On diagnosis being bullshit

"It's bullshit," was originally a comment by Allen Frances, the Chairman of the APA committee which wrote DSM-IV, to psychologist Gary Greenberg, in 2011. Keeping that point closely applied to the DSM itself is a good idea for two reasons.

First, the DSM is the single most important modern source by far, of the idea that mental illnesses are discrete medical conditions that can and should be diagnosed. It names hundreds of such medical conditions, and details precisely how anyone should decide whether or not any one of them exists in any individual. It is a manual (that's what the M stands for). It is strongly reminiscent, as I have frequently said before, of the Malleus Maleficarum, which preceded it by about 500 years.

Very few people read the Malleus any more. They may read more recent historical perspectives, analyses and commentaries about it; but there's no substitute for the whole medieval text itself, in a reliable English translation assuming a reader is not proficient in Latin. This was a manual eerily similar to the DSM. It continued in widespread use for the detection and prosecution of witches, and it remained in print, for about 300 years. (The DSM has only been around for about 50.) The Malleus was probably not known by common people in the 16th and 17th Centuries, at least not nearly as well as the DSM is known by the general population in the West today: the "Hammer of Witches" was a handbook only for the most educated and powerful men in Europe.

My point is that the DSM has had similar influence and cultural impact to the Malleus. Allen Frances' 2011 statement would be comparable to a hypothetical admission in the year 1500 by Jacobus Sprenger and Heinrich Kramer that after all, there were no witches.

The second reason one might limit application of Frances' honest admission, "It's bullshit," is to save time and headaches. Psychiatric "diagnosis" evolved into such an incredible rabbit hole in the last seventy-five years that even trying to follow what is called research about it now becomes an endless maze of confusion and a very long journey through strange lands of arcane nomenclature and weird acronyms.

For example, "e-mhGAP-IG." You may laugh... but this stands for the World Health Organization's latest mobile app. It's intended to improve detection of depression in primary care, which has supposedly not been up to par in certain countries that only use the standard "mhGAP-IG" (an earlier non-screen, paper version of the same tool). Here's a research report all about it from no less authority than the Journal of the American Medical Association (JAMA), published just last week!

I spent at least an hour going down this rabbit hole this morning. I never got a better understanding of anything being done in the real world, beyond the thought I had when I read the first sentence of this report, which identified a purpose, "to improve detection of depression." 

My thought, immediately, was that detection of depression isn't really detection of a fact, it's promotion of a theory or proposed explanation. Real diseases are actually detected by medical tests. Psychiatric disorders are merely alleged by evaluations from checklists in the DSM. Big difference. Huge!

Read this research report. By the end, you'll laugh at yourself for even caring what these ridiculous people are talking about, but you'll cry for the human wastage: so much blood, uncountable treasure, a century of lost progress in mental health knowledge.

And read the Malleus Maleficarum. Tom Szasz wrote a whole book comparing the European witch hunts to the modern mental health movement, and it may have been his best book.

Torquemada had "research," too. The Church and APA are scientists!

Stahl's Deprescriber's Guide--seriously?

One fascinating story from the American Psychiatric Association's annual meeting this month in Los Angeles is the mere fact that such a stalwart psychopharmacology authority as Stephan M. Stahl may be jumping on a bandwagon, which until very recently was widely derided as "antipsychiatry." Stahl must be one of the top  ten promoters of psychiatric drugs in the world! Why would he help "deprescribe"-?

Maybe it's an opportunistic business move for Stahl. His new book is due out in exactly six months, and it's expensive ($60 for a paperback of just over 500 pages). I may buy a couple dozen copies and give them out to clients and nuthouse psychiatrists. Any legitimacy attributed to getting people off psychiatric drugs is deliciously seditious in the context of the state plantation system. But I can't help thinking my friend Rodney Yoder will be absolutely sure that the real intention here is to own the deprescribing craze, i.e., own it to exploit it, or to make it disappear.

If we take everybody off the drugs, we will inevitably saddle the forensic psychiatric system with the impossible requirement that clinicians must talk to patients. They hate that. They want to be doctors who are obeyed, not counselors who must listen or empathize. And anyway, it's too expensive (not to mention useless) to do anything with dangerous crazy people other than just drug them into sufficient disability so that they conveniently, without ugliness, disappear. That is clearly the modus operandi of Illinois' Department of Human Services.

In the meantime, I saw headlines this morning about North Carolina's psychiatric slave system, which sounds to me very similar to Illinois' plantations. It can be expected that horrible abuses will be found in every state if competent investigations are conducted. They might be. We are inches away from a widespread realization by the American public that the kind of "mental health" we have been sold since 1945 has been a harmful scam. Psychiatry as we have known it will cease to exist without forced "hospitalization" and "treatment." Tom Szasz predicted that long ago.

Involuntary psychiatry has long been lamented, at least on and off, as necessary. But it doesn't protect the public or serve justice. The drugs have long been lamented, at least occasionally, as imperfect. But they don't help anyone or cure anything.

These facts are being acknowledged, implicitly, even in the media and amazingly, at APAAM2025! There will be efforts to distract attention from the facts, but psychiatry may lose its status and power.

That would be a happy development indeed. Psychiatria delenda est!

Talking the British out of their illusions...

Menachem Begin supposedly told David Ben-Gurion in 1946, "You should continue to talk the British out of their illusions, and I will continue to drive them out of Palestine." 

Begin's organization, the Zionist paramilitary Irgun, bombed the King David Hotel in Jerusalem on July 22 that year, destroying the British administrative headquarters and increasing British resolve to withdraw, opening the door for the founding of Israel in 1948. The quote is said to suggest the utility of combining disparate tactics of diplomacy and militancy, as demonstrated in the historic Zionist success.

I watched a celebrated YouTube debate yesterday between Dr. Josef Witt, who describes himself on X as an MD psychiatrist turned drug tapering educator and pharma doc from Utah, and Anias Aftab, a psychiatrist from Cleveland and author of Conversations in Critical Psychiatry (2024, Oxford University Press). Dr. Josef looks like an analog of Ben-Gurion, and Aftab, perhaps, like a 1946 British Palestinian Mandate administrator. The Begin role could be performed by some good friends of mine. I'll paraphrase: You should continue to talk the psychiatrists out of their illusions, and we will continue to drive them out of mental health.

The critical point which separates psychiatry from any legitimate future in mental health is quite contained in the word mental. It means relating to that element of a person that enables awareness, thinking, consciousness and intellect: mind, which closely shares etymology with meaning, but not with brain.

Psychiatrists believe there is no such thing as meaning or mind. They worship the brain, effectively as a magical object, although they are not neurologists who actually specialize in the brain as scientists and medical doctors. Psychiatrists call themselves medical doctors and desperately want the public to believe that's what they are, but they have degraded and demeaned the ethical rule, First do no harm! to First do something to the brain! By insisting that we all look in the mirror and admit that we see nothing but a machine, understandable and controllable by manipulation of reactions between chemical transmitters and receptors which define all meaning, emotion, personhood and creativity, they have tried to destroy the soul, insulted humanity, and drastically harmed civilized culture. They have perpetrated this harm with the full complicity of government authority and the reliable back-up of police power.

Reports from many conversations at this month's 2025 Annual Meeting of the American Psychiatric Association in Los Angeles highlight a predominant unofficial theme: psychiatric drugs, including "antidepressants," "mood stabilizers," "anti-anxiety meds," and "antipsychotics," probably need to be re-evaluated. It turns out that they cause certain harms which were ignored, minimized and covered up for decades. This is an unfolding catastrophe. 

The public is losing confidence, doubting the legitimacy of psychiatry, as the false pretense of "safety and efficacy" is revealed by scientific evidence and prominent psychiatric survivor narratives all over social media. The promise of new drugs is suddenly very poor, as psychedelics are not being approved quickly enough to save the world. Research in general is threatened by lack of finances. A petition just went live for public comment with an official docket number on an FDA government website, calling for warnings about serious and severe risks from SSRI/SNRI antidepressants. 

We may be at what Laura Delano lately called "an inflection point" which will totally reshape the long narrative of religious freedom and science. If the Jews could have their own state after so many centuries of persecution culminating in the Holocaust, who knows?

We might compare the idea that the study of the mind and the healing of mentally caused ills shouldn't be alienated from or condoned outside of religion with a claim that Israel is inextricable from Judaism.

(I trust my nephew Zev as a rabbi for perspective, I'll ask him.)

The Packard psychiatric slave plantation

One of the most valuable rights involuntary "patients" have, enshrined in Illinois' Mental Health and Developmental Disabilities Code [405 ILCS 5/1-100 et seq.], is the right to unimpeded, private and uncensored communication with anyone they choose. Section 2-103 of the Code presents a few, slightly elaborate qualifications or exceptions to this right, but the intent of the law is more clear from the careful, precise language of the qualifications or exceptions themselves. 

For example, the law makes the Director of any particular plantation (e.g., Sara Broyles at Packard) personally responsible for ensuring that this right is respected, and personally accountable to issue written rules and written explanations of any restrictions of this right.

In other words, it is very clear that the law does not intend for individual clinicians on the units to spontaneously make up rules about phone use or restrict "patients" from using the phones in any arbitrary way when they just feel like talking to any friends or family, for any reason. This is important, by the way. Section 2-103 appears in the chapter of the Code which is entitled, "Rights of Recipients of Mental Health and Developmental Disabilities Services." (Emphasis added.) It's a matter of rights, not merely an administrative detail. They have to let patients talk on the phone as freely as possible, and they have to organize and document doing so.

Well, there's this social worker on Lincoln South Unit named Michael Fitz who seems to believe he can gratuitously violate the intent and letter of this law, for his own purposes of (perhaps) proving that he can punish and harass a "patient" whom he doesn't like on any particular day or who causes a mere nuisance once in a while. Fitz may also need to prove he's smarter than the "patient", or failing that (since he definitely isn't smarter), prove that he can overwhelm that "patient" and treat her or own her as a slave. Packard is a plantation, after all. Fitz is an overseer, he's absolutely not any helping professional.

Yesterday at about 2:00 PM, Fitz's "patient" got a phone call from a friend she had not spoken to in a long time, who may not have even known she was "hospitalized" (I am heavy on the sarcastic quotation marks for this article) in Illinois. She spoke with her friend for about half an hour, and hung up. The friend called her back to continue the conversation after about twelve minutes. But Michael Fitz, who evidently had been meticulously clocking the phone time of this "patient", quickly interrupted to say in a hostile or impatient, arrogant tone, "You've been on the phone for an hour and forty-five minutes, and you have to hang up!" The "patient" complied, and Fitz went back into the office or nurses' station  from which he had been surveilling the phone use with an eagle eye, and wrote up a report.

Later, the evening shift staff on Lincoln South (who only must be presumed to have read Fitz's report) unnecessarily and unpleasantly admonished the "patient" that she had to "follow the rules and not spend so much time on the phone."

But what rules? As best we know there is no written restriction signed by Sara Broyles saying that no "patient" may spend more than some stated amount of time on the phone. The rule (Section 2-103) is unimpeded, private and uncensored communication with anyone. Not to mention, if Fitz actually wrote that the "patient" had been on the phone for an hour and forty-five minutes, that was a false report possibly amounting to perjury; and there was no one else waiting or asking to use the phone at any time while Fitz's "patient" and been on it. Fitz was just being a petty tyrant, acting arbitrarily out of spite. But of course, this is normal on the plantations. The slaves must be kept under control and dominated by any means.

Section 2-103 also mentions attorneys, and apparently gives them special importance as far as "patients'" communication access goes. (See, 405 ILCS 5/2-103(d).) A recent experience with the same "patient" and her social worker Fitz (among other overseers of slaves at Packard) illustrates how the spirit of the law, often, is frustrated by the plantation's desperate obsession to control the slaves.

Several Defendants in a federal case I have recently filed consider that they should remain as the Plaintiff's clinical team, and that they need not have their attorneys present in a treatment plan review meeting which I attend as an advocate for that "patient". This seems rather dicey to me, but I know several of the plantations are severely understaffed to the point that they are technically unable to provide mental health and developmental disabilities treatment as required by law. (I wrote about this in some detail recently.) So, maybe Packard is as severely understaffed as Choate, and their calculation here is, it's better for Defendants in a civil suit to take the chance that they may inadvertently provide evidence for civil claims, than to end up being criminally culpable.

The "solution" to this quandry, as best I can decipher, is to carefully clarify, or get me to admit, that I am only the "patient's" advocate when I attend a treatment plan review (TPR), and I am not acting as the Plaintiff's attorney for those minutes while the Defendants in the case are present without counsel. I went along with this the other day, even though I'm not sure I understand or anyone can predict all the implications. 

For practical purposes, of course it's all nonsense: first and foremost because the "treatment" the "clinical team" is supposedly "planning" in a TPR is itself pure nonsense, when they pretend to be curing a non-existent brain disease with their horribly damaging "medicine" but cannot even bring themselves to efficiently diagnose a condition as obvious and medically treatable as pregnancy, and they implicitly admit all that in an opposition attorney's presence, without their own state-provided counsel; secondly, in the particular case, these Defendants will settle or not according to the specific facts discovered, not according to shades of definition unless they want a jury trial with lots of media.

As I've written before, pregnancy is a stubbornly objective fact, especially when it's carried to term; and a child is an expensive responsibility that somebody will certainly have to pay for.

So prevent communication, severely control phone use, and maybe words will count more than deeds.

Right, Fitz? Right, Gadson?

Xiamara is back!

I am told that social worker Xiaomara Ramirez has returned to her old office on N Unit at EMHC. I'm not sure anyone will even admit that she was gone for several months, and they definitely won't ever say why. The big question is whether she'll return to her old habit of papering over the window to her office door so nobody can see what she's doing in there.

Xiaomara is perhaps the starkest example I have encountered, of clinical staff at EMHC who cannot take criticism from "patients" and believe they simply don't have to even speak to those lesser humans, those mentally ill defectives, those genetically inferior slaves who should be bowing and scraping every time an overseer steps out of his/her little tiny office into the day room cotton field.

On the other hand, maybe I completely misestimate Xiaomara. I really don't know her, and my whole picture comes from one patient who has a way of holding grudges. (He passes tests for the general truth of the details he tells me though, and the people on the units who try to discredit him are idiots and liars who cannot pass those tests.)

My threat of a Passover-type plague on EMHC staff and administrators has been defused, I think. The patient who was a perfect client for a habeas corpus petition was suddenly, mysteriously granted his court-ordered passes, without the knowledge of his public defender and without any hearing or even a motion by counsel. The judge reportedly just signed an order granting the passes because EMHC recommended them. It is a clear demonstration of the fact that the courts do what the mental health experts tell them, period. In countless monthly staffings over a period of decades, I've heard treatment teams tell patients, "Oh your fate is not up to us, it's up to the criminal court." But the sad fact is, judges have abdicated their authority to assess and dispense justice, in favor of a mystical facility that they say should "cure" bad behavior medically. They imagine or cynically pretend to believe that such ability resides in the special knowledge and talents of psychiatry. This is delusion or fraud.

People seem to be confused. They just point at each other when forced hospitalization and coercive "treatment" is questioned. The court points at the doctors and the doctors point at the judges. "Don't ask me, ask him!" When something is clearly wrong, nobody is responsible, they're all just doing what somebody else says is necessary, and nobody ever knows why or whether it's right.

We take people who do really bad things, people who disgust us or terrify us, and we send them away. The age-old social mechanism of banishment was understandable and practical. The problem in modern times is that we have to feel like our "science" has made us better, like we have evolved into a rational, more capable species. EMHC isn't a prison, it's not exile, it's a hospital. Right?

That's bullshit. Illinois taxpayers spend about a billion dollars a year to make themselves fell better about experimenting on, torturing or abandoning their fellows. The bronze plaque in the EMHC forensic program building lobby is the perfect symbol of such hypocrisy and debilitating self-deception.

No wonder Xiaomara Ramirez doesn't want to be seen!