It is a sad reality of contemporary American psychiatry that many clinicians do not have the time or appropriate training to talk and listen to patients. Instead they are quick to assign the diagnosis du jour, which is often stunningly incorrect, and implement the corresponding treatment, with disastrous medical and psychological consequences.
Every Tuesday I teach a seminar with my colleague, Tim Dugan, MD, another child psychiatrist and psychoanalyst. We provide consultation and teaching to the staff and trainees of the child and adolescent psychiatric inpatient units of one of the Harvard teaching hospitals. Repeatedly we are aghast at the inappropriateness of the diagnoses children carry upon admission to the hospital. Tim has designated this phenomena the “biologization of suffering”. One favorite diagnosis is Bipolar Disorder.
Children are frequently diagnosed with Bipolar Disorder if their mood is unstable and they are unable to manage their feelings appropriately. They may exhibit a variety of symptoms and behaviors: aggression, trouble sleeping, attentional problems, hyperactivity, anxiety, depression, law breaking, defiance, self-injurious behaviors, suicidal threats or actions, or grandiosity (which means they are acting like they are all powerful and invincible), all as an expression of how deeply they are suffering and how helpless and overwhelmed they feel.
Their compromised mental state and dysfunctional behavior is the result of a variety of factors, prominently trauma, neglect, abuse and loss, often against a backdrop in the home and neighborhood of poverty, violence, mental illness, substance abuse, and the standard American diet. A hospitalized child has insufficient psychological skills to manage their feelings of anxiety, rage and grief. Instead of linking the home, school and social milieu with the presenting symptoms, they are given a biological diagnosis of Bipolar Disorder. It is as though their disturbed state is not a response to their experience of their families and environment.
A diagnosis of Bipolar Disorder commonly results in the prescription of a several powerful psychotropic agents, many of which result in weight gain, and some of which induce metabolic syndrome, and even diabetes in children and adults. In addition these medications frequently cause decreased energy and sexual dysfunction. Often additional medications are prescribed to treat the side effects from the original agents.
Not surprisingly, in July 2011 an influential Harvard Medical School faculty, famous for his research and teaching about the diagnosis and treatment of Bipolar Disorder in children, was sanctioned by Harvard for not disclosing over a million dollars in fees by the pharmaceutical companies. The same story is unfortunately familiar to us in many different industries today. Powerful corporations motivated by profit, manipulate the consensus reality, and disseminate disinformation that has nothing to do with science or public health.
It is imperative that this dangerous trend of medicalizing natural and normal responses to experience be recognized and reversed. The current practice of making psychotropic medications the centerpiece of treatment is misguided and dangerous, particularly to vulnerable populations like children.
Hi Judy,
thanks for the compliment. My first language was alemannic. It’s the dialect that is spoken in SouthwesternGermany.
In school I decided to speak the official German language because it is annoying when your teachers don’t understand you.
English class started in 5 th grade in school and ended in 13th great. English is obligatory subject in German schools, so it’s no big deal.
After school came University and some interestingmbooks were/are not available in German. Esp. Film and Dance Science. And I watch movies in English, French or whatever with subtitles. Dubbing is terrible and if you don’t hear the actor’s real voices you miss 50% of the information.
And then came the world of Google, high speed internet and blogs and forums (Paleo, health, fitness & sports etc.).
In search of solutions for my health problems (forget about our broken healthcare system and Conventional Doctors), Ihad the glorious idea of feeding Google with English terms.
Search in German was almost useless. Americans are more advanced in bad stuff (Big Pharma, Food Inc.) and in good stuff (the grasroot movements and contrarian knowledge).
I spent a lot of time in the Paleo/Primal/WAPF community and found terrific material about athletic training and physical culture. And again reading American books (like Lierre Keith, Robb Wolf, Scott Sonnon, Mark Sisson…..). And Pubmed stuff
But my English is far from perfect. I wouldn’t read Virginia Woolf and other sophisticated literature in English. I wouldn’t get the finer points. And when I watched “Jackie Brown” (ghetto slang or hip hop slang) I was lost! The subtitles saved me. And the puctuation rules? What are those? When do I put a comma and when not? It is different from German rules. But I noticed in the blogosphere that I am better in orthography than a lot of native speakers. 🙂
Then there are those nasty prepositions. Which one is correct? But I am getting better because of the blog surfing, reading, writing.
Yes, bread is the most common legal drug in Germany. If you say “I don’t eat the stuff, it is unhealthy and not sustainable agriculture” you will probably get a psychiatric diagnosis.
I am looking forward to meet you at “Sauvage”. If you are in Berlin next time let me know. 🙂
You are totally amazing! Your writing is better than most native English speakers, really!
I will definitely get in contact with you when I am planning my next trip to Berlin, so that we can rendezvous. That will be a lot of fun!
Hi Judy,
I am glad I made your day. 🙂
I apologize for answering so late but I didn’t had the time for blog surfing lately.
Paleo/Primal/GAPS in Germany?
With your eyes you can’t see the little critters so grab a miscroscope. They are rare but all over the place between Hamburg and Munich. Even some GAPS species.
And some German Paleo/Primal/LCHF blogs:
• http://www.paleo24.de
• http://paleosophie.de/
• http://germancavegirl.blogspot.com/
• http://paleomami.wordpress.com/
• http://hu-ga.de/
• http://www.urgeschmack.de/
• http://www.originalhealth.net/
• http://kikilula.blogspot.com/
• http://urzeiternaehrung.blogspot.com/
• http://urzeitrezepte.blogspot.com/
• http://www.gostoneage.com/
• http://www.originalhealth.net/
We have a Facebook Group “Paleo/Primal Germany” with some GAPS people sprinkled in. About 240 members and exponentially growing like tribbles. I can add you to this group if you like. 🙂
http://www.facebook.com/groups/263774986981871/
And we have FB “Paleo in Europe” which looks like this:
Paleo Nederland — 125 members
Paleo Danmark — 349 members
Paleo Poland — 52 members
Revolucao Paleo (Portugal) — 87 members
Paleo Spain — 22 members
Paleo Suomi (Finland) — 81 members
British Paleo — 543 members
Primal/Paleo in Germany — 235 members
Paleo Belgié — 64 Likes
Paleo Italia — 89 Likes
—————————-
Tha’s only facebook. As you know, the dark figure is always much higher. 😉
The Medical-Industrial-Complex in Germany is basically the same as in US. Big Pharma is everywhere. Monsanto too. It’s called “Globalization”. 😉
Crappy medicine, crappy insurance, drugging kids, supressing symptoms instead of looking for causes. The same fun stuff like in the US.
I have the same problems as a patient in Germany as the Paleo/Primal community in US. Ignorant doctors and health insurance paying only for Big Pharma’s toxic drugs and useless expensive surgery, not for “Functional Medicine”.
Which would be actually cheaper in most cases but we are not talking about rational thinking here. “Follow the money” and “institutionalisierte Abwehr” (Mario Erheim) I suppose.
Soooooo…..you have friends in Berlin. Hm…….. That means you visit Berlin from time to time? 🙂
Then what about meeting at “Sauvage” when you are in town?
No, not Levi-Strauss, wrong association. “Sauvage” is the first Paleo-Restaurant in Europe. Delicious food.
http://www.sauvageberlin.com/
For any questions about German Paleo, Psycho or whatever feel free to shoot me an e-mail.
Hi Andrea,
Thanks so much for writing. And what a wonderful informative e-mail! I am sad to hear that its not much different in Germany than the US. I thought that there was perhaps a bit more openness. For example, I think homeopathy is more mainstream there than here. I love that list of Paleo Europe and the German Paleo Blogs.
Sauvage looks delicious, and that would be incredibly fun to meet you for dinner there. I have no trip planned any time soon, but do go regularly, so hopefully we can rendezvous.
Hi Judy,
you are right. Germany is not as bad as US. Only bad. So there is room for improvement for Pfizer’s shareholder. But you will find enough homeopaths and psychoanalysts if you need one or if you just want to hang out with someone who doesn’t talk in software programming pidgin when they are talking about human brains or bodies. There is a large segment of naturopaths and healers (homeopathy, Isopathy, Chinese Medicine, Ayurveda, Energy Medicine and what not ) in Germany.
http://www.dzvhae.com/portal/loader.php?navigation=1119&org=1113&seite=1115
So yes, Germany is a different culture.
But concerning Mainstream Medicine, Conventional Wisdom in nutrition and physical Culture , health insurance and all that ugly stuff Germany becomes more and more “American”.
It used to be much different 30 or 40 years ago. But in chronic disease ( diseases of civilisation) it is as bad as in US and probably everywhere.
And critical psychology and psychoanalysis is losing ground to neuroscience, cognitive psychology , behavioural therapy and other trendy fashions. Managing symptoms with “Mothers Little Helpers” (Rolling Stones) and treating humans like idiots or broken computers (which is basically the same).
But there are survivors
Like “Neue Gesellschaft für Psychologie”
http://www.ngfp.de/
And even Sigmund Freuds dream realized in Berlin:
Internationale Psychoanalytische Universität: Freuds Erbe lebt weiter
Seit Herbst 2009 gibt es – in Deutschland erstmalig – eine private Hochschule, die das Studium der Psychologie mit psychoanalytischer Orientierung anbietet.
Sigmund Freud selbst hatte 1926 bereits die „Phantasie“ einer psychoanalytischen Hochschule. In seinem Werk „Die Frage der Laienanalyse“ stellte er sich vor, dass an einer solchen Hochschule „vieles gelehrt werden“ müsse, nicht nur aus den Bereichen Medizin und Psychologie, sondern auch aus den Gesellschafts- und Kulturwissenschaften. An diese Fantasie erinnerte die Direktorin der International Psychoanalytic University (IPU), Prof. Dr. Christa Rohde-Dachser, bei der Gründung der privaten Hochschule im Herbst 2009. Eine solche Hochschule habe die „einmalige Chance“, die Zusammenhänge zwischen psychischen Erkrankungen und der Gesellschaft zu erforschen.
http://www.aerzteblatt.de/archiv/74029/Internationale-Psychoanalytische-Universitaet-Freuds-Erbe-lebt-weiter
http://www.ipu-berlin.de/hochschule.html
Hi Andrea. Your English is incredible. Are you a native German speaker?
Your e-mail contained good and bad news. I am sorry to hear that Germany is following in our misguided footsteps. Very disturbing, but I guess not surprising either.
I told my 14 year old daughter, who visited in Germany for the first time last Spring with me, about our e-mail exchange and the Paleo restaurant in Berlin, and her response was, “How would that ever be accepted there since all they eat is “Brot”” She did not enjoy how much bread is eaten in Germany, which is usually the main course for both breakfast and dinner with my friends in Hamburg and Berlin. I had not thought of that. Germans do eat much more bread than typical Americans do, so Paleo would even be more difficult.
How remarkable, a psychoanalytic University! That is really intriguing.
Thanks for all the great links. Hopefully we will have a chance to meet in person sometime in the near future.
Great post. I agree.
I am a fan of intelligent thinking. That’s why I like “subject-oriented” psychology like psychoanalysis and critical psychology.
Mainstream psychology is the opposite: subject-object-relationship instead of subject-subjects-relationship. Humans as rats. Gimme a break! It’s social technology, not interested in the well being of humans. Only in their well functioning for the labour market. And it’s bad Science.
I learned a lot from Prof. Klaus Holzkamp (FU Berlin) about the crux of Mainstream Psychology.
http://tap.sagepub.com/content/19/2/149.abstract
http://en.wikipedia.org/wiki/Critical_psychology
Instead of complaining: some stuff for empowerment. 🙂
Here’s a nice rap about drugging our children: Big Pharma – Define Better
http://www.youtube.com/watch?v=g7rACI-WJEw
And here a statement by Shane Ellison who worked a a chemist for Big Pharma. Today he is a whistleblower against Big Pharma’s practices.
http://www.youtube.com/watch?v=fOT5DSIUTOY
Best regards from Berlin, Germany
Andrea
Hi Andrea. This makes my day getting a message from Berlin! I look forward to looking up all the links that you included. Your English sounds like you are an American. I have very dear friends who live in Berlin, and I actually went to medical school for 3 years in Hamburg in the late 70’s early 80’s before transferring to medical school in Chicago. I often visit them in Berlin. I took an elective in “Ernaerhung” when I was in medical school in Germany. How much consciousness is there now in Germany about GAPS and Paleo and low carb diet? What is it like in Germany in terms of prescribing medications to kids these days? Thanks so much for writing. Its really fun to get messages from around the world. I love that.
Thanks for writing. The situation you describe is sadly all too familiar. I sometimes think about what would happen if these kids were fed a healthful diet instead of prescribed mediations. But with all of the poverty and psychosocially chaotic conditions you so accurately described, it seems impossible to implement dietary changes. Its very hard for many functional families. Your point about medication seeming like the only practical option in that situation is understandable, but terrible. Sometimes it seems to me that its doing more harm than good. Its just such a desperate state of affairs.
Even among adults, bipolar disorder is the diagnosis du jour. So many folks with a bit of anxiety, a bit of ADHD, and some poor coping skills and maybe childhood trauma (ie personality disorders) come to me on lamictal and abilify, or seroquel and effexor. No therapy, not even taught a bit of breathing exercise for the anxiety. Among children the onus is even worse – the party line is if you don’t treat aggressively with psychotropics, the kid will have no friends and end up in jail!
I have to think that with the sanctions and the recent clinical research failures of psychotropics, the trend is swinging the other direction. One would hope.
Thanks for your comment which I could not agree with more. Clinicians do not know how to talk to patients to understand their stories, and instead employ check lists. Enough qualifying symptoms and then bingo- you are Bipolar and then begins the standard medication regimen with all the serious side effects and often terrible metabolic consequences. Its heart breaking to see a young woman who has gained 50 pounds after having been misdiagnosed and started on atypical anti-psychotics or a child who has developed diabetes after having been prescribed these medications to treat his rage and despair because all the adults in his life have abandoned him.
I don’t know if you are aware of the proposed revised guidelines for the DSM-5. Check out this link:
http://www.ipetitions.com/petition/dsm5/?utm_medium=email&utm_source=system&utm_campaign=Send+to+Friend
The new revisions even further lower the threshold for diagnosis of a variety of conditions, paving the way for even more automatic inappropriate prescription of psychotropics. The new guidelines disconnect to an even greater extent the link between response to environment and symptom formation. The field is in big trouble.
I work as a tech/therapist at an inpatient psychiatric unit. I get pretty frustrated at the over-medication and doctor-neglect that I see. I often get the feeling that I’m simply a baby-sitter to look after the patients while the MDs tweak their meds — and they do so remarkably on the basis of a few 2-3 minute (at the most) conversations with the patients. Anyways, some observations from my perspective:
Many of the patients have no families, and spend their entire youth being passed around foster homes, detention centers, group homes, and psych units. So, their environments are horrendous and have almost no support network in the life. It seems that there’s pretty much zero chance that any advice about coping skills or diet/exercise/sunshine/etc. is going to be implemented. It often seems that, unless some rich and loving family adopts them, they’re sort of a lost cause. Unfortunately, given this situation, it starts to become understandable why doctors see medication as the only practical option for managing patients’ behavior.
As for the side effects, they are definitely pretty nasty. It’s hard to watch what the meds do to these kids’ appetites and energy-levels. The inevitable result, of course, is weight gain and poor performance in other areas of life (school, sports, etc.) — which is sure to do wonders for a teenager’s quality of life.
I think this is why I feel my social work degree is not something I want to pursue. We set up people to fail, and then tell them it is their fault that they failed.
Entire systems need to be overhauled in order to address the issues. But, it isn’t profitable to the pharmaceutical companies to suggest a no sugar diet.
Thanks for writing. It can really be discouraging if you try to accommodate and just work within a system that you do not agree with. My own response is to try and educate and speak out about my beliefs regarding this dangerous situation. With my blog and teaching at the hospital, I am able to speak out and hopefully make a difference. Maybe you can find your way to make use of your education and training to make a difference, so that you do not have to compromise your convictions. We all need to do what we can to change this dysfunctional world.
I’ve been enjoying this blog…glad I found it, Judy….
and to Amanda,
I was a social worker and had to stop as a result of my disgust. There are some people who manage to do good work within the system but it’s pretty much setting yourself up against the odds, no doubt.
It’s far easier for a doctor in a private practice to stand up and say what they think than a social worker in a social service agency…it simply becomes grossly toxic all too often if one is truly aware of what is going on.
good luck…there are people who pull it off…certainly.
Gianna and Amanda,
I know I am in a completely different position as a psychiatrist in private practice than as a social worker in an agency. I totally get it. But anyhow, I believe that we all need to do whatever we can that is within our own scope and possibility to not be silent and tacitly support this very sick status quo. Of course what you choose do to must also in some way be self enhancing and not self sacrificing.
Judy said:
“I believe that we all need to do whatever we can that is within our own scope and possibility to not be silent and tacitly support this very sick status quo.”
yes! indeed. I’ve spent the last five years full-time on my blog doing just that. It’s the most honest, impassioned work of my life.
Bravo! You can tell that you are on the right track when you feel authentic and impassioned. I am glad for you and the world that you have figured out how to make your valuable contribution.