At 39-years of age, Ron had been a respected employee in a department store for nearly ten years. If he had made it to ten full years, he would have qualified for some extra benefits. Upper management chose to replace him with someone new a week before the ten years were up. Discovering that landing a new job was leading to one rejection after another, Ron fell into an anguishing depression.
Observing him having sleepless nights and losing weight, Ron’s wife urged him to see a mental health professional.“You’ve been paying for mental health coverage on your health policy for over fifteen years. You might as well take advantage of it and see if a professional can help you through this.”
Ron resisted, but when he received yet another terribly anxiety producing employment rejection, tears streamed down like two little waterfalls.At his first appointment with Dr. Sigmund, a cigar smoking psychologist, Ron discovered that to access mental health services with his health policy, he would have to be labeled as a person with a mental disorder. “I don’t want that kind of nonsense in my medical record,” he told Dr. Sigmund. “I’m not mentally ill! I’m just going through some tough times right now and I can use some professional help getting through this.”
“After a long drag on his cigar, Dr. Sigmund sadly explained, “I have to place on the insurance form a mental disorder diagnosis or I can’t see you.”Thoughts began to race through Ron’s head. Sometimes, on a job application form it asks if I had ever been treated for a mental disorder. If I answer truthfully, that could end up costing me the job. If I lie and someone broke into the insurance records system and released them to the public, I could be convicted of fraud. I was thinking of some day going into politics. If anyone ever got wind of the fact that I was given a so called mental disorder diagnosis, that could be the end of that.“Listen, Doctor, I’ve been paying for this mental health coverage for years and no one ever told me I had to be given a stigmatizing label to access services. That’s not fair.”
“You feel it’s unfair,” said Dr. Freud. He then paused, frowned, and said, “I’m sorry, but that’s how the system works. And, after all, these are real disorders, based on sound science.In fact we have recently learned that these disorders are properly viewed as genetic diseases. The evidence is pretty plain. We have learned that these types of conditions run in families, and genetic research has even identified the actual genes that are involved.”
Upon hearing this, Ron chose to walk out of the doctor’s office feeling more miserable than when he arrived.
- “I have to place on the insurance form a mental disorder diagnosis or I can’t see you.”
- “these [mental disorders] are real disorders, based on sound science.”
- “these disorders are properly viewed as genetic diseases.”
Dr. Sigmund’s First Two Statements
First, Dr. Sigmund declares that “Without a mental disorder diagnosis, which I must place on the insurance form, I can’t see you.” This is pretty often true. In the United States, if you want to take advantage of your mental health insurance coverage, insurers require a mental disorder diagnosis [see HERE]. Some mental health service providers will see paying customers without the necessity of labeling if the customer pays the entire cost for the services. Paying for services that are not at least partly covered by insurance typically are too costly for the average Joe or Jill.
In my opinion, it is not sound science that came up with these types of labels, but rather, a business model that serves the pharmaceutical industry and psychiatry. Psychologists have gone along with the plan for practical reasons. Additionally, some actually are convinced that the labeling system is indeed based on principles of science. For a full critique of their position, see HERE.The Third Statement by Dr. Sigmund
In the parable, Dr. Sigmund declares that “these disorders are properly viewed as genetic diseases.” Is this a fair statement? The simple answer is no. To reasonably arrive at this answer, we’ll have to spend some time going step by step through some basic ideas.
Dr. Sigmund provides two general statements as a defense for his declaration–“We have learned that these types of conditions run in families, and genetic research has even identified the actual genes that are involved.”
When psychologists say that a certain set of characteristics that is classifiable as a mental disorder runs in the family, it doesn’t mean that if someone in the family has that set of characteristics, everyone in the family will have the same set of characteristics. 
Even identical twins won’t always have the same set of these types of characteristics despite the fact that a pair of identical twins have the same set of genes.
What psychologists typically mean by saying a set of characteristics run in the family, is that there is evidence that there is an increased probability that if one member of the family has the set, other family members are more likely to also have that set. Should this type of evidence lead us to conclude that such a set indicates the presence of a genetic disease?
To understand why the answer is no, we have to first understand that all species have a great number of characteristics, and each of their characteristics vary to some extent between different members of their species. For example, human beings have a typical height, they can run at a typical speed, etc. The average height of male humans is about 5 feet, 9 inches. Some, men are, however, somewhat taller, others are somewhat shorter, and some are quite a bit taller or quite a bit shorter. Similarly, some men can run at the average speed for men, while others can run at various rates that are different from average.
If someone is above average in height, this does not mean he or she will be above average in running speed. Each of our numerous characteristics can be either within the average range, above average, or below, and because someone is below average in some set of characteristics does not mean that he or she will not have some characteristics that are average or even above average. And these differences are a great boom to the human race. If everyone was brilliant in academics and also had a strong genetic desire to be a professor at Ivy League universities, who would build the roads, drive our trucks, grow our crops, serve in law enforcement, cut our hair, tend to the sick, serve as fire fighters, staff stores, serve us in restaurants, etc.? People with different interests and talents enhance our own lives.
Now, clearly some human characteristics do run in the family. How tall you become is one such characteristic. Nevertheless, even if both of your parents are taller than average, you may still end up shorter than average.
If you do end up shorter than average this does not mean you have a genetic disease, even if we can demonstrate that taller people tend to have some advantages over people who are shorter. Saying that people who are shorter than average have a dysfunction would be stigmatizing while clouding the fact that we cannot determine a person’s overall functioning based on just one set of characteristics. Being shorter, when combined with the rest of a person’s characteristics, can lead to him or her being more useful in a variety of ways.
Let’s move on now from discussing a person’s height to a more complex set of characteristics–athletic performance. There is some evidence that athletic performance might be a set of characteristics that, to some degree, runs in the family. Deliberate practice seems to be a much greater predictor of skill in a particular sport, but let’s say for argument sake that at least to some extent there is indeed some inheritability to this set of characteristics. If a physical education teacher sees a child performing below average in athletic achievement, even if we are completely confident that this characteristic runs in the family, does this mean that this child has a genetic disease?
We could, if we wanted, label the child as having a “Muscle Deficit Disorder,” and claim that he or she rightfully has a genetic disease which is treatable with steroids. That would not, in my opinion, be in the child’s best interest. Admittedly that is just my value judgment. But I also contend that if we wanted to label the child as having a “Muscle Deficit Disorder,” that too would be a decision based on a value judgment, rather than one based on being consistent with principles of science.
Rather than pathologizing below average athletic skills, I’ve seen physical education teachers who encourage such children to participate in some after school programs that develop skills in sports that can be practiced non-competitively, such as running, bicycling, and golf. Some of these children take to such programs willingly and end up staying in fine physical shape the rest of their lives. If they don’t, they suffer the consequences and all of us end up paying higher health premiums because they are at an increased risk of getting sick. At the same time, their other sets of characteristics, when combined with their couch potato ways, may offer them and the rest of us some valued fruits.
Just because some people have a different group of genes that might increase the likelihood that a certain set of characteristics will be expressed does not mean these people have a disease. 
I know that some psychologists say, it is only the sets of characteristics that can be linked in some way to a “dysfunction” that are properly labeled as a disease. But the dysfunctional descriptor is so vague that it can be applied to the vast majority of people, and, perhaps, everyone.
Let’s say we can identify a set of genes that increase the chances that someone will enlist in the military. Now, let’s say we find that joining the military places these people at greater risk of harm, and even death. Would the finding of this type of connection require us to say that this means all who join the military have a dysfunction and therefore they also have a genetic disease? How about people who have become addicted to smoking, like old Dr. Sigmund? At one point, most Americans were smoking. Smoking can be labeled a dysfunctional characteristic. If it tends to run in the family, would that justify our declaring that all of this majority had a genetic disease?
How about becoming a psychiatrist? This may run in the family. If we find that becoming a psychiatrist increases the likelihood of committing suicide, which some data suggests, are all of them to be viewed as having a genetic disease, or would it be clearer, and more scientific, to say their set of characteristics is a “risk factor” for some negative outcome? I believe the latter is more scientific.
How about just being a male? Being a male increases the risk of violence. Or how about being a woman? Being a woman increases a person’s risk of becoming depressed, which psychopathologists are eager to tell us is a dysfunction. Don’t these facts pretty much indict us all with regards to having a genetic disease?
Now let’s turn to the statement that genetic research has identified the actual genes that are involved in mental disorders. I have read this research carefully and came away convinced that we are not even close to making this claim. Evaluating the research is complicated, but I’ll just make two simple points about this that can help readers to better understand this issue.
First of all, if Dr. Sigmund’s statement was true, mental disorders would be diagnosed by doing a test of one’s genes. This is not how mental disorder diagnoses are made. 
Instead, psychologists have a conversation with the person seeking mental health services.
Second, if genes determined whether or not someone had a particular set of characteristics that gets labeled a mental disorder, what happens to those genes when someone who was labeled as having a mental disorder recovers, which often occurs? Do the genes somehow float out of the person’s body, and rise up to heaven? Actually the genes in the body remain right where they were when the person was said to have a mental disorder.
As I read the research on this issue, it became plain to see that genes can be likened to the buds of a beautiful flower. If they meet up with the right soil, sunlight, water, and care, they typically blossom into something beautiful. But even with a great deal of wonderful nourishment, sometimes they get tangled up with some surrounding weeds. Stigmatizing labels don’t help in such situations. Instead, some wise gardening can make a beautiful difference.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Dr. Kandel’s credentials are pretty impressive–he’s a Nobel Prize laureate and professor of brain science at Columbia University. Therefore, if you are among those who believe a person’s credentials should determine who is right and who is wrong, you need not read any further. You must simply conclude that what is referred to as mental illnesses are indeed brain diseases because you would be hard pressed to find someone with better credentials disagreeing with Dr. Kandel.
The argument that such labeling practices are not scientific, but, rather, value judgments, was intelligently made by William James when he defended the religious sentiment. He explained that pathologizing these sentiments as mental diseases was superficial medical talk. He called the reasoning doctors used to declare religious beliefs a type of mental illness, “medical materialism.”
assumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content.
All states of mind are related in extremely complex ways to neural functions. There is a crucial distinction to be made between a brain difference and a brain pathology. The significance of each state of mind must be tested, not by some neurological difference, but by the value of its fruits. When the term “pathological” is applied to an experience, rather than an identified physiological pathology, it wrongly implies a neutral science classification.
In contrast to biological arguments, 
Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.
Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.
Literature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:
I actually like Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly uses diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.
At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”
Does it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.
For example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.
Having indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.
In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.
Although there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.
Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.
A six-month investigation by The New York Times found that in the push to win customers, some Abbott managers instructed employees to pursue sales at virtually any cost. Among the ploys used to sell drugs, Abbott managers told sales staff to hold what the company called health camps, where representatives would perform tests on patients for various ailments in an effort to drum up business for doctors, who would then prescribe Abbott drugs.
Immediately on the heels of the suicide story, I began to hear the media uproar over the marketing strategy by the company that manufactures EpiPens.
Mylan has a veritable run of the market. It therefore, in a few short years, raised the price of EpiPens again and again. As of this May, they cost 
These latest two media stories are just a tip of the iceberg when it comes to how the pharmaceutical industry is treating its customers disrespectfully. Anyone who really wants to know the full story would do well to read Dr. Marcia Angell’s superb book, The Truth About the Drug Companies: How They Deceive Us and What To Do About It. The author has an M.D. degree, and for two decades was editor in chief of the prestigious New England Journal of Medicine. There she had a front row seat on the growing power and corruption of the industry.
As Dr. Angell powerfully demonstrates, claims that high prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into marketing of their products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.
How do the drug companies get away with this, since a patent is only supposed to be issued when the new drug is useful, novel, and non-obvious. The drug companies have the largest army of lobbyists in Washington, D.C. If you think the gun lobby has an unfair hold on politicians, it is small potatoes when it comes to the pharmaceutical industry.
How do drug companies justify all of their me-too drugs? They claim that it is good to have more than one drug to treat a condition, because if the first one doesn’t work, the second might. Here’s Dr Angell’s reply:
The solution to getting the drug companies to start treating us respectfully would be fairly easy if only Congress could fire up the will to stop listening to the industry’s lobbyists. Laws could simply be enacted that would replace the 20 year patents on new drugs with laws that would provide a patent that lasts only until the company recoups its investment in creating the drug. When the patent runs out, they could still continue to sell the drug without the patent. After all, companies that sell off-patent generic drugs do make profits, but just not as outrageous profits that allow the industry to employ more lobbyists on Capital Hill than there are congressmen.
Unfortunately, the influence of the lobbyists have been way too great for the lawmakers to resist going along with the drug companies. So, as is often the case, it is up to those of us who are being treated disrespectfully to stand up and powerfully advocate that we begin to be treated respectfully. 
This would entail making it known that we voters will only support candidates who are running for office who refuse to take money from the pharmaceutical industry. If there are no such politicians running in the district we live in, we must identify someone who is willing to run on this issue, and then we must work to get that person elected. Without such action, we folks will have to accept that being treated disrespectfully by the drug companies is just a sad part of life.
Welcome to “From Insults to Respect.” Regular readers know that I have some serious objections to how mental health service providers treat those seeking their services. As things stand now, unless you can afford to completely pay for such services without any insurance coverage, to access services you are very likely to be required to be labelled as having a mental disorder.
Recently I provided a post titled, “
Whitaker was a medical writer at the 
In 2002, 
As Stip noted in his 2002 paper, there is no compelling evidence in the literature that antipsychotics improve long-term outcomes. The relapse studies do not provide such evidence, and there is no other body of research that does. However, as can be seen in this paper, there is a history of science, stretching across six decades, that consistently tells of a medical treatment that, in the aggregate, does more harm than good.
The first long-term study reveals a higher rehospitalization rate for patients treated initially with antipsychotics.
Guy Chouinard and Barry Jones, drawing on an emerging understanding of how antipsychotics change the brain, provide a biological explanation of why that would be so. They then test their hypothesis and find that a significant percentage of medicated patients suffer from drug-induced tardive psychosis. 
MRI studies reveal that antipsychotics induce changes in brain volumes that are associated with a worsening of positive and negative symptoms, and adverse cognitive effects. 
In order to argue that antipsychotics do not worsen long-term outcomes in the aggregate, all of this evidence would have to be explained away. This entire history of science would need to be discounted. In addition, this review has focused on the benefit side of the risk-benefit equation for antipsychotics. The drugs are supposed to provide the benefit of reducing psychotic symptoms. 
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.
I believe that if more of us were presented with this outline, and then discussed why many people feel that people who reason at the lower levels are more immature, and, at the higher levels, more mature, this would begin to challenge us to learn how to make our judgments stand out like the sun after a long bout of rainy skies. If we then practiced writing assignments in which we had to defend a position, while utilizing the model of the highest level of reasoning, this would further challenge us to make some improvements in making sound judgments.
Moreover, each stage is discussed in such a way that the reader gets an idea of not only what the position looks like when it is firmly established, but also what it looks like as a person begins to emerge from a lower stage to a higher stage of reasoning. But, as written by Perry, each stage is way too complicated to be readily understood by most of us. I have, therefore, taken the liberty of simplifying Perry’s terminology and transforming his four stages into seven, so that each level can be described in a relatively concise, easy to understand manner. Unfortunately, some of the subtleties of Perry’s higher level discourse are lost in my translation. The reader interested in a full description of his model is referred to Perry, 1970.
Examples: Mary asks Pete, Sally, and John, “Please tell me how much two plus two equals, and then defend your answer?” Pete answers that he doesn’t know the answer. Sally answers, “The answer is four but I don’t know why.” and John answers, “The answer is four because it just does.” Pete, Sally, and John are all at Stage 1.
For issues that seem straight forward to a student like simple math problems, (How much does two plus two equal?) or relatively clear cut moral issues (Is lying wrong?) Stage 3 students might have just heard one position taken on the subject and are therefore likely to answer just like Stage 2 students, mentioning only one authority. We can only tell that a student has moved from level two to level three when they are asked to defend a position on which they have heard differences of opinion. Then two or more authorities are oftentimes mentioned.
Stage 4: Like those at Stage 3, students at Stage 4, when asked to defend their position on a topic, will demonstrate that they are aware that sometimes different authorities may have different opinions on a topic. What makes students at Stage 4 different than students at Stage 3 is that they can summarize some of the reasons authorities provide when defending their positions. Although students at Stage 4 are beginning to be able to describe different points of view, they oftentimes have a hard time deciding what is true from their own perspective. This is less likely to occur with simple math answers, or relatively clear cut moral issues such as, is lying wrong? For more difficult issues, when challenged to choose between two positions the one that seems more right, they may indicate that they don’t know, or that both are right, or they will pick a position, without any conviction, just to please the questioner.
Examples: 1. Mary asks Sally, “Please tell me how much two plus two equals, and then, defend your answer.” Sally answers, “The answer is four. I know it’s four because my teacher showed us that if you take two sticks and you put them side by side, and then you take two more sticks, and put them beside the other two sticks, and then if you counted all the sticks that were there you’d get four. If you did the same thing for pennies or bricks, or anything, you’d also get four.” 
2. Nancy asks Bob, “Please tell me who you think was the greatest baseball player that ever lived and defend your answer.” Bob answers, “My dad says he thinks Mickey Mantle was the greatest ball player because he was so fast, and when he hit a home run it’d go a mile. My uncle thinks Willie Mays was better because he was great for a lot more years than Mantle.” Nancy then says to Bob, “You told me what your dad and your uncle think. Now tell me who you think was the best and defend your answer.” Bob answers, “I really don’t know.”
Stage 5: Students at this level, when asked their position on a topic, will answer a lot like Stage 4 students. What makes students at Stage 5 different than Stage 4 students is that if they are not familiar with two or more positions on the topic of interest they do research, deliberately seeking out authorities with different opinions in an effort to challenge themselves and their audience to think more deeply about the issue.
“Everyone has a right to her own opinion and mine is as good as any.” As students’ personal opinions are challenged by their teachers’ insistence on evidence and support for opinions, Stage 7 students become better at stating the reasons authorities give for their opinions, doing research that identifies different points of view, listing the pros and cons of each position, and recognizing that the meaning of an event depends on the context in which the event occurs. These skills occur at Stage 6 as well as Stage 7, but become stronger and more elaborated for students at Stage 7. Finally, Stage 7 students can do one thing that Stage 6 students are unable to do. After Stage 7 students review the different positions of authorities, and point out that answers depend on certain situations, they can then take a tentative stand as to what answer is right from their own point of view. Notice in the example below that much of the answer is very similar to one that would be given by a person at Stage 6.
If you did the same thing for pennies or bricks, or pretty much anything else you’d also get four. The thing is, my dad showed me that the answer to how much two plus two equals depends on the situation. Let’s say you have two family members, a husband and a wife. And then, let’s say you have two more family members, also a husband and a wife. In this kind of situation, a husband and a wife can start to have children, and in time, two family members plus two family members can end up equaling five, or six, or even more family members. Also, let’s say you have two pieces of glass, and you add two more pieces of glass, and then, in this special situation, one of the pieces of glass breaks. All of a sudden, two pieces of glass plus two pieces of glass ends up equaling more than four. So it depends on the situation. For me, I think that most of the time the best answer for the question, what does two plus two equal, should be four. That’s the answer that works most of the time. Still, it’s important to be aware that in certain unique situations, a different answer might be better. 
First of all, I should note that I am a member of the American Psychological Association, and have been so for over forty years. Nevertheless, there is one particular aspect of the association that is deeply troubling to me.
As part of the psychological organization’s strong interest in science, pretty much anyone entering its approved doctoral psychology program is required to study the ideas of Thomas Kuhn’s thesis on The Structure of Scientific Revolutions. Such revolutions, we learned, come about after a period of time when a field presupposes a conceptual and instrumental framework accepted without question. Then, more and more, members of the community begin to see a buildup of anomalies in the framework until a “crisis” which can no longer be resolved within the pre-established framework.
It just so happens that the psychiatrist’s stigmatizing diagnostic system, which is described in its Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), has huge anomalies that have been recognized for years, and despite this, psychologists continue to utilize it without taking substantive steps to create a more scientific alternative. Let’s take a quick look at these anomalies. Afterwards, we’ll look at the benefits to psychologists that may be motivating it to continue to go along with the DSM-5 approach despite its major scientific weaknesses.
The process described in the DSM-5 for assessing the subjective notions of “disturbance” in the individual is left to the clinician who decides if these are “clinically significant.” Thus, it provides clinicians an opportunity to include anything that benefits their set of values.
All psychologists are taught that if a hypothetical construct, such as a mental disorder, is to have any validity, it must first demonstrate that it can be reliably identified. Upon reading the DSM-5, we find that there is no documentation that people, whether they are clinicians or not, can reliably distinguish between those who have mental disorders and those who do not have mental disorders. Thus, the lack of this documentation is analogous to a classification system of birds that has no documentation that people can reliably distinguish birds from non-birds.
The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century, as we have understood that symptoms alone rarely indicate the best choice of treatment.
In addition to the DSM’s shortcomings with regards to its classification system’s reliability and validity, there are also serious shortcomings with regards to its claim of being a diagnostic system. A diagnostic system speaks to etiology, that is, the cause, set of causes, or manner of causation of a disease or condition. But the DSM-5 specifically states that it is not designed to identify the cause of the various “disorders” it classifies. Then why use the term “diagnosis” rather than the more scientifically defensible term, “classification?” As we will see, this gets us back to our larger question, why does the psychologist organization accept the use of the DSM-5 given its problematic record of reliability and validity, as well as its use of the word “diagnosis” in a misleading, imprecise manner?
Moreover, symposium proposals on this issue are oftentimes accepted for presentations at its national convention. (See 
A well recognized usefulness of the DSM-5 is that by using its medical sounding terms to refer to all of the experiences that this approach classifies as “mental disorders” it legitimizes in the minds of many the prescribing of drugs for these experiences.
Now keep in mind that the psychiatric association membership consists largely of psychiatrists who make their living by prescribing these drugs. Moreover, there are several reports indicating that the majority of the major players who developed the DSM-5 were on the payroll of the pharmaceutical industry. So, it makes sense to theorize that the psychiatric organization may very well be influenced by all of this wealth. But what about the psychological association?
Welcome to From Insults to Respect. Today’s topic, addiction. When we see we have become addicted to something and find we are having difficulty breaking the habit, we may begin to lose some self respect. And sometimes our actions related to our addictions lead to others losing respect for us. So, it makes sense that we spend a little time giving this topic some thought.
Regular readers of this blog know that from time to time I like to enrich some ideas about a subject with some relevant thoughts that Bob Dylan has shared on his 
Today’s show is all about smoking. We’re not here to encourage it or to glorify it. You’re smart enough to look up all the facts. What we’re going to do over the next hour, is to give a looking and a listen to what happens when the tobacco plant collides with popular culture. As Oscar Wilde once said, “A cigarette is the perfect type of a perfect pleasure; it is exquisite and it leaves one unsatisfied. What more can one want?” We’ll be examining tobacco in all of its forms, from plant, to ash, with stops at cigars, cigarette, snuff, and chewing tobacco. So sit back, smoke em if you got em, and enjoy the next 60 minutes as we blow a few musical smoke rings your way.
Now I’m a fellow with a heart of gold
One of the problems when you smoke is when you’re not smoking, you can have one of those nicotine fits. Here’s how nicotine fits work. Nicotine is physically addictive; it alters your brain functions. Every nerve in your brain’s nervous system has these very tiny neurotransmitters. Nicotine works on some of them, tricking your body that it needs more of these receptors. When you started smoking, your body started responding to the nicotine, and started growing these extra receptors. Over the years, your body has gotten used to these extra receptors, and needs the nicotine to feed them. When you stop smoking, your body thinks your body’s transmitters have been shut off. Your body seeks equilibrium. That’s what the craving for nicotine comes from. When you have a craving for nicotine, the only thing that will help you, is another cigarette. 
Your body does so, according to this theory, because at first the nicotine leads to your receptors firing more frequently than usual. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first started smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”
However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not addicted to the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.
Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.
Dim lights, thick smoke, and loud loud music
We’re going to start off with George Zimmerman and the Thrills doing “Ain’t Got No Money to Pay for this Drink.”
“Just give me a drink,” says Mr. Birnam with exquisite anguish.
Well you thought I’d be waitin’ up when you came home last night
Beer is, it’s not just a drink to me, it represents something, it reminds me of being in college and high school, and discovering getting drunk, and having a sixteen pack in the trunk of my friend, Tommy’s car, drinking it hot out of the can in a parking lot in Las Vegas. Something about beer equals good times to me. 
I love java, sweet and hot
Now when I get up in the morning
Well, there you have it, a little Bob Dylan meditation on the nature of addiction. As I listened to his shows, it came vividly clear to me that many people reach a point at which they decide that they want to get off the merry-go-round of their addiction. When this occurs, what is the best way to go about doing this?