I just realized is has been two months since my last blog entry. At that moment of realization, I said to myself, "I should write another!" But then I noticed that I just did what my clients often do. They continually wonder and talk about what they should do and ask me frequently the same question: "You're the expert here. What should I do?"

​Frankly, I have no idea.

In my view, wondering what one should do, what one needs to do, what one ought to do, what one must do, or what one has to do, merely indicates that the person doesn't want to do it, and instead, that somebody else wants them to do it. This might be a significant other, a parent, a friend, or just society in general. Otherwise, wouldn't they just say they are going to do it?

Now, I realize we talk in this imprecise sort of way colloquially. But the problem is that doing so has a great impact on our sense of being free or coerced in life. We constantly go back and forth between split off parts of our self with one part trying to convince the other part what needs to be done. This is quite an odd phenomenon, given that there is only one of us, and if we are trying to convince ourselves of something, who is the one doing the convincing and who is the one being convinced? Which is the one who has the market on "the right way of doing things." How do we know when a success occurs in this argument: when the convincer wins or when the one being convinced wins?

This brings us to the solution to this conundrum. I propose that a far more effective and fulfilling way of approaching life is to focus on our desires and preferences, not on what we should do. But I think there is a general hesitation to do so because most of us do not have faith in ourselves and in many situations believe we have an obligation to justify our desires to someone else. But this is impossible. We might be in a position to explain our desires and preferences to others, but there is no way to justify them that carries any kind of absolute authority. Even when we resort to quoting secular or religious authority, we are not justifying. This is because the authority we choose to quote is based completely on our desires. We can't get away from this fundamental reality that personal and individual desire is the primary motivating factor for choices. 

So, this brings us back to the role of a therapist and telling you what you should do. We just don't know and that is because we are not the experts in individual desires. You are the expert in your desires. Trust them, listen to yourself, listen to your gut. 

Of course, I am not suggesting a "free-for-all" way of life where are we all just do whatever we want (although to get philosophical about this that is exactly what we do – but we won't go there for now). Instead, we desire to do things in the context of living in a relational world where many, many other people are also desiring to do things and there is inevitable conflict among them. So, as a simple example, I might desire to drive 90 miles an hour in a 50 mile an hour zone. But I recognize that fulfilling that initial desire would be dangerous to others. Given that consequence of speeding, I realize I don't actually desire to do that so I slow down.

Life is like a jigsaw puzzle, it consists of many interlocking pieces and you can't take the puzzle unless you take all the pieces. The puzzle of speeding has a piece reserved for danger. One can't speed without also being dangerous.

We are constantly assessing our desires and all the consequences that go with the completion of those desires. It is when we notice negative consequences like the speeding example above that we recognize we really don't want to do it.

​And that, my friends, is what we should do!

At the risk of sounding overly insulting, I'm appropriating James Carville's popular 1992 phrase to emphasize that mental disorder is about the mind, not the brain or body. Carville's "it's the economy, stupid" emphasized that the economic situation during a presidential election is paramount, and far surpasses other campaign issues.

By borrowing his phrase, I'm emphasizing that the mind is paramount for understanding mental disorder. Further, not only does mind far surpass the brain and body in this understanding, the brain/body is irrelevant. The brain is not the mind and the mind is not the brain. Looking at one in order to understand the other is foolish.

Let's do a thought experiment. Take all mental and behavioral problems and identify the ones caused by defective bodily functioning: confusion brought on by drug use, uncharacteristic behaviors caused by a brain tumor, fatigue due to a vitamin B12 deficiency, mania as a result of cocaine intoxication, hallucinations because of Parkinson's disease. Those mental and behavioral problems are not examples of mental disorder. They are straightforward physiological disorders. As I explained earlier, merely having a mental or behavioral symptom does not make a problem a mental disorder.

Once those examples are thrown out, what is left? These: desiring to shut down int he face of extreme apathy and disappointment about life, a keen interest in being prepared and hypervigilant, a desire to numb painful feelings with drugs, entertaining alternative realities that better explain strange personal experiences, an unwillingness to live within social and biological limitations. These are, respectively, diagnosed as depression, anxiety, substance use, schizophrenia, and bipolar disorder. But they have no pathophysiological basis. They have a meaningful basis. They are about mind, not brain or body.

Certainly, while those "mental disorders" are occurring, the brain is undergoing physiological activity. But that brain activity is not pathological or otherwise a matter of dysfunction. It is working quite well. Instead, the problems are about how the person responds to those meaningful things and how that response works or doesn't work in their social contexts. That is the essence of mind - it is the experiential foundation upon which all meaning and choices are based. Physiologically tinkering with a person who doesn't have a physiological problem is dangerous.

In Sunday's MSNBC "Yasmin Vossoughian Reports," Ms. Vossoughian interviewed Dr. Ira Glick about mass shooters. In the interview, Dr. Glick presented blatant falsehoods about mental disorder. He dangerously perpetuated a myth that unmedicated mental patients are prone to violence. This does nothing but provide a scapegoat, not a solution.

Although Dr. Glick admitted that "people with mental illness" have less risk of being violent than others, he nonetheless went on to say that "...the public should be made aware that some [my emphasis] unmedicated mental patients do pose an increased risk of violence." If those "with mental illness" have less of a chance of being violent to start with, how could not taking medication raise that risk?

It is also important to note what Dr. Glick didn't say. He failed to mention that some unmedicated mental patients pose no risk. Further, he failed to point out that some non-patients still pose an increased risk of violent behavior. Therefore, his statement that some unmedicated mental patients pose an increased risk of violence is meaningless and tantamount to saying some Golden Retrievers bite people, while failing to point out that some of them don't bite, and some other breeds do bite. This is useless information for someone wanting to obtain a family pet, just as it is useless information to tell the pubic and policy makers that some unmedicated mental patients pose an increased risk of violence.

It isn't the patient status that increases one's risk for violence. In my previous blog post, I explained the empirically-derived factors known to increase one's risk, and being diagnosed with a mental disorder is not one of them. Moreover, I emphasized that science tells us that medication actually increases the risk of violence - the science involved includes the drug companies' own pre-marketing clinical trials. Sadly, despite knowing these risk factors, our leaders lack the political will to address them seriously - money and self interest stands in the way.

Perhaps the most troublesome flaw in Dr. Glick's reasoning is his study. He claims it is the first of its kind. This is a dubious claim as many studies have been conducted on the same topic for several years, even if not with exactly the same method and focus. The study is based on a very select sample of 35 shooters (those who lived) between 1982 and 2019 and obtained from one popular news magazine's database.

The research is based solely on after-the-fact information gleaned from documents and individuals who were involved in the prosecution of the shooters. This means that all shooters would have been diagnosed with a serious mental disorder, skewing the picture. What mass shooter would be clinically cleared by a forensic psychiatrist after the fact, especially while being detained for prosecution? Ans. None.

The researchers attempted to determine if those who died in their shooting were different in terms of mental disorder from those who lived, but that was done by reviewing the available information on the deceased shooters, but only after the shooting. This would ensure that most of them also would have been diagnosed mentally ill, which was then conveniently presented as evidence that the ones who lived were no different than those who died, and designated mentally ill.

The main thrust of Dr. Glick's message is a reinforcement of the long-since-debunked falsehood that people identified as mentally ill have a brain "illness" or their brains are "sick" and "damaged" in some way, and that the alleged illness is what drives them to kill. There is no such illness, as there is no scientific evidence of brain defect or dysfunction in those labeled mentally ill, despite more than a century of looking for it. Still, orthodox practitioners, academicians, and researchers among the mental health professions continue to peddle such gibberish.

The icing on Dr. Glick's cake is that he encourages us to identify these potential shooters and give them the treatment "they need" in order to prevent the violence. Welcome to Bizarro World!

"What are we doing?" These are the words repeated over and over again yesterday by Senator Chris Murphy in an excoriation of his colleagues on the floor of the U.S. Senate. He was urging them to take action towards better gun safety and background checks in the hopes of preventing the horrible tragedies like the one we just experienced in Uvalde, Texas, where 19 school children and 2 teachers were killed by an 18-year-old with an assault rifle. Yet, as important as Senator Murphy's challenge is, I fear this opportunity will go unfulfilled, once again, just as many others have gone since that fateful day in 1999 in Columbine, Colorado.

The debate on this issue isn't over whether guns kill people or people kill people - both do. It is about what things in our world precipitate gun violence like this and what things are we willing to do to reduce this characteristically American phenomenon. Neither is this a matter of good vs. evil, identifying those at fault, or being able to tell the difference between the bad guys and the good guys. And, focusing our efforts at how to "take down" the bad guy once the shooting starts is merely reactionary and short-sighted, only giving us a smug sense of justice, yet leaving the problem untouched while we wait for the next mass shooting. So what do we do?

All too often the debate centers on mental illness and how we need "better mental health care" as a solution. But this is wildly off target.

Whether or not someone has been diagnosed with mental illness, or even if they were never diagnosed but meet the clinical diagnostic criteria for a mental disorder, has no impact on their propensity for violent acts like this. The common belief that it does merely reflects a gross misunderstanding. The science is clear about that. The science is also clear that a few basic factors increase one's risk of committing such acts:

     1) being male;
     2) being younger;
     3) being unempathetic, remorseless, and callous;
     4) having committed prior acts of violence, especially starting in youth;
     5) having easy access to weapons, especially lethal ones like guns;
     6) having poor social support;
     7) feeling paranoid, persecuted, and mistreated, and;
     8) using alcohol and drugs to cope with distress.

You'll notice that a mental disorder is not one of these. You might think that #7 is about mental disorder, but it is not. Those things (feeling paranoid, persecuted, and mistreated) do not fulfill diagnostic criteria. Many people feel those things without ever having been thought of as mentally disordered or having been diagnosed as such. In fact, many of us have felt that way at some point, and likely at many points, in our lives.

Nevertheless, as with previous tragedies like the one in Uvalde, mental illness is sure to be targeted and then a simplistic "better mental health care" will be proposed as the answer, as well as background checks to disallow the "mentally ill" from buying guns. Such a strategy will not address the people who have the risk factors listed above. But, there will still be a false sense of comfort addressing the problem as the hype dies down and other events in our life crowd out the realization that 21 people have just been massacred. 

To make matters worse, psychiatric interventions typically imposed on people thought to be "mentally ill" would include psychiatric drugs, which ironically is one of the risk factors above (#8 - See the film "Prescripticide"). At present, there are 30 commonly prescribed psychiatric drugs that are well-known to increase the risk of violent behavior by those taking them.

The people subjected to these interventions would also feel paranoid, persecuted, and mistreated in the process (risk #7), especially if they are committed to a hospital against their will, are forced to take the drugs, and are prohibited from owning guns. All these things together are likely to increase the chances they become socially disconnected from others (risk #6). Therefore, this form of intervention will have the opposite effect of actually increasing the risk of these violent acts in this wrong-headed strategy of reducing the risk.

What are we doing?

From the very inception of the medical model of mental distress, psychiatry (and I include all other mental health professions) has put itself on a path to destruction by  painting itself into a corner where it must admit it is not a medical profession unto itself.

Psychiatry started out as the application of medical science to discover medical causes of and treatments for distressing experiences and behaviors. For over two centuries though, it has failed to discover any such causes. Yet, this failed campaign continues in vain. It is bad enough that this is the present state of the profession - seeking a fantasy - but there's a more damning issue that is becoming clearer and clearer. If psychiatry ever did find those elusive bits of brain or body physiology that cause human distress, it would no longer be psychiatry!

This is because all medical specialities, except psychiatry, have a bodily organ or system as its focus. Pathology within that organ or system becomes that specialty's target of assessment and care. Psychiatry has no such system or focus because all are already taken by those other specialties. If faulty brain chemistry or dysfunctional neural circuits cause mental distress, that is handled by neurology, not psychiatry. If endocrine flaws cause mental distress, that is endocrinology, not psychiatry. If nutritional deficiencies cause mental distress, that is nutritional science, not psychiatry. If genetic anomalies cause mental distress, that is handled by genetics, not psychiatry. In all those cases, the problem is not "mental" illness. It is straightforward illness.

The best (and an important) role for psychiatry to play is in helping to identify what bodily pathology is likely causing mental distress and wayward conduct, and then to hand it over to the specialty that deals with that bodily system. When no pathology can be found or reasonably theorized, it is not an illness or medical matter. Still, thousands of mental health professionals ignore this consulting role for psychiatry and march on, seeking fantastical anomalies in people and doling out even more fantastical cures.

​Calling a problem "mental" illness obscures the real cause and solution.

Let me begin this new blog by revealing a secret that is hiding in plain sight: The conventional mental health industry isn't about health and illness. Instead, the industry has bastardized the reputation of the medical professions in order to disguise a morality crusade. Its purpose has always been to control unwanted and distressing people. Nowhere in the process do we find actual treatment of an illness. What we find are moral judgments about the appropriateness of behaviors, thoughts, and feelings, and methods to stop them using physical, chemical, electrical, or persuasive means. This is not medicine. It is crowd control. For this reason, many professionals within that system have abandoned its medical model and try to help others in a humane and compassionate way. These professionals can be very helpful, but only if they remember the goal is to assist to the extent and in the way that person wants assistance.