Eric Kuelker
@DrEricKuelker
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Husband, Dad, psychologist in private practice, skier and cyclist. Interested in reforming mental health, and finding new ways to tease my offspring.
Canada
Joined September 2009
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Any psychiatrist who defines 'treatment resistant depression' as failing to respond to two different pills is an intellectual slave to the drug co#. What if depression is from incessant emotional abuse in childhood? How would chemicals ever treat the crushing of self-esteem?
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DSM III was written when psychiatry believed that incest never occurred. They created a diagnostic system that entirely ignored the role of abuse, trauma, and neglect in childhood. DSM profoundly misleads people as to the actual nature of their suffering.
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Public Service Announcement: Psychedelics will not heal your emotional wounds of grief, neglect, abuse, and betrayal. They are psychoactive chemicals, and unable to bring healing to psychological injuries. We have tried chemicals for decades, they fall short of the hype.
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Whatever psychiatric diagnosis was pasted on you was made up by a committee. It did not emerge from a science lab, where careful measurement and independent sets of researchers cross-checked it. It is not grounded in reality. It emerged from a discussion over lunch. 1/
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When "All my friends have ADHD" does that not signal that it is a hysterically overused diagnosis? When all the 12 year old boys at a birthday party have been labeled as ADHD, does that not show we have a pandemic of labeling everyone with this?
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I did not see anyone with mental illness on a recent day of therapy. I saw people molested as kids, or emotionally neglected by their mother, or abused by step-dad. But they did not have a brain disease, an aberration of flesh, which is what is implied by 'mental illness'. 1/
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If you want to "Understand Major Depression" as an ad says, do not show us a brain. Show us an angry parent screaming at their child. Or a boss telling an employee their work is 2 out of 10. Depression comes from these psychological injuries, not from malformed neurons.
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Psychiatry would be profoundly different if it started by listing all ACE's and stressful life events the person had. It would put their psychological injuries as top priority. It would look at how to heal your childhood emotional neglect, or recent rape. Not just give a pill.
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The hyper-individualism of Western culture puts a huge burden on the specific person to cure themself of psychological injuries. Yet we are embedded in matrices of relationship, and need to find those that facilitate our healing. This is ignored by many therapies, such as CBT
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I cannot treat a diagnosis. If someone tells me their dx, that is useless info. However, I can help a person. I can inquire about their psychological injuries, I can hear what they felt, how they coped, and what they want to change in the future. 1/
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I am not anti-psychiatry. I am anti-corruption. I think psychiatry could make great contributions if it started with psychological injuries as the single largest factor as to why people have intense negative emotion, and distressing behavior. 1/
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If psychiatry truly held the biopsychosocial model, then why do multiple studies find that 0 - 22% of service users were asked about child abuse and neglect? The rates even are lower for people with psychosis.
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Next time someone wants to study a psychiatric pill, measure not just change in depression level, but also adverse side effects. Then, ask the person if on balance, the pill made life better for them or not. Is loss of sexual function worth a modest improvement of mood?
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Your symptoms are real. But the label attached to them is tenuous. It is a contrivance, a product of a group, not a result of science.
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The medical model was created when psychiatry completely denied incest was real. This alone shows we need a new model, one that takes these psychological injuries very seriously as the cause of distress.
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How many people find it very problematic that a clinician can assign a DSM dx, and is NOT obligated to ask a person if they were sexually abused, or bullied, or emotionally neglected before doing so?
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A diagnosis really distracts from doing effective therapy. Instead of thinking, 'she was so neglected, that is why she is seeking attention, how can I help her feel affirmed in her web of relationships?' the trap is to think 'that is a typical borderline thing to do'. 1/
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For those who think DSM is helpful in working with people with mental health problems, remember, it does not obligate you to ask the person if they were sexually abused as a child. Or if Mom was an alcoholic. Or if they were emotionally neglected. 1/
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Mental disorders are not brain disorders. When a mother repeatedly tells her daughter 'no man would ever want you', that emotional abuse deeply affects her self-concept, and how she relates to others. She may become severely depressed. Or promiscuous, to prove Mom wrong. 1/
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A high score on a measure of anxiety (GAD-7) is meaningless. Is the person so anxious because they have a toxic boss? Are they so anxious because they were physically abused in childhood? What I say to the first client will be very different from what I say to the second.
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@mellojonny
@psychgeist52
This is a hilarious level of denial. I personally heard multiple psychiatrists tell me that depression was a chemical imbalance.
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Client: I do not know why I cry all the time. My doctor tried me on 8 different pills, and none work.
Me: What was it like growing up?
Client: I have 8 ACE's.
Me: You do not have a brain disorder that needs pills. You have severe emotional wounds that need healing.
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Again, psychiatry relentlessly ignoring the influence of trauma and neglect in childhood as a massive cause of later emotional distress. Kendler's opinion piece in JAMA psychiatry about brain diseases is all about genes, NOTHING about being sexually abused in childhood.
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The deep lack of soothing, safety, support, this is what resulted in pain for years. We need to ditch the synonyms of brain disease, or mental illness, and their statement that flesh is the source of emotional pain. We need to look for the person's psychological injuries 3/.
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I would be disordered in Africa. I cannot sing, or dance. These abilities are valuable in African village life. Instead, I sit and read for hours. This is valued in our culture, as I fit nicely in a classroom. Cultural values hugely influence what we consider disordered.
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They had deep emotional wounds, which created pain, negative thoughts, and sometimes compulsive behavior. Nothing was wrong with the physiology of their neurons. Everything was wrong in the matrix of relationships they lived in as children. 2/
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@drjanaway
My best friend hung himself while taking SSRI's. So, yeah, I am sceptical of the degree to which these are 'life-saving medications'
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DSM dx does NOT guide treatment. If two women have Major Depression, that label is useless. If one has a new boss who is a bully, I treat her very differently than the other, who had an emotionally abusive mother. It is knowledge of psychological injuries that guides tx.
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But it ignores emotional wounds as the fundamental cause, in favor of biological reasons as a way to maintain status. Even though there are no biomarkers, except for the dementias. Psychiatry is so corrupted by drug co's, that nearly all the research is twisted.
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@justin_garson
A universe where US psychiatrists received 340 million dollars in the last 6 years from drug companies to promote their products. That fact should explain a great deal of the dynamics you encounter.
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@ryjodo
The highest risk of suicide is a week after release from psych hospital. Is that not a reaction to involuntary commitment, and an increased feeling of hopelessness? 'I was in distress, and they treated me like a criminal. I'll never be helped.'
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People heal people. It is the caring response from another person that calms the painful emotions and grounds the person in severe distress. Pills may be an short-term adjunct, but psychological healing only comes from connection with another person.
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We can work together to help them grow. Ignore the DSM labels. Focus on the person, their history, and what may be helpful for them.
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'Treatment resistant depression' is a dx that compounds the failures of medical model. If people do not respond to two different pills, they have this 'condition'. It ignores the psychological injuries that cause 88% of depressions, such as rejection, stress, $ problems, etc
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Do psychotropic pills reduce self injury? Depends who pays for study. Articles w/ $ ties to drug co's had stronger tx effects... whereas studies w/out COIs more likely to report poss iatrogenic effects of treatment (RR’s 0.90 vs. 1.16], respectively)
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@markhoro
88% of episodes of depression are caused by stressful life events, such as being fired, getting dumped by your fiance, $ stress. Serotonergic pathways may be involved in the thoughts and feelings people have about these events, but they certainly are not the cause of depression.
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@justin_garson
Everything about this is designed to perpetuate misery. The natural impulse to comfort another person in pain is punished. People are put in solitary. Further punishment and isolation, as a follow up to the injustice. And people wonder why mental health outcomes are poor.
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Dear techno-fantasists : AI can never replace psychotherapy. People heal people, and it is the ineffable connection between two people that is healing. This can never be generated by multiple regressions, no matter how many layers of equations are stacked upon each other.
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DSM ignores the 8/9 of the iceberg under the waterline, and obsesses about the shape and contour of the ice above the water. In turning away from the person's truth, it does a deep disservice to them. DSM hinders, it does not ultimately help. 5/5
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Her needs, her history, her emotional wounds are screened out when diagnosis is put in front of the therapist. You are not reacting to her as a person, you are reacting to a label contrived by committee. Healing is different from judging and classifying with invalid categories
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The clinician does not HAVE to ask about these life-altering events. They can inquire about current symptoms, fill in the ticky-boxes, and assign a dx. Meanwhile, the source of the person's profound pain, troubling thoughts or behaviors, is ignored 2/
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Exhibit B for psychiatry not believing in the biopsychsocial model, but being hard bio-bio. 1) They went looking for biological differences between the brains of depressed and normal people. 2) Despite fancy analysis...... 1/ .
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Exhibit A of why the 'biopsychosocial' model is a facade for psychiatry. 1) Psychosocial causes to depression are entirely ignored. 2) Psychosocial treatments for depression are completely ignored. 1/
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How to read psychiatry research papers in three simple steps. 1. Read title i.e. Psilocybin in Major depression. 2. Scroll to bottom, to look at financial conflicts of interest. Discover that the for-profit sponsor .... 1/n
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@Altostrata
"No psychiatrist has used the 'chemical imbalance' explanation for a couple of decades". Funny how the participants in these studies heard it over and over, and it framed their distress and pill-taking.
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@doctorid
@DrDoyleSays
I think another factor is at play. CPTSD clearly points to the abusive/neglecting people around the person as the source of their emotional and behavioral difficulties. It points to psychological injuries, not biological abnormalities.
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The observation that their delusions are a reprise of trauma they suffered, is not relevant to DSM and its' adherents. Only symptoms are relevant, not the cause of them. The clinician can plunge ahead with intervention, ignoring the profound experiences of the afflicted. 3/
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Almost feel sad for psychiatrists who churn through many patients an hour doing med checks. Sure, you make tons of $. But you are missing the growth in people, as they heal from their emotional wounds. It is deeply fulfilling to participate in their transformation. 1/
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@markhoro
Just read the conflicts of interest section in their paper and you will understand what is animating them.
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I have done about 35,000 hours of therapy. And I am still learning so much. Important truths, powerful truths, things that are critically important to know. Of course, it is my clients who are my teachers. I cannot name you, but when you share your life, it enriches others.
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By middle age, 86% of people would get a DSM dx. Of those who got one, 85% got two or more. This is hysterical over-reach psychiatry, that vast majority of people have a 'mental illness.' If nearly everyone is sick then the concept is wildly inflated
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@taperclinic
This is an extremely important post. It shows how drug companies have intellectually captured nearly all of psychiatry, and it is a very rare psychiatrist (you, Dr. Bruce Perry, Dr. Alan Schore) who is not enmeshed with the drug co's.
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They can proclaim that the person has 'a brain disease' and 'must take these pills for the rest of their life'. They can and do ignore the terrifying events that shaped the afflicted person, the emotional starvation that gnaws at them. 4/.
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@SameiHuda
@PaulMinotMD
Actually, I made a big mistake, and I apologize. There was no evidence you complained about Legedin, and it was entirely wrong for me to make that statement. I was off skiing, hence the delay. I will carefully double check, and not confuse someone being mentioned in a 1/2
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Antidepressants are so good at decreasing your sex drive that a leading forensic psychiatrist recommends giving them to sex offenders to reduce their risk of recidivism.
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@_Eric_Reinhart
You keep asking these insightful and important questions. Every field should read it's opponents, to understand what their points are, and how to address or change in light of them.
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DSM dx are described as a short-hand to facilitate communication. Well, what about saying "She has 7 ACE's, and therefore has a lot of difficulty in relationships, and regulating her emotions." Is that not brief? Does that not describe what is really going on with the person?
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@PaulMinotMD
"convenient untruth'. How about wildly lucrative untruth? In 6 years, they received 340 million dollars from drug companies to promote their pills.
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@wdpsychiatry
Don't forget the massive role of the drug companies in shaping the system into this dynamic. The drug co's wrote the textbooks psychiatrists read, funded the academics, funded the studies, and sent out the pretty pharma reps to create this system.
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@psychgeist52
It is a profound illusion that these labels are objective. The public has no idea that they were made up by psychiatrists bickering and yelling at each other over lunch from a deli.
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@wdpsychiatry
Doctors would also tell their patients that 5) The difference between placebo and SSRI is 1.8 points on a 53 point scale.
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@_Eric_Reinhart
The drug companies are the gasoline, the psychiatrists are the engine. The billions of dollars the co's have poured in have shaped American society to a staggering degree.
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Yesterday, I saw many references to Complex PTSD. Remember, according to Amer Psychiatric Assoc, this diagnosis does not exist. It is not in DSM 5 TR. APA does not recognize that incest or emotional or physical violence in childhood results in a pattern of sx in adults. 1/
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@SameiHuda
@PaulMinotMD
thread with someone being directly involved. I would be angry if someone made that mistake, because it is unfair. You and I can agree or disagree on many points, and I do regret my harsh remarks.
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@TraceyHiggins92
I think an awful lot of psychiatrists are intentionally trying to help their patients. However, pharma dollars and guild adherence to a medical model lead them down a wrong path.
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@psychgeist52
The folly of thinking that a chemical can be a wonder cure for 18 years of emotional neglect from your parents. Or 4 months of sexual abuse from your neighbor when you were 8 years old. People heal people. Pills do not heal people, they may mute some of the emotions.
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@RadoslawStupak
I wish these researchers would pay attention to the study that 88% of depressive episodes are due to stressful life events, and stop wasting all this money on trivial genetic causes, and do research that would actually help people with depression.
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@IljaOblomow
The DSM III committee met over lunch to come up with the labels and criteria, and Robert Spitzer typed up the results of the bickering to form the book.
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Total bullshit alert: Watch out for psychiatrist Owen Scott Muir. He sent email from 'Frontier Psychiatrists' claiming 'Scientists like your author deliver treatment for depression, OCD, anxiety, and more to remission with as few as 5 days of treatment..... 1/n
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They found no difference in brain structure, connectivity, or genetics. 3) They found massive differences between depd and non-depd in terms of childhood maltreatment, and social support. 4) However, they ignored these huge psycho-social findings ...... 2/
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I would pick being born in a poor, but emotionally healthy family, over a wealthy family that inflicted multiple ACE's, every single time. Wealth plays a far smaller role in adult emotional health, than having caring parents with good boundaries.
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@Ryan_ETyler
@justin_garson
@mood_adrift
The drug industry funded 90% of the research into SSRI/SNRI. It might have reduced stigma, but it increases hopelessness. Great, I have an imbalanced brain, I cannot do anything except swallow pills.
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@PloederlM
Where does their pain come from? Do they realize that basically the entire intellectual leadership of psychiatry was paid by the drug co's to advocate for the pills? Do they feel betrayed by their own profession?
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@paddison154
@jf_moore
88% of episodes of depression are precipitated by stressful life events, such as romantic loss, being victim of crime, grief, family conflict, etc.
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but the daughter's negative self-concept and mood are not fundamentally due to a malformation of tissue. They are due to the mother's spiteful, vicious mind acting on her mind. The mother is fundamentally inflicting a psychological injury, with downstream physical results.
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@AllenFrancesMD
88% of depressions were due to major life stressor in a 12 year study of 2000 people Keller, Neale, 2007 Am J Psychiatry. It shreds the idea that depression is a disease or a physiological issue. It is hugely due to emotional wounds, not bad tissue.
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Another week of seeing clients, not one had a mental illness. They had psychological injuries from bullying bosses, emotionally abusive mothers, cheating husbands, being first responders to crime scenes, sexual abuse, alcoholic parents. But not one brain disorder/mental illness
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@chrisaikenmd
@CarlatPsych
@DrDavidHealy
How can we reverse the widespread belief in the public that depression is a chemical imbalance, when the intellectual leadership of psychiatry was either active or complicit in promoting it for over two decades?
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@DrMcFillin
If we were to discard the DSM, and instead explore the psychological injuries (ACE's and SLE's) that people have experienced, this would not happen.
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The concept of 'psychological injury' has far more optimism than 'brain disease / mental illness'. If you are highly anxious and depressed because of a bullying boss, you recover rapidly when you transfer to a honest, caring one. But the same sx would attract 1/
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@RadoslawStupak
@Mad_In_America
This is a stunning indictment of the concept that people need a diagnosis in order to improve. In truth, believing that you have a permanently defective brain induces hopelessness and shame, which can easily lead to self-loathing, and thus, self-harm.
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@ChrisPalmerMD
88% of depressions are due to highly stressful life events. So, no, No, NO, mental disorders are not metabolic disorders. They are almost always the result of emotional neglect, sexual abuse, bullying, physical abuse, rejection, and other psychological injuries.
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@wdpsychiatry
There is a step after 1. Ignore the emotional neglect, physical abuse, bullying, and parental alcoholism that causes their symptoms.
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@DrMcFillin
This is why we need to rip up DSM, and replace it with a list of all the psychological injuries of bullying, rejection, neglect, abuse etc that the person has experienced. It would make their emotional wounds the first focus of intervention. How do we heal them?
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@JDaviesPhD
Maybe they reject the label because they focus on reality. "I am not schizophrenic, I was raped for two years by my father in childhood, and that is why I hear a man's voice saying he will kill me. Why do you doctors ignore what I say?"
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@PaulMinotMD
I strongly prefer to explore the psychological injuries the person experienced. Were they emotionally neglected? Was their father an alcoholic? Bullied in school? These are wounds we can work on healing. I cannot help heal a dx, I can help heal emotional wounds
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injuries. That should be the focus of attention and intervention. Her dx of BPD stigmatizes her unnecessarily, and carries a imprint of permanence. Emotional wounds can be healed from, while dx (esp BPD) are superglued to a person.
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@DrMcFillin
88% of the time, major depression is due to adverse life events, like being fired, or romantically rejected. Why would you give pills to address life events? Why not talk about the pain they cause, and try to seek meaning and growth through them?
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@PamelaWibleMD
Yes, there is no well financed group visiting MD's every week to refute the spin that the drug reps have told the doctors. There is only one side, which has billions to spend to tell their marketing story.
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@jersey_flight
Well, since there are no biological markers in psychiatry, I do not see why you think anti-biological is anti-science. The science proves there is no fundamental biological cause to mental health problems.
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@justin_garson
One guy murdered his wife in front of his children. Two of them are now 'schizophrenic'. Actually, some parents *not all* deserve blame. They deserve jail time for what they did to their kids.
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Is there anyone out there who has *not* been told that they probably have autism, or ADHD? I am feeling extremely lonely.
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If the biopsychosocial model was truly the intellectual framework of psychiatry, the major psycho-social differences would receive the attention from the authors, the editors, and the reviewers. That did not happen, only the bio results got the focus.
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DSM sceptics may want to point out that the exclusion of 'Complex PTSD' shows how DSM is a political document, not one that recognizes the impact of ACE's on millions of people. 3/
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Never forget the benefit of exercise in improving mental health
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PubMed needs to be revised. It should list the $ conflicts of interest in the research article. That way, we can know whether the article is worth clicking on or not. The literature on fCOI corrupting research papers is vast and compelling (STAR-D trial, anyone?)
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Up for debate: The DSM is the most consequential book published in the last 50 years, because of the way it has shaped how we define ourselves, and our behavior, that 1 in 4 Americans takes psych pills. Agree? Disagree? (Note: consequential does not equal correct)
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@jill_d35
If one in 50 people died as a result of psychotherapy, would the media be as blase as they are about this impact of ECT?
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5) The single most reliable factor that results in genuine change is the therapeutic alliance. Holds in both psychotherapy and psychiatry. The quality of relationship is far more important than the particular technique or intervention used. 6/n
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