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Who is CRAZY and Who is NORMAL? (with Dr. Lisa Alastuey)

Uploaded 9/26/2023, approx. 36 minute read

Awesome. Awesome. Well, welcome, everybody. I'm super excited today. My guest is narcissism expert Dr. Sam Vackman, who is the author of "Malignant Self-Love, Narcissism Revisited," which is in its 10th edition.

Along with being an author of several books and publications, he is a former visiting professor of psychology, a faculty member of CEOPS, and a senior professor of psychology. He is a faculty member of CEOPS, holds a PhD in physics, and is a columnist, editor, and is an economic advisor to governments and multinationals.

Welcome, Sam. Thank you. You make me sound almost human. Yes, yes. I'll be putting a link to your YouTube channel and your resume so people can see just how impressive your background is. Thank you. Good to see you again, Lisa. Thank you, Lisa. Thank you, Lisa. So, before we get started, I just want to say a couple of things. I would like to thank Sam for being here today. I'm sure Sam is going to be here. I don't know. Sam was actually my very first guest on my YouTube channel back in April of 2021, and I'm super excited to have you returning and to talk about today's topics. What goes wrong comes wrong. Yes, yes. Okay. So, let's break down what's the difference.

Praising and insane are value judgments. They are not, of course, clinical entities or clinical designations.

We can talk about people who are ill, mentally ill, and people who are mentally well.

And even this implies some kind of value judgments because it indicates the existence of a benchmark, a standard against which we measure other people's traits, behaviors, emotions, and cognitions.

And this standard or benchmark is the ideal, healthy, normal person.

But that's, of course, fiction. There is no such thing.

Additionally, we can divide the Diagnostic and Statistical Manual, the International Classification of Diseases, the CCMD, which is China's DSM. We can divide all these books, all these hefty tones. We can divide them roughly into disorders that are culture-bound.

In other words, disorders or alleged mental illnesses that actually have to do with societal and interpersonal functioning and reflect society's judgments of certain behaviors, predilections, emotions, and cognitions, and so on and so forth.

So, for example, psychopathy, antisocial personality disorder, the extreme form is known as psychopathy.

By the way, psychopathy is not a clinically accepted diagnosis. You won't find this word in the Diagnostic and Statistical Manual.

But psychopathy is a good example because psychopaths are people who disrespect authority. They are consummation. They are defiant, so they have a reactance mode. They react to stimuli by becoming aggressive. They are reckless. In other words, they don't foresee, nor do they contemplate, nor do they take into account the consequences of their own actions.

So they are reckless and impulsive, and so on and so forth. They lack empathy. They're ruthless. They're callous, and so on.

To my mind, this is not a mental health illness. It's a personality style. It's just the way some people are. It doesn't mean that they are mentally ill. It means that they are a-holes, if you wish, or jerks.

And another kind of jerk is the narcissist, narcissistic personality disorder.

Now, how can we tell apart real mental illnesses from alleged or ostensible mental illnesses, which are very dubious, clinical entities?

When the diagnostic criteria are comprised mainly of social mores, conventions, norms, and judgments, when the diagnostic criteria describe or deal mainly with interpersonal functioning in relationships, relational functioning, that is not a mental illness.

In my view, it's not a clinical entity.

Because societies change.

A psychopath in Western society is not the same thing as a psychopath in Nazi Germany. A narcissist in Japan is not the same as a narcissist in the United States, because Japan is a collectivist society, and so on and so forth, where the diagnostic criteria reflect societies and cultures and types of relationships which are contemporary, which are context dependent, then this is not a mental illness.

Allow me to remind you that homosexuality used to be classified as a mental illness until 1973 by the American Psychological Association. No less.

And today, anyone who would say that might end up in prison.

So, you know, things change. Morays, norms, conventions, attitudes, beliefs, values, they change all the time. We can't build a foundation, a clinical foundation on shifting sense.


And then you have the other types of mental illnesses, which are founded or where the diagnostic criteria are comprised of real biological processes and observable phenomena.

And an example would be schizophrenia, psychotic disorders, bipolar disorder. There can be no debate. Ten observers from ten different cultures and ten different societies and ten different periods of history, they would all agree on the same observations.

So this is a real thing. It's like cancer or tuberculosis. It's real.

But narcissism, psychopathy, homosexuality. No, these are not clinical entities. These are relative things.

So when we say crazy or sane or insane, what actually we are saying in the vast majority of cases is someone who fails to comply with and conform with social expectations, scripts, social mores, social edicts, laws, the legal system and so on and so forth.

And I am therefore inclined to believe that this kind of pathologizing is a pernicious form of social control.

It has nothing to do with psychology or psychiatry.

And that is very reminiscent, for example, of the Soviet Union, where psychiatry has been compromised to lock up dissidents.

And I think the West, priding itself on not being authoritarian, is actually very authoritarian when it comes to this.

Because we do penalize and we do lock up people using diagnostic criteria and diagnoses and diagnostic manuals that do not reflect anything real, clinically speaking.

So even when we say mentally ill, we should be very careful. We should ask, is the mental illness, can the mental illness, the alleged ostensible mental illness, can it be an influence? Can it be different in different societal and cultural contexts?

If the answer is yes, that's not a mental illness. Can it be described differently by observers from different societies, cultures and periods of history? If the answer is yes, it's not a mental illness.

So had we applied this standard that I've just described, the DSM would have been reduced by 90 percent and not exaggerated.

The first edition of the DSM, more than 70 years ago, the first edition was 100 pages long. The current edition of the DSM, the fifth text revision of the DSM, is well over 1,100 pages long.

There is no other discipline in medicine where the manual has multiplied itself ten times over within 70 years, none.

A textbook about cancer published in 1952 would be 30 percent thinner than a textbook about cancer today.

But it wouldn't be one tenth of a textbook about cancer today.

Something is wrong. We are over pathologizing.

There are two processes at work. We are over pathologizing and we are over criminalizing.

We have taken daily acceptable, millennia-old behaviors and we are criminalizing.

And that is especially true in intergender relationships. And we have taken behaviors which are anomic, behaviors which are not socially unacceptable, behaviors which are socially condemnable, behaviors which are socially detrimental and disruptive, I agree, and we are pathologizing.

Consequently, our criminal code has exploded supernova and so did the diagnostic and statistical manual. Everyone is crazy and everyone is a potential criminal.

This is the world we live in.

And the two are often profited. Crazy people are often considered criminals.

Yes, yes. And so why do you think that?

I think that they have added so many diages going, like you said, from 100 pages to 1,000 pages? And why didn't they allow that? Why is nobody questioning that this is, we don't do this in medicine?

A lot of money involved.

The Diagnostic and Statistical Manual is a tool at the service of the insurance industries, healthcare insurance industries, and the pharmaceutical industry. The equivalent, the global equivalent of the DSM, which is the ICD, International Classification of Diseases, at its 11th edition, published by the World Health Organization, the ICD has more or less doubled in size over the last 60, 70 years. Doubling in size is also extremely questionable, but okay, it's tolerable.

In the United States, there is a huge incentive to pathologize. Look what has happened with ADHD and the medications around ADHD. Look what has happened with numerous such diagnoses.

There is a whole industry of therapies, treatment modalities, medications, retreats, self-help, and there's a lot of money sloshing around. We have pathologized caffeine consumption, internet usage, behaving abrasively, also known as narcissistic personality disorder, disliking authority, also known as oppositional defiant disorder, behaving recklessly and defiantly, also known and impulsively, also known as antisocial personality disorder.

I mean, just stop for a minute. Stop to think for a minute. How can any mental illness be antisocial? Society should have no entry and no track with mental illness.

Illness is a clinical entity. We don't have antisocial cancer disorder. It's idiotic. Any alleged mental illness that starts with the word antisocial is suspect. Suspect. There's something wrong there.

Same with borderline and similar.


Now the whole field of mental health has been caught up in the intergender war because we used to have gendered mental disorders.

For example, borderline personality disorder was over-diagnosed among women and narcissistic personality disorder used to be over-diagnosed among men.

So the whole thing was gendered. And of course, when the gender wars started, because there's a gender war going on, there's a war between the genders.

It's politically incorrect to say this, but there's a war going on. And it's a war. I'm using the word judiciously.

These are not skirmishes. There's a lot of disagreements. This is not a process of negotiation. It's an all-out war between men and women.

And between, of course, minorities such as LGBTQ and straight, there's an all-out war going on.

And of course, the DSM consequently is heavily politicized. And this is more true for the DSM than for the, for example, CCMD in China.

But still, even the ICD is being politicized. So the whole field is contaminated. It's no longer rigorous. It's no longer scientific. It's no longer even the taxonomy suspect. It's the classification is suspect. It's all of it is suspect. So what's the outcome?

The outcome is that people don't trust therapists. They don't trust psychologists and they don't trust psychiatrists. And they definitely distrust the DSM committee.

So what they do, they go online and they fall prey to charlatans and con artists and wanna be experts with and without academic degrees.

For example, people don't realize that even if you have a PhD in psychology, that doesn't mean that you're an expert on any subfield of psychology. It doesn't mean you're an expert on narcissism.

And yet this is the situation. People leverage their academic degrees, dubiously, to claim credit for an expertise where they have none.

And this is the online scene.

And today people derive 80, 90 percent of their need for succor and advice and support and healing and recovery. They derive 80, 90 percent of these needs online because they have given up. They've given up on the institutionalized mainstream alternative because it has been tainted by money and politics.

Yes, yes. And I think that's why we see such a rise in life coaches, health coaches, spiritual coaches, because people are like, have not gotten good results with like their primary care or the traditional system.

So they're looking for anything online that maybe could give them hope.

Yeah. Some of it is good. For example, the fact that victims of abuse congregate together and support each other. That's not a bad thing.

But a lot of it is really, really bad. Bad advice, misinformation, myths, nonsense, infusion of mental health issues with demonology, religion, and if you want an example of insanity, just go on YouTube any given day.

Yes. Yes.


So let's get back to the crazy versus not crazy.

When I was kind of doing my research, one thing that I came across that somebody defined it as, they thought that crazy was not being in touch with reality and not crazy was being in touch with reality.

Do you like that definition? Anyone who is crazy, crazy, anyone who is mentally ill, truly mentally ill, has loss, has impaired reality testing. His ability to, or her ability to gauge reality properly is impaired, is damaged.

But not everyone with an impaired reality testing is mentally ill. That's a very important distinction.

So the fact that someone has an impaired reality testing does not necessarily lead to the conclusion that there is mental illness involved.

Because we are all prone, for example, to fantasy defenses. We are all reframe reality in order to avoid hurt and pain and possible disintegration. We all affiliated with institutions which distort reality for social causes.

So the nation state, the church and so on, they're based around distorting reality. They are non real.

So the ability to divorce reality, to reframe reality, to create narratives which are only partly real, to engage in fantasy, daydreaming, for example, is a form of fantasy. These are crucial survival and coping strategies. They definitely do not imply automatically mental illness.

However, it's true that every mentally ill person has impaired reality testing.


Another distinguishing feature of mentally ill people, they are unable to tell the difference between external objects and internal objects. They confuse the inside with the outside.

So the psychotic, for example, believes that elements in his mind, also known as introjects, elements in his mind are actually real and out there. So the voices in his head are coming from the outside. Images in his mind are projected externally and he sees them. That is known as hallucinations.

So and the narcissist is exactly the opposite. The narcissist internalizes external objects. The narcissist is unable to perceive the externality and the separateness of people. So what he does, he internalizes them. He creates representations of these people in his mind and he continues to interact with these representations. Whenever there's a confusion between inside and outside, external and internal, there's a strong indication of mental illness.

Actually, it has a name in psychosis. It has a name. It's called hyper-reflexivity.

So that's another test.

I think the third test is a lack of self-efficacy.

People with mental illness are very bad at securing long-term beneficial outcomes to themselves and to other people they care about.

So a normal healthy person is self-aware and a normal healthy person realizes her limitations, her strong points, her weaknesses. A normal healthy person conducts a swat analysis, strengths, weaknesses, opportunities and threats.

The mentally ill person has a misperception of everything about himself. His strengths are exaggerated or his weaknesses are exaggerated or opportunities are perceived as threats. For example, love is perceived as a strength in many mental illnesses, but it's an opportunity. Or threats are perceived as opportunities, which is what the psychopath does. The psychopath perceives threats as opportunities.

So there is a total misapprehension of facts about oneself.

And this leads to long-term behaviors which are self-defeating, self-destructive.

Short-term, a psychopath or a narcissist or a mentally ill person can maximize or optimize performance.

The performance can be okay, but never long in the long term. Never.

The errors, the mistakes accumulate. They undermine functioning.

So yeah, we can come up, I can continue for another two hours, we can come up with many, many dimensions of personality, many traits, many behaviors, many emotions and many cognitions.


Another example, access to emotions. Mentally ill people do not have access to their emotions. And mentally healthy people have access to their emotions.

But you say, "But wait a minute, the borderline, for example, the borderline is overwhelmed by her emotions."

Yes, because access implies also regulation and control.

So the borderline doesn't access her emotions. Her emotions take over. Her emotions access the borderline, not the other way.

So when you have a conflicted relationship with your emotions and cognitions, that's an excellent indicator of mental illness.

And again, I can continue with a very long list, but there's no need.

And the reason there's no need, and the reason I'm against such lists, is that each and every one of the things that I've just said also happens, also occurs with mentally healthy people.

So that's a serious problem.

Like, where's the line? Where's the thin line separate? Is it quantitative? Is it qualitative? Is it frequency? Is it what? Is it intensity? Where's the line where we say detachment from reality is actually conducive to functioning and performance?

Because, for example, you can daydream and fantasize and then realize your dreams, you know?

And beyond that line, the fantasy takes over and you are detached from reality and you perform badly.

So where's this line?

And I don't think there's any way in principle to delineate this line.

So I think all these tests are very nice on the surface, and they provoke aha moments and lightbulb moments and say, "Yeah, right. Yeah, that's it.

Yeah, that's the definition of mental illness. But then you wake up and you say, "But this is also very common among healthy people, normal people.

So what are we going to do about this?"

And therefore, I return to my suggested definition of mental illness.

Mental illness is a series of observable behaviors attributable in part to self-reported cognitions and emotions. Where these observable behaviors are not dependent on social contexts, cultural contexts, or period in history, and therefore these behaviors could be described amply and in a satisfying way by a machine. And these behaviors are such that they lead to self-defeat or self-destruction or bad outcomes for the individual and for people around the individual. Period.

This is a very objective measure.

I observe you. If you engage in behaviors which damage you and damage people around you, but especially damage you, and you do so on a consistent basis, then something is wrong and we need to intervene.

I'm not even sure we need to call it illness. Maybe a much better word is dysfunction. Dysfunction or dysregulation.

Why do we need to call it illness? I tell you why we call it illness.

Because psychologists and psychiatrists, or especially psychologists, they want to be scientists. They want to be like medical doctors. This is grandiose. This is totally grandiose.

Psychology is motor science and will never be a science.

Psychology is good at describing, observing, and classifying. Period.

There's no way to replicate experiments in psychology. That's why we have the replication crisis.

But psychologists want to work in laboratories. They want to wear white coats. They want to be considered scientists, the equivalent of physicists.

It's a grandiose fantasy there. They think if they use statistics, that makes them scientists. It's ridiculous. It's a grandiose psychosis of the whole profession.

And that's why you're using words like illness, which is borrowed from medicine. There are no illnesses. There is no craziness and there's no insanity in psychology.

All these terms are very misleading. There is proper functioning and dysfunction.

And where there is dysfunction, we can and should intervene, especially if there's danger to the person or to other people. We can and should intervene to the best of our very limited abilities.

And that's also the end of it.


Another thing, if you have, I mean, there are periods of remission, even in schizophrenia, it's only a period of remission.

It's very reminiscent of cancer. You see, it's like cancer. You have cancer, then you have remission, then you have cancer again, you have remission.

Same with schizophrenia. That is very misleading again.

Cancer, actually all, all clinical entities in medicine are localized. Cancer can metastasize, but even then it remains localized.

I mean, you have cancer in the brain, cancer of the liver and cancer of the lungs, but that's it. You don't have cancer of the body. There's no such thing. Everything is localized. Tuberculosis is in the lungs and some other organs, but it's always localized.

Schizophrenia is not localized. Schizophrenia is the patient. That's why the Diagnostic and Statistical Manual, when it describes personality disorders, the Diagnostic and Statistical Manual says an all-pervasive pattern, all pervasive, every dimension, every trait, every behavior, every cognition, every emotion, every function, every area of life, everything is permeated by the dysfunction.

That's the difference between medicine and psychology. That's why when you have a remission of a psychotic disorder, it's not the same like having a remission of cancer. A remission of a psychotic disorder implies that there is a healthy personality there lurking somewhere. And a remission of cancer implies that a certain organ is cancer-free.

This is a huge difference.

And if there is a lurking personality which is healthy and comes out when schizophrenia is in remission, then can we really say that schizophrenia is a clinical entity, a disease?

Clearly, there has been a survival of some healthy nucleus. Otherwise, there would have never been a remission.

So we don't know even the internal relationship between our healthy core and our alleged ostensible mental illnesses. We don't know anything.

This is an infantile field. It just started.

Physics has been in existence for 3,000 years. Psychology is in the best case 130 years old.

Yes, yes. And so what happens when we take it to a societal level and we look at different countries and cultures as far as what we might consider as normal?

They might see it as, "That's insane that you do that."

So on a collective mass level, what are we dealing with then and how to classify it?

We have to accept cultural relativism. Some behaviors would be considered abnormal and deviant or even perverted.

Do you know in French the term for malignant narcissist is "pervert narcissist"?

So we have to accept that there would be always disagreements about what constitutes the mentally healthy and the mentally ill. And that these disagreements are a very powerful indicator that many of what we call mental illnesses are simply cultural and societal norms and mores, which are ever shifting and ever changing.

Promiscuity was considered seriously a serious mental illness until well into the beginning of the 20th century. Promiscuity, not homosexuality. Sleeping with multiple men. Of course, promiscuity was a female thing. Sleeping with multiple men was considered mentally ill.

And in the Middle Ages, many of these behaviors were considered the outcomes of demon possession.

Luckily for the Middle Ages, they didn't have the diagnostic and statistical money. So they had religious texts. And in the religious state, I mean, they had a different language. So they didn't say mental illness. They said demon possession, which was the same thing.

And they pathologized in the Middle Ages. They pathologized many, many behaviors. Actually, all the behaviors which today are considered the core of health.

What is today considered the core and nucleus of mental health was frowned upon in the Middle Ages as forms of demon possession.

For example, sexuality, free sexuality, individuality, individualism, atheism, or not atheism so much as questioning authority. These are considered to be healthy things.

We teach our children to be critical thinkers. We teach our children to be individuals with ambition and so on and so forth. We teach our children to be socially liberated and to embrace sexuality.

Well, not all of us do, but, you know, this is the liberal consensus on what constitutes mental health. And all the elements in it, without a single exception, were considered in the Middle Ages demon possession, mental illness.

So it's nonsense. It's simply nonsense.

Yes.


So let me ask you about, okay, so for example, mental hospitals and how some people may end up in a mental hospital and they get labeled as the crazy one when in fact maybe if you were to dig deeper, they were, you know, emotionally abused. They were gas lit. They had a nervous breakdown. And the person that did it to them is walking free and they're considered sane and normal.

This is a serious emerging problem in psychology nowadays. For example, it is almost impossible to tell the difference between someone who suffers from complex trauma, complex post-traumatic stress disorder, and someone who has borderline personality disorder. It's very difficult to tell the difference. Emotional dysregulation is common in both of them, impulsivity, decline in empathy, etc.

So CPTSD is indistinguishable from BPD. And yet BPD is a mental illness. CPTSD is a circumstance, a reaction to circumstances. It's not mental illness.

But if we can't tell the difference, how many people are treated for borderline personality disorder, which are actually just victims of abuse and have undergone complex trauma?

We don't know the answer. Suspicion is strong that many, many people who've been diagnosed with BPD should have never been diagnosed with BPD. They were simply victims of extreme abuse and trauma.

So that's one example. That's one example.

So there have been attempts to cope with this by distinguishing disorders from style and style, from personality.

There's been the work of Sperry and the work of Millon and others. And they suggested that, for example, in narcissists, you have narcissistic personality disorder, but you also have narcissistic style. Narcissistic style is someone who, it's narcissist light.

And then you have subclinical narcissists. It's a narcissist who cannot be diagnosed with NPD, narcissistic personality disorder.

So, for example, the famous Dark Triad. Dark Triad, everyone and his dog, of course, now is an expert on plus the B.

So everyone is saying the Dark Triad is narcissism, psychopathy and Machiavellianism. It's not actually. Dark Triad is subclinical narcissism, subclinical psychopathy and Machiavellianism.

In other words, Dark Triad is when you cannot diagnose someone with narcissism and you cannot diagnose someone with psychopathy. They display traits or behaviors that are reminiscent of narcissism and reminiscent of psychopathy, but you cannot diagnose it.

And then they become a dark personality.

So we are beginning to have so many nuances, style, dark personalities, these that we have lost the script.

I believe the field of clinical psychology is in a total disarray. So many overlaps, so many comorbidities when you diagnose the same person with multiple diagnoses. So many disputes and arguments about differential diagnosis that you can't really today sit with a patient and in good conscience provide a diagnosis.

And consequently, many practitioners refuse to diagnose. They refuse to diagnose. They should just tell me what your problems are, what your issues are. Let's work on your problems or preserve your issues.

Let me teach you a few techniques, strategies and get out of my office.

And I want to tell you that you have narcissistic personality disorder or borderline personality disorder because there's a massive disagreement in the field.

Take, for example, narcissistic personality disorder. We have at the very least two major types, the overt grandiose narcissist and the covert shy, fragile, vulnerable narcissist.

And what is in common between these two types? Zilch. Nothing. Absolutely nothing. With perhaps one exception, there will be grandiose.

But grandiose is also common in antisocial personality disorder.

Grandiose is also common in borderline personality disorder. It's also common in bipolar disorder.

Bipolar disorder one, the manic phrase, you have grandiose.

It's also common in psychotic disorders. Many psychotic grandiose people have become prophets and established religions.

So grandiose cannot be the differential diagnosis between overt and covert narcissists. And with the exception of grandiose, these two diagnoses have nothing and I mean nothing in common.

And yet they're both called narcissists.

In short, it's a bloody mess.

So where do we go from here as far as like if you could wave a wand to improve how we are diagnosing, treating, you know, mental illnesses and what would you do? What would you recommend to clean the semester?

The primal scene has been labeling. We need to get rid of this habit of labeling. We need to focus on problems, issues, dysfunctions, self-efficacy, harm, harm reduction. We need to focus on these issues, preventative measures, you know, preemptive.

And so we need to focus on these issues and we need to throw away the DSM and all the diagnostic manuals that use labeling. And we need to reconfigure the insurance industry and the pharmaceutical industry to reimburse practitioners according to the issues treated and the problems resolved and to dispense of medication that has to do with issues and problems, not with labels.

What's your problem? I'm sad. Great. I have a medicine for this. What's your problem? I'm sad. Oh, that is that is eight five six point one. I can get reimbursed.

So the form submitted to the insurance company would say I had a patient today. The patient patient was sad. She had problems one, two, three. And this is my reimbursement for treating these issues and these problems. And I gave her this medication because this medication helps with someone who said anyhow, no one knows what is depression.

So bloody mess. We are now realizing that most of the antidepressants have nothing to do with the alleged mechanisms of the message in the struggle because of labeling. Just because of labeling.

I think if we get rid of labeling and we focus on phenomenology, you're sad. That's your problem. It's your main problem.

Are you sad? Yeah, I'm sad. OK, let's see why you're sad.

I can't get I can't leave home. OK, you can't leave home. Why are you afraid of open spaces? Are you afraid to fail?

This should be the focus. Your fear of failure, not whether you are agoraphobic. Why does the word matter? You're afraid to fail. Let's deal with this.

You know, and this was, of course, ironically, the approach until the 1950s.

Until the 1950s, I know it would come as a shock to many people. There were no diagnoses.

Until the 1950s, there was a single diagnosis called psychopathy. Everything was a copy of the narcissism was a copy of the psychopathy was a copy of the psychopathy.

And you had, of course, schizophrenia, which is again a biological entity, that's really medicine.

The excuse for a name at psychopathy.

And there was nothing else.

When Freud described narcissism, he didn't call it narcissistic personality disorder. He described the problem, a series of problems.

Kowood introduced the term narcissistic personality disorder in 1974.

A lot later, decades after Freud, who was the first to describe narcissism and Jung, who was the first to develop the theory of narcissism.

None of them, not Jung and Freud and not Adler and not Unafraid and not the object relation schools and not the behaviorist either thought to quantify anything in a list of diagnoses.

The idea would have struck them as totally insane.

Behaviorists, for example, said that all behaviors are predicated on stimuli response, stimulus response.

Like, why do we have to? Everything is stimulus response. We just have to identify the stimulus and identify the response and then take care of it.

Why do we need to call it by different names? This was the insurance industry they insisted on because they were used to medicine.

In medicine, it should be this way, of course, in medicine.

We need to be in terms of labeling and focus on the work that we do. We are too busy labeling people. We are too busy pathologizing. We are too busy pretending to be very important by using jargon.

So, you know, and then we mislead people and the people take words that they don't understand and misuse them online like gaslighting. And I know what it's it's a mess.

Like even pathologizing healthy people because those are new customers. I mean, that's that's probably another sinister reason maybe why they have grown and made it big business.

It's business. That's what I'm saying is it can remain a business.

The insurance companies and the pharmaceutical companies can continue to make the same money.

Just don't use labels. Use a problem oriented approach.

What's the problem of the patient? Let's help the patient with his problems or issues.

We don't need to label the patient and then we will get reimbursed according to the problems and we will provide a list of issues and we will get reimbursed. And we will give medications which deal with or medicate for issues and problems.

People are not people are not diagnostic labels. People are bundles of issues.

Do we have a similar problem in medicine?

In medicine, you reduce the patient to an organ. So you call the patient liver. I have liver on bed three. I have liver in ward six. I have a liver that's a patient with a liver problem or you reduce the patient to the diagnosis.

So you say in this section, we have six tuberculosis and three cancers. So it's a reductionist approach.

And in psychology, the first thing you should never, ever do. Human mind is interconnected. Everything is interconnected. You cannot pluck a certain element and deal with it separately.

That's ridiculous. It's counterfactual and it's self-defeating.

Very good.


So what are maybe some final thoughts on this difference between crazy and not crazy that you would like to sum up?

We need to realize that the risk of social control via labeling, pathologizing and diagnosing is bigger than ever.

And I think the profession needs to fight back by decoupling from money, decoupling from social politics and decoupling from social pressures, including social pressures by victimhood movements and walk movements and so on.

Don't misunderstand. Left and right, both are exerting undue pressure on and both are contaminating the process.

We need to regain the purity and innocence and virginity, if you wish, of the profession.

And the only way to do this is to dictate to the insurance companies and the pharmaceutical companies how we wish to get reimbursed on the one hand and to decouple completely from politicians, activists, interest groups and so on and so forth.

Decouple, I mean refuse to engage in dialogue.

If someone comes to you as a psychologist or a psychiatrist or a therapist and they want to talk to you about gender relations and gender roles, your answer is only one.

No. No. I am not going to engage in this conversation. Period. I have no idea what is gender. It has no place in clinical psychology. End of story.

Go talk to an anthropologist.


But today gender issues, for example, have penetrated and permeated the discourse in psychology. And we are talking about gender bias in diagnosis and all kinds of things. That is illegitimate discourse.

You can ask the question why a certain diagnosis is more prevalent than incident in a given gender, Why borderline is over diagnosed with women, for example. And then you can study, of course, biases and so on and so forth.

But that is the problem of the community of psychologists.

No one external has any right and should be given access to this process. No one should contaminate this person.

So unfortunately, through a system of grants and in universities and academic institutions and so on and so forth, there is a lot of pressure, a lot of pressure to conform.

There are questions you can never ask unless you want to lose your tenure. There are conclusions you should never reach.

However, evidence-based they are. And there are debates you must participate in, however irrelevant they are to the field.

That right there is insane.

Yes, yes.

Well, thank you, Sam. I appreciate today talking about, you know, just food for thought, for people to think about what we're doing at the individual level, the societal level, with regards to what we might label as crazy or insane or sane or crazy.

And so I'm really glad that you broke that down for us today.

Thank you for having me again.

Yes, yes.

Okay.

And if you guys like this video, be sure to give it a thumbs up. And don't forget to subscribe and hit the bell to be alerted when the next video drops. And don't go crazy. And don't go crazy.

Awesome, awesome.

Okay, so we're going to go take two, and we're going to talk about spiritual narcissists next.

Okay.


So you want to kind of terminate the recording? Start a new one?

You don't have to. I can put this in my video editor and I can slice it and I can make two.

Yeah, I can do the same.

Okay, awesome.

Okay, okay. Go ahead.

Yes, okay.

You're ready to go with this one?

Do you mind if I cut it and we have another session?

Sure, we do that.

Okay.

Yeah. Let us say goodbye for a minute or two.

I know it's difficult, but let's try.

And are you just going to come back on this one?

I'm going to come back.

Or do I need to send a new one?

No, no, no need.

Do I need to send a new one?

No need.

I'm going to come back on this one.

And, but give me five minutes. It's going to save the file.

Okay.

Oh, okay. Yes.

Okay.


Okay.

Same.

Five minutes time.

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Professor Sam Vaknin argues that mental illness is a culturally dependent concept and questions the validity of the insanity defense in legal cases. He highlights the lack of universally agreed-upon definitions of insanity and the discrepancies between psychiatric and legal insanity. Vaknin also discusses the limitations of current mental health diagnoses, which are often based on value judgments and cultural context rather than objective scientific criteria. He concludes that mental illness is a complex and evolving concept that requires further study before making definitive claims in courts or other settings.


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Transcripts Copyright © Sam Vaknin 2010-2023, under license to William DeGraaf
Website Copyright © William DeGraaf 2022-2023
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