Talk:Mental disorder/Archive 1

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Wondering why

Anome keeps removingink I put in for a mental health support resource and then doesn't enter a reason!

Why is the "facts are disputed" tag here? I suggest that people work on rewriting portions of the article with sources so that the facts are disputed tag can be removed. I started by cracking open my psychology textbook and putting some stuff in.  :)

Wondering why

Is there a reason why paranoia is not here? I suspect a complot!

According to current thinking, paranoia is a symptom of a number of mental illnesses, most notably schizophrenia, rather than an specific illness in itself. However, we do have a tinfoil hat article... -- The Anome 08:53, 12 Oct 2003 (UTC)
But paranoia is also a major part of Paranoid personality disorder and can be a large part of Delusional disorder. I think symptoms are as important to explain as the illnesses themselves. Think dissociation here - it's not an illness but a symptom of several illnesses.--seanetal 09:53, 16 Sep 2004 (UTC)
This is a very important point. No two cases are the same, despite identical diagnoses (and despite my personal theory that crazy is predictable ;p); in most cases, especially those of personality disorders (e.g., Borderline Personality Disorder), it is the symptoms that can be treated. The disorder is often just a label to help understand the syndrome.

Removed from the article:

Mental illness can also be caused by unstable blood sugar levels due to insulin resistance (hypoglycemia). If this happens then the brain is not supplied with a steady concentration of glucose, its only source of energy.
When there is sudden drop in blood sugar levels, the adrenal glands are stimulated into secreting stress hormones - adrenaline and cortisol - that function to raise blood sugar levels in order to feed the brain with energy again. But these internally generated stress hormones interfere with the normal synthesis of serotonin and dopamine, causing the various forms of mental illness, such as depression, anxiety attacks, phobias, alcoholism and drug addiction among others.
See “What is Hyppoglycemia” at http://www.hypoglycemia.asn.au/articles/what_is_hypo.html

Is this a mainstream point of view? If so, please give mainstream cites supporting it. -- The Anome 10:08, 27 Aug 2004 (UTC)

shift from negative to positive

We need to shift this article's perspective from mental illness to mental health. Focus on the positive. Much more constructive and useful way of looking at the problem of mental illness.--Sonjaaa 18:06, Sep 13, 2004 (UTC)

I agree completely.--seanetal 09:49, 16 Sep 2004 (UTC)

Then please write a separate article about the quite valid topic of mental health. Unfortunately, however, serious mental illness exists and cannot be made to go away by focusing on the positive. This is one of the most common mistakes made by people with no clinical knowledge or experience of mental illness. Mental illness, like all other topics, needs to be studied objectively, without any considerations of "nice" or "nasty".

An analogy: take the topic of aortic dissection; pretending that this does not exist, or is not a serious and life-threatening (and in many cases life-ending) condition, is not helpful. However, this does not mean that there is not a place for a heart health article describing the positive things which can be done to keep the heart healthy. -- The Anome 10:52, 16 Sep 2004 (UTC)

Well said Anome, I'll defer to Sonjaa to start this one.--seanetal 13:50, 16 Sep 2004 (UTC)

Mental Health does not refer to the absence of mental illness. The term refers to the mental state of a person, ill or nil. variable 23:55, 18 Jan 2005 (UTC)

Thoughts on content

In the "symptoms" section, it would be nice to have some sort of reference to numbers to back up the comparison of crimes committed by elderly and the mentally ill. I have no idea if what's said is true or not, but it's a bold statement to make with no reference to support it.

With that said, the "Cures of mental illness" section...well, it has absolutely nothing to do with anything I or anyone I know does in therapy. Ignoring that there don't currently seem to be cures, in general, just treatments and ways of dealing with mental illness, that doesn't particularly sound like a modern approach that's used (in my experience, at least). It doesn't mention medication at all, and it doesn't mention anything like Cognitive Behavior Therapy, or other types of currently used talk therapy. To be honest, that entire section is rather insulting to anyone who's had to deal with serious problems and how much work it can be to "cure" them or make them manageable, especially the last sentence about "other cures". No offense intended, but if you say something like that directly to most people with mental illness, you're lucky if you don't get smacked in the face (exaggerating a bit, but "suggestions" like that don't tend to be appreciated).

Maybe this will be the article that finally gets me to create an account and do some editing... --anon

Regarding "cures", you're absolutely right. I've rewritten the section to be more reflective of what treatment of mental illness actually involves. For reference, here is the old version:
Cures of mental illness
People with mental illness almost always have thoughts that are too complicated, chaotic, or unorganized. This is called a "complex". The psychiatrist's job is to help the patient think in a simpler way, such as to focus on food, water, shelter, and physical warmth - basic human needs. Everything else is unimportant: stress from family, friends, work, love and other complex and difficult emotions and problems are ignored in favor of "the basics". This helps the patient focus on what is important in life. These basics are solid objects that are easier to understand and control. The patient relaxes because he/she no longer has the burden of complicated expectations and emotional stress. This is called "shrinking the complex". This is why psychiatrists are sometimes called "shrinks". Some psychiatrists are accused of making the patient's complex more complex, by focusing on relationships and asking the patient stressful questions.
Other cures are relaxation, a stress-free environment, soothing music, fun non-stress games, easy exercise, easy physical outdoor activities, coloring, "brain food" (like fish), the sound and smell of water, and regression therapy.

Movie list

Because the movie list was so large and really added very little to the article directly, I moved it to a seperate list (List of Movies featuring mental illness). siafu 22:26, 4 May 2005 (UTC)

Dispute

I think the links in the category box I put in should be disputed, since I don't think all of these illnesses are not a form of mental illness. That is why I have the disputed meta tag on top of the box. If anyone agrees, pleas edit the box and remove the links that are not a form of mental illness. Thank you. --Admiral Roo 14:05, Jun 21, 2005 (UTC)

As I stated on the main talk page, they all appear to be pulled from the DSM-IV (save for Multiple Personality Disorder, which has been renamed and redescribed as Dissociative Identity Disorder, already listed), which is about a strong a reference as we are likely to find for determining if something is or is not a mental illness. siafu 22:11, 21 Jun 2005 (UTC)

Recovery Model

It's hard to believe that there's nothing here on the Recovery Model! We're behind the times here, folks. If I get a chance, I'll try to put something together--but I'm spread very thin now... Aliman 07:07, 20 August 2005 (UTC)

Mentally handicapped

It seems extraordinary to me that 'mentally handicapped' redirects to 'mental illness'. Mental handicap and mental illness are two are quite different things. (Schizophrenia is not a 'mental handicap'. Very low IQ is not a 'mental illness'.) Ben Finn 23:16, 21 November 2005 (UTC)

Schizophrenia is indeed a rather serious mental handicap, and mental retardation is indeed considered a mental illness. Both appear to be genetic, and both seriously impair a person's ability to function. siafu 05:41, 22 November 2005 (UTC)
I'm not an expert on this, but the distinction as I understand it is that mental handicap refers to a birth defect or later brain injury, whereas mental illness refers to disorders with a less overtly physical cause (i.e. biochemical). (Possibly this is a UK-specific distinction.) I remember in the late 1970s or early 1980s there was a UK press advertising campaign specifically designed to educate the public into the distinction - photos of two men, one looking normal and the other appearing to have Down's syndrome or similar. The headline was, 'Which of these men is mentally ill?' The answer in the text being the normal-looking one - the other was mentally handicapped, not mentally ill. Ben Finn 19:49, 22 November 2005 (UTC)
Well, according to the DSM-IV, mental retardation and similar mental "handicaps" (by your understanding) are classified as mentall disorders, all of which fall under the blanket of mental illness. The distinction your suggesting seems a little weird, especially considering that its not at all recognized in medicine at large. Consider genetic diseases, like PKU, which are definitely "illnesses", or diseases caused by complications in pregnancy or birth, like FAS, also an "illness". Generally speaking, I think it's safe to say that anything that can be labelled a handicap for medical reasons can be called an "illness". I think perhaps the confusion comes from the fact that many people equate the word "illness" with "disease", which is something that can be "cured". Really, we're just talking about blanket terms that don't mean anything specific; it's more specific to say "disorder", "infection", or "condition" depending on what's being discussed. siafu 00:37, 23 November 2005 (UTC)

Emotional disability?

I would not have thought that 'mental illness' could also be known as 'emotional disability' as I can think of countless 'mental illnesses' with no emotional manifestations. Thoughts? Sparkleyone 01:11, 3 March 2006 (UTC)


It is not necessary that a secondary article name be as precise as the primary name. Just that it is what the majority of English speakers would most easily recognize as description of the disability.

There has been a move in modern times to address the stigma of the disability and the language used to describe this condition. “Emotional disability” is a term that is a term that is considered to be better received. There are now over one hundred and seven thousand web pages that use the term.

It is a term that is being used now when referring to school children with mental illness. --WikiCats 14:17, 9 April 2006 (UTC)

I would dispute that the majority of english speakers would consider them interchangeable. Why doesn't it go in the second sentence "Mental health, mental hygiene, behavioral health, and mental wellness are terms used to describe aspects of mental illness and mental health" as another term used? Sparkleyone 09:01, 10 April 2006 (UTC)

Ok. Agreed. --WikiCats 09:42, 10 April 2006 (UTC)


If mental illness is not about the emotions, then what is it about? --WikiCats 14:04, 15 April 2006 (UTC)

Cognitions, which include emotions of course, but encompass far more of the symptomology and critical factors in play when we talk about "mental illness". The term is far too broad to be limited by summing it up under "emotional disability". Sparkleyone 09:01, 16 April 2006 (UTC)


Well, this is pretty insightful stuff. From a science that says that it does not understand it, does not know what causes it and can not cure it.

Given that, it’s an extremely arrogant attitude for them to claim ownership of the terminology.

Would it be fair to say that your real objection is to the condition being referred to as a disability? --WikiCats 08:24, 17 April 2006 (UTC)

I'm not certain what you mean by "claim ownership of the terminology". Mental illness is such an all-encompassing term, of course science doesn't know what causes it etc - we're talking about hundreds of disorders here! There could not possibly be one defining cause, which is why I am concerned with the notion that all mental illness be classified as being caused by some emotional dysfunction. I'm primarily concerned with 'emotional' not 'disability', though that's probably not ideal either from a political correctness pov. Oh as an aside, I'm just being argumentative for the fun of it, it doesn't bother me that much what term some American schools are using to try and be non-discriminating. Sparkleyone 02:48, 19 April 2006 (UTC)

It is unhelpful to start a debate or delete content for fun. The proposal is to include Emotional disability [1]as an additional description of the article. The article name (Mental illness) is usually the most common name with additional names less commonly used. The term “Emotional disability”[2] is being used more often in preference to referring to children as mentally ill. --WikiCats 14:52, 24 April 2006 (UTC)

Please don't make claims that I "delete content for fun" - my point in my previous post was that a lengthy debate over two words is *probably* a little excessive. My original deletion of the words 'emotional diability' were because I do not believe they are accurate. Yes, I agree that many departments are using the term as a PC way of describing mental illness, but that is not my concern. I have issues with it being used as an alternate description of ALL the disorders that are presented as coming under the term 'mental illness'. Autism, epilepsy, psychosis, delerium, dementia, amnesia and schizophrenia are presented in this article as 'mental illnesses', yet I a) don't believe most would consider them disabilities primarily involving emotion, and b) what evidence there is regarding the etiology of such disorders doesn't suggest that they primarily involve emotion. If this were a page about mood disorders, anxiety disorders, eating disorders, sleep disorders etc. then yes, 'emotional disability' would be appropriate, but on a page that is set up to describe basically every cognitive dysfunction, not just emotion based ones, a term like 'emotional disability' should not be presented as an alternate name. If we're going to have that as an alternative, it would be equally accurate to have 'behavioural disability' and 'cognitive disability' as alternate names. Sparkleyone 03:10, 25 April 2006 (UTC)

This is the same argument. - That modern psychiatry has sole ownership and rights to name the condition. This is a condition that has existed since the beginning of time. Modern psychiatry is a recent invention. This condition is discussed in everyday life. So modern psychiatry does not have sole ownership and rights to define the condition as you claim. You claim that a science that says it does not understand it, does not know what is happening and can’t cure it has sole right to define it. --WikiCats 10:57, 25 April 2006 (UTC)

If it's not scientists that should be trying to define 'mental illness', who is it? Also, calling mental illness 'a condition' as opposed to 'group of conditions' or similar implies that all the manifestations of disability that we call mental illness are variants of the same thing. Do you believe, based upon what you know, that everything that is listed on this page as part of mental illness is caused by some emotional problem? Sparkleyone 13:55, 25 April 2006 (UTC)

Of cause it’s all about the emotions. But I don’t have to establish the truth. All I have to do is verify a connection between Emotional disability and Mental illness.

It seems that you are pedantic about micro analyzing the interpretation of terms. Maybe the term we should be examining is present title of this article. In literal terms “Mental illness” means retardation. And in the form “mental handicap” means exactly that. The lead section of this article says that the concept of mental illness remains a highly controversial one. It amazes me that you would be insistent that children suffering from this condition should be described in the most degrading of terms. --WikiCats 13:21, 26 April 2006 (UTC)

Alright, let me get this straight. Mental Illness means retadardation. I am going to assume that you mean this in the way 'retardation' is generally used. Therefore, according to your argument, Mental Retardation is caused by a disability in emotions, no? I am not trying to be a smart alec, I am interested in your opinion.
Secondly, I never said I had a problem with what some American schools want to call the mentally ill. That is their business. My concern here is that people coming to this page would look at all the disorders listed here and assume their etiology or symptomology is emotionally based, which I do not believe to be the case.
If you are going to put emotional disability as a second title to the page, them cognitive dysfunction and behvioural dysfunction are equally viable. And yes, perhaps we should be examining the title of the article itself. I mean, isn't it degrading the children that the term 'mental illness' is even present here? why not censor the entire encyclopedia? And in whose opinion is 'emotional disability' any better than 'mentally ill'? In my opinion, the former sounds like something that can be fixed with a nice cup of tea. Sparkleyone 13:46, 26 April 2006 (UTC)

If your compromise is to include additional terms after Emotional disability then that is fine with me. --WikiCats 13:56, 26 April 2006 (UTC)

This is utterly absurd. Maybe if Wikicats were to experience artificially induced mental illness as a result of someone secretly slipping a bunch of illicit drugs into his or her drink they might not think the experience of mental illness was all emotional after all? Lykaestria 14:14, 26 April 2006 (UTC)

WikiCats, if you put Emotional Disability as an alternate title then I will add the additional terms, however if it's staying where it is I'll leave it. As I said before, I'm more than happy for it to be where it is, as an additonal term. Sparkleyone 02:34, 27 April 2006 (UTC)

I'm happy for the three phrases to be there. --WikiCats 05:47, 27 April 2006 (UTC)

If you are happy with the additional article names: Mental illness or Emotional disability, Cognitive dysfunction - then I am happy. --WikiCats 10:58, 27 April 2006 (UTC)

Sounds good :) Sparkleyone 02:09, 28 April 2006 (UTC)

Unreasonable bias

This article does not seem to reflect the view of mental illness here in the UK according to my experience. Claims that the matter is settled and that physical causes in the brain are to blame seem quite unwarranted to me, as confirmed by later claims that diagnosis is still a matter of assessment not physical diagnosis. Here we are shocked by the extent of prescribing to children with supposed ADHD in the US. If so many children are mentally ill, what on earth has happened in their brains to bring this about within one generation? I am not aware that any physical mechanism has even been suggested. Food additives maybe, but that's poisoning, not mental illness! --Lindosland 00:33, 21 April 2006 (UTC)


Be bold! --WikiCats 10:45, 21 April 2006 (UTC)

I was. If I screwed things up, whoever spots it gets to fix it. PatrickFisher 03:27, 26 April 2006 (UTC)


Your answer to why the U.S. has so many "mental illnesses" is the following link.

That link is [3]

The link states that the Mental health writers in the U.S. have ties to the Pharmacutical Indusry. Go to Jeff Rense's Homepage, then see the article title: Mental Illness Writers Have Ties To Big Pharma, since the primary link is malfunctioning. Martial Law 22:38, 23 April 2006 (UTC) :)


Cleanup

I tagged this article for cleanup because I think the overall organization needs reworking. PatrickFisher 03:29, 26 April 2006 (UTC)

The "See Also" section needs serious trimming. If the links are elsewhere in the article, they may not need to be there also. I also question the inclusion of very specific and narrow articles. PatrickFisher 03:36, 26 April 2006 (UTC)


A "clean up" should not be seen as an excuse for bulk rewriting of the article without discussion.

It's not sufficient to say that because links appear elsewhere in the article that important links should not be listed in "See also". Readers often go straight to "See also" when looking for related articles. --WikiCats 13:45, 26 April 2006 (UTC)

i've been looking at this article and think maybe a reorganization/rewrite is in order. i've been writing some trying to get in better order. will not delete other stuff, but will include in entry for all to review.Platypusjones 18:44, 11 May 2006 (UTC)

External links

As part of the cleanup, are there any links that are particulary valuable per Wikipedia:External links? - brenneman {L} 07:21, 7 July 2006 (UTC)

prevalence and diagnosis

in this section: 1. should read: additionally, the National Alliance for the Mentally Ill (NAMI), reports that 23% of North American adults will suffer from a clinically diagnosable mental illness in a given year... this differentiates NAMI's data from the Feds data. 2. I am unsure of the appropriatness of this qualification here, with regard to NAMI: an American advocacy organisation which accepts funding from the pharmaceutical industry. I understand the sigificance of the statement (the possibility of conflict of interest) but i think it would be more appropriate in NAMIs own entry. IMO

3. The current DSM is the DSM IV-TR (text revision)

4. not sure if the rest belongs in this section. More appropariate info might include the rates of specific disorders as diagnosed in a given year (not just general as stated in intro paragraph). the remainder could have its own section on the cultural remifications of diagnosis Platypusjones 20:21, 8 May 2006 (UTC)

mental illness is not a diagnostic label

mental illness is a broad generic label for a category of illnesses that may include affective or emotionally instability, behavioral dysregualtion, and/or cognitive impairment. a diagnostic label is "major depression" "schizophrenia, catatonic type", etc...

this article really needs to be brushed up. am willing to do it, but would like feedback. Platypusjones 18:23, 9 May 2006 (UTC)

Yup, you're right about the generic label bit. Go ahead and clean it up, others will probably join once you start. Anything you don't want to change without someone else's opinion pop on here and we'll provide feedback. Sparkleyone 02:59, 10 May 2006 (UTC)
i added a reworked introduction, although i did not delete the other introduction. while this may not be SOP in wiki, i felt uncomfortable removing it first without consensus (tho i doubt that would ever be reached). although it is not a major change, my reading of the other discussions suggests there is some conflict about terminology. while valid, i think an appropriate place to discuss this would be in a terminology section or in the controversy section. will wait for feedback.Platypusjones 18:33, 10 May 2006 (UTC)
I agree that the term itself is controversial and not understood the same way in all contexts. In the broadest sense, an illness is a medical condition that can be diagnosed by a professional, so an 'illness of or pertaining to one's mind' should in this context theoretically be an appropriate term for a pathological condition. On the other hand, colloquially, the term is often used interchangeably with other, less neutral labels, such as "crazy" or "insane", which are not medical conditions themselves, but rather, "insanity" may be a result of a symptom of an underlying medical illness, such as schizophrenia, schizoid personality disorder, etc. We should include all relevant uses and contexts of the term in the article and elaborate, beginning with the most prevalent ones. The term is probably used most often in medicine, second in a legal context, in academic settings, and so on. The most "profane" use of the term may probably be found in common conversations with people who claim that they themselves or some other person has a diagnoseable mental condition, even though the claims are merely subjective and have not been made by a professional, but I obviously don't know about all the context in which it could apply. The bottom line, I'll help clean up, let's be comprehensive and objective. I'll add it to the "pending" items on my to-do list. Feel free to leave your comments. (Patrick 11:52, 12 May 2006 (UTC))

indeed, i agree with many of your points, with some clarifications. "mental illness" is not itself a technical term, as is insanity (a legal term). mental illness, as i have suggested, is a broad generic label. it is differntiated from "physical" illnesses, conventionally, because it pertains to affects, behaviors, and cognitions, "mental" or psychological features. colloquial uses include "mad" "crazy" etc. however, i don't think we can relagate the term "mental illness" solely to the domain of medicine, since there are many professionals that deal with mental illness who are not medical doctors, and many mental illnesses that have not had verifiable physical bases.

with regard to form and organization, i think that the issues rasied are important and should be included, but the convention of encyclopedic entries strongly suggests brevity in the introduction followed by expansion in subsequent sections. we can discuss controversies and contexts of the term there.Platypusjones 14:55, 12 May 2006 (UTC)

have removed second (original) intro, as Platypusjones' version is generally more inclusive and appropriate. The controversy stuff, as mentioned by others, should be in it's own section rather than in the intro. As conversation on this seemed to dry up a few weeks ago I hope no-one minds that I removed the other paragraph. If so, edit away, but lets not have the duplication sitting there again without input. Sparkleyone 04:36, 31 May 2006 (UTC)
Thanks Sparklyone.

[UK user] I disagree completely with the point made above that the term mental illness can cover psychological issues as well as biological disorders. By defintion something that is both "mental" (relating to the mind/brain) and is an "illness" (relating to biological dysfunction or invasion by a foreign body) must be biological in nature. Equally, patients with "mental illnesses", i.e. psychiatric disorders, will also receive psychological interventions, but that does not mean that the psychological interventions are addressing the biological issues or, as it has been called here, the "mental illness". I think the article would be far clearer and up to date with contemporary thinking if it referred to psychiatric and psychological disorders. Psychiatric disorders being those with a medical basis and dealt with using drug/physical interventions and psychological disorders being those relating to conceptualisation disorders dealt with through the talking therapies. The use of the term "mental illness" here is too broad, confusing and, I think, stigmatising. The article could be prefaced with a note to the historic existence and use of the term "mental illness" and explain how it has now been replaced with more appropriate and accurate alternatives. Zebulon99 22:16, 5 September 2006 (UTC)

Article Bias

This article -- particularly the "Causes" section of it -- seems extremely biased against the biological theories of mental illness. It seems to have an almost mocking tone, calling legitimate treatments "treatments" (with quotes, as if they weren't really treatments). I would also like to see some of this person's assertions about mental illness being non-biological supported with specific references.

User Educational Researcher had reverted back to some very biased edits he/she made in April, also removing a lot of worthwhile changes made since then. I have reverted back to previous version, which, while it may not be perfect, is far more reflective of popular opinion in the mental health arena. I hate to harp on, but this is an encyclopedia, not a soap box. Stick to popular, or supported opinion. I'd like to see a citation for the twin studies comments especially. Sparkleyone 03:16, 31 August 2006 (UTC)

Actually, I think that at the moment, the article is biased TOWARDS biological theories of mental ilness. (see biopsychiatry controversy) Here's what it read under "Causes" on the 30th of August '06, before someone reverted it back to the pro-biological theory biased paragraph we see today on the 31st:

Thus, while the most popular explanations for mental illness, currently, are biological 
explanations; that is, a person with a mental illness may have a difference in brain structure 
or function or in neurochemistry, through either genetic or environmental vulnerabilities 
(such as in utero alcohol exposure) this has not been borne out. For example, it is often 
cited in support of this theory that many people diagnosed with schizophrenia have been shown 
to have enlarged ventricles and reduced grey matter in the brain, however, these are people 
who have been medicated with drugs that cause this enlargement. It is really the "treatment" 
(the drugs) that have created the brain difference. Similarly, those who argue that 
neurotransmitter imbalance may cause mental illnesses have no evidence to support this 
hypothesis. Finally, the many genetic studies or twin studies cited as showing strong evidence 
that mental illnesses such as bipolar disorder (manic depression) and schizophrenia can be 
inherited do not hold up under scrutiny

I think what was written about the medication causing the enlarged ventricles, and the part about genetic and twin studies not holding up to scrutiny may acutally be true facts. At least, I personally have heard those same arguments from a psychologist who is a friend of my fathers, named Toby Watson. I don't know where HE got the info from, but he's a pretty intellegent and knowledgable guy in my experience. I think I'll contact him and maybe I can re-introduce the Aug. 24th-31 "Causes paragraph #2" to the mental illness page WITH SOURCES!! Unless someone else has heard of these same arguments and can source them themselves saving me trouble. While I agree that most of the article changes introduced considerable bias against psychiatry in general, I must also admit that I think some of the things that were written were true, or at least may have contained some truth in them. Perhaps others can re-introduce pieces of the August 24-31 article with sources and such to back them up. Yes I am serious. Please no hate mail. Anyhow just a thought. Later! MeEricYay 05:31, 1 September 2006 (UTC)

The reason that paragraph was removed is because it is absolutely ridiculous. The idea that biological causes for schizophrenia have "not been borne out" is utterly absurd, and only continues to serve those who cling to the idea of an insight-oriented treatment for schizophrenia (e.g. Scientologists). The exact mechanisms of schizophrenia (and bipolar disorder, &c.) are still sometimes debated, but that they are biological in origin, and even that that origin has a strong genetic component, is very well established. siafu 13:38, 1 September 2006 (UTC)
Ok, first of all, PLEASE can we not bring scientology into this? What scientologists believe has ABSOLUTELY no bearing on weather or not mental illnesses are biologically based or not. I would also like to point out that the "anti-psychiatry" movement was around well before scientologists latched onto it. Moving along. I would like to point out that it is at least POSSIBLE that mental illness is not biologically caused. Experience could cause "chemical imballance," and not the other way around. What if I'm right? What if the "enlarged ventricle" argument and the "twin study" argument have in fact been proven false by later studies? I'm e-mailing Toby Watson today to ask him if he can back up those claims. But hypothetically speaking, IF those arguments for a biological cause of mental illness are wrong, then the whole current, pro-biological basis paragraph, under causes, falls apart, and you have no other basis for claiming biological basis for mental illness in the entire article. All you can say is that the majority of psychologists believe in the theory. This doesn't make it true, not by a long shot. I would like to point out that the history of psychology has been quite shakey. It used to be the majority oppinion that wrapping schizophrenics in towels and leaving them in a bathtub for weeks was an acceptable treatment. It used to be the majority oppinion that lobotomy was an acceptable treatment for mental illness. (Go ahead, click the link. You might just like it :-D) It used to be mainstream to believe that a miracle cure for schizophrenia was to DROWN patients, then recusitate them. Of course many people died because they couldn't be brought back. I must say that, as a person who was once diagnosed with schzophrenia, I'm glad I don't live back then, but then again I'd rather live in a future where "chemical labotomies" have gone the same way as physical ones, or at least aren't forced on people. Ok sory that was a bit of a tangent there. Anyhow, if the arguments for a biological cause are shot down, isn't it at least POSSIBLE that mental illness could be caused by a person's experiences alone? You guys should check out the Wikipedia article on chemical imbalance, especialy the talk page. On the talk page, various people have tried to argue that chemical imballances are real, or that mental illness is deffinitely biologically caused, but they have been succesfully refuted by other authors in almost every case. Thank you for at least considering my arguments, and I will keep people updated on whether or not I can get more info from my dad's psychologist friend. MeEricYay 01:46, 2 September 2006 (UTC)
The mistakes of psychiatrists past have no bearing whatsoever on this discussion. Moreover, even if the "enlarged ventricle" argument you're bring up is true (I've never heard anyone suggest that "enlarged ventricles" are a cause of schizophrenia, btw) and the twin studies, it does not in any way indicate either that the cause of mental illness is not biological, or even that it is not genetic. As for chemical imbalance, I see a great deal of contribution by yourself, but no evidence of refutation of the biological basis of mental illness. I'm afraid I put a great deal more stock in the APA, NAMI, BPS, CPA, WFMH, and evey single mental health professional I have ever met (a not inconsiderable number), than I do in your "dad's psychologist friend". The fact is that the old paragraph was blatantly wrong-- the biological origin of schizophrenia is very much borne out, and the genetic link to schizophrenia and bipolar disorder (among many others) does indeed stand up to scrutiny and very much has done so.
Let me point out, also, that the model you're proposing, that experience causes chemical imbalance, is also very much a biological cause. "Experience" causes broken legs, also, experience in the form of a blow to the femur-- that does not make the cause of a broken non-biological. What you are really arguing against, if you do accept that model, is the genetic link of certain mental illnesses, particularly the various forms of schizophrenia and bipolar disorder. This link has also been very much borne out by research-- if you're merely feeling that the article is short on sources, then say so, and they can be provided (we could start with the websites of the organiztions mentioned above). There is, however, no reason to suggest that the causes of mental illness are not predominantly biological-- at least the two mental illnesses that have been discussed here.
There are, however, many diagnoses that fall under the rubric of "mental illness" that are not linked to genetics, and thus far have proved resistant to medication; personality disorders come to mind. The physiological nature of many of them is still, as yet, unclear, but brains are inherently biological entities. Talk therapy may well prove to be the best method of treatment, but similar to physical therapy, this does not at all evade the biological nature of the illness. siafu 02:16, 2 September 2006 (UTC)
Hey guys, I'm kinda busy w/some some stuff (like getting ready for school) right now, but I promise to post a rebutal soon-ish... in case anyone was wondering. MeEricYay 09:31, 4 September 2006 (UTC)
Sorry for the delay, but I've found my sources. Here is a powerpoint presentation, in two parts, with sources to back up my contention that the ORRIGIONAL cause of mental illness is neither biological nor gentetic. Part one[4] and part two.[5] While experience may change biology which may cause mental illness, it is orriginally experience causing the mental illnes, and not genetics. At least according to the sources in those powerpoint presentations. Here [6] [7]is a more detailed list of those sources used in the presentation. And if you don't have powerpoint, here[8] is the same two part presentation which you can download and view in html with your web browser by unzipping the files to your desktop or somewhere. Update: Here is a link to a free PowerPoint viewer for PC [9] and for Macintosh.[10] Also I updated the references list.--MeEricYay 13:20, 27 September 2006 (UTC).
I would like to point out that I was told by the person who usually presents these slides (Toby Watson) that I could change the medical abbreviations Dx, Tx, Hx, and Sx to the terms diagnosis, treatment, history, and sympoms for easier read. These are the only changes I have made, and the only reason the word "revised" is at the end of the file names.
As soon as I can, I plan to do a thorough revision of paragraph two in the cuases section of the mental illness article, with sources from this powerpoint presentation, assuming nobody else beats me to it. Good day. MeEricYay 18:03, 5 September 2006 (UTC)
No offense to Mr. Watson, but the Powerpoint presentation is terrible. For example:

In a 1995 psychopathology textbook still used for Medical Students it states “psychiatry is the only medical specialty that…treats disorders without clearly known causes…including disabling diseases such as schizophrenia.”

No mention of which textbook we might be discussing, which medical students (and which specialty?), and this statement is simply false. It is not at all unknown for treatments to be addressed to conditions/syndromes whose clear causes are not delineated (e.g., cancer). Another gem:

In 1996 the American Psychiatric Association referring to theories about schizophrenia stated “research hasn’t pinpointed the origins.”

"Hasn't pinpointed the origins" does not mean "has no idea what's involved". See my comment above about debates re: exact mechanism of illness. Here, again:

In 1998 and 1999 the 1000 page Textbook of Psychopharmacology(5) & the 1700 page Textbook of Psychiatry(6), both published by the APA, found NO reference to any known cause for any mental illness.

Indeed! That's not the purpose of said textbooks. It also makes improper use of statistics, for example quoting that a 38% chance of identical twins sharing schizophrenia averaged over a number of studies (whose individual weight or validity is not discussed) is not significant. In fact, 38% is an overwhelming result in favor of inheritance.In short, this presentation is an anti-psychiatrist polemic using misleading quotations (which are "debunked") and drawing excessively on the work of one author, Andreasen. Inserting a "paragraph or two" based on this research would be a clear violation of WP:RS and WP:NPOV (undue weight). And please, if you DO attempt to make any major changes, use a spellchecker before saving them. siafu 23:12, 5 September 2006 (UTC)
P.S. Anyone attempting to read the sources presented should beware, as they make extensive use of yellow text on a white background. siafu 23:13, 5 September 2006 (UTC)

Sorry for my spelling, I've changed the yellow text to blue to make a second revised version of the presentation (Mr. Watson didn't use any blue in the original presentation, so you will know what text was originally yellow,) and I've forwarded your response to him via e-mail. He's a busy guy, but I'll let you know if/when he responds. Here are the links to the second revised version: PowerPoint versions part one[11] and part two.[12] Zipped HTML versions: [13]. And finally the detailed list of the references used in these presentations: [14] [15]. MeEricYay 01:59, 6 September 2006 (UTC) Update: Here is a link to a free PowerPoint viewer for PC [16] and for Macintosh.[17]. Also I updated the references list. It now includes a reference to the psychopathology textbook.--MeEricYay 13:20, 27 September 2006 (UTC)

Here, at last, is Toby Watson's response to siafu's previous comment. It was sent to me via e-mail at 19:01 UTC 26 September 2006:

Thank you for highlighting that I did not properly cite the source or provide more details as to the specialty. I assumed the reader would understand the coarse that still uses the textbook was "psychopathology" for medical students, social workers and psychology students. Drake University, Berkley and UCLA all use this text. I have attached the full citation here:
Maxmen, J.S., & Ward, N.G. (1995). Essential psychopathology and its treatment. New York: W.W. Norton. P.57.
Commentary note: I understand that much of the material within this presentation is new and may be personally upsetting to many. However, I have given this lecture at many professional conferences and I have never had any medical researcher, doctor, psychologist, psychiatrist, social worker, attorney or otherwise be able to dispute any of the facts or ideology contain within.
I will be presenting in two weeks in Washington D.C. at the American University Washington College of Law Washington, D.C.,and would be happy to talk with anyone who may have an interest or concern.
Regarding the textbook of psychiatry, this resource would be the one resource to discuss if there was any sort of biological cause to any of the psychiatric disorders. I suggest the responder read the introduction to these books for a further understanding of the purpose of the 1,700 page textbook on Psychiatry and Psychopharmacology.
Regarding the concordance rates of schizophrenia, the responder makes an excellent point about the fact the older studies used by texts today do not have reported validity coefficients, and thus, they should be thrown out completely. However, the older studies had higher rates (i.e. thus, helping push the rate to 38%). Thus, if you take these out of the statistical analysis, the concordance rate significantly drops.
Regarding the personal attack that I am anti-psychiatry. I am the clinical Director and Doctoral Training Director of Associated Psychological Health Services, and I work closely with our psychiatrist. I also have the pleasure to know dozens of other psychiatrist worldwide whom I call friends. Psychiatry has a place, as does medication; however, we have an obligation to point out flaws in the research, point out how little we really know about these issues and point out how the data supports a non-biological model of healing (see www.psychrights.org)[18].
I cite Andreason simply because she is one the main biological model supporters and researchers who is one of the most well respected in her field. Please see the reference list, as this undoubtedly will show the broad areas that I drew information from.
Kindest regards,
Dr. Watson

--MeEricYay 05:30, 27 September 2006 (UTC)

If by "lecture and professional conferences" you are referring to conferences sponsored by the ICSPP, then it should be no surprise to anyone that you have yet to meet any "medical researcher, doctor, psychologist, psychiatrist, social worker, attorney or otherwise" (attorney?) who disputes the facts presented as the ICSPP is specifically organized to combat the biological model. However, if you're looking for those who would dispute those facts, they are not hard to find; consider contacting the APA for starters.
However, I am not myself contesting the specific facts, and I will leave that to others. But I do contest the interpretations of those facts that are presented.
For example, when I was questioning the relative validity of the twin studies and they're methodology I was hoping for more information than just the validity coefficients. For example, are all the studies longitudinal? Did they all use the same diagnostic criteria? In short, is it even valid to compare them side by side, and just as importantly some reassurance is sought that they have not been "cherry-picked" to present only the studies that reinforce the point of view being presented. The fact that 38% still overwhelming enforces a strong genetic link has not been addressed; this is higher than it is for many genetically-influenced illnesses (e.g. heart disease, prostate cancer, Marfan syndrome).
As for the textbook; there's no reason presented to suggest that it should necessarily discuss biological causes for mental illness, because there is so far no reason to suggest that the book should necessarily discuss the root causes of illness at all. As a book used in a psychopharmacology class, I would personally expect it to discuss mechanisms of illness (e.g. chemical imbalance) and treatment (in this case pharmacological) and not genetics or environment. As such, it's no surprise that it does not mention biological or genetic causes, and there isn't really any conclusion to be drawn from that fact.
Finally, the response that it "may be upsetting to some" is rather unwarranted. What is upsetting to me is the idea that there exist practitioners who actively advocate treatments and methods that have been shown to be ineffective, in this case talk therapy for schizophrenia. Whether or not schizophrenia is caused by genetics, the research has overwhelmingly shown that pharmacological treatment (at least, as an essential component in the whole process of recovery) is much more effective and that simple therapy is completely ineffective in treatment. As someone who has known clients who have, after following such advice to abandon drug therapies, killed themselves, killed others, set buildings on fire, attempted to kidnap children, and attacked their care providers with knives (among other things, the stories abound)-- all outside of any enforced treatment regime (e.g., hospitalization), advocating this seems to me to be very irresponsible. siafu 17:00, 28 September 2006 (UTC)


Dr. Toby Watson <e-mail hidden> to me

 More options   Oct 5 

Eric,

Here is the response.

ICSPP is a diverse group and organization complied of neurologists, psychiatrists, reserachers, ivy legue graduates, professors, psychologists, social workers, attorneys and law persons interested in mental health research and policy. There are over 400 members world wide, and their ideaology spans greatly from belieivng medications, ECT and other new technologies are in fact harmful, to medications, ECT and new technologies definately having a place in psychiatry.

In addition to ICSPP, I would suggest reading the material at the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (www.isps.org), yet another organization of hundreds of researchers, professors, psychiatrists, psychologists and concerned individuals. I have lectured at their conference as well as other mainstream conferences. I strongly urge you to read the following citations regarding treatment choices and outcomes.

A third organization which I also belong to, amoung many others, is the Alliance for Human Research Protection (www.AHRP.org).

Regarding treating people diagnosed schizophrenic, I suggest the following for an introduction to the research.

Whitaker, R., (2004). Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill. This article was cited in the British Medical Journal, Vol. 328/414, February, 2004: Maintaining people diagnosed schizophrenic on neuroleptics maybe a disservice. According to a 50 year review, long term treatment worsens long term outcomes, and up to 40% of people would do better without neuroleptics. Epstein, L., (1962), "An Approach to the Effect of Ataraxic Drugs on Hospital Release Rates," In American Journal of Psychiatry, 119, 36-47. This was the first large scale study of hospital release rates in the 1950s for schizophrenia patients treated with and without neuroleptics, and it concluded that "drug-treated patients tend to have longer periods of hospitalization." P. 44.

Schooler, N., (1967), "One year after discharge: community adjustment of schizophrenic patients," American Journal of Psychiatry, 123, 986-995. This NIMH study looked at one-year outcomes for 299 patients who had been treated either with neuroleptics or placebo upon their admission to a hospital, and was the first long-term study conducted by the NIMH. The researchers found that "patients who received placebo treatment in the drug study were less likely to be rehospitalized than those who received any of the three active phenothiazines (thioridazine (Mellaril), fluphenazine (Prolixin), chlorpromazine (Thorazine)." However, in spite of this finding, which the researchers wrote "was so unexpected," the NIMH investigators stated that they "were unprepared to recommend placebo as treatment of choice." In other words, the NIMH researchers decided they wouldn't develop treatment guidelines based on their own research, which found that placebo patients did better than the drug-treated patients. SEE PAGE 991.

Prien, R., (1968), "Relapse in Chronic Schizophrenics Following Abrupt Withdrawal of Tranquillizing Medication," In British Journal of Psychiatry, 115, 679-86. The critical finding of this NIMH study was that relapse rates rose in direct relation to dosage-- the higher the dosage patients were on before the drugs were withdrawn, the greater the relapse rates. At the start of the study, 18 patients were on placebo, and only one got worse over the next six months (6%). Sixty-five patients were on 300 mg. of chlorpromazine at the start of the study, and 54% of these patients worsened after the drug was withdrawn. One hundred thirteen patients were on more than 300 mg. of chlorpromazine at the start of the study, and 66% of these patients got worse after drug withdrawal. See Table Three, Page 684.

Prien, R., (1971), "Discontinuation of Chemotherapy for Chronic Schizophrenics," In Hospital and Community Psychiatry, 22, 20-23. In this NIMH study, the earlier finding that relapse rates rose in correlation with neuroleptic dosage was confirmed. Only 2 of 30 patients who were on placebo at the start of the study relapsed during the next 24 weeks (7%). Twenty-three percent of the 99 patients who were on under 300 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal. Fifty-two percent of the 91 patients who were on 300 to 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal, and sixty-five percent of the 81 patients who were on more than 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal. The researchers concluded: "Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo--the higher the dose, the greater the probability of relapse." SEE PAGE 22, AND 23

Sanbourne Bockoven, J., (1975), Comparison of Two Five-Year Follow-Up Studies: 1947 to 1952 and 1967 to 1972, American Journal of Psychiatry, 132, 796-801. Researchers compared relapse rates in the pre-drug era to those in the drug era, and found that patients in the pre-drug era had done better. Forty-five percent of the patients treated at Boston Psychopathic Hospital in 1947 had not relapsed in the five years following discharge, and 76% were successfully living in the community at the end of that follow-up period. In contrast, only 31% of patients treated in 1967 with drugs at a Boston community health center remained relapse-free for the next five years, and as a group they were much more "socially dependent"--on welfare, etc.--than those in the 1947 cohort.

Other researchers who reviewed relapse rates for New York psychiatric hospitals in the 1940s and early 1950s reported similar findings: approx 50% of no drug discharged schizophrenic patients remained well on follow-ups periods, which was markedly superior to outcomes with neuroleptics. See Nathaniel Lehrman, "A state hospital population five years after admission: a yardstick for evaluative comparison of follow-up studies," Psychiatric Quarterly, 34 (1960), 658-681; and H.L. Rachlin, "Follow-up study of 317 patients discharged from Hillside Hospital in 1950," J. Hillside Hospital, 5 (1956), 17-40.

Carpenter, Jr., W., (1977), "The treatment of acute schizophrenia without drugs: an investigation of some current assumptions," In American Journal of Psychiatry, 134, 14-20. In this 1977 NIMH study, 49 schizophrenia patients, placed into an experimental hospital program that provided them with psychosocial support, were randomized into drug and non-drug cohorts. Only 35% of the non-medicated patients relapsed within a year after discharge, compared to 45% of those treated with medication. The medicated patients also suffered more from depression, blunted emotions, and retarded movements.

Rappaport, M., (1978), "Are there schizophrenics for whom drugs may be unnecessary or contraindicated?" International Pharmacopsychiatry, 13, 100-111. In this 1978 study, Maurice Rappaport and his colleagues at the University of California, San Francisco randomized 80 young male schizophrenics admitted to Agnews State Hospital to drug and non-drug groups.Only 27% of the drug-free patients relapsed in the three years following discharge,compared to 62% of the medicated group. Most notably, only two of 24 patients (8%) who weren�t medicated in the hospital and continued to forgo such treatment after discharge subsequently relapsed. At the end of the study, this group of 24 drug-free patients was functioning at a dramatically higher level than drug-treated patients.

Mathews, S. (1979), �A non-neuroleptic treatment for schizophrenia: analysis of the two-year postdischarge risk of relapse,� Schizophrenia Bulletin, 5, 322-332; Loren Mosher, �Community residential treatment for schizophrenia: two year followup,� Hospital and Community Psychiatry, 29 (1978), 715-723; Mosher, �The treatment of acute psychosis without neuroleptics: six-week psychopathology outcome data from the Soteria project,� International Journal of Social Psychiatry, 41 (1995), 157-173; Mosher, �The Soteria project: twenty five years of swimming upriver,� Complexity and Change, 9 (2000), 68-73.

During the 1970s, the head of schizophrenia studies at the NIMH, Loren Mosher, conducted an experiment that compared non-drug treatment to drug treatment, and he reported better outcomes for the non-drug patients. See, e.g.: Mosher LR and Menn AZ. Soteria: An Alternative to Hospitalization for Schizophrenia. In JH Masserman (Ed), Current Psychiatric Therapies, (Vol. XIV). New York: Grune and Stratton, Inc., pp. 287‑296, 1974. Menn AZ and Mosher LR. The Soteria Project. An Alternative to Hospitalization for Schizophrenics: Some Clinical Aspects. In J Jorstad and E Ugelstad (Eds), Schizophrenia 75. Oslo, Norway: Universitetsforlaget, pp. 347‑372, 1976. Mosher LR and Menn AZ. Dinosaur or Astronaut? One‑Year Follow‑Up Data from the Soteria Project. In M Greenblatt and RD Budson (Eds), "A Symposium: Follow‑up of Community Care". American Journal of Psychiatry, 133:8, 919‑920, 1976. Mosher LR and Menn AZ. Lowered Barriers in the Community: The Soteria Model. In LI Stein and MA Test (Eds), Alternatives to Mental Hospital Treatment. New York: Plenum Press, pp. 75‑113, 1977.

Muller, P., & Seeman, P., (1978), "Dopaminergic Supersensitivity after Neuroleptics: Time-Course and Specificity, Psychopharmacology 60, 1-11. Guy Chouinard, �Neuroleptic-induced supersensitivity psychosis,� American Journal of Psychiatry, 135 (1978), 1409-1410; Chouinard, �Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics,� American Journal of Psychiatry, 137 (1980), 16-20. In the late 1970s, Canadian investigators identified the biological changes induced in the brain by neuroleptics that led to the higher relapse rates. Because the drugs dampen down dopamine activity, the brain tries to compensate by becoming "supersensitive" to dopamine. (The drugs trigger an increase in the density of dopamine receptors.) This perturbation in dopamine function makes the patients more biologically prone to psychosis and to worse relapses upon drug withdrawal. Chouinard concluded: "Neuroleptics can produce a dopamine supersensitivity that leads to both dyskinetic and psychotic symptoms. An implication is that the tendency toward psychotic relapse in a patient who has developed such a supersensitivity is determined by more than just the normal course of the illness . . . the need for continued neuroleptic treatment may itself be drug-induced."

Gardos, G., & Cole, J. (1976), �Maintenance Antipsychotic Therapy: Is the Cure Worse than the Disease.� American Journal of Psychiatry, 133, January, pager 32-36. After discussing the problems with neuroleptics, the authors conclude, "every chronic schizophrenic outpatient maintained on an antipsychotic medication should have the benefit of an adequate trial without drugs." Jonathan Cole was the head of the NIMH, I believe, in the 1960s. This is just a general discussion paper, but note his conclusion: �An attempt should be made to determine the feasibility of drug discontinuance in every patient.�

The WHO Studies- The evidence of an association between use of neuroleptics and poor long-term outcomes can be seen in studies by the World Health Organization.

1st Study:

Leff, J. (1992), "The International Pilot Study of Schizophrenia: five-year follow-up findings," Psychological Medicine, 22, 131-145. The first World Health Organization study that compared schizophrenia outcomes in "developed" and "developing" countries was called The International Pilot Study of Schizophrenia. It began in 1968, and involved 1202 patients in nine countries. At both two-year and five-year follow-ups, the patients in the poor countries were doing much better. The researchers concluded that schizophrenia patients in the poor countries "had a considerably better course and outcome than (patients) in developed countries. This remained true whether clinical outcomes, social outcomes, or a combination of the two was considered." Two-thirds of the patients in India and Nigeria were asymptomatic at the end of five years. The WHO investigators, however, were unable to identify a variable that explained this notable difference in outcomes. SEE PAGES 132, 142, 143.

2nd Study

Jablensky, A., (1992), "Schizophrenia: manifestations, incidence and course in different cultures, A World Health Organization ten-country study," Psychological Medicine, suppl. 20 (1992), 1-95. The second WHO organization study of this type was called the Determinants of Outcome of Severe Mental Disorders. It involved 1379 patients from 10 countries, and was designed as a follow-up study to the International Pilot Study of Schizophrenia. The patients in this study were first-episode patients, and 86% had been ill fewer than 12 months. This study confirmed the findings of the first: two-year outcomes were much better for the patients in the poor countries. In broad terms, 37 percent of the patients in the poor countries (India, Nigeria and Colombia) had a single psychotic episode and then fully recovered; another 26.7% of the patients in the poor countries had two or more psychotic episodes but still were in "complete remission" at the end of the two years. In other words, 63.7% of the patients in the poor countries were doing fairly well at the end of two years. In contrast, only 36.9% of the patients in the U.S. and six other developed countries were doing fairly well at the end of two years. The researchers concluded that "being in a developed country was a strong predictor of not attaining a complete remission."

Although the WHO researchers didn't identify a variable that would explain this difference in outcomes, they did note that in the developing countries, only 15.9% of patients were continuously maintained on neuroleptics, compared to 61% of patients in the U.S. and other developed countries.

This difference in outcomes is also consistent with research in the U.S. showing that neuroleptics induce brain changes that make people more biologically prone to psychosis. One would expect that drugs that induced such changes would lead to increased chronic illness, and the failure of most patients to attain a complete remission. See, Table 4.10 page 64 and page 90. [Table 9.1 from Mad in America reproduced because of quality in original]

Also see, "Culture and Schizophrenia: Criticisms of WHO studies are answered," by A. Jablensky, N. Sartorius, J.E. Cooper, M. Anker, A. Korten and A. Bertelsen, British Journal of Psychiatry (1994) 165, 434-436.

Studies by the esteemed Dr. Courtenay Harding show that it is the patients who do not use psychiatric medications regularly on a long-term basis that are the ones that tend to recover from schizophrenia. In Harding, C., Zahniser, J. (1994), Empirical Correction of Seven Myths About Schizophrenia with Implications for Treatment, In ACTA Psyciatrica Scandinava, 90 (suppl 384): 140-146. These Studies have consistently found that half to two thirds of patients significantly imporved or recovered, including some cohorts of very chronic cases. The universal criteria for recovery have been defined as no current signs and symptoms of any mental illness, no current medications, working, relating well to family and friends, integrated into the community and behaving in such a way as to not being able to detect having ever hospitalized for any kind of psychiatric problems.(p. 140) There are no data existing which support the myth these people need to by on medication all their lives. When analyzing the results from the long term studies, it was clear that that a surprising number (at least 25% - 50%), were completely off their medications, suffered no further signs and sympoms of schizophrenia, and were functioning well. (p. 143). "Even in the second and third decades of illness, there is still potential for full or partial recovery." All of the recent long-term follow-up investigators have recorded the same findings.

Harding, C., Brooks, G. at el (1987), The Vermont Longitudinal Study of Persons With Severe Mental Illness, II: Long-Term Outcomes of Subjects Who Retrospectively Met DSM-III Criteria for Schizophrenia, In American Journal of Psychiatry 144:6, June, 727 at p. 730. 68% of people diagnosed with schizophrenia had recovered and of these 50% never took psychiatric medications and another 25% only took them periodically when they felt they needed to control symptoms. See, also Harding, C., & Brooks, at el (1987), American Journal of Psychiatry 144:6, June 1987, 718,

Hegarty, J., Baldessarini, R. at el (1994), One Hundred Years of Schizophrenia: A Meta-Analysis of the Outcome Literature, American Journal of Psychiatry: 151, 1409-1416. At the same time that the WHO was reporting on poor outcomes in developed countries, Harvard Medical School researchers published a study concluding that outcomes for schizophrenia patients in the U.S. had declined since the 1970s, to the point they were no better than they had been in 1900. Since 1986, ONLY 36.4% of patients in the U.S. have had favorable outcomes or were "improved" during a follow-up period that averaged 5.6 years. The authors did not blame neuroleptic use for the poor outcomes; on the contrary, they argued that despite the poor outcomes in the modern era, neuroleptics still should be seen as beneficial, but this part of their conclusions is not supported with any research.

Viguera, A, Baldessarini, R, at el, (1997), Clinical Risk Following Abrupt and Gradual Withdrawal, Archives of General Psychiatry: Vol 54, Jan. They quantified the how much the abrupt discontinuation of long-term neuroleptic use increased relapse rates. This study concluded that the relapse risk was relatively high within six months; most patients who remained stable for 6 months continued to do so for long periods without medication; and the risk of relapse was lower when the medication withdrawal was gradually discontinued as compared to abrupt discontinuation. On page 52 Figure three shows that two-thirds of those gradually withdrawn haven�t relapsed at the end of 24 weeks, and they have a good chance of remaining well indefinitely.

Ciompi, L, Dauwalder, L, at el, The Pilot Project Soteria Berne; Clincial Experiences and Results, In this study, Switzerland researchers duplicate Mosher�s results (more or less.) Note on page 148 conclusion that: �patients who received no or very low-dosage medication demonstrated significantly better results.�

Lehtinen, V, Aaltonen, J., at el, (2000), Two-year outcome in first episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?, In European Psychiatry August; 15(5): 312-20. In this study, 43% of the patients in the experimental group didn�t receive any neuroleptics at all, and that overall, the outcome for the experimental group �was equal or even somewhat better" than those treated conventionally with neuroleptics. The recommendation out of this study by the authors was that an integrated approach stressing intensive psychosocial measures be used for first-episode psychosis.

Cullbert, J., (1991) Integrating intensive psychosocial therapy and low dose medical treatment in a total material of first episode psychotic patients compared to "treatment as usual" a 3 year follow-up. In Acta Psychiatry Scandinavia, May;83(5):363-72. This is study from Sweden in which they copied the Finnish project. Note that only 45 of the patients in the experimental group were on neuroleptics at 3-year follow-up, and those on it were on 62 milligrams of Thorazine a day (a very low dose). This experimental group had much lower hospital use than those treated conventionally over a three-year followup. In other words, they did better, and this of course saves

Ho, B., Alicata,D,Ward, J., Moser,D. et al (2003). Untreated Initial Psychosis: Relation to Cognitive Deficits and Brain Morphology in First-Episode Schizophrenia. Am J Psychiatry, 160, 142-148. This is the largest study of first-episode subjects to date (156). Its negative findings fail to support the theory of "toxic psychosis" and suggests that "large-scale initiatives designed to prevent neural injury through early intervention in the prepsychotic or early psychosis phase may be based on incorrect assumptions." (p142 (A) Increase in Caudate Nuclei Volumes of First-Episode Schizophrenia Patients Taking Antipsychotic Drugs, Chakos, Lieberman, Bilder, Borenstein, Lerner, Bogerts, Wu, Kinon and Ashtari, American Journal of Psychiatry, October 1994; 151:1430-1436; (B) Neuroleptics in progressive structural brain abnormalities in psychiatric illness by Madsen, Keiding, Karle, Esbjerg and Hemmingsen, The Lancet, Vol 32, September 5, 1998, 784-785; (C) Subcortical Volumes in Neuroleptic-Na�ve and Treated Patients with Schizophrenia by Gur, Maany, Mozley, Swanson, Bilker and Gur, American Journal of Psychiatry December 1998; 155:12 1711-1717; (D) Increased Volume and Glial Density in Primate Prefrontal Cortex Associated with Crhonic Antipsychotic Drug Exposure by Selemon, Lidow and Goldman-Rakic, Biologic Psychiatry 1999; 46:171-172; and (E) A Follow-up Magnetic Resonance Imaging Study of Schizophrenia: Relationship of Neuroanatomical Changes to Clinical and Beurobehavioral Measures, by Gur, Cowell, Turetsky, Gallacher Cannon, Bilker and Gur, Archives of General Pscychiatry: Feb 1998 Vo. 55:145-152.

These last five are studies showing that the drugs shrink frontal lobes, and cause an enlargement in the basal ganglia. Please see the Gur MRI study in which she notes that this enlargement of the basal ganglia were associated with greater severity of symptoms. In other words, we have here an MRI study that charts brain changes that lead to greater severity of symptoms.

Specifically related to postive psychological treatments, please see the following list provided by Attorney Jim Gottstien:

Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies, by Jaakko Seikkula1, Jukka Aaltonen, Birgittu Alakare, Kauko Haarakangas, Jyrki Kera�Nen, & Klaus Lehtinen, Psychotherapy Research, March 2006; 16(2): 214/228. This study of the Open Dialogue approach in Finland that used as little neuroleptics as possible found that in a group of 42 patients, 82% did not have psychotic symptoms at the end of five years, 86% had returned to their studies or jobs, and only 14% were on disability allowance. Only 29% had ever been exposed to a neuroleptic medication at all during the five years, and only 17% were on neuroleptics at the end of five years. Other studies of this program are:

Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two- year Follow-up on First Episode Schizophrenia, by Jaakko Seikkula, Birgitta Alakare, Jukka Aaltonen Juha Holma and Anu Rasinkangas, Ethical and Human Sciences and Services, 2003, 5(3), 163-182.

Open Dialogue in Psychosis II: A Comparison of Good and Poor Outcome Cases, by Jaakko Seikkula, Birgitta Alakare and Jukka Aaltonen, Journal of Constructivist Psychology, 14:267-284, 2001.

Remember Our Heritage, by Cloe Madanes, Psychotherapy Networker, November/December 2004. 2.2 Megabytes.

Soteria and Other Alternatives to Acute Psychiatric Hospitalization A Personal and Professional Review, by Loren R. Mosher, M.D., The Journal of Nervous and Mental Disease, 187:142-149, 1999.

The Michigan State Psychotherapy Project study compared standard medication treatment for those diagnosed with severe schizophrenia with quality controlled psychotherapy both alone and with medication as an adjunct. The study demonstrated extremely more favorable long-term outcomes (at lower cost) for those receiving psychotherapy alone from psychotherapists with relevant training and experience.

Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes from the Soteria Project by John R. Bola, Ph.D., and Loren R. Mosher, M.D., finds that a relationally focused therapeutic milieu with minimal use of antipsychotic drugs, rather than drug treatment in the hospital, should be a preferred treatment for persons newly diagnosed with schizophrenia spectrum disorder.

Luc Ciompi, M.D., Professor Emeritus, MD, Switzerland The Soteria-concept. Theoretical bases and practical 13-yearexperience with a milieu-therapeutic approach of acute schizophrenia, Special lecture given at the 93 Annual Meeting of the Japanese Society of Psychiatry and Neurology, Tokyo, May 29th-31th, 1997, published in Psychiatria et Neurologia Japonica 99: 634-650, 1997. The Concept of Affect Logic: An Integrative Psycho-Socio-Biological Approach to Understanding and Treatment of Schizophrenia, Psychiatry, Vol. 60, Summer 1997. The Effects of Medicating or Not Medicating on the Treatment Process by Bertram P. Karon, Ph.D. discusses both the harm caused by neuroleptics and the efficacy of a psycho-dynamic process (2003). Longer version presented at Division of Psychoanalysis (39), American Psychological Association, New York, NY, April, 2002.

Psychotherapy with "Schizophrenia": Analysis of Metaphor to Reveal Trauma and Conflict, by Richard Shulman, PhD, Co-published simultaneously in The Psychotherapy Patient (The Haworth Press, Inc.) Vol. 9, No. 3/4, 1996, pp. 75-106; and: Psychosocial Approaches to Deeply Disturbed Persons (eds: Peter R. Breggin, and E. Mark Stern) The Hawthorn Press, Inc., 1996, pp.75-106.

The Benefits of Individual Psychotherapy for People Diagnosed with Schizophrenia: A Meta-Analytic Review by William H. Gottdiener and Nick Haslam, Ethical Human Sciences and Services, (2002) 4 (3), pp. 163-187. This comprehensive review of the literature finds that psychotherapy is as effective as medication and that adding medication does not increase effectiveness.

How Non-Diagnostic Listening Led to Rapid "Recovery:" from Paranoid Schizophrenia: What is Wrong With Psychiatry? by Al Sieberts, Ph.D. In this paper, Dr. Sieberts finds that Psychiatry lacks insight into its own behavior, invalidates constructive criticism, avoids the kind of self-examination it urges on "patients," shows little interest in accounts of successes with schizophrenic" individuals, erroneously lumps all the schizophrenias (plural) together in research studies, feels helpless and hopeless about schizophrenia, dismisses evidence that contradicts its inaccurate beliefs, and misrepresents what is known about "schizophrenia" to the public and to patients.

The Soteria Project: Twenty Five Years of Swimming Upriver, Loren R. Mosher, John R. Bola, Complexity and Change, (2000) 9: 68-74. This paper identifies the key ingredients to Soteria's success in treating patients diagnosed with schizophrenia without or with minimal medication.

Recovery: The Lived Experience of Rehabilitation, by Patricia E. Deegan, Ph.D., revised version of paper originally published in Psychosocial Rehabilitation Journal, 1988, 11(4), 11-19. This very important paper describes in moving, personal terms the importance of hope in recovery. And willingness. And responsible action. It also provides very important information on how to structure a program to achieve recovery.

Soteria-California and Its Successors: Therapeutic Ingredients By Loren R. Mosher M.D., suggests that the strikingly beneficial effects of the Soteria type treatment are likely due to (a) the milieu, (b) attitudes of staff and residents, (c) quality of relationships, and (d) supportive social processes. Dr. Mosher also discusses how leadership effects the success of these programs. Soteria Project: Final Progress Report, by Loren Mosher and Bob Vallone, 3/14/92. (9 megabytes) William Carpenter, Jr., "The treatment of acute schizophrenia without drugs: an investigation of some current assumptions," American Journal of Psychiatry, 134 (1977), 14-20.

New Hope for People with Schizophrenia, Monitor on Psychology, Volume 31, No. 2, February 2000 discusses the growing evidence that people can and do recover from serious mental illness with the critical ingredient being psychosocial rehabilitation.

Psychoanalysis and Psychosis: Trends and Developments by Ann-Louise S. Silver, M.D Journal of Contemporary Psychotherapy, Vol 31, No. 1, Spring 2001. Psychodynamic work is too often dismissed as outmoded, while no theory has been developed that rivals it in effectiveness or in ability to offer cohesive theory.

Maurice Rappaport, "Are there schizophrenics for whom drugs may be unnecessary or contraindicated?" International Pharmacopsychiatry, 13 (1978), 100-111, concludes Many un-medicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer re-hospitalizations and better overall function in the community than patients who were given chlorpromazine while in the hospital.

Psychoanalysis and Psychosis: Players and History in the United States, by Ann-Louise Silver M.D., Psychoanalysis and History 4(1), 2002. In this paper, Dr. Silver outlines how psychoanalysis has had significant success in treating schizophrenia and other psychoses since the early 1900's in the United States.

Deinstitutionalized Residential Care for the Mentally Disordered: The Soteria House Approach, by Holly Skodo Tilson, 1982, Grune & Stratton, Inc. Beware: 39 Megabytes.

Susan Mathews, �A non-neuroleptic treatment for schizophrenia: analysis of the two-year postdischarge risk of relapse,� Schizophrenia Bulletin, 5 (1979), 322-332 finds that at 12 months postdischarge, the cumulative probability of remaining well significantly favors the alternative Soteria program over the standard use of neuroleptics.

Consumer Operated Support Programs Traditional community resources for mental health: a report of temple healing from India, by R Raguram, A Venkateswaran, Jayashree Ramakrishna, Mitchell G Weiss, British Medical Journal, v325 p38, 6 JULY 2002 bmj.com Loren Mosher, �Community residential treatment for schizophrenia: two year followup,� Hospital and Community Psychiatry, 29 (1978), 715-723 finding that two years after discharge while the alternative Soteria program patients didn't show significantly different readmission rates or symptoms, they received medications significantly less often, used less outpatient care, showed significantly better occupational levels and were more able to live independently.

Effective Psychotherapy of Chronic Schizophrenia, by Nathaniel S. Lehrman, M.D., American Journal of Psychoanalysis, (1982), Vol.42, No. 2: 121-131. This 1982 paper presents the evidence already existing that over-reliance on neuroleptics was worsening outcomes. In this paper Dr. Lehrman discusses how individually tailored psychotherapy can get people who have chronically suffered schizophrenia well and back out into the community as a full member.


Finally, you way wish to read:

Edward Podvoll, 1990. The seduction of Madness. London: Century. This book outlines how a Psychitrist succesffuly treated people diagnosed schizophrenic s without the need for medication. He created a safe, home-like environment with volenteers, whereby they slept, worked, cooked and made choices with volunteers on an equal basis. Once situated, medications were slowly terminated and yes, the psychosis did return for brief time, but there were �moments of clarity� with the new supportive, nurturing and affirming environment. Over time, this program increased the longevity of �the moments�, and finally these individuals emerged from psychosis and did not have further psychotic symptoms.

Deikman & Whitaker (1979). These researchers compared pure psychosocial treatments verses a pure medication group, over an eleven month period. The psychotherapy group resulted in no suicides, no elopements, and no significant acts of aggression; however, the medication alone group resulted in three suicides. The authors also note that the pure psychotherapy group was also heavily weighted with individuals who were more severely distrubed and had worse symptoms.

I have dozens of other references that I could cite, but I think I have demonstrated the fact that there is an abundance of research supporting an effective psycho-social model of treatment.

Warmly,

Dr. Watson

Moving sections 10.19.2006

When I was working on one of the sections of this article I noticed the sections seemed to be WAY out of order. Most health articles read 1.Introduction, 2.Causes or overview, 3.Symptoms, 4.Diagnosis, 5.Treatment and then any other related topics. I know the controversy is a hot topic, but I'm not sure it belongs ahead of diagnosis or treatments. Think about going to a doctor when you are ill (mentally or physically, to a psychiatrist or psychologist) - you or others, before you go, will notice symptoms. You'll consult with the professional. Then there will be a diagnosis, if applicable. Then if diagnosed, be treated. I think this order really makes the article flow smoothly. Thoughts? Chupper 05:01, 20 October 2006 (UTC)

Controversy too long?

I'm sort of a visitor to this article, I can be found more in the psychs and mental health professional pages, but I hope I'm not being to bold here. First off, the controversy seems to be focused on psychiatry, which I'm not refuting, but this is not a psychiatry or anti-psychiatry article. Mental illness can be treated with psychiatrics, yes, but what about psychology? This article should be covering both and the controversy section is not. Additionally, there are already two other main articles referenced for users to click on. Is it just me or does more than 800 words seem a bit in excess considering this is not the main article on controversy. I think by shrinking this section to a FEW key points would make the anti-psychiatry people happy (because shorter is often more powerful) and the pro-psychiatry people happy (because it wouldn't be taking up 21.5% of the article as it is now). Thoughts? Chupper 05:08, 20 October 2006 (UTC)

Yes this section is excessive. Controversy never deserves more then a few lines, especially when the viewpoint is neither majority or a minority viewpoint. Deletions to made soon without further feedback.--scuro 11:20, 3 April 2007 (UTC)

Definining "mental illness"

I came to this article looking for a definition of mental illness. I was looking for, in other words, an explanation of what qualities something must have in order to be considered a mental illness (as well as who decides what qualifies as a mental illness, and what criteria and methods do they use- I'm sure this varies between cultures). I thought that it would be something like "Mental illnesses are patterns of thought and behavior which society considers to be unacceptable, which cause significant distress to the individual, and over which the individual has little or no control."

The definition given in this article basically just says that a mental illness is an illness of the mind. Although this is true, it sheds very little light on the meaning of the term. Is this because the definition or mental illness varies so widely that it is not possible to specifically define it? Doesn't the APA have to have to have some sort of definition in order to classify something as a mental illness? Amillion 04:41, 10 November 2006 (UTC)

I agree with this comment. Looks like some of the definitional issues are only addressed down in the 'controversies' section, mixed in with other issues. I guess a definition of 'mental' and of 'illness' could help people clarify things for themselves, or links to those pages? EverSince 16:58, 15 November 2006 (UTC)
I'm not sure that would help much; the article on illness says that illnesses are "Abnormal conditions of the body or mind that cause discomfort, dysfunction, or distress to the person afflicted or those in contact with the person." But really, something can be abnormal about you which causes you or other people distress without it being an illness. For example, abnormally extreme intelligence, an abnormally overwhelming love of music, and abnormal artistic abilities are conditions having to do with the mind which often cause those afflicted with them or those around them discomfort, and they may even interfere with everyday activities, but they are not mental illnesses. Homosexuality also may result in discomfort or distress, but is no longer classified as a mental illness. For something to be a mental illness, it has to be more than just abnormal, distressing, and having to do with the mind. There must be some factor which is missing in this definition. Perhaps something has to cause a negative affect objectively, regardless of the cultural context, for it to be a mental illness? Perhaps there is something else as well? I still can't seem to find a satisfactory definition anywhere. Amillion 05:35, 29 November 2006 (UTC)
I think the problem is that the work on mental illness isn't actually founded on an agreed definition that fits everything that is called a mental illness but excludes everything not called such. And the concept is ambiguous, even in general medicine (e.g. take essential hypertension), let alone psychiatry. The DSM purports to be atheoretical as to etiology, and mainly describes 'syndromes' rather than disorders despite its name, mainly using consensually-agreed (literally voted on by committee) clinically-useful categories and cut-offs (according to some sufficient mixture of distinct abnormality, distress and dysfunction). I don't think there is actually any definitional reason why your examples couldn't be defined as disorders by DSM when routinely causing distress/dysfunction (in reality such cases would probably be fudged in to a diagnosis of OCD or Aspergers or something. BTW gender identify problems are still included in DSM, which some see as a way of still pathologising homosexuality, and there is also Sexual Disorder Not Otherwise Specified" which can be used for someone with "...persistent and marked distress about sexual orientation".). And many of the diagnoses are fudged to allow precisely the cultural subjectivity you mention, e.g. delusions only counting as delusions if they appear incongruous with the person's culture or religion etc.EverSince 20:25, 6 December 2006 (UTC)
The intro at the moment equates mental illness with several similar concepts. It seems to me it is different in at least one important sense - it implies (at least in its strong usage) a medical illness akin to the sorts of bodily illnesses identified in general medicine. Implying a medical understanding to do with signs and symptoms and a specific underlying 'hardware' pathology or disease process, and the primary suitability of medical care and treatment. I think this could be indicated in the introduction. EverSince 16:58, 15 November 2006 (UTC)
I agree. I also think that there ought to be some sort of description of the ways in which people who subscribe to this model explain culturally specific mental illnesses. Do they commonly believe that these aren't "really" illnesses? Do they believe that biological or environmental factors that cause certain illnesses are specific to certain areas or populations? Have there been studies done to see whether or not people who assimilate into these cultures are susceptible to these illnesses? Amillion 05:54, 29 November 2006 (UTC)
I agree this is a very important issue. Variation from the Western norms are often argued to be just different 'manifestations' of the same underlying illness. Definitions are often tailored to actually make this the case (e.g. defining psychosis in terms of form rather than content). Those cultures might be seen as wrong to not see things as illness symptoms, e.g. shamanistic experiences that might be valued. However since many diagnoses depend on distress or dysfunction, this in itself allows for cultural variability depending on how a society is prejudiced for or against particular behaviors. On the other hand, it's commonly held that a lot of the behaviours picked out by the DSM as disordered are based in culture-specific moral judgements. EverSince 20:25, 6 December 2006 (UTC)
I think some of the terms listed in the intro as equivalent to 'mental illness' are actually often used as alternative concepts - either in professional work by those not adopting a medical model, or by those defending against the term being suitable or helpful to apply to them. EverSince 16:58, 15 November 2006 (UTC)
p.s. Quote from American Psychiatric Association statement 2003: "In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by a person who has a mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population-based norms for cognitive processes, mood regulation, or other indices of thought, emotion, and behavior" I think actually even if there is some putative biological 'marker' this 'variety of concepts' still usually applies. —The preceding unsigned comment was added by EverSince (talkcontribs) 11:01, 7 December 2006 (UTC).
I've tried some editing of the intro section along the above lines and see what happens EverSince 20:25, 6 December 2006 (UTC) p.s. I've created Cross-cultural psychiatry and Spectrum disorder (the latter needing a sourced definition before building up) EverSince 12:44, 20 December 2006 (UTC)


I noticed the article talks about the DSM as diagnosing mental illnesses, which I think isn't quite accurate. The DSM is the Diagnostic and Statistical Manual of Mental Disorders, and includes many diagnoses that aren't generally considered illnesses. Also realised the page 'mental disorder' diverts to this one. I would like to propose that it be the other way round (or with perhaps this page clarifying the particular unique usage of mental 'illness'). All the other Wikipedia pages are headed 'disorders', as is the table listing all the different kinds of disorders at the end of this page. I'd be interested to know of any objections or other suggestions. EverSince 18:10, 4 January 2007 (UTC)

THE OVERLOOKED RELATIONSHIP BETWEEN INFECTIOUS DISEASES AND MENTAL SYMPTOMS

[http://www.personalconsult.com/articles/infectionsandmentalsymptoms.html THE OVERLOOKED RELATIONSHIP BETWEEN INFECTIOUS DISEASES AND MENTAL SYMPTOMS]


Seems that a very probable cause of mental illness symptoms, has been overlooked.

The key word parasites.

If you examine the symptoms associated with some mental illnesses like schizophrenia, they include intestinal disorders that may be wrongly associated with emotional disorders.


--Son of Maryann Rosso and Arthur Natale Squitti 23:16, 30 November 2006 (UTC)



The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.