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.
Now, many mental health professionals and service users are fine with this labelling requirement, and for those who are, I’m not seeking to do anything to interfere with them going about this practice to their hearts content. But there are many other mental health professionals who would much prefer to treat each person seeking their services as an individual, and one of the last things they desire is to label people with a “so called” diagnosis well known to be stigmatizing. At the same time, many who seek mental health services, when hearing about the requirement that they be labelled as having a mental illness, object to this, and discover that despite having paid their insurance premiums that cover such services for decades, cannot access these services without accepting this stipulation.
Last year, the American Psychological Association Convention was held in Toronto, and I was invited to present a paper on a proposal that would solve this problem for mental health professionals and those seeking services. I was invited back again this year to speak on this topic for this year’s APA Convention, which was held in Denver last week. A couple of months ago, I provided a summary of what I was planning to say. I now provide to you the full text of my entire speech.
My 2016 APA Speech
As most of you surely know, the DSM and ICD are pretty much the same approach for classifying people who seek mental health services. Mental disorder is the overarching theoretical construct for both, and both share the same coding system used by third party payers. Supporters of the DSM and ICD approach say that it is a classification system that has been helpful because it provides a common language for mental health professionals to communicate about those utilizing their services; its various diagnostic terms, such as Major Depressive Disorder, Anxiety Disorder, etc., are short phrases that are convenient for placing them into search engines to retrieve valued relevant information, and into titles of book and articles; third party payers of mental health services have found that the DSM-ICD coding system works well as part of a practical method for their record keeping; with the aid of these codes, people do manage to access mental health services, mental health service providers do manage to get paid, and for-profit health companies do tend to make a profit.
So, those are the basic reasons supporters of this approach say that it is useful.
Now, it seems to me that if we are to have any hope that an alternative to this approach might be widely adopted, we would have to be able to make an excellent case that the alternative would be at least just as helpful while, at the same time, have significantly less shortcomings.
So, is it really possible to come up with such an alternative? Well, for your consideration, I offer you the Classification and Statistical Manual of Mental Health Concerns, or, for short, the CSM. Not the DSM, but the CSM! Let’s look at what each chapter of the CSM would contain.
Chapter 1: The CSM Basics
This first chapter would begin with the following statement: “The developers of the CSM fully recognize that persons seeking mental health services have far more expertise about what is going on in their lives than any mental health service provider. Moreover, the developers of the CSM fully recognize that individuality outruns any classification system. It is for this reason that the CSM does not seek to classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider.”
This first chapter would go on from here to explain that the CSM begins from the perspective of the person seeking services. Because the expression of a mental health concern is a clearly observable event that occurs at a specific time and place, by making it the event being classified in the CSM it solves the reliability problems that have been plaguing the DSM and ICD approach’s far more abstract theoretical construct of “mental disorders.”
After this statement, the CSM would clearly define its main construct, which is mental health concerns:
A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, addictions, meaning of life, death, dying, managing chronic pain, work, interpersonal relationships, intrapersonal relationships, education, eating, cognition, sleep, and challenging life situation.
So, there’s a summary of the basic ingredients of Chapter 1.
Chapter 2: Classification of Mental Health Concerns and Codes
This chapter would begin by explaining that the CSM has two classes of expressed concerns–Concerns expressed about oneself, and concerns expressed about someone else.
An example of the first class is, Sally is seeking mental health services and expresses a concern to a mental health service provider that she has been experiencing a great deal of anxiety when she enters social situations.
An example of the second class is Bob, a father, upon seeking counseling for his son, expresses a concern about his son’s behavior.
Each of these two classes of concerns would have under each of its headings a list of specific concerns, along with an assigned code to be used for third-party payer record keeping.
So, let’s quickly return to the example of Sally expressing a concern that she has been experiencing a great deal of anxiety in social situations. This would be referred to, for classification purposes, as a “social situation anxiety” concern. Notice that “social situation anxiety” is just three words, thus it is short enough to be used in titles and search engines.
Concerns that would be included in the first edition of the CSM would be selected from survey data. For example, mental health service providers would be asked to list the various concerns that they have been asked to address in their practice in the past year without couching them in psychopathological language and to stick as closely as possible to the language used by those seeking their services.
Chapter 3: The CSM Approach to Psychological Formulation
As noted, the previous chapter would be designed to provide the method for identifying and coding a set of brief mental health concern descriptors suitable for a number of practical purposes. Once this is achieved the CSM then provides a method to develop a two or three paragraph psychological formulation approach that is designed to fill in additional details about the expressed concern.
Thus, Chapter 3 of the CSM would be devoted to describing good practice guidelines for the use of a type of psychological formulation that is consistent with the CSM’s philosophy of not psychopathologizing individuals.
Defending the CSM
Okay, those are the basic chapters of the CSM. I contend that it would achieve all of the benefits that the supporters of the DSM-ICD approach claim for it. It would provide a common language. And, in fact, I actually tested the CSM approach for years. When I worked in a mental health center, although I capitulated to the requirement that I inserted a DSM diagnosis in its proper place on the insurance form, other than that, I had no need to use DSM terms to communicate. When a colleague would ask me to tell him or her about my cases, I would reply with words like, “My 9:00 a.m. case is concerned about feeling depressed, my 10:00 case is concerned about his failing grades, my 11:00 case is concerned about how anxious she is in social situations. If a colleague wanted to know more about a case, we went into the psychological formulation type of information. I found that communication flowed easily and my colleagues readily understood me.
So, I contend that the CSM would provide an easy to learn, non-pretentious, dogma free, common language. Additionally, it would provide a practical approach for third party payers’ record keeping. Let me explain clearly how easy and simple this could work.
Third party payer systems have a form that must be filled out whenever someone seeks mental health services under their plan. This form has a little box that currently typically says, “Diagnosis.” In that box, mental health professionals are required to fill in the DSM or ICD code that corresponds to their so-called diagnosis of the person seeking services.
With the CSM proposal, all that we would be asking third-party payer institutions to do differently in order to add value for their customers, is to slightly change that little box. Instead of just saying “Diagnosis” as it currently says, that box would end up saying, “Diagnosis or Concern.” Then, when mental health professionals fill in the box, they would be given the choice to either write in the letter “D,” thus indicating a diagnosis code will be entered into the box, or they would write the letter “C” thus indicating a concern code will be entered into the box. Once the letter “D” or “C” is written into the box, the appropriate code number would be entered.
With the creation of the CSM, not only will mental health providers have a new option to choose from, but so too will people seeking mental health services. They would be given the choice to go to psychopathologizing mental health service providers or to those using the CSM approach.
So, we would of course have to convince third party payers to make just this small change on their insurance form in order to increase value for a significant number of mental health providers and service users. The rest of their form would remain exactly the same.
In making the case to insurance companies, and others as well, that this choice would be beneficial, we could point to a March, 2008 research article titled, “The Effects of Choice on Intrinsic Motivation and Related Outcomes: A Meta-analysis of Research Findings.” Published in Psychological Bulletin, here we find that 41 studies were examined for the effect of choice on a variety of outcomes in a variety of settings. Results indicate that providing choice enhances intrinsic motivation, effort, task performance, and perceived competence, among other positive outcomes. There are a few studies out there that suggest that if you provide an enormous amount of bewildering options to a targeted population, the typical positive effects begin to diminish, but keep in mind that the CSM proposes just one additional option for mental health professionals and service users.
Here’s another benefit of the CSM approach in contrast to the DSM-ICD approach. The DSM-ICD approach, by using the “mental disorder” construct, simplistically devalues all of the experiences it refers to as mental disorders, providing a cognitive set that they are “bad” experiences. It does so despite the fact that there are a great number of people who have testified that having gone through these very types of experiences it brought forth valued fruits. With the CSM approach, we instead begin by addressing someone’s “concern.” Thus, there is no automatic need to assume that the experience that led to the concern is necessarily bad. Together with the mental health service provider, service users may come to understand that these experiences are part of a useful process; they may be a different than an average process with strengths and weaknesses. Though perhaps not bad, there may be a better approach to be discovered, etc. The DSM-ICD approach that pathologizes these types of experiences tend to close people to such possibilities. The CSM approach opens up these possibilities.
Conclusion
Now my time is almost up, so in closing, I’ll leave you with this; The CSM can do everything that the DSM-ICD approach can do with regards to providing a common language for mental health professionals to communicate about those utilizing their services, providing short phrases convenient for placing into search engines and titles, and providing a practical method for third party payer record keeping. Additionally, when compared to the DSM and ICD approach, the CSM approach would be less stigmatizing, as well as more scientific, person-centered, culturally sensitive and recovery-oriented. Therefore, it is my sincere hope that in the name of justice, we psychologist can fire-up the will to break out of the monopolistic DSM-ICD approach. I’m hoping we can fire up the will to make a real change by having us psychologists roll up our sleeves and then getting down to do the necessary work simply because we believe this is in the best interest of those we seek to help.
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 and social intelligence. To begin at the very first post you can click HERE.
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?
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:
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.
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.
William James, in his book, Pragmatism, tells us the following story. 
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)
“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 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.
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.
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 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 
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.
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.
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.
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.”