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Psychiatric Questions, Queries, and Quarrels

Psychiatric Questions, Queries, and Quarrels


  • Cannabis use. ADHD. Legislated suicide. Hot debates abound if you just look around—but what makes these conversations different is the vehemence with which the arguments are made in the context of psychiatry. The result? If this Special Report collection is any indication, it is a balance of opinion and civility made richer by virtue of opposing views.


  • More Dives and Intellectual Jujitsu. Almost everything about the psychiatric profession has been doubted—our assumptions about the nature of psychiatric disorders from psychoanalysis to neuropsychiatry, and our interventions from ECT to CBT. Scroll through the slides for hot discussions affecting psychiatry today. In this overview of the DSM diagnostic system, the medicalization of normal variants of human behavior, and physician-assisted suicide, Special Report Chair, Cynthia Geppert, MD, introduces this collection and puts it into context, getting to the heart of what makes psychiatry so fascinating.


  • Medical Marijuana and Mental Health: Cannabis Use in Psychiatric Practice. The authors discuss the 2 compounds in herbal cannabis that have received the most research attention and have also been of greatest clinical interest: THC and CBD. There are, however, numerous other compounds that are unique to cannabis. Patients may feel stigmatized not only by their mental disorder, but also by their cannabis use, and may be reluctant to discuss it with their provider for fear of being denied treatment or labeled a substance abuser in need of rehab. Open discussions between psychiatrist and patient about the patient’s cannabis use can potentially be beneficial, especially if the psychiatrist is receptive to learning about the perceived benefits of using cannabis. This is one reason psychiatrists and other mental health professionals need to understand the relationship between cannabis and mental disorders.


  • Are We Overdiagnosing and Overtreating ADHD? Many claim psychiatric disorders are overdiagnosed in an effort to medicalize and medicate normal variants in human behavior. Psychiatric detractors give a variety of rationales—some suggestive of conspiracy theories—for this tendency. Rahil R. Jummami, MD, Emily Hirsch, and Glenn Hirsch, MD, take on one of the most heated topics—the diagnosis and treatment of ADHD in children. Mining the epidemiological data field, they draw interesting, and at times opposing, conclusions as befits a Special Report dedicated to dissension. Readers can decide after reading the article whether ADHD is really over—or perhaps even under—diagnosed as well as parse out the logical fallacy that a diagnosis leads ineluctably to medication management. This article speaks to the care with which ADHD must be diagnosed and managed to reduce the significant negative impact of the disorder on the individual, family, and society.


  • Diagnosis of ADHD depends on phenomenology, subjective reports, and clinical observations of symptoms. Further, overdiagnosis may cause medicalization of normal variants and lead to unnecessary treatments with little or no benefit and with unacceptable risks. The Table summarizes DSM and ICD diagnostic criteria. For a mobile-friendly view, click here.


  • From “Delete Your Account” to “Delete Yourself”: Legislated Suicide and the Role of Psychiatry. Physician-assisted suicide (PAS) is now legal in several states. But none of the state statues mandates a mental health evaluation by a psychiatrist or psychologist before the writing of a lethal prescription by an attending physician. PAS has been legal and ethical not only in Europe for years but more contemporaneously in our neighbor to the north—Canada. No other issue in this collection of debates has aroused such polarized and powerfully held opinions, and this is not surprising given that PAS or PAD (physician-assisted dying), depending on your view, goes to the heart of the ethical commitment of psychiatry as a profession.

Comments

Euthanasia? All life is terminal!
I understand that later this year there may be a parliamentary discussion on euthanasia (or “assisted dying”). While I understand that the first “commandment” of the Hippocratic Oath is to “do no harm” you may be interested in my views regarding this contentious topic:-
To only allow (or disallow) a “terminally” ill person to decide when they wish to end their life is looking at this problem from the wrong end. It is not if they are ill, terminally or otherwise, but a person’s quality of life – their perception of that quality, which should be the main issue.
Recall and understand that all life, repeat all life, is terminal – we cannot escape the end. It is terminal! Sooner or later we all die – ill or not.
We, and by “we” I include all humans, were presumably born to live in the world. Now if a human being decides, for whatever reason, that the life he or she is currently experiencing in the world is not a “quality life”, who is to say they are wrong? We, you or I, cannot experience that person’s view with all the emotional, stressful or painful events they may have suffered or endured during their life to date. How can anyone, other than the person concerned, determine what level of “quality” is acceptable or unacceptable?
We can have no idea how this expression of life plays out; or how life events affect a person’s outlook, towards themselves or others – no one can “know” this except the person concerned. They make a choice based on such experienced – good, bad or indifferent - it their decision. You or I are in no position to say they are wrong.
All human life is bound to individuals who manifest it, and is simply inconceivable without them. But every human is charged with an individual destiny and destination, and the journey to that destination or the fulfilment of that destiny is the only thing that makes sense of human life. The individual journeys and destinations may differ but the fundamental purpose is the same – the expression of life (whatever this is determined to be).
What evidence, what insight do we have such that we can “proclaim” that a particular person’s view of life is wrong and that we (or at least the “experts”) alone know better? We may not like or approve of their view but - so what! Furthermore, what evidence is there for the “experts” to state categorically that those who wish to end their life must be suffering from a “mental disorder”. Disordered from what? What are these people supposed to be disordered from? From “normal”? What is “normal”? As far as I can discover there is no accepted definition of “normal”. Possibly those considered “mentally disordered” react to life’s trials and tribulations differently from those around them. Are they “wrong”? Or are those who condemn suicide or euthanasia just being intolerant and lacking in understanding or compassion?
Consider what may have a bearing on a person’s perception of a “quality” life; lack of adequate employment; the current gross inequality in income; inequality in access to adequate medical facilities; inequality in access to adequate levels of education; widespread condemnation of various religious beliefs and practices (in the “West” principally those that are non-Christian); widespread racism, abuse and bullying (abuse in any form – emotional, financial, physical or sexual) particularly the use of social media to attack the vulnerable.
And then there is extreme pain! Anything that results in an actual or perceived loss of personal control will (possibly) bring about a loss of “hope” - that most subjective attitude of mind.
Furthermore for some to say that only God can decide when or where any person dies is surely a gross over assumption – how do they know? What special insight do they possess? Is it not possible, because (I assume) God gave us free will that He/She/It may have already decided to allow a person who wants to die, to die?
Then what about those who say that the legalization of euthanasia would see the end of compassion? Surely it would be more compassionate to allow someone who wishes to end their life to do so in a private setting of their choice, with (possibly) family and friends in attendance?
Far rather this than forcing a person to take extreme actions to get their way – drinking or drugging themselves to death; jumping off a high rise building or cliff; driving at high speed into the support column of a freeway overpass or into a tree on a country road; or drink some corrosive liquid (such as ammonia) and take four days, in agony, to die; or consume rat poison.
Why should a person “live” according to another’s expectations? We have no “right” to interfere. It is not our life; it is not our choice.
Recall also that the British philosopher David Hume (1711 –1776) said, “I believe that no man ever threw away Life while it was worth keeping.”
Finally I will repeat a quote, from the Indian sage Jiddu Krishnamurti (1895-1986), who said, “It is no measure of health to be well adjusted to a profoundly sick society”.
There we have it – in a nutshell!
What follows below is a “Black Box” warning relating to anti-depressant medications:-

Federal Drug Administration Product Information Warning:
Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

Read into this what you will!

Andrew Campbell-Watt
87/2462 Albany Hwy
Gosnells WA 6110
Phone: 0413582949
Email: acampbellwatt@gmail.com

PS. I am a 76 year old retiree who has never had any contact with any euthanasia group.

Andrew @

Thank you for your insightful, well-formulated comment mr. Campbell-Watt...I agree with virtually all of your tenants here...you are quite wise. As for the 'Black Box' mention at the end...this always has had me perplexed regarding continuation on such medications...if the thoughts produced produce further 'darkness' . Interesting thoughts...thank you for taking the time to document them for the readers here.

Donna @

Mr. Campbell-Watt,

I must express my appreciation of what you shared with us above. For years, I have tried to figure out which words represent my thoughts on subjects such as judging one's quality of life, depression, melancholia and suicide. Much as it is right now, the eloquence I craved evaded me. I feel as though your thoughts echo my own. Thank you for sharing your views.

Jennie @

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