Another bad psychiatrist!

I actually forgot a psychiatrist!  This story is mostly funny but very much a Miami story.

I only saw the woman twice.  It was during that period before we were in the house, here, and I had decided to drive up to Lauderdale to see if things were better, there.  They weren't.

The first time, we did the intake interview.  She kept on with the current medication I was on, no changes.  The next and last time we met, I mentioned how I hated living in Miami.

Said she, "Oh, Miami is great!"

Full stop.  That is simply bad mental health care.  It was not her place to argue with me over my opinion about Miami.  I am allowed to hate it.  I knew, at that moment, I would not be returning.

She went on to say that Miami was great because the Keys were so close, and the Bahamas, plus Tampa Bay is SOOOOO beautiful!

Think about that for a second.  Her list of good things about Miami all involve leaving Miami!  Well, I can certainly get behind that.  I think the best thing about Miami is leaving it, too!

Miami: Medical "Care"

I used scare quotes because Miami medical care is fucking scary.  Of all the reasons we're leaving Miami, this is probably the biggest, objective reason.  While we eventually learned to deal with the realities of Miami in many ways, and you can certainly choose your doctors (y'know, within the confines of your insurance plan), emergency medical care is pretty much whatever is there at the time - and with as many medical problems I've had in Miami, I simply have no faith if I get into an accident or get seriously ill that I'll get care worth having.  I am even less willing to take that risk with Adrienne.

The biggest problems I've had with mental health care.  Not surprising.  HuffPo rates Florida 48 out of 50 and Our Health Policy Matters rates it 47.  Florida clearly occupies the bottom ten percent in both occurrence (the most people with serious mental health issues) and patient care (with a shockingly tiny amount of money being spent).  My experiences bear this out in a really, really big way.

I don't currently have a psychiatrist.  This is not because my mental health issues have disappeared - though I have made considerable progress, I feel - but because all five of my psychiatrists have been incompetent morons.  I decided it was better to go it alone.  I was right.

So, the first psychiatrist I saw decided to take me off the drug combination that I was on in Ohio.  "Too much dopamine" was his entire response as he tapped away at his keyboard, not even looking at me.  I, again, feel the urge to emphasize that I am not using any artistic license.  The man barely looked at me.

At the time, I was a fucking mess.  This was during the first two months and the stresses of dealing with the corrupt, abusive and incompetent house sellers and our crook of a landlord were driving me crazy.  I was seriously depressed, suicidal ideation, I was lashing out at people with considerable emotional cruelty.  I feel bad just thinking about how bad I was and how I acted.

I didn't argue with him because, well, clearly the drugs I had in California weren't doing it for me in Miami.  Perhaps it was too much dopamine.  The psychiatrist gave me and SSRI, over my objections - admitting that due to my mental state I didn't object too loudly.  I had taken SSRIs in the past, and they hit me hard with emotional flattening.  I didn't really feel to bad, but I didn't feel much of anything at all.

These SSRIs also gave me emotional flattening.  Which, to be honest, wasn't bad in the short term.  But then I noticed something else - they were making me stupid.  They crushed my creativity and diminished my intelligence.

This caused me considerable stress.  So I scheduled another appointment but when I arrived, well, I have no idea what happened, really, because no one in the office spoke English.  I considered this a deal breaker.  I have no hostility towards Spanish-speakers, or I don't think I do, but since the doctor wasn't there and the staff couldn't tell me why, I believed that it would be impossible for me to get good service.  So I found another shrink.  Well, I think it is more accurate to say I tried because it didn't happen immediately.

What happened, instead, is I explained my situation to my primary care physician - the best doctor I've had in Miami, a Jamaican woman who I couldn't keep going to because after the first six months being here FIU changed our insurance plan and she wasn't in the new policy - who filled the scripts the previous physician had given me, including the SSRI.  I should have tried to get back on the stuff my Santa Cruz doctor was on, but I was still a giant mess and my ability to aggressively demand things of people was seriously diminished by the emotional flattening and stupid-making of the SSRIs.

During this time, I tried to get a psychiatrist and failed to do so.  The worst was I went to a group practice and the place was awful.  I didn't make it out of the waiting room.  Everyone was being rude in that way Miami has.  One person was singing a song, one was listening to music on his phone, everyone was talking over everyone else, tightly packed together in this tiny office space.  The staff ignored the incredibly unpleasant environment this created for, y'know, mental health patients.

Part of my presentation of anxiety is disliking crowds and noises.  I was in this group of rude assholes making a huge ruckus in the waiting room and realized this was no place for someone who was mentally ill.  I left, barking out that I was cancelling my appointment, went outside and had a bit of a breakdown.  Just sobbing and hands shaking, embarrassed, depressed, planning out suicide options in my head, angry at the crowd, disgusted at myself because I couldn't handle a crowd . . . like I said, I was a mess.

Eventually, we sorted out our housing situation and bought the house we are currently in.  Our current place is a couple of blocks away from a big mental health hospital.  Fine, I thought, I'll go there.  There are lots of doctors and it has the benefit of being within easy walking distance.

There, my shrink and her supervisor talked to said I was bipolar.  They changed my medication to the most common effective medication for treating bipolar, valproic acid.  It made me suicidal.  So they switched me to lithium bicarbonate . . . which has as a side effect yet more mental exhaustion.  I was still on the SSRI at this point, too, and they put me on another antidepressant, busipirone - is another serotonin effecting drug which made me even more mentally exhausted.  I was also put on clonezepam for anxiety, and that's just a straight up relaxant.

This combined to make me a fucking moron with no energy, intellectual or physical.  All the weight I'd lost in Santa Cruz (fifty pounds) I put on and more, too boot.  I can honestly say that this sequence of events has been an utter medical disaster to me from which I have still not recovered.

Anyway, the key point here is that I'm not bipolar.  More on that later, but the key point, here, is that this is a grotesque and inappropriate diagnosis, putting me on powerful drugs that - if you are not bipolar - can really, really fuck you up.  They really, really fucked me up.

The good part during this time is that we had moved into our current place.  The effects of having OUR PLACE was dramatic.  My major malfunction is anxiety - my depression is usually a reaction to anxiety.  Anxiety usually presents when triggered.  My triggers are things like authority figures, being judged, stuff like that.  Getting a house has a whole lot of authority figures who judge you, not to mention I was constantly dealing with idiots and scam artists.  However, when we moved into the house, much of that went away, not to mention the simple quality of our living area dramatically increased.  After ten months, Adrienne and I finally had enough space so we weren't always in the same room, I had a proper kitchen, stuff like that.  But the bipolar diagnosis was bullshit.

Anyway, I never got into it with that physician because I went down one day and got into a silly fucking argument with the office staff.  I came into the office and I was told that I needed to pay a twenty dollar co-pay.  I hadn't had to do that before, I said, and I didn't have the money with me.  I had an appointment today, so could I just pay the whole bill the next day, after I could get some money.

I was lectured on my responsibilities.  It didn't matter that I'd been going there months and hadn't been asked to pay.  And I wasn't trying to duck paying!  I just wanted to go to the appointment I had and I would have been happy to settle the bill next time, or even later that day.

The lack of sympathy over a superficial billing matter - I mean, my insurance was paying the other $120 bucks of the bill, so it wasn't like I was really putting a financial hurt on them by asking to come by the next day - and the hectoring tone of the asshole behind the desk made me walk away.

At that time, my primary care physician was at FIU Faculty Care.  They had just gotten a psychiatrist on the staff, so I went there.  But I was returning to life due to my improved situation.  I had also come to the conclusion that I wasn't bipolar, I had done the research to conclude that an SSRI, a serotonin agonist and a benzodiazepine (all of which had mental exhaustion and weight gain as side effects) weren't a good match for me.

So I went into this doctor's office and I said, very flatly (I still have my notes) that these three drugs weren't doing it for me.  I was mentally tired all of the time, I hated the emotional flattening, that my creativity was for shit and I would, quite frankly, prefer to be unmedicated than continue to suffer the feelings of stupidity and weight gain caused by these drugs.  His response was to increase the dosage of busipirone, one of the problem medications.

Afterward, I sat down by myself and decided to go off all of those drugs all on my own.  If he wasn't going to listen to me, I would act on my own.

I went back and told him I had gone off of those drugs because, as I said, I would prefer to be on nothing at all than to be on drugs that destroyed my emotions and made me stupid.  I also challenged the bipolar diagnosis directly.  I asked, "How do you tell the difference between manic episodes and a fat kid in a rough neighborhood doing stupid things to demonstrate his masculinity in order to avoid being bullied?"  His response was, "That's a good question."

Fuck yeah it's a good question.  I know that it's a good question because I framed it and asked it.  What I wanted was a good ANSWER.  I said to him that I was certain I was not bipolar and wouldn't take any more bipolar medication.

What I got from him was a bunch of tests that he said would help create a proper diagnosis.  What they were, however, is a bunch of tests to prove I'm bipolar.  They were the same fucking tests that got me the goddamn bipolar diagnosis in the first fucking place!  Jesus fucking Christ!

So I fired him, too.  He pushed drugs on me I said I did not want and didn't listen to me.  I have no use for such incompetence.

Since then, I have been on nothing.  It was the right call.  While Miami does make me crazy from time to time, I now have the intellectual and emotional capacity to manage it most days.  Sure, I have bad days - but no worse than when I was on all that crap, but now I have good days, too.  I decided that I would not get psychiatric care in Miami, due to the persistence of incompetence across so many doctors.

My interactions with primary care physicians have been fewer, but still poor.  My current PCP tried to tell me that I shouldn't lift weights to help with weight loss, suggesting I do some kind of magic cardio exercise.  I asked him what exercise I should do since I will not ride in Miami, my knees can't bear running and I have no access to a swimming pool.  He said I would think of something.

Fuck you.

He also suggested that I get bariatric surgery.  I'm not opposed to bariatric surgery as it is clearly the best way to lose and keep off large amounts of weight.  The more I thought about bariatric surgery, though, the more I kept wondering why this was being pushed instead of a drug-based solution, a non-surgical method.

I mean, there are several drugs out there that could help.  He never tested for a thyroid condition, for instance, though there is a very good chance I have one (a lot of extra weight creates hypothyroidism in patients).  And there is a dextroamphetamine-based weight loss pill approved by the FDA.  I'm not even talking experimental or off-brand use, here, but things the FDA and AMA have approved for weight loss.

You might be going, "Chris, amphetamines are dangerous!  Didn't you see Requiem for a Dream?"  I did and it was a good movie, but also sensationalistic.  Weight loss drugs result in a tiny hand full of deaths every year, whereas thousands (!!) die every year under the knife for bariatric surgery.  Not to mention that the side effects of any bariatric surgery are severe and awful - including stuff like severe gastric pain, severe acid reflux, malabsorption of proteins and vitamines, vomiting and explosive diarrhea.  Also, in 1 in 200 cases, death.  Just awful, terrible stuff.  It just seems to me that what we should try first is the less invasive, less side-effect ridden option.  But, no.

My last medical problem that I'll mention was with dentistry.

I had a rotten molar.  I'd lost the matching molar years ago, so it wasn't doing anything except, apparently, rotting.  So I went to a dentist to have it removed.

Well, I was there for, like, three hours, because what they would do is shoot me up with some lidocaine and then walk away while it took effect.  I've been in that situation before and generally after a couple of minutes, they come back.  Lidocaine is a very quick acting but also short lived local painkiller.  I also seem to have some resistance to it, or a lower pain threshold than I imagine.

So, they came back after AN HOUR.  By that time, the lidocaine had numbed me and then worn off so I was feeling everything, again.  They shot me up with lidocaine, again, and then left, again, for another hour.

At that point, I was, like, "It's only a pulled tooth.  It'll hurt for a couple of minutes and then be done.  Then they'll give me some hydrocone for the pain and I can get pleasantly whacked out for the afternoon, no sweat."  I told them to pull the tooth.

Without telling me, they decided to do a surgical extraction.  I didn't realize this until the drill touched the nerve.  You know how in TV shows and movies, torturers will do amateur dentistry as torture?  I can say with some experience now that it is, without a doubt, torture.  I once broke a leg and had to drag myself a hundred feet to get help - that was kiddie stuff compared to the whole drill on a nerve business.

When I choked back an agonized scream, the dentist asked me what was wrong.  I said that I wasn't numb.  She offered to shoot me up with more lidocaine and come back when it had taken effect . . .

Well, I'd been down that road before.  I didn't want to be there for an hour with an open hole in my tooth that had just been attacked by a drill.  So I told them to shoot me up with lidocaine and then keep at it.  Which they did.

It takes about five minutes for lidocaine to effect you.  It was a long five minutes.  Afterward, the counter person said I was brave.  Well, you shouldn't need fucking bravery in a dentist's office.

The actual extraction isn't very good, either.  There are bone spurs in my mouth where the tooth used to be that sometimes get bloody when I eat crispy food, like corn chips, and a couple of times when I have brushed my teeth.  It's not exposed bone, but just barely.  I'm sure that my dentist in Ohio will mention it and maybe there is something that can or should be done.

When I left, I did NOT get a prescription for any painkiller.  I was told to take some ibuprofen.  I did some research and it was probably due to the fact that practice had, at some point in the recent past, been a drug mill for painkillers - so they were acting really cautious about painkillers to avoid being shut down.  It's a big problem in Miami and the subject of crackdowns, legislation, investigative journalism expos, you name it.  We are in the midst of a crackdown, which is the probable reason they were so light on pain medication.

Which hints at the systematic problems that Miami has with medical care.  Doctors in Miami, as a group, give out so many painkillers that they're considered drug dealers.  As I said at the top of this post, the medical issues are among the firmest objective reasons that we have to leave.  This one isn't about how we feel about Miami.  It's more . . . Miami doctors are not safe.  The care here is terrible in many ways, just awful.

The effects of this mismanaged health care have been dramatic.  I look at the first two years I was here and I am still angry, very angry, at the way I was treated by psychiatrists.  I feel that two years of my life has been stolen from me.  The drugs they put me on made me sick and stupid and I still feel less mentally capable than I once did - I still feel a lack of creative energy that stymies my writing.  Not to mention the damage to my physical health - I gained seventy pounds in Miami, and I wasn't light when I arrived.  I have knee trouble that I never had before, as well.  It will take me years to get back to where I was, if I ever can.  Considering this fills me with white hot rage at the years wasted and the damage to my body, all of which I consider avoidable, all of which is a result of the malicious practices of Miami psychiatrists.

I, apparently, still have more of these in me, too.  Miami has troubled me like no other place I've lived, ever been.  I hope people continue to read these!

Problems with Irving Kirsch's Critique of Antidepressants as Placebos

Recently, a FB pal posted an article run on 60 Minutes based on the work of Irving Kirsch. He's a psychologist who has been making the rounds saying antidepressants don't work - and, indeed, depression is not caused by a chemical inbalance at all. It's a pretty radical claim. The overwhelming medical belief is that antidepressants do more good than harm by a considerable margin. Kirsch believes otherwise. To quote him, "Depression is not a brain disease, and chemicals don’t cure it.”

(I'm not going to provide links, here, because linking is largely meaningless. You can find someone on the Internet to take virtually any position at all, so links that "prove" a given point do nothing of the sort - they merely show the person can search around for data that agrees with their conclusions. I encourage people to do independent and substantial research on any field that interests them and advise they read books to do it. The Internet has certainly broadened our knowledge, but it has also made much of it shallow and muddy.)

I've been following Kirsch's work for about a year, now. This is shortly after I started taking antidepressants and feeling considerably better - so I had some vested interest in the research. Was the effect I feeling a placebo effect?

For the record, I am extremely critical of psychological research for both historical and theoretical grounds. I think this bias is justified - psychology has not done a very good job of policing itself. The case of Cyril Burt is particularly significant. But was a psychologist who did twin studies. After his death, it was found he had massively falsified his information, lying about the sample size of the twins studies he did, inventing collaborators and their credentials - this has not prevented his work from continuing to be taught. This is unprecedented. I can't think of a single case where a person, caught committing fraud over the span of decades, would still be taught. The articles "known" to be fraudulent have been removed, but if there was no direct "proof" that a given paper was fraudulent it has remained in the academic canon. (Such proof is hard to get, because Burt burned all his notes before he died!) Furthermore, due to the vagaries of attribution inheritance, articles whose substance is based on Burt's findings are still part of the psychological data record - no effort was made to purge the effects of his fraudulent work from the data pool.

I wish I could say this was something that died with Burt. But you can find the continuation of such fraud in psychology in books like The Bell Curve, issues like gender studies and evolutionary psychology - not to mention, like I said, Burt's work has not been purged from the psychological canon; while those papers known to be fraudulent have been removed, the papers that source Burt's work were not and are themselves sourced by modern research.

(An interesting comparison between corrupt scientific fields and how they clean themselves up, or in psychology's case, fail to, is anthropology. Anthropology was, sadly, very much part of the early twentieth century's eugenics movement. After World War II, though, anthropologists, horrified at what they had helped to do, given intellectual weight to atrocity, purged eugenics from its discipline almost entirely. Psychology, whose IQ tests were also used to justify eugenics, who were equally guilty of giving intellectual force for the eugenics massacres of the early twentieth century, well . . . the Bell Curve is still influential. The eugenicists are still there in psychology, they were never purged or repudiated. In short, there is no psychology equivalent to Jane Goodall because the field never cleaned it's house after World War II.)

Theoretically, psychology is a mess. (And by theory, I'm talking about theory in the scientific jargon sense, which is an explanation for diverse phenomenon inside the field of study, demonstrated by considerable proof without substantial internal contradiction.) It is the only science that has no generally accepted theory regarding the field's object of study. This is a very simple statement, but the consequences are enormous. In short, psychologists are not in agreement, at all, as to what the mind actually is. When compared to chemistry's atomic model, astronomy's relativity, biology's natural selection, physics' mechanics and quantum mechanics, so forth and so on, this lacuna is enormous. If you don't agree about what it is you're studying, how on earth can you study it? What, precisely, are you studying? They literally cannot agree.

(This is in contradistinction to psychiatry, which has a very strong, stable theory of mind. Your mind is your brain, they are one in the same. It is a theory for which there is tremendous evidence, of course.)

So, when I read psychological research, I do so with a grain of salt. They have a lousy track record of policing themselves, the worst in science, and no unifying theory!

Well, when you look into Kirsch's work, it's actually pretty atrocious. Not the hypothesis, so much as his methodology and, indeed, his theoretical understanding of human consciousness.

I'm going to tack the methodological failures of his work. In particular, he cherry picked data. For instance, in the APA journal Prevention and Treatment, where much of his early work was published, the editor of that journal called Kirsch's statistical models "clearly arguable" and warned that his paper's subject-selection criteria were heterogenous. In particular, Kirsch only looked at short term studies.

Now, I do not doubt that antidepressants are overprescribed - but prescribing drugs is what doctors do. Most physicians take the attitude that it's better to ere on the side of caution. Because of the difficulties in communicating psychological conditions, when a patient comes in and says they've been depressed for a long time and nothing seems to pull them out of it - what is the psychiatrist to do? Ignore the suffering of their patient? No. They prescribe medication and usually suggest therapy. After all, antidepressants are generally safe.

In many of these cases, however, the depression wasn't clinical. It's not even that the medication acted as a placebo - it's that there was no illness in the first place. So when Kirsch argues, on the grounds of short term studies, that there is substantial placebo effect - he's wrong. It wasn't the medication or the placebo effect that halted the depression; it was just the normal passage of time in an unknown number of cases. How can this be construed as data at all?

For instance, you take a group of people with headaches. Half you give ibuprofin, half you give sugar pills. An hour later, you ask them how they feel and find that almost all of them, in both groups, now feel fine, most of them attributing their improvement to their medication. Out of these groups, how do you find the people whose headaches just stopped naturally, as most headaches do? It's the same with short term depression studies. It is impossible to determine how many of the people felt better not because of the medication or of the placebo.

In psychiatric and psychological studies, there is tremendous self-selection of subjects. People who feel bad tend to join. While in most medical science, they can perform an actual test to determine who has the condition for which they are testing (say, a virus), this is not generally possible in psychological and psychiatric cases in the short term. So it is known that many of the people who join psychological and psychiatric studies aren't sick in the first place, but it's impossible to know how many! How can you determine the efficacy of the placebo effect if you don't even know if they're clinically ill in the first place? The only good method of determining a person's psychological state is long term observation - something impossible to do with short term studies. By avoiding long-term studies, Kirsch is avoiding the very data that would counter his hypothesis. Ouch. That's a huge scientific no-no.

Additionally, the placebo effect is, itself, short term. The longest known placebo effect is two and a half years. Any study that goes over that is just assumed to be free of placebo effects. So, not only does Kirsch avoid the studies that select out the mentally ill from the temporarily distressed, he also avoids studies where the placebo effect is eliminated or minimized due to the long term nature of the studies. Double whammy.

Indeed, the very idea of the placebo effect is itself under fire - using methods similar to Kirsch's, but with larger data sets over longer periods of time, Asbjørn Hróbjartsson and Peter Gøtzsche have basically demonstrated that there is no clinically significant placebo effect. So, who's right? Kirsch who says that antidepressants are placebos or Hróbjartsson and Gøtzsche who say that the placebo effect is clinicially insignificant?

This is awful methodology. It's simply scientifically unethical to ignore the data that contradicts your conclusions, to study only those things that allow you to be right. To have scientific legitimacy, Kirsch must address long term studies that are free of the placebo effect and the growing body of evidence that the placebo effect is not clinically significant. He does not do this.

One might ask, then, why he can get these high falutin' jobs, like the University of Leeds and now, well, he works at Harvard. Remember what I said about Cyril Burt, The Bell Curve and evolutionary psychology - psychology is a field full of quacks, even at the highest levels of education and research.

Not to mention this is a highly politicized area. There are a lot of people who simply reject the idea that mental illness has a physical component. I'll talk more on that in a bit, but my point here is that there are a lot of people who actively reject the idea of mental illness, who believe that mentally ill people should "pull themselves up by their bootstraps", or seek solace in religion, or "just get over it". (Thomas Szasz published, in 1961, The Myth of Mental Illness - a book that was just reprinted last year and still has considerable influence; see also The Manufacture of Madness and more recently The Manufacture of Depression, which came out last year - and it goes back as far as the written language goes - there are always people who say mental illnesses don't really exist, you can read about it in medieval sources, in classical antiquity; Pythagoras said that depression was merely lack of self control, akin to laziness; Hippocrates believed that melancholia - what we call depression, nowadays - was an imbalance of the four humors, which is to say a medical problem. This argument is ongoing, but nowadays is largely farcical. The medical basis of mental illness is well understood.) They are emboldened by a researcher like Kirsch, who gives the air of legitimacy to their beliefs.

Science is not some purely intellectual field - it takes money to do it, and the people in charge of that money are not, by and large, scientists. They are corporations and political bodies, pursuing their own agendas. But no one brings it up that there are non-scientific social forces that reject mental illness for no good reason - but then use their status in order to support research in that area. As an example, the University of Oklahoma's geology department is the ConocoPhillips School of Geology and Geophysics. Guess what their position on global climate change is? This is as true in psychology as geology - people with social and political agenda control research funding and publication. And there have always been people who are swift to side with people who say that mental illness isn't physical, that it's a defect in will or character. It goes back at least as far as Pythagoras and Hippocrates!

Additionally, there's just the prima facie stupidity of asserting that you can effect mood with drugs. I mean, prima facie. There are a huge number of studies about the effects of drugs on mood, not to mention nearly every adult reading this has personal experience with alcohol lifting their spirits and lowering their social anxiety. Even more powerful are the opiates - it is impossible to be depressed when you're on Percocet. Unfortunately, these drugs have such dangerous side effects that it is unethical to administer them or they must be administered very carefully. But it's absurd to say that drugs can't effect mood and feelings. It's silly and juvenile! The only question is to what extent does a given drug effect our feeling of depression. That drugs can alter our feeling of depression is simply prima facie true.

The aquisition of funding and possession of high titles does not make a person right. It only means that someone in a position of power agrees with what you say and is willing to give you money to prove it. While it shapes all scientific endeavors to some degree, it is particular pernicious in a field where there is no theory. In psychology's theoretical void, their lack of agreement about what the mind is, anything goes. So you come up with racist crap justifying eugenics and people doubting the physiological origins of mental illness.

Which brings me to the theoretical problems I have with Kirsch's work and all work that supposes a mind/body dualism. Kirsch believes that depression isn't a brain disease. Well, for crying out loud, man, what kind of disease can it be, then? Because all the actual evidence suggests that the mind and the brain are the same thing. All mental activity - thought, reason, emotion, perception - they're all brain activity. If depression exists at all, it must exist as a brain disease because that's where the mind is located. To say that you believe that depression exists but isn't a brain disease makes as much sense as saying you believe in heart attacks but it's not a heart disease.

But we live in a world that is steeped in dualism - the belief that there is some sort of perfected, non-physical sense that exists independent of our flesh. Sometimes it's called the soul, but just as often it's called the mind and the two are mixed up in religion and culture all the time. Dualism is present in all the world's largest religions.

However, that's not science. Science has never been able to find a soul. It has never been able to find a mind separate from the brain. Meaning, Kirsch is proposing something preposterous, again: that you can have a mental illness that isn't in the brain.

I can't say it's short, but those are my main reasons for thinking Kirsch is a quack.