discuss the pros and cons of the models offered and state and explain why you subscribe to one or the other.

Based on the lectures and readings (in text references should be included in your statements and will improve your grade):
1. Take your best shot at describing your view on what the term Mental Illness means. You have been presented with two different models of “Crazy” Behavior. In your answer please discuss the pros and cons of the models offered and state and explain why you subscribe to one or the other. (You may offer a hybrid version, but please explain why.)
2. Please select at least one of your classmates’ response to the above question to comment on. As part of your response please express respectfully your agreement or disagreement with your colleague’s position and explain why.
Make sure you are familiar with and follow the instructions and guidelines for discussion board posts.
For this assignment please review the Podcast Lecture directly below and the Thomas Szasz video conversation at the Center of Excellence in Interdisciplinary Mental Health, University of Birmingham, England.
Podcast:
Szasz videos on the University of Birmingham website.
Additionally, read the following article, which is an interview with Thomas Szasz:
Wyatt, 2004 Download Wyatt, 2004
and the article about the SPIEL model by Gomory et al., 2017 Download Gomory et al., 2017.
There should be some discussion of at least three of these resources (podcast/lecture, Szasz video, Wyatt interview with Szasz, Gomory et al. article) in your post as you answer the question.
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PODCAST: The class in this podcast I like to discuss how we can think about what we call sometimes psychopathology or mental illness. What I call human behavioral disorderliness thoughtfully and critically So let’s talk a little bit about this idea of human behavior. Particularly what we sometimes call volitional behavior which is a form of what we call moral agency. Generally aligned with the idea of intentional behavior. That is behavior or action we take. Because we intend to take the action. So in the sense that we could have acted otherwise. So when we get dressed and select Particular clothing you can see my beautiful Vivienne Westwood jacket and my red t-shirt. That was taken from a selected wardrobe that I have and I have alternatives. So I chose specifically to dress this way. You also constantly decide to act getting dressed showing up for class face-to-face or to open up the computer and engage with our online psychopathology course So interestingly should we consider these actions responsible actions. I’m going to have a series of sort of rhetorical questions which really you should answer for yourself and decide whether my perspective seems to make sense or not. So are any of our acts that is the intended activity as opposed to Slipping on a banana When you’re walking on the streets that is happening as our choice to slip and fall. But it might be our choice to jump over the banana peel to avoid falling are such intentional acts ever outside of our control. And if you think yes when what particular aspect of it sometimes we do argue that folks Can’t help themselves from what appeared to be volitional action. For example people who drink alcohol sometimes are considered not to have any control over their drinking. This is an interesting question. And the argument has to be made in detail why people who drink are not responsible for controlling their own behavior this is very important to us because we sometimes argue that certain folks cannot help what a2 we may call them addicted. For example. While addiction is again another complicated notion. Do we mean physically that is that as the chemical is habituated into the body that is physical withdrawal symptoms may occur. If you rapidly withdraw from ingesting the chemical then you may have a physical reaction Delirium treatments a very serious medical condition. If you rapidly stop drinking if you have been a large consumer of alcohol. Sometimes people say psychological addiction. This is a more problematic notion. It is hard to be able to discriminate between. I have a great deal of desire for using the psychoactive chemical. For example chocolate happens to be a psychoactive chemical although we don’t think of it that way. But many people eat chocolate because it tastes good And may say gee I just can’t stop eating chocolate as a way of suggesting that it’s not within their own control. But we know that many people can stop rather quickly. And how we can determine when someone is really unable to control their behavior. And when they are using it as a way to excuse their behavior which is condemn perhaps by others but is very very preferable for the person It’s hard to say this is an interesting question that I think you as social workers will confront and need to think about. When people say I can’t help myself. How do we know that that claim is accurate. That is is there some scientific information that will help us or do we simply have to judge based on our best. Guess that is always a problem guessing around issues like that because they may have major consequences. For the folks that we’re working with And of course we know many acts can be used as excuses. If we aren’t careful. So these issues requires some critical reflection. I hope you’ll just think about some of these issues. Let’s go on to talk a little bit more detail. So can very generic discussion above. The next thing is are troubling deviant acts or behaviors ever not our responsibility. Can you think of any if so for what reasons I’ve mentioned a couple of deviant behaviors. Drug misuse is sometimes considered something that isn’t directly in our control. But what’s so very interesting about this whole argument that even in 12-Step programs the solution the treatment for these acts is nothing more than not using 12th stuff so forth provide some support individuals and groups. But fundamentally and ultimately the person has to stop. Ingesting the psychoactive chemical. For example as they say one day at a time so each and every day you have to decide not to take the drug swallow it snort it injected. But again it’s still requires you to physically not ingested. And that sort of treatment obviously is a volitional choice. You can decide to use it ingested or not. So let’s look at two sort of large-scale responses social responses to deviant unacceptable or unwanted human behavior. One major institution is the criminal justice system. We label the on desired or unacceptable behavior criminal. And these behaviors are viewed as volitional. As under personal control. Individuals generally are viewed as legally responsible for their actions and our sentence for their criminal behavior. This is based of course on the assumption that you determine to behave this particular way versus some other way. You know holding someone up with a weapon requires a whole series of complex volitional choices. Then there is the other major system that I think we often as social workers Find ourselves engaged with and that’s the mental health system which is in the system really that deals with madness. Mental illness mental disorder ring. Mental disorder is same words. Different words rather for the same context. So crazy bee behavior excuse me are viewed as sort of like determined motion like a robot somehow controlled from the outside knifed by the individual who seems to be behaving in this troubled were trumpeting way. And it’s seen that those behaviors are the result of something called mental illness. Generally individuals are seen as legally not responsible for their actions although sometimes they are. And as a result are treated for their mad psychotic mentally ill behavior. So let’s think a little bit about this concept which is currently labeled societally as mental illness I prefer behavioral disorderliness. I think that that’s a more fundamental descriiption of what actually we see when we consider people who are considered to be crazy. He was one way of looking at it. So we have to take this behavior and specify it operationally. So if someone says that they are depressed we need to enquire further because to press can mean many many different things. Someone being very sad a little sad. Someone being unable to get out of bed. Physically unable to move suicidal. That is they want to kill themselves. They are so unhappy. They may consider themselves depressed and having chemical imbalances. So we need to specifically ask our clients. What do they mean by this term in order for us to be able to helpful to be helpful to them. That is we are looking for behavioral descriiptions or mood state descriiptions with which we can work we can’t really work with the word depression. It contains too many possible options which we need to clarify. So that there is one. So we have to define the problem than we might have a tentative theory about what that is. So one possible theory about what is going on is personal Personal troubling or troubled behavior towards self or others. That’s one way of looking at it. We can call them problems in living which are from my perspectives. Groupings of socially undesirable habitual behaviors that are valued deviant behaviors which then are often judged. In our case through DSM labels but uncivic sophisticatedly they may just speak labeled crazy. Insane those sorts of terms. But I want to focus just for a minute on the groupings of socially undesirable habitual behaviors. I want to just have you think about groupings of socially desirable habitual behaviors that may you may routinely. Engage it. Well your morning rituals in terms of how you brush your teeth. Take a bath. Have your breakfast or examples of habituated behaviors that we routinely. And almost in very angrily utilized that is pretty much the same grouping of actions or behaviors are taken each and every time. And in fact we get disturbed if for example our toothbrush isn’t in it’s place or shaving cream isn’t where we expect it to be. That is weird disturbed by that sort of unavailability of what we have habituated ourselves into another example would be you’re habituated habit of driving to work or going to school. Pretty much the same routes are taken. Over and over. We don’t wake up each and every day and decide we’re going to drive a different route just by random choice but in fact we kind of are routinely take the same route although we may have some other options but we don’t usually pursue them unless there is for example very heavy traffic. Now what is this set of habitual behaviors help us with what well you should always think of behaviors. All behaviors have a function. They have reasons for why we take these behaviors. In this case root ionizing them. Behaviours are essentially reassurances about stability in a world that really is rather chaotic. But if we can habituate and regularly perform certain behaviors we feel less stressed Less uncomfortable. They are reassurances about our lives. We as human beings hate ambiguity ambivalence. We rather have clear guidelines even if they’re not the best than have No explanations in terms of what we’re feeling ambivalent about. So this is really the reason that we have habitual behaviors that are desirable to have a meaningful purpose. We also have this undesirable. Setup habitual behaviors. Personally we have them not only crazy people. But all of us many of us for example bide our nails. Pick our nose. Pull our eyebrows pick our lips. Those are what we could label as undesirable because of course there’s a component of harm. And as a result you may not have this seen by others as something that’s pleasant although for you it’s soothing The calms you down. And so we have to think of undesirable habitual behaviors also as having a function. I want to make sure that you are not going to be using another term which is close to a cold. This function or behavior. There are no dysfunctional behaviors. There are only functional behaviors dysfunctional behaviors. Have a reason for why we do it. The term dysfunctional is a judgment by some authority looking at someone’s unacceptable behavior and labeling it as bad. This is an important difference. And it will always help you as you work with clients to see everything that they exhibit in terms of their behaviors as having a reason that that is it’s a function may not be the best solution to the problem that they’re working with. But it is the best they can at that point. Utilize. Of course your job perhaps might be to help them. Look at some alternative behaviors that may be more helpful. So that’s sort of one view of mental disorderliness. The second view that is perhaps the most mainstream view is looking at mental And behavioral disorderliness as medical disease brain disease. These are also including the DSM disorders. So there’s one view the DSM definition which we’ll look at shortly. And then the other one that we conventionally here. That these mental diseases or disorders illnesses are just like other diseases such as cancer. Heart disease et cetera diabetes is also used. So what we do as good critical thinkers is then if we are serious about trying figure out what are the better models to use for our analysis. Is we rigorously evaluate the results of various conceptualizations that we just discussed above through scientific research about the empirical realities of the postulated entities. Let’s remember that these are conceptual explanations which may or may not have good science behind it or engage or and or or engage in political debate. The fact that according to the research literature and the DSM itself not a single DSM mental disorder entity as a physical marker. That is the fat. The DSM is quite clear about its physical marker lesion genetic marker biological markers. These are all the same terms for you know chemical tests blood tests. There isn’t a single one of the DSM mental disorder criteria sets that we find the DSMB have those. That should be provocative to you to you if you thought that you are looking at what are called medical disorders. After all how we know cancer is not by the cancer specialists just looking at us and say You look like you have cancer. But by having a biopsy before or blood tests depending on the particular cancer that can confirm or refute whether you actually have cancer. We do not ever rely simply on the diagnostic overview of our physical doctors for any physical illness that is serious heart disease also requires a invasive test to see. In fact if there are clogged arteries we do scans We take blood tests x-rays et cetera. So there seems to be a difference in how we evaluate the DSM mental disorders and other so-called medical diseases. So here are just a couple of models that I think might be useful for us to think about. So the psychosocial slash moral agents slash educational model. Views What we call madness or mental illness as deviant behaviors which are volitional acts as we spoke about earlier and they have reasons not causes as opposed to a clogged artery causing a heart attack and can be understood and altered change sometimes with the support of helping professionals. Willing to take time with responsible voluntary clients those who are really trying to solve their issues who would like to learn about and ameliorate their personal difficulties. There’s no coercion that needs to be used. Some libertarian therapists or educators and I use that term educators because I would argue rather than psychotherapy. What we do is we educate if you look carefully at psycho therapy that term is deeply troubling. It’s hard to know where the psyche actually is. And are we doing what’s called therapy. Doctors is when they prescribe medication or give us injections or tell us to do certain physical therapy. Is that what we do I would argue that all we do although this is very important to do is talk to our clients sometimes with specialized language because we have certain treatment models that we use but those models are just protocols for how to use language. So we talk to people. That is our key and perhaps only tool. When we work with folks I tend to call this the using of blah blah blah blah blah blah that is persuasive blah blah blah. So we just use language in terms of our work. So we have to be very cautious in calling this therapy. I would prefer the term education. We are providing information knowledge to our clients about what’s going on with them and what options they may have gone forward. In a dialogue Some of the important folks that you may look into and I think we ought for you some of the work in this course. The conceptual work of Thomas us who unfortunately passed away some time ago but was a very good personal friend of mine. And you can see him in action. When you look at the Thomas us interview in the area to module area. His interview with The Center of Excellence in interdisciplinary Mental Health at the University of Birmingham England. There are several videos which I strongly urge you to carefully review. And if you feel like having a discussion with me you should feel free to email me some other folks that I think can be very helpful. Mary boil I have her book listed as one of the suggested readings and Richard Ben tall who is a clinical psychologist the United Kingdom who has written a great deal about psychosis. Voice hearing And hallucinatory claims and then finally yours truly published in 2017 the genre of a journal of humanistic psychology my own module solving problems in everyday living educational approach which you can find attached in area two right below this video. Now the alternative model and the mainstream model and perhaps something one You ascribe to it my bad behaviors are seen as the result of medical diseases. Disorders sometimes labeled brain disorders and conceptualized and diagnosing the sql manual of mental disorders. And are asserted by psychiatry to be like all other medical diseases. Such as i mentioned cancer. The assumption is that bad behaviors occur in voluntarily Determined motion as I argued before. And as a consequence a person is not held responsible. The treatment of choice generally as psychotropic medication and were deemed appropriate. Some supported supportive talk therapy but it’s not meant to be the main approach. But generally in support of the medication. By the way when we think psycho-active chemicals are good for our prospective we call them Medications when we see these psycho-active chemicals as troubling or problematic we call them drugs. This kind of treatment is routinely enforced against individuals against her will all of the major theoreticians in mainstream psychiatry. Agreed that coercion is a requirement of good practice will address some of these issues as we go along in our course. So here are a set of alternative ways of looking at psychosocial models. Psychosocial model means that it’s an interpersonal conversation all engagement between the client and the worker needs to folks. Tom SaaS I’ve already mentioned. More spec is someone who has done wonderful work in terms of the use of language in understanding human behavior you could if you choose Google Beckham and see if you are interested in using his work. So I’m just going to quickly go over a couple of possible ways of looking at psychosocial approach. In assign using model. Mental illness is a special form that word mental illness and it’s definitional terminology a special form of communication by means of bodily signs and complains. That is there is a set of language data and ways of behaving that are internalized and learned by individuals who are considered to be mentally ill. Because other forms of appropriate behavior have through their developmental history not been learn well enough. Or because this approach has worked Very well for the individual based on his development. So it may be useful to appear to be dependent in order to get goodies. If that is the interpersonal activity that has gone on in this young person’s childhood adolescence and young adulthood. Generically rule-following my behavior. We all I don’t prescribe to that we all are rule followers and rule breakers. We need to follow societal rules in order to run into each other indiscriminately and randomly and cause a great deal of chaos. So societal rules governess in terms of what is expected in terms of our behavior. And we also learn various roles in order to be accepted and make our way throughout our life. So You all for example have learned the student role very well. And you all know how you if you’re in a classroom should sit. Look at the teacher. With appropriate posture. Turning towards the teacher rather than turning your back. For example. These are expectations that we internalize. We could do otherwise There would be consequences. Some of the key researchers are Talcott Parsons George Meade. Erving Goffman. If you’re interested in following up with these bits of information the game-playing model engages the therapists and trying to find out what what Sorts of games regarding life the client plays. Some people play the game of life better than others. That is they understand what’s expected of them based on the societal requirements and they are more smooth and able to play the game. Conventionally some people for a variety of reasons may not have the skills or may not wish to be Playing the game in those acceptable ways but rather in alternative ways. Sometimes people then become. Deviance. Sometimes deviance can be seen as very good geniuses are deviance in the sense that they are uniquely skilled in certain areas more skill than the rest of us. But that deviance is a positive deviance. On the other hand if you are a violent Unpleasant human B then you are seen as deviant that needs to be controlled by society. Generally so-called psychiatric problems have a significant intra personal. That’s within person interpersonal between people education and social dimensions. And they have ethical and moral dimensions as well. That is they take place within a social context and present ethical dilemmas. That for their resolution require human choice. And our willingness to follow through the game of life as all games maybe played well or poorly. Based on the rules that are presented. The Game of Life is a very complex game where they played as a normal or a disturbed person. And most people are unaware of the rules nor fully aware of what goals they wish to obtain as a result of their efforts. People are often confused about how to live their lives. We have young people say they are searching for meaning. They are trying to find themselves. These are all indications of the deep confusion and lack of clarity that society offers individuals as to how to live their lives. Therefore as a result the likelihood of serious conflict in pursuing the goals and obeying the rules of the game is great. We all often are subject to making errors. And unless we are offered some Well cushioned feedback that doesn’t punish us. It will be hard to make our way. Let’s look at some of the key aspects of the medical model. That is the main stream conventionally accepted bottle. A doctor regardless of what he does. This is a quotation from a very important thinker in Clinical Epidemiology. Dr. Feinstein Regardless of whatever else the medical doctor is or does he acts as a clinician when he performs that traditional medical function of treating a patient that’s where the word clinician comes from this medical framework. So the interesting question is by what right do social workers or counselors or psychologists or marriage and family therapists have to assert that they are also clinicians. After all you’re not doing any injecting examining physically. Taking Blood pressure listening to the heartbeat x-ray someone taking blood tests when you are engaging with your client what we still call it clinical work. The truth of the facts are that. In the early 20th century we were labeled as a semi profession. When professions were being evaluated and we are as a result quite defensive about the work that we do because it’s simply talking to people and you realize very quickly on the hierarchy of professions medical doctors are at the top. And if we use language that’s the language that’s used by doctors. Somehow we impress people. So the word clinician has been taken over by helping professionals like us like all the other counselors who do this sort of work because it seems to impress society. If we do clinical work as opposed to talking. Although it’s interesting if you’re a teacher you’re not called a clinician. You call an educator. And you also only talk of course and there is a certain value that society thus place on us. And certainly you are listening to this PowerPoint. Because in some sense you think that I have something valuable to say to you. But that’s all I’m doing is talking to you. Here is the definition. Sediments medical dictionary is one of just a very few important medical dictionaries that are routinely used fs u as sediments medical dictionary. There’s also an online version if you want to check my definitions. So instead means this is the definition of medical disease. An interruption cessation or disorder of body functions systems or organisms. That’s one more bit entity characterized usually by at least two of these criteria. Recognized ideological agent that is a causal agent identify a group of signs and symptoms which we will go on to define very shortly or consistent anatomical alterations. And finally literally this is the opposite of ease when something is wrong with a bodily function. If you look at all three definitions what appears to be consistent in all is that talks about the physiology the organism the body of the individual which can become Diseased nowhere does it discuss anything to do with mental it is focused on physiological deviance. From what our expected norms of bile larger call conventional bodies. So let’s socket signs and symptoms as defined by sediments. Symptom something felt or noticed by the patient that is reported by the patient The observed behavior of a patient. So clearly it’s a report by the patient or the observation by the worker about the behavior of the patient. So it is a subjective inference about what’s going on with that person. A sign is any abnormality. Indicative of disease. Discoverable on examination of a patient that is on objective symptom of disease in contrast to a symptom which is subjective. That is the examination is one of tests of various sorts blood tests. X-rays. Identifying of tumors. Taking Other tests invasive or non-invasive regarding whatever the complaints are. So in order to identify disease you not only need the object or the subjective complaints or the physical observations. After all if someone’s limping you really don’t know for sure until you provide an x-ray let’s say that the person is actually limping because of a reason based on physiology or that they’re faking it. In other words we don’t know until we can corroborate through Objective testing whether a person is suffering from a particular physiological problem that we would call a disease process or not. This is Alvin Feinstein who I mentioned previously his definition of what makes up medical illness and his very important book. The illness consists of clinical phenomena. The hosts. That is the person suffering from the disease They are subjective sensations which are called symptoms and certain findings called signs which are discerned objectively during physical examination of the disease host. The data describing the disease can often be obtained by examining patients fluid cells tissues excreta x-rays graphic tracings and or the derivative substances. That is in fact a disease can be identified by a lab technician who was simply looking at the blood Central laboratory without ever having to see the the so-called patient. So you an object it does not even require engaging with the person to verify some disease process. This is very very important. Because in mental illness there are no biological markers of any sort. So they are really not formal signs. In the DSM mental disorders There are simply symptomatic claims that psychiatrists listen to and if they are going to go along with the diagnosis believe because they have no objective way of evaluating the experiential reporting of the patients or as we social workers call. These folks are clients. Again this is just moving along with the same important definitional terminology and statements. You have to be able to see a lesion that is a wound re-injury. A tumor growing in the pathological alteration of the tissues which can be a tumor. For example an injury a broken arm which can be X-rayed will confirm the pain. You might be feeling in your arm that can only in any other situation it could just be a a slight Wound in a sense that you bang it. But you haven’t really broken. You’re Those are two very different physic physical injuries. So you’d want to be able to discriminate that. So you need to have some verify ApoE. Lesions are cells that are abnormal in order for you to be able to verify disease. If you cannot verify it then you have what’s called a putative Disease that is a possible disease but you cannot claim that you have a disease process unless you can validate it by identifying actual signs of the injury. A syndrome really is just a grouping of both signs and symptoms which are required for medical disease. If you were to review in the glossary of the DSM signs and symptoms. You will not see a definition of signs which is exactly the same as what I just defined that is having a physical physically identifiable marker of like a tumor or a blood test or x-ray or brain lesion. Because state very clearly tell you that the DSM is a descriiptive manual. That is all they do is look at the reports of people who are the clients and make judgments based on those reports about where they might fit in the DSM without having any corroborating objective evidence to verify it. So these are all interpretive processes based on the reports of the individuals their physical behavior. And judgments made by psychiatrists for example sometimes social workers also diagnose. So this is again just pulling together the definition Of disease again in sediments which is all about the biology the abnormal development in the biology of an individual organism in this case human beings and of course trees or plants also can be disease because of the same problems that human beings have. The deep question you might want to think about is do trees get schizophrenia This is what the definition is of mental disorder. Founded the DSM is a syndrome. In theory they would be signs and symptoms but as I suggested there are no signs. In the sense of the medical definition of science that can be found. And you’ll see in this definition that that’s corroborated there’s a syndrome characterized by clinically significant disturbance in an individual’s cognition It’s emotion regulation or behavior. So you notice all of those that reflect this function in the psychological biological developmental processes underlying mental function. You would need to find the evidence for the biological in some objective fashion which as we review the DSM you find we don’t have validated biological markers so it that is absent. Is it expectable furthermore an expectable culturally approved response is not a mental disorder. Socially deviant behavior and conflicts that are primarily between the individual and society also are not mental disorders unless the deviance or conflict results from what this function into individual as described above. So one of the key assumptions that DSM makes is that all of this occurs within the person. But of course one must think about How do we know that it occurs in the person as opposed to an interpersonal disagreeing disagreement or conflict with others and societies rule. How do we know that it’s internally within the individual and this is a very problematic notion. Interpersonal approaches in psychotherapy for example argue that it is based on the engagement between people and not a thing that’s carried within an individual Tom SaaS argued very much that disease refers to the Master will alterations in the structure or function the body. As a material object which is considered harmful to the organism. For example cancerous lesion or paralysis as a result of a stroke. So he agrees with the medical model. And he also because he wrote a very famous book called The Myth of Mental Illness switch. Of course one has to read to understand what he’s trying to argue. Wants to suggest that this comfort which denotes that complaint of an individual about his body or behavior. Pain fatigue depression is not a disease. Just because you are unhappy. Doesn’t mean that you are sick in the medical definition of the term. In other words important Attitudes mood states and feelings may be difficult and troubling and hard to deal with but are not by definition diseases. And then there’s this other idea of deviance which identifies their complaint of individuals about the behavior of others. That is the habitual use for example of legal or illegal drugs illegal sexual behavior or behavior causing fear injury or death to others or the self. Deviant behavior is not sick behavior. In medical terms people may not like it May disapprove of it condemn it. It doesn’t mean that the person is sick. He may be a bad human being despicable unpleasant. But those are not necessarily describing people sickness. So we have to be very careful that we try to differentiate between immoral unpleasant or unwanted unacceptable behavior and sickness in the medical definitions. So Tom because he your film was attacked. Talked about why his view is about disturbing human behavior. My critics are fond of asserting that I deny the reality of mental illness that is without reading the book that’s titled Myth of Mental Illness. People just take it that that means that he denies the reality the problems. It is not that simple. He responds the person who insists that a whale is not. A fish does not deny its existence. Asserting that a whale is a mammal. It’s not a denial of its existence. It is a way of classifying the animal that contradicts the beliefs are claims of those who wrongly think. It is a fish. Because in fact it is a mammal although it could appear on a superficial level to be a fish. Merely he says classify the phenomena people called mental illness differently than those who think they are diseases. They in fact reify an abstraction or a metaphor. Now you might want to Google. What abstraction on metaphor is. But it generally is that you use a term out of context. That sounds like something else. So if I have love sickness that obviously refers to some I’m unhappy Love affair. That makes me completely unable to do anything else except focus on my love object. It doesn’t mean that I have a physical illness that needs the intervention of a doctor or medication. That is the meaning of metaphor which he argues is the way people are using the term mental illness. When lesions can be demonstrated by physicians they speak of bodily illnesses. So where you see a Lesion on the brain it may mean that you’ve injured the brain as a consequence. You can’t think as well or perhaps your language functions are impaired. When none can be demonstrated when there is no lesion or physiological marker perhaps because none exist. But when physicians and others nevertheless want to treat the problem as a disease. They speak of mental illnesses. He further goes on to say the term mental illness that label is a semantic strategy a language strategy for medicalizing economic moral personal and social problems. There’s a whole literature on this. It is a perspective that I describe in my book Mad Science if you’re interested in more detailed discussion I would recommend taking a look at that book or any of Tom’s 30 some odd books. Let me just briefly and rather quickly go over this notion of diagnoses. So diagnosis because it’s just a word or a sign maybe use formerly to identify a disease. A bottle you malfunction for example diabetes or informally to identify malfunction in a car or cracked drive shaft. So we have diagnose diagnostics run on cars. But it’s not done by doctors. It’s run by mechanics. So we call it diagnosing a problem but it’s not the same as diagnosing the original way that doctors did. So we cannot distinguish between the literal and metaphorical uses of terms such as disease. Unless we identify the particular words root meaning fundamental midi and agree that it is the literal meaning of the word and read all other uses of it as a figure of speech or metaphor. The root meaning of disease is determined by finding a bodily lesion Understood to include not only structural malfunctions as described before but also deviations from normal physiology such as elevated blood pressure or lowered white cell count. So when we use the term diagnosing by auto mechanics we are clearly not talking about the same things as we are when medical doctors are diagnosing we are using it metaphorically because it helps us to think about what kind of this be done. Once a clear definition is established critical analysis of the literature and or empirical research is conducted to test the various models for explanatory power. So once we know what we’re talking about once perhaps we identified depression. And if we think it’s a chemical imbalance then we can look up the randomized double-blind trials and depression which use placebo as a comparison to see. If that assumption. Well founded Well as we know or at least you all learned later but I just want to make that statement. Now. When you look at the Federal Drug Administration’s randomized double-blind trials on serotonin re-uptake inhibitor. Antidepressants. There is effectively no difference between placebo. And the active drug meaning that you could not have a chemical imbalance as the cause of depression because placebos don’t impact And the brain chemistry that is thought by those who argue for chemical imbalance to be the mechanism of depression. So we are left with two approaches. One we can evaluate the medical model and all of the treatments that go along with it. By reviewing the critical literature about These claims I just mentioned the Federal Drug Administration’s database on SSRI antidepressants. But there are thousands of articles that can be also utilized for these other elements. If you think any of these things are credible you should look at the critical literature here in terms of the psycho social bottles you can look at the various Again thousands of articles on these various therapies evidence-based practices. Then there is a whole literature on the so-called common factors. Common factors are the. We have specific factors and common factors in psychotherapy. The evidence-based practice people think that the specific factors are the are the specific factors are particular treatment models are the real reason for effectiveness whereas those who believe that it is the common factors or therapeutic alliance plus placebo which are the most Important in explaining the outcomes using these treatment models there’s a lot of literature on that. My model problems in everyday living is to be tested. I hope you’ll review the article that’s right below there to see what you think of it. It argues education rather than psychotherapy as a meaningful mechanism. But I would love for you to read it and give me some feedback So those are the things that I would recommend doing and you will in some way need to utilize this when you actually start working as so-called psychotherapists or in my terms educators in dealing with human difficulties. I wanted to just thank you for your listening to this fairly lengthy discussion. And I’m going to try to kick us out I can figure out how to do that. Let me see. Thank you very much for your attention. Feel free to send me emails. Regarding any questions you may have I look forward to hearing from all of you. Thank you