Sunday, March 23, 2008

Fat people are mad


It has long been accepted that fat people are stupid. Further progress has been made in the investigation of obesity. It seems now that not only are fat people stupid - they are mad as well.

Sandy Szwarc of the excellent Junkfood Science discusses the treatment of a mad fatty in the USA.
An ‘obese’ man was surgically implanted with electrodes deep inside the hypothalamus of his brain, and for months he was given electrical stimulation at various frequencies, to try to get him to eat less and lose weight. Fifteen months after this experimental treatment, he weighed 1.5 kg more. The researchers blamed the patient for being noncompliant.
That sums up so well the double bind in which the obese find themselves. Because they are fat, they are labelled as stupid and mad - and if they do not respond to “treatment” they are non-compliant.

Karen Stimson is obese and therefore stupid and mad:
The stick used to beat us into submission and pressure us into taking extreme risks to lose weight are the scares that we are a pathology, that our natural size is a deadly disease and that if we don’t do something about it, we will die before our time. This death sentence leaves many feeling so desperate, they’ll do almost anything to lose weight. Those of us who are labeled ‘morbidly obese’ are subjected to probably the most severe pressures.” — Karen Stimson, 390 pounds

Mrs. Stimson’s insights are seen in the accounts of countless ‘obese’ people who’ve been beaten down by the constant berating, come to believe they overeat and eat unhealthfully, and are terrified they’re going to die. Certain that their only chance at life is to get the weight off, not matter what the price, they fall prey to the riskiest diets, pills and surgeries. The popular myths of obesity have added to the stigma of obesity and been used to rationalize the most extreme, invasive and dangerous weight loss interventions, even without basis in good science. One cannot permanently change into a different genetic body type by varying what or how much one eats or does. Hence, dietary and caloric interventions tried for more than a century have proven ineffective. - Sandy Szwarc

Do the psychiatrists really think that the obese are mad? The American Psychiatric Association has “form” on medicalising variants of normality. In 1952 they declared homosexuality to be an illness
For years, though, it was believed that if you stopped having sex and went to therapy five times a week and worked very hard at transformation, you could become a practicing heterosexual, said Martin Duberman. [How many fat people have been led to believe that if they stop eating, get help for their eating issues and work very hard to control their hunger, they could pass for thin?] As behavioral therapies for homosexuality failed (as they have for obesity), people became research subjects and efforts to change their inborn characteristics became more extreme.

With the new sickness branding and homosexuality classified as an illness, psychiatrists developed a whole range of treatments... electric shock... and it got worse, from hormone injections and lobotomies to castrations, hysterectomies and forced incarceration in mental institutions. Really insane attempts to convert people to different sexualities. — Lillian Faderman, Ph.D., A Visible History, February 2008.
It was not until 1973 that the American psychiatrists finally decided that homosexuality was not an illness. It remains to be seen what will happen with obesity.

Read : Electric current ‘lobotomies’ for weight loss?

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28 Comments:

Blogger Zarathustra said...

This post has been removed by the author.

Sunday, March 23, 2008 10:45:00 AM  
Blogger Zarathustra said...

It was not until 1973 that the American psychiatrists finally decided that homosexuality was not an illness.

Wow. Only 35 years ago? A mere three years before I was born. Good to see you're keeping up with current thinking, John.

Do the psychiatrists really think that the obese are mad?

In my corner, the answer is "no" and has always been "no". Admittedly there is such a thing as Binge Eating Disorder in the ICD-10, but that's not being fat per se, that's more referring to an eating disorder - basically bulimia without the purging.

In that blog you link to, the only evidence offered that the APA are supposedly considering making obesity a mental illness is a single editorial piece in the American Journal of Psychiatry. In other words, it's one person's opinion, nothing more than that.

I could write a piece stating an opinion that compulsive blogging should be recognised as a mental disorder in the ICD-10 and DSM, but it wouldn't actually make it so.

Sunday, March 23, 2008 10:58:00 AM  
Blogger Dr John Crippen said...

Zarathustra has left a new comment on your post "Fat people are mad":

It was not until 1973 that the American psychiatrists finally decided that homosexuality was not an illness.

Wow. Only 35 years ago? A mere three years before I was born. Good to see you're keeping up with current thinking, John.

Do the psychiatrists really think that the obese are mad?

In my corner, the answer is "no" and has always been "no". Admittedly there is such a thing as Binge Eating Disorder in the ICD-10, but that's not being fat per se, that's more referring to an eating disorder - basically bulimia without the purging.

As for this chap receiving deep brain stimulation, I can't find any actual news reference to this specific case (the blog you link to doesn't seem to be citing a source) but I presume it went through all the usual requirements for valid and informed consent.


++++++

Rather odd comment, rather missing the point.

I find it staggering that homosexuality was still classified as an illness in the USA as relatively recently as 1973. You don't. Well, that's a reflection on you, not me.

The obese are a section of society who are treated badly by the media and often by the medical profession.

The question of consent is interesting; a lot of gay men "consented" to treatment for their "illness". Doesn't mean the treatment was valid.

John

Sunday, March 23, 2008 11:01:00 AM  
Blogger Dr John Crippen said...

Zarathrustra

You ARE behind the times. You say:

I could write a piece stating an opinion that compulsive blogging should be recognised as a mental disorder in the ICD-10 and DSM, but it wouldn't actually make it so.

+++++++++

IAD has actually been proposed for inclusion as a psychiatric diagnosis in the next issue of Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Writing in the new issue of the American Journal of Psychiatry, Dr. Jerald J. Block, M.D., said that excessive internet and computer usage should be labeled a mental disease, as it has all of the components of a compulsive-impulsive disorder:

1) excessive use, often associated with a loss of sense of time or a neglect of basic drives,
2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible,
3) tolerance, including the need for better computer equipment, more software, or more hours of use, and
4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue
Fat people will soon find millions of others joining them being targeted as mental cases by the psychiatric industry. IAD shares similarities with obesity, Dr Block noted. It’s a “comorbid disorder” that is “resistant to treatment, entails significant risks and has high relapse rates.”

+++++++


John

Sunday, March 23, 2008 11:05:00 AM  
Blogger Zarathustra said...

Rather odd comment, rather missing the point.

I find it staggering that homosexuality was still classified as an illness in the USA as relatively recently as 1973. You don't. Well, that's a reflection on you, not me.


My point, John, is that prior to 1973 doctors (and not just psychiatrists) did and said a lot of things that would be considered unacceptable today. 1973, incidentally, was the year after the Tuskegee experiment was finally terminated. Suggest to your colleagues in genito-urinary medicine that this appalling experiment is a reflection on how they do things nowadays, and I think you'll find they'd be rightly appalled.

Is it a reflection on me? I think it's possibly a reflection of the fact that I wasn't even conceived in 1973, let alone in clinical practice.

As for the paper you mention about "Internet Addiction Disorder" - as with the obesity paper it's one person's (slightly silly) opinion, not an actual psychiatric diagnosis.

Tell you what John, I'll place a bet with you. I'll bet you a large cod and chips and a cordless mouse and keyboard that when the DSM-V comes out that neither obesity nor "internet addiction disorder" will be in there. My treat if you win the bet, but I don't think I'll lose this one.

And now, it is Easter Sunday, and I think my compulsions to binge-eat on chocolate should take precedence over compulsions to blog, so I shall bid you adieu for now. xx

Sunday, March 23, 2008 12:10:00 PM  
Anonymous NI GP said...

timely pop piece on internet addiction (in what used to be a fine newspaper, alas no more)

http://www.guardian.co.uk/technology/2008/mar/23/news.internet

Sunday, March 23, 2008 12:32:00 PM  
Anonymous dearieme said...

I take it that Psychiatry is rather like Archaeology, in that while facts may intrude from time to time, consensus opinion seems mainly to be driven by fashion and politics?

Sunday, March 23, 2008 2:07:00 PM  
Blogger Katy Newton said...

I read in the Sunday Mail today that two obese parents risk having their overweight children taken away from them if they don't start slimming down. The children are aware of this thanks to the constant presence of social workers in their home, and one of the children is already showing signs of anorexia.

If that piece is reported properly, and coming as it does from the Sunday Mail one can't be sure that it is, but IF it is, that's dreadful - especially given the studies that show that tendency towards obesity is genetic (I am thinking of a study that showed that adopted children overwhelmingly took after their birth parents in terms of body shape/weight regardless of how healthy, unhealthy, over- or under-weight their adopted parents were). Perhaps the whole family should be given regular shock therapy instead?

Sunday, March 23, 2008 2:29:00 PM  
Blogger Jason said...

390 lbs. is not Ms. Stinson's "natural weight". It has nothing to do with nature, and everything to do with the ready availability of energy-dense, easily-obtained, and easily-digested foods.

Transport her to a place or time where food is something that comes from a garden and takes a significant fraction of our effort to obtain, and her "natural weight" would be another number entirely.

Is obesity a form of insanity? No. But the belief that it "just happens" without any connection to environment or behavior is a form of denial.

Sunday, March 23, 2008 3:04:00 PM  
Anonymous Anonymous said...

The problem that I have with the medical profession and obesity is the point at which they determine you to be obese. I am obese according to the currently used scale.

At 13 - 14 stone I would agree that I am fat. Thinner would be healthier. But. I exercise regularly, I have an active job, I buy normal clothes, I don't eat junk or processed food, I do eat chocolate. I also eat around 7 portions of fruit and veg a day. I don't eat butter or much saturated fat. I have never smoked and I keep within the arbirary recomendations on alcohol.

I rarely get ill. So why am I classed as obese and told that I am going to die soon and am a burden on the NHS?

Sunday, March 23, 2008 3:55:00 PM  
Anonymous Anonymous said...

I wouldn't call obesity a form of insanity, but surely binge eating is addictive behaviour? My sister-in-law is currently 24 stone and her health is at serious risk. She knows this, but she is not prepared to change her eating habits. She doesn't like low fat food, preferring her diet of fried and full fat everything. It may not be insanity, but surely it is irrational thinking on her part?

Sunday, March 23, 2008 4:55:00 PM  
Blogger Zarathustra said...

I wouldn't call obesity a form of insanity, but surely binge eating is addictive behaviour?

Absolutely. Binge-eating can certainly be linked to issues like depression, boredom and low self-esteem. And yes, sometimes it can become a compulsive behaviour - people continuing to binge-eat when not even hungry, for example.

So yes, there certainly can be a psychological component to behaviours like binge-eating, and there are some diet plans like Lighterlife that have incorporated cognitive-behaviour therapy techniques with the dieting.

However, all this is NOT the same as saying the psychiatry profession is likely to declare obesity to be a mental illness. Dr Crippen may feel that's about to happen. I'd say the chances of that happening are pretty much nil.

Sunday, March 23, 2008 5:47:00 PM  
Blogger The Shrink said...

Weight gain is now a psychiatric illness?

My, oh my. Let's look at the drug treatments I have :
- mood stabalisers for mood disorders
- antidepressants for depressive disorders
- anxiolytics for anxiety disorders
- antipsychotics for psychotic disorders
- cognitive enhancers for neurodegenerative disorders

Sure, I could ask my psychology colleagues to try and effect a cure, but this is looking weak.

Two problems concern me.
1) Mental health has no generally useful, valid therapeutic intervention for this
2) There's no compelling evidence it's a mental disorder and it strikes me as madness (ha!) to feign otherwise

Sunday, March 23, 2008 6:04:00 PM  
Blogger Dr John Crippen said...

Hi Shrink

Now the interesting question. Which SSRI or other drug will Big Pharma point at internet addicts?


John

Sunday, March 23, 2008 6:23:00 PM  
Blogger Zarathustra said...

Now the interesting question. Which SSRI or other drug will Big Pharma point at internet addicts?

None whatsoever, because internet addiction is not a mental illness.

As I've said before in this thread, something becomes a recognised pyschiatric disorder if it's in the ICD-10 or the DSM, not if some berk writes an editorial.

Sunday, March 23, 2008 6:30:00 PM  
Anonymous Fx said...

Zarathustra, I think you're going to lose that bet: http://www.jonmd.com/pt/re/jnmd/abstract.00005053-200511000-00004.htm;jsessionid=HmkFr97TchNk1kc3W9Pw08c2vFhnSh6cjTlBnqntj6T3KySQMn6R!1675702673!181195628!8091!-1

That's the Journal of Nervous and Mental Disease. Article entitled: Proposed Diagnostic Criteria of Internet Addiction for Adolescents.

This area (Internet Addiction) began to be explored back in 1996 ... only a matter of time.

Fx

Sunday, March 23, 2008 6:46:00 PM  
Anonymous Anonymous said...

SSRI & and Naltrexone for Internet addiction in Korea


http://www.tgdaily.com/content/view/33445/113/
Treatment for Internet addiction suggested
Filed in Trendwatch
By Wolfgang Gruener
Friday, August 17, 2007 15:55
Tel Aviv (Israel) – Is your computer mouse your first thought when you get up in the morning? Are you obsessed with email, MySpace or YouTube? A psychiatrist said that such behavior should be put on the same level with other extreme addictive disorders and be treated as such.

According to Dr. Pinhas Dannon, a psychiatrist from Tel Aviv University’s Sackler Faculty of Medicine, says that Internet addiction should be taken seriously and grouped together with gambling, sex addiction, and kleptomania. In a new report, he describes Internet addiction as a "pathological condition that can lead to anxiety and severe depression."

Internet addiction is currently classified by mental health professionals as an Obsessive Compulsive Disorder (OCD), a mild to severe mental health condition that results in an urge to engage in ritualistic thoughts and behavior, such as excessive hand-washing or, in the case of the Internet, Web surfing. This, however, needs to change, Dannon claims. “Internet addiction is not manifesting itself as an ‘urge.’ It’s more than that. It’s a deep ‘craving.’ And if we don’t make the change in the way we classify Internet addiction, we won’t be able to treat it in the proper way,” he said.

According to the psychiatrist, especially teenagers and empty nesters are at risk to suffer from Internet addiction disorder. Diagnosis of form this condition may be difficult, he said, but stated that it will reveal itself through loss of sleep, anxiety when not online, isolation from family and peer groups, loss of work, and periods of deep depression.

Dannon believes that Internet addiction can be treated effectively, if it is viewed as any other extreme addiction. This treatment, he suggests would include medication such as Serotonin blockers and Naltrexone, which are typically used in cases of kleptomania and pathological gambling.

According to Dr. Dannon, Internet addiction is an "inevitable" product of modernization: “They are just like anyone else who is addicted to coffee, exercise, or talking on their cellular phone. As the times change, so do our addictions,” he said

Sunday, March 23, 2008 6:53:00 PM  
Blogger Zarathustra said...

arathustra, I think you're going to lose that bet: http://www.jonmd.com/pt/re/jnmd/abstract.00005053-200511000-00004.htm;jsessionid=HmkFr97TchNk1kc3W9Pw08c2vFhnSh6cjTlBnqntj6T3KySQMn6R!1675702673!181195628!8091!-1

That's the Journal of Nervous and Mental Disease. Article entitled: Proposed Diagnostic Criteria of Internet Addiction for Adolescents.


But the key word there is "proposed". People propose diagnostic criteria all the time. It doesn't mean they get accepted.

I guess it's conceivable that people might be spending large amounts of time on the internet as part of behaviours associated with pathologies like Obsessive-Compulsive Disorder (though I've never come across such a client myself) in which case just diagnose them with Obsessive-Compulsive Disorder and treat accordingly. There's no need for a new category.

Sunday, March 23, 2008 8:18:00 PM  
Blogger The Shrink said...

"Now the interesting question. Which SSRI or other drug will Big Pharma point at internet addicts?"

Indeed. The issue isn't of whether there's merit in this being conceptualised as a psychaitric disorder, or if there's a psychiatric intervention to effect beneficial change. The issue will crystalise in to coin. If it's a disorder then it needs treatment, thus the NHS will have to proffer treatments, thus Big Pharma markets an SSRI, SNRI or other placebo (in this scenario) that coins in squillions.

I'd see this as an issue as seeking to validate a disorder to codify dubious treatment for certain profit.

Sunday, March 23, 2008 8:33:00 PM  
Anonymous Fx said...

Zarathustra

Couldn't agree with you more ... but as The Shrink says, we're talking big business here.

Do SSRIs really work well with obsessive compulsive behaviour? CBT anyone?

Fx

Sunday, March 23, 2008 8:46:00 PM  
Blogger Zarathustra said...

SSRIs are used for treating OCD, although CBT is supposed to be the first line of treatment. Often CBT isn't the first line, which can have as much to do with the relative availability/non-availability of CBT compared with SSRIs as it is to do with the depredations of Big Pharma.

Anyone why are you lot posting so compulsively on the internet on Easter Sunday? Shouldn't you all be off eating chocolate eggs or something? :p

Sunday, March 23, 2008 9:03:00 PM  
Anonymous Fx said...

Ate them already ... wasn't much of a mountain (can you have an egg mountain?). In our house, we're obsessive about teeth as well as diabetes. Lol.

Didn't you say you were off to eat yours?

Fx

Sunday, March 23, 2008 9:16:00 PM  
Blogger Zarathustra said...

I've finished them, and the Easter Sunday movies were rubbish. Indiana Jones and the Temple of Doom just isn't as good as I remembered it to be from when I was 10.

Sunday, March 23, 2008 9:24:00 PM  
Anonymous Fx said...

No Satellite? Shame :(

Have a window in my busy schedule ;)

And you know Dr C is always interesting.

To return to the point: CBT is for those with private health insurance/money ... but the plebs get drugs.

As you know (probably), neither work reliably with, say, alcoholics ... what about gamblers?

Fx

Sunday, March 23, 2008 9:33:00 PM  
Blogger Zarathustra said...

Personally I work a lot with CBT in my current role. To be honest, I'm increasingly of the view that in some ways CBT is just as over-hyped as a supposed panacea cure-all as the meds are. Six to eight sessions of CBT and all your problems will be miraculously cured..?

But this is probably another rant for another day.

Sunday, March 23, 2008 9:41:00 PM  
Anonymous Fx said...

You may be right. How does 12-step differ from CBT? The Priory use both, plus drugs ... their success rate is - comparatively - high.

Any thoughts?

Sunday, March 23, 2008 10:10:00 PM  
Anonymous Anonymous said...

OK i think Crippo is right in that internet-blogging can be a form of addiction but surely it could already be adequately classified under the existing OCD diagnoses?!?!

Sunday, March 23, 2008 11:34:00 PM  
Blogger Seaneen said...

Hello there,

I'm Seaneen, over at http://www.mentallyinteresting.org

I wondered if you'd ever seen this blog?

http://fathealth.wordpress.com

It's a blog gathering obese and overweight patient experiences with doctors. Enlightening, and disturbing, reading.

Wednesday, March 26, 2008 8:09:00 PM  

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