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Current classification of mental disorders is wrong

classification mental disorders sluggish cognitive tempo aspergers syndrome adhd autism

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#1 jack black

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Posted 17 July 2016 - 03:50 PM


Because it's based on subjective and imprecise criteria.

I strongly belive in science and I don't find psychology or psychiatry scientific at all.

You have a whole gamut of human personalities and behaviors most often shaped by genetics (by all those thounsands of SNPs, polymorphisms, and mutations) and yet we are trying to pigeon hole them into one of several disorders. When something doesn't fit, you qualify it with comorbidities. Now, while the current classifications are useful for treatments of some or even most conditions, it fails in some others, such as sluggish cognitive tempo (SCT) or Asperger's syndrome, that are not currently oficially recognised (DSM-5) and lumped with ADHD and autism, respectively.

 

IMHO, the emerging population genetics and advanced in neurobiology will change it all.

 

Here is my personal problem.

When I take an Asperger's syndrome quiz here: http://psychcentral....zzes/autism.htm

It cames back strongly positive (scored a total of 38, Autism likely).

 

When I take an ADHD quiz here: http://psychcentral....zes/addquiz.htm

It cames back strongly positive (scored a total of 41, Inattention Subscale: 26, Hyperactivity/Impulsivity Subscale: 15, Adult ADHD).

 

When I take a bipolar quiz here: http://psychcentral....ipolar-test.cgi

It cames back somewhat positive (Depression score: 24, Mania score: 16, People who have answered similarly to you typically qualify for a diagnosis of Bipolar disorder. However, you wouldn't ordinarily meet the diagnostic criteria for bipolar disorder given the symptoms you've checked off).

 

When I take a depression quiz here: http://psychcentral....ession-quiz.cgi

It cames back moderately positive (scored a total of 47, Based upon your responses to this depression quiz, you appear to be suffering from a moderate to severe depression).

 

When I take a SCT quiz here: http://psychcentral....-tempo-quiz.cgi

It cames back strongly positive (scored a total of 29, strong sluggish cognitive tempo).

 

When I take a Borderline Personality Disorder quiz here: http://psychcentral..../borderline.cgi

It cames back strongly positive (scored a total of 35, severe Borderline Personality Disorder).

 

At this point I'm bored and I'm not taking them any more (granted I ommitted the ones that were not likely to result positive).

 

Now, someone will say, I should stop self diagnosis and see a mental health specialist. The thing is I did numerous times in my life and I found out I was given contradictory and useless advice or treatments. Same with my kids. We spent a lot of money for similarlly contradictory and useless advice or treatments.

 

I rest my case.

 

Anyone cares to comment?

 

 

 

 

 

 

 

 


Edited by jack black, 17 July 2016 - 03:53 PM.

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#2 gamesguru

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Posted 17 July 2016 - 10:19 PM

have you considered the possibility that you are a sick puppy, or a piece of work, with a large cluster of symptoms which overlap on the core of multiple disorders?



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#3 jack black

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Posted 18 July 2016 - 02:19 AM

have you considered the possibility that you are a sick puppy, or a piece of work, with a large cluster of symptoms which overlap on the core of multiple disorders?

 

I'm a piece of work alright, thanks for the complement.

Fortunately, i'm fairly highly functioning (this is what i think, I'm sure my family and coworkers disagree).

 

I could be wrong, but I feel a lot of people can satisfy criteria for multiple mental disorders.

 

Quick search shows I'm not alone with the critism: https://en.wikipedia...ental_disorders

 

 

There is some ongoing scientific doubt concerning the construct validity and reliability of psychiatric diagnostic categories and criteria[41][42][43] even though they have been increasingly standardized to improve inter-rater agreement in controlled research. In the United States, there have been calls and endorsements for a congressional hearing to explore the nature and extent of harm potentially caused by this "minimally investigated enterprise".[44][45]

Other specific criticisms of the current schemes include: attempts to demonstrate natural boundaries between related syndromes, or between a common syndrome and normality, have failed; the disorders of current classification are probably surface phenomena that can have many different interacting causes, yet "the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise operational definition tends to encourage us to assume that it is a "quasi-disease entity" that can be invoked to explain the patient's symptoms"; and that the diagnostic manuals have led to an unintended decline in careful evaluation of each individual person's experiences and social context.[30]

Psychodynamic schemes have traditionally given the latter phenomenological aspect more consideration, but in psychoanalytic terms that have been long criticized on numerous grounds.

Some have argued that reliance on operational definition demands that intuitive concepts, such as depression, need to be operationally defined before they become amenable to scientific investigation. However, John Stuart Mill pointed out the dangers of believing that anything that could be given a name must refer to a thing[citation needed] and Stephen Jay Gould and others have criticized psychologists for doing just that. One critic states that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions. Thus in psychology, as in economics, the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992, 275) for mainstream methodological practice."[46] According to Tadafumi Kato, since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews. Kato argues there has been little progress over the last century and that only modest improvements are possible in this way; he suggests that only neurobiological studies using modern technology could form the basis for a new classification.[47]

According to Heinz Katsching, expert committees have combined phenomenological criteria in variable ways into categories of mental disorders, repeatedly defined and redefined over the last half century. The diagnostic categories are termed "disorders" and yet, despite not being validated by biological criteria as most medical diseases are, are framed as medical diseases identified by medical diagnoses. He describes them as top-down classification systems similar to the botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori which visible aspects of plants were relevant. Katsching notes that while psychopathological phenomena are certainly observed and experienced, the conceptual basis of psychiatric diagnostic categories is questioned from various ideological perspectives.[39]

Psychiatrist Joel Paris argues that psychiatry is sometimes susceptible to diagnostic fads. Some have been based on theory (overdiagnosis of schizophrenia), some based on etiological (causation) concepts (overdiagnosis of post-traumatic stress disorder), and some based on the development of treatments. Paris points out that psychiatrists like to diagnose conditions they can treat, and gives examples of what he sees as prescribing patterns paralleling diagnostic trends, for example an increase in bipolar diagnosis once lithium came into use, and similar scenarios with the use of electroconvulsive therapy, neuroleptics, tricyclic antidepressants, and SSRIs. He notes that there was a time when every patient seemed to have "latent schizophrenia" and another time when everything in psychiatry seemed to be "masked depression", and he fears that the boundaries of the bipolar spectrum concept, including in application to children, are similarly expanding.[48]Allen Frances has suggested fad diagnostic trends regarding autism and Attention deficit hyperactivity disorder.[49]

Since the 1980s, psychologist Paula Caplan has had concerns about psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label". Caplan says psychiatric diagnosis is unregulated, so doctors aren’t required to spend much time understanding patients situations or to seek another doctor’s opinion. The criteria for allocating psychiatric labels are contained in the Diagnostic and Statistical Manual of Mental Disorders, which can "lead a therapist to focus on narrow checklists of symptoms, with little consideration for what is causing the patient’s suffering". So, according to Caplan, getting a psychiatric diagnosis and label often hinders recovery.[50]

The DSM and ICD approach remains under attack both because of the implied causality model[51] and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.[52][53]


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#4 gamesguru

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Posted 18 July 2016 - 08:15 AM

are you suggesting we must devise a system whereby each person is mapped bijectively to a single disease? such a system may be impossible to devise, for the way diseases present themselves, it is often impossible to fully delineate their symptoms. for example, autism, schizophrenia, and ADD all have (remarkably similar) components of attentional and emotional dysregulation.  that's also the reason why people often satisfy criteria for more than one personality disorder, yet can you devise a system where each person only gets one? you might start lumping diseases together, ADD and depression, just call it ADDD (3 Ds). anxiety and depression? AADD.

 

studies using modern technology could form the basis. great. til then we're stuck with this top-down, outside-in sort of guess-work model of the brain. and it works sort of well at compartmentalizing and classifying people into appropriate treatments. you can even go against the advice of the institution, be a total savage, self-diagnose and -medicate yourself, and say some such thing as, gosh, i bet i would benefit from a daily tab of lithium orotate over amazon.

 

just because a sea slug is infected with both a bacteria and a fungus does not mean, of necessity of simply explaining its disease-state, that we ought to be required to come up with the phrase eukaryotic infection, to encompass in our description the simultaneous presence of both agents. no ffs. you just say it has Chlamydia and Achyla



#5 jack black

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Posted 18 July 2016 - 06:35 PM

are you suggesting we must devise a system whereby each person is mapped bijectively to a single disease? such a system may be impossible to devise, for the way diseases present themselves, it is often impossible to fully delineate their symptoms. for example, autism, schizophrenia, and ADD all have (remarkably similar) components of attentional and emotional dysregulation.  that's also the reason why people often satisfy criteria for more than one personality disorder, yet can you devise a system where each person only gets one? you might start lumping diseases together, ADD and depression, just call it ADDD (3 Ds). anxiety and depression? AADD.

 

studies using modern technology could form the basis. great. til then we're stuck with this top-down, outside-in sort of guess-work model of the brain. and it works sort of well at compartmentalizing and classifying people into appropriate treatments. you can even go against the advice of the institution, be a total savage, self-diagnose and -medicate yourself, and say some such thing as, gosh, i bet i would benefit from a daily tab of lithium orotate over amazon.

 

just because a sea slug is infected with both a bacteria and a fungus does not mean, of necessity of simply explaining its disease-state, that we ought to be required to come up with the phrase eukaryotic infection, to encompass in our description the simultaneous presence of both agents. no ffs. you just say it has Chlamydia and Achyla

 

LOL, I had to look up what bijectively is. Maybe in the future the patients will have all genetic and epigenetic info mapped and scorred in multiple dimensions and that will be their exact diagnosis.

 

But, we cannot treat psychiatry as serious science now, when all it does is look at the (often overlapping) symptoms, but not the cause of the disease, and throw different drugs and see what sticks.

 

Also. I don't think the analogy of sea slug is good. In medicine or biology, one can see or test for the infectious agent(s) and treat accordingly. We have nothing like that in psychiatry yet. The psychologic tests and diagnostic criteria are a joke.

 

But it you insist using that analogy, this is my story translated for you.

A sea slug showed up in a psychiatrist's office complaining of fever and fatigue.

The psychiatrist noticed fever and said it must be bacterial infections and gave a script for antibiotics. It didn't help but gave slug diarrhea.

The sea slug went to another psychiatrist who noticed fever and diarrhea, said it must be ameba infection and gave a script for toxic anti-protozoal. It didn't help but made slug very weak.

The poor slug felt much worse and went to see a psychologist. The psychologist didn't check for fever and determined it's all in slug's head, gave him some expensive talk therapy, and send slug home where he died.

 

Alternative ending: the slug examined a blood smear himself (is blood green in those?) noticed fungi and cured himself with anti-fungal smuggled from the dry land. He lived happy after.


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#6 gamesguru

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Posted 18 July 2016 - 07:19 PM

"all genetic and epigenetic info mapped"

that may happen eventually, but it doesn't change the fact that each disease expresses itself as a unique set of symptoms, which can (usually) be differentiated from similar diseases. thus after APPROPRIATE examination, a firm and reliable diagnosis may be made without all this thorough, internal, molecular examination of the brain (not that it won't contribute to our understanding, it will).

 

the overlap isn't going away, what it may do is highlight contexts in which new drugs work and old ones don't. if we find genes common to autism and shizophrenia (which we will), it's going to help us find out the cause and explain why different medicines vary in effectiveness.

 

the symptoms also aren't going away. you may say genes ABC, NOP, and XYZ are frequently mutated and thought to be associated with mental illness. but without any actual population, any actual sample, any actual observation on symptoms, how to put a name to the face? it's a shot in the dark. same with medication, then how to say if it is working? just re-analyze your genes and molecules, tear you apart from the inside? ok, chief.

 

already people are looking at biomarkers. proposed for schizophrenia... endocannabinoids, dopamine/HVA, kyneurenic acid, and NGF to name a few. just recently they discovered a blood test for alzheimers, purportedly 100% accurate[1].



#7 jack black

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Posted 25 September 2016 - 07:19 PM

I have an update in a separate thread: http://www.longecity...-what/?p=790291


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#8 farware

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Posted 28 September 2016 - 06:25 PM

I agree with all of your points. Unfortunately I cannot propose an alternative and if I could I would probably get a nobel prize for it, eh? 

 

This is not accurate science because we lack the tools to properly diagnose illnesses (not just mental). So unless you have a new way to identify illnesses via your gene profile (SNPs and the like) and couple that with nanotechnology we are stuck. 

 

I do believe such technology and tools will emerge eventually but the current monopolistic system is preventing innovation. Pharma companies are doing to well and are often paying huge sums to falsify studies or to pay pharmaceutical salespeople that promote drugs to doctors on retreats and such


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#9 psychejunkie

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Posted 29 September 2016 - 04:44 AM

Science is still growing and we're far away from Ultimate Science or Absolute Truth.

anything can be wrong and maybe modified in later times or decades, like it have changed and renewed many times already.



#10 jack black

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Posted 29 September 2016 - 11:36 AM

Well yes but that particular discipline of "science" is very far from the truth and it's very obvious to anyone (with common sense), but the actual establishment. They will fight the change of course.

I do believe I have common sense. When I've heard about Freud and his psychoanalysis (long time ago) i thought it was a bunch of baloney. It took some time to prove me right.

It's actually tragic that the whole thing was taken seriously, although less so in Europe.

Edited by jack black, 29 September 2016 - 11:39 AM.

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#11 psychejunkie

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Posted 01 October 2016 - 04:14 AM

Well yes but that particular discipline of "science" is very far from the truth and it's very obvious to anyone (with common sense), but the actual establishment. They will fight the change of course.

I do believe I have common sense. When I've heard about Freud and his psychoanalysis (long time ago) i thought it was a bunch of baloney. It took some time to prove me right.

It's actually tragic that the whole thing was taken seriously, although less so in Europe.

 

Actually, lots of things which Freud and Jung were emphasizing, have been proved right!

but most people only can see the half empty of glasses.

 

good luck



#12 jack black

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Posted 01 October 2016 - 06:17 AM

Well yes but that particular discipline of "science" is very far from the truth and it's very obvious to anyone (with common sense), but the actual establishment. They will fight the change of course.

I do believe I have common sense. When I've heard about Freud and his psychoanalysis (long time ago) i thought it was a bunch of baloney. It took some time to prove me right.

It's actually tragic that the whole thing was taken seriously, although less so in Europe.


Actually, lots of things which Freud and Jung were emphasizing, have been proved right!
but most people only can see the half empty of glasses.

good luck

Ok I'll bait.
What exactly did Freud say that was right? besides discovery that cocaine is addictive after using it as a miracle drug on his patients?

BTW, keep Jung and Adler away from this.

#13 psychejunkie

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Posted 01 October 2016 - 08:41 AM

 

 

Well yes but that particular discipline of "science" is very far from the truth and it's very obvious to anyone (with common sense), but the actual establishment. They will fight the change of course.

I do believe I have common sense. When I've heard about Freud and his psychoanalysis (long time ago) i thought it was a bunch of baloney. It took some time to prove me right.

It's actually tragic that the whole thing was taken seriously, although less so in Europe.


Actually, lots of things which Freud and Jung were emphasizing, have been proved right!
but most people only can see the half empty of glasses.

good luck

Ok I'll bait.
What exactly did Freud say that was right? besides discovery that cocaine is addictive after using it as a miracle drug on his patients?

BTW, keep Jung and Adler away from this.

 

 

Freud:

  • There are subconsciousness and unconsciousness parts of human psyche.
  • Dreams are meaningful and have interpretations due to psychological activities
  • There are certain Libido or psychological energies which drives emotions and sexual behaviors
  • There are stages of psychological development throughout one's life and age.

 

CG Jung:

  • Dreams are psyche's ability to repair and consolidate certain memories and thought processes
  • unconsciousness part of human psyche have multiple layers of collective unconsciousness 


#14 jack black

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Posted 01 October 2016 - 02:58 PM

Freud:

  • There are subconsciousness and unconsciousness parts of human psyche.
  • Dreams are meaningful and have interpretations due to psychological activities
  • There are certain Libido or psychological energies which drives emotions and sexual behaviors
  • There are stages of psychological development throughout one's life and age.
Good luck proving the first 3. The fact that terminology got imbedded in western culture doesn't make them true (just like religion).

As for the 4th one. This is so common sense we didn't need Freud to tell us about it. Besides he got it wrong and had to be corrected by Erikson.

Edited by jack black, 01 October 2016 - 03:12 PM.

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#15 Mind_Paralysis

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Posted 01 October 2016 - 07:54 PM

Well yes but that particular discipline of "science" is very far from the truth and it's very obvious to anyone (with common sense), but the actual establishment. They will fight the change of course.

I do believe I have common sense. When I've heard about Freud and his psychoanalysis (long time ago) i thought it was a bunch of baloney. It took some time to prove me right.

It's actually tragic that the whole thing was taken seriously, although less so in Europe.

 

Actually, to some extents, it was actually even more so.

 

For instance - France has the lowest amount of clinically diagnosed ADHD-patients in the world - why is that then? Not because of statistically deviating genetics, no - but because they still have a very social-sciences way of viewing the disease - only the sickest and most ailing patients get the diagnose, and the proper medication.

 

They try at it with pointless and meaningless social sciences semi-support stuff instead, for the rest - giving them several smaller diagnosis to explain the issues, instead of acknowledging a highly disabling and pervasive neurological disorder.

 

I am less than enthused by the social sciences part of psychiatry, because of similar issues - such as a duo of sociologists trying to inject doubt into the efficacy and necessity of medication for ADHD - the "Gillberg vs Kärfve" case, to be accurate.

 

You can read about it here:
 

https://en.wikipedia..._and_perception

 

To me, these social sciences people, are in essence, ruining lives and trying to tell me water isn't wet, when anybody can fully damn well see that it IS!

 

Overall, as I understand it, there is less perscription of psychiatric drugs and ADHD-drugs in perticular, in the EU, than in the U.S.


Edited by Stinkorninjor, 01 October 2016 - 07:56 PM.


#16 psychejunkie

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Posted 02 October 2016 - 04:41 AM

 

Freud:

  • There are subconsciousness and unconsciousness parts of human psyche.
  • Dreams are meaningful and have interpretations due to psychological activities
  • There are certain Libido or psychological energies which drives emotions and sexual behaviors
  • There are stages of psychological development throughout one's life and age.
Good luck proving the first 3. The fact that terminology got imbedded in western culture doesn't make them true (just like religion).

As for the 4th one. This is so common sense we didn't need Freud to tell us about it. Besides he got it wrong and had to be corrected by Erikson.

 

the 4th is mostly about psychosexual development, I have to correct that.

 

but in general, I've to agree with that.

science isn't absolute and it even might not become one!



#17 jack black

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Posted 03 October 2016 - 12:00 AM

OK, instead of whining about my displeasure with the current state of psychology/psychiatry, maybe i should provide something constructive.

 

Here is my attempt. let's concentrate on depression, one of the most common mental "disorders." IMHO, it's not really a disorder, it's a symptom of many diseases. From my understanding of depression, it is a state of decreased brain functioning due to cortical neuronal loss and/or neurotransmitter dysregulation. We can consider it a type of mild, chronic brain failure, not dissimilar to that of say liver or renal failure.

 

Just like liver or renal failure can be caused by myriads of causes (genetic, autoimmune, infections, drugs, toxins, hypoxia, radiation, etc), the same way depression is caused by the similarly variable causes (genetic, autoimmune, infections, drugs, neurotoxins, hypoxia, radiation, etc). Some of those causes could be external to the organ (ie systemic inflammation/infection) vs internal (ie excitotoxicity).

 

But here is where the analogy of psychology/psychiatry to regular medicine breaks down. while a hepatologist or nephrologist will do a bunch of lab tests to determine the causes of organ failure to provide a specific treatment, a psychologist will do none of that and simply offer a "talk therapy" or a psychatrist will just slap a prescription of SSRI and see if it sticks.

 

Sometimes, the SSRI will stick, even though depression is not usually caused by low serotonin. but even then the treatment is just symptomatic and doesn't fix the underlying cause, not mentioning the side affects (including suicides at the beginning of therapy). many other times, the therapy/drugs won't work, simply because they target wrong things.

 

IMHO, patients complaining about symptoms of depression should be examined first (including blood and urine lab tests) to determine if the cause is outside the brain. for example, sinusitis, allergies, some drugs, gluten sensitivity, and nutritional deficiencies are common causes of depression. Hormonal issues like excessive corticosteroids or low thyroid would also belong here. These cases of secondary depression should be classified according to specific causes.

 

Only when those are excluded, primary depression should be classified according to specific pathways: low 5HT, high 5HT, high ACh, low DA, low NE/E, low methylation, excessive NMDA, low CD59, mitochondrial defects, defective oxidation defense, mixed pathways, etc. genetic testing should be very helpful to determine those.

 

There should be also room set aside for depression from chronic stress, chronic anxiety, etc. that should be obvious after some good history and psychology exams, but biomarkers also exist for those.

 

In the process of working up depressive patients with biomarkers, it will often be discovered that patients actually suffer from different psychiatric diseases (like bipolar, a common misdiagnosis now), or even early dementia.

 

I think technologically it's already feasible. we have the next generation sequencing and there are high resolution and/or functional brain scans available. the few psychiatrists that use brain imaging (outside the academia) seem to be very successful, yet are considered fraud by their conservative colleges (I'm talking about dr Amen here). 

 

i'm just not sure the current establishment is willing to adopt the paradigm shift yet. who knows, maybe it's time for a new generation of mental practitioners, naturoneuropaths?

 

 

 


Edited by jack black, 03 October 2016 - 12:48 AM.

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#18 hydrus

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Posted 26 August 2017 - 10:58 AM

my 2 cents:

 

psychiatry has become greedy, lazy and corrupted by big pharma which leads to 5 minute consultations and prescriptions for often ineffective(but very profitable) drugs.

 

Psychology is an arrogant vulture preying on vulnerable people, blaming them or their parents for their neurological problems without being able to provide any real help or cure.

 

Both are like monopolists which can survive providing sub-par service since no real alternatives exist.



#19 jack black

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Posted 08 May 2020 - 03:42 PM

came back later to this after seeing some evidence from the science that slowly proves my point.

 

 

Every single mental disorder predisposed the patient to every other mental disorder — no matter how distinct the symptoms1.

 

 

the old system of categorizing mental disorders into neat boxes does not work. They are also hopeful that, in the long run, replacing this framework with one that is grounded in biology will lead to new drugs and treatments. Researchers aim to reveal, for instance, the key genes, brain regions and neurological processes involved in psychopathology, and target them with therapies. Although it might take a while to get there, says Steven Hyman of the Broad Institute of MIT and Harvard in Cambridge, Massachusetts, “I am long-term optimistic if the field really does its work.”

 

from: https://www.nature.c...586-020-00922-8

 

there is more, mental disorders share some roots with epilepsy and migraine, that are not even considered mental diseases.

 


Edited by jack black, 08 May 2020 - 03:47 PM.

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#20 james freele

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Posted 09 May 2020 - 09:50 PM

I agree with you Jack Black. They are clueless as to what's going on Mark my words it is in the intestines the nerves will get help with lithium, I preferred zinc. As far as I'm concerned the holy Grail for life extension right now is the nerves. Some things like fluoride people know from brushing their teeth kills nerves I would rather enforce that and make it better with zinc. I had a doctor once say if I do not take the seizure medicine I cannot drive. I told him where to go I never had a seizure. That was many years ago when I was working on my intestinal issues using zinc in the wintertime when certain lipids will break up with temperature changes releasing viral problems more. Aka cold season.



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#21 jack black

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Posted 17 February 2021 - 07:06 PM

i came to update my old thread. the update is here: https://www.longecit...ental-deaseses/

 

in summary, the current practice of psychology/psychiatry focuses on labeling the mental diseases according to the symptoms ignoring that most of those have one common denominator: complex trauma, with some genetic variations of course.







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