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Re: The medicalization of character

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  • TheophileEscargot
    I think this is a fascinating subject. Via Neuroskeptic, here s a bit more on the DSM-V changes.
    Message 1 of 5 , Mar 1, 2010
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      I think this is a fascinating subject. Via Neuroskeptic, here's a bit more on the DSM-V changes.

      http://www.mindhacks.com/blog/2010/02/the_draft_of_the_new.html
      http://neuroskeptic.blogspot.com/2010/02/dsm-v-change-we-can-believe-in.html

      "One of the most striking extra features is the addition of dimensions. These are essentially mini questionnaire-like ratings that allow the extent of a condition to be numerically rated, rather than just relying on a 'you have it or you do not' categorical diagnosis."

      There seems to be an increasing trend to seeing mental illnesses as part of a continuum with character traits.

      But it seems to me this may well be correct. I'm not sure there's any clear dividing line between a person with a gloomy disposition and a person with depression: the difference may be one of degree.

      It's interesting that the trend works both ways. Cognitive Behaviour Therapy is partly based on techniques of stoic philosophy. So in some cases, a person with a mental illness may be treated with techniques originally meant to make a normal person a better person. On the other hand, it's disturbing that character traits may be "corrected" with drugs.



      --- In stoics@yahoogroups.com, Dave Kelly <ptypes@...> wrote:
      >
      > http://m.gosanangelo.com/news/2010/feb/28/a-cure-for-character/
      >
      > GEORGE WILL: A 'cure' for character
      >
      > Published Sunday, February 28, 2010
      >
      > SAN ANGELO, Texas — WASHINGTON — Peter De Vries, America's wittiest
      > novelist, died 17 years ago but his discernment of this country's
      > cultural foibles still amazes. In a 1983 novel, he spotted the
      > tendency of America's therapeutic culture to medicalize character
      > flaws:
      >
      > "Once terms like identity doubts and midlife crisis become current,"
      > De Vries wrote, "the reported cases of them increase by leaps and
      > bounds."
      >
      > And: "Rapid-fire means of communication have brought psychic
      > dilapidation within the reach of the most provincial backwaters, so
      > that large metropolitan centers and educated circles need no longer
      > consider it their exclusive property, nor preen themselves on their
      > special malaises."
      >
      > Life is about to imitate De Vries' literature, again. The fourth
      > edition of the Diagnostic and Statistical Manual of Mental Disorders,
      > psychiatry's encyclopedia of supposed mental "disorders," is being
      > revised.
      >
      > The 16 years since the last revision evidently were prolific in
      > producing new afflictions. The revision may aggravate the confusion of
      > moral categories.
      >
      > Today's DSM defines "oppositional defiant disorder" as a pattern of
      > "negativistic, defiant, disobedient and hostile behavior toward
      > authority figures." Symptoms include "often loses temper," "often
      > deliberately annoys people" or "is often touchy." DSM omits this
      > symptom: "is a teenager."
      >
      > This DSM defines as "personality disorders" attributes that once were
      > considered character flaws. "Anti-social personality disorder" is "a
      > pervasive pattern of disregard for ... the rights of others ...
      > callous, cynical ... an inflated and arrogant self-appraisal."
      > "Histrionic personality disorder" is "excessive emotionality and
      > attention-seeking."
      >
      > "Narcissistic personality disorder" involves "grandiosity, need for
      > admiration ... boastful and pretentious." And so on.
      >
      > If every character blemish or emotional turbulence is a "disorder"
      > akin to a physical disability, legal accommodations are mandatory.
      > Under federal law, "disabilities" include any "mental impairment that
      > substantially limits one or more major life activities"; "mental
      > impairments" include "emotional or mental illness." So there might be
      > a legal entitlement to be a jerk. (See above, "anti-social personality
      > disorder.")
      >
      > The revised DSM reportedly may include "binge eating disorder" and
      > "hypersexual disorder" ("a great deal of time" devoted to "sexual
      > fantasies and urges" and "planning for and engaging in sexual
      > behavior"). Concerning children, there might be "temper dysregulation
      > disorder with dysphoria."
      >
      > This last categorization illustrates the serious stakes in the
      > categorization of behaviors. Extremely irritable or aggressive
      > children are frequently diagnosed as bipolar and treated with powerful
      > antipsychotic drugs. This can be a damaging mistake if behavioral
      > modification treatment can mitigate the problem.
      >
      > Another danger is that childhood eccentricities, sometimes
      > inextricable from creativity, might be labeled "disorders" to be
      > "cured."
      >
      > If 7-year-old Mozart tried composing his concertos today, he might be
      > diagnosed with attention-deficit hyperactivity disorder and medicated
      > into barren normality.
      >
      > Furthermore, intellectual chaos can result from medicalizing the
      > assessment of character. Today's therapeutic ethos, which celebrates
      > curing and disparages judging, expresses the liberal disposition to
      > assume that crime and other problematic behaviors reflect social or
      > biological causation. While this absolves the individual of
      > responsibility, it also strips the individual of personhood, and moral
      > dignity.
      >
      > It is scientifically sensible to say that all behavior is in some
      > sense caused. But a society that thinks scientific determinism renders
      > personal responsibility a chimera must consider it absurd not only to
      > condemn depravity but also to praise nobility. Such moral derangement
      > can flow from exaggerated notions of what science teaches, or can
      > teach, about the biological and environmental roots of behavior.
      >
      > Or — revisers of the DSM, please note — confusion can flow from the
      > notion that normality is always obvious and normative, meaning
      > preferable.
      >
      > And the notion that deviations from it should be considered
      > "disorders" to be "cured" rather than stigmatized as offenses against
      > valid moral norms.
      >
      > George Will is a Washington columnist and television commentator.
      > Contact him at georgewill@...
      >
      >
      > --
      > The universe is change: life is judgment.
      >

    • Dave Kelly
      On Mon, Mar 1, 2010 at 6:26 AM, TheophileEscargot ... The problem that a Stoic trying to make progress will have with Cognitive Behavior Therapy is that he or
      Message 2 of 5 , Mar 1, 2010
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        On Mon, Mar 1, 2010 at 6:26 AM, TheophileEscargot
        <snailman100@...> wrote:
        >
        >
        >
        >.......Cognitive Behaviour Therapy is partly based on techniques of stoic philosophy. So in some cases, a person with a mental illness may be treated with techniques originally meant to make a normal person a better person...........
        >

        The problem that a Stoic trying to make progress will have with
        Cognitive Behavior Therapy is that he or she will not be getting a
        therapy based on, or aiming at, Stoic values. And the transformation
        of one's values to Stoic values can be said to be the entire program
        of Stoic _therapeia_.

        Ellis' basic philosophy is hedonism. He calls the aim of his therapy
        "long term hedonism."

        http://www.rebtnetwork.org/essays/hedonism.html

        Aaron Beck, the other acknowledged 'founder' of CBT, seems to me to be
        promoting Aristotelian values, which is fine, I guess, for folks with
        ordinary beliefs and aims. But I think that that therapy would
        short-circuit the committed Stoic's progress. (Perhaps a wise
        cognitive therapist would allow a Stoic to pursue Stoic aims and
        values).

        Beck's grounding in Aristotelian values can be seen, I think, in this
        case study:

        http://www.ptypes.com/beck_case_study.html

        "Both the patient and the therapist realized that the patient was
        skating on thin ice because of his personality problems, which
        consisted of a mixture of compulsive and narcissistic features. The
        patient put tremendous emphasis on achievement, systems, high
        productivity, efficiency, and perfectionism. At first, he regarded
        those values as normal, healthy, and adaptive, but he came to see
        himself as driven by his beliefs relevant to the necessity for
        high-level achievement. When those traits were translated into
        beliefs, he began to see how dysfunctional they were...."

        [snip]

        "The patient coped with the painful beliefs of inadequacy and fear of
        rejection by developing and living up to extremely high standards. He
        crystallized a cluster of beliefs: "I must be the best at everything I
        do. It isn't enough to excel at one thing. If I have the potential in
        any area, I must live up to that potential in each of those areas."

        "For many years he did fulfill his potential in professional areas as
        a biochemical researcher. That success strengthened the belief "I can
        and should excel at everything now and in the future." But there were
        problems inherent in that belief. He paid a tremendous personal price
        for overvaluing professional achievements. He had no time to smell the
        roses, to nurture his wife and children, to appreciate the joys of
        nature, to replenish himself physically and emotionally. He suffered
        from chronic anxiety, sleep problems, and psychosomatic symptoms, and
        he could not continue to increase his scientific achievements over a
        long period of time."

        [snip]

        "The therapy consisted of delineating and modifying the dysfunctional
        beliefs. The therapist explored with him his perfectionistic,
        dichotomized view of success: "Either I live up to my potential in all
        areas, or I've failed." (Again, one misstep felt fatal to him.) He
        believed that he must continuously drive himself to stay at the top
        because even one step below the top was equal to failure (in his
        mind). In addition, he was hypersensitive to and became either anxious
        or irritated at perceived obstacles to smooth functioning: signs of
        physical or emotional illness in himself, a secretary's mistake, the
        lateness of others' reports--in short, anything that could interfere
        with his optimal achievement.

        "The therapist helped the patient fashion more functional beliefs: (1)
        "It is rewarding to succeed highly, but less success is rewarding also
        and has no bearing on my adequacy or inadequacy. I am adequate, no
        matter what." (2) "Scientific achievement is important but not vital."
        (3) "What is vital is a reasonable mix of achievement, emotional and
        physical well-being, an enriching family and social life, joy in
        recreation, relaxation, nature, and spiritual and personal growth."
        (4) "It is impossible for anyone to achieve that vital balance if any
        one area is overvalued."

        "In the course of therapy, extending over a year, the patient's
        dysfunctional attitudes were gradually attenuated, and the new
        attitudes were incorporated. He continued to have a few miniepisodes
        of anxiety and depressive disorders but no full-blown recurrences of
        the clinical disorders."

        Best wishes,
        Dave

        --
        The universe is changed: life is judgment.
      • TheophileEscargot
        I only said partly based . But Ellis himself specifically mentioned stoic philosophers as his influences.
        Message 3 of 5 , Mar 1, 2010
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          I only said "partly based". But Ellis himself specifically mentioned stoic philosophers as his influences. 

          http://www.psychologytoday.com/articles/200703/albert-ellis-confident-and-kicking
          "A half-century ago, Ellis drew from Seneca and Epictetus in devising rational emotive behavior therapy" 

          http://www.rebt.bham.ac.uk/
          "Rational Emotive Behaviour Therapy was developed by Dr Albert Ellis in 1955. As such, it was the first form of cognitive behavioural therapy to be developed. It stemmed from Dr Ellis's keen interest in philosophy, most notably the ancient Stoic philosophers"

          http://tuftsjournal.tufts.edu/2008/04/features/06/
          "...rational emotive therapy, the brainchild of Dr. Albert Ellis. That model is almost a direct descendent of the Stoics. Ellis frequently quoted Epictetus"


          I think if you take the phrase "long term hedonism" out of context it can carry a false implication that Ellis was a naive hedonist. In fact he specifically wanted to differentiate it from "short term hedonism", which is the immediate gratification of the senses.


          --- In stoics@yahoogroups.com, Dave Kelly <ptypes@...> wrote:
          >
          > On Mon, Mar 1, 2010 at 6:26 AM, TheophileEscargot
          > snailman100@... wrote:
          > >
          > >
          > >
          > >.......Cognitive Behaviour Therapy is partly based on techniques of stoic philosophy. So in some cases, a person with a mental illness may be treated with techniques originally meant to make a normal person a better person...........
          > >
          >
          > The problem that a Stoic trying to make progress will have with
          > Cognitive Behavior Therapy is that he or she will not be getting a
          > therapy based on, or aiming at, Stoic values. And the transformation
          > of one's values to Stoic values can be said to be the entire program
          > of Stoic _therapeia_.
          >
          > Ellis' basic philosophy is hedonism. He calls the aim of his therapy
          > "long term hedonism."
          >
          > http://www.rebtnetwork.org/essays/hedonism.html
          >
          > Aaron Beck, the other acknowledged 'founder' of CBT, seems to me to be
          > promoting Aristotelian values, which is fine, I guess, for folks with
          > ordinary beliefs and aims. But I think that that therapy would
          > short-circuit the committed Stoic's progress. (Perhaps a wise
          > cognitive therapist would allow a Stoic to pursue Stoic aims and
          > values).
          >
          > Beck's grounding in Aristotelian values can be seen, I think, in this
          > case study:
          >
          > http://www.ptypes.com/beck_case_study.html
          >
          > "Both the patient and the therapist realized that the patient was
          > skating on thin ice because of his personality problems, which
          > consisted of a mixture of compulsive and narcissistic features. The
          > patient put tremendous emphasis on achievement, systems, high
          > productivity, efficiency, and perfectionism. At first, he regarded
          > those values as normal, healthy, and adaptive, but he came to see
          > himself as driven by his beliefs relevant to the necessity for
          > high-level achievement. When those traits were translated into
          > beliefs, he began to see how dysfunctional they were...."
          >
          > [snip]
          >
          > "The patient coped with the painful beliefs of inadequacy and fear of
          > rejection by developing and living up to extremely high standards. He
          > crystallized a cluster of beliefs: "I must be the best at everything I
          > do. It isn't enough to excel at one thing. If I have the potential in
          > any area, I must live up to that potential in each of those areas."
          >
          > "For many years he did fulfill his potential in professional areas as
          > a biochemical researcher. That success strengthened the belief "I can
          > and should excel at everything now and in the future." But there were
          > problems inherent in that belief. He paid a tremendous personal price
          > for overvaluing professional achievements. He had no time to smell the
          > roses, to nurture his wife and children, to appreciate the joys of
          > nature, to replenish himself physically and emotionally. He suffered
          > from chronic anxiety, sleep problems, and psychosomatic symptoms, and
          > he could not continue to increase his scientific achievements over a
          > long period of time."
          >
          > [snip]
          >
          > "The therapy consisted of delineating and modifying the dysfunctional
          > beliefs. The therapist explored with him his perfectionistic,
          > dichotomized view of success: "Either I live up to my potential in all
          > areas, or I've failed." (Again, one misstep felt fatal to him.) He
          > believed that he must continuously drive himself to stay at the top
          > because even one step below the top was equal to failure (in his
          > mind). In addition, he was hypersensitive to and became either anxious
          > or irritated at perceived obstacles to smooth functioning: signs of
          > physical or emotional illness in himself, a secretary's mistake, the
          > lateness of others' reports--in short, anything that could interfere
          > with his optimal achievement.
          >
          > "The therapist helped the patient fashion more functional beliefs: (1)
          > "It is rewarding to succeed highly, but less success is rewarding also
          > and has no bearing on my adequacy or inadequacy. I am adequate, no
          > matter what." (2) "Scientific achievement is important but not vital."
          > (3) "What is vital is a reasonable mix of achievement, emotional and
          > physical well-being, an enriching family and social life, joy in
          > recreation, relaxation, nature, and spiritual and personal growth."
          > (4) "It is impossible for anyone to achieve that vital balance if any
          > one area is overvalued."
          >
          > "In the course of therapy, extending over a year, the patient's
          > dysfunctional attitudes were gradually attenuated, and the new
          > attitudes were incorporated. He continued to have a few miniepisodes
          > of anxiety and depressive disorders but no full-blown recurrences of
          > the clinical disorders."
          >
          > Best wishes,
          > Dave
          >
          > --
          > The universe is changed: life is judgment.
          >
        • Dave Kelly
          On Mon, Mar 1, 2010 at 3:29 PM, TheophileEscargot ... Ellis based his Rational Emotive Therapy on Epictetus core idea that it s our judgments of things that
          Message 4 of 5 , Mar 1, 2010
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            On Mon, Mar 1, 2010 at 3:29 PM, TheophileEscargot
            <snailman100@...> wrote:
            >
            >
            >
            > I only said "partly based". But Ellis himself specifically mentioned stoic philosophers as his influences.
            >

            Ellis based his Rational Emotive Therapy on Epictetus' core idea that
            it's our judgments of things that distress us, not the things
            themselves. As far as I know that's the extent of the use of Stoicism
            by Ellis.

            But Ellis is surely not a Stoic, or Stoical:

            (from the interview)

            Q: One tenet of REBT is stoicism. How do you use it to cope with
            seemingly horrible events?

            A: Some things are bad, a few things are exceptionally bad but not
            awful, and no matter how bad it is, you can stand it.

            > http://www.psychologytoday.com/articles/200703/albert-ellis-confident-and-kicking
            > "A half-century ago, Ellis drew from Seneca and Epictetus in devising rational emotive behavior therapy"
            > http://www.rebt.bham.ac.uk/
            > "Rational Emotive Behaviour Therapy was developed by Dr Albert Ellis in 1955. As such, it was the first form of cognitive behavioural therapy to be developed. It stemmed from Dr Ellis's keen interest in philosophy, most notably the ancient Stoic philosophers"
            > http://tuftsjournal.tufts.edu/2008/04/features/06/
            > "...rational emotive therapy, the brainchild of Dr. Albert Ellis. That model is almost a direct descendent of the Stoics. Ellis frequently quoted Epictetus"
            >
            > I think if you take the phrase "long term hedonism" out of context it can carry a false implication that Ellis was a naive hedonist. In fact he specifically wanted to differentiate it from "short term hedonism", which is the immediate gratification of the senses.
            >

            It's not taken out of context. "Long-range hedonism" is Ellis' own
            definition of the philosophy underlying REBT. The following is from a
            paper about Ellis, but I also quote Ellis, below.

            "Albert Ellis, Hedonism and Suffering"

            [I've removed some special characters that were included in the text]

            "Perhaps one of the clearest modern exponents of the notion that
            suffering is irrational in nature and, by implication, pointless is
            Albert Ellis, who maintains that one of the basic philosophic aspects
            of rational-emotive therapy . . . is an emphasis on hedonism, pleasure
            and happiness. . . . ([Reason_and_emotion_in_psychotherapy] 1990, p.
            336). Indeed, Ellis (1990) has stated that, at least in this regard,
            his Rational Emotive Behavior Therapy is no different than most other
            forms of therapy, in that:

            'Just about all existing schools of psychotherapy are, at bottom,
            hedonistic, in that they hold that pleasure or freedom from pain is a
            principle good and should be the aim of thought and action. . . . The
            rational-emotive therapist, therefore, is far from unique when he
            accepts some kind of a hedonistic world-view and tries to help his
            patients adopt a workable hedonistic way of life'. (p. 363)

            "Although he has repeatedly asserted that his main therapeutic goal is
            to minimize the irrational anxiety, depression, and anger his clients
            feel, Ellis is not content with merely a negative definition of
            psychological health and well-being. Rather, in a more positive vein,
            he argues that the rational-emotive therapist should encourage clients
            to adopt the notion that it is good for me to live and enjoy myself
            and decide to strive for more pleasure than pain (Ellis, 1973, p. 23).
            Because hedonism is assumed to be identical with rationality in this
            system of therapy, suffering, in whatever psychological form it might
            take, is ipso facto irrational, the product of an inappropriately
            directed style of living and reasoning. Because it is irrational,
            suffering is also pointless and unnecessary. The solution to the
            dilemma of suffering is to simply adopt a more healthy and rational
            style of living and thinking, one that will prove to be more
            personally satisfying and self-enriching.

            "Ellis does not, however, advocate a short-range, self-defeating
            hedonism of a childish variety (1990, p. 336). Rather, that immature
            form of hedonism is spurned in favor of a more long-range form of
            hedonism, one that is clearly reminiscent of that found in ancient
            Stoic philosophy. [Yes, Ellis explicitly associated long-term hedonism
            with Stoicism]. Borrowing terminology from Freud, Ellis (1990)
            suggests that the reality principle of putting off present pleasures
            for future gains is often a much saner course to follow than the
            pleasure principle of striving only for present gains (p. 363; italics
            added). In short, Ellis (1990) argues for:

            '. . . the philosophy that one should primarily strive for one's own
            satisfactions while, at the same time, keeping in mind that one will
            achieve one's own best good, in most instances, by giving up immediate
            gratifications for future gains and by being courteous to and
            considerate of others, so that they will not sabotage ones own ends'.
            (p. 134)

            "This philosophy of long-range hedonism is consistently stressed in RT
            (Ellis, 1990, p. 363) so that clients will come to understand that the
            unhappiness they are experiencing is ultimately the result of failing
            to engage in the rational calculation and pursuit of their own
            long-term self-interest. As Ellis (1990) has stated, the main aim of
            RT is to help the patient to clearly see what his own basic
            philosophic assumptions or values are and to significantly change
            these life premises (p. 348). If these irrational values are not
            significantly changed (i.e., abandoned in favor of a philosophy of
            long-term hedonism), however, the client's underlying anxiety and lack
            of self-confidence will not be greatly ameliorated (p. 349)."

            http://psychology.byu.edu/Faculty/BBrown/Assets/Atonement_%20Suffering_%20and%20Psychotherapy2.doc

            (from my website)

            "Albert Ellis has stated a number of times in his published works that
            REBT is based on the moral philosophy of hedonism. This is what he
            says in Reason and Emotion in Psychotherapy (pp. 292-93):

            ' It is sometimes alleged that REBT is too crassly hedonistic and
            that it teaches people to enjoy themselves at the expense of their
            deeper or more rewarding commitments. This is a false charge, since
            one of the main tenets of Rational Emotive Behavior Therapy is the
            Stoic principle of long-range rather than short-range hedonism'.

            ' Just about all existing schools of psychotherapy are, at bottom
            hedonistic, in that they hold that pleasure and freedom from pain are
            good and preferably should be the aims of thought and action . This is
            probably inevitable, because people who do not believe in a hedonistic
            view would continue to suffer intense anxiety and discomfort and would
            not come for therapy. And therapists who did not try in some manner to
            alleviate the discomfort of those who did come for help would hardly
            remain in business very long. Rational Emotive Behavior therapists,
            therefore, are far from unique when they accept some kind of a
            hedonistic world view and try to help clients work for a hedonistic
            way of life'.

            ' It has been found through the ages that the short-range
            hedonistic philosophy of "Drink, eat, and be merry, for tomorrow you
            may die," is unrealistic: because most of the time you don't die
            tomorrow, but are much more likely to live and rue the consequences of
            too much drinking, eating, and merrymaking today. Consequently (as
            Freud, for one, kept stressing) the reality principle of putting off
            present pleasures for future gains is often a much saner course to
            follow than the pleasure principle of striving mainly for present
            gains. This reality principle, or the philosophy of long-range
            hedonism, is consistently stressed in REBT'.

            ' Instead of being encouraged to do things the "easy way," clients
            are encouraged to do them the more rewarding way—which, in the short
            run, is often more difficult. REBT, while embracing neither the
            extreme views of the Epicureans nor those of the Stoics, strives for a
            more moderate synthesis of both these ways of life. In the course of
            the therapy process itself, a fundamental principle of REBT is that
            clients had preferably better work, work, work at changing their own
            self-defeating [293] assumptions, feelings, and actions if they are to
            overcome their emotional disturbances'.


            Ellis, Albert (1994). Reason and emotion in psychotherapy, revised and
            updated. New York: Carol Publishing Group.

            Best wishes,
            Dave

            --
            The universe is change: life is judgment.
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