Welcome to From Insults To Respect. Today’s post takes a close look at an exchange that Senator Martha McSally of Arizona had with CNN Reporter Manu Raju while he attempted to ask her a question in a Capitol Hill hallway.
The exchange went like this:
RAJU: Senator McSally, should the Senate consider new evidence as part of the impeachment trial?McSALLY: You’re a liberal hack. I’m not talking to you.RAJU: You’re not going to comment, Senator?McSALLY: You’re a liberal hack, buddy.
A little background on the Senator might be helpful. She was not elected to her position. She lost to Kyrsten Sinema and was then appointed to fill the seat vacated by Senator Jon Kyl. Currently she is in a very competitive race against Mark Kelly, hoping to be elected as Senator this coming November.
There’s been talk that McSally staged the episode to excite the Republican base. And indeed, Republicans are already using it to raise money for her reelection campaign, in which McSally is very vulnerable.”
Supporting this notion that the incident was staged is that McSally quickly posted the video. Fox News host Sean Hannity instantly began to praise her conduct, and she got additional publicity by appearing on Laura Ingraham’s Fox News show. Meanwhile, President Trump’s 2020 campaign tweeted out “THREE CHEERS” for the senator while directing followers to donate to her campaign. To me, this appears to be a bit too choreographed to have come out of an unplanned emotional outburst.
That said, I hasten to say, I did not choose this incident in order to attack a Republican candidate. Instead, I chose it because just as I was about to write today’s post the McSally incident happened to go viral. The incident, therefore, is particularly fresh in the minds of readers and of high interest, so that it serves as a useful jumping off point to address issues relevant to this blog. Before going on, in an effort to be fair, I point out that I personally have seen both Democrats and Republicans throw insults at news outlets that tend to be biased toward their opposing political party.
Why Did The Incident Go Viral?
Although it is not unusual for both Democrats and Republicans to insult news outlets when it publishes a specific negative story about their representatives, this McSally incident is nevertheless unusual for the following reason. We don’t typically see a senator, upon being asked a reasonable question by a reporter, responding disrespectfully, quickly post it on line, and then have the president cheer the insulter.
Senator McNally received a great deal of free press coverage, so should this become the new norm? Is this really how Americans want to see their elected officials respond to reporters? And do we really want our kids learning to insult everyone they disagree with by observing our national leaders acting this way? I suggest that the anxiety provoked by these questions are at the heart of why the McSally incident went viral.
A Paradox
On the one hand, there is a considerable amount of evidence that people who are very insulting tend to be less liked and respected. On the other hand, many politicians can be very insulting toward people with whom they disagree, and despite this, they win elections and many people idolize them.
Explaining the Paradox
First of all, the negative effects of being insulting is strongest in interpersonal relationships. As I define these terms, your interpersonal relationships are your interactions with people with whom you have direct, face to face interactions on an ongoing basis.
The relationship that politicians have with voters is best viewed as an intergroup relationship. The intergroup relationship I’m discussing today regarding McSally involves the group of people who might potentially vote for her, the groups of people who have a vested interest in getting her elected, and the groups of people who are working to get someone else elected. Although insulting people is relevant to intergroup relationships, other issues often become more important.
In an interpersonal relationship, if you attempt to insult the person with whom you are personally interacting, that person might insult you back and the interaction can escalate into violence. In fact, the most common reason people turn to violence is because they felt someone treated them disrespectfully.
When we see politicians seeking to insult someone, they are modeling for others this type of violence producing behavior. But what makes this type of behavior very different for politicians is that they almost always have a group of supporters standing by them and a team of armed security personnel well trained to intervene if an insulted party makes any moves at all that can be viewed as violent. Under this set of circumstances, it is far safer to play the part of a tough person who doesn’t take any crap. Meanwhile, as politicians model this behavior for people without the protections afforded to politicians, it can potentially increase levels of violence for non-politicians.
Here’s another difference between what typically happens during your interpersonal relationships and the intergroup interactions that involve politicians. When someone directly seeks to insult you, unless you are well trained in handling this in a peaceful manner, you are likely to take the insult personally. The emotions that arise in this situation are more likely to be stronger than typically experienced when groups of people see on TV or in a large arena a politician throwing insults at someone they don’t personally know.
Politicians, moreover, are not seeking to develop a sound interpersonal relationship with you. They are, instead, seeking your vote. They know very well that not everyone is going to vote for them. If they anger the voters who aren’t likely to vote for them anyway, and end up getting 51 percent of the vote, this, to them, is success.
Now, when it comes to interpersonal relationships, if you act in a manner that leads to even a minority not liking you, this can lead to far more direct problems for you than if a minority of people don’t vote for some politician. If those who personally know you don’t like you, they can begin to say things behind your back to people who actually personally interact with you. Some of what gets said can be untrue and very unfair, but you may never hear about this. This behind your back treatment may result in people that you like no longer inviting you to parties. When you used to be invited to go bowling, now someone else is getting invited. In a work setting, you may be passed up for promotion. These types of consequences can have direct effects on your personal life. For politicians, the personal effects that may occur if they anger a minority of people who would have been unlikely to vote for them, would be far less important to them than getting elected.
Also, note that when people decide on who to vote for, they consider many issues, not just whether or not the candidate insults anyone. When politicians insult someone, many voters are apt to say to themselves, they aren’t doing anything much different than all the other politicians. These voters then choose a candidate based on other issues. If some voters recognize that a particular politician insults others more than other candidates, they may feel that his or her stand on immigration is a far more important issue.
Others will actually like the insulting because the insults are aimed not at them, but at people whom they have come to dislike. If you have become angry because you like to use the “N-word” and people have criticized you about it, you may have become angry about what str
ikes you as political correctness.
Other voters are very angry at the lack of progress being made by current career politicians on solving immigration, economic, and other problems. Many of these voters’ own personal style for dealing with this anger is to throw insults at these politicians. When politicians do the same thing, these voters see them as one of them. These same individuals are apparently unable to see that if these politicians were throwing the same types of insults at them, they would not like this. To them, it’s perfectly okay to insult people they have come to dislike. If they are personally insulted, however, then they would view it as wrong. It seems to me that because it is wrong for people to insult them when someone disagrees with them, it is equally wrong for them to insult others when they disagree with others.
Many like to characterize politicians that use insults as their way of being a tough no-nonsense kind of person. But in my view a person can surely be a tough no-nonsense kind of person without seeking to insult people.
When politicians are asked why they use insults, they at times say that those whom they insult, insulted them first. But those who insulted them often say they did it because others insulted either them, or someone they personally know. And so many who are either leaders of our nation, or hope to be so, are choosing to engage in this “You Started it First” name-calling game.
It is simply not true that if someone throws an insult at you the only intelligent way to respond is to seek to insult them back. In my view, within the political arena, one way to respond in a manner that I would respect is to state firmly, “I’m not here to get into this name-calling game. I’m here to let the public know what my positions are on the problems of this nation, and how I, if elected, plan to go about fixing them.”
I hope this post will help you to think twice if you have begun to think that the type of insulting behavior that appears to be helping to get attention from politicians would be just as effective in your own interpersonal relationships.
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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.
“Blowin’ In The Wind.” “With God On Our Side.” “Masters Of War.” These are songs Bob Dylan has written and performed expressing deep emotions about the wisdom of going to war. As I began to reflect on these songs, to my mind came the pounding of war drums, the cries of vicious insults emanating from a deadly divide, images of fear, pride, disgrace, bombs exploding, and thousands screaming in horror.
And then I found myself pulling up on the internet Bob Dylan’s Theme Time Radio Hour show, and clicking to hear his specific show on the theme of war. It’s available for free 
The show begins with a series of brief audio clips of the sounds of a country at war–bombs going off as Marine helicopters are approaching a battle field, a news reporter describing the scene of burning tanks, the voice of President Lyndon Johnson committing an additional 20,000 troops to Viet Nam as that war was escalating, etc. Then we hear Bob introducing the show’s theme:
Plato once said, “Only the dead has seen the end of war,” and sadly it is as true today as it was then. 
Today we are going to examine battles and beaches, skirmishes and embroglios, we are going to let loose the dogs of war, pay tribute to Mars in Aries, shed a tear for the widows and orphans. We’re mustering cadets, for Theme Time Radio Hour is going to war!
Why I crossed three thousand miles of rolling waves.
When I was a young man I carried me pack 
When the ship pulled away from the quay 
Some say war is a game that men play using boys as the tools. Truth to tell, you don’t see many men in battle, but you see a lot of boys. Wars used to be fought by men and I think that fairer. Men are the ones waging the war, they ought go out and fight it. 
I’m just a poor ex-soldier that’s broken down and blue,
One staple of songs about war is the letter. Sometimes it’s the letter that the guy writes from the battlefield. Other times it’s from home. But the worse kind of letter of all to receive was one written by a military chaplain. It usually had a line in it, something like, “You would be delighted to know that your son died a hero.” It’s a nice sentiment, but I doubt it was really any solace. 
I close my eyes every night
Is don’t they pray
Peace to the world
An American flag waving in the breeze along with stirring patriotic music; this can be a fitting end to a Hollywood movie, but before we go marching once again into war, there is far more to consider.
I hope all of you are having a fine holiday season. This, of course, is the time of year when the longing for peace on Earth and good will to all is beautifully expressed in songs and stories.
For example, during the American Civil War, Henry Wadsworth Longfellow wrote a poem titled “Christmas Bells,” that was later made into a song renamed “I Heard the Bells on Christmas Day.” It begins with pleasant aspects of the season, but then the reality of the war sets in:
In the earliest period that humans thrived, they were chiefly hunters and gatherers. At that time, it has been estimated that death came as a result of one person killing another about twenty percent of the time. Evidence for this was obtained by looking at the skeletons from that period. Quite often we find fractured skulls and arrowheads embedded in chest cavities.
Another dramatic decrease occurred around the Age of Reason and the European Enlightenment in the 17th and 18th centuries. The invention of the printing press had made pamphlets and books far more readily available, spreading humanistic values throughout the human population. That era saw the first organized movements to abolish slavery, dueling, judicial torture, superstitious killings, sadistic punishment, and cruelty to animals.
Actually, we find that the vast majority of Muslims who are living under similar sets of conditions as other religious groups in the developed countries are in no way more violent, nor are they more likely to violate what are now viewed by most as basic human rights. Also relevant to this question is the fact that people from religious groups other than Muslims, when raised under the conditions similar to the violent Muslim areas, are every bit as violent as groups like ISIS. Consider the murder rate in communities like South Chicago.
Today, the major parts of the world that are most violent prone are at the same psychological developmental level as the largely Christian southern states were just about when the American Civil War began. Let us compare, for example, the highly violent group known as ISIS with that bloody period of American history. The confederate southern states had, like ISIS has today, an ideology that slavery was essential to their way of life, and outsiders (the northern states) were actively interfering with what they believed is right. Moreover, the confederate states used quotations from their holy book to defend their beliefs and to justify going to war to protect their ideology in a way that is similar to how ISIS utilizes sections of their holy book.
After abolishing slavery, England continued for about a hundred years to use violent force to maintain its hold on colonial labor, but Mahatma Gandhi effectively used nonviolent resistance to put an end to colonial rule. Soon afterwards, colonialism began to end elsewhere.
There are some credible reasons for supporters of the most violent regions of the Earth to feel that there has been an ongoing effort to force them to do whatever is in the interest of the US and its allies. Years before the creation of ISIS, for example, meddling in Middle East affairs occurred by the US’s CIA. Then came the US invasion of the largely Muslim inhabited Afghanistan and Iraq countries.
With regards to responding to regions that continue to enslave people, the US would use nonviolent approaches such as boycotting any goods or services that might fund the violent group’s operations, along with boycotting any country or enterprise that does business with such violent groups, while offering a vision for engaging in peaceful commerce as described in step 4.
Therefore, the US would launch an all out peaceful advocacy effort to have the United Nations offer to fund a constitutional convention for all of the stakeholders in the regions where violent groups are operating. Those violent groups’ representatives would be invited to be central players, and incentives to participate would be provided. UN Peace Keepers would be employed throughout the convention period to help decrease the likelihood that some would seek to violently sabotage such efforts.
Professor Steven Pinker provides evidence in his book, 
And in fact, many believe that it is this set of challenges that is the main cause of the region’s violence problems. In mid-day much of these regions are often so hot it could make the Dalai Lama ignite in irritability. Large sections of these regions are as parched as the moon’s surface. But the regions do have some natural resources. For example, they tend to have plentiful sunshine. Nevertheless, they remain rather poor in contrast to the more developed countries.
Professor Pinker notes that prior to the invention of the printing press there were very few books available. Those people who lived in the upper classes rarely had much direct contact with the lower classes. A nobleman’s quick glance while passing by a downtrodden worker often merely left the impression of a filthy, smelly soul, hardly human at all. After novels became available, a nobleman might read of a poor young woman pressed into very sad circumstances by a cruel person of the upper classes, and discover tears running down his cheeks. Discovering that people all over the world, in all classes, and other religions have very similar desires, dreams, and feelings that we can all relate to, increases empathy and the desire to deal with a wider range of humanity in kind and respectful ways.
So, how would we get these kinds of stories before those who are in groups prone to violence? At the two types of conventions I mentioned above that would be funded by the United Nations (constitutional and commerce) short, readable, relatable books would be freely provided that convey these heartwarming stories. International funding for public libraries for regions too poor to provide for them on their own would be provided. Moreover, there are ways to make these types of stories particularly accessible on internet sites that violent groups tend to visit, not only in written form, but also in audio-visual forms as well. And instead of the steady dropping of bombs in regions occupied by violent groups, an international coalition could drop little parachuted packages that include a little tasty healthy treat, a little toy or stuffed animal as a gift to the children, an interesting puzzle that adults would enjoy doing, and the type of stories that I have just described.
What does this controversy look like? Well, let’s begin by looking at an 
“The effectiveness of timeouts has been proven through decades of research, including work in the field of “
And a number of smaller, focused studies have specifically tested timeout and found it to be 
Apparently, part of the controversy is due to the timeout technique being employed in different ways. Consider a parent who says she uses time out with her 5-year-old daughter. Then, when we watch her using the technique, we discover that whenever her daughter acts in any way that is annoying her, she begins to scream, shoves her into her room, while shouting, “You better shut-up you little brat!” She keeps her alone in her room for an hour.
Because she has a number of tools to teach her child to learn how to behave in effective ways, she only uses timeouts on rare occasions, lasting only 5 minutes, and targeting just one behavior during a period of a few weeks until her child has learned a new positive behavior pattern to replace the negative behavior pattern. Then, slowly, she incorporates the technique for teaching another behavior pattern. She never tells her child to stop doing the negative behavior pattern, but instead, she explains, as best that she can, what behavior pattern would be better, and explains why it would be better. 
When she sends her child to timeout, she does so in a calm, supportive voice, and remains in the same room with him. Prior to carrying out this approach, she has discussed with her child this technique, explaining that learning a new skill takes time, and timeout will help him to learn to act in a manner people will respect. She emphasizes throughout the process that she loves him, and expresses confidence that he will master the new skill soon.
So, here we see two parents believing they use timeouts with their child, but both use dramatically different approaches. I used timeouts with my two sons when they were very young in an even different way. I’ll describe this other approach shortly, but, for now, my main point in this section is that part of the controversy has to do with the fact that when people say they use timeouts, without finding out more details about how they use it, a great deal of misunderstanding can ensue.
Removing access to rewards is a type of punishment, and research on punishment indicates it leads to variable results, sometimes good, sometimes bad. Dadds and Tully appear to hope to mitigate any bad results by advocating that rather than using timeout as a stand alone strategy, its use “must be part of a broader behavior program that promotes a warm and rewarding relationship, and explicitly teaches alternative positive child behaviors to replace the problem behavior to improve the child’s self-efficacy in meeting their own needs.”
These authors, reviewing the research evidence, conclude that timeout, when used as they describe, can promote a child’s mental health and that there is an absence of evidence showing it is harmful after five decades of research. Meanwhile, inappropriate parental discipline strategies have been, and continue to be implemented in the name of “timeout,” and these are potentially harmful.
I have described my broader child rearing strategy in earlier posts (see 
As William James, the great psychologist and philosopher, described using this approach with children:
Note that in contrast to the American Psychologist article I discussed earlier, my use of this type of timeout was not intended to take away some valued reward. Rather, I would seek to do something pleasant with them. At some point, when all was calm, I would ask gently, “When you were making all that noise near Mom, had she asked you to quiet down?” I would then listen to their responses and gently ask what they could do better if a similar situation comes up in the future? When they were very young, sometimes they blamed someone other than themselves for what happened, and I would frown. Sometimes they responded in a manner that took responsibility for their actions, and I would say how much I appreciated what they had said.
As another example, when we were in a restaurant, if one of my boys began to make too much noise, I would take him outside, and explain that people who go to restaurants typically prefer to eat in a pleasantly quiet atmosphere. I would then explain that when he was ready to go back and speak softly we could enjoy a nice family meal together. Typically, in less than five minutes, we would be back at our table.
If they go to someone in the medical profession, they typically find that after a visit of somewhere between ten minutes to an hour they have been labeled as having a mental disorder and then are prescribed one of the psychiatric drugs, or even a whole cocktail of them. This pattern of dealing with such concerns leads, in some circles, to a conflict. Some involved in the conflict think that the pathologizing of these very human experiences and the encouraging of the use of drugs to manage them is the very opposite of a healthy approach. Meanwhile, other people feel that drug treatment for these types of concerns are enormously helpful, and anyone questioning this position is irresponsible. Insults have been known to fly back and forth from people on both sides of this conflict.
You can hear me, for free, being interviewed on this topic by the insightful Emily Whyte Rubin on a recently recorded Feeling Deeply podcast by clicking 
You see, when I look to see if someone has a conflict, I think of the word 
Being guilty, as I use the term, means the person would be deserving of some punishment, such as being insulted.
That’s not to say that I advocate that those people already taking these drugs should immediately stop taking them. There are some physiological withdrawal effects that occur if someone suddenly stops, which some experience as awful. If some of you who have been taking these drugs decide that you want to try to wean yourself off, a good resource to help can be accessed 
Although I don’t have a conflict with those who believe in the psychiatric medical approach, I do find that as I go about advocating for my own view on this issue, many with opposing views do end up having a conflict with me.
There are, however, other people who do support the psychiatric medical model, and yet, like me, treat people with opposing views respectfully. Today’s post comes out of one such respectful discussion. This person, without insulting me, defended his support of the psychiatric drugs by claiming that all of the research clearly indicates that the “antipsychotic” drugs, when used by people diagnosed as having schizophrenia, decrease the risk of dying. I then, very respectfully, asked that he supply me with the references that he is relying on to make his assertion, and within a very brief period, he did just that.
Prior to looking at the articles that the respectful criticizer of my position provided to defend his belief that the “antipsychotics” reduce mortality for people being treated for schizophrenia, let’s first look at some relevant research studies that he left out. You will note that each time I use the term “antipsychotics” I put it within quotation marks. This is to help remind readers that these drugs do not work like antibiotics, which are designed to kill bacteria that have infected an organism. Nor am I at all convinced that these drugs work to counter any of the causes that lead someone to be given a psychotic label.
Patients diagnosed as having schizophrenia have a 15-20 year shorter life expectancy than the general population, according to a 2014 study published in the Annual Review of Clinical Psychology titled “Excess Early Mortality in Schizophrenia.” Just in case there is any confusion of what “mortality” means, it means risk of death.
Adjusted for age and gender, people with schizophrenia taking either no “antipsychotic,” one, two and three or more antipsychotics had relative mortality risks of 1.29, 2.97, 3.21, and 6.83 respectively. Said in a simpler manner, individuals who were labelled as having schizophrenia who did not take any “antipsychotic” drugs had the least chance of dying during the 17-year follow-up period, compared to the other patients who were labeled as having schizophrenia but were taking “antipsychotics.” If the patients took just one of the “antipsychotic” drugs, they were more likely to die, and if they took more than one “antipsychotic” drug, they were even more likely to die. The association remained stable throughout the observation period.
The authors note that it has been claimed that the contemporary high natural mortality in schizophrenia results from a variety of lifestyle factors. Of these factors, the study that they did was able to consider several (smoking, exercise, body mass index, blood pressure, serum total and HDL cholesterol). After adjustment for these factors the excess mortality of people with schizophrenia persisted. The association with “antipsychotics” and mortality was, according to the authors, very clear.
Mental health services have advanced in many parts of the world during the past few decades. Apart from a different mix of community-based care, the introduction of the second-generation antipsychotic medications [also referred to as atypical antipsychotics] in the early 1990s was initially found to be associated with better quality of life and reduced risk of relapse.
During the 1970s through the 1990s, the authors note, mortality rates were improving for the general population. In contrast to this general trend, mortality of those classified as having schizophrenia was trending in the opposite direction. The median SMR for those diagnosed in the 1970s, 1980s, and 1990s were 1.84, 2.98, and 3.20, respectively. The higher the SMR, the higher the rate of mortality.
Adverse health outcomes associated with weight gain and/or metabolic syndrome (eg, myocardial infarction, cerebrovascular accidents, or cancer) may take decades to fully emerge. Thus, it seems likely that studies undertaken in the 1990s (ie, the most recent studies included in this review) would capture only a small fraction of the eventual burden of mortality associated with the adverse effect profile of the second-generation antipsychotic medications. In light of the rising secular trends in SMRs already identified by this review, the prospect of further increases in mortality risks for schizophrenia is alarming.
In 2009, another study looked at the relevant research, this one appearing in the journal Schizophrenia Research. Titled, “Influence of Antipsychotics On Mortality in Schizophrenia: Systematic Review,” it concluded, “There is some evidence that long-term exposure to antipsychotics increases mortality in schizophrenia. More rigorously designed, prospective studies are urgently needed.”
Also in 2009, there was a relevant study published in the prestigious New England Journal of Medicine. Titled, “
In 2010, the British Journal of Psychiatry published a study titled “Twenty-five Year Mortality of a Community Cohort with Schizophrenia.” Here, data from 1981 to 2006 was examined. The authors concluded that:
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.”
The first study on my critic’s list used 
Rather than supporting his position, this article supports the theory that given the evidence that the “antipsychotic” drugs have a number of serious side effects, and once started, physiological withdrawal effects can be awful, it is prudent to safely hold off on the use of these drugs for at least 13 weeks to see if some patients will begin to recover without them. Despite this evidence, I am under the impression from dialogues with many psychiatric patients that the standard practice is to prescribe these types of drugs within somewhere between 10 minutes to an hour after the patient is first brought to the attention of a prescribing doctor. 
Before moving on, I would like readers to note that this was the only randomized controlled study on my critic’s list of references that he said supports his position. The rest of the studies compared different groups of patients that were not randomly chosen to be in each of the groups. These studies compared a group of patients described as not taking “antipsychotics,” with others said to be either taking just one of them, more than one, different dosages of them, or another drug such as a benzodiazepine. Without random placement to each of the groups, these studies, from a scientific point of view, cannot speak to whether it was the prescribed drug that was the cause of the different rates of mortality, or other reasons. This is an essential point to keep in mind.
First, random assignment only increases the likelihood, but does not guarantee, that the different groups being compared will be so similar prior to any intervention that any difference found after the intervention is due solely to the different interventions each group does or does not receive. Thus, with random assignment the pre-intervention groups can end up quite different. When this happens, the researchers can end up attributing any difference between the groups after the intervention to the intervention when the difference might be due to the groups being poorly matched prior to the intervention. A second reason why random assignment studies are not perfect is, those who did the experiment may report the results incorrectly because of a mistake, subconscious biases, or monetary motivations that lead to bending the truth.
Now, I am not faulting researchers for trying to get some relevant evidence using the nonrandom assignment to groups methodology. Although random assignment to groups is considered the gold standard, carrying out long-term studies with psychiatric patients is almost impossible. Patients who are assigned to take the drugs often don’t take them, or don’t take them as prescribed, and the longer the study, the more likely this will happen. A significant number of patients wander off and can’t be found at various follow-up points. Many doctors refuse to participate in long-term studies that utilize a placebo group believing it is unethical to withhold a promising treatment for such a long period of time when they see their patients suffering; and over the decades newer, more promising interventions come along, so to continue to use the drugs that were popular at the start of the study would be considered unethical.
The most important finding from the set of nonrandom to groups studies my critic provided, from my perspective, came out of a 2009 study. There we find that patients that were on “antipsychotics” for less than 6 months had a lower rate of dying than those who were on the drug for longer periods. The authors note this in the results section of their article with a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.” This is accompanied by a graph showing this. Then, in the discussion section, the authors again mention this in a single sentence.
If you read just the abstract of the article, as many practitioners do because time reading research studies is not billable, you would find no mention of this statistically significant finding, a finding that could have life saving implications. And this finding can easily get lost in the numerous paragraphs of the study which focused instead on the evidence that those on the drugs for longer periods had a lower mortality than those who were said to be in the “no antipsychotic group.” However, the vast majority of the patients said to be in the “no antipsychotic group,” and probably all of them, actually were on these drugs at various points throughout the study. While they were hospitalized, they were almost certainly on the drugs, according to one team of researchers who had engaged in a similar study using the same data set, and many were hospitalized multiple times. What the researchers actually meant by labelling the group the “no antipsychotic group” were patients who didn’t take them each time they were released from the hospital. Thus, each time they left the hospital, they were suffering from withdrawal reactions.
There are a number of other serious problems with the design of these types of studies that was chronicled in a peer reviewed article that came out shortly after the 2009 study, including incomplete reporting of data, questionable selection of drug groups and comparisons, important unmeasured risk factors, inadequate control for potentially confounding variables, exclusion of deaths occurring during hospitalization leading to exclusion of 64% of deaths on current “antipsychotics” from the analysis, and survivorship bias due to strong and systematic differences in illness duration across the treatment groups. The writers of this critique concluded:
Thus, it is very possible that although a relatively higher percentage of patients not taking “antipsychotics” during periods when they were not in the hospital died when compared to the other patients during the five to eleven year periods that were looked at during the course of these studies, we still don’t know what would have happened if we could have looked at what age all of these patients ended up dying. The added risk factors that come with ingesting these drugs, such as weight gain and metabolic syndrome, may not exert their influence on mortality rates until a longer period of time.
This presents the theory that when compared to those patients in the other comparison groups, the group of individuals who did not take “antipsychotics” when they were not hospitalized may have had a higher percentage of members who not only avoid “antipsychotic” treatment, they also avoid all medical treatment. With this theory, it is not taking the “antipsychotics” that protects the patients from dying, but rather it is the increased likelihood that more “antipsychotic” compliant patients are more likely to comply with all medical treatment. Said another way, with this theory, we have less of a reason to conclude “antipsychotics” provide some protection from dying from these conditions; rather, it is this non-compliance to all medical treatment characteristic of some in the “no antipsychotic” treatment group that is the real cause for the statistical increased rate of death for those in this group during the relatively short window of time that these researchers were able to peek into.
In considering how dependable the evidence is from this entire set of studies, it is worthwhile to look how frequent they came up with contradictory findings. A few of the studies, for example, found a statistically significant decreased risk of suicide for those taking “antipsychotics” when compared to the so called “no antipsychotic” group, while another study that looked at the same data set found no significant difference. One study found a significant reduction in risk of dying when the patients used the “antipsychotic” clozapine, whereas another study did not find this, and found instead that clozapine was one of the drugs that appeared to slightly increase the risk of dying. A couple of studies found that even patients who took the highest doses of “antipsychotics” had a similar risk of dying when compared to a moderate dose, while another found the highest dosed patients were at an increased risk of dying. Thus, anyone making firm conclusions based on these types of studies is trying to build a house on shifting sands.
The first study that appears on his list was published in The Lancet in 2018, and titled “
These two studies were carried out by the same team of authors and applied a similar methodology using a data base from Finland. The first of these is titled, “Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of Patients in Community Care After First Hospitalisation Due to Schizophrenia and Schizoaffective Disorder: Observational Follow-up Study,” and was published in 2006 in the British Medical Journal. It looked at a nationwide cohort of 2230 consecutive adults hospitalized for the first time because of schizophrenia or schizoaffective disorder, from January 1995 to December 2001. All of the patients had been hospitalized at various points in time, and during their hospitalization, no record was kept to see if while they were there they had been placed on antipsychotics and/or other drugs. Those patients who chose not to fill their prescriptions whenever they left the hospital were said to be in the no antipsychotic group. However, it is very possible that many of the patients in this group had repeatedly gone into a hospital for various periods of time and while there were placed on an “antipsychotic,” or a cocktail of “antipsychotics” and other drugs, and each time they were discharged they went through drug induced withdrawal reactions.
Moving on to the other Finland study by this team of authors, it was published in 2009 in Lancet and titled “11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).” As I mentioned, it is very similar to the previous Finland study, but extends the follow-up period an extra few years. Both studies have very similar results. Those who are labeled as not using any “antipsychotics” but probably did use them when they were in the hospital, had relatively higher rates of death than most of the other comparison groups. However, the patients that had the lowest rate of deaths were those in the group labeled as using “antipsychotics” for less than 6 months. In the main body of the journal article the authors note this in a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.” There is a graph that illustrates this. It does repeat this again in another single sentence in the “Discussion” section of the report. Nothing else in the write-up of the report bothers to discuss this, and it can easily get lost in the numerous paragraphs defending the evidence that those on the drugs for longer periods had a lower mortality than those who were in the “no antipsychotic group” even though all of those patients in that group had probably been on such drugs each time they were hospitalized, and were only not taking them each time they were released from the hospital.
The next study on my critic’s list is titled “Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study” and was published in a 2016 edition of the American Journal of Psychiatry. The lead author is, once again, Dr. Jari Tiihonen, the same researcher of the last two studies that we looked at and who has numerous pharmaceutical industry conflicts of interest.
Using a very similar methodology as the Finland studies, it found that over a period of 5 years the prescription of moderate or high-dose “antipsychotics” for people labeled in Sweden as having schizophrenia was associated with lower overall mortality, compared to those said to be in a “no antipsychotic” group.” For those prescribed a benzodiazepine along with an “antipsychotic,” the results were quite different in that this group had the highest likelihood of dying when compared to the other groups. Thirty-eight percent of the patients were prescribed a benzodiazepine. Common benzodiazepines are Valium (diazepam) and Xanax (alprazolam).
This 2013 study, titled “Comorbidities and Mortality in Persons With Schizophrenia: A Swedish National Cohort Study,” was published in the American Journal of Psychiatry. It is pretty much the same type of study as the one’s carried out with Dr. Tiihonen and uses the same Swedish group of patients over a very similar time period as one of his studies, but here a different team of researchers looked at that data set. Again, lack of antipsychotic treatment was associated with elevated mortality. However, as hard as I looked in the article to see how the researchers defined “lack of antipsychotic treatment” I was not able to find it. As in other similar studies, most of those in the “lack of antipsychotic treatment group” were still alive, so we don’t know if they would, as a group, have begun to die at an earlier age if all were followed up until all in their group died.
This 2017 study, titled “Reduced All-Caused Mortality With Antipsychotics and Antidepressants Compared to Increased All-Cause Mortality with Benzodiazepines in Patients With Schizophrenia observed in Naturalistic Treatment Settings,” was published in Evidence-Based Mental Health. This study examined the same Sweden data set as our “Fourth Study,” but utilized a different set of researchers. The outcomes were largely the same. Five years were looked at. Compared to the “no antipsychotic” group, the prescription of “antipsychotics” for people labeled in Sweden as having schizophrenia was associated with lower overall mortality, unless they were also prescribed a benzodiazepine, in which case they had the highest likelihood of dying. As in the earlier Sweden study that I discussed, inferences from this study’s findings are limited due to lack of randomization to the various comparison groups which prevent differentiation of causal from non-causal associations. This study actually does not really compare patients who took no “antipsychotics” with those who did, because all of the patients took “antipsychotics” at various points in their lives. Despite statistical adjustment for some relevant baseline variables, highly relevant variables were unaccounted for, including direct measures of schizophrenia severity, unhealthy lifestyle behaviors, degree of substance use, medical comorbitities and treatment, health service use pattern, and treatment adherence. And, of course, the study just looked at what could be observed in a five year period at which point the vast majority of the patients studied were still alive. Such studies don’t reveal what the average age of death is for those who are labeled as having schizophrenia and are taking “antipsychotics” versus those who were also labeled as having schizophrenia but did not take “antipsychotics.” Like other studies that were done after the 2009 study, this one did not bother to find out if patients that were on “antipsychotics” for less than six months was the group least likely to die during the followup period.
This 2017 study, titled “Mortality and Antipsychotic Drug Use in Elderly Patients With Parkinson’s Disease in Nursing Homes,” was published in the Journal of the American Medical Directors Association. It looked at some data over a period of 18 months and does not directly address the issue under discussion. That is, these patients were elderly and had Parkinson’s Disease, rather than being labeled as having schizophrenia. For this group, prescribed antipsychotics for an 18 month period was not associated with the risk of death.
This 2015 study, titled “Antipsychotic Treatment and Mortality in Schizophrenia,” was published in Schizophrenia Bulletin. It looked at the same Sweden data set as our “Fourth Study” and “Eighth Study.” Each had looked at the follow-up that began on January 1, 2006 and ended on December 31, 2010.
Consequently, some of my readers showered me with praise for having the courage to stand up to the powerful pharmaceutical-psychiatric institutions, while others showered me with the most disrespectful insults known to the human race. 
And then there were those who disagreed with me but did so in a respectful manner. I believe it is my responsibility to now provide them a respectful response.
Any pill prescribed by a doctor will lead many to experience a placebo effect, which can be, for a period of time, helpful. I hasten to point out that a person can get a placebo effect with non-drug treatment approaches as well, and this would avoid the various harms associated with this type of drug.
These drugs are not only known as “antipsychotics,” but also “major tranquilizers,” because they sometimes do appear to calm someone in distress.
Unfortunately, once someone begins to take these drugs to help with agitation, when they try to come off of the drug, they are left with drug withdrawal experiences that have been described as awful. I hasten to point out that there are other ways to help someone to calm down that need not rely on these types of drugs. I have worked on many occasions with people who are agitated, and without the aid of a drug prescription I listened in a caring way, and in time the person eventually calmed down. If, however, you give someone a drug that calms the person down, it is sometimes much easier, and less time consuming. For people who witness someone they care about in high distress drift into a calmer state upon taking an “antipsychotic,” this can seem enormously helpful.
Some of them would have recovered in a fairly short period without the drug, but because they recovered while taking the drug, they, and their loved ones, attribute the improvement to the effectiveness of the drug. If the person tries to see whether the improvement was due to the drug or the natural recovery process, he or she may try to stop ingesting the drug.
However, the withdrawal from the drug, as I mentioned above, often causes a nasty physiological reaction which, in some ways, is similar to someone who is a coffee drinker who suddenly decides to stop, cold turkey. However, the “antipsychotic” physiological withdrawal reaction can be experienced as much worse. When people who care about this person see the downward spiral that occurs from the physiological withdrawal reactions, they may come to attribute it to the person’s “mental illness” returning, and thus, the illusion of long term effectiveness is now deeply entrenched.
Another way in which the illusion of the long term effectiveness of the drugs can occur has to do with the fact that even when the “diagnosed” person is not functioning well on a drug treatment regimen, human beings can always imagine that the patient would be doing even worse without taking the drug. And of course, when the patient does try to go off the drug, the raging physiological withdrawal process occurs. So, in this way, the combination of the belief that the patient could be doing worse, and upon becoming worse when trying to do without the drug, it convinces people that the drug treatment is helpful.
Once they take that position, and tell others what they had done, information that comes their way in the form of the distressed person having bad side-effects, or hearing from people who take the position that the drugs may be more harmful than helpful, a psychological phenomenon known as cognitive dissonance occurs. The principle of cognitive dissonance states that human beings strive for internal psychological consistency. When they experience internal inconsistency they become psychologically uncomfortable and a major way that they try to reduce the discomfort is by avoiding circumstances and contradictory information likely to increase the magnitude of the cognitive dissonance.
I have publicly supported the argument that these drugs cause more harm than good. Therefore it can be argued, it is I who suffer from cognitive dissonance whenever evidence comes my way that might support the idea that these drugs are helpful in the long run.
By the late 1990s, investigators had reported that antipsychotics caused basal ganglion structures and the thalamus to swell, and the frontal lobes to shrink, with these changes in brain volumes “dose related.” Then, in 1998, Raquel Gur, from the University of Pennsylvania, reported that the swelling of the basal ganglia and thalamus was “associated with greater severity of symptoms.”
The MRI studies provide objective evidence that antipsychotics cause changes in brain volumes that are associated with a worsening of symptoms, and a worsening of functional impairment.
And so, parents start getting phone calls from these frustrated teachers, urging them to consider having their son or daughter evaluated for ADHD. “There are medications available for children that help these kinds of problems,” the teachers explain.
To do my best to offer balance to the pharmaceutical industry’s point of view, in earlier posts I review the research pertaining to how effective and ineffective these drugs are (see 
That is, many of these children have no problem paying attention to many types of tasks, such as art projects, singing songs, and playing sports, but find academic school lessons boring. 
Others are the youngest student in the class and are actually acting in a manner typical for their age.
Nevertheless, it does sadden me when I hear about this decision, for I become concerned about the child’s stomach, kidney, nerves, hormones, developing brain, and bone structure. Drugs that physicians have said are safe and effective have, in the past, proven to be far more toxic than anyone ever dreamed. The latest such case involves the use of pain killers that fall in the class of Oxycontin, which many physicians cooperated in creating a situation now declared a national emergency. I for one have been deeply grieving over the suffering of the tens of thousands of family members caught up in this horrible deadly mess.
I grieve as well over the social misery that goes along with being singled out as a child that must take a pill to fix the problem said to be in his or her brain. More than a few kids have told me that this process, for them, became a dreaded experience.
I prefer to put forth a view that encourages us to teach our kids about the value of keeping our bodies in lifelong possession of its full youthful state by avoiding the use of stimulants and narcotics. I wish to teach our kids it is possible that the morning sun and air are far better and healthier intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being–these are the directions I wish we would point to when we guide a child toward a fulfilling life.
In the article, Dr. Szasz put forth his belief that the behaviors and experiences that are considered “mental illnesses” are more accurately construed as problems in living. As someone whose family narrowly escaped the violent, inhumane actions of Hitler in 1938, he expressed a concern about society giving psychiatrists the authority to convert these problems into a language of illness. As he saw it, his own profession has a financial interest in converting more and more problems in living into illnesses that require its services to reach some vague harmonious state thought of as mental health. However, according to Szasz,
To Dr. Szasz, it is logically absurd to expect that it will help solve these types of problems by prescribing tranquilizers and other drugs as if they were like a bacterial infection, or the growth of a tumor. To be sure, people on their own have tried to deal with these problems by taking a wide range of drugs, such as alcohol, tobacco products, stimulants, and heroin. Such approaches, rather than promoting healthy outcomes, tend to lead to less healthy outcomes. 
To Szasz, changing to the drugs doctors prescribe to deal with these problems in living is like changing seats on the Titanic.
Dr. Szasz’s book, Law, Liberty, and Psychiatry, also was met with high praise. In a review published in the New York Times, Edward de Grazia wrote;
One boy had recently become depressed. When I asked him why he thought he was depressed, he said that his mother was making him take Ritalin to treat his ADHD. The boy didn’t believe he had ADHD, and when the drug’s stimulant effects began to wear off each evening, he was left feeling awful, with waves of sadness, stomach aches, and difficulty falling asleep.
At the same time, I had become concerned that so many of the kids referred to me who were in foster care were on drugs typically prescribed for people diagnosed as psychotic. These students typically were dealing with serious emotional challenges involving being taken from their parents’ home. A couple of these cases involved parental child abuse, others involved parents being sent to prison, and I had another case of a boy dealing with his parents dying in a car accident. My efforts to help these grieving kids became ever more difficult because of the side effects of the psychiatric drugs prescribed to them. Some of the side effects were known to be life threatening.
Regarding the October 3rd Binghamton Conference, I am writing in great dismay and utter incredulity that so much mental health money would be spent in this fashion. The money for the needed basic services has been so sharply reduced for our ill family members; plus with the number of mentally ill homeless ever increasing, then to see the large number of participants in such a program was definitely upsetting to me.
This time I did add to the panel a family member who belonged to the local chapter of the National Alliance On Mental Illness. Despite that, I received a letter from the president of that organization’s New York State chapter asking that the debate be cancelled. In his letter, he specifically objects to Dr. Szasz expressing his views.
Over the years, I found his love for his two daughters particularly heartwarming. I could easily relate to his feelings toward them because I have two dear sons.
So, what do you do in a situation like this, that is, a situation in which some people highly respect your friend, while others don’t? As for me, when I meet someone saying negative things about Dr. Szasz, I take some time to listen carefully, and I respectfully summarize the person’s position. I then gently say a few supportive things about Dr. Szasz, while bracing myself to deal with the person’s reaction. As the other person replies, I again listen, seeking to be as empathic as possible.
Mentoring programs, which provide one-on-one relationships, such as the Big Brother/Big Sister Program have demonstrated they can be helpful, but most communities find they have a severe shortage of mentor volunteers. 
In addition, it has become apparent that some who do manage to get mentors need significantly more time with a positive role model then the hour or two per week that mentoring programs typically provide.
It would begin with offering an elective course to high school and college students titled “An Introduction to Counseling and Conflict Resolution.” It would provide lessons on basic counseling skills such as empathic reflective listening. A major unit in the course would be on how to discipline children nonviolently, and another unit would be on how to teach skills for dealing with anger arousing situations.
These interns would serve as mentors for younger students at least four years younger than they. For their participation, mentors would receive an authentic sense of helping their community, a modest stipend of about $4 an hour, earn additional course credit, and have an opportunity to receive a sterling recommendation for any future job or advance education opportunity. Survey data that was administered at my school district and local college indicated there would be plenty of students who would agree to become mentors if the program became funded.
On site at each high school would be two adult supervisors, one of which would be a psychologist, the other, a volunteer senior citizen.
Then they would work for twenty minutes doing homework.
Every 6 weeks, all of the parents of the mentees would be invited to an evening meeting. The focus of these meetings would be on seeing the little video shows that their sons and daughters had made that illustrate peacefully handling some conflict.
Our tale begins when Tony is 12-years old. Because of several fights that he has gotten into at the afterschool program, Tony has just been banned.
Shortly afterwards, Nick, 17-years old, begins to mentor Tony every day after school. Nick had been bored before beginning to work with Tony, and without this constructive activity available, he could have easily gotten into trouble. But now he finds that the way Tony looks up to him very rewarding, and Nick gets great satisfaction knowing he’s helping his community. And he also likes the money that he’s earning from the stipend.
June, 11-years old, is wearing a cute pink dress. She has been brought to see Dr. Shure, a psychologist. Leaning forward on her desk, Dr Shure asks,“Do you know why your mother asked me to meet with you, June?”
“Really!” exclaims June. “She’d be like a big sister! I’d love to try something like that!” A delightful smile is now lighting up June’s face.
In this One-On-One Program, the mentors would benefit because it would give them something constructive to do instead of getting embroiled with some harmful groups of bored students looking for trouble. 
They would learn useful skills taught in the counseling and conflict course and be given an opportunity to apply peace promoting skills in real life situations under supervision, skills that they would be able to use later in life and to a time when they become parents. They would also earn some money, and work daily on developing some valued skill.
For thirty mentor-mentee pairs, the cost would be approximately the same as it would be to send one young person to a juvenile correctional facility or prison for one year. 
So, if the One-On-One Program was to succeed as a violent prevention program, with fewer folks going to residential programs or prisons, and fewer folks being rushed to the emergency room to be treated for a violent injury or attempted suicide, communities would actually end up saving hundreds of thousands of dollars. Of course it is my hope community members will think beyond the money that can be saved, and act to make the One-On-One Program a reality because this is in the best interest of our youth, and our entire community.
This labeling process relies on descriptions provided in the Diagnostic and Statistical Manual of Mental Disorders–Fifth edition (DSM) and the International Classification of Diseases–Tenth edition (ICD). Both are manuals that are conceptually similar, utilizing as their core concept, mental disorders, and both share the same “diagnostic” codes. Because of their similarities, I will simply refer to them as the DSM/ICD approach.
Many professionals defending the use of this approach explain that it provides a common language for mental health professionals to communicate about those utilizing their services; its various classification terms, such as major depressive disorder, anxiety disorder, and so on, are short phrases that are convenient for placing into titles and search engines, and for efficient/streamlined communication in high-speed hospitals and clinics; third-party payers of mental health services have found that their coding system works well as part of a practical method for their record keeping; with the aid of these codes, people manage to access mental health services, mental health service providers manage to get paid, and for-profit health companies tend to make a profit.
It tends to be stigmatizing to mental health service users. The lack of reliability and validity of the various so called diagnoses violate basic principles of science. The process of coming up with a psychiatric label privileges the clinician’s perspective over that of the mental health service user. It ignores the fact that many people who have been labeled with these stigmatizing psychiatric terms come to realize that the experiences which led to their seeking services, rather than being an indication of a pathological condition, are really an essential element to their creative development. Many have also expressed concerns about the “mental illness” terminology which medicalizes mental health concerns, thus leading to an incredible number of people being prescribed psychiatric drugs, the use of which leads to numerous serious side effects.
Just as I was writing this post, major news outlets began to report that researchers found nearly a 50% increased odds of dementia for those taking the most popular drugs for treating depression and other mental health concerns. Although the study could not prove conclusively that these drugs caused the increased risk of developing dementia, because these same drugs had already been linked to confusion or memory issues, the new evidence is deeply troubling. The researchers expressed concerns that if this association is causal, it “would equate, for example, to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom.” With the population of the US being 6 times larger, this could mean that over 100,000 cases of dementia may be attributed to these drugs every year here in my own country.
As part of this effort, I have come up with one alternative proposal which I discuss most extensively in a peer reviewed article published in a 2018 volume of the Journal of Humanistic Psychology (see 
The CSM approach begins with a full recognition that individuality outruns any classification system. It is for this reason that the CSM does not classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider. 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, meaning of life, death, dying, managing chronic pain, addiction, work, relationships, education, eating, cognition, sleep, and challenging life situations.
Classifying the expressed concern would provide mental health service providers a common language that is helpful when communicating among other professionals. So, a professional might say to a colleague something 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.” Such communications are straightforward and easy to understand, not only for professionals, but for the general public as well.
Each expressed concern listed in the CSM would be a sufficiently short phrase so that it can be conveniently used in titles and search engines to retrieve valued relevant information. Along with each classified expressed concern, there would be a numerical code that would be convenient for third-party payer bureaucratic record keeping.
This process involves a mental health service user and a mental health service provider co-constructing a hypothesis or “best guess” about the origins of the mental health service user’s concerns in the context of his or her relationships, social circumstances, cultural heritage, life events, and the sense that he or she has made of them. Once it has been established what the concerns are, the immediate next question is, “How do we jointly understand these experiences, why they arose, and how we might be able to address them?” This formulation is not something that is shared with third party payers of mental health services, but is utilized exclusively by the mental health service user and service provider.
With the CSM approach, no one is viewed as mentally ill, having a mental disorder, or having some psychopathological condition. Instead, it highlights that the progress of society is due to the fact that individuals naturally vary from the human average in all sorts of directions, that the originality is often useful, while, at the same time, being different can create a variety of concerns. Moreover, some people become concerned about how they are handling enormously stressful and traumatic experiences. Still others are living in unhealthy ways, such as making unhealthy choices in what they consume, or getting insufficient exercise. Mental health professionals, with the CSM approach, are viewed as seeking to address these types of concerns that arise from these conditions in a supportive setting while relying on a variety of wisdom traditions. Central to this approach, is an honoring of what Ralph Waldo Emerson referred to as the grand sweep of humanity.
Compared with the DSM/ICD approach, the use of the CSM would be less stigmatizing, more respectful to those seeking services, and more practical because of the ease of understanding the words and phrases that it utilizes. Moreover, it would be more consistent with principles of science because instead of using as its core concept the vaguely defined “mental disorders,” the CSM uses as its core concept “mental health concerns,” which is a clearly recognized event that occurs at a specific time and place. Finally, the CSM approach would provide a new choice to both mental health service users and providers, challenge old ideas, stimulate fresh perspectives, and open new avenues of research.
In an article titled, “What Might an Alternative to the DSM Suitable for Psychotherapists Look Like?” Jonathan D. Raskin notes that recent surveys of psychologists and counselors indicate they are dissatisfied with the DSM/ICD approach and are interested in coming up with alternatives better suited to their professions. Nevertheless, more that 90% said they will use the DSM/ICD; after all, that is how they get paid by third party payers.
In a commentary on Dr. Raskin’s article that appears in the same JHP issue, Rachel Cooper, a senior lecturer in philosophy at the United Kingdom’s University of Lancaster, and author of Diagnosing the Diagnostic and Statistical Manual of Mental Disorders, puts in some of her own thoughts on this topic.
She begins by agreeing with Dr. Raskin that most psychologists and counselors would be keen for an alternative classification to be developed. She then reviewed research indicating that social workers should be included among the professionals unhappy with having to use the DSM/ICD approach. In surveys, most indicated they would not use it if it was not required for insurance purposes.
She then refers to my CSM approach, stating that I suggest that insurance companies could be persuaded to pay for “Mental Health Concerns,” as they would readily come to understand, with a little explaining, that mental health service providers now using the current DSM/ICD approach do not turn anyone away who has mental health insurance coverage and comes to their office expressing what the CSM refers to as a mental health concern. She then writes,
First of all, when Dr. Cooper says insurance companies usually try to prevent mental health providers from recording diagnoses to facilitate payment even in cases where a diagnosis criteria is not met, I strongly disagree with her. I’ve never in my entire career heard of an insurance company questioning a diagnosis, and on what basis could they possibly do so? Insurance funders are not present in the room when a so called diagnosis is made. All that they get as documentation for a given diagnosis is a code indicating the diagnosis.