69% of people taking antidepressants don't fit the criteria for clinical depression or major depressive disorder (MDD). Research suggests that, instead, they're suffering normal sadness and hardships, which are just part of life.
The authors of the study conclude:
"Many individuals who are prescribed and use antidepressant medications may not have met criteria for mental disorders. Our data indicate that antidepressants are commonly used in the absence of clear evidence-based indications.
This assumes that the DSM contains perfect definitions of discrete mental conditions that additionally indicate whether a person will experience a reduction in symptoms if they're put on the "right" medication. That's nonsense. People who don't meet the DSM criteria for depression could be suffering considerably and experience relief on an antidepressant. People who fit the criteria perfectly can be unresponsive to antidepressants.
I'm not advocating casual use of anti-depressants or psychiatric medications more generally. I believe that they're over-prescribed. But to pretend that DSM diagnoses are remotely definitive in these matters, and to pretend that responsiveness to medication is bound to those diagnoses, runs counter the experience of every clinician I know.
“People want an easily graspable handle to help understand this, to blame something or scapegoat,” said Dr. James L. Knoll, the director of forensic psychiatry at the State University of New York Upstate Medical University.
But to zero in on depression is “a low-yield dead end,” he said, adding, “There’s something fundamentally different here, aside and apart from the depression, and that’s where we need to look.”
Serious mental illness, studies of mass killers suggest, is a prime driver in a minority of cases — about 20 percent, according to estimates by several experts. Far more common are distortions of personality — excesses of rage, paranoia, grandiosity, thirst for vengeance or pathological narcissism and callousness.
“The typical personality attribute in mass murderers is one of paranoid traits plus massive disgruntlement,” said Dr. Michael Stone, a forensic psychiatrist in New York who recently completed a study of 228 mass killers, many of whom also killed themselves.
The article emphasizes that these incidents almost always begin with a grievance. I would link the power of grievance with oversensitivity to narcissistic injury. From there, vengeful fantasies of narcissistic restoration may provide temporary relief from the humiliating injury, but these fantasies can become obsessions that increasingly demanding real-world satisfaction. Add emotional callousness and lack of empathy to the mix, and a major hurdle to inflicting grievous harm on others is removed.
In early January 2002, four months after the September 11 attacks, Israeli national security council director Uzi Dayan met in Washington with his American counterpart Condoleezza Rice. She told him — to his surprise, he later told me — that President Bush had decided to invade Iraq and topple Saddam Hussein. A month later Dayan’s boss, Prime Minister Ariel Sharon, met with Bush in the White House and offered some advice, based on decades of Israeli intelligence.
Happy Easter to my readers who celebrate this day. Eating your ham and supporting those who refuse to serve pizza is easy. Walking the walk is much harder:
Doris Hernandez still doesn't know who killed her son Freddy Cervantes two years ago. She said she doesn't need to know. She already forgives the perpetrator.
At a vigil in memory of her son the day after he died, she stunned a crowd of young mourners by telling them to let go of their anger and forgive the killer, too.
Just as Easter celebrates Christ's compassion and victory over death, Hernandez has embraced compassion for her 20-year-old son's killer and other young men and women who find themselves drawn into gangs and conscripted to commit violence. She will do whatever it takes to let them know they all are loved.
Moral injury is discussed in academia but is rarely talked about — and is often misunderstood — among those who suffer from it. It isn’t really a part of the “returning veteran” lexicon; instead, veterans use PTSD as a convenient catchall. Yet there is a danger in conflating post-traumatic stress and moral injury. While in many cases they can overlap, differentiating the two allows the returning veteran to understand not only the trauma he or she experienced but also the damage left by the decisions made in war.
An old post is seeing a bump in traffic, so I'm bumping it to the top.
"Nobody ever thinks they're stupid. It's part of the stupidity."--Detective Ray Cole, interrogating Preston 'Bodie' Broadus, The Wire: Season 2, episode 9.
I laughed when I heard this articulation of the Dunning-Kruger Effect (explained below) while we watched The Wire last night. During a police interrogation of a murder suspect, an interrogating detective tells the suspect that he's stupid. The other interrogator, Detective Cole, smugly follows up with the stupidity quote above. He says this just before the suspect outsmarts him. Cole is a homicide detective who has some history of difficulty clearing the cases he's been assigned.