Raising kids is one of the more challenging responsibilities that many of us take on in our lives. I know this from personal experience. My wife and I raised two rambunctious boys, and I’d be lying if I claimed I never once lost my temper.
I remember one particular incident when one of our boys was about ten. I had a pretty rough day at work, it was late, and I was pretty exhausted. Our son began making a great deal of noise in his room. I called up to him to quiet down. He got louder. I screamed again. When he still didn’t listen, infuriated, I rushed into his room and found him lying on the floor with a smirk on his face. I flung my foot back and then forward, kicking him in his thigh while screaming, “You think this is funny!”
I was barefoot, and I’m pretty sure I hurt my toes a heck of a lot more than his thigh, but my point is that from time to time, in a fit of anger, I went off the “ideal father” script. 
So, that said, in what is to follow, I’m not suggesting that the first time you lose your temper with your kids you have suddenly turned them into a future serial murderer, or anything of that sort. Both of my boys are now fully grown, and they are wonderful. Nevertheless, I do think it is worthwhile for parents to think about the most helpful approaches for bringing up their children, and to be guided by the best information available.
What about Spanking?
According to the most recent UNICEF study, 80% of children are spanked or otherwise physically punished by their parents. Is this a wise way to be raising children?
Over the years, hundreds of studies have been conducted that looked at the effects of this form of discipline on children’s behavioral, emotional, cognitive, and physical outcomes. Taken together, they provide evidence that physical punishment is associated with negative outcomes.
As this body of work on spanking and physical punishment has accumulated, supporters of spanking have argued that the current studies do not clearly distinguish spanking from more serious physically abusive parenting behaviors. They claim that it is probably only “real physical abuse” that leads to harm. Additionally, spanking, they have argued, has only been linked with detrimental outcomes in methodologically weak studies.
A Recent Study
A peer reviewed study (see study HERE) addressed the criticisms launched at the earlier ones. Titled, “Spanking and Child Outcomes: Old Controversies and New Meta-Analyses,” the researchers Elizabeth T. Gershoff and Andrew Grogan-Kaylor took a more up to date and sophisticated look at the research on this topic.
First, they looked separately at studies of parents’ behaviors labeled as “spanking” defined as noninjurious, open-handed hitting on the buttocks or extremities with the intention of modifying child behavior. This definition therefore excluded the use of objects, the use of methods that have a reasonable expectation of causing harm or injury (e.g., beating, burning, choking, whipping), and the use of methods that are gratuitous expressions of parent displeasure without a clear disciplinary component (e.g., pulling hair, shaking, shoving). In this way, the researchers were able to determine the extent to which ordinary spanking is linked with child outcomes.
Then they examined the ways in which the strength and direction of the associations between spanking and child outcomes compare with the strength and direction of the associations between clearly abusive methods and child outcomes.
To deal with the issue of poorly designed studies being included in previous analyses, these two researchers selected only peer-reviewed journal articles, and subjected them to a more advanced random effects meta-analyses. Finally, they were able to incorporate several dozen new, particularly well done, up to date studies not included in previous meta-analyses.
The Findings
Spanking was associated with more aggression, antisocial behavior, externalizing problems, internalizing problems, mental health problems, and negative relationships with parents. Spanking was also significantly associated with lower moral internalization, lower cognitive ability, and lower self-esteem.
Another finding strongly suggested that even for parents who do not intend to go beyond spanking as a form of punishment, the more children are spanked, the greater the risk that they will, in a fit of temper, end up physically abusing their children. Physical abuse was defined in the various studies somewhat differently. For example, one study referred to it as, “hitting with fist or object, beating up, kicking, biting, or beaten to injury.” Another defined it as “physical abuse leading to bruising.”
As expected, although spanking was associated with negative outcomes, physical abuse was found to have even greater negative outcomes. Said in a more technical manner, weighted mean effect size for spanking was d .25, while for physical abuse it was d .38. Both were significantly different from zero and both were positive in sign, indicating that both spanking and physical abuse were associated with greater levels of detrimental child outcomes. The magnitude of the mean effect size for spanking was 65% of the magnitude of the mean effect size for physical abuse.
Four of the studies compared adults who were spanked as children to those who were not. In three of the four, adults with a history of spanking from parents had more difficulties with controlling antisocial behavior, had more mental health problems, and came to believe physical punishment was a proper discipline strategy for their children.
It is important to point out that the researchers in these studies explained:
“While these findings suggest that there may be lasting impacts of spanking that reach into adulthood, they are only suggestive, as adults who engage in antisocial behavior or who are experiencing mental health problems may focus on negative memories of their childhoods and report more spanking than they actually received. The finding that a history of received spanking is linked with more support for spanking of children as an adult may be an example of intergenerational transmission of spanking, or it may be an example of adults selectively remembering their past as a way of rationalizing their current beliefs.”
Conclusions
The above research did not find any support for the contentions that spanking is only associated with detrimental outcomes when it is combined with abusive methods or that spanking is only associated with such outcomes in methodologically weak studies. The weight of the best evidence available indicates spanking has been linked with detrimental outcomes for children, a fact supported by several key methodologically strong studies that isolate the ability of spanking to predict child outcomes over time.
Now, as consistent as these findings are, they could very well have been far stronger if they had looked separately at a group of parents who not only didn’t use any form of physical punishment, but also didn’t use other forms of harmful approaches for raising kids. Said another way, within the group of non-spanking parents there may have been some who don’t spend much quality time with their children, or most frequently interact with them by screaming whenever they catch them misbehaving. If those parents were eliminated from the group of non-spankers, the difference between non-spankers and spanking parents probably would have been even far more impressive. Why do I say this? For several reasons.
In one study, for example, caregivers whose eyes wander during playtime due to distractions such as smartphones or other technology had babies with shortened attention spans when compared to parents who were more fully engaged with their babies. 
In another study, parents who had children already beginning to have discipline problems received some parenting training that involved such skills as catching their children doing some positive actions and praising them. By learning to do this at least three times for every one time they provided negative criticism when their child misbehaved, there was a distinct improvement in their child’s behavior when compared to parents who had been placed on a wait list to get parenting skill training.
In my view, one of the best ways to raise children is to have parents anticipate what types of problems might arise, and then discussing with their children how best to deal with them. By doing this at times when the child has not already begun to behave in the problematic manner, it is easier to have these discussions without a great deal of defensiveness interfering with reasoning processes. 
This is one of the reasons I’ve written a novel called A Hero Grows In Brooklyn. It can be downloaded on a computer or any of the popular electronic readers for free HERE. Parents can read a little of it each night with their children. Most children tend to identify with the hero, Cool Steve, along with his friend, Mysterious Jane. After each chapter, during a time that is pleasant and free of discord, parents can discuss with their children some of the issues that come up and the kindness that the two lead characters display.
Well, those are some thoughts for this week. Until next time, may you find life filled with wonderful opportunities to grow.
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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.
Just because some people have a difference in their genetic makeup that might be involved in a specific behavior pattern does not mean these people have a disease. I know that some say, it is only if the behavior pattern can be linked in some way to some risky behavior would we properly label those with such a pattern, diseased. But the risky descriptor is highly problematic for the following reason:
Let’s say we can find a reliable gene difference in some people who enlist in the military. We then find that joining the military places these people at greater risk of harm, and even death. Would the finding of this type of connection require us to say that this means all who join the military have a genetic disease? I think that would be wrong and unfair.
How about being a male? Being a male is clearly due to some genetic difference when compared with the other sex. Males are clearly at a greater risk of violence, and they are more prone to dying from a number of diseases at an earlier age than women. Therefore, does it make sense that all males have a genetic disease? Not in my opinion.
These include tumors, microbe infections, tissue tears, bone fractures, and blockages to organs such as the heart. If some genetic difference is correlated to one of these pathological conditions, we say that the genetic difference is a risk factor for the particular disease.
With regards to the individuals who are now being classified as having ADHD, the vast majority have no identified scientific pathology. Moreover, often we find that once they get out of a setting in which they are forced to sit in school for hours and hours, they find a career and life style that many value.
In my view, the motivation behind physicians classifying the behavior pattern now referred to as ADHD has nothing to do with science, but rather, to make money. The pharmaceutical companies make billions of dollars by promoting the disease concept of ADHD, and many physicians have found their medical practice has enormously benefited as well.
In contrast, Director Martin Scorsese put out a statement saying he was “overjoyed” that Dylan was awarded the prize. He went on from here to say:
Alfred Nobel was the inventor of dynamite and was one of the original (to quote from one Dylan song) “Masters of war/You that build the big bombs” — i.e. he not only was a major producer of modern cannon, but also was one of the first modern armament producers. In addition, a premature obituary of Nobel, calling him a “merchant of death,” presumably inspired Nobel to turn philanthropist by creating the prizes.
If he ends up landing on the other side, he’d end up in the mucky manure of folks who think that he would be disrespectful of a bunch of fine folks, such as Martin Luther King, Jr. and Albert Einstein. Such folks were as passionate as anyone with regards to promoting peaceful ways to work out human problems and yet chose to accept a Nobel Prize.
At 39-years of age, Ron had been a respected employee in a department store for nearly ten years. If he had made it to ten full years, he would have qualified for some extra benefits. Upper management chose to replace him with someone new a week before the ten years were up. Discovering that landing a new job was leading to one rejection after another, Ron fell into an anguishing depression.
“You’ve been paying for mental health coverage on your health policy for over fifteen years. You might as well take advantage of it and see if a professional can help you through this.”
At his first appointment with Dr. Sigmund, a cigar smoking psychologist, Ron discovered that to access mental health services with his health policy, he would have to be labeled as a person with a mental disorder. “I don’t want that kind of nonsense in my medical record,” he told Dr. Sigmund. “I’m not mentally ill! I’m just going through some tough times right now and I can use some professional help getting through this.”
“Listen, Doctor, I’ve been paying for this mental health coverage for years and no one ever told me I had to be given a stigmatizing label to access services. That’s not fair.”
In fact we have recently learned that these disorders are properly viewed as genetic diseases. The evidence is pretty plain. We have learned that these types of conditions run in families, and genetic research has even identified the actual genes that are involved.”
First, Dr. Sigmund declares that “Without a mental disorder diagnosis, which I must place on the insurance form, I can’t see you.” This is pretty often true. In the United States, if you want to take advantage of your mental health insurance coverage, insurers require a mental disorder diagnosis [see 
In my opinion, it is not sound science that came up with these types of labels, but rather, a business model that serves the pharmaceutical industry and psychiatry. Psychologists have gone along with the plan for practical reasons. Additionally, some actually are convinced that the labeling system is indeed based on principles of science. For a full critique of their position, see 
In the parable, Dr. Sigmund declares that “these disorders are properly viewed as genetic diseases.” Is this a fair statement? The simple answer is no. To reasonably arrive at this answer, we’ll have to spend some time going step by step through some basic ideas.
Even identical twins won’t always have the same set of these types of characteristics despite the fact that a pair of identical twins have the same set of genes.
To understand why the answer is no, we have to first understand that all species have a great number of characteristics, and each of their characteristics vary to some extent between different members of their species. For example, human beings have a typical height, they can run at a typical speed, etc. The average height of male humans is about 5 feet, 9 inches. Some, men are, however, somewhat taller, others are somewhat shorter, and some are quite a bit taller or quite a bit shorter. Similarly, some men can run at the average speed for men, while others can run at various rates that are different from average.
If someone is above average in height, this does not mean he or she will be above average in running speed. Each of our numerous characteristics can be either within the average range, above average, or below, and because someone is below average in some set of characteristics does not mean that he or she will not have some characteristics that are average or even above average. And these differences are a great boom to the human race. If everyone was brilliant in academics and also had a strong genetic desire to be a professor at Ivy League universities, who would build the roads, drive our trucks, grow our crops, serve in law enforcement, cut our hair, tend to the sick, serve as fire fighters, staff stores, serve us in restaurants, etc.? People with different interests and talents enhance our own lives.
If you do end up shorter than average this does not mean you have a genetic disease, even if we can demonstrate that taller people tend to have some advantages over people who are shorter. Saying that people who are shorter than average have a dysfunction would be stigmatizing while clouding the fact that we cannot determine a person’s overall functioning based on just one set of characteristics. Being shorter, when combined with the rest of a person’s characteristics, can lead to him or her being more useful in a variety of ways.
Let’s move on now from discussing a person’s height to a more complex set of characteristics–athletic performance. There is some evidence that athletic performance might be a set of characteristics that, to some degree, 
Rather than pathologizing below average athletic skills, I’ve seen physical education teachers who encourage such children to participate in some after school programs that develop skills in sports that can be practiced non-competitively, such as running, bicycling, and golf. Some of these children take to such programs willingly and end up staying in fine physical shape the rest of their lives. If they don’t, they suffer the consequences and all of us end up paying higher health premiums because they are at an increased risk of getting sick. At the same time, their other sets of characteristics, when combined with their couch potato ways, may offer them and the rest of us some valued fruits.
I know that some psychologists say, it is only the sets of characteristics that can be linked in some way to a “dysfunction” that are properly labeled as a disease. But the dysfunctional descriptor is so vague that it can be applied to the vast majority of people, and, perhaps, everyone.
How about becoming a psychiatrist? This may run in the family. If we find that becoming a psychiatrist increases the likelihood of committing suicide, which some data suggests, are all of them to be viewed as having a genetic disease, or would it be clearer, and more scientific, to say their set of characteristics is a “risk factor” for some negative outcome? I believe the latter is more scientific.
Instead, psychologists have a conversation with the person seeking mental health services.
As I read the research on this issue, it became plain to see that genes can be likened to the buds of a beautiful flower. If they meet up with the right soil, sunlight, water, and care, they typically blossom into something beautiful. But even with a great deal of wonderful nourishment, sometimes they get tangled up with some surrounding weeds. Stigmatizing labels don’t help in such situations. Instead, some wise gardening can make a beautiful difference.
Dr. Kandel’s credentials are pretty impressive–he’s a Nobel Prize laureate and professor of brain science at Columbia University. Therefore, if you are among those who believe a person’s credentials should determine who is right and who is wrong, you need not read any further. You must simply conclude that what is referred to as mental illnesses are indeed brain diseases because you would be hard pressed to find someone with better credentials disagreeing with Dr. Kandel.
The argument that such labeling practices are not scientific, but, rather, value judgments, was intelligently made by William James when he defended the religious sentiment. He explained that pathologizing these sentiments as mental diseases was superficial medical talk. He called the reasoning doctors used to declare religious beliefs a type of mental illness, “medical materialism.”
assumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content.
All states of mind are related in extremely complex ways to neural functions. There is a crucial distinction to be made between a brain difference and a brain pathology. The significance of each state of mind must be tested, not by some neurological difference, but by the value of its fruits. When the term “pathological” is applied to an experience, rather than an identified physiological pathology, it wrongly implies a neutral science classification.
In contrast to biological arguments, 
Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.
Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.
Literature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:
I actually like Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly uses diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.
At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”
Does it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.
For example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.
Having indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.
In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.
Although there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.
Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.
A six-month investigation by The New York Times found that in the push to win customers, some Abbott managers instructed employees to pursue sales at virtually any cost. Among the ploys used to sell drugs, Abbott managers told sales staff to hold what the company called health camps, where representatives would perform tests on patients for various ailments in an effort to drum up business for doctors, who would then prescribe Abbott drugs.
Immediately on the heels of the suicide story, I began to hear the media uproar over the marketing strategy by the company that manufactures EpiPens.
Mylan has a veritable run of the market. It therefore, in a few short years, raised the price of EpiPens again and again. As of this May, they cost 
These latest two media stories are just a tip of the iceberg when it comes to how the pharmaceutical industry is treating its customers disrespectfully. Anyone who really wants to know the full story would do well to read Dr. Marcia Angell’s superb book, The Truth About the Drug Companies: How They Deceive Us and What To Do About It. The author has an M.D. degree, and for two decades was editor in chief of the prestigious New England Journal of Medicine. There she had a front row seat on the growing power and corruption of the industry.
As Dr. Angell powerfully demonstrates, claims that high prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into marketing of their products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.
How do the drug companies get away with this, since a patent is only supposed to be issued when the new drug is useful, novel, and non-obvious. The drug companies have the largest army of lobbyists in Washington, D.C. If you think the gun lobby has an unfair hold on politicians, it is small potatoes when it comes to the pharmaceutical industry.
How do drug companies justify all of their me-too drugs? They claim that it is good to have more than one drug to treat a condition, because if the first one doesn’t work, the second might. Here’s Dr Angell’s reply:
The solution to getting the drug companies to start treating us respectfully would be fairly easy if only Congress could fire up the will to stop listening to the industry’s lobbyists. Laws could simply be enacted that would replace the 20 year patents on new drugs with laws that would provide a patent that lasts only until the company recoups its investment in creating the drug. When the patent runs out, they could still continue to sell the drug without the patent. After all, companies that sell off-patent generic drugs do make profits, but just not as outrageous profits that allow the industry to employ more lobbyists on Capital Hill than there are congressmen.
Unfortunately, the influence of the lobbyists have been way too great for the lawmakers to resist going along with the drug companies. So, as is often the case, it is up to those of us who are being treated disrespectfully to stand up and powerfully advocate that we begin to be treated respectfully. 
This would entail making it known that we voters will only support candidates who are running for office who refuse to take money from the pharmaceutical industry. If there are no such politicians running in the district we live in, we must identify someone who is willing to run on this issue, and then we must work to get that person elected. Without such action, we folks will have to accept that being treated disrespectfully by the drug companies is just a sad part of life.
Welcome to “From Insults to Respect.” Regular readers know that I have some serious objections to how mental health service providers treat those seeking their services. As things stand now, unless you can afford to completely pay for such services without any insurance coverage, to access services you are very likely to be required to be labelled as having a mental disorder.
Recently I provided a post titled, “
Whitaker was a medical writer at the 
In 2002, 
As Stip noted in his 2002 paper, there is no compelling evidence in the literature that antipsychotics improve long-term outcomes. The relapse studies do not provide such evidence, and there is no other body of research that does. However, as can be seen in this paper, there is a history of science, stretching across six decades, that consistently tells of a medical treatment that, in the aggregate, does more harm than good.
The first long-term study reveals a higher rehospitalization rate for patients treated initially with antipsychotics.
Guy Chouinard and Barry Jones, drawing on an emerging understanding of how antipsychotics change the brain, provide a biological explanation of why that would be so. They then test their hypothesis and find that a significant percentage of medicated patients suffer from drug-induced tardive psychosis. 
MRI studies reveal that antipsychotics induce changes in brain volumes that are associated with a worsening of positive and negative symptoms, and adverse cognitive effects. 
In order to argue that antipsychotics do not worsen long-term outcomes in the aggregate, all of this evidence would have to be explained away. This entire history of science would need to be discounted. In addition, this review has focused on the benefit side of the risk-benefit equation for antipsychotics. The drugs are supposed to provide the benefit of reducing psychotic symptoms. 
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.
I believe that if more of us were presented with this outline, and then discussed why many people feel that people who reason at the lower levels are more immature, and, at the higher levels, more mature, this would begin to challenge us to learn how to make our judgments stand out like the sun after a long bout of rainy skies. If we then practiced writing assignments in which we had to defend a position, while utilizing the model of the highest level of reasoning, this would further challenge us to make some improvements in making sound judgments.
Moreover, each stage is discussed in such a way that the reader gets an idea of not only what the position looks like when it is firmly established, but also what it looks like as a person begins to emerge from a lower stage to a higher stage of reasoning. But, as written by Perry, each stage is way too complicated to be readily understood by most of us. I have, therefore, taken the liberty of simplifying Perry’s terminology and transforming his four stages into seven, so that each level can be described in a relatively concise, easy to understand manner. Unfortunately, some of the subtleties of Perry’s higher level discourse are lost in my translation. The reader interested in a full description of his model is referred to Perry, 1970.
Examples: Mary asks Pete, Sally, and John, “Please tell me how much two plus two equals, and then defend your answer?” Pete answers that he doesn’t know the answer. Sally answers, “The answer is four but I don’t know why.” and John answers, “The answer is four because it just does.” Pete, Sally, and John are all at Stage 1.
For issues that seem straight forward to a student like simple math problems, (How much does two plus two equal?) or relatively clear cut moral issues (Is lying wrong?) Stage 3 students might have just heard one position taken on the subject and are therefore likely to answer just like Stage 2 students, mentioning only one authority. We can only tell that a student has moved from level two to level three when they are asked to defend a position on which they have heard differences of opinion. Then two or more authorities are oftentimes mentioned.
Stage 4: Like those at Stage 3, students at Stage 4, when asked to defend their position on a topic, will demonstrate that they are aware that sometimes different authorities may have different opinions on a topic. What makes students at Stage 4 different than students at Stage 3 is that they can summarize some of the reasons authorities provide when defending their positions. Although students at Stage 4 are beginning to be able to describe different points of view, they oftentimes have a hard time deciding what is true from their own perspective. This is less likely to occur with simple math answers, or relatively clear cut moral issues such as, is lying wrong? For more difficult issues, when challenged to choose between two positions the one that seems more right, they may indicate that they don’t know, or that both are right, or they will pick a position, without any conviction, just to please the questioner.
Examples: 1. Mary asks Sally, “Please tell me how much two plus two equals, and then, defend your answer.” Sally answers, “The answer is four. I know it’s four because my teacher showed us that if you take two sticks and you put them side by side, and then you take two more sticks, and put them beside the other two sticks, and then if you counted all the sticks that were there you’d get four. If you did the same thing for pennies or bricks, or anything, you’d also get four.” 
2. Nancy asks Bob, “Please tell me who you think was the greatest baseball player that ever lived and defend your answer.” Bob answers, “My dad says he thinks Mickey Mantle was the greatest ball player because he was so fast, and when he hit a home run it’d go a mile. My uncle thinks Willie Mays was better because he was great for a lot more years than Mantle.” Nancy then says to Bob, “You told me what your dad and your uncle think. Now tell me who you think was the best and defend your answer.” Bob answers, “I really don’t know.”
Stage 5: Students at this level, when asked their position on a topic, will answer a lot like Stage 4 students. What makes students at Stage 5 different than Stage 4 students is that if they are not familiar with two or more positions on the topic of interest they do research, deliberately seeking out authorities with different opinions in an effort to challenge themselves and their audience to think more deeply about the issue.
“Everyone has a right to her own opinion and mine is as good as any.” As students’ personal opinions are challenged by their teachers’ insistence on evidence and support for opinions, Stage 7 students become better at stating the reasons authorities give for their opinions, doing research that identifies different points of view, listing the pros and cons of each position, and recognizing that the meaning of an event depends on the context in which the event occurs. These skills occur at Stage 6 as well as Stage 7, but become stronger and more elaborated for students at Stage 7. Finally, Stage 7 students can do one thing that Stage 6 students are unable to do. After Stage 7 students review the different positions of authorities, and point out that answers depend on certain situations, they can then take a tentative stand as to what answer is right from their own point of view. Notice in the example below that much of the answer is very similar to one that would be given by a person at Stage 6.
If you did the same thing for pennies or bricks, or pretty much anything else you’d also get four. The thing is, my dad showed me that the answer to how much two plus two equals depends on the situation. Let’s say you have two family members, a husband and a wife. And then, let’s say you have two more family members, also a husband and a wife. In this kind of situation, a husband and a wife can start to have children, and in time, two family members plus two family members can end up equaling five, or six, or even more family members. Also, let’s say you have two pieces of glass, and you add two more pieces of glass, and then, in this special situation, one of the pieces of glass breaks. All of a sudden, two pieces of glass plus two pieces of glass ends up equaling more than four. So it depends on the situation. For me, I think that most of the time the best answer for the question, what does two plus two equal, should be four. That’s the answer that works most of the time. Still, it’s important to be aware that in certain unique situations, a different answer might be better. 