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Though Sigmund Freud was a trained neurologist, he never liked the idea of other doctors practising psychoanalysis. In a paper written in 1927, he explained that a medical degree was a disadvantage to the aspiring analyst because it would leave his head full of ideas “of which he can never make use”. There was even a “danger of its diverting his interest and his whole mode of thought from the understanding of psychical phenomena”, which ought instead to be informed by “psychology, the social sciences, the history of civilisation and sociology”. Psychoanalysis was not – not on Freud’s watch – to be “swallowed by medicine”.
It is lucky he didn’t see what happened next. Today the most widely accepted method for understanding “psychical phenomena” is one practised by doctors and dependent on concepts derived from the study of physical disease. Pre-eminent in the field is a medical institution, the American Psychiatric Association (APA), whose latest taxonomy of human suffering is published this month.


In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.

The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversybecause of several contentious changes to existing diagnostic criteria.


“The strength of each of the editions of DSM has been ‘reliability’ — each edition has ensured that clinicians use the same terms in the same ways,” reads the announcement from NIMH director Thomas Insel. “The weakness is its lack of validity.” In particular, Insel notes, diagnostic criteria in the DSM are based on symptom clusters, rather than any objective measures. As experts continue to broaden their understanding of genetics and cognitive science, for instance, Insel anticipates the possibility of more rigorous diagnoses. “Patients with mental disorders deserve better,” he added.

To promote those rigorous diagnoses, the NIMH will now focus on funding research that digs into these underlying biological mechanisms. The eventual goal, Insel writes, is to collect “the genetic, imaging, physiologic, and cognitive data to see how all the data — not just the symptoms — cluster and how these clusters relate to treatment response.”

Of course, it’ll be decades before these new research programs inform diagnoses or yield new treatments for mental disorders. But for now, the move — and its timing — suggests that the “bible” of mental health might not merit that moniker for much longer.

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs.

For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.

Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as “chemical imbalances”.

This leads us to be blind to the social and psychological causes of distress.

More importantly, we tend to prescribe medical solutions – anti-depressants and anti-psychotic medication – despite significant side-effects and poor evidence of their effectiveness.

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The criteria for “generalised anxiety disorder” would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”

Prof Peter Kinderman
This is wrong. We should not be diagnosing many more people with meaningless “mental illnesses”, telling them these stem from brain abnormalities, and prescribing medication.

Sex addiction
An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.

But this latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.

The new diagnosis of “disruptive mood dysregulation disorder” will turn childhood temper tantrums into symptoms of a mental illness
Normal grief will become “major depressive disorder”, meaning people will turn to diagnosis and prescription as a response to bereavement
The criteria for “generalised anxiety disorder” will be significantly relaxed, making the worries of everyday life into targets for medical treatment
Lower diagnostic thresholds will see more diagnoses of “adult attention deficit disorder”, which could lead to widespread prescription of stimulant drugs
A wide range of unfortunate human behaviours, the subject of many new year’s resolutions, will become mental illnesses – excessive eating will become “binge eating disorder”, and the category of “behavioural addictions” will widen significantly to include such “disorders” as “internet addiction” and “sex addiction”
Stigma of diagnosis
Standard psychiatric diagnoses are notoriously invalid – they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.

In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.

Scientific evidence strongly suggests distressing experiences result not from “faulty brains”, but from complex interactions between biological, but more importantly, social and psychological factors.

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach
There are humane and effective alternatives to traditional psychiatric diagnoses.

It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.

We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.

This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.

Wouter Basson is currently getting headlines for his role in waging chemical warfare for the apartheid military. But less well known is the case of apartheid doctor Aubrey Levin, who is alive and well and, until last year, was still practicing psychiatry in Canada. By REBECCA DAVIS.

They called him ‘Dr Shock’. Levin, chief psychiatrist in the apartheid-era military, earned the nickname for his belief that homosexuality could be cured by electric shock treatment. Levin’s involvement in this line of work began in the late 1960s. In 1967 the UK passed its Sexual Offences Act, which decriminalised certain homosexual acts, and the apartheid government mooted the possibility of doing the same. But into the breach stepped Levin, who wrote to the parliamentary committee in charge of considering the idea, to inform them that there was no need to take this legislative route because he could “cure” gayness.

Accordingly, Levin was appointed to Ward 22 at the Voortrekkerhoogte military hospital in 1969. The ward was notorious because it was set aside for the treatment of “deviants”, a category which included not just homosexuals of both genders, but also conscientious objectors. Homosexuals were treated by Levin with electroconvulsive aversion therapy. Here Levin would strap electrodes to the arms of his subjects, and show them pictures of naked men (if they were men) or naked women (if they were women).

Levin encouraged the subjects to fantasise about the images, and then subjected them to increasingly painful shocks. They were then shown heterosexually appropriate pornographic material, without any shocks administered. We know all this largely thanks to the testimony of a brave intern who worked with Levin, who took the name of Trudi Grobler to give evidence. She had witnessed Levin shock a woman being treated for lesbianism so hard that her shoes flew off her feet. Grobler was so horrified that she reported Levin to her superiors. For this act, Levin had her removed from the ward. And those gay soldiers who suffered the electric shocks may have been the lucky ones. The TRC heard from investigators that more than one gay soldier had been chemically castrated by Levin.

Levin’s activities were not confined to homosexuals. He also worked with men who objected to serving in the military on moral grounds. In these cases he administered the patients the so-called “truth drug”: sodium pentathol, known to lower inhibitions. Author Terry Bell, who wrote a book on the TRC called “Unfinished Business”, interviewed a man who underwent this procedure. He revealed how Levin would strap down the subject and drip feed them the drug, proceeding then to psychologically goad them until their “thoughts, fantasies and fears were laid bare”. All of this was taped and later played back to the patient, who in this case heard himself “howling like an animal”.

Levin refused to appear before the TRC, who heard that he was guilty of “gross human rights abuses”. News of this appears not to have reached Canada, who welcomed him as an émigré in 1995. In an interview with The Guardian in 2000, Levin said he’d left South Africa “because of the high crime rate”. Levin is believed to have suppressed the truth about his past in Canada by threatening lawsuits against media agencies who tried to discuss it. He did this with so much success that he was able to work as a psychiatrist at the University of Calgary’s medical school for 15 years.

That is, until March 2010, when he was arrested – but not for any offence connected with his apartheid past. The doctor who had tried to cure homosexuality with torture was arrested for sexually abusing a male patient. The plaintiff secretly filmed the psychiatrist making sexual advances on him. By July 2010 a further 20 counts of sexual assault had been laid against Levin by other male patients who came forward with similar allegations. Levin pleaded not guilty to all charges at the first hearing two weeks ago, and the judge has now set the two-week trial by jury to begin in October 2012.

What is truly astonishing, however, is that the Canadian press appears still ignorant of Levin’s past. The Calgary Herald concluded their account of the initial hearing with the neutral words: “He previously practised psychiatry in South Africa”

Apartheid Psychiatry on Trial?

A pre-trial hearing starts in Canada on Wednesday to determine the mental competence of the former head of psychiatry at 1 Military Hospital in Pretoria, Dr Aubrey Levin, who faces 10 charges of sexually abusing male patients.

The former South African psychiatrist headed a controversial programme at the hospital during the apartheid years, designed to “cure” gay soldiers with shock therapy, Beeld reported on Tuesday.

The charges against him had all been brought by former patients — mostly prisoners, for whom he provided psychiatric counselling on behalf of the Canadian government.

Terry Lynch on SSRIs

Serotonin imbalance theory bunk?

The psychiatric profession has finally come clean and confessed on a national media outlet that there is no evidence to support the Serotonin Theory of Depression. Today, on NPR’s Morning Edition there is a segment about the chemical imbalance theory, and virtually all the psychiatrists who are interviewed acknowledge that the there was never any evidence in support of the idea that low serotonin causes depression. But then, amazingly, they go on to say that it is perfectly fine to tell patients that serotonin imbalance causes depression even though they know this isn’t the case.

This article was published by the Wall Street Journal, July 30 2011

Depression in Command
In times of crisis, mentally ill leaders can see what others don’t

When times are good and the ship of state only needs to sail straight, mentally healthy people function well as political leaders. But in times of crisis and tumult, those who are mentally abnormal, even ill, become the greatest leaders. We might call this the Inverse Law of Sanity.

Consider Neville Chamberlain. Before the Second World War, he was a highly respected businessman from Birmingham, a popular mayor and an esteemed chancellor of the exchequer. He was charming, sober, smart—sane.

Winston Churchill, by contrast, rose to prominence during the Boer War and the first World War. Temperamental, cranky, talkative, bombastic—he bothered many people. During the “wilderness” years of the 1930s, while the suave Chamberlain got all the plaudits, Churchill’s own party rejected him.

When not irritably manic in his temperament, Churchill experienced recurrent severe depressive episodes, during many of which he was suicidal. Even into his later years, he would complain about his “black dog” and avoided ledges and railway platforms, for fear of an impulsive jump. “All it takes is an instant,” he said.

Abraham Lincoln famously had many depressive episodes, once even needing a suicide watch, and was treated for melancholy by physicians. Mental illness has touched even saintly icons like Mahatma Gandhi and Martin Luther King Jr., both of whom made suicide attempts in adolescence and had at least three severe depressive episodes in adulthood.

Aristotle was the first to point out the link between madness and genius, including not just poets and artists but also political leaders. I would argue that the Inverse Law of Sanity also applies to more ordinary endeavors. In business, for instance, the sanest of CEOs may be just right during prosperous times, allowing the past to predict the future. But during a period of change, a different kind of leader—quirky, odd, even mentally ill—is more likely to see business opportunities that others cannot imagine.

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Abraham Lincoln

In looking back at historical figures, I do not speculate about their relationships with their mothers or their dark sexual secrets, the usual stuff of “psychohistory.” Instead, I base my diagnoses on the most widely accepted sources of psychiatric evidence: symptoms, family history, course of illness, and treatment. How, then, might the leadership of these extraordinary men have been enhanced by mental illness?

An obvious place to start is with depression, which has been shown to encourage traits of both realism and empathy (though not necessarily in the same individual at the same time).

“Normal” nondepressed persons have what psychologists call “positive illusion”—that is, they possess a mildly high self-regard, a slightly inflated sense of how much they control the world around them.

Mildly depressed people, by contrast, tend to see the world more clearly, more as it is. In one classic study, subjects pressed a button and observed whether it turned on a green light, which was actually controlled by the researchers. Those who had no depressive symptoms consistently overestimated their control over the light; those who had some depressive symptoms realized they had little control.

For Lincoln, realism bordering on political ruthlessness was central to his success as a war leader. Few recall that Lincoln was not a consistent abolitionist. He always opposed slavery, but until 1863 he also opposed abolishing it, which is why he was the compromise Republican candidate in 1860. Lincoln preferred a containment strategy. He simply wanted to prevent slavery’s expansion to the West, after which, he believed, it would die out gradually.

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Rev. Martin Luther King

When the Civil War came, Lincoln showed himself to be flexible and pragmatic as a strategist, willing to admit error and to change generals as the situation demanded. He was not the stereotypical decisive executive, picking a course of action and sticking with it. He adapted to a changing reality and, in the end, prevailed.

As for Churchill, during his severely depressed years in the political wilderness, he saw the Nazi menace long before others did. His exhortations to increase military spending were rejected by Prime Minister Baldwin and his second-in-command, Chamberlain. When Chamberlain returned from signing the Munich agreement with Hitler in 1938, only Churchill and a small coterie refused to stand and cheer in parliament, eliciting boos and hisses from other honorable members.

At dinner that night, Churchill brooded: How could men of such honor do such a dishonorable thing? The depressive leader saw the events of his day with a clarity and realism lacking in saner, more stable men.

Depression also has been found to correlate with high degrees of empathy, a greater concern for how others think and feel. In one study, severely depressed patients had much higher scores on the standard measures of empathy than did a control group of college students; the more depressed they were, the higher their empathy scores. This was the case even when patients were not currently depressed but had experienced depression in the past. Depression seems to prepare the mind for a long-term habit of appreciating others’ point of view.

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Mohandas Gandhi

In this we can see part of the motivation behind the radical politics of Gandhi and Martin Luther King. Their goal was not to defeat their opponents but to heal them of their false beliefs. Nonviolent resistance, King believed, was psychiatry for the American soul; it was a psychological cure for racism, not just a political program. And the active ingredient was empathy.

Gandhi and King succeeded to a degree, of course, but they also failed: India was fatally divided because Hindus and Muslims could not accept each other; segregation ended in the U.S., but it happened slowly and at the cost of social traumas whose consequences still afflict us. The politics of radical empathy proved, in the end, to be beyond the capacity of the normal, mentally healthy public.

Great crisis leaders are not like the rest of us; nor are they like mentally healthy leaders. When society is happy, they toil in sadness, seeking help from friends and family and doctors as they cope with an illness that can be debilitating, even deadly. Sometimes they are up, sometimes they are down, but they are never quite well.

When traditional approaches begin to fail, however, great crisis leaders see new opportunities. When the past no longer guides the future, they invent a new future. When old questions are unanswerable and new questions unrecognized, they create new solutions. They are realistic enough to see painful truths, and when calamity occurs, they can lift up the rest of us.

Their weakness is the secret of their strength.

—Dr. Ghaemi is a professor of psychiatry at Tufts University School of Medicine and director of the Mood Disorders Program at Tufts Medical Center. This essay is adapted from his new book, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.”

Psychiatry by the Avalanches


A psychiatrist, who used shock aversion therapy to “cure” gay conscripts into the apartheid SA Defence Force, is facing 21 charges in a Canadian court of rape and sexual assault against males.


Aubrey Levin, 71, became known as “Dr Shock” because of the severe shock methods he used in attempting to “cure” homosexuals. He appeared in court yesterday for his preliminary hearing on 21 charges of sexual assault.


Levin’s hearing is expected to run until the end of June.


He was arrested in Calgary, Canada, in March last year after a 36-year-old male patient alleged he had sexually abused him over a number of years.


Shortly before the birth of South Africa’s democracy, Levin fled to the Albertan city of Calgary where he practised as a psychiatrist and lectured at the College of Physicians and Surgeons.


He qualified as a registered psychiatrist in South Africa in the late 1960s and later commanded the major psychiatric wing of 1 Military Hospital at Voortrekkerhoogte in Pretoria. Later he became the apartheid government’s head of mental health.


Before leaving South Africa he refused to testify before the Truth and Reconciliation Commission (TRC) about the allegations that he was guilty of gross human rights violations.


This related to his methods of using severe electric shocks as part of “aversion therapy” that was supposed to “cure” homosexuals in the military.


“Pacifists” in the army were dealt with by means of narco analysis, by administering drugs such as sodium penthanol – the so-called “truth” drug – which lowers people’s inhibitions.




Levin admitted that he used


the drug but “only sparingly and in cases where patients suffered severe post-traumatic stress”. Many serious allegations against him were to have been investigated by the TRC, but this never happened.


Now, more than a year after his arrest, Levin is not only facing the initial rape charge in Canada but a total of 21 sexual assault charges.


In December, CBC News in Canada reported that the Alberta Justice Department had sent out letters to lawyers whose clients had been ordered by the court to see Levin.


The letter said: “If you have any concerns about Dr Levin in his professional capacity, you may also wish to contact the Calgary Police Service.”


Nearly 60 letters were sent out, while the Alberta Justice Department said at the time that its “primary concern was to see that justice is done”.


Canadian lawyers were also quoted as saying that they had never seen so many letters, and that the response was “unprecedented”.


Levin was appointed by the courts as a forensic psychiatrist numerous times for a period of about 13 years.


Convicted criminals were ordered to see him before sentencing.


However he is now the one facing charges as many of the men he assessed have accused him of crimes.


The Canadian press has reported that, in the letters, some of the men alleged that Levin sexually assaulted them during court-ordered assessments or counselling sessions.




In another twist, a judge last week banned international media from attending Levin’s hearing.