (or those masquerading as such) write of wanting to sexually assault her with lady cock, as a punishment for speaking out. I haven’t seen misogyny like this since Julia Gillard became our prime minister.

The Balkanisation of culture into silos of unreason means that the responses have not followed what might be loosely called the pre-digital rules of discourse. These rules assume that the purpose of public debate is to discern truth and that interlocutors on opposing sides—a reductionist bifurcation, because, in fact, there are many sides—engage in argument because they are interested in something higher than themselves: an ideal of truth, no matter how complicated, multifaceted and evolving. While in-group preferences and biases are inevitable, these exist within an overarching deliberative framework. This style of dialogue assumes the validity of a persuasive argument grounded in reason and evidence, even if—as Rowling does—it also utilises experience and feeling. By default, it assumes that civil conflict and opposition are essential devices in the pursuit of truth.

Three decades of postmodernism and ten years of Twitter have destroyed these conventions and, together with them, the shared norms by which we create and sustain social consensus. There is no grounding metanarrative, there are no binding norms of civil discourse in the digital age. Indeed, as Jaron Lanier shows with his bummer paradigm (Behaviours of Users Modified and Made into an Empire for Rent) social media is destroying the fabric of our personal and political lives (although, with a different business model and more robust regulation, it need not do so). The algorithm searching for and recording your every click, like and share, your every purchase, search term, conversation, movement, facial expression, social connection and preference rewards engagement above all else—which means that your feed—an aptly infantile descriptor—will quickly become full of the things you and others like you are most likely to be motivated to click, like and share. Outrage is a more effective mechanism through which to foster engagement than almost anything else. In Lanier’s terms, this produces a “menagerie of wraiths”—a bunch of digitised dementors: fake and bad actors, paid troll armies and dyspeptic bots—designed to confect mob outrage.

The norms of civil discourse are being eroded, as we increasingly inhabit individualised media ecosystems, designed to addict, distract, absorb, outrage, manipulate and incite us. These internecine culture wars damage us all. As Lanier notes, social media is biased “not towards the left or right but downwards.” As a result, we are witnessing a catastrophic decline in the standards of our democratic institutions and discourse. Nowhere is this more evident than in the contemporary culture wars around the trans question, where confected outrage is the norm.

This is why the furore over Rowling’s blog post misses the point: whether we agree with her or not, the problem is the collapse of our capacity to disagree constructively. If you deal primarily in subjective experience and impulse-driven reaction, under the assumption that you occupy the undisputed moral high ground, and you’ve been incited by fake news and want to signal your allegiances to your social media friends, then you can’t engage in rational discussion with your opponent. Your stock in trade will be unsubstantiated accusations and social shaming.

In this discombobulating universe, sex-based rights are turned into insults against trans people. Gender-critical feminists are recast as immoral bigots, engaged in deliberately hurtful, even life-threatening, speech. Rowling is not who we thought she was, her ex-fans wail, her characters and plots conceal hidden reservoirs of homophobia and bigotry. A few grandstanders attempt to distinguish themselves by saying that they have always been able to smell a rat—no, not Scabbers—and therefore hated the books from the outset. Nowhere amid this morass of moral grandstanding and outrage is there any serious engagement with her ideas.

Those of us on the left—and left-wing feminists in particular—who find trans ideology fraught, for all the reasons Rowling outlines, are a very small group. While Rowling is clearly privileged, she has also become the figurehead of a rapidly dwindling and increasingly vilified group of feminists, pejoratively labelled terfs, who want to preserve women’s sex-based rights and spaces. Although our arguments align with centrist, conservative and common sense positions, ours is not the prevailing view in academia, public service or the media, arts and culture industries, where we are most likely to be located (when we are not at home with our children). In most of these workplaces, a sex-based rights position is defined a priori as bigoted, indeed as hate speech. It can get us fired, attacked, socially ostracised and even assaulted.

As leftist thinkers who believe in freedom of speech and thought, who find creeping ideological and bureaucratic control alarming, we are horrified by these increasingly vicious denunciations by the left. The centre right and libertarians—the neo-cons, post-liberals and the IDW—are invariably smug about how funny it is to watch the left eat itself. But it’s true: some progressive circles are now defined by a call out/cancel culture to rival that of the most repressive of totalitarian states. Historically, it was progressives who fought against limits on freedom of speech and action. But the digital–identitarian left split off from the old print-based left some time ago, and has become its own beast. A contingent of us are deeply critical of these new directions.

Only a few on the left have had the gumption to speak up for us. Few have even defended our right to express our opinions. Those who have spoken out include former media darlings Germaine Greer and Michael Leunig. Many reader comments on left-leaning news sites claim that Rowling is to blame for the ill treatment she is suffering. Rowling can bask in the consequences of her free speech, they claim, as if having a different opinion from the woke majority means that she is no longer entitled to respect, and that any and all abuse is warranted—or, at least, to be expected. Where is the outrage on her behalf? Where are the writers, film makers, actors and artists defending her right to speak her mind?

Of course, the actors from the Harry Potter films are under no obligation to agree with JK Rowling just because she made them famous. They don’t owe her their ideological fealty: but they owe her better forms of disagreement. When Daniel Radcliffe repeats the nonsensical chant trans women are women, he’s not developing an argument, he’s reciting a mantra. When he invokes experts, who supposedly know more about the subject than Rowling, he betrays his ignorance of how contested the topic of transgender medicine actually is: for example, within endocrinology, paediatrics, psychiatry, sociology, and psychology (the controversies within the latter discipline have been demonstrated by the numerous recent resignations from the prestigious Tavistock and Portman gender identity clinic). The experts are a long way from consensus in what remains a politically fraught field.

Trans women are women is not an engaged reply. It is a mere arrangement of words, which presupposes a faith that cannot be questioned. To question it, we are told, causes harm—an assertion that transforms discussion into a thought crime. If questioning this orthodoxy is tantamount to abuse, then feminists and other dissenters have been gaslit out of the discussion before they can even enter it. This is especially pernicious because feminists in the west have been fighting patriarchy for several hundred years and we do not intend our cause to be derailed at the eleventh hour by an infinitesimal number of natal males, who have decided that they are women. Now, we are told, trans women are women, but natal females are menstruators. I can’t imagine what the suffragists would have made of this patently absurd turn of events.

There has been a cacophony of apologies to the trans community for Rowling’s apparently tendentious and hate-filled words. But no one has paused to apologise to Rowling for the torrent of abuse she has suffered and for being mischaracterised so profoundly.

So, I’m sorry, JK Rowling. I’m sorry that you will not receive the respectful disagreement you deserve: disagreement with your ideas not your person, disagreement with your politics, rather than accusations of wrongspeak. I’m sorry that schools, publishing staff and fan clubs are now cancelling you. And I’m sorry that you will be punished—because cancel culture is all about punishment. I’m sorry that you are being burned at the digital stake for expressing an opinion that goes against the grain.

But remember this, JK—however counterintuitive this may seem to progressives, whose natural home is on the fringe—most people are looking on incredulously at the disconnect between culture and reality. Despite raucous protestations to the contrary, you are on the right side of history—not just because of the points you make, but because of how you make them.

[96thdayofrage]

How an African-American psychiatrist helped design a groundbreaking television show as a radical therapeutic tool for helping minority preschoolers.

IN THE WAKE of the assassination of Martin Luther King Jr. on April 4, 1968, a newly formed group called the Black Psychiatrists of America began to challenge their white colleagues to think about racism in a new way. Its members had been discussing for some time the possibility of creating an organization that would address their lack of representation within the key bodies of American psychiatry. But now, as one of these men, Dr. Chester Pierce, later put it ”we anguished in our grief for a great moderate leader,” and it seemed that the time for moderation on their side was also over. In Pierce’s words: “As we listened to radio reports and called to various sections of the country for the on-the spot reports in inner cities, our moderation weakened and our alarm hardened.”

WHAT I LEFT OUT is a recurring feature in which book authors are invited to share anecdotes and narratives that, for whatever reason, did not make it into their final manuscripts. In this installment, Anne Harrington shares a story that didn’t make it into her latest book “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness,” (W. W. Norton & Company.)

Racism had led directly to King’s assassination, and not only had white psychiatry consistently failed to take racism seriously; it had, in ways both subtle and overt, enabled it.

The decision was thus made to organize black psychiatrists into an independent body that would use tactics of the civil rights movement to force American psychiatry to acknowledge both its own racism and its professional responsibility to address the scourge of racism in the country.

On May 8, 1969, representatives from the Black Psychiatrists of America interrupted the trustees of the American Psychiatric Association while they were eating breakfast, and presented them with a list of demands. These included a significant increase in African-American representation on APA committees, task forces, and other positions of leadership; a call for the APA to commit itself to desegregating mental health facilities; and a demand that any individual member of the society who was found to be guilty of racial discrimination be barred from practicing psychiatry.

The most fundamental demand made that morning, however, was that the profession begin to think about racism differently than it had in the past. Racism did not just happen because some bad people had hateful beliefs. Unlike many of their liberal white colleagues, who were fascinated by the potential mental pathologies of individual racists, the Black Psychiatrists of America (drawing on new sociological work) insisted that racism was built into the systems and structures of American life, including psychiatry itself. For this reason, as some of them put it in 1973, “institutional change (as opposed to personality change) are needed to root out and eliminate racism.”

Chester Pierce — the founding president of the Black Psychiatrists of America — was most concerned about the pernicious influence of one institution in particular: television. By 1969, virtually every American family home had at least one set. As one commentator at the time observed: “American homes have more television sets than bathtubs, refrigerators or telephones; 95 percent of American homes have television sets.”

Small children of all ethnicities were growing up glued to TV screens. This worried Pierce, because he was not just a psychiatrist but also a professor of early childhood education. And from a public health standpoint, he believed, television was a prime “carrier” of demeaning messages that undermined the mental health of vulnerable young black children in particular. In fact, it was Pierce who first coined the now widely used term microaggression, in the course of a study in the 1970s that exposed the persistent presence of stigmatizing representations of black people in television commercials.

It seemed to Pierce, though, that the same technology that risked creating another generation of psychically damaged black children could also be used as a radical therapeutic intervention. As he told his colleagues within the Black Psychiatrists of America in 1970: “Many of you know that for years I have been convinced that our ultimate enemies and deliverers are the education system and the mass media.” “We must,” he continued, “without theoretical squeamishness over correctness of our expertise, offer what fractions of truth we can to make education and mass media serve rather than to oppress the black people of this country.”

Knowing how Pierce saw the matter explains why, shortly after the founding of the Black Psychiatrists of America, he became personally involved in helping to design a new kind of television show targeted at preschool children.

The show had had originally been conceived as a novel way of bringing remedial education into the homes of disadvantaged children, especially children of color. Pierce, though, saw a different kind of potential for a show like this: one that could directly counter and counteract the racist messages prevalent in the media of his time. The issues for him were even more personal than they might otherwise have been: at the time, he had a 3-year-old daughter of his own. He thus agreed to serve as a senior advisor on the show, working especially closely with the public television producer Joan Ganz Cooney, one of its two creators (the other was the psychologist Lloyd Morrisett).

In 1969, the show aired on public television stations across the country for the first time. It was called “Sesame Street.”

It was not only the most imaginative educational show for preschoolers ever designed: it was also, quite deliberately, populated with the most racially diverse cast that public television had ever seen. All the multi-ethnic characters— adults, children and puppets — lived, worked, and played together on a street in an inner-city neighborhood, similar (if in an idealized way) to the streets in which many minority children were growing up.

Each show opened with scenes of children of different races playing together. Episodes featured a strong black male role model (Gordon, a school teacher), his supportive wife, Susan (who later is offered the opportunity to develop a profession of her own), a good- hearted white storekeeper (Mr. Hooper) and more.

Within a few years, Hispanic characters moved into the neighborhood as well. As Loretta Moore Long (who played Susan) later reflected: ‘“Sesame Street’ has incorporated a hidden curriculum … that seeks to bolster the Black and minority child’s self-respect and to portray the multi-ethnic, multi-cultural world into which both majority and minority child are growing.”

The radical nature of this “hidden curriculum” did not go unnoticed. In May 1970, a state commission in Mississippi voted to not air the show on the state’s newly launched public TV network: the people of Mississippi, said some legislators, were not yet “ready” to see a show with such an interracial cast. The state commission reversed its decision after the originally secret vote made national news — though it took 22 days to decide to do so.

“Sesame Street” would go on to become the most successful children’s show of all time. Over time, though, the radical mental health agenda fueling its creation was largely forgotten. Later critics would instead increasingly suggest that the show, as a straightforward experiment in early education, benefited white middle-income children more than its primary target audience of disadvantaged minorities, and in that sense had arguably partly misfired.

Chester Pierce, however, never lost sight of the hidden curriculum that, for him, had always been at the heart of “Sesame Street.” “Early childhood specialists,” he reflected in 1972, “have a staggering responsibility … in producing planetary citizens whose geographic and intellectual provinces are as limitless as their all-embracing humanity.”

What mattered most about “Sesame Street” was not the alphabet songs, the counting games or the funny puppets. What mattered most was its vision of an integrated society where everyone was a friend and treated with respect.

The program had originally been a radical experiment in the use of mass media to give the youngest generation of Americans their first experience of what Martin Luther King Jr. had famously called the Beloved Community: one based on justice, equal opportunity and positive regard for one’s fellow human beings, regardless of race, color or creed.

Anne Harrington is the Franklin L. Ford Professor of the history of science and medicine at Harvard University, director of undergraduate studies in her department, and faculty dean of Pforzheimer House, a 400-strong undergraduate community on the Harvard campus. She is the author of four books and numerous articles.

[the-compassion-project]

A Collaborative Approach to Diagnosis

We need to eradicate stigma from the psychiatrist’s office. One way to do this would be to drop diagnoses which already carry too much stigma. We could consider these diagnoses not fit for purpose. For example, a diagnosis I do not have is Borderline Personality Disorder which has recently been changed to Emotionally Unstable Personality Disorder. There has been much criticism of the name of this disorder with many individuals voicing their discomfort with the label ‘Personality Disorder.’ A fellow student at my undergrad institution conducted a study which found psychiatrists were much more sympathetic when the same patients had a diagnosis of PTSD than when they held a diagnosis of BPD. Yet we know that the vast majority of people with a BPD diagnosis have a history of trauma. Because “dissociation” is poorly understood in society professionals frequently stigmatise individuals with trauma histories and still hold unacceptable prejudices such as that people with BPD are manipulative and vengeful, when there is no basis at all to these accusations. People with the label BPD are empathetic individuals who have PTSD. Why do we not then give them a more validating diagnosis like that one? Since all their pain and difficulty in life stems from trauma. People with BPD are never manipulative or vengeful. They believe their reality at the time and often isolate themselves from people they find difficult or painful. We cannot give these people, often with complex PTSD, meaningful treatment until we admit that the diagnosis Emotional Unstable Personality Disorder carries too much stigma to be acceptable to the APA, and therefore should not appear in the DSM. It is also a misunderstanding of the difficulties people with trauma experience. It is clear that trauma should be central to any diagnosis given to these people. But I also believe that diagnosis should be a consensual act and that service users should be able to be part of the discussion before a diagnosis is decided upon.

I want to continue with this argument, that psychiatry and the medical profession should be about alleviating pain and not adding to pain or imposing its own reality upon individuals. This is not an easy argument to make. But I fully believe it is the direction of a more progressive society which makes service users high status and collaborative partners in their treatment. Intervoice petitioned decision makers to consider changing the diagnoses related to voice hearing such as Schizophrenia and Schizoaffective Disorder. They also wrote an open letter to the English mental health charity Rethink questioning the validity of the diagnosis Schizophrenia and asking them to reconsider the language of their advocacy. This was a very brave act. I agree with them. I think we should reconceptualise voice hearing and how we respond to people who hear voices or those having other experiences. If we made the diagnoses more validating and more accurate we would realise that people who have these experiences are normal people. This would be a first step in raising the status of people who experience psychosis or voice hearing or other experiences. It is important therefore that diagnosis is not imposed upon an individual but emerges as part of a discussion between the individual and psychiatry. 

People who hear voices or who have other experiences are normal people. There is always a reason why they believe the things they do. That reason may be organic but it is not irrational. They are having a rich and complex experience. The idea that they are strange or irrational is from the dark ages. Anyone who has experienced psychosis could, if empowered, enlighten society about this. Just like people who have BPD always have a reason for their emotions and their reactions, people with psychosis have good reason to believe the things they experience. It is their experience after all. Society must realise these people are normal and not stigmatise them. The existing labels for psychosis all stigmatise because they refer to “unusual beliefs.” But that is the wrong way around. They are often unusual experiences and understandable reactions and beliefs. It will take a lot of research to change this way of seeing psychosis but it must change in the future.

We live in a time of ‘wokeness.’ What is being ‘woke’ about? It is about many things but mainly allowing marginalised people to assume their own identities and choose their own labels. It is important that in the future people with mental health difficulties choose their own labels and that diagnosis is a consensual act. We need research (but we need a wholly different kind of research that works with and not against service users). Individuals have important insights and we must not lose sight of this. Service users should work with the APA to conceive of validating diagnoses that are therapeutic, that heal rather than harm. And if an individual does not want a diagnosis that should be respected too. Some people might not want to be diagnosed with Autism for example. That should be respected. I know this is radical thinking but I know it is the direction of the future. Professionals can draw ideas from research but they need to act reflexively to the needs of the service user who is not the enemy but an empathic and wise person. Let them define who they are and then develop the tools to help them achieve their recovery. If you can do this you can help them heal.

We need a collaborative approach to diagnosis and we need to include service users as problem solvers. If you apply intelligence and good sense to this way of conceptualising mental health then you would end up changing the culture of mental health care around the world.

[yasbxxgie]

In the wake of the assassination of Martin Luther King Jr. on April 4, 1968, a newly formed group called the Black Psychiatrists of America began to challenge their white colleagues to think about racism in a new way. Its members had been discussing for some time the possibility of creating an organization that would address their lack of representation within the key bodies of American psychiatry. But now, as one of these men, Dr. Chester Pierce, later put it ”we anguished in our grief for a great moderate leader,” and it seemed that the time for moderation on their side was also over. In Pierce’s words: “As we listened to radio reports and called to various sections of the country for the on-the spot reports in inner cities, our moderation weakened and our alarm hardened.”

Racism had led directly to King’s assassination, and not only had white psychiatry consistently failed to take racism seriously; it had, in ways both subtle and overt, enabled it.

The decision was thus made to organize black psychiatrists into an independent body that would use tactics of the civil rights movement to force American psychiatry to acknowledge both its own racism and its professional responsibility to address the scourge of racism in the country.

On May 8, 1969, representatives from the Black Psychiatrists of America interrupted the trustees of the American Psychiatric Association while they were eating breakfast, and presented them with a list of demands. These included a significant increase in African-American representation on APA committees, task forces, and other positions of leadership; a call for the APA to commit itself to desegregating mental health facilities; and a demand that any individual member of the society who was found to be guilty of racial discrimination be barred from practicing psychiatry.

The most fundamental demand made that morning, however, was that the profession begin to think about racism differently than it had in the past. Racism did not just happen because some bad people had hateful beliefs. Unlike many of their liberal white colleagues, who were fascinated by the potential mental pathologies of individual racists, the Black Psychiatrists of America (drawing on new sociological work) insisted that racism was built into the systems and structures of American life, including psychiatry itself. For this reason, as some of them put it in 1973, “institutional change (as opposed to personality change) are needed to root out and eliminate racism.”

Chester Pierce—the founding president of the Black Psychiatrists of America—was most concerned about the pernicious influence of one institution in particular: television. By 1969, virtually every American family home had at least one set. As one commentator at the time observed: “American homes have more television sets than bathtubs, refrigerators or telephones; 95 percent of American homes have television sets.”

Small children of all ethnicities were growing up glued to TV screens. This worried Pierce, because he was not just a psychiatrist but also a professor of early childhood education. And from a public health standpoint, he believed, television was a prime “carrier” of demeaning messages that undermined the mental health of vulnerable young black children in particular. In fact, it was Pierce who first coined the now widely used term microaggression, in the course of a study in the 1970s that exposed the persistent presence of stigmatizing representations of black people in television commercials.

It seemed to Pierce, though, that the same technology that risked creating another generation of psychically damaged black children could also be used as a radical therapeutic intervention. As he told his colleagues within the Black Psychiatrists of America in 1970: “Many of you know that for years I have been convinced that our ultimate enemies and deliverers are the education system and the mass media.” “We must,” he continued, “without theoretical squeamishness over correctness of our expertise, offer what fractions of truth we can to make education and mass media serve rather than to oppress the black people of this country.”

Knowing how Pierce saw the matter explains why, shortly after the founding of the Black Psychiatrists of America, he became personally involved in helping to design a new kind of television show targeted at preschool children.

The show had had originally been conceived as a novel way of bringing remedial education into the homes of disadvantaged children, especially children of color. Pierce, though, saw a different kind of potential for a show like this: one that could directly counter and counteract the racist messages prevalent in the media of his time. The issues for him were even more personal than they might otherwise have been: at the time, he had a 3-year-old daughter of his own. He thus agreed to serve as a senior advisor on the show, working especially closely with the public television producer Joan Ganz Cooney, one of its two creators (the other was the psychologist Lloyd Morrisett).

In 1969, the show aired on public television stations across the country for the first time. It was called “Sesame Street.”

It was not only the most imaginative educational show for preschoolers ever designed: it was also, quite deliberately, populated with the most racially diverse cast that public television had ever seen. All the multi-ethnic characters— adults, children and puppets — lived, worked, and played together on a street in an inner-city neighborhood, similar (if in an idealized way) to the streets in which many minority children were growing up.

Each show opened with scenes of children of different races playing together. Episodes featured a strong black male role model (Gordon, a school teacher), his supportive wife, Susan (who later is offered the opportunity to develop a profession of her own), a good- hearted white storekeeper (Mr. Hooper) and more.

Within a few years, Hispanic characters moved into the neighborhood as well. As Loretta Moore Long (who played Susan) later reflected: ‘“Sesame Street’ has incorporated a hidden curriculum … that seeks to bolster the Black and minority child’s self-respect and to portray the multi-ethnic, multi-cultural world into which both majority and minority child are growing.”

The radical nature of this “hidden curriculum” did not go unnoticed. In May 1970, a state commission in Mississippi voted to not air the show on the state’s newly launched public TV network: the people of Mississippi, said some legislators, were not yet “ready” to see a show with such an interracial cast. The state commission reversed its decision after the originally secret vote made national news — though it took 22 days to decide to do so.

“Sesame Street” would go on to become the most successful children’s show of all time. Over time, though, the radical mental health agenda fueling its creation was largely forgotten. Later critics would instead increasingly suggest that the show, as a straightforward experiment in early education, benefited white middle-income children more than its primary target audience of disadvantaged minorities, and in that sense had arguably partly misfired.

Chester Pierce, however, never lost sight of the hidden curriculum that, for him, had always been at the heart of “Sesame Street.” “Early childhood specialists,” he reflected in 1972, “have a staggering responsibility … in producing planetary citizens whose geographic and intellectual provinces are as limitless as their all-embracing humanity.”

What mattered most about “Sesame Street” was not the alphabet songs, the counting games or the funny puppets. What mattered most was its vision of an integrated society where everyone was a friend and treated with respect.

The program had originally been a radical experiment in the use of mass media to give the youngest generation of Americans their first experience of what Martin Luther King Jr. had famously called the Beloved Community: one based on justice, equal opportunity and positive regard for one’s fellow human beings, regardless of race, color or creed.

[2whatcom-blog]

Was Thomas Kuhn Evil

In 1972 Thomas Kuhn hurled an ashtray at Errol Morris. Already famend for The Construction of Scientific Revolutions, printed a decade earlier, Kuhn was on the Institute for Superior Research in Princeton, and Morris was his graduate pupil in historical past and philosophy of science. Throughout a gathering in Kuhn's workplace, Morris questioned Kuhn's views on paradigms, the webs of acutely aware and unconscious assumptions that underpin, say, Aristotle's, Newton's or Einstein's physics. You can not say one paradigm is more true than one other, in keeping with Kuhn, as a result of there is no such thing as a goal commonplace by which to guage them. Paradigms are incomparable, or "incommensurable." If that had been true, Morris requested, would not historical past of science be not possible? Would not the previous be inaccessible--except, Morris added, for "someone who imagines himself to be God?" Kuhn realized his pupil had simply insulted him. He muttered, "He's trying to kill me. He's trying to kill me." Then he threw the ashtray at Morris and threw him out of this system. Morris went on to turn out to be an acclaimed maker of documentaries. He received an Academy Award for The Fog of Warfare, his portrait of "war criminal"--Morris's term--Robert McNamara. His documentary The Skinny Blue Line helped overturn the conviction of a person on demise row for homicide. Morris by no means forgave Kuhn, who was, in Morris's eyes, a nasty particular person and unhealthy thinker. In his ebook The Ashtray (Or the Man Who Denied Actuality), Morris assaults the cult--my time period, however I believe Morris would approve, because it describes a bunch sure by irrational allegiance to a domineering leader--of Kuhn. "Many may see this book as a vendetta," Morris writes. "Indeed it is." Morris blames Kuhn for undermining the notion that there's a actual world on the market, which we will, with some effort, come to know. Morris desires to rebut this skeptical assertion, which he believes has insidious results. The denial of goal fact permits totalitarianism and genocide and "ultimately, perhaps irrevocably, undermines civilization." I really like Morris's movies, and I really like The Ashtray. It's an eccentric in addition to lethal critical ebook, a combination of journalism, memoir and polemic. It options Morris's interviews with Noam Chomsky, Steven Weinberg and Hilary Putnam, amongst different massive photographs. It's filled with illustrations and marginalia on all method of arcana, together with pet rocks, the Sapir-Whorf speculation, Borges's "Library of Babel," The Man Who Shot Liberty Valance, Humpty Dumpty, unicorns and the pink fairy armadillo. These obvious digressions, whereas entertaining in their very own proper, serve the principle theme. The armadillo, for instance, helps Morris make some extent in regards to the evolution of scientific definitions. A pink fairy armadillo is a pink fairy armadillo, whether or not outlined by its DNA or morphology. Effectively, duh, you would possibly suppose. However in keeping with (Morris's model of) Kuhn, there is no such thing as a goal actuality to which language refers. All we have now are phrases and their ever-changing meanings. We're "trapped in a fog of language with no way out," as Morris places it. That is radical postmodernism, which holds that we don't uncover armadillos, electrons and even Earth, we think about, invent, assemble them. Postmodernists cannot say "truth," "knowledge" and "reality" with out smirking, or wrapping the phrases in scare quotes. Morris calls Construction a "postmodernist Bible." As a substitute for Kuhn's perspective, Morris gives us that of thinker Saul Kripke. I've listened to philosophers yammer advert nauseam about Kripke's magnum opus, Naming and Necessity, and I sat in on a seminar with him in 2016. He was frail, confined to a wheelchair, and he mumbled. To the extent that I understood him, I used to be underwhelmed. Kripke appeared to push philosophical fussiness over definitions to absurd extremes. Due to Ashtray, now I recognize Kripke's achievement. He sought to determine that the issues to which our phrases refer exist independently of our conceptions of them. To a non-philosopher that may sound like a truism, nevertheless it contradicts the postmodern competition that phrases and ideas are all we all know. Simply because we invent phrases and their meanings, Morris insists through Kripke, doesn't imply we invent the world. I agree, to an extent, with Morris's tackle Kuhn. I spent hours speaking to Kuhn in 1992, when he was at MIT, and he struck me as virtually comically self-contradicting. He tied himself in knots attempting to elucidate exactly what he meant when he talked in regards to the impossibility of true communication. He actually did appear to doubt whether or not actuality exists independently of our flawed, fluid conceptions of it. On the similar time, Morris beats Kuhn so viciously that I really feel sympathy for him. Morris calls Kuhn a "megalomaniac," "perverse dictator" and "maleficent deity," who utilized his skepticism to everybody however himself. Being Kuhn's graduate pupil, Morris says, was like being the man in 1984 who, threatened with having his face eaten off by rats, says fact is no matter Massive Brother says it's. 2+2=5. (Satirically, Kuhn, in Construction, in contrast scientists to Massive Brother's brainwashed followers.) I might like to supply a number of factors in Kuhn's protection. *Postmodernism Is Progressive. Morris proposes that postmodernism is a gorgeous ideology for right-wing authoritarians. To help this declare, he notes the scorn for fact evinced by Hitler and the present U.S. President, for whom energy trumps fact. Morris means that "belief in a real world, in truth and in reference, does seem to speak to the left; the denial of the real world, of truth and reference, to the right." That is merely fallacious. Postmodernism has usually been coupled with progressive, anti-authoritarian critiques of imperialism, capitalism, racism and sexism. Postmodernists like Derrida, Foucault, Butler and Paul Feyerabend (my favourite thinker) have challenged the political, ethical and scientific paradigms that allow folks in energy to take care of the established order. *Questioning Science Is Wholesome. Sure, postmodernism can turn out to be decadent, questioning even the paradigms that underpin confirmed science, and social-justice actions. However it serves as a beneficial counterweight to our craving for certainty. Kuhn was proper that even probably the most ostensibly rational thinkers--scientists!--can idiot themselves into considering they know greater than they actually do. Scientists usually cling to paradigms for non-scientific causes. (In actual fact, that may be a main theme of my ebook Thoughts-Physique Issues: Science, Subjectivity and Who We Actually Are.) Kuhn's mannequin is all too apt for describing trendy psychiatry, which frequently acts just like the advertising arm of the pharmaceutical trade, or evolutionary biology, some proponents of which have made excuses for the persistence of racism, sexism and militarism. *Kuhn, Mysticism and Solipsism. One of many defining traits of mystical states--whether spontaneous or induced by meditation or LSD--is that they can't be described with odd language or ideas. Throughout a mystical expertise you're feeling, you understand, that you're seeing issues as they are surely, and but, paradoxically, you may have a tough time describing what you see. God, Reality, Actuality, no matter you need to name it's ineffable, as William James put it. Kuhn would certainly be horrified at this analogy, however Construction works as a form of unfavourable theology, which insists that God transcends all our descriptions of Him. Kuhn's philosophy additionally captures a profound fact about human existence, that we're all trapped in our personal little solipsistic bubbles. Language will help us talk with one another, however finally we will solely guess what's going on in others' minds. *Does Morris Actually Admire Kuhn? Towards the tip of Ashtray, because the insults piled up, I started questioning whether or not Morris is slyly, or maybe subconsciously, defending Kuhn. Morris's protection of goal fact makes no pretense of objectivity. His blatantly emotional, biased, over-the-top screed implicitly corroborates Kuhn's level that truth-seeking is an inescapably subjective endeavor. Morris conjectures that Kuhn, deep down, knew that he was fallacious, and that was why he defended his philosophy so fiercely. Maybe Morris bashes Kuhn with equal ferocity as a result of he suspects Kuhn was, in some respects, proper. A ultimate level. I've lengthy felt that philosophy, when it tries, or pretends, to be rigorously rational and goal, commits a class error. Philosophy is nearer to artwork than to science or arithmetic. Philosophy helps us see the world by another person's eyes, as novel, portray, movie or music does. In Past Good and Evil, Nietzsche mentioned that "every great philosophy" is a "confession," a "species of involuntary and unconscious autobiography." Construction is a good work of philosophy, and so is the ebook it spawned, Ashtray, which helps us see the world with Morris's obsessive curiosity. Morris, who calls his philosophy "investigative realism," writes, "I feel very strongly that, even though the world is unutterably insane, there is this idea--perhaps a hope--that we can reach outside of the insanity and find truth, find the world, find ourselves." Kuhn, for all his faults, goaded Morris into writing an excellent work of investigative realism. For that, if for nothing else, he, and we, ought to thank Kuhn. Additional Studying: I wrote about Morris's views of Kuhn in three earlier columns: Did Thomas Kuhn Assist Elect Donald Trump?, Second Ideas: Did Thomas Kuhn Assist Elect Donald Trump? and Filmmaker Errol Morris Clarifies Stance on Kuhn and Trump. What Thomas Kuhn Actually Thought of Scientific "Truth" Was Thinker Paul Feyerabend Actually Science's "Worst Enemy"? The Paradox of Karl Popper Was Wittgenstein a Mystic? What Is Philosophy's Level? Half 1 Jellyfish, Sexbots and the Solipsism Downside Expensive "Skeptics," Bash Homeopathy and Bigfoot Much less, Mammograms and Warfare Extra A Dig Via Previous Recordsdata Reminds Me Why I am So Important of Science Everybody, Even Jenny McCarthy, Has the Proper to Problem "Scientific Experts" Science, Historical past and Reality on the College Membership Thoughts-Physique Issues (free on-line ebook) For various takes on Ashtray, see evaluations by Tim Maudlin, David Kordahl and Philip Kitcher. Read the full article

[red-pillgrimage]

Debunking bullshit, partie deux

This is a continuation of a previous critique of a long-winded anti-feminist/MRA propaganda piece. 

Domestic Violence

Women are perpetrators often as men.(1) 286 sources on assaults on partners by women(2) Women are more violent(3) Domestic violence being equally committed by women, only males get arrested(4) Men are over 40% of domestic abuse victims(5) Male DV victims are discriminated against(6) Gay and bisexual men experience abuse in intimate partner relationships at a rate of 2 in 5, which is comparable to the amount of domestic violence experienced by heterosexual women. (7) About 17-45% of lesbians report having been the victim of a least one act of physical violence perpetrated by a lesbian partner (1,5,6,13). (8) Men or DV is Not the leading cause of death among women under 50 (9) More DV facts (10)

1. An academic paper? What a surprise. But a mighty surprise indeed for anyone who actually bothers to finish reading it. I’ll take a guess that OP isn’t an academic because one of the keywords on the title page includes “Feminist Theory”. 

It’s also of great importance to mention that in the introduction to the paper, the author makes the very narrow scope of the research known:

the article does not cover sexual assault because there is no controversy concerning the fact that almost all heterosexual rapes are perpetrated by men. When the term "violence" is used, it will refer to nonsexualphysical violence.

So I guess OP agrees with the author that “almost all heterosexual rapes are perpetrated by men” but I have a feeling the next post won’t necessarily agree. Does OP also think that physical violence is the only worth-while measure? What about emotional abuse? Psychological? Financial?Sexual? Are those not important measures of spousal violence as well as physical?

The Importance of Ending Cultural Norms Tolerating Male Violence

Until nearly the end of the 19th century, husbands were allowed to use "reasonable chastisement" to deal with "errant" wives (Calvert, 1974). Thus, even though female PV has been documented since the Middle Ages (George, 1994), men who "allowed" this were ridiculed. Thus male PV, like corporal punishment of children then and now, has been an accepted part of the culture, It has taken a major effort by feminists and their academic colleagues, including the author (Straus, 1976), to. change the continuing implicit cultural norm that accepts a certain amount of male PV.

So the author of the article wants us to know that it’s been legally & socially prescribed to beat your wife if she was “errant” up until the late Victorian period. Y’know, up until the late 1800s. What the author failed to mention is that this belief in the “duty”/”right” to beat women started centuries ago but was religiously predicated in the Tudor period. By means of publishing a little book known as the Malleus Maleficarum (Hammer of Witches), a couple of German priests outlined how one could detect demonic possession. Women, they argued, as the source of Original Sin, were predisposed to Satan’s influence. A ‘good’ woman was docile, quiet, obedient and weak. A ‘bad’(see: under Satan’s power) woman was opinionated, strong-willed and ‘disobedient’.

As centuries passed and religion was traded in for (pseudo)science, these Satanic influences were traded in for “biological instability”. “Hysteria” was initially conceptualized as a woman’s uterus was literally bouncing around inside of her and thus made her manic. Woman with a strong opinion? Must be her sexual organs, just smack her back in place!

And though the author outlined early on that only physical violence between partners was to be discussed in their research, for the sake of this section it is of great relevance to mention that “marital rape” was only outlawed as of the early 1970s-1980s for most western countries(Greece has only had marital rape law as of 2006). So your grandfather probably couldn’t beat his wife, but he could force himself on her sexually and not be considered a criminal rapist. 

Gender Stereotypes 

Most cultures define women as "the gentle sex," making it difficult to perceive violence by women as being prevalent in any sphere of life. More specifically, there are implicit norms tolerating violence by women, on the assumption that it rarely results in injury (Straus, Kaufman Kantor, & Moore, 1997). This assumption is largely correct, but as previously noted, it is also correct that about a third of homicides of partners are perpetrated by women, as well as about a third of nonfatal injuries (Catalano, 2006; Rennison, 2000; Straus, 2005).

Holy shit. Is there actual scientific evidence to show that women can in fact be violent contrary to patriarchal gender norms?  Radical. If only there were a group of people looking to dismantle existing gender stereotypes which promote mentalities that women are incapable of violence.

Defense of Feminist Theory

even though male dominance and male privilege may no longer be the major cause of PV in more egalitarian western societies, dominance by either party, regardless of whether it the male or female partner, is associated· with an increased probability of PV (Straus, 2007a).Moreover, comparative studies have shown that the more male dominant the society or segment of society, the more PV (Archer, 2006; Straus,1994, 2007a; Yodanis, 2004). Perhaps most important, although ending male dominance and male privilege may not be central to ending PV in western nations; it is central to creating a better society for men as well as women.

Huh, so when one partner behaves in dominant and aggressive ways, violence is more likely?  So male dominant societies likely value masculine values? Could this be why both men and women would exhibit these toxic masculinities in violent manner?

CONSEQUENCES OF THE DENIAL

The criticism inherent in this article is directed primarily to the research community, The thousands of dedicated women and their allies who developed and maintain services for battered women are part of a social movement that has benefited the entire society, not just women, The objective of social movements and advocacy groups. is to change society, 

 I am concerned that denial of the evidence On female PV may ultimately interfere with the very goals the denials intended to achieve because, when the evidence finally prevails, the discrepancy could undermine the credibility of the feminist cause. It may alienate young women from the feminist cause, and it could weaken the public base of feminist support. At the same time. casting PV as almost exclusively a male crime angers men who feel that they are. being unjustly accused and provides fuel for the fire of extremist men's groups. These organizations often have a larger antifeminist agenda and publicize feminist denial and distortion of the evidence on PV as part of that larger effort.”

Hahahahahaha. I was in tears reading this. 

At the very top of an MRA anti-feminist evidence pile is an article that promotes feminist efforts and specifically warns against being used by “extremist men’s groups” who “often have a larger antifeminist agenda and publicize feminist denial and distortion of the evidence of PV as part of that larger effort.” 

Pure fucking gold. Nice pick OP.

2. Ah, another academic source. Sorta. This isn’t really much ‘new’ to what has previously been said in (1). Especially seeing as OP sure as shit isn’t an academic, these academic ‘findings’ don’t mean shit. Unless you know the methodology employed, sample data and actually read the conclusion section of the peer-review research, findings don’t mean shit. See (1) for how that might work out.

3. Ah, another UK journalist. But I’m not sure this news paper article really says that “women are as violent as men”...

Male violence remains a more serious phenomenon: men proved more likely than women to injure their partners. Female aggression tends to involve pushing, slapping and hurling objects. Yet men made up nearly 40 per cent of the victims in the cases that he studied - a figure much higher than previously reported.

“Women are as violent as men” but only constitute of aggressors and according to this data are less likely to injure. Hm, dubious conclusion from what is here.  

Terrie Moffitt, professor of social behaviour at the Institute of Psychiatry at King's College, London, admitted that women do engage in abusive behaviour and said the Home Office should fund research into the issue in the UK. "If we ask does women's violence have consequences for their kids then the answer is 'yes'," she said. "There is also an elevated risk of children being victims of domestic violence if there is central violence between parents." However, Dr Anne Campbell, a psychologist at the University of Durham, said that women should still receive the most support because they were the greater victims of domestic violence. "The outcome of violence is that women are more damaged by it and need the bulk of resources," she said. "But women's violence has become increasingly legitimised. There is a sense now that it's OK to 'slap the bastard'."

Well, this sounds about right: when parents are violent, it fucks up the kids both psychologically and potentially physically as well. However, the conclusion that women are more harmed by it and deserve the most of the resources is actually contrary to OP’s argument, isn’t it? Hell, (1) tried real hard to disprove that argument actually. 

4. WOW OP, trying to play another fast one of us? This is the exact same link as (2), again distorting facts to promote wider antifeminist agenda.

5. Ah well, another british news paper article. Alright then. So what does this one say?

The official figures underestimate the true number of male victims, Mays said. "Culturally it's difficult for men to bring these incidents to the attention of the authorities. Men are reluctant to say that they've been abused by women, because it's seen as unmanly and weak."

So cultural gender norms prevent men from being perceived as “unmanly”/”weak”? I really wish we had a group of people looking to dismantle gender...

The number of women prosecuted for domestic violence rose from 1,575 in 2004-05 to 4,266 in 2008-09. "Both men and women can be victims and we know that men feel under immense pressure to keep up the pretence that everything is OK," said Alex Neil, the housing and communities minister in the Scottish parliament. "Domestic abuse against a man is just as abhorrent as when a woman is the victim."

Hm. The number of women prosecuted for PV nearly triples from 2004 to 2009 even though the reported crime rate actually drops for women? Doesn’t sound like there’s any conspiracy here protecting women from being prosecuted for conjugal violence. 

6. This privately funded research demonstrates that the outcome of decades of feminist activism amidst a patriarchal society has lead to resources being distributed towards women who are victims of partner violence.

It is absolutely abhorrent when the police blame victims or mock their dismay. Victim-blaming has no place in society, nor do patriarchal values that promote the idea that men cannot be victimized by women. As (1) outlined, regions with more conservative gender norms have higher rates of PV, which we can assume leads to higher rates of dismissal by law/courts. Soooo republican leaning institutions= raped male deniers? 

7. Another broken link, but if I may infer from the “conclusion” OP derived, non-straight men assault their partners as often as straight women? What? ? ? How does this demonstrate anything OP wants? ?  ?

8. So uh, this fact sheet that’s 18 years old (though based on 19-26 year old data now) isn’t really scientific. Know how I know?

The research usually has been done with mostly white, middle-class lesbians who are sufficiently open about their sexual orientation to have met researchers seeking participants in the lesbian community. Subsequently, these findings may not apply to women who are less open, less educated, or of other ethnic backgrounds.

Neeeext.

9. Lol? Really? Why OP put this here I have no idea. Probably to make this shit list longer. This is straight up a fact-checking page about what some idiot said during a government session. Not a researcher, not an activist, not a statistician. Just a politician throwing out numbers into the wind. So this one dude made some shit up, sooooo?

10. This fact sheet makes a good point

Range of findings due to variety of samples and operational definitions of PV

So all those different % we saw across the different studies are actually comparing apples and oranges? Wow.

Within military and male treatment samples, only 39% of IPV was bi-directional; 43.4% was MFPV and 17.3% FMPV.

Well I mean, this is straight up what we saw earlier from (1) about “male dominant” parts of society having higher rates of PV. 

[kansascityhappenings]

Facebook screens posts for suicide risk, and health experts have concerns

A pair of public health experts has called for Facebook to be more transparent in the way it screens posts for suicide risk and to follow certain ethical guidelines, including informed consent among users.

The social media giant details its suicide prevention efforts online and says it has helped first responders conduct thousands of wellness checks globally, based on reports received through its efforts. The authors said Facebook’s trial to reduce death by suicide is “innovative” and that it deserves “commendation for its ambitious goal of using data science to advance public health.”

But the question remains: Should Facebook change the way it monitors users for suicide risk?

‘People need to be aware that … they may be experimented on’

Since 2006, Facebook has worked on suicide prevention efforts with experts in suicide prevention and safety, according to the company.

In 2011, Facebook partnered with the National Suicide Prevention Lifeline to launch suicide prevention efforts, including enabling users to report suicidal content they may see posted by a friend on Facebook. The person who posted the content would receive an email from Facebook encouraging them to call the National Suicide Prevention Lifeline or chat with a crisis worker.

In 2017, Facebook expanded those suicide prevention efforts to include artificial intelligence that can identify posts, videos and Facebook Live streams containing suicidal thoughts or content. That year, the National Suicide Prevention Lifeline said it was proud to partner with Facebook and that the social media company’s innovations allow people to reach out for and access support more easily.

“It’s important that community members, whether they’re online or offline, don’t feel that they are helpless bystanders when dangerous behavior is occurring,” John Draper, director of the National Suicide Prevention Lifeline, said in a press release in 2017. “Facebook’s approach is unique. Their tools enable their community members to actively care, provide support, and report concerns when necessary.”

On Monday, the National Suicide Prevention Lifeline told CNN in an email that “the Lifeline has advised Facebook on the development of their suicide prevention reporting tools and guidelines.”

When AI tools flag potential self-harm, those posts go through the same human analysis as posts reported by Facebook users directly.

The move to use AI was part of an effort to further support at-risk users. The company had faced criticism for its Facebook Live feature, with which some users have live-streamed graphic events including suicide.

In a blog post, Facebook detailed how AI looks for patterns on posts or in comments that may contain references to suicide or self-harm. According to Facebook, comments like “Are you OK?” and “Can I help?” can be an indicator of suicidal thoughts.

If AI or another Facebook user flags a post, the company reviews it. If the post is determined as needing immediate intervention, Facebook may work with first responders, such as police departments to send help.

Yet an opinion paper published Monday in the journal Annals of Internal Medicine claims that Facebook lacks transparency and ethics in its efforts to screen users’ posts, identify those who appear at risk for suicide and alert emergency services of that risk.

The paper makes the argument that Facebook’s suicide prevention efforts should align with the same standards and ethics as would clinical research, such as requiring review by outside experts and informed consent from people included in the collected data.

Dr. John Torous, director of the digital psychiatry division in Beth Israel Deaconess Medical Center’s Department of Psychiatry in Boston, and Ian Barnett, assistant professor of biostatistics at the University of Pennsylvania’s Perelman School of Medicine, co-authored the new paper.

“There’s a need for discussion and transparency about innovation in the mental health space in general. I think that there’s a lot of potential for technology to improve suicide prevention, to help with mental health overall, but people need to be aware that these things are happening and, in some ways, they may be experimented on,” Torous said.

“We all agree that we want innovation in suicide prevention. We want new ways to reach people and help people, but we want it done in a way that’s ethical, that’s transparent, that’s collaborative,” he said. “I would argue the average Facebook user may not even realize this is happening. So they’re not even informed about it.”

In 2014, Facebook researchers conducted a study on whether negative or positive content shown to users resulted in the users producing negative or positive posts. That study sparked outrage, as users claimed they were unaware that it was even being conducted.

The Facebook researcher who designed the experiment, Adam D.I. Kramer, said in a post that the research was part of an effort to improve the service — not to upset users. Since then, Facebook has made other efforts to improve its service.

Last week, the company announced that it has been partnering with experts to help protect users from self-harm and suicide. The announcement was made after news around the death by suicide of a girl in the United Kingdom; her Instagram account reportedly contained distressing content about suicide. Facebook is the owner of Instagram.

“Suicide prevention experts say that one of the best ways to prevent suicide is for people in distress to hear from friends and family who care about them. Facebook is in a unique position to help because of the friendships people have on our platform — we can connect those in distress with friends and organizations who can offer support,” Antigone Davis, Facebook’s global head of safety, wrote in an email Monday, in response to questions about the new opinion paper.

“Experts also agree that getting people help as fast as possible is crucial — that is why we are using technology to proactively detect content where someone might be expressing thoughts of suicide. We are committed to being more transparent about our suicide prevention efforts,” she said.

Facebook also has noted that using technology to proactively detect content in which someone might be expressing thoughts of suicide does not amount to collecting health data. The technology does not measure overall suicide risk for an individual or anything about a person’s mental health, it says.

What health experts want from tech companies

Arthur Caplan, a professor and founding head of the division of bioethics at NYU Langone Health in New York, applauded Facebook for wanting to help in suicide prevention but said the new opinion paper is correct that Facebook needs to take additional steps for better privacy and ethics.

“It’s another area where private commercial companies are launching programs intended to do good but we’re not sure how trustworthy they are or how private they can keep or are willing to keep the information that they collect, whether it’s Facebook or somebody else,” said Caplan, who was not involved in the paper.

“This leads us to the general question: Are we keeping enough of a regulatory eye on big social media? Even when they’re trying to do something good, it doesn’t mean that they get it right,” he said.

Several technology companies — including Amazon and Google — probably have access to big health data or most likely will in the future, said David Magnus, a professor of medicine and biomedical ethics at Stanford University who was not involved in the new opinion paper.

“All these private entities that are primarily not thought of as health care entities or institutions are in position to potentially have a lot of health care information, especially using machine learning techniques,” he said. “At the same time, they’re almost completely outside of the regulatory system that we currently have that exists for addressing those kinds of institutions.”

For instance, Magnus noted that most tech companies are outside of the scope of the “Common Rule,” or the Federal Policy for the Protection of Human Subjects, which governs research on humans.

“This information that they’re gathering — and especially once they’re able to use machine learning to make health care predictions and have health care insight into these people — those are all protected in the clinical realm by things like HIPAA for anybody who’s getting their health care through what’s called a covered entity,” Magnus said.

“But Facebook is not a covered entity, and Amazon is not a covered entity. Google is not a covered entity,” he said. “Hence, they do not have to meet the confidentiality requirements that are in place for the way we address health care information.”

HIPAA, or the Health Insurance Portability and Accountability Act, requires the safety and confidential handling of a person’s protected health information and addresses the disclosure of that information if or when needed.

The only protections of privacy that social media users often have are whatever agreements are outlined in the company’s policy paperwork that you sign or “click to agree” with when setting up your account, Magnus said.

“There’s something really weird about implementing, essentially, a public health screening program through these companies that are both outside of these regulatory structures that we talked about and, because they’re outside of that, their research and the algorithms themselves are completely opaque,” he said.

‘The problem is that all of this is so secretive’

It remains a concern that Facebook’s suicide prevention efforts are not being held to the same ethical standards as medical research, said Dr. Steven Schlozman, co-director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, who was not involved in the new opinion paper.

“In theory, I would love if we can take advantage of the kind of data that all of these systems are collecting and use it to better care for our patients. That would be awesome. I don’t want that to be a closed book process, though. I want that to be open with outside regulators. … I’d love for there to be some form of informed consent,” Schlozman said.

“The problem is that all of this is so secretive on Facebook’s side, and Facebook is a multimillion-dollar for-profit company. So the possibility of this data being collected and being used for things other than the apparent beneficence that it appears to be for — it’s just hard to ignore that,” he said. “It really feels like they’re kind of transgressing a lot of pre-established ethical boundaries.”

If you are having suicidal thoughts, we urge you to get help immediately.

Go to a hospital, call 911 or call the National Suicide Hotline at 1-800-SUICIDE (1-800-784-2433).

Click on the boxes below for our FOX 4 You Matter reports and other helpful phone numbers and resources.

CLICK THIS BOX FOR FOX 4 STORIES ON MENTAL HEALTH.

CLICK THIS BOX FOR MORE MENTAL HEALTH RESOURCES.

  from FOX 4 Kansas City WDAF-TV | News, Weather, Sports https://fox4kc.com/2019/02/12/facebook-screens-posts-for-suicide-risk-and-health-experts-have-concerns/

from Kansas City Happenings https://kansascityhappenings.wordpress.com/2019/02/12/facebook-screens-posts-for-suicide-risk-and-health-experts-have-concerns/

[chestnutpost]

Facebook screens posts for suicide risk, and health experts have concerns

The social media giant details its suicide prevention efforts online and says it has helped first responders conduct thousands of wellness checks globally, based on reports received through its efforts. The authors said Facebook’s trial to reduce death by suicide is “innovative” and that it deserves “commendation for its ambitious goal of using data science to advance public health.”

But the question remains: Should Facebook change the way it monitors users for suicide risk?

‘People need to be aware that … they may be experimented on’

Since 2006, Facebook has worked on suicide prevention efforts with experts in suicide prevention and safety, according to the company.

In 2011, Facebook partnered with the National Suicide Prevention Lifeline to launch suicide prevention efforts, including enabling users to report suicidal content they may see posted by a friend on Facebook. The person who posted the content would receive an email from Facebook encouraging them to call the National Suicide Prevention Lifeline or chat with a crisis worker.

In 2017, Facebook expanded those suicide prevention efforts to include artificial intelligence that can identify posts, videos and Facebook Live streams containing suicidal thoughts or content. That year, the National Suicide Prevention Lifeline said it was proud to partner with Facebook and that the social media company’s innovations allow people to reach out for and access support more easily.

“It’s important that community members, whether they’re online or offline, don’t feel that they are helpless bystanders when dangerous behavior is occurring,” John Draper, director of the National Suicide Prevention Lifeline, said in a press release in 2017. “Facebook’s approach is unique. Their tools enable their community members to actively care, provide support, and report concerns when necessary.”

When AI tools flag potential self-harm, those posts go through the same human analysis as posts reported by Facebook users directly.

The move to use AI was part of an effort to further support at-risk users. The company had faced criticism for its Facebook Live feature, with which some users have live-streamed graphic events including suicide.

In a blog post, Facebook detailed how AI looks for patterns on posts or in comments that may contain references to suicide or self-harm. According to Facebook, comments like “Are you OK?” and “Can I help?” can be an indicator of suicidal thoughts.

If AI or another Facebook user flags a post, the company reviews it. If the post is determined as needing immediate intervention, Facebook may work with first responders, such as police departments to send help.

Yet an opinion paper published Monday in the journal Annals of Internal Medicine claims that Facebook lacks transparency and ethics in its efforts to screen users’ posts, identify those who appear at risk for suicide and alert emergency services of that risk.

The paper makes the argument that Facebook’s suicide prevention efforts should align with the same standards and ethics as would clinical research, such as requiring review by outside experts and informed consent from people included in the collected data.

Dr. John Torous, director of the digital psychiatry division in Beth Israel Deaconess Medical Center’s Department of Psychiatry in Boston, and Ian Barnett, assistant professor of biostatistics at the University of Pennsylvania’s Perelman School of Medicine, co-authored the new paper.

“There’s a need for discussion and transparency about innovation in the mental health space in general. I think that there’s a lot of potential for technology to improve suicide prevention, to help with mental health overall, but people need to be aware that these things are happening and, in some ways, they may be experimented on,” Torous said.

“We all agree that we want innovation in suicide prevention. We want new ways to reach people and help people, but we want it done in a way that’s ethical, that’s transparent, that’s collaborative,” he said. “I would argue the average Facebook user may not even realize this is happening. So they’re not even informed about it.”

I n 2014, Facebook researchers conducted a study on whether negative or positive content shown to users resulted in the users producing negative or positive posts. That study sparked outrage, as users claimed they were unaware that it was even being conducted.

The Facebook researcher who designed the experiment, Adam D.I. Kramer, said in a post that the research was part of an effort to improve the service — not to upset users. Since then, Facebook has made other efforts to improve its service.

Last week, the company announced that it has been partnering with experts to help protect users from self-harm and suicide. The announcement was made after news around the death by suicide of a girl in the United Kingdom; her Instagram account reportedly contained distressing content about suicide. Facebook is the owner of Instagram.

“Suicide prevention experts say that one of the best ways to prevent suicide is for people in distress to hear from friends and family who care about them. Facebook is in a unique position to help because of the friendships people have on our platform — we can connect those in distress with friends and organizations who can offer support,” Antigone Davis, Facebook’s global head of safety, wrote in an email Monday, in response to questions about the new opinion paper.

“Experts also agree that getting people help as fast as possible is crucial — that is why we are using technology to proactively detect content where someone might be expressing thoughts of suicide. We are committed to being more transparent about our suicide prevention efforts,” she said.

Facebook also has noted that using technology to proactively detect content in which someone might be expressing thoughts of suicide does not amount to collecting health data. The technology does not measure overall suicide risk for an individual or anything about a person’s mental health, it says.

What health experts want from tech companies

Arthur Caplan, a professor and founding head of the division of bioethics at NYU Langone Health in New York, applauded Facebook for wanting to help in suicide prevention but said the new opinion paper is correct that Facebook needs to take additional steps for better privacy and ethics.

“It’s another area where private commercial companies are launching programs intended to do good but we’re not sure how trustworthy they are or how private they can keep or are willing to keep the information that they collect, whether it’s Facebook or somebody else,” said Caplan, who was not involved in the paper.

“This leads us to the general question: Are we keeping enough of a regulatory eye on big social media? Even when they’re trying to do something good, it doesn’t mean that they get it right,” he said.

Several technology companies — including Amazon and Google — probably have access to big health data or most likely will in the future, said David Magnus, a professor of medicine and biomedical ethics at Stanford University who was not involved in the new opinion paper.

“All these private entities that are primarily not thought of as health care entities or institutions are in position to potentially have a lot of health care information, especially using machine learning techniques,” he said. “At the same time, they’re almost completely outside of the regulatory system that we currently have that exists for addressing those kinds of institutions.”

For instance, Magnus noted that most tech companies are outside of the scope of the “Common Rule,” or the Federal Policy for the Protection of Human Subjects, which governs research on humans.

“This information that they’re gathering — and especially once they’re able to use machine learning to make health care predictions and have health care insight into these people — those are all protected in the clinical realm by things like HIPAA for anybody who’s getting their health care through what’s called a covered entity,” Magnus said.

“But Facebook is not a covered entity, and Amazon is not a covered entity. Google is not a covered entity,” he said. “Hence, they do not have to meet the confidentiality requirements that are in place for the way we address health care information.”

HIPAA, or the Health Insurance Portability and Accountability Act, requires the safety and confidential handling of a person’s protected health information and addresses the disclosure of that information if or when needed.

The only protections of privacy that social media users often have are whatever agreements are outlined in the company’s policy paperwork that you sign or “click to agree” with when setting up your account, Magnus said.

“There’s something really weird about implementing, essentially, a public health screening program through these companies that are both outside of these regulatory structures that we talked about and, because they’re outside of that, their research and the algorithms themselves are completely opaque,” he said.

‘The problem is that all of this is so secretive’

It remains a concern that Facebook’s suicide prevention efforts are not being held to the same ethical standards as medical research, said Dr. Steven Schlozman, co-director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, who was not involved in the new opinion paper.

“In theory, I would love if we can take advantage of the kind of data that all of these systems are collecting and use it to better care for our patients. That would be awesome. I don’t want that to be a closed book process, though. I want that to be open with outside regulators. … I’d love for there to be some form of informed consent,” Schlozman said.

“The problem is that all of this is so secretive on Facebook’s side, and Facebook is a multimillion-dollar for-profit company. So the possibility of this data being collected and being used for things other than the apparent beneficence that it appears to be for — it’s just hard to ignore that,” he said. “It really feels like they’re kind of transgressing a lot of pre-established ethical boundaries.”

CNN’s Selena Larson and Charles Riley contributed to this report.

The post Facebook screens posts for suicide risk, and health experts have concerns appeared first on The Chestnut Post.

from The Chestnut Post https://www.thechestnutpost.com/news/facebook-screens-posts-for-suicide-risk-and-health-experts-have-concerns/

[douglasbergerpsychiatristto-blog]

Tests, testing, and tested – we need to critically evaluate the meaning of tests in psychiatry

Douglas M. Berger Meguro Counseling Center, Tokyo, Japan

A recent article entitled, “Perils of Newborn Screening”[1] led me to think of how we in psychiatry and our patients also have some perilous ideas about screening and testing. The article describes testing initiated in 2006 in New York State for Krabbe disease of the nervous system. Krabbe disease is a rare inherited disorder where lack of the enzyme galactocerebrosidase causes the myelin coating on the nerves to break down. Mental and motor development are affected, and muscle weakness, deafness, and blindness may occur.[2]

Out of the total one-million babies tested, 24 tested positive and out of 24, 4 developed symptoms. One family refused treatment and subsequently the child died; another child died from complications of the treatment; another’s illness is progressing despite treatment, and one baby who had been treated successfully has recently lost his ability to walk. Parents of babies who test positive, are described to be in a constant state of worry, some pursue risky tests, and the emotional trauma (not to mention the cost) incurred is likely to outweigh the benefits.

This example illustrates how one kind of test may have pros and cons. The pros and cons of ‘testing’ can also be seen in one’s daily practice of psychiatry. The following are personal experiences of my practice in Tokyo.

CLINICAL EXAMPLES

“My 8-year-old child is depressed, should they have psychological (psych) testing to determine if antidepressants are warranted?” A woman I have been treating for a few years for major depression told me about her 8-year-old son who is irritable, has been crying more, and has written some notes contemplating suicide. She first brought her son to a large local counseling center where they recommended in-person counseling with their staff psychologist, school observations, and psych testing (costing about $4,500), and told the mother that they could not recommend starting antidepressants until the psych testing was complete. The son could not finish the testing because he was unable to maintain concentration.

The mother eventually decided she couldn’t wait anymore and asked me to evaluate the child who clearly looked depressed. I explained that if the psych testing assessed the son having a depression, this affirms the obvious. If the psych testing assessed the son without a depression, we are still left with a depressed-looking child who is writing suicide notes, and with an anti-depressant responsive depression in his mother. Neither family dynamics nor school issues could explain the child’s depression.

We agreed that there was no logic for psych testing in terms of, ‘to treat’ or ‘not to treat’; and in tandem to a medical work-up for depression, we initiated 2.5 mg of escitalopram a day with a good response. Scales and tests for depression may indeed provide some helpful information; however, predictive value, sensitivity, and specificity are still far from perfect,[3] and the National Institute of Mental Health (NIMH) guidance only mentions medical examination and history of symptoms in the evaluation of depression.[4]

While no test can fully prove a psychiatric diagnosis, we understood that the medication can be construed to be both a treatment as well as a kind of diagnostic test, i.e., improvement on administration, and relapse on discontinuation would support the diagnosis of a major depression.

In addition, while the son was ill with depression, the other aspects of psych testing, i.e., personality or intellectual testing, would not properly reflect these areas of functioning. It would be like asking a person with pneumonia to run around a track, time them, and then make an interpretation of this person’s ability to run (not to mention the cost saving of the psych testing).

The next peril is the way the school authorities may use the results of his psychological testing, which may have a negative impact on the child’s education in the future. I opined that the school only needed to know that the son would get help, but did not need to know the diagnostic or treatment details.

“My 4-year-old has been tested and diagnosed with Asperger’s Disorder, can you counsel him?” This has been a more frequent inquiry in recent years. Some parents or adult patients almost seem to be proud to have this diagnosis, thinking that it portends high intelligence, but it may actually be a way to avoid a more uncomfortable mental illness diagnosis. Most of these parents do not realize that there is no test to prove that someone has Asperger’s, (the criteria for Asperger’s includes: Marked impairment in social relations, often with stereotyped motor movements, and a vast knowledge of some topic of esoteric or impractical value),[5] and that the incidence of Asperger’s is thought to be extremely low (about three in 10,000)[6] when compared with other disorders whose symptoms overlap with Asperger’s (i.e., attention deficit disorder/ attention deficit hyperactivity disorder (ADD/ADHD), which may affect up to 10% of children.[7]) Few of the patients who come in with a supposed diagnosis of Asperger’s actually fulfill the criteria for Asperger’s.

On examination, most of these children have symptoms suggesting ADD or ADHD; some have depression or anxiety, and others a shyness or awkwardness that may be normal or may evolve into social anxiety disorder later in life. On rare occasion some do look like high-functioning autistic children, although it seems parsimonious and logical to assume that these children have the far more common diagnosis rather than a rare diagnosis if the symptoms overlap significantly.

The peril here is when the parents or an adult patient does not accept having a diagnosis or treatment other than that for Asperger’s. If a child also seems to have a comorbid ADD or ADHD, it needs to be treated first; to ascertain what Asperger’s symptoms may be left. Otherwise, it would be like making a diagnosis of asthma in a child with pneumonia (i.e., it is impossible to see if Asperger’s is there while the person is clearly impaired with ADD or ADHD).

In addition, once a child gets a diagnosis in their educational record, it tends to have a life of its own as definitive, and neither parents, educators, nor even psychologists or psychiatrists, endeavor to change the record.

“Cognitive behavioral therapy has been tested and proven to be effective for depression; can you give it to me?”

This is another situation where the use of the word ‘tested’ comes in and is an inquiry that can be a challenge for the psychiatrist to handle when the patient has vegetative symptoms, a strong family history, and a chronic course of depression because these patients usually require antidepressant medication in addition to any therapy.

Cognitive behavioral therapy (CBT) aims at repairing negative thoughts that are thought to cause depression.[8] Clinically, it is easy to observe; however, that negative cognitions improve when depressed mood improves, be it with antidepressants or the natural cycling course out of depression.[9] This is analogous to delusions improving, when one is given an antipsychotic, so that negative thoughts are more likely the result of depression rather than the cause, just like a runny nose and a cough are the result of a cold. If negative thoughts were the cause of depression, then this would be the only Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I condition where the symptoms are also construed to be the cause.

However, it can often be seen that CBT may help persons with depression function better. Degree of depression is usually evaluated by a rating scale that assesses both neuro-vegetative symptoms as well as misery (i.e., cognitive symptoms such as despair and helplessness). Giving persons hope and support can alleviate some of the misery symptoms decreasing depression scores. Allowing some time to pass where the persons improve by themselves or cycle out of depression can also decrease scores. In either case, the person functions better and their depression scores decrease over time. Even a few points lower on a depression test can result in a call of a “statistically significant difference” compared to a supportive therapy control group, but that does not mean the illness is really treated. For example, I broke my arm by falling on the ice. I had real pain and also misery because I couldn’t do things I normally liked to do. When my orthopedist told me, “I see many fractures like this, you will be fine in a few months,” all my misery disappeared, but the fracture did not change. Patients in misery can respond well to an authority figure which gives them hope.

A more important problem with using the word ‘tested’ is that it is not easy to study psychotherapy as a modality of treatment because the studies cannot be double blinded like a drug study that has a placebo arm—an extremely crucial point. A study on bias in treatment outcome studies concluded that the results of unblinded randomized clinical trials (RCTs) tended to be biased toward beneficial effects if the RCTs’ outcomes were subjective (as they are in psychotherapy studies) contrary to being objective.[10]

Patients and even professionals assume that the words “randomized and controlled” mean that the studies looking at a therapeutic modality are fully evidence based, even if they are not double blind. They may be single blinded, i.e., the rater may not know the treatment the patient received, but the patient themselves cannot be blinded to the type of therapy, thus potentially biasing the results. Depression studies notoriously have large random errors due to the wide variety of subjects many of which have mild forms of low mood, investigator and patient preference and economic incentive, or non perfect rating instruments, etc. Bias can lead to a result very far from the true value.[11]

A recent meta analysis[12] examined how effective CBT is when placebo control and blindedness are factored in. Pooled data from published trials of CBT in schizophrenia, major depression, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of major depression, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder.

This does not mean that CBT has no value, it only means that we need to consider CBT as an adjunctive modality to help functional impairment and suffering vs. an illness course-changing intervention. It is imperative that our field does not allow studies that are unblinded to be called “evidence based tests.” They need to be in a different category, i.e., “uncontrolled clinical data”, or “clinical impressions” (of CBT practitioners and/or their patients).

CONCLUSION

To the lay-person, the word “test” implies some absolute truth. The value of a test or a diagnosis given by an authority is very hard to evaluate by the average lay-person, and when it comes to testing of a therapeutic intervention, even most mental health professionals do not understand why it is crucial to control bias by double-blinding in a clinical trial of an intervention, whether psychotherapy or drug. The words “controlled” or “randomized” seem to carry more weight than they are worth if there is no placebo or double blind to back them up. We must also not avoid a critical discussion of the economic incentive to do a test or to “prove” the evidence base of a certain therapy.

{Ed.: Dr. Berger is in private practice in Japan and consultant on pharmaceutical clinical trials. Web page is at: www. japanpsychiatrist. com. This article is intended as a personal opinion piece and not a scientific analysis.}

REFERENCES

1. Bleicher A. Perils of newborn screening: Doctors may be testing infants for too many diseases. Sci Am 2012;307:16-7.

2. Pastores GM. Krabbe disease: An overview. Int J Clin Pharmacol Ther 2009;47(Suppl 1):S75-81.

3. Rivera CL, Bernal G, Rossello J. The Children’s Depression Inventory (CDI) and The Beck Depression Inventory (BDI): Their validity as screening measures for major depression in a group of Puerto Rican adolescents. Int J Clin Health Psychol 2005;5:485-98.

4. Available from: http://www.nimh.nih.gov/health/publications/men-anddepression/diagnostic-evaluation-and-treatment.shtml. [Last Accessed on 2013 Mar 30].

5. F84. Pervasive developmental disorder. International Statistical &ODVVL¿FDWLRQRI’LVHDVHVDQG5HODWHG+HDOWK3UREOHPVth (ICD-10) ed. World Health Organization (2006).

6. Fombonne E. Epidemiological surveys of pervasive developmental disorders. In: Volkmar FR, editor. Autism and Pervasive Developmental Disorders. 2nd ed. Cambridge: Cambridge University Press; 2007. p. 33-68.

7. Centers for Disease Control and Prevention. Summary Health Statistics for U.S. Children. National Health Interview Survey, 2002. March 2004, Series 10, No. 221.

8. Burns, David. Feeling Good, The New Mood Therapy. Avon Books; 1980.

9. Fava M, Davidson K, Alpert JE, Nierenberg AA, Worthington J, O’Sullivan R, et al. Hostility changes following antidepressant treatment: Relationship to stress and negative thinking. J Psychiatr Res 1996;30:459-67.

10. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: Meta-epidemiological study. BMJ 2008;336:601-5.

11. Steven Piantadosi. Clinical Trials: A Methodologic Perspective. 2nd ed. Hoboken: Wiley-Interscience; 2005.

12. Lynch D, Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: Does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine 2010;40:9-24.

[ramialkarmi]

There's a medical problem that marijuana might be able to help that no one is talking about

In a sun-filled room overlooking a smattering of palm trees, power lines, and cement-and-terracotta bungalows, a 73-year-old recovering alcoholic rolls a joint.

Frank, whose name has been changed for this story, doesn't particularly like the feeling he gets from smoking cannabis, but he doesn't hate it either. And he admits it helps him sleep.

High Sobriety, the southern California rehab center where Frank is staying, incorporates cannabis into its treatment regimen for people with drug and alcohol addiction. Frank hasn't touched scotch, his former drink of choice — or any other alcoholic beverage, for that matter — in 30 days.

A month ago, he was living alone and drinking around the clock, despite repeated warnings from his physicians about negative interactions between alcohol and the medications he takes for high blood pressure and other age-related health issues. During a bender over the holidays, Frank knocked over the carriage holding his daughter's 10-month-old baby. Concerned, his family took him to Alcoholics Anonymous. Nothing stuck, and Frank's health continued to decline.

One day last year, his daughter called Joe Schrank, High Sobriety's founder, and asked if he could help.

The idea behind High Sobriety is simple: Help addicts stop abusing the substances that are causing them the most harm, using cannabis as a tool to do so.

"Our retention rates are so much better with being able to give them something," Schrank, a trained social worker who has spent the last 15 years working with addicts, told Business Insider. "The truth is a lot of these people are deep, deep, deep into the weeds with drug and alcohol use, and to think there's a light switch and they can just turn it off ... I mean, you're dealing with a different person when you talk about cessation of drug use."

Schrank's unconventional approach has put him at odds with many people in the recovery community. But his strategy is part of a new and growing movement that aims to treat addiction like any other mental illness — with science. The approaches coming out of this movement share the belief that we should stop treating addiction as a moral issue and start treating it as a medical one.

Reducing harm

Schrank disapproves of AA and other similar programs that portray drinking and using drugs as moral problems. That approach is out of touch with science, he says.

"I never think of drug use as any kind of moral thing," Schrank said. "Actually, I like drug use, although it didn't really work out for me."

Maia Szalavitz, a neuroscience journalist and the author of "Unbroken Brain: A Revolutionary New Way of Understanding Addiction," agrees.

"This stuff that emphasizes this morality, we don't have anything else like that in medicine," said Szalavitz, a former heroin addict and AA member. "And the 12-step thing talking about 'defects of character,' that's not exactly helpful for someone who already has a lot of self-hatred."

Like Schrank, Szalavitz believes that for many addicts, giving up their drug of choice is necessary for recovery, but giving up all drugs may not be.

"This whole idea that total abstinence is the only route to recovery has been incredibly damaging to the addiction field," she said.

Instead, a better approach might be to identify addicts' problem drug — which Szalavitz describes as "that one partner that you long for but if you get them you'll go crazy" — and remove that substance.

This idea is in line with decades of research in a field called harm reduction, which accepts that drug use is a part of daily life. Instead of trying to get people to give drugs up altogether, it aims to improve people's safety by reducing the negative consequences that can be linked with using drugs. This, Szalavitz believes, could save the lives of the many people who have struggled with AA's hardline approach.

"Addiction is compulsive behavior despite negative consequences," she said. "If you're using a substance responsibly and not having negative consequences, why should anyone care?"

Research seems to suggest that partial abstinence may help some people who've struggled with substances like alcohol. Keith Humphreys, the section director for mental-health policy at Stanford's department of psychiatry, published a paper in 2003 that reviewed an approach called "moderation management." He concluded that making the method an option for people with drinking problems "seems on balance a benefit to public health."

'To say there's only one option ... is wrong'

Six years ago, Schrank's friend Gregory Giraldo was found unconscious in a New Jersey hotel room after overdosing on cocaine and Valium. He died shortly after.

Schrank, 48, says that if he could see Giraldo today and offer him cannabis instead of the drugs he died taking, there'd be no question about it.

"I'd say, 'Smoke up there, Gregory, go ahead,'" Schrank said.

Giraldo, a comedian, had been to rehab and tried the abstinence-only route several times. But the 12 steps didn't save him. Schrank thinks his new program might have.

"He was a brilliant dude," Schrank said. "Maybe he wouldn't have been as functional as an abstinent-only person. I don't know. But when I hear people tell others that [abstinence-only] is 100% of the pie — they're wrong."

Schrank has also gone through AA. He got sober that way 20 years ago and hasn't touched a drink or a drug — even cannabis — since. (He doesn't even like the smell of pot.)

While he says AA helped him "immensely in a lot of ways," Schrank takes issue with the idea that addicts are given only two choices: complete abstinence or nothing.

"To say there's only one option and to present people with only one option is wrong," Schrank said. "It's like saying, 'I have a moral objection to insulin, so I'm just not going to take it.' It's malpractice if you ask me."

Schrank and other critics of AA's methodology cite its dismal success rates as one of many reasons new approaches are necessary.

"About one of every 15 people who enter these programs is able to become and stay sober," Lance Dodes, a retired professor of psychiatry at Harvard Medical School, wrote in his well-known 2014 book, "The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry."

A large 2006 review of eight trials involving more than 3,400 people in total also concluded that "no experimental studies unequivocally demonstrated the effectiveness of AA ... for reducing alcohol dependence or problems."

Abstinence-only approaches are untenable for people like Frank, Schrank says.

"The truth is he's 73 years old, he's alone, and the idea that we're gonna make him go to AA and stop drinking, it's fantasy — that's not compassion," he said.

Still, there is some evidence that AA can help some people. A study of more than 400 people found that "some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."

A 29-year-old recovering alcoholic who has been sober for eight years put it to me this way: "If it wasn't for the rooms [of AA], I'd be lying in a gutter somewhere. That's my reality."

Does cannabis help curb addiction?

There aren't many studies on whether cannabis works for those struggling with addictions.

The research that exists suggests that cannabis may be a helpful tool in reducing the use of opioids by people who use them for long-term pain relief. It also could help reduce the physical and psychological symptoms of withdrawal. And it might help some addicts stop using other substances like nicotine, although a large report published in January by the National Academy of Sciences, Engineering, and Medicine said that "only one randomized trial assessing the role of cannabis in reducing the use of addictive substances" exists.

In addition to these studies being few and far between, each suffered from at least one research error. In some cases, the sample was too small to extrapolate; in other cases, the data was based only on surveys, which can't provide scientific answers. In others, people in the study knew which drug they were taking, which might have contaminated the findings.

Clearly, more research is needed.

"I think ideally you'd study it before you just go and do it," Szalavitz said. "I think it's an intriguing idea that we need more research on."

But many researchers say the idea of using cannabis to treat addiction is absurd.

"Marijuana has exactly no role in the treatment of any mental illness, especially substance-use disorders," Thomas McLellan, who founded the Treatment Research Institute and served briefly as the deputy director of the Office of National Drug Control Policy in the Obama administration, told The Guardian.

These issues put Schrank in a tough spot.

"It's not the easiest place. AA people hate me. Rehab people hate me," he said. "I'm OK with that."

SEE ALSO: The answer to treating drug and alcohol addiction may be far simpler than you think

DON'T MISS: Why psychedelics like magic mushrooms kill the ego and fundamentally transform the brain

Join the conversation about this story »

NOW WATCH: This is how long drugs actually stay in your system

[ramialkarmi]

This rehab program gives addicts marijuana — and it's part of a transformation in drug treatment

In a sun-filled room overlooking a smattering of palm trees, power lines, and cement-and-terracotta bungalows, a 73-year-old recovering alcoholic rolls a joint.

Frank, whose name has been changed for this story, doesn't particularly like the feeling he gets from smoking cannabis, but he doesn't hate it either. And he admits it helps him sleep.

High Sobriety, the southern California rehab center where Frank is staying, incorporates cannabis into its treatment regimen for people with drug and alcohol addiction. Frank hasn't touched scotch, his former drink of choice — or any other alcoholic beverage, for that matter — in 30 days.

A month ago, he was living alone and drinking around the clock, despite repeated warnings from his physicians about negative interactions between alcohol and the medications he takes for high blood pressure and other age-related health issues. During a bender over the holidays, Frank knocked over the carriage holding his daughter's 10-month old baby. Concerned, his family took him to Alcoholics Anonymous. Nothing stuck, and Frank's health continued to decline.

So one day last year, his daughter called up Joe Schrank, High Sobriety's founder, and asked if he could help.

The idea behind High Sobriety is simple: Help addicts stop abusing the substances that are causing them the most harm, and use cannabis as a tool to do so.

"Our retention rates are so much better with being able to give them something," Schrank, a trained social worker who has spent the last 15 years working with addicts, tells Business Insider. "The truth is a lot of these people are deep deep deep into the weeds with drug and alcohol use and to think there's a light switch and they can just turn it off...I mean you're dealing with a different person when you talk about cessation of drug use."

Schrank's unconventional approach has put him at odds with many people in the recovery community. But his strategy is part of a new and growing movement that aims to treat addiction like any other mental illness — with science. The approaches coming out of this movement share a common thread: the belief that we should stop treating addiction as a moral issue and start treating it as a medical one.

Reducing harm

Schrank disapproves of the way AA and other similar programs portray drinking and using drugs as moral problems. That approach is out of touch with science, he says.

"I never think of drug use as any kind of moral thing. Actually, I like drug use, although it didn't really work out for me," Schrank says.

Maia Szalavitz, a neuroscience journalist and the author of "Unbroken Brain: A Revolutionary New Way of Understanding Addiction," agrees.

"This stuff that emphasizes this morality, we don't have anything else like that in medicine," Szalavitz, a former heroin addict and AA member, says. "And the 12-step thing talking about 'defects of character', that's not exactly helpful for someone who already has a lot of self-hatred."

Like Schrank, Szalavitz believes that for many addicts, giving up their drug of choice is necessary for recovery, but giving up all drugs may not be.

"This whole idea that total abstinence is the only route to recovery has been incredibly damaging to the addiction field," she says.

Instead, a better approach might be to identify addicts' problem drug — which Szalavitz describes as "that one partner that you long for but if you get them you'll go crazy" — and remove that substance.

This idea falls in line with decades of research in a field called harm reduction, which accepts that drug use is a part of daily life. Instead of trying to get people to give drugs up altogether, it aims to improve people's safety by reducing the negative consequences that can be linked with using drugs. This, Szalavitz believes, could save the lives of the many people who have struggled with AA's hardline approach.

"Addiction is compulsive behavior despite negative consequences. If you're using a substance responsibly and not having negative consequences, why should anyone care?," she says.

Research seems to suggest that partial abstinence may help some people who've struggled with substances like alcohol. Keith Humphreys, the section director for mental health policy at Stanford's department of psychiatry, published a paper in a 2003 that reviewed an approach called "Moderation Management." He concluded that making the method an option for people with drinking problems "seems on balance a benefit to public health."

'To say there's only one option is wrong'

Six years ago, Schrank's friend Gregory Giraldo was found unconscious in a New Jersey hotel room after overdosing on cocaine and Valium. He passed away shortly after.

Schrank, who's now 48, says that if he could see Greg today and offer him cannabis instead of the drugs he died taking, there'd be no question about it. "I'd say, 'Smoke up there, Gregory, go ahead.'"

Giraldo, a comedian, had been to rehab and tried the abstinence-only route several times. But the 12 steps didn't save him. Schrank thinks his new program might have.

"He was a brilliant dude," Schrank says. "Maybe he wouldn't have been as functional as an abstinent-only person, I don't know. But when I hear people tell others that [abstinence-only] is 100% of the pie — they're wrong."

Schrank has also gone through AA. He got sober that way 20 years ago and hasn't touched a drink or a drug — even cannabis — since. (Ironically, he doesn't like the smell of pot.) While he says AA helped him "immensely in a lot of ways," Schrank takes issue with the idea that addicts are only given two choices: complete abstinence or nothing.

"To say there's only one option and to present people with only one option is wrong," Schrank says. "It's like saying I have a moral objection to insulin so I'm just not going to take it. It's malpractice if you ask me."

Schrank and other critics of AA's methodology cite its dismal success rates as one of many reasons that new approaches are necessary.

"About one of every 15 people who enter these programs is able to become and stay sober," Dr. Lance Dodes, a retired professor of psychiatry at Harvard Medical School wrote in his well-known 2014 book, "The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry." A large 2006 review of 8 trials involving more than 3,400 people also concluded that "no experimental studies unequivocally demonstrated the effectiveness of AA ... for reducing alcohol dependence or problems."

Abstinence-only approaches are simply untenable for people like Frank, Schrank says. "The truth is he's 73 years old, he's alone, and the idea that we're gonna make him go to AA and stop drinking, it's fantasy — that's not compassion."

Still, there is some evidence that AA can help some people. A study of more than 400 people found that "some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA." A 29-year old recovering alcoholic who's been sober for eight years put it to me this way, "If it wasn't for the rooms [of AA] I'd be lying in a gutter somewhere. That's my reality."

Does cannabis help curb addiction?

There simply aren't many studies on whether cannabis works for those struggling with addictions.

The research that exists suggests that cannabis may be a helpful tool in reducing opioid use in people who use them for longterm pain relief. It also could help reduce the physical and psychological symptoms of withdrawal. And it might help some addicts stop using other substances like nicotine, although as a large report published in January by the National Academy of Sciences noted that "only one randomized trial assessing the role of cannabis in reducing the use of addictive substances" exists.

In addition to being few and far between, each of these studies suffered from at least one research error. In some cases, the sample was too small to extrapolate; in other cases the data was based only on surveys, which can't provide scientific answers. In other cases, people in the study knew which drug they were taking, which might have contaminated the findings.

Clearly, more research is needed.

"I think ideally you'd study it before you just go and do it," Szalavitz says, adding, "I think it's an intriguing idea that we need more research on."

And of course, many researchers simply say the idea of using cannabis to treat addiction is absurd.

"Marijuana has exactly no role in the treatment of any mental illness, especially substance-use disorders," Thomas McLellan, who founded the nonprofit Treatment Research Institute and served briefly as deputy drug czar under the Obama administration, told The Guardian.

All of these issues put Schrank in a tough spot.

"It's not the easiest place. AA people hate me, rehab people hate me," he says. "I'm ok with that."

SEE ALSO: The answer to treating drug and alcohol addiction may be far simpler than you think

DON'T MISS: Why psychedelics like magic mushrooms kill the ego and fundamentally transform the brain

Join the conversation about this story »

NOW WATCH: This is how long drugs actually stay in your system