Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
Hi there. This discussion had a brief start on the Perverted Justice thread but then lost steam (and seriousness.) Here's a link to a Washington Post article that provides a nice introduction to the issue.

Psychiatry Ponders Whether Extreme Bias Can Be an Illness

Just to iterate what I said in the PervJus thread, I think this would be an area worthy of psychiatric research and further discussion.

Thoughts?
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
15+ Year Member
Dec 2, 2004
6,299
4,068
58
Left of Center
Status
Attending Physician
Shrinky said:
Hi there. This discussion had a brief start on the Perverted Justice thread but then lost steam (and seriousness.) Here's a link to a Washington Post article that provides a nice introduction to the issue.

Psychiatry Ponders Whether Extreme Bias Can Be an Illness

Just to iterate what I said in the PervJus thread, I think this would be an area worthy of psychiatric research and further discussion.

Thoughts?
Gives me chills, actually.
Better all get reading up on the abuses of psychiatry at the start of the Holocaust, or in the former Soviet system...
 

MDgonnabe

your royal travesty
7+ Year Member
15+ Year Member
May 26, 2001
492
4
40
in the state of insanity
www.livejournal.com
Status
excellent article! thanks for the interesting read. i'd say if a person's prejudice interferes with functional, daily living, then sure, it's pathological. a lot of things in the dsm are behaviors any normal individual exhibits given the right circumstances only taken to the extreme, and this is no different.

and really, isn't the prison system this country's largest mental health care network as it is? if it helps to study and treat individuals by classifying them into more specific disorders, i'd say go for it.
 
About the Ads

Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
OldPsychDoc said:
Gives me chills, actually.
Better all get reading up on the abuses of psychiatry at the start of the Holocaust, or in the former Soviet system...
Could you elaborate on that?
 

Poety

10+ Year Member
5+ Year Member
Dec 22, 2004
2,226
1
47
Bible Belt and loving it
Status
Resident [Any Field]
Ok, I've got a question for anyone/everyone and please know this is coming from my philosophy background and true naivete about the true development of the DSM IV.

I see everyone saying all the time "if its behavioral and interferes with functioning" (not to you MDgonna, just in general I've seen this) that it should be classified as a psychiatric d/o - I'd like to know why? What is it about a behavior that interferes with functioning makes it a d/o? Just because you aren't functioning at the level at which you were? Or is there something else?

Im asking because if you think about, we are beings that adjust to situations with alternate behaviors - its a mechanism of defense - and I just can't see how a maladaptive behavior is a mental illness - can someone please help me? I do clearly understand the logistics of having severe d/o that completely encompass ones ability to function and I see why/how those are serious problems - but racism? or antisocial personality d/o? Are these REALLY going to interfere with someones ability to function? Aren't we just labeling any deviation from the norm and calling it a day at this point?

I'm seriously asking - and I'm not stupid so don't flame me here, I'd just like to see if anyone else is seeing this as I am.

Thanks!
Poety :)
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Feb 19, 2003
3,505
27
The innocent shall suffer...big time
Visit site
Status
Attending Physician
Labeling racism a mental illness, and worse, putting it into the DSM is a hugely bad idea for a number of philosophical and economic/political reasons.

According to the article and not surprisingly, it's the psychologists that are advocating most heavily for this, while most psychiatrists seem opposed to it. Moronic studies such as having study subjects associating America with "sunrise, paradise and loyal," while the fictional country is associated with more negative words shows absolutely nothing.

Human behaviors such as racism, in some respects, is adaptive and expected, given certain life experiences. The thought of someone going on SSD and getting medicaid because they hate blacks or vice versa is sickening.

Many of those case scenarios that the psychologists describe are elements of engrained thinking...not a thought disorders per se. And certainly not deserving of medication, as one psychiatrist pointed out. I've treated many patients that have had overt delusional disorders - these delusions sometimes have everything to do with fear of certain groups of people. These, however, are delusions. The psychiatrist should be able to tell the difference between prejudices, racism and delusions, and make clinical decisions accordingly, depending on how it affects the patient's life.

Some patients are admitted and medicated for delusions focusing on racial or other groups that are harmful to the patient or society. However, the difference is that the context is in that of a delusional disorder, not racism.
If someone's thoughts are just that...thoughts that do no harm to other people, themselves, or causes them grave disability, they are fully entitled to their thoughts and views, regardless if you like them or not, or how politically incorrect they are. To begin to think otherwise is fascism.
 

Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
Poety said:
Ok, I've got a question for anyone/everyone and please know this is coming from my philosophy background and true naivete about the true development of the DSM IV.

I see everyone saying all the time "if its behavioral and interferes with functioning" (not to you MDgonna, just in general I've seen this) that it should be classified as a psychiatric d/o - I'd like to know why? What is it about a behavior that interferes with functioning makes it a d/o? Just because you aren't functioning at the level at which you were? Or is there something else?

Im asking because if you think about, we are beings that adjust to situations with alternate behaviors - its a mechanism of defense - and I just can't see how a maladaptive behavior is a mental illness - can someone please help me? I do clearly understand the logistics of having severe d/o that completely encompass ones ability to function and I see why/how those are serious problems - but racism? or antisocial personality d/o? Are these REALLY going to interfere with someones ability to function? Aren't we just labeling any deviation from the norm and calling it a day at this point?

I'm seriously asking - and I'm not stupid so don't flame me here, I'd just like to see if anyone else is seeing this as I am.

Thanks!
Poety :)
Check out the article link in my original post. They give some real-life examples of how bias has prevented individuals from functioning at their baseline.

And I think that that is what DSM trys to address- syndromes that prevent a person from functioning at an established basline.
 

Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
Anasazi23 said:
The thought of someone going on SSD and getting medicaid because they hate blacks or vice versa is sickening.
"...or vice versa." So, you're concerned that folks might get to collect social security if blacks hate them ?

By the way, how about substantiating your claim that the visual-language studies are meaningless. Is there something I missed that proves exploration of cognition is no longer worthwhile?
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
15+ Year Member
Dec 2, 2004
6,299
4,068
58
Left of Center
Status
Attending Physician
Shrinky said:
Could you elaborate on that?
Basically in both cases, psychiatric diagnosis was used as a tool of political policy:

1) The Holocaust began with the euthanization of the mentally ill. A good overview for those of you interested in medical ethics:
http://www.amazon.com/gp/product/04...102-1266980-1985724?s=books&v=glance&n=283155

2) The Soviet system was notorious for considering opposition to the state as a mental illness, in essence turning psychiatric hospitals into political prisons.

Now, I'm sure that such things would NEVER be possible in the USA, :rolleyes: unless perhaps possibly a very dogmatic, inflexible class of people* rose to power and were somehow so convinced of their own correctness that anyone not agreeing with them was deemed to have a deficit in reality testing...

(*And yes, this could be on either the Right or the Left, lest I be accused of having a specific political ax to grind.)
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Feb 19, 2003
3,505
27
The innocent shall suffer...big time
Visit site
Status
Attending Physician
Shrinky said:
"...or vice versa." So, you're concerned that folks might get to collect social security if blacks hate them ?
Yes, if by "them" you mean a black person getting SSD or Medicare because they hate white people.

By the way, how about substantiating your claim that the visual-language studies are meaningless. Is there something I missed that proves exploration of cognition is no longer worthwhile?
I didn't say visual-language studies in general are meaningless. I said that one particular study is meangless in greater context. It's a grave mistake when nondescript studies such as this are applied to clinical medicine.

What you may consider racism (and your interpretation of DSM criteria) may be seen as normal or adaptive behavior to another.
 

Poety

10+ Year Member
5+ Year Member
Dec 22, 2004
2,226
1
47
Bible Belt and loving it
Status
Resident [Any Field]
Sazi, can you tell me anything about that question I asked? I'm still confused about some stuff - like why we always have the underlying thought process of "if it interferes with functioning" when in fact some mental illnesses won't interfere with functioning - woudl that mean they shouldn't get help? What I mean is - say for instance someone has delusions (clearly a mental illness or perhaps sub induced) but its not bothering them - would we then not treat? I'm just confused on the whole DSM reasoning for using functioning as the basis for dx and tx :oops:

Sorry if I'm not making sense.

Shrinky, I'm going to read that article now~

edit: I just skimmed through it and I think they're treating a delusion here. Why would it even need a separate entrance in the DSM? Just treat as delusional d/o right?

And I think that one psych is right - you start adding in specific thoughts/ideas (i.e. I don't like gays/blacks/whites) as a d/o and you're going to see a bunch of legal issues being raised like "can they use this as a defense?" because in the end - you know eventually someone will.

We seriously need to be careful and quit trying to classify everything into a neat little box completely seperate unto itself - the more we do that (without the biological research to back it up) we risk of "theorizing" all these behaviors, substantiating these theories (without EBM) with a diagnosis and ultimately allowing them to happen because hey, they're a mental illness right? oy, scary stuff :scared:
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Feb 19, 2003
3,505
27
The innocent shall suffer...big time
Visit site
Status
Attending Physician
Poety said:
I see everyone saying all the time "if its behavioral and interferes with functioning" (not to you MDgonna, just in general I've seen this) that it should be classified as a psychiatric d/o - I'd like to know why? What is it about a behavior that interferes with functioning makes it a d/o? Just because you aren't functioning at the level at which you were? Or is there something else?

Im asking because if you think about, we are beings that adjust to situations with alternate behaviors - its a mechanism of defense - and I just can't see how a maladaptive behavior is a mental illness - can someone please help me? I do clearly understand the logistics of having severe d/o that completely encompass ones ability to function and I see why/how those are serious problems - but racism? or antisocial personality d/o? Are these REALLY going to interfere with someones ability to function? Aren't we just labeling any deviation from the norm and calling it a day at this point?

I'm seriously asking - and I'm not stupid so don't flame me here, I'd just like to see if anyone else is seeing this as I am.

Thanks!
Poety :)
There are lots of maladaptive personality manifestations that are not psychiatric disorders per se.

Someone who is rude, has a short temper, tends to insult others, is excessively sarcastic, belches in public, does not necessarily have a mental disorder. Any of the above 'conditions' can be severe enough that it interferes with your functioning (i.e. getting fired from a job).

Disorders such as antisocial PD are a somewhat different ballgame. These are descript behaviors that cause the person difficulty in functioning - but this must be interpreted in context.

As per the DSM-IV the "big" and often overlooked and unread version regarding antisocial PD:
"Antisocial Personality Disorder appears to be associated with low socioeconomic status and urban settings. Concerns have been raised that the diagnosis may at times be misapplied to individuals in settings in which seemingly antisocial behavior may be part of a protective strategy. In assessing antisocial traits, it is helpful for the clinician to consider the social and economic context in which the behaviors occur."

As seen, the DSM provides provisions for interpreting this particular disorder in context. The point is that if a person behaves in a way that could be adaptive and resulted in a small "maladaptive" outcome (being late for work, for example), this could easily be interpreted by an overzealous psychiatrist as a disorder worthy of inpatient treatment and/or medication.
 

Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
OldPsychDoc said:
Basically in both cases, psychiatric diagnosis was used as a tool of political policy:

1) The Holocaust began with the euthanization of the mentally ill. A good overview for those of you interested in medical ethics:
http://www.amazon.com/gp/product/04...102-1266980-1985724?s=books&v=glance&n=283155

2) The Soviet system was notorious for considering opposition to the state as a mental illness, in essence turning psychiatric hospitals into political prisons.

Now, I'm sure that such things would NEVER be possible in the USA, :rolleyes: unless perhaps possibly a very dogmatic, inflexible class of people* rose to power and were somehow so convinced of their own correctness that anyone not agreeing with them was deemed to have a deficit in reality testing...

(*And yes, this could be on either the Right or the Left, lest I be accused of having a specific political ax to grind.)

Definately good points. :thumbup: We could be faced with the unwieldy task of trying to distinguish the pathological from the political. But I think it's exactly this kind of gray area, like the one that separates zeal and fanaticism, that warrants broader research.
 

Poety

10+ Year Member
5+ Year Member
Dec 22, 2004
2,226
1
47
Bible Belt and loving it
Status
Resident [Any Field]
Anasazi23 said:
There are lots of maladaptive personality manifestations that are not psychiatric disorders per se.

Someone who is rude, has a short temper, tends to insult others, is excessively sarcastic, belches in public, does not necessarily have a mental disorder. Any of the above 'conditions' can be severe enough that it interferes with your functioning (i.e. getting fired from a job).

Disorders such as antisocial PD are a somewhat different ballgame. These are descript behaviors that cause the person difficulty in functioning - but this must be interpreted in context.

As per the DSM-IV the "big" and often overlooked and unread version regarding antisocial PD:
"Antisocial Personality Disorder appears to be associated with low socioeconomic status and urban settings. Concerns have been raised that the diagnosis may at times be misapplied to individuals in settings in which seemingly antisocial behavior may be part of a protective strategy. In assessing antisocial traits, it is helpful for the clinician to consider the social and economic context in which the behaviors occur."

As seen, the DSM provides provisions for interpreting this particular disorder in context. The point is that if a person behaves in a way that could be adaptive and resulted in a small "maladaptive" outcome (being late for work, for example), this could easily be interpreted by an overzealous psychiatrist as a disorder worthy of inpatient treatment and/or medication.
:idea: Thanks Sazi, I get it now :) You rock! :love:
 

Shrinky

Junior Member
10+ Year Member
5+ Year Member
Nov 22, 2005
21
0
50
Brooklyn
Status
Medical Student
Poety said:
Sazi, can you tell me anything about that question I asked? I'm still confused about some stuff - like why we always have the underlying thought process of "if it interferes with functioning" when in fact some mental illnesses won't interfere with functioning - woudl that mean they shouldn't get help? What I mean is - say for instance someone has delusions (clearly a mental illness or perhaps sub induced) but its not bothering them - would we then not treat? I'm just confused on the whole DSM reasoning for using functioning as the basis for dx and tx :oops:

Sorry if I'm not making sense.

Shrinky, I'm going to read that article now~

edit: I just skimmed through it and I think they're treating a delusion here. Why would it even need a separate entrance in the DSM? Just treat as delusional d/o right?

And I think that one psych is right - you start adding in specific thoughts/ideas (i.e. I don't like gays/blacks/whites) as a d/o and you're going to see a bunch of legal issues being raised like "can they use this as a defense?" because in the end - you know eventually someone will.

We seriously need to be careful and quit trying to classify everything into a neat little box completely seperate unto itself - the more we do that (without the biological research to back it up) we risk of "theorizing" all these behaviors, substantiating these theories (without EBM) with a diagnosis and ultimately allowing them to happen because hey, they're a mental illness right? oy, scary stuff :scared:
Poety,

I get what you're saying and, in fact, do think that you may be ahead of your time. Here's what I mean: In the historical context of a science, let's say physics, alot of time is devoted to trying to separate out all that exists into namable entities- the quarks from the leptons from the positrons from the magnetic fields, etc. But the other side of the story is trying to unify everything under a broader, single theory.

In psychiatry right now, I think we are still at the stage of trying to figure out one disorder from another and placing them into their own neat little catergories. But maybe down the line we might be able to put the pieces together to find more elegant and useful ways of describing mental illnesses.

"I just saw patient X. He has a case of frontal cortex dopaminergic type 4 disorder. What a session that was!"

We'll see...
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
15+ Year Member
Dec 2, 2004
6,299
4,068
58
Left of Center
Status
Attending Physician
Shrinky said:
Poety,

I get what you're saying and, in fact, do think that you may be ahead of your time. Here's what I mean: In the historical context of a science, let's say physics, alot of time is devoted to trying to separate out all that exists into namable entities- the quarks from the leptons from the positrons from the magnetic fields, etc. But the other side of the story is trying to unify everything under a broader, single theory.
So indeed, one is either a "lumper" or a "splitter"... ;)
 

Poety

10+ Year Member
5+ Year Member
Dec 22, 2004
2,226
1
47
Bible Belt and loving it
Status
Resident [Any Field]
Shrinky said:
Poety,

I get what you're saying and, in fact, do think that you may be ahead of your time. Here's what I mean: In the historical context of a science, let's say physics, alot of time is devoted to trying to separate out all that exists into namable entities- the quarks from the leptons from the positrons from the magnetic fields, etc. But the other side of the story is trying to unify everything under a broader, single theory.

In psychiatry right now, I think we are still at the stage of trying to figure out one disorder from another and placing them into their own neat little catergories. But maybe down the line we might be able to put the pieces together to find more elegant and useful ways of describing mental illnesses.

"I just saw patient X. He has a case of frontal cortex dopaminergic type 4 disorder. What a session that was!"

We'll see...
Thanks Shrinky :) And I totally see what you're saying - and to really flip my whole argument around (can ya tell I was a philo minor?) I really do believe that all of the schizophrenic spectrum is going to turn out to be a multitude of different d/o with varying degrees of illness. i.e. I don't think we can just throw the DSM criteria for schizophrenia onto everyone that fits the dx - I think we're going to see that there are different pathways at work with different deficiencies - hence the reason why some patients respond so well to certain meds and others are resistant - ACK I'm rambling sorry!
 

Poety

10+ Year Member
5+ Year Member
Dec 22, 2004
2,226
1
47
Bible Belt and loving it
Status
Resident [Any Field]
:laugh:
OldPsychDoc said:
So indeed, one is either a "lumper" or a "splitter"... ;)
:laugh:
 

Miklos

Guest
15+ Year Member
Nov 26, 2003
729
0
Status
Resident [Any Field]
Anasazi23 said:
Labeling racism a mental illness, and worse, putting it into the DSM is a hugely bad idea for a number of philosophical and economic/political reasons.

According to the article and not surprisingly, it's the psychologists that are advocating most heavily for this, while most psychiatrists seem opposed to it. Moronic studies such as having study subjects associating America with "sunrise, paradise and loyal," while the fictional country is associated with more negative words shows absolutely nothing.

Human behaviors such as racism, in some respects, is adaptive and expected, given certain life experiences. The thought of someone going on SSD and getting medicaid because they hate blacks or vice versa is sickening.

Many of those case scenarios that the psychologists describe are elements of engrained thinking...not a thought disorders per se. And certainly not deserving of medication, as one psychiatrist pointed out. I've treated many patients that have had overt delusional disorders - these delusions sometimes have everything to do with fear of certain groups of people. These, however, are delusions. The psychiatrist should be able to tell the difference between prejudices, racism and delusions, and make clinical decisions accordingly, depending on how it affects the patient's life.

Some patients are admitted and medicated for delusions focusing on racial or other groups that are harmful to the patient or society. However, the difference is that the context is in that of a delusional disorder, not racism.
If someone's thoughts are just that...thoughts that do no harm to other people, themselves, or causes them grave disability, they are fully entitled to their thoughts and views, regardless if you like them or not, or how politically incorrect they are. To begin to think otherwise is fascism.
Very well written.

I get very worried when I hear proposals like this one. I have no desire to become a social engineer.
 
About the Ads