In 1961 psychiatrist Thomas Szasz published an article in the American Psychologist titled, “The Myth of Mental Illness.” There he proposed that the set of experiences, behaviors, and thoughts viewed as “mental illness” are more aptly construed as “problems in living.”
The following year, Dr Szasz published a best selling book by the same name. Some loved it while others writhed in anger. One reviewer, for example, gave it five stars out of five, and wrote:
Incredibly eye opening book. Shows how “mental illnesses” are not illnesses at all. Mental illness is best viewed as a metaphor. This isn’t to say that what we normally refer to as “mental illness” doesn’t exist, clearly these many psychological experiences do exist…but they are not genuine illnesses and when they are assumed to be this can lead to profound misunderstanding.
In contrast, another reviewer wrote:
Here is my curse on you, Thomas: May you suffer ten minutes of acute clinical depression. Ten minutes in that “over-heated room”, that “bell-jar”, that “bed of nails” which we sufferers know oh too well.
Why were there such strong reactions to a proposal for describing something in a new way? I began to get some understanding of this when I recently began to advocate that the phrase “mental health concerns” is a more apt alternative for referring to the patterns now referred to as either mental illnesses or mental disorders.
More specifically, my proposal, which was published in a peer reviewed journal (see HERE) calls for the development of a scientifically defensible classification system that would be called, “The Classification and Statistical Manual of Mental Health Concerns,” or, for short, the CSM. With this alternative, people who have mental health service insurance coverage would be given a choice–they could access this service either by going to a mental health service provider who requires that they be labeled as having a mental disorder (which is currently their only option), or they could choose to go to one that would only label their expressed mental health concerns. Like Dr. Szasz’s proposal, mine, too, has been met with enthusiastic support from some, while others have angrily called me a mental illness denier and dangerous.
I was initially puzzled about the anger that appears to come from many who genuinely believe, and demand others believe as well, that without any doubt mental illness is an illness like any other illness. My puzzlement stemmed from my experience that oftentimes when someone proposes a different way to describe something, it doesn’t create great uproars. The proposal is either met with feelings that the new way to describe something is either helpful, or not.
After much thought and discussions with others, I now see that this mental illness conflict is not purely about how to describe what is now typically called mental illness. Rather, it is about the feared consequences that may flow from any new way to describe this set of phenomenon.
To help others to see this clearly, today I’ll present a William James anecdote illustrating why definitional issues often don’t lead to conflict, but rather clearer understandings. Then I’ll seek to explain the unique resistance to questioning whether or not the patterns now called mental illnesses are best construed as illnesses.
A Definitional Issue Anecdote
William James, in his book, Pragmatism, tells us the following story.
One day the good professor, being with a camping party in the mountains, returned from a solitary ramble, and found everyone engaged in a dispute about a squirrel. The squirrel is clinging to a tree trunk trying to hide from a person by moving to the opposite side of the tree where the man is looking.
This human witness tries to get sight of the squirrel by moving rapidly round the tree, but no matter how fast he goes, the squirrel moves as fast in the opposite direction, and always keeps the tree between himself and the man, so that never a glimpse of him is caught. (p. 43)
So, given this set of agreed upon facts, the dispute was about this: Does the man go round the squirrel or not? Apparently everyone agreed that the man does go around the tree, and the squirrel is on the tree; but does he go round the squirrel?
Half the participants involved in the dispute felt the man did go round the squirrel, and half disagreed. Upon returning to the campsite, each side appealed to William James to help explain who was right.
“Which party is right,” I said, “depends on what you practically mean by ‘going round’ the squirrel. If you mean passing from north of him to the east, then to the south, then to the west, and then to the north again, obviously the man does go round him, for he occupies these successive positions. But if on the contrary you mean being first in front of him, then on the right of him, then behind him, then on his left, and finally in front again, it is quite obvious that the man fails to go round him, for by the compensating movement the squirrel makes, he keeps his belly turned towards the man all the time, and his back turned away. (p. 44)
Once James simply explained to those involved in the dispute that there are these two different ways to define the verb “to go round” the majority appeared to think that the distinction settled the dispute. One or two who had strongly taken a different position before James showed up, mumbled an objection to his argument, stating the decision really should be made based just on plain honest English, but this soon passed.
I tell this anecdote because it clearly illustrates that when someone describes a new way to look at a phenomenon, it has the potential to clarify the nature of the phenomenon. Disagreements that had sprung up because of vague descriptions may have gone on and on with no progress in sight. 
Once the process of comparing and contrasting two or more descriptive approaches gets underway, it can lead to an understanding of just how vague some of the descriptions were, and they can be abandoned for more precise descriptions. Of course, the new description may also be so terribly vague as well, and nothing positive occurs. In such cases, a little time was wasted, and people get on with their lives without furious reactions.
So, with this in mind, why do people so angrily resist even considering an alternative to describing the set of phenomenon now referred to as mental illness? In the next section, I’ll try to provide some answers.
The Three Major Consequences that People Fear Might Flow from a Change in Descriptive Terms
Let me begin here by asking you to note that in the squirrel anecdote, those who discussed whether or not the squirrel went around the tree were not going to lose their job, money, freedom, or any other highly significant valued thing depending on who ended up being proved correct. Once everyone declared their positions, each might have had a little sense of prestige that might be derived if they could convince others that they came up with the most respected answer. But for people who like to discuss issues, learning from the discussion is typically the most important reward for them, and they can well handle their emotions that come from having taken a position that ends up being faulty.
How about the issue of whether or not mental illness is, or is not, really an illness? From my discussions with supporters of the mental illness descriptor, I theorize that they fear three major consequences of any change.
Diminished Profits of the Pharmaceutical Industry and Prescribing Physicians
The pharmaceutical companies make billions of dollars convincing people that their experiences are illnesses like any other illnesses. Thus, they claim that taking a pill to manage their illness is not any different than taking insulin for diabetes. Psychiatrists and other doctors who prescribe these drugs have an enormous financial interest in keeping this position unchallenged.
For me, I find this sales pitch unconvincing. 
The facts are that there are numerous examples of people who could have easily been classified as having a mental illness who come to a state of enormous improvement either through a religious experience, a philosophy such as Buddhism, a delightful romantic love, an exciting new job, a support group such as AA, counseling, etc., You don’t see diabetes being “cured” by changes in relationships, work settings, religious beliefs, and thinking patterns. The fear of those invested in pharmaceutical company profits and the prescribing of their pills leads to great resistance to any descriptive changes that are not in line with the illness approach.
The Risk of Losing Access to Services
The second consequence that I think people fear is that people who now have access to mental health services might lose them if people stop thinking that the patterns now viewed as real illnesses are really not illnesses. Dr. Szasz’s “problems in living” alternative and my “mental health concerns” approach, they fear, will trivialize these experiences.
Some argue that if everyone could go to a mental health professional merely to have their concerns addressed, then the system would soon be overloaded with clients, and insurance policy costs would soar. Because insurance companies only cover people with more serious conditions known as mental disorders, so the argument goes, this limits the number of people who can get to see a mental health professional. However, I believe that third-party-payer executives would readily come to understand, with a little explaining, that mental health service providers now using the current mental illness approach do not turn anyone away who has mental health insurance coverage and comes to their office expressing what my approach refers to as a mental health concern. Professionals are in the business of increasing their clients. The current relevant definitions are so vague that with little imagination, anyone can be “diagnosed” as having a mental illness.
Fears About Blame
Finally, many people believe that the mental illness conceptualization absolves them of any blame for certain actions. For example, many parents believe they were unfairly blamed for the serious actions that their children began to display. They think that by saying that their children have an illness they are no longer blamed, or at least shouldn’t be blamed.
Similarly, people who seriously hurt others while drinking alcohol or in some furious fit might be blamed for their actions. Thinking that they have an illness, somehow makes them blameless.
In my view, not everyone who hears that their conduct is due to an illness suddenly feels relief from any guilt that they may be feeling. There is a process that one must undergo to learn how to effectively handle guilt feelings and this can occur at least as well with a mental health concern approach as with an illness approach.
This process involves learning that there is a dramatic difference between taking some responsibility for what has occurred and blaming oneself for what has occurred. Blame suggest that you should be punished for your actions. Taking some responsibility for your actions allows one to realize that there may indeed be some very strong conditions that are out of your control regardless of whether or not you have an illness. Blaming yourself for these is not helpful, but allowing yourself to experience deeply the dissatisfied feelings about whatever control you do have can spur you to make valued changes.
Giving people the opportunity to choose a mental health concern approach rather than an illness approach does not necessarily mean that people will be blamed any more or less for certain actions. The competition between these two models can improve outcomes for both approaches.
Conclusion
Okay, so those are the three feared consequences that I have come to believe ignite anger whenever there is a discussion about conceptualizing the set of concerns now called mental illnesses. In my view, “mental health concerns” are a more apt way to conceptualize these concerns than “illnesses.” However, I fully support that for those who prefer the illness approach, that they be free to access services using that model. At the same time, I believe that ending the monopoly of the illness approach could very well stir up some valuable competition that will improve services for all.
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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.
Between 1931 and 1933, Albert Einstein engaged Sigmund Freud in a discussion that addressed the question, “Is there any way of delivering mankind from the menace of war?” Their exchange was subsequently published as a pamphlet that is available for free on line by clicking 
Do you not share the feeling that a change could be brought about by a free association of men whose previous work and achievements offer a guarantee of their ability and integrity? Such a group of international scope, whose members would have to keep contact with each other through constant interchange of opinions, might gain a significant and wholesome moral influence on the solution of political problems if its own attitudes, backed by the signatures of its concurring members, were made public through the press. 
Such an association would, of course, suffer from all the defects that have so often led to degeneration in learned societies; the danger that such a degeneration may develop is, unfortunately, ever present in view of the imperfections of human nature. However, and despite those dangers, should we not make at least an attempt to form such an association in spite of all dangers? It seems to me nothing less than an imperative duty!
As one immune from nationalist bias, I personally see a simple way of dealing with the superficial (i.e., administrative) aspect of the problem: the setting up, by international consent, of a legislative and judicial body to settle every conflict arising between nations. Each nation would undertake to abide by the orders issued by this legislative body, to invoke its decision in every dispute, to accept its judgments unreservedly and to carry out every measure the tribunal deems necessary for the execution of its decrees…. Thus I am led to my first axiom: The quest of international security involves the unconditional surrender by every nation, in a certain measure, of its liberty of action–its sovereignty that is to say–and it is clear beyond all doubt that no other road can lead to such security….
The craving for power which characterizes the governing class in every nation is hostile to any limitation of the national sovereignty. This political power hunger is often supported by the activities of another group, whose aspirations are on purely mercenary, economic lines. I have especially in mind that small but determined group, active in every nation, composed of individuals who, indifferent to social considerations and restraints, regard warfare, the manufacture and sale of arms, simply as an occasion to advance their personal interests and enlarge their personal authority….
But then he notes that he realizes that Einstein is not so much interested in a lot of theorizing, but rather, in concrete steps that may be taken to promote lasting world peace. The answer, he says, perhaps lies in trying to figure out why he, Einstein, and some others developed into human beings who are so much less likely than others to heed the drums of war. Perhaps if we understand this, we can create the conditions for others to reach a similar level of development. Thus, Freud wrote,
Because every man has a right over his own life and war destroys lives that were full of promise; it forces the individual into situations that shame his manhood, obliging him to murder fellow men, against his will; it ravages material amenities, the fruits of human toil, and much besides. Moreover, wars, as now conducted, afford no scope for acts of heroism according to the old ideals and, given the high perfection of modern arms, war today would mean the sheer extermination of one of the combatants, if not of both. This is so true, so obvious, that we can but wonder why the conduct of war is not banned by general consent…. 
The psychic changes which accompany this process of cultural change are striking, and not to be gainsaid. They consist in the progressive rejection of instinctive ends and a scaling down of instinctive reactions. Sensations which delighted our forefathers have become neutral or unbearable to us; and, if our ethical and aesthetic ideals have undergone a change, the causes of this are ultimately organic. On the psychological side two of the most important phenomena of culture are, firstly, a strengthening of the intellect, which tends to master our instinctive life, and, secondly, an introversion of the aggressive impulse, with all its consequent benefits and perils. 
Now war runs most emphatically counter to the psychic disposition imposed on us by the growth of culture; we are therefore bound to resent war, to find it utterly intolerable. With pacifists like us it is not merely an intellectual and affective revulsion, but a constitutional intolerance, an idiosyncrasy in its most drastic form. And it would seem that the aesthetic ignominies of warfare play almost as large a part in this repugnance as war’s atrocities.
But actually solid research evidence, brilliantly summarized by Steven Pinker in his book, The Better Angels of Our Nature: Why Violence has Declined, indicates that over the course of human history we have been finding less and less violent ways to resolve our differences.
Those who point the way toward alternatives to violent interactions, can, in time, perhaps way too slowly than we would like, effect change. As Pinker says in the conclusion of his book, “the data we have seen in this book show it is a goal on which progress can be made–progress that is halting and incomplete, but unmistakable nonetheless.” It is my sincere hope that Einstein’s and Freud’s efforts so many years ago will serve as an enduring inspiration to all of us to keep up the struggle toward bringing about a more peaceful world.
Do you not share the feeling that a change could be brought about by a free association of men whose previous work and achievements offer a guarantee of their ability and integrity? Such a group of international scope, whose members would have to keep contact with each other through constant interchange of opinions, might gain a significant and wholesome moral influence on the solution of political problems if its own attitudes, backed by the signatures of its concurring members, were made public through the press. 
Such an association would, of course, suffer from all the defects that have so often led to degeneration in learned societies; the danger that such a degeneration may develop is, unfortunately, ever present in view of the imperfections of human nature. However, and despite those dangers, should we not make at least an attempt to form such an association in spite of all dangers? It seems to me nothing less than an imperative duty!
As one immune from nationalist bias, I personally see a simple way of dealing with the superficial (i.e., administrative) aspect of the problem: the setting up, by international consent, of a legislative and judicial body to settle every conflict arising between nations. Each nation would undertake to abide by the orders issued by this legislative body, to invoke its decision in every dispute, to accept its judgments unreservedly and to carry out every measure the tribunal deems necessary for the execution of its decrees…. Thus I am led to my first axiom: The quest of international security involves the unconditional surrender by every nation, in a certain measure, of its liberty of action–its sovereignty that is to say–and it is clear beyond all doubt that no other road can lead to such security….
The craving for power which characterizes the governing class in every nation is hostile to any limitation of the national sovereignty. This political power hunger is often supported by the activities of another group, whose aspirations are on purely mercenary, economic lines. I have especially in mind that small but determined group, active in every nation, composed of individuals who, indifferent to social considerations and restraints, regard warfare, the manufacture and sale of arms, simply as an occasion to advance their personal interests and enlarge their personal authority….
But then he notes that he realizes that Einstein is not so much interested in a lot of theorizing, but rather, in concrete steps that may be taken to promote lasting world peace. The answer, he says, perhaps lies in trying to figure out why he, Einstein, and some others developed into human beings who are so much less likely than others to heed the drums of war. Perhaps if we understand this, we can create the conditions for others to reach a similar level of development. Thus, Freud wrote,
Because every man has a right over his own life and war destroys lives that were full of promise; it forces the individual into situations that shame his manhood, obliging him to murder fellow men, against his will; it ravages material amenities, the fruits of human toil, and much besides. Moreover, wars, as now conducted, afford no scope for acts of heroism according to the old ideals and, given the high perfection of modern arms, war today would mean the sheer extermination of one of the combatants, if not of both. This is so true, so obvious, that we can but wonder why the conduct of war is not banned by general consent…. 
The psychic changes which accompany this process of cultural change are striking, and not to be gainsaid. They consist in the progressive rejection of instinctive ends and a scaling down of instinctive reactions. Sensations which delighted our forefathers have become neutral or unbearable to us; and, if our ethical and aesthetic ideals have undergone a change, the causes of this are ultimately organic. On the psychological side two of the most important phenomena of culture are, firstly, a strengthening of the intellect, which tends to master our instinctive life, and, secondly, an introversion of the aggressive impulse, with all its consequent benefits and perils. 
Now war runs most emphatically counter to the psychic disposition imposed on us by the growth of culture; we are therefore bound to resent war, to find it utterly intolerable. With pacifists like us it is not merely an intellectual and affective revulsion, but a constitutional intolerance, an idiosyncrasy in its most drastic form. And it would seem that the aesthetic ignominies of warfare play almost as large a part in this repugnance as war’s atrocities.
But actually solid research evidence, brilliantly summarized by Steven Pinker in his book, The Better Angels of Our Nature: Why Violence has Declined, indicates that over the course of human history we have been finding less and less violent ways to resolve our differences. Human beings who take the time to make vivid the negatives of war, rather than glorifying it, do make a difference. 
Those who point the way toward alternatives to violent interactions, can, in time, perhaps way too slowly than we would like, effect change. As Pinker says in the conclusion of his book, “the data we have seen in this book show it is a goal on which progress can be made–progress that is halting and incomplete, but unmistakable nonetheless.” It is my sincere hope that Einstein’s and Freud’s efforts so many years ago will serve as an enduring inspiration to all of us to keep up the struggle toward bringing about a more peaceful world.
Although remaining serious throughout a conflict has some merit, many people like to interject a little humor. Such a style raises some important considerations that we will explore in today’s “From Insults to Respect” post. We’ll go about exploring these considerations by first taking another look at the original parable, and then I’ll present it again, but with some humor thrown in. After discussing the different approaches illustrated in the two versions of the parable, we’ll discuss a few more examples of people using humor in conflict situations. 
As Abraham Lincoln once said, ‘Better to remain silent and be thought a fool than to speak out and remove all doubt.'” Then Kate provides a delightful smile. She notices a hint of a smile come to Mr. Nelson’s face. She then says, “I will be ready to move this discussion forward within a week, Sir.” She then looks into Mr. Nelson’s eyes and says gently, “Please give me a little time.” 
The anger that Mr. Nelson is experiencing has, in a sense, placed him on a train barreling in one direction, toward punishing Kate for what has occurred. When Kate presents the Lincoln quote and uses it to provide her an opportunity to provide a pleasant smile, it begins to slow the train down, then brings it to a halt, and then gives Mr. Nelson an opportunity to get off. Once off the anger train, he has an opportunity to look around at some other paths he could take besides the path the train had been taking him. Said another way, in contrast to being close minded, he becomes more open minded.
At the time this example took place, Kennedy was a young senator running for president. It had recently become clear that he was rising in the polls, and the outcome was beginning to look more and more favorable for him. Senator Kennedy, to promote his candidacy, decided to invite leading opinion writers from the press to discuss the issues of the day.
Then a huge smile spreads across Senator Kennedy’s face, and all of those present break out laughing, including Fred.
Much better is to make the joke teller the butt of the joke. Second, there are times when humor might be in the form of satire that counters the other party’s position. When this is done, it’s a great idea to say some kind things about the person who holds the other party’s position.
For example, Lincoln got a tremendous laugh from the audience when, during the famous Lincoln-Douglas Debates, he said that Judge Douglas’s arguments were “as thin as the homeopathic soup that was made by boiling the shadow of a pigeon that had starved to death.” At another point, after Judge Douglas made the case that slavery wasn’t all that bad, Lincoln cracked up the audience when he replied, “Whenever I hear anyone arguing for slavery, I feel a strong impulse to see it tried on him personally.”
From time to time, I like to enrich some ideas that I introduced in earlier posts with some relevant thoughts that Bob Dylan has shared on his 
Are the drugs used to treat ADHD as safe and effective as the pharmaceutical industry claim? Are many of the students now classified as having ADHD really more aptly construed as having an “attention priority difference?” Are many of those who are classified really just the youngest students in their class? Are there safer ways than drugs to deal with the challenges that are associated with the behavior patterns that lead to an ADHD classification? These are some of the questions that I addressed in my earlier posts. Let’s see what Bob has to say about this.
What a day for a daydream
“Back when I was going to school you would see kids daydreaming and sometimes not paying attention, running around or acting impulsively. I always thought that was being a kid. Nowadays, everybody’s got Attention Deficit/Hyperactivity disorder–ADHD. They say it’s hyperactivity, impulsivity, and all sorts of other things. I’m sure there are kids with real problems. But quite often people just didn’t want to pay attention. I see parents not wanting to spend time with their kids, and for them, not paying attention or being bored or acting impulsively is the kid’s problem. I don’t think so. Spend time with your kids. You might find that they don’t have ADHD, they have other needs, a need to see their parents. I’ll tell ya something, I didn’t pay a lot of attention, and I was known to daydream in class and things turned out pretty good for me. I’ll be the first to agree with you that sometime medication is necessary. But maybe we are too often in a hurry to treat things chemically and not look at what the real problem is. Sometimes there is not even a problem there, at least one that couldn’t be solved with a little bit of patience, attention, care, and love.
Mr. Kramer is a professional photographer, who got a sweet deal when he was hired to follow Bob around for a little over a year to take pictures of him at home, going around different places, and before and during performances. Here’s a little of what he observed.
“he would grab at moments that were available, often writing in a small black looseleaf notebook, in which he probably wrote new material or kept ideas. He would interrupt something in order to glimpse a TV screen to see another performer. I’ve seen him use ten minutes working out melodies on a backstage piano while someone was out locating the key to his dressing room.” (p. 36)
“No matter how scatter-brained the type of a man’s successive fields of consciousness may be, if he really cares for a subject, he will return to it incessantly from his incessant wanderings, and first and last do more with it, and get more results from it, than another person whose attention may be more continuous during a given interval, but whose passion for the subject is of a more languid and less permanent sort.
In typical American classrooms, a subject is brought up by teachers at a given time and for a specific period of time. Those in the class who have the ability to switch their attention to what the teacher brings up at a given time and then stay focussed throughout the scheduled time, are often more highly valued by teachers then those students who are less skilled at this. Teachers often refer to the Special Education Department those children who are not following along in lockstep with their schedule and they urge parents to take these children to doctors to get prescriptions for drugs. Like Bob, I’m not comfortable with this.
“
Trying to get the kids off your hands by sticking them in front of a TV or computer game terminal may be a pretty enticing thing to do. If that doesn’t work, it is oh, so easy to just give them some pills.
When I say, “take the responsibility” I don’t mean to imply that parents should blame themselves. Blame suggests that parents should seek to punish themselves whenever their approach at discipline doesn’t work well. Punishing themselves in such situations only makes a challenging situation worse.
What I mean by taking responsibility is that we recognize within ourselves that we are dissatisfied with where things are at. We observe in a nonjudgmental manner how this goes along with some physical sensations in our body–perhaps a tightening in our chest, and tension around the forehead. Perhaps we might observe ourselves making some nasty comments about ourselves because of old habits. Although we observe these nasty comments, we don’t accept them as correct, just habitual statements learned oh, so many years ago. But as we observe all of this, from time to time we consider the attitude that these sensations that we are experiencing have the potential of spurring us to make some improvement in our own actions.
I never heard back from Richard, and so I put the gay issue aside believing it wasn’t necessary to take it on directly because it is only a small minority who could relate to this. According to a 2015 Gallop poll, less than 4 percent of the adult population identify themselves as gay. It seemed to me that my blog posts should focus on issues with which the vast majority of people could identify. Moreover, the many suggestions that I do provide in my posts to deal with insults in a general way could easily be applied by someone who is called gay in a disrespectful manner.
I responded with an email directly to the writer of this email, offering some suggestions. Then, after a little more thought, I decided that the issues raised earlier by Richard from Colorado and the writer of the email I recently received actually do impact a majority of people. Moreover, even if it didn’t, taking a little time to directly address a concern that a minority are dealing with is a decent thing to do. And so, in this light, I offer the following meditation on this topic.
A pianist, Liberace, played a pretty impressive number, and then, as he was being interviewed by the show’s host, my mom turned to me and said, “He’s a faygala, but I like him anyway.”
The fact that my mom still liked Liberace despite his being gay was not all that unusual. With his unique blend of piano prowess and over-the-top showmanship, Liberace was one of the most loved performers of the 20th century. For several years he had his own TV show, with an estimated 35 million mostly female viewers. He sold millions of records and was one of the highest paid performers in Las Vegas.
I happened to be talking to a friend of mine that we’ll call for today Nick. As we discussed some stuff, at one point he told me that a guy who was a mutual friend of ours was insulted by someone. As soon as I heard about it, I immediately called the insulter “a dirty faggot.”
“Hmmm,” I said. And then, after giving this some thought, I replied, “I see what you mean. I’ll try to stop using those types of words. It’s an old habit, so if you catch me slipping up some time, feel free to call me on it.”
If you hear someone using terms for gay people in an insulting manner, consider having a similar conversation that Nick had with me. Perhaps it might motivate you to do so if you keep in mind that someday you might find out that your own child might turn out to be gay, and if you had remained silent all those years before you became aware of this, how would you end up feeling?
In my earlier blog posts, I also reviewed research studies that indicate that almost immediately after taking these types of drugs, many children will complete more academic work and get more of the items correct. Parents also tend to report behavioral improvements. But these effects begin to wane. According to the best available evidence, by a little over a year, any perceived improvement, when objectively measured, had completely disappeared. The available studies indicate no lasting benefits for those who use them in terms of academic achievement, social outcomes, and high school graduation rates. In the end, thousands of dollars have been spent and the drug treated children, having suffered the various side-effects and been subjected to serious risks are no better off than children who had similar behavior challenges but did not take any of the ADHD drugs.
“Researchers in Taiwan looked at data from 378,881 children ages 4 to 17 and found that students born in August, the cut-off month for school entry in that country, were more likely to be given diagnoses of A.D.H.D. than students born in September. The children born in September would have missed the previous year’s cut-off date for school entry, and thus had nearly a full extra year to mature before entering school.”
On March 13, 2016, 
In my opinion, I did not have a medical illness. Out on the streets of Brooklyn, I was as healthy as a horse as I got into handball, basketball, and stickball games for hours and hours during my free time. Nevertheless, I am certain that if my parents had taken me to a doctor in this modern world of ours, I very likely would have been given an ADHD label and placed on one of the ADHD drugs.
“I love the old days. You know what they used to do to guys like that when they were in a place like this? They would be carried out in a stretcher, folks. I’d like to punch him in the face. I tell you.”
“All right, get him out, try not to hurt him. If you do, I’ll defend you in court. Don’t worry about it.”
After an incident of this kind, Mr. Trump, when questioned about it by a reporter, stated, “This guy started screaming by himself, and, I don’t know, roughed up, he should have, maybe he should have been roughed up because it was absolutely disgusting what he was doing.” Then he said, “Violence would help to deter protesters.”
In perhaps the most disturbing example that I have seen, Mr. Trump is seen defending a guy who sucker punched an interrupter who was being escorted out of an arena. Thus, when Mr. Trump was asked about this incident by a reporter, he answered, “He obviously loves this country, and maybe he doesn’t like seeing what’s happening to the country.”
But then he says things like, “In the good old days this doesn’t happen because they used to treat them very, very rough. And when they protested once, you know, they would not do it again so easily.”
On this blog, when we discuss conflicts we 
When we use the DIG Conflict Model to describe a conflict, we try to get the perspective of not just one side of the conflict, but from both sides. Unfortunately I have not personally met any of the interrupters, nor have I seen any interviews with them. 
So, hazarding a guess, perhaps it typically involves one or more of the following three desires: the desire to discourage people from voting for Mr. Trump, the desire to express their anger at Mr. Trump for stirring up hatred toward groups of people they care about, or the desire to get attention.
There are fair opportunities for demonstrators from the full spectrum of opinions to put forth their views as people file into the site of the rally and when people leave. As long as this is done peacefully and without interfering with the flow of people into and out of the site, this seems consistent with principles of free speech, which is something I personally treasure. 
Moreover, once law officers arrive, any effort that you make to avoid the law officers’ arrest will lead to the far more serious charge of resisting arrest. So, those are your options–either you now come peacefully with us as we usher you out of here, or deal with law enforcement. We recommend coming with us. Let’s go.” Then the security officials firmly, but not violently, lead the interrupter away.
The effective use of the technique I just described works best when the disrupter is in a state that he or she can think somewhat reasonably. Mr. Trump’s baiting the disrupter while the process is going on increases the probability of igniting rage within the interrupter, and the probability of violence goes up. Even well trained security personnel can become injured dealing with this, and the whole process can take far more time to resolve.
Ohio, a furious man jumped a barrier and rushed the stage. No one was hurt, but Mr. Trump was obviously shaken up from the incident, sweating profusely. Since then, he has been more vocal about not supporting violence. I hope he has learned to let security and law enforcement do their job without interfering by wildly throwing out taunts.
This blog seeks to empower its readers, many of whom are directly involved in the mental health arena or will become so in the future. Others are, or will become, involved indirectly because of someone they care about. Thus, it makes sense to spend some time learning how to effectively engage with mental health service providers.
One way to achieve this is to be aware of some of the arena’s major ethical challenges. Today, we will focus on four involving psychiatric diagnoses.
The American Psychiatric Association provides a definition of a “mental disorder” in its most recent version of the Diagnosis and Statistical Manual of Mental Disorders (DSM-5). Let’s take a look at it:
Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. (p.20) 
Notice how broad this definition is. It makes mention of a “disturbance” that reflects a “mental dysfunction in the individual.” We all run into some disturbances in our life. How can a professional reliably tell if the disturbance is due to a “mental dysfunction?” We are left in the dark about this. The process described in the DSM-5 for assessing the subjective notions of “clinical significance,” “disturbance” and “dysfunction in the individual” provides clinicians an opportunity to include anything that benefits their set of values.
If the social deviance or conflict results from a “dysfunction in the individual,” then a mental disorder exists in the individual. Once again we are left in the dark about how this distinction is made. It is left to the subjective judgment of the clinician.
An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.
Although he survives, he suffers the loss of a leg and an arm. Moreover, in the attack, two of his closest team members had burned to death in front of his eyes. This soldier seeks psychological help. He tells his story with tears running down his face and his one hand that he has left is shaking. He reports having nightmares and difficulty functioning in social situations. The clinician is well aware that such stressful experiences are fairly common under the set of circumstances faced by this soldier. And yet can anyone imagine the clinician denying services to this soldier because his response to the stressor is expected and culturally approved? If the clinician does agree to provide services, he or she would have to provide some mental disorder “diagnosis” on an intake form.
In my view, clinicians routinely ignore the “expected or socially approved” clause. It might have sounded like a good idea to insert into the mental disorder definition for those who developed the DSM-5, but I think few people genuinely believe that in practice clinicians are turning away paying customers when someone seeks help after having experienced the death of a loved one, or any other common stressor. To see such clients, clinicians are required in most mental health settings to assign a mental disorder “diagnosis.”
Most clinicians have a financial interest in deciding whether or not those seeking their services have a “clinically significant” condition. When they judge that their clients’ conditions are indeed significant, they indicate this on the third party intake forms by assigning a mental disorder “diagnosis” and this allows them to continue to see these clients and to get paid for additional visits.
Clinicians refer to mental health service users with “mental illness” and “mental disorder” terminology. These are the same terms that many people use as insults and the media regularly pairs with the most heinous crimes. The stigma associated with such terminology is well recognized. There would be some justifiable reasons to continue to use such terminology if it provided scientific precision to those who wish to communicate about those utilizing mental health services, but as we have seen, this is not the case.
The current psychiatric diagnoses approach focuses on the “dysfunctions” of individuals accessing mental health services rather than human strengths within a cultural context. Moreover, it seeks to legitimize the privileging of the “expert” who supposedly has access to the truth and who can see the truth of the truth. We see this reflected in the mental health arena when we find that it is the clinician that makes the so-called “diagnosis.” The expert is thus seen as always equipped with technical knowledge and jargons without which the truth of knowing would be imponderable. This perspective can paralyze the power of choices for mental health service users.
Although the CSM has not yet been fully developed, becoming familiar with its basic ideas are empowering. Combining these ideas with knowledge about the three psychiatric diagnoses ethical challenges–conflicts of interest, stigma, and violating the respect of mental health service users–can assist people to become far more effective in interacting with mental health service providers.
The idea that certain actions that violate societal norms are mental illnesses like any other illnesses is attractive to many people because they believe it helps to reduce this guilt and shame. To understand this a little better, let’s take a look at a quick parable:
Rachel, the mother of five-year old Jonathan, recently went through a very sad divorce. Now, at Jonathan’s parent-teacher conference, his Kindergarten teacher expresses some serious concerns. “Your son is very hyperactive and he has a great deal of difficulty paying attention. Have you considered taking him to a doctor? He may have ADHD.”
“There is no need to blame yourself,” the doctor explains. “ADHD isn’t caused by bad mothering. It is an illness very much like diabetes. Just like insulin is a drug that treats diabetes, the drug I’m prescribing for your son’s ADHD will treat his medical condition.”
But when she tells her father what the doctor has said, he grumbles and says that the doctor is full of crap. “Jonathan is angry and upset because of the divorce and not having his father with him any more. Anyone can see that!”
“You did your best, Rachel. I think it makes sense that you take some responsibility for what has happened, but blaming yourself isn’t being fair, nor is it helpful. When people blame themselves a lot of the time they think they deserve some type of punishment. In my opinion, a better way to take responsibility for what went wrong is to accept the strong emotional experiences that go along with taking responsibility, accept that you played at least a part in what went wrong, and then set yourself on becoming determined to take steps to improve. The genuine sad, heartfelt feelings that come with taking responsibility leads us to do a search for making improvements.”
In the above parable, a doctor tries to reduce the shame and guilt that a mother is feeling about her son’s behavior by framing the behavior as an illness. Although this initially appears to help, she runs into some people who refuse to go along with this anti-shame/mental illness notion. Let’s explore this notion a little more thoroughly with the help of some of the writings of psychologist and philosopher, William James.
In an 
To suggest personal will and effort to one “all sicklied o’er” with the sense of weakness, of helpless failure, and of fear, is to suggest the most horrible of things to him. What he craves is to be consoled in his very impotence, to feel the Powers of the Universe recognize and secure him, all passive and failing as he is.
From my discussions with people in Alcoholic Anonymous, it seems to me that many of its members found themselves in a state similar to what James describes in his letter. The program seems to provide them a way to stop blaming themselves by using the “I have a real sickness” idea. It also offers a sense that they could put themselves in the hands of a higher power, while, at the same time, they receive a great deal of support from peers who have managed to recover.
It is in no other way that we overcome balkiness in a horse: we divert his attention, do something to his nose or ear, lead him around in a circle, and thus get him over a place where flogging would only have made him more invincible.
By apperceiving the case as neural pathology, what does James hope to gain? He does not explicitly say. The technique that he describes of dropping the subject, diverting the mind, then springing it on the pupil later, is stated plainly enough so that many individuals can employ it without first apperceiving the case as neural pathology. I have done so, myself, on numerous occasions.