Welcome to From Insults to Respect. A few weeks ago I asked for some feedback on a presentation I was preparing to deliver at the American Psychological Association’s 2017 Convention in Washington DC. I here want to thank all who chimed in.
After reading the many comments, mostly from Facebook and Google+ members of groups/communities that I belong to, I thought long and hard on what to include, and what to leave out. Many of the suggestions that were excellent could not be included in the presentation because only 10 minutes were provided for me to read my paper. Nevertheless, many suggestions that I didn’t incorporate into my formal talk were utilized when I responded to questions afterwards. I plan to be writing far more about this topic in the future, and so many of the proposed suggestions will be fully developed at that time.
How did my presentation go? I thought it went well and I received a warm round of applause. Here’s what the final draft ended up looking like:
Final Draft
The CSM: A Revolutionary Alternative to the DSM
Albert Einstein created a revolution in the branch of science known as physics. Prior to the 20th century, physicists tried to explain the propagation of light with the use of a theoretical construct known as the ether. There were experts in the ether. They sought ways to define it, along with ways to describe its various characteristics. It was thought, for example, that the ether didn’t move in any direction, but it could vibrate. There was much discussion about an ether wind. And then Einstein came along and described the nature of light without resorting at all to the ether.
Oh, there was a great deal of resistance to Einstein’s theory at first, but in time his theory came to be accepted as a distinct improvement compared to the old paradigm. Today I want to make the case that the theoretical construct known as mental disorder is the ether of psychology. Oh, I expect a great deal of resistance to this. Nevertheless, here’s a little of what I have in mind.
For a long time now, when people seek to access mental health services, they find that in most settings the concern they want addressed must be converted into mental disorder terminology. In the United States, the text used for this purpose is typically the DSM.
Criticism of the mental disorder construct began at the very beginning of American psychology when William James declared that it was nothing more than superficial medical talk. Criticism continued throughout the 20th century, and when the latest version of the DSM came out, there was a ton of media and professional articles that once again pointed out it’s numerous scientific shortcomings. Some within general psychology expressed concerns that psychologists utilizing the DSM approach had sold out to psychiatry and the pharmaceutical industry. Moreover, the continuing subservient acceptance of the DSM approach brings down respect for psychology as a legitimate branch of science.
Jonathan D. Raskin and Michael C. Gayle surveyed psychologists who regularly use the DSM, and published their findings in the Journal of Humanistic Psychology (DSM-5: Do Psychologists Really Want an Alternative? 2015, pages 1-18). Here’s their summary:
Only two published studies, both from the early 1980s, have specifically examined psychologist attitudes toward the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current article rectifies this by presenting the results of a recent survey of attitudes toward the DSM-IV-TR and DSM-5. Though the DSM has changed over the years, psychologist attitudes toward it have remained remarkably consistent. Although more than 90% of psychologists report using the DSM, they are dissatisfied with numerous aspects of it and support developing alternatives to it—something that psychologists over 30 years ago supported, as well. The finding that almost all psychologists use the DSM despite serious concerns about it raises ethical issues because professionals are ethically bound to only use instruments in which they are scientifically confident.
That said, is there anything that we can do?
Well, in thinking about this, I hasten to mention that Thomas Kuhn’s (1972) classic book, The Structure of Scientific Revolutions, rightly points out, for real change to occur in a branch of science, it is not enough to point out the weaknesses of a paradigm. There needs, as well, a new approach that is a distinct improvement over the old paradigm.
So, is it possible to really come up with a distinct improvement over the current DSM approach? I think our APA can do this easily if it set its mind to it, and it could do it in as little as a year.
What would this new approach look like? 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 a summary of what it would contain.
It would begin with the following statement: “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.”
Now think about this for a moment. The expression of a mental health concern is a clearly observable event that occurs at a specific time and place. Thus, its use beautifully solves the reliability problems that have been plaguing the DSM’s far more abstract theoretical construct of “mental disorder.”
Here’s the CSM’s definition of its main construct:
A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about thinking, mood, behavior or challenging life situation.
That’s it’s definition, plain and simple.
It is important to note that in the CSM there would be two classes of mental health concerns—The first of which is concerns expressed about one’s self. The second would be, concerns expressed about someone else.
In the CSM, the various concerns would be provided, along with a code for third party payer record keeping. Concerns that would be included in the first edition of the CSM would be selected empirically from survey data. For example, practicing psychologists would be asked to identify the types of concerns they were asked to address in their practice over the past year, but to avoid utilizing psychopathologizing words.
So, the CSM, with its survey data, would provide the basis for identifying the primary mental health concern in a word or brief phrase that would be convenient for use as search engine terms to retrieve relevant research studies. The CSM also provides a process for developing a psychological formulation. This is a three-paragraph narrative co-constructed by the person seeking services and the mental health professional. It consists in identify the service seeker’s strengths, other concerns he or she would like to have addressed, and how he or she is functioning in major life areas such as interpersonal relationships, sleep, eating, and workplace or educational setting.
Okay, those are the basics of the CSM. I contend that it would achieve all the benefits that the supporters of the DSM approach claim for it while having significantly fewer shortcomings.
I already touched upon the well-recognized reliability problems of the DSM and how the CSM would be a significant improvement in that crucial area. Here’s another area of improvement over the DSM. Supporters of the DSM 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. The CSM also provides a common language, but in an easier to understand and jargon free manner. To see if this is true, I field tested the CSM approach for years. When I worked in mental health centers I found that I had no need to use DSM terms to communicate with my colleagues. 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, the creation of the CSM would provide a common, jargon-free language for mental health service providers that utilizes a distinctly more scientific alternative than the DSM approach. It would also stimulate research programs that compare outcomes for services that utilized the DSM approach with that of the CSM approach. Moreover, it would provide a new choice to mental health service consumers, challenge old ideas, and stimulate fresh perspectives.
For a more complete description of the CSM, you can readily find an article that I recently had published that greatly expands on these ideas. Up on the screen is the reference. It is available in the current OnlineFirst version of the Journal of Humanistic Psychology. The titled is “The Classification and Statistical Manual of Mental Health Concerns: A Proposed Practical Scientific Alternative to the DSM and ICD.” [Click HERE to read the journal article]
Conclusion
Well, there you have it. I’m hoping that in time I can develop a large enough coalition of folks who are willing to request a meeting with APA’s leadership and at that meeting we advocate that we move forward in making a real change. For those of you who would like to join in this effort, please feel free to contact me at jrubin@stny.rr.com. Until next time, have a great week.
Regular readers know that I have, from time to time, been dealing with a conflict regarding psychiatric diagnosis. Said briefly, there are many people who immediately lose respect for anyone who questions the validity of the mental illness/mental disorder theoretical construct. On the other hand, many people have lost respect for the psychiatric profession because of its pathologizing approach of addressing concerns related to thinking, mood, behavior, or challenging life situations. Amidst this conflict, I have been trying to put forth on this blog, and in a number of other publishing outlets, an alternative approach with which the disputing parties can live in relative peace. 
Last year, I presented a paper on this topic at the American Psychological Association convention in Denver (see 
Albert Einstein created a revolution in the branch of science known as physics. Prior to the 20thcentury, physicists explained the propagation of light with the use of a theoretical construct known as the ether. There were experts in the ether who described ways to define it, along with its various characteristics. It was thought, for example, that the ether didn’t move in any direction, but it could vibrate. There was much discussion about an ether wind. And then Einstein came along and described the nature of light without resorting at all to the ether.
Criticism of the mental disorder construct began at the very beginning of American psychology when William James declared that it was nothing more than superficial medical talk. Criticism continued throughout the 20th century, and when the latest version of the DSM came out, there was a ton of media and professional articles that once again pointed out its numerous scientific shortcomings. Many throughout general psychology expressed deep concerns that psychologists utilizing the DSM approach had sold out to psychiatry and the pharmaceutical industry. Moreover, they bitterly complained that a paradigm that utilizes the mental disorder construct brings down respect for psychology as a legitimate branch of science. What can be done about this?
Well, in thinking about this I hasten to mention that Thomas Kuhn’s (1972) classic book, The Structure of Scientific Revolutions, rightly points out, for real change to occur in a branch of science, it is not enough to point out the weaknesses of a paradigm, there needs, as well, a new approach that is a distinct improvement over the old paradigm. So, is it possible to really come up with a distinct improvement over the current DSMapproach? I think our APA can do this easily if it set its mind to it, and it can do so within a year.
Let’s say Mary Doe comes to a licensed practicing psychologist and says she has been feeling a great deal of sadness much of her days. The psychologist, for verification purposes can say, “I hear you saying that you are concerned about how sad you have been feeling much of your days, and you would like us to work together to address this concern, is that correct?” If the service seeker says yes, this would verify that a mental health concern has been expressed, and what the concern is.
Well, there you have it. I only have seven minutes to present the paper, so many of the essential points that I would love to make have to be left out. There will be some time for questions and discussion, so some additional information could be shared then. And, for those who are interested, as I point out in my paper, they can now readily retrieve a far more complete presentation of my proposal by assessing the journal article I wrote that was just published last month.
Regular readers know that I have, from time to time, been dealing with a conflict regarding psychiatric diagnosis. Said briefly, there are many people who immediately lose respect for anyone who questions the validity of the mental illness/mental disorder theoretical construct. On the other hand, many people have lost respect for the psychiatric profession because of its pathologizing approach of addressing concerns related to thinking, mood, behavior, or challenging life situations. Amidst this conflict, I have been trying to put forth on this blog, and in a number of other publishing outlets, an alternative approach with which the disputing parties can live in relative peace. 
Last year, I presented a paper on this topic at the American Psychological Association convention in Denver (see 
Albert Einstein created a revolution in the branch of science known as physics. Prior to the 20th century, physicists explained the propagation of light with the use of a theoretical construct known as the ether. There were experts in the ether who described ways to define it, along with its various characteristics. It was thought, for example, that the ether didn’t move in any direction, but it could vibrate. There was much discussion about an ether wind. And then Einstein came along and described the nature of light without resorting at all to the ether.
Criticism of the mental disorder construct began at the very beginning of American psychology when William James declared that it was nothing more than superficial medical talk. Criticism continued throughout the 20th century, and when the latest version of the DSM came out, there was a ton of media and professional articles that once again pointed out its numerous scientific shortcomings. Many throughout general psychology expressed deep concerns that psychologists utilizing the DSM approach had sold out to psychiatry and the pharmaceutical industry. Moreover, they bitterly complained that a paradigm that utilizes the mental disorder construct brings down respect for psychology as a legitimate branch of science. What can be done about this?
Well, in thinking about this I hasten to mention that Thomas Kuhn’s (1972) classic book, The Structure of Scientific Revolutions, rightly points out, for real change to occur in a branch of science, it is not enough to point out the weaknesses of a paradigm, there needs, as well, a new approach that is a distinct improvement over the old paradigm. So, is it possible to really come up with a distinct improvement over the current DSM approach? I think our APA can do this easily if it set its mind to it, and it can do so within a year.
Welcome to From Insults to Respect. Today’s topic, friends.
Next, Bob tells us a little about Sister Rosetta Tharpe, the lead singer of the song he is about to play, “Don’t Take Everybody to Be Your Friend.”
Moving right along, Bob tells us about Moon Mullican, a Texan. Bob surmises the guy must be a friendly fellow from the song he sings, “Make Friends.”
Next, Bob tells us about one of the wisest guys he ever got to know, Muhammad Ali, who once said, “Friendship is the hardest thing in the world to explain. It’s not something you learn in school. But if you haven’t learned the meaning of friendship, you really haven’t learned anything at all.”
If you need a friend, here’s some things that makes a good friend: Good friends listen to each other. Good friends help each others solve problems. Friends are dependable. This one is very important, good friends never borrow money. 
Good friends never change the channel on your radio. Good friends will always tell you when you have food in your teeth. Good friends sometimes pay for dinner. And good friends sometimes let you have the last beer. And if you are doing all of those things, maybe you’ll have a friend, like Carol King sings about. Here’s Carol King. She’s going to brighten up even your darkest night. 
When you’re down and troubled,
You just call out my name
If the sky above you grows dark and full of clouds
Now, ain’t it good to know that you’ve got a friend
Tapestry, the Carol King album this song appears on, was the most popular of the early 1970s era, remaining on the charts for over 6 years. So, on that series of notes, I think we’ll begin to fade out for this week. I hope you enjoyed our little meditation on friends, and I hope you’ll join us again right here at From Insults to Respect.
According to the FDA, there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) classified as having major depressive disorder and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a very slight reduction with antidepressants compared to placebo in adults aged 65 and older.
This may sound somewhat encouraging for those who are thinking of taking antidepressants and are over 24-years old if they are willing to put aside concerns about the many other negative side effects associated with taking this class of drugs. However, interpreting these findings is highly problematic for a number of reasons. For example, these results were based on short-term studies, typically lasting just a few weeks, while many people used the drugs for years. Many drugs that were viewed as relatively safe when the short-term evidence became available later turned out to have serious negative effects when the long-term effects started to come in.
Other concerns have to do with the fact that the current available studies are almost always carried out by the drug companies that have a massive interest in proving that the drugs are safe. With the largest lobbyist group in Washington, DC (see 
“In a meta-analysis of the placebo-controlled trials from 2006, the FDA reported only five suicides in 52,960 patients on SSRIs (one per 10,000 patients)(3), but there were many more suicides in these trials(2). Five years earlier, in 2001, Thomas Laughren, who was responsible for the FDA’s meta-analysis, published a paper using FDA data where he reported 22 suicides in 22,062 patients randomised to antidepressants(4), which is 10 per 10,000, or 10 times as many as he reported in 2006. In Laughren’s 2001 paper, there were four times as many suicides on antidepressants as on placebo, which was statistically significant (P = 0.03, my calculation). However, Laughren did not tell his readers about this but wrote: “There is obviously no suggestion of an excess suicide risk in placebo-treated patients.” No, but there surely was in the drug-treated patients!”
In interpreting the safety of these types of drugs, there are many other types of concerns hidden in the data. For example, there is strong reason to think that the subjects in these published studies are not at all the typical people who take antidepressants. Usually when someone is depressed and is open to taking antidepressants to feel better, they go to a nearby physician and get a prescription for the actual drug. That’s not at all how the subjects in these studies go about it. They have to fill out more forms than usual, and they have to agree to be part of an experiment that has them being randomly assigned to taking either the real drug or a placebo.
Now think about that. If you are depressed and open to taking these types of drugs, why would you agree to not knowing if you are taking the real pill or the fake one? Here’s a possible clue. As it turns out, many, if not all, of the subjects who agree to this are already taking one or more psychiatric drugs, including antidepressants. They have to agree to stop taking the antidepressants that they were taking, which typically leads to very uncomfortable withdrawal reactions.
So, again, why would people who are already depressed agree to undergo such an ordeal. It seems to me that it is very possible that many of these subjects had come to feel that the drugs that they had been taking had not been helping them. Thus, they became willing to try being part of the experiment in the hope that they will be put on another experimental drug they have not tried yet and it might end up providing the relief they were seeking.
Now, add this to the picture. Those who agreed to being subjects were excluded if they had had any suicidal thoughts or attempts. So, keeping this in mind, it turns out that many in this group of subjects are those who were placed in the past on antidepressants and did not have suicidal issues when taking them. This leads one to conjecture that this is a group of people who are particularly less likely to have suicidal issues than most people when they use antidepressants. After all, many people who choose to go on antidepressants in the usual manner (going to a local doctor) do so because they have begun to have suicidal thoughts and feelings, and some may have made an attempt to end their life. These folks would be excluded from participating in the study. Thus, those who participate in these studies are a special group who tend to not have suicidal reactions before taking antidepressants and when taking antidepressants.
Given all of these problems, how can we get some additional relevant information about whether these drugs increase suicidal issues for adults? Well, here’s a recent published study that I think is worthwhile to consider.
We found that antidepressants double the risk of suicidality and violence, and it is particularly interesting that the volunteers in the studies we reviewed were healthy adults with no signs of a mental disorder….
In one of the two crossover trials we excluded because we did not have data on the first period separately, a healthy volunteer committed suicide, which was mentioned in both published articles.A14,A15 She had received duloxetine in increasing doses for 16 days, tapered off the maximum dose of 400 mg daily very quickly (in just four days according to the design of the study) and killed herself four days later while on placebo. 
The authors, several of whom were employees of Eli Lilly or owned stock in the company, judged her suicide ‘to be unrelated to study drug treatment’,A15 although it is well known that the suicide risk is high when an antidepressant is stopped abruptly.
Although only two of the 29 clinical study reports were eligible for our meta-analysis, e.g. as the studies needed to be double-blind, two researchers (AØB and PBD) read them all (2224 pages) and extracted data independently, as we wanted to explore possible selective reporting of harms in the published articles. Nineteen clinical study reports reported on the harms we investigated and nine of these were published, but less than half of the harms were reported in the articles (21 of 50 events on antidepressants and two of four events on placebo)….
There can be little doubt that we underestimated the harms of antidepressants. For 11 of our 13 trials, we only had access to the published article, and it well documented that the drug companies underreport seriously the harms of antidepressants related to suicide and violence, either by simply omitting them from the reports, by calling them something else or by committing scientific misconduct.
Psychiatrists believe that the suicide risk with antidepressants is only increased till age 24, but this misconception builds on seriously flawed trial data that the FDA has published.
They also found out that many suicide attempts must have been missing; some of the investigators responded that there were suicide attempts they had not reported in their trials, while others replied that they did not even look for them. Further, events occurring shortly after active treatment was stopped were not counted. Another 2005 meta-analysis conducted by independent researchers used UK drug regulator data and included 40,826 patients; they found a non-significant doubling in suicides or self-harm events when events occurring later than 24 hours after the randomised phase was over were included (relative risk 2.14, 95% confidence interval 0.96 to 4.75, our calculation).
Even the FDA’s 2006 meta-analysis of 100,000 patients in 372 placebo-controlled trials
Well, this is just one study that discusses the issue of suicide risks for adults choosing to take antidepressants. I chose to present it because it is the most recent study on this topic, and it seemed to me to present some additional information not usually available in the US literature.
There is something similar to this when it comes to how Americans feel about psychiatrists. There are many people who hold the belief that psychiatrists are enormously helpful to our society by relieving suffering while others believe that psychiatrists have sold out to the pharmaceutical industry, consequently leading to enormous harm.
We get to see and hear favorable positions for the psychiatric point of view from the numerous ads on TV, radio, and print media sponsored by the fabulously wealthy pharmaceutical industry, which has the biggest lobbyist group in Washington, DC (see 
Psychiatrists have become addicted to the enormous financial benefits of transforming human suffering into a language of mental illness and then convincing people that they need to spend the rest of their life on psychiatric drugs. The consequences to society of this mental illness/drug approach is an enormous increase in people becoming disabled due to the negative drug effects. There is also some recent research suggesting that when women on these drugs become pregnant, there is an increased risk of miscarriages, and if the infant is brought into this world alive, she or he is at an increased risk of serious health consequences.
In my opinion, one of the best places to obtain the arguments about the harmful approach of psychiatric drugs is at the “Mad In America” site that readers can access 
The latest version of what is viewed by psychiatrists as the most authoritative American text on mental illness is the DSM-5. It tells us that mental disorders “are usually associated with significant distress in social, occupational, or other important activities (APA, 2013, p. 20).” There is some additional vague wording here about also having a “dysfunction.” Although my focus here is on the suffering component of the definition, I will say a few words about the functioning part of the definition shortly.
n case this vague definition does not provide enough wiggle room for clinicians to label all people seeking their services as having a mental disorder and to prescribe a drug for it, the ICD tells the clinician, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes” (p. 8). This type of double talk is one of the reasons why many people view the mental illness construct as too vague for scientific purposes.
Now, lets get back to the “suffering” component of the mental disorder definition. According to Buddhist philosophy, the first Noble Truth is that to live is to suffer. According to Christian philosophers that I have read, suffering is something to make us think. It is a tool to get our attention and to accomplish the Lord’s purposes in our lives in a way that would never occur without the trial or irritation. In Judaism, the Talmud teaches us that the righteous suffer in this world in order to increase their reward in the Eternal World. Rabbi Eliezer, in the Talmud, welcomed his suffering, calling his pains ”my friends.”
If we look outside the religious teachings, we find that giving birth is accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition. When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences.
Add to all of this the problems one encounters when one tries to decide objectively how much suffering, beyond the “normal” amount that one experiences during life’s parade of disappointments, is required to ascribe a diagnosis. In the end, can we really determine if one’s “suffering” is really a symptom of a disorder, or just life being life.
In saying this, I am not seeking to encourage people to be disrespectful to people who choose to take psychiatric drugs. It is their life, and it is their right to make the best decision they know how to make, and I wish them well. At the same time, I believe suffering may best be served by exploring what it could potentially provide. In my own life, I have seen numerous examples of people growing from their suffering. And one of the hardest lessons I had to learn, when seeking to be of help, is that there are times when it is best to address another’s suffering not by trying to fix it, but to stand respectfully beside the person’s misery and sharing what they are going through.
It begins with Sanders turning to Kasich and asking him, “Is Trump a liar?”
Kasich, 
Then, Kasich says, “But I’m not going to go so far as to call someone a liar! That when you get, when you start using terms like that, Bernie, we saw it in Congress. You know, back in the days when we were in the majority and they were after Jim Wright and all those things and there was a lot of calling people dogs and liars. Just let the facts speak for themselves, and then we can draw a conclusion. And I’m only saying this, not because I’m trying to defend anybody. I’m worried about my country. I’m worried about getting through this.”
At this point, Sanders replies, “But when we talk about the facts, I mean Jake asked a pretty simple question. All that I’m saying is, it’s not a question of, you’re a Conservative and I don’t think you’re a liar. We disagree on everything, but that doesn’t make you a liar, and I don’t think that makes me a liar. But if you were to tell me that three to five million people voted illegally in this election, of which no Republican or Democratic official believes, what can I say? I think that it’s a lie.”
Here Kasich looks troubled, and replies, “I, I, look, I guess I’m gonna do it, I didn’t think I would, does that mean that someone who writes a campaign ad that distorts somebody’s record is a liar? I mean, we have to be careful about our terms. That’s all I’m saying, okay?” 
Regular readers of this blog well know that name calling leads to me and others to lose some respect for the name caller. Calling someone a “liar” is name calling, and we can see the loss of respect that Governor Kasich feels for those who use that term when we watch the video clip.
As Bob Dylan once said on his radio show, “According to a survey, 4 out of 5 people admit to telling white lies at least once a day, and I’m telling you that that other guy, he’s lying.”
And they love pictures of him illustrating his lying ways. This might have been the reason for the chuckling of Senator Sanders and those in the audience when Governor Kasich began to reply to the question, “Is Trump a liar?” But consider how you would feel if someone called the candidate you support a liar. 
Recall that there were people calling President Obama a liar during his administration and illustrations of what some believed were his lying tendencies. 
I think the Golden Rule applies here. Moreover, calling the president a liar stirs up his supporters to be angry, and this can produce less than ideal conditions for people to come together in mutually beneficial ways.
Now, Senator Sanders has been trying to make the case that there is something different in the type of lying that President Trump engages in compared to what most people engage in. He is seeking to see how he can best make that distinction by bringing up the liar issue. In the clip, he brings up the example of the president declaring repeatedly that between three million and five million people voted illegally, and that if just the legal votes were counted, he not only won the electoral votes, he also won the popular vote. At other times, Sanders noted that the president has repeatedly claimed that his electoral vote victory was by the largest amount in history. When the president is confronted with the facts that the previous president, Mr. Obama, had won more electoral votes then he did, that many other presidents also won by more electoral votes then he did, and that this can easily be verified by anyone really interested in the truth of the matter, he just continued to claim he won the election by the greatest margin in history. At another time, the president claimed he was against the Iraq War despite a videotape clearly showing his support of that war, and no evidence that he spoke out against the war when it was getting under way.
These, along with others that he has made, are indeed whopper-sized lies. By providing the type of specifics that I provided in the previous paragraph it makes the point clearer than calling him a liar.
The good professor first covers the fact that to most the question of whether or not life is worth living hardly ever comes up, so intent are they to live every moment that they have. Others, spend most of their lives questioning whether it would be better to enter into the peace of being consigned to the earth. And then there are those who drift back and forth. After a poetic discourse of these different types, James delves into what we might say if we meet someone who indeed is questioning whether it would be better just to end it all.
“To breathe the air, how delicious!
“To come immediately to the heart of my theme, then, what I propose is to imagine ourselves reasoning with a fellow-mortal who is on such terms with life that the only comfort left him is to brood on the assurance, ‘You may end it when you will.’ What reasons can we plead that may render such a brother (or sister) willing to take up the burden again?”
At this point, Professor James hastens to confess that nothing he has to say will be able to prevent all suicides. If we make an effort to help and despite this, the person ends his or her life, “cases like these belong to the ultimate mystery of evil, concerning which I can only offer considerations tending toward religious patience at the end of this hour.”
He tells us that certain people who have grown up with a religious background, find that as they get older what they were taught and came to sincerely believe is not meshing well with their personal experiences. They observe that their own actions don’t accord with every teaching of the scriptures, and guilt begins to mount. And they begin to learn in science based teachings that the world was not created a few thousand years ago in six days, the animal kingdom evolved in a manner very differently than their religious stories, and when some of this science stuff seems to make sense to them, they feel they are engaging in blasphemy. They feel confused and fearful. Thus, Professor James tells us,
Once the springs of vitality are let loose in this way, without the burden of infinite responsibility, many experience an immense relief. Meanwhile, whatever is causing the suffering “can be tolerated for another twenty-four hours longer, if only to see what tomorrow’s newspaper will contain, or what the next postman will bring.”
Professor James believed that for some suicidal folks, once they have reached the first stage, it may be possible to incite a fighting spirit within. Identify one or more perceived evil from their perspective, and make appeals to help to overthrow it. Professor James explains,
From these words, James encourages us to use inspiring narratives of those who, through acts of courage, made a real and wonderful difference. In the essay, Professor James’s examples are very dated. Therefore, readers may prefer to turn to my 
Some promote the idea that depression is a disease with genetic factors playing an important role in its development. This line of thinking is theorized to reduce stigma because it reduces any blame for the person who is having the experience. But others say that promoting the idea that this group of people have faulty genes will actually increase stigma even if it does reduce blame.
The current study attempted to replicate the initial findings with a large sample of over 38,000 people of European ancestry, using methods that are viewed as “rigorous best practices.” The team of researchers involved in the study found that the presence of the 5-HTTLPR genotype did not increase a risk of depression, even in those who experienced significant life stressors and traumatic events. However, as expected, stress and trauma by themselves were strongly associated with the development of depression.
As we have seen above, the argument that depression is a genetic disease currently has little scientific support. Nevertheless, there are people who will continue to insist that it is due to genetics because some research indicates that if you have family members who experience depression, you are at an increased risk of also having this type of experience.
There are many examples of people who, when they become depressed, take to their beds for a period of time. And indeed, some people who become depressed, though not most, will violently end their lives.
I am not seeking to eliminate this support, though I bemoan the fact that for many the only support that is offered is a prescription for drugs which I believe in the long run leads to far more harm then good.
To counter stigmatizing these individuals, it is far better than pathologizing their experience if we focus on pointing to the numerous examples of people, such as Abraham Lincoln, who suffered deeply from depression experiences, and yet made enormous contributions to our society. Equally important is to explain that simply being at an increased risk for something doesn’t mean someone has a disease. Risk takers, such as the Wright brothers, are well known to be at an increased risk of an early death, but that characteristic allows some folks to bravely enter into a tiny capsule to explore the moon.
Currently, in many countries a wide variety of children are being classified as having ADHD and placed on a regimen of consuming psychiatric drugs. Supporters of this trend often cast a disrespectful eye toward their critics while arguing that scientific research supports their position. Meanwhile, equally scientific minded individuals who have looked at the same research come up with a completely different set of conclusions. So, about once a year I take a look at the most current research to see if I can throw some light on this topic.
Factors looked at were academic achievement and social functioning. Although the medicated ADHD students didn’t do any better or worse on these measures then the unmedicated ADHD students, they did endure many uncomfortable side effects while they were on the ADHD drugs, such as sleep problems, headaches, stomach aches, and feelings of depression each evening when the drug wore off. Thousands of dollars per child were consumed on purchasing the medications that achieved some modest short term gains but had no lasting positive effects.
“In this study, the authors pooled together MRI brain-scan data for the 3,242 participants in the study (which had been collected and archived at the 23 sites), and then calculated, for each cohort, mean intracranial volumes and mean volumes of specific brain regions. They reported the differences for each of these comparisons and the “effect size” of the differences. This is the critical aspect of the results to consider and understand: effect sizes reveal the true strength of the findings and how much overlap there is between the individual brain volumes in both groups, and thus establish the likelihood that an individual in the ADHD group has a smaller brain volume than an individual in the control group.
The biggest effect size that was found was .19. This was for differences in the mean volume of a region known as the accumbens for ADHD labelled children under 15 years of age. An effect size of 3, which is the largest effect size one can obtain using this type of statistic, would have suggested that pretty much all of the children in the study that were labelled as having ADHD had a distinctly smaller volume in that region than controls. An effect size of 2 would have suggested a distinctly weaker relationship and that some of the children in the ADHD group did not have smaller volumes than the control group, some in the ADHD group had larger volumes than the control group, and some of the control group had smaller than average volumes in that region and yet showed no signs of ADHD. An effect size of 1 would have indicated even a weaker relationship. The effect size of .19 is less than a fifth the size of 1, that is, about a small an effect size as you can imagine. (To learn more about what an effect size is, access this article by Robert Coe: 
Particularly troubling is the suggestion by the study’s authors that their findings will help to reduce stigma. How in the world does telling people that ADHD people have smaller brains help to reduce stigma for that group of people? Moreover, even if we found enough evidence to conclude that there are some differences in the brains of people being labelled ADHD, this would still not lead us to conclude they have a brain disorder. A difference is not automatically a disorder. Having people with different brains can be a wonderful thing. For example, it can mean that some people will prefer to work sitting all day, while others prefer to do work requiring lots of activity. We need both types of people, and other types as well, to enrich our lives.