Human Rights and Managed Care: Part 5, Conclusion

Steven Moffic, M.D.

May 26, 2012

(As Memorial Day approaches, pause for a moment of memory, not only for our soldiers who have died in war, but those related to our area of concern that have died all over the world from human rights violations).

Now that it may be apparent that human rights should cover not only the extremes but the everyday, and that human rights are relevant for managed care, what now? There may be some hope on the horizon. After fizzling out in the 1970s, before for-profit managed care, integrated care of psychiatry with medicine is gaining traction again. Putting more psychiatrists and other mental health clinicians in primary care settings, as well as vice versa, is being tested out in many new models, which hopefully will turn out to be more financially viable and sustainable. This would likely reduce stigma.

For another, by putting managed car and psychiatry into the larger framework of international human rights, broader even than medical ethics, we have another lens to assess managed care. Given the emotional weight of human rights, and given its focus on torture and other more extreme deprivation, if we can apply human rights to what seems like more mundane human rights violations in the USA, we may have a chance.

I might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights, for mental disorders often compromises what we can accomplish as human beings, as well as effecting our core identities. Certainly, it inhibits “life, liberty, and the pursuit of happiness”, among the “unalienable rights” in our own Declaration of Independence. For those with mental disorders, or whatever that may be called, to achieve more independence from the constraints of their illness, or more control in how to successful adapt to the changes, adequate and appropriate mental healthcare and help of any kind should be self-evident.

Speaking of the Declaration of Independence, we must then close with a political recommendation. What can take us to the next level of human rights and managed care” I would suggest that it could be something like a not-for-profit, managed single payer system, like Canada’s, but with some more not-for-profit management for quality and cost-effectiveness, all monitored by a consumer council.

As to the answer to the initial poll, perhaps it is now obvious: managed care BOTH hinders and benefits human rights. Like most powerful forces we have in the world, such as atomic energy, how this force is used is up to all of us.

Steven Moffic, M.D.

Sad in Psychiatry: Affectionately called a “gadfly,” and  known as “da man in psychiatric ethics,” Steven Moffic writes about what makes him sad about modern day psychiatry, and how to “treat” that condition so that we will become glad about what psychiatrists can do to help.

 

 

Human Rights and Managed Care: Part 5, Conclusion Comments RSS

69 thoughts on “Human Rights and Managed Care: Part 5, Conclusion

  1. Dr. Moffic and I had originally agreed to post this on the Monday morning, to allow time for more posts to go up between this and his prior installment. But when I saw Corinna’s post, it seemed better to put it up right away keep them all in close proximity.
    This was my call, not Dr. Moffic’s, who is only too happy to make sure there is plenty of space for discrepant views.

    • Don’t bother trying to give off the impression to me that this guy is tolerant. This is the guy who thinks there is nothing wrong with giving psychiatrists carte blanche to rape people with chemicals, an action he decorates with linguistic tinsel to prettify the unjustifiable reality of what psychiatrists do to people they don’t understand, against their will.

      What about the soldiers who died in the war? Sorry to play the iconoclast here people, but most soldiers are not very nice people. They are bigoted, intolerant and atavistic enough to do the job no morally refined person could do, which usually consists of murdering defenseless people and nicking their resources, even though hatred of the west in the middle east is little more than a corollary of bullying them for years only to find that the bullied can fight back, so we use the mass-audio visual media to create the lamentably preponderant misconception that it is they who are the aggressors, and our troops (I’m British and we are just as bad) are these brave, noble warriors, until you meet them in person that is!

      So let’s dispense with the conventional pieties concerning that institution that is considered so sacred amongst the generality of bully-worshipers, sorry, I mean honest, noble patriots, that such reality-checks as some of the foregoing statements are, are considered lese majeste! The average soldier is even more depraved and merciless than the average institutional psychiatrist!

      Who will psychiatrise the delusions of such people, because delusion it is? Who will say, ‘you have mad herd’s disease!’?

      What is he talking about human rights for, as if he were some sort of authority? Is there no limit to the presumption of these psychotyrants, these totalitarians in humanist clothing?

      Hope on the horizon? I’ll let my own eyes be the judge of that, and all I can see is yet another epoch of outrageous self-deception and mendacity, with millions of lives offered to propitaite psychiatric deities, and hee-haw else.

      It as I have said somewhere else, the history and future of psychiatry can be conceptualised metaphorically in terms of some cockroaches going round and round a table, believing they are going forward, but they are really just traversing familiar territory.

      Mental disorders can hinder what we can accomplish as human beings, eh? Whether or not a mind is disordered is in the eye of the bigoted, arrogant beholder. What is so axiomatically ‘ordered’ about your mind and the minds of other wicked utopians, of people who tell themselves they are therapists when they are torturers, benefactors when they are malefactors? Quit the humanist posturing, even Moliere couldn’t have conceived of such imposture.

      I love how he sneaked a ‘certainly’ in there. There’s nothing certain about anything you say. There is far more reason to say that psychiatry hinders life and liberty. We know psychiatry kills and oppresses, but mental illnesses are nothing more than verbal constructs, and whatever reality they stigmatisingly point to is far more nebulous than you imply, which is why philosophers have been arguing about these things for millenia.

      Like all tyrants, you consider your right to control others to be completely natural. Maybe you really do mean well, but people also must be protected from the good intentions because aren’t they, according to Dr Johnson, the material with which the way to hell is paved?

      ‘It is hardly too strong to say that the Constitution was made to guard the people against the dangers of good intentions.’-Daniel Webster

      ‘…was there ever any domination which didn’t appear natural to those who possessed it?’-John Mill

      ‘I cannot accept that we are to judge Pope and King unlike other men, with a favourable presumption that they did no wrong. If there is any presumption it is the other way against holders of power, increasing as the power increases.-Lord Acton

      • A Howell, you are a man after my own heart. Please point me in the direction of any other of your writing that exists on the internet apart from these exceptional comments you’ve been leaving here the past few days.

        You’re a rare bird. Especially coming from socialist Britain.

        I’m very impressed. Keep it coming A Howell.

        Moffic’s five part alleged human rights talk. Remember, people actually sat through all five parts at the APA meeting earlier this month. That is its provenance, he told us so weeks ago in case you missed that.

    • Kermit:

      If you had even half an ounce of compassion for Dr. Moffic, you would never have posted this, “Human Rights and Managed Care: Part 5, Conclusion.”

      You would have done him the service of telling him, in all honesty, that he should hire a ghost writer.

      “For those with mental disorders, or whatever that may be called, to achieve more independence from the constraints of their illness, or more control in how to successful adapt to the changes, adequate and appropriate mental healthcare and help of any kind should be self-evident.”

      What???

      • It seems that he doesn’t really care if what he’s saying makes any sense, as long as a pro-psychiatry POV is expressed here. After half a dozen circular arguments, I really stopped trying to piece it together. I’ve learned a lot from the comments to his articles, tho…

  2. I, too, salute the brave soldiers who have sacrificed life, limb, and neurological integrity in both our just and stupid military adventures.

    Steve Moffic writes: “I might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights, for mental disorders often compromises what we can accomplish as human beings, as well as effecting our core identities.”

    Is there anyone whose “core identity” does not include a “mental disorder,” whatever the heck that is? Having a “mental disorder” is part of the human condition.

    Any human being who accomplishes anything has done it with a “mental disorder.” Sigmund Freud! Indira Gandhi! Eleanor Roosevelt! Bill Clinton! Donald Trump! Margaret Thatcher! Sarah Palin! Abraham Lincoln! Charles Nemeroff!

    I guess an audience of psychiatrists would know what “mental disorders” means in this speech: “those people out there, the ones that are not us.”

    I cannot imagine a more emphatic reinforcement of the stigma of “mental disorders” than this distinction between anosognosic specialists and their target customers.

  3. “I might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights, for mental disorders often compromises what we can accomplish as human beings, as well as effecting our core identities.”

    So basically what you’re saying is that not only do I have the right to be both mad and insane, I also have rights as to how these matters will be addressed or NOT – if I so choose either way.

    Do I get it?

    And yes – I am genuinely mad (50%) and insane (25%). I prefer to be NOT provoked, and I also prefer to carefully guard my insanity. Neither of these are organic or genetic; they are consequences.

  4. Well, this a romantic notion of “Human Rights and Managed Care”. Approaches being as interesting as a Rorschach test. Note to Moffic from a prior post in “Human Rights and Managed Care” part 4: it’s spelled Rorschach not Rorshach…

    Psychiatry is involved with human rights, but inflicting human rights abuses is supposedly again helping people with their pursuit of happiness: just stick on that label of human rights and the pursuit of happiness, and instead of acknowledging that psychiatry has made an epidemic, you can act romantic about this notion that it will ever come up with solutions for the growing problem it’s in collusion with causing.
    Um, and putting more of these people that have accomplished this in “managed care” is going to help get rid of stigma!?

    This paragraph is priceless:
    “For another, by putting managed car and psychiatry into the larger framework of international human rights, broader even than medical ethics, we have another lens to assess managed care. Given the emotional weight of human rights, and given its focus on torture and other more extreme deprivation, if we can apply human rights to what seems like more mundane human rights violations in the USA, we may have a chance.”

    Um…

    “For another, by putting managed car and psychiatry”
    Evidently the car manufacturers have teamed up with Pharma, not surprising…
    “into the larger framework of international human rights, broader even than medical ethics,”
    Wow, “broader” than medical ethics! Sort of in the line of more holy. The religion of torturing people with medications that cause the chemical imbalances they are said to address of an alleged chemical imbalance, yet to be discovered, allegedly causing an alleged disease that’s more closely linked to being caused and not healed by all of this. But if a few psychiatrists step in and say what any compassionate person with common sense should say about torture through other means, this makes their own holy torture a mission.
    “we have another lens to assess managed care.” Yes folks, another lens, rosy it would seem. And at extreme cost…
    “Given the emotional weight of human rights, and given its focus on torture and other more extreme deprivation, if we can apply human rights to what seems like more mundane human rights violations in the USA, we may have a chance.”
    This seems to imply that human rights is a torture in itself, an emotional weight… But anyhow, back to extreme deprivation, like taking away a person’s rights, depriving them of making their own choice for a treatment that has actually has been proven to correlate with a chance for recovery; depriving them of a support system, while often incarcerating and taking away 20-35 years of their life and calling it health care… yes this would make the “human right” of the pursuit of happiness which needs to be defended by preventing it with “treatment,” an extreme emotional weight. Sort of like helping someone from drowning by tying a rope with a 200 pound weight around their leg. One can only wonder what more mundane human rights violations refers to. For those who aren’t as lost as this made me already, the article continues going on about the same old same old that psychiatric torture isn’t torture, it’s about the right to have the noble indoctrinated right that is the human right of the pursuit that is towards pursuing the pursuit of happiness, a race which requires more and more distance running the more psychiatry gets involved, something which Mr. Moffic says will be accomplished when psychiatry is more involved with “managed care,” something which could get rid of stigma….

    • Given Steve Moffic’s audience at the APA, perhaps he can be forgiven for the rhetorical inflation of putting “mental healthcare” up among the inalienable rights of the US Declaration of Independence (as well as his typos).

      In the real world, it is, of course, absurd to equate “mental healthcare” with the inalienable right of “pursuit of happiness.” Substitute “being rich” for “mental healthcare” and you’ll see what I mean.

    • I seemed to have typed 20-35 rather than 20-25 in reference to the loss of life span.

      I also MUST reiterate that making inappropriate references defending psychiatric abuse by calling what it supposedly is “healing” “more mundane human rights,” although this statistically, morally and scientifically is the opposite to what data tells us, this does NOT separate psychiatric abuse from torture. In fact, it’s an attempt to make the abuse more covert…

      The right to not be treated by a bunch of people (“professionals” if you will) who have made an epidemic with their treatment, and say that more of the same will stop the epidemic; this can hardly be skipped over by saying that including a person in the epidemic they are causing is instating “mundane human rights.”

      No even when such mind control torture is done in a more overt way, and criticized by those trying to keep it covert!

      • No even when such mind control torture is done in a more overt way, and criticized by those trying to keep it covert!

        should read:

        Not even when such mind control torture is done in a more overt way, and criticized by those trying to keep it covert!

  5. In terms of psychiatry, stigma, and human rights, a study was just released about people’s attitudes towards wording of DSM diagnoses http://psychiatryonline.org/article.aspx?articleid=1109030&journalid=13

    According to Neuroskeptic http://neuroskeptic.blogspot.com/2012/05/shyness-by-any-other-name.html “They gave people a brief description of someone who’s uncomfortable in social situations and often avoids them. The question was: should they seek mental health treatment for this problem?

    When the symptoms were labelled as “social anxiety disorder”, 83% of people recommended treatment. But when the same description was deemed “social phobia”, it dropped to 75%, a statistically significant difference.”

    The “social uncomfortable” description given is that of an introvert. Introverted traits are not very highly thought of in modern society, although they are perfectly normal.

    The proportion of introverts is thought to be about 25% of the general population.

    The other 75% (extroverts) matches pretty closely the proportion of people who would have the introverts seek psychiatric treatment.

    The term “social anxiety disorder” was originally invented by Glaxo Smith Kline to sell Paxil. GSK had contracted for studies to show Paxil was specifically effective for SAD. It then blanketed TV with advertising for Paxil and “social anxiety disorder.”

    “Social anxiety disorder” was embedded in DSM-IV. Now it’s about to be enshrined in the DSM-5, perhaps under a euphemism.

    This is another example of how psychiatry, in partnership with pharma, is medicalizing normality, and how far this terrible misconception has penetrated into popular culture.

    Why does psychiatry cooperate in stigmatizing 25% of the population? What about the human rights of introverts? Do they deserve to be thought of as psychiatrically defective?

    Steve, isn’t this of concern to you?

  6. “I might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights…”

    ???

    Dear Dr. Moffic:

    Perhaps, it was an urgent desire, of yours, to get this “Human Rights and Managed Care” series finished by Memorial Day, that led you to write such a nearly unintelligible conclusion?

    It contains so many nebulous phrases, typos and general failures to make subject and verb agree. I figure you may have felt the compelling urgency of such a self-imposed deadline.

    That’s pure speculation on my part.

    But, whatever the reason for your carelessness, in crafting your thoughts, I forgive you; really.

    After all, it’s just writing, and everyone makes mistakes. Everyone’s fallible – even psychiatrists.

    So, in deed, why do so many (like me) criticize the work of those in your profession?!?!

    Why not criticize all doctors equally??? Fair is fair.

    Speaking only for myself, I’d say it’s because psychiatric fallibility is ultimately more troublesome than that of other doctors – as psychiatrists wield more power and work with far more impunity than others; and, your pronouncements (e.g., your “diagnoses”) are all subjectively perceived (i.e., basically unsubstantiated); moreover, through the immense power that you and your colleagues are granted, by the State, you are officially declaring citizens “mentally disordered” and “a danger…” in order to ‘justify’ forcing “medical treatment” upon them (psychopharmacological drugs, ECT, and other brain-damaging measures) which can be literally torturous in effect; to me, this seems an outrageous lot of responsibility for mere (mistake-making) mortals, to wield.

    Mere mortals make mistakes. Everyone makes mistakes. That is, by the way, why I questioned you (in the comments section of your previous installment – part 4 of this series); you may have missed my question; I was asking you, why do you say,

    “Without ['intramuscular medication'] he’d surely relapse into psychosis and possible dangerousness” ???

    You made that remark about one of your so-called “patients”; I asked you to, perhaps, tell us why said that about him??? I mean: what made you say “surely” ???

    You never answered; so, I’m still wondering.

    (I’m thinking: Perhaps, you mistakenly forgot that one can’t reasonably make such a completely self-assured claim???)

    Meanwhile, I’ve been pondering this grand finale of yours, part 5 – until, at last, I noticed: it seems you mistakenly left out two key words.

    For your benefit, I’ve added them (in all-caps and brackets, as follows):

    “I might even go so far as to now suggest that [REFUSAL OF] mental healthcare may be one of the most essential, if not THE essential, human rights…”

    Now, there you go!

    Were you to make that small change (putting “refusal of” into your conclusion, as I have), I assure you, that, without a doubt, you’d be very well-remembered, by many, as a true champion of Human Rights.

    I am wishing you all the best this Memorial Day…

    Sincerely,

    J.

    • …on second thought, this may be even better:

      “I might even go so far as to now suggest that [REFUSING] mental healthcare may be one of the most essential, if not THE essential, human rights…”

      Yes, I believe that’s an improvement, and isn’t it amazing what carefully chosen words can do to fully clarify ones thinking!

      (Suddenly, I am flooded with memories of my distant past “hospitalizations” – specifically, the stark horror of being forced, then, to consume a certain psychiatric drug, which made the choosing of words nearly impossible.)

      The right to refuse mental health care!!

      Wonderful.

      Here’s to the spread of such a concept…

      • Spot on, it’s the “refusal” component, that is missing here.

        There’s already far too much well intentioned (yet ultimately traumatic) paternalism in psychiatry as it is.

        The notion that someone would curtail my human rights again, whilst adding insult to injury that it’s actually to *protect* my human rights, is insulting.

        To make that argument makes a sham and a mockery of everything human rights legislation seeks to accomplish.

        There’s a saying, “Bad people will do bad things, but for good people to do bad things, you need religion”…perhaps we can add to that, “or psychiatry”?

    • “I might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights…” (you might be correct)

      +

      “…you are officially declaring citizens “mentally disordered” and “a danger…” in order to ‘justify’ forcing “medical treatment” upon them (psychopharmacological drugs, ECT, and other brain-damaging measures) which can be literally torturous in effect;”

      = “So basically what you’re saying is … I also have rights as to how these matters will be addressed or NOT”.

      I have the right to be NOT commanded into a treatment that is ineffective or harmful. I have the right to be NOT tortured.

      Now THAT is a right I’ll gladly spill my blood for.

      I should also have the right to be NOT punished or penalized for using my rights to refuse psychiatric evaluation or treatment.

  7. While this piece was so poorly written as to be alomost incomprehensible, I was able to discern that Dr. Moffic thinks that access to mental health “care” is an important human right. I think he’s got that backward – freedom from forced psychiatric interventions is one of the most basic human rights.

  8. Steven would you please give me a reply to these questions?
    Do you think that the people you diagnose should have the right to choose the help they want?
    Do you think that you as a caring doctor should try to provide non clinical services when many people find medical intervention to be harmful?
    Do you meet many people who are severely effected by psychotropic drugs?
    Do you notice the adverse effects of drugs on people?
    Do you try to reduce drugs slowly when people want to be drug free?
    Do you seek out other ways of helping people because the toxic effects of drugs are very severe?
    Do you realize that the drugs and electroshock can even cause problems for people who do not have severe psycho/social problems?

    I think these questions are important for all those who are interested in human rights. The most fundamental question of all is the right to BE HUMAN!

  9. Hi Steve,

    I sincerely appreciate your effort to try to create a bridge between psychiatry and the MIA public.

    Maybe you should have reminded at the top of each part that this speech was targeted to your fellow psychiatrists at the APA, and was written before you were involved with MIA. There is a big difference of culture between the APA and MIA, and everybody should be able to understand you would not have made the same speech for a MIA audience. A difference of focus between audiences is compatible with integrity and consistent goals, and is desirable to be effective (as long as nothing is done in a hidden fashion). Thank you for you transparency in posting that speech here.

    It seems a lot of the criticism in the comment section does not seem to fully take into account this context. You responsibility was to be understood by psychiatrists. And you intent in posting here was probably to show that internal talks between psychiatrists are not about how to disable mentally ill people.

    I am glad to see that between those two cultures, there is a common ground of concern for the well-being and human-rights of mentally ill people.

    I was wondering if you think the main driving forces that are pushing psychiatry to change are forces inside the heterogeneous medical community (like Marcia Angell, Irvin Kirsch, Daniel Carlat, Allen Frances, SAMHSA, all the numerous psychiatrists of MIA, and many others), or the equally heterogeneous “outside” forces (R. Whitaker, various bloggers at MIA, mindfreedom, …)?

    I am personally grateful for R. Whitaker for creating a website that enables people of incredibly different backgrounds to talk to each other, understand each other, influence each other, and hopefully find together new and creative powerful ideas.

    • “and everybody should be able to understand you would not have made the same speech for a MIA audience. ”

      Ah… he would, and he just did.

      I find your constant mental gymnastics entertaining though.

    • I agree with Stanley.

      Consider this speech was presented at the APA annual meeting, perhaps the highlight of the social season for members of the organization.

      Then maybe you can forgive the hyperbole of suggesting psychiatric treatment might be included among inalienable rights in the US Declaration of Independence.

      It’s an inspirational message for the troops.

      And I really appreciate the plug for single-payer national health care!

  10. ” might even go so far as to now suggest that mental healthcare may be one of the most essential, if not THE essential, human rights, for mental disorders often compromises what we can accomplish as human beings, as well as effecting our core identities. Certainly, it inhibits “life, liberty, and the pursuit of happiness”,

    I would disagree. I think freedom from mental healthcare is THE more essential human right. This would include freedom from being identified as disordered.

    • Oops I didn’t read the other comments first. My first point had all ready been made. Could you expand upon this point you made?

      “For another, by putting managed car and psychiatry into the larger framework of international human rights, broader even than medical ethics, we have another lens to assess managed care. Given the emotional weight of human rights, and given its focus on torture and other more extreme deprivation, if we can apply human rights to what seems like more mundane human rights violations in the USA, we may have a chance.”

      Do you believe that forced drugging or ECT is torture or extreme deprivation? Would it be if it were being done to the prisoners in Gitmo or political prisoners in some other country?

  11. Jonah,

    You wrote:

    ///“I might even go so far as to now suggest that [REFUSING] mental healthcare may be one of the most essential, if not THE essential, human rights…”///

    I agree with you up to a point and that point is that many people want mental health care- not only far-right politicians and money greedy psychiatrists.

    As important as the right of refusing treatment might be, offering humane and not paternalistic treatment for those asking for it is not to be ignored.

    Not even peer support is for everyone and being homeless and alone with painful hallucinations should be an informed choice not a solution to cut spendings.

    • Ivana,

      I don’t think anyone is proposing here that people who DO want care should have access to it.

      The issue at hand is that it should be a choice, not an imposition.

    • Ronald Pies does not get it either: That unpleasant noise he hears is thousands of dissatisfied customers.

      Until psychiatry can listen to people who are unhappy with psychiatric care, it can’t improve or even aspire to be a medical discipline.

      Is there a way to say “The treatment you gave me made me worse” so they’ll hear, listen, and respond appropriately?

  12. Mary,

    My answers to all your questions would be an emphatic “yes”.

    Stanley, thanks once again for trying to clarify what I was attempting. This was a transcript of a speech and hence not the best writing. But I wanted to be transparent to this audience. It was also geared to psychiatrists, to try to nudge them toward taking what Mr. Whitaker pointed our. If psychiatrists read some of the commentary here, they would for sure not return. Perhaps that is what is wanted; no psychiatrists here or anywhere. No one has to answer this rhetorical question.

    For human rights, what I was trying to say is that mental health is the supreme goal.

    • Dr. Moffic,

      I appreciate the distinction you just made between mental health care and mental health as human rights. I think this would have been an important distinction to make in your speech, even to an audience of psychiatrists at the APA. Emphasizing access (forced or otherwise) to current mental health care as a means to reach a human rights vision of everyone experiencing “good mental health” (though I think even this concept is problematic, difficult to meaningfully operationalize, and is entwined with so many other issues) when the framework of understanding psychopathology/health is highly contested, treatments available lack strong efficacy and have noted risk of harm, diagnoses of mental illnesses pushes people into a stigmatized class for which the majority of the public believe is essential (biological/fixed) to people’s identity, and payment for care is based on output of services (how many patients seen, scripts written, etc.) and not based on the extent of good outcomes experienced by clients, treatment as is seems like an ineffective way to approach our more “mundane” human rights crisis in mental health.

      Perhaps taking to task your fellow psychiatrists at the APA to focus on more robust outcomes associated with “good mental health” and how the work they do, their goals, how managed care complicates this work and goals, move people towards or away from those outcomes. Perhaps it could push people to think about what the limits of their work is, what else has to change (besides psychiatric care) in order to achieve more robust population-level mental health outcomes, how resources could be better allocated to address those gaps, etc.

      If your goal was to push for a discussion about expanding everyone’s well-being, I did not come across very clearly to me in your piece, but I do appreciate your interest in that discussion. I think from that lens, critically examining ways psychiatric care is funded, delivered, studied, and its outcomes have to be part of that discussion, not just assumed to be the means to which ensure the human rights goal as everyone has a right to mental health. This doesn’t mean that there isn’t a positive role for psychiatry, but you just can’t assume that is has been only positive or that access to psychiatric care is a mandate for a vision of human rights. I think that comes off as naive, insensitive to the damages of psychiatric care as expressed by so many here, and makes me question your ability to partner with a movement to address the current harms of the system as is and move towards better well-being for all.

      I do appreciate your helpful intentions and your hopes that telling psychiatrists what they do is human rights work would help them understand Robert Whitaker’s work. As many pointed out, however, psychiatric care is viewed by many here as a violation of human rights, especially in light of the poor, long-term outcomes of standard practices of psychiatric care highlighted by Whitaker. My fear is that a speech likes this bolsters practioners with more zeal that what they do is not just robustly helpful, but necessary and just, despite the evidence Whitaker gathered to show otherwise, which would lead to worse overall mental health, which is ultimately counter to your now proposed vision of mental health as a human right.

    • Steve Moffic says “Mental health is the supreme goal.”

      Steve, what does this mean? Who determines mental health? How many people meet the criteria of someone who is mentally healthy?

      “Mental health” means something different to each person in individual circumstances. What “mental health” means to Donald Trump may be different than what it means to Mother Theresa.

      If you mean self-determination, I believe that is implicit in the Declaration of Independence, not “mental health” as an inalienable right.

      However, in your speech you said “mental health care.” I believe this is understood in a specific way by your psychiatrist audience. How do they understand it?

  13. Thank you, Nathan, for your thoughtful commentary. I think how you discussed my talk was done in a way that can move us forward. Believe me, if you will, that the speech did not increase zeal for continuing what we were doing. I’d just be cautious about scapegoating psychiatrists and psychiatry for everything wrong, as well as taking Mr. Whitaker’s book as being the gospel truth.

    • I certainly don’t take Bob Whitaker’s books as sacred texts, but a thorough investigation of evidence (and often lack of systematically gathered evidence) underpinning psychiatric care. There are lots of potential reasons for poorly conducted and disseminated research, its translation to practice, the corruption of the process of scientific inquiry, and the public policy that seems to privilege profits of the already most profitable companies to ever exist at the expense of care. All of these of course are not the “fault” of or malicious intent of the vast majority of psychiatrists. I certainly feel though that with the great power our societies invest in psychiatrists and often the (for many therapeutic interventions required utmost) trust patients put in them (and perhaps psychiatrists don’t feel this prestige when they feel looked down on by other doctors), psychiatrists have a responsibility to own what they actually know and don’t and how they know and don’t know. The confidence and faith in psychiatric care as is we hear many psychiatrists (and policy makers and physicians and case managers etc.) I believe outpaces what can be inferred from the data. Perhaps talking about psychiatric care in the realm of human rights as intentionally emotionally evocative seemed even more disproportionately grandiose and lacked an informed humility of what is actually known and not. I don’t like writing off Psychiatry and psychiatrists, because I do believe ethical scientific inquiry and application has and can be helpful, but the hope of that helpfulness does not and should not obscure the realities at hand. I think this is one of the reasons why your first piece for MiA was so poorly received. Psychiatrists may have a really positive role to play in making change, but the rationales for inclusion of psychiatrists in change making you referenced are ones that had already been sufficiently challenged; they seemed based on confidence and power that many agree are unjustified by the science as it has been conducted and published.

      I know many of my most visceral reactions to posts from psychiatrists here are related to my feeling duped, pushed to trust and hold in high regard my clinicians and their knowledge, to pay them a great deal, when the rationales for diagnosis and treatment and expected outcomes of treatments were actually not actually all that based on good scientific inquiry and lacked sufficient informed consent procedures, all during a time when I was at my most vulnerable and in need. Though I have never had the experience of forced treatment (though members of my family have), when this mix of power, undue confidence, and lack of evidence of sufficient helpfulness is forced upon someones I can only imagine how disorienting, disempowering, humiliating, and frightening it could be. Dr. Moffic, you don’t have to agree with many other bloggers and commentators to have a voice here, but it is hard for people who have experienced harm by people who vowed to do no harm while calling their interventions helpful without the evidence to back it up and then being told that they lack the capacity to even differentiate help and harm to not be at least skeptical of people who have the same power of the people who they feel harmed them.

      I hope I can keep my commitment to being open to discussion and debate, but I hope you realize that I and many come from a place of mistrust, not due to pathology, but to the scientific literature and our own, legitimate experiences. If you can make the appeal for commentators to not write off psychiatrists or their potential value completely and without question, then I can and will make the appeal to you to not write of people’s responses to you as merely spiteful, deluded, or fringe.

      I know you come to this audience wanting to make helpful changes to mental health care. It’s a good goal. Many here have ideas and frustrations related to their own in that endeavor. Please do remember, however, that you come here from a position of power/authority that people have been abused by, and asserting your ideas while not being open to the criticisms of those hurt/critical reifies the your position as someone who comes offering to “help” whether people want it or not. I hope instead you could ask, “How can I help make things better?” and be ok with, take seriously, and even embrace the answers “please just stay away from me and my body” or “stop treating people with substances/interventions that have known significant harms until you can make a better case for their efficacy” (perhaps with a few expletives) that many would give. You don’t have to agree with people or their tone, but I think the approach would demonstrate greater respect for people’s lived experiences, their sophisticated understanding of many of the issues you have addressed in your writings, and your genuineness in ally with people for substantive change.

  14. I would agree that the freedom to make informed decisions about “mental health”, including what we define as healthy/unhealthy and what (if anything) we decide to do about it if we’re feeling mentally “unhealthy,” is the real human right at issue here. I certainly can’t tolerate arguments for the “right to mental health treatment” when that “treatment” is based on lies and manipulation and is focused primarily on the authorities defining what “illness” is and what has to be done TO me in order to “manage” my so-called “illness.”

    It is interesting that Dr. Moffic, apparently an apologist for the psychiatric “Bible”, the DSM, is suggesting we not take Bob Whitaker’s work as “gospel.” Bob actually provides scientific evidence to support his views, which is more than can be said for the DSM’s biblical editors. If anyone needs to look at their adherence to “gospel,” it’s the psychiatric profession itself. Declaring something a “disorder” doesn’t make it so. If you care so much about human rights, why don’t you start with the right to informed consent, including the truth about the spurious and subjective “disorders” psychiatry pretends to “treat?”

  15. Thanks again, Nathan. Your explanation is most helpful, as is your way of discussing things. Although it seems to me that this site is very helpful for those hurt in their interactions with psychiatry, I believe it would eventually be even more helpful if those helped by psychiatry were comfortable in participating, as well as more mainstream psychiatrists. I’ll do my best to try to be respectful, but again the tone and vitriol are obstacles to moving on.

    • Mainstream psychiatrists have the capacity to come visit MiA and read and comment all they like. If they don’t like what they read, they are free to not continue reading. Many posters here wish they had that same freedom during their engagement with psychiatrists.

      Dr Moffic, you have talked a great deal about how psychiatrists and others in “dominant” or “privileged” roles are necessary partners/allies for liberation or rights movements to be successful. In my experience in social change/justice work, privileged allies have a couple of conditions to meet to truly be helpful (as opposed to co-opting, blocking, making movements about oppressor guilt/shame, having savior delusions, continuing to assert their dominant values as universal, etc.).

      The big one is that they have to be willing to listen to criticisms of oppressive paradigms they have not only not questioned but have often contributed in maintaining and/or significantly benefited from, and reflect on their personal relation to those paradigms. This really is difficult, because for a lot of material purposes, people privileged by systems benefit a great deal from them, and even simply investigating that privilege can shake a lot of truths/relationships/narratives that have been important to them and lead to material loss. Challenging that privilege can lead to more difficulty. but People in privileged positions have the privilege to not confront these issues, so when they get hard, they can always leave.

      The next conditions are just an offshoot of the first one of willingness to listen/investigate, and that is to continue/tolerate engaging in issues oppressed people raise, and to own/apologize for unintended hurts. People don’t have to be perfect in their investigating/questioning, as they are bound to do/say a lot of offensive things as they learn/unlearn. While allies do not get a pass for being allies, if they take the responsibility to own their learning/growth and mistakes along the way and still have the humility to continue being an ally, than I have found justice movements to be forgiving and welcoming.

      While these conditions are foundational, this last condition I have found is clinching. Allies from privileged positions in the struggle have to realize what the costs and losses of their experience as configured as dominant to their personal life and well-being. While materially they are often better off, costs might include stifled relationships with folks different than them, living in fear of backlash, lack of integrity, lack of creativity, etc. Basically, they have to come to understand how oppressive systems also hurt/limit folks who materially benefit from that system, and see that some of their liberation is bundled with the liberation of folks who have been oppressed. This may come with shifting definitions of self/others, roles, expectations, etc., but allies who can discover they have a personal stake in the movement (their participation is not just an altruistic or paternalistic) find they themselves can live more free/at ease and actually be useful in advancing a movement. I believe this has been key for white anti-racists, straight folk in queer liberation, men in feminism, etc. It may be key for psychiatrists wanting to change oppressive mental health systems/paradigms.

      I know this is a bit off-topic, but I write this because one role I see for MiA is being a platform for people to develop the ideas/consciousness expand well-being for all people who have or may experience distress and those marginalized/disabled/hurt by diagnoses/participation in particular treatments or rightfully fear marginalization/hurt by diagnosis/treatments. If participation by mainstream psychiatrists and folks who have experienced help from psychiatry is just to provide a counterpoint, then I fear that is inhibitory to movement-building, especially as there are so few virtual spaces like MiA in which to gather, and so many to hear the perspectives of mainstream psychiatrists and fortunate patients. I welcome perspectives of these people, but they come from a dominant position where they potentially have a lot to lose from being challenged, and unless discover how their lives can be made richer by listening to the insightful critiques of people who have been hurt/oppressed, recognize they themselves may be continually hurtful/offensive in their participation and be wiling to be called out and own their actions/words, I fear that one of the beneficial roles of this unique community may be compromised.

    • Steve M., many of the participants on this site were drawn here by the themes of Robert Whitaker’s books: broadly, psychiatric care may do more harm than good.

      These are people who have been injured by psychiatry. Most of us have had the experience of not being listened to by doctors when we described our adverse reactions, being lied to when we asked questions, or being derided when trying to participate in our own care.

      This is the audience you have. You have called several times for a different audience — patients who admire psychiatry.

      I can understand why the hostile behavior of some makes you uncomfortable, but when you call for a different audience, it makes me feel like you really don’t want to listen, like so many other psychiatrists I’ve known.

      (In other human rights movements, do insurgents tend to be deferential?)

      I believe you, as an ethicist, might have something to say to patients injured by psychiatry, and I would like to hear what that is.

  16. This is really not about whether some people feel they are helped by psychiatry and some feel they are harmed. It is about psychiatry’s ethical responsibility to be intellectually honest about what is and is not known about the mind and what the drugs can and cannot do. It is highly irresponsible of the profession to represent that their drugs “rebalance brain chemistry” when there is not an evidence base to deduce that “mentally ill” brains are chemically unbalanced nor that the drugs do anything to promote healthy brain chemistry. It is perfectly OK for people who feel they have been helped by psychiatric drugs to post here, and I hope they feel welcome. As many folks say, I am “pro choice” when it comes to drugs – people are entitled to do what they feel works. But they’re also entitled to the truth. The DSM deception is well established and needs to be undone before real change can be made in psychiatry. There is no sense in arguing for more funds for a system that tells people lies and sells them products based on those lies. We can start by admitting that all of the DSM diagnoses, with a few notable exceptions, are INVENTIONS, not scientific discoveries, and acknowledge that there can’t possibly be a coherent physical cause for these inventions, as they are created from observations of behavior rather than pathology. Are some of these behaviors caused by pathology? No doubt. But when that evidence comes forth, we can treat that small subset of mental problems with physical means and may possibly have results. But to seriously diagnose a child with a brain disorder because they won’t remain in their seat and blurt out answers in class – PLEASE, don’t pretend that has anything to do with science.

    I have no issue with someone taking medication. I have an issue with promoting medication and labels with the force of psychiatric authority and with the funding of those who benefit from their sale.

    —- Steve

  17. Despite all the limitations and problems with psychiatric medication, are you familiar with the recent comparative studies that they are as good as most general medical treatments for common illnesses?

    If this site is just for those who feel hurt, fine. You will never get more psychiatrists who might be willing to listen if the language is so hateful. Why hurt others, even privileged others, if you have felt hurt? And are some really so confident in their knowledge to make recommendations about medications a la psychiatrists? Well, I think I know the answers, but it is useless to say it.

    For me, I’ll take a rest for a while in posting. I had one or two posts in mind for here that I will post elsewhere, where people can look if they like. I know that is what many have desired.

    • Dr. Moffic,

      I have read the article comparing psychiatric drugs to other drugs. One of my criticisms of it is that other medications tend to address illness that have some validity and reliability in diagnostics and we have a better understanding of mechanisms of pathology and mechanisms of the medication. This is still up in the air for psychiatric disorders. Comparing a drug’s effect on cholesterol levels is different than comparing an effect on psychotic or anxious symptoms. Additionally, a lot of medications in other branches of medicine aren’t all that great either, with NNT’s for expected outcomes being very high. Some are willing to take medicines like this because they can tolerate or not experience side effects and the outcome they want to achieve (ex. preventing a heart attack) is worth it to them. Pharma influence is not limited to psychiatric drugs.

      I also don’t think many here claim themselves to be expert psychopharmacologists. Many do raise the point given a lot of the studies of psychiatric medication effectiveness and risk, how they are prescribed and for what, and the longterm outcomes of their use, that many prescribers (psychiatrists and other) are not as expert as many patients used to or are expected to believe.

      As for my own language, I hope it does not come across as hateful. I know I have been critical, but to me that is different than hateful. On a forum of free discussion where we all freely choose to spend our time and energy commenting here, I do want to speak as honestly as I can. I have no desire to hurt “privileged” others because I myself have been hurt, but I also have no desire to hide my beliefs or be falsely gracious in order to coax supporters or placate their concerns/egos or feelings of discomfort. I believe an honest discussion is how we can all learn the most, and having to sugar-coat my arguments/experiences is a sign that I am engaging in a system from a position of marginalization. I experience that position in many other areas of my life, I want this forum to allow freer exchanges. It isn’t easy to learn about how one’s privileged position has contributed to the hurt of others, how one’s sense of self is dependent on that oppression, how difficult it is to challenge the systems that structure that privilege/oppression, and to sort out one’s willingness to rethink/change how they see themselves and act in the world in a more just fashion. As I have already said, it is a privilege to be able to leave difficult discussions of privilege/oppression and keep a privileged position intact without more thought, folks on the other side don’t have the luxury to view or engage the world or themselves in that way.

      I agree that being intentionally mean/hurtful does not serve much, but part of the benefits of online communication and forums such as this is that some of the hierarchical aspects of relationships (experts/lay people, doctors/patients, healthy/ill, etc.) can be destabilized. Though it does risk “trolling” or intentional mean comments, it also provides space for more open discussion to those who lack the ability to be as open elsewhere or in the physical world.

      Dr. Moffic, I appreciate your engagement hence far, and know this hasn’t been your favorite of audiences. I wish you well in your future writing and thinking.

      • Nathan:

        Dr. Moffic writes, “You will never get more psychiatrists who might be willing to listen if the language is so hateful.”

        And, you (Nathan) have responded, “As for my own language, I hope it does not come across as hateful. I know I have been critical, but to me that is different than hateful.”

        Personally, I feel it is extremely important to point out, that there is no hateful language in this entire thread (none whatsoever – at least, not by this point).

        Nor have I seen any hateful language, anywhere on this web site; though, I am quite perfectly willing to admit, that I have not read everything here, on this site, so I can’t say for sure that no one has ever posted hateful language. (I imagine someone probably has done so, at some point; and, the moderator deleted it.)

        There was, in this particular threat of comments, one comment that was deleted by the moderator; it was dated May 27, 2012 at 2:25 am; and, it was not in the least way hateful; it was actually a very brief and innocuous – but, yes, irreverent – joke, suggesting that its author was playing psychiatrist with Dr. Moffic, offering various diagnoses.

        When I think about it, I suppose it was somewhat (minimally) rude; though, I don’t believe it was so rude as to require deleting; after all, it was making a point about the lunacy of psychiatric labels; but, in any case, it was not “hateful”; and, I believe it’s very important to avoid genuflecting in the face of anyone’s false claims of hate speech.

        Hateful language is language that is truly threatening – and certainly should not be allow in these discussions.

        Claiming that there is “hateful” language here without ever pointing to what language he is speaking of, Dr. Moffic may be creating spurious accusations, to seemingly ‘convict’ others of misbehavior that has not occurred.

        Truly, I think it would be to his benefit to point out any “hateful” language that’s exemplary, of what he’s referring to.

        Otherwise, he perpetuates the common belief that psychiatrists, generally speaking, are inclined to exaggerate the ‘misbehaviors’ of those they assess for the possibility of establishing the existence of supposed “personality disorders” of various kinds.

        Really, he does himself and his readers a disservice by failing to address what he feels is “hateful” (I feel).

        Meanwhile, I have occasionally seen people attempt to ‘make peace’ in the comments of these MiA blogs, simply for the sake of making-nice, but I believe you, Nathan, are someone who demonstrates a capacity to be a genuinely honest broker, in speaking truth to power; for, honestly, if Dr. Moffic can read your words understandingly, he may begin to see, that, as a psychiatrist, he is most highly empowered in a system which leaves countless people variously dispossessed.

        And, how you’ve attempted to explain that to Dr. Moffic, in your comments, is with anything but “hateful” language.

        I, myself, have been highly critical of Dr. Moffic in my preceding comments, here in this thread – as well as in comments accompanying his previous blog entry (part 4 of his series).

        Does he take my criticisms as demonstrating ‘hateful’ language – I wonder??

        I simply critiqued his writing style – and emphasized that everyone makes mistakes – and went on to very courteously express my displeasure with his failure to address my query regarding his having written, about an IOT “patient” of his, that:

        “Without [‘intramuscular medication’] he’d surely relapse into psychosis and possible dangerousness.”

        I wanted (and, still, I want) to know: Why did Dr. Moffic express such surety; how did he arrive at such a completely self-certain prognosis???

        I asked him in the comments section, to his previous blog entry, as well; he never answered; I did not care to presume he was ignoring me; so, I mention that same curiosity of mine, here, again.

        Would he be more inclined to address this question were I to address him with reverence?

        I don’t know; but, there were others who repeated my question; so, I do not think he avoids answering just because he does not like the tone in which it was asked.

        But, I confess I do not appreciate Dr. Moffic’s brand of psychiatry – largely because it entails the kind of prognosis which he offered us, regarding the above-mentioned “patient” – but, also, because he calls for longer “hospitalizations” for supposed ‘psychosis’ and, in fact, hopes for more State “hospitals” to accommodate those “patient”; so, there is a tone – of certain distaste – in my writing, when I’m addressing Dr. Moffic.

        But, as far as critiquing writing-style goes, actually, I am an equal opportunity critic.

        Therefore, having criticized Dr. Moffic’s writing-style (above) for its somewhat unintelligible nature, now, I criticize yours, Nathan.

        (Hopefully, you’ll take it ok.)

        Simply, you may need to do a better job of proof-reading your writing (or, find someone who can do this for you).

        Your sentences have a tendency to become terribly long and unwieldy. :)

        E.g., on May 29, 2012 at 1:33 pm, you wrote,

        “Though I have never had the experience of forced treatment (though members of my family have), when this mix of power, undue confidence, and lack of evidence of sufficient helpfulness is forced upon someones I can only imagine how disorienting, disempowering, humiliating, and frightening it could be. Dr. Moffic, you don’t have to agree with many other bloggers and commentators to have a voice here, but it is hard for people who have experienced harm by people who vowed to do no harm while calling their interventions helpful without the evidence to back it up and then being told that they lack the capacity to even differentiate help and harm to not be at least skeptical of people who have the same power of the people who they feel harmed them.”

        I had to stare at those two sentences of yours quite a long while, until finally I came to see that they made a whole lot of sense – (i.e., the content of what you are saying there is highly appreciated by me) – as this is probably what you meant:

        “I have never had the experience of forced treatment (though members of my family have); when this mix of power, undue confidence, and lack of evidence of sufficient helpfulness is forced upon [someone,] I can only imagine how disorienting, dis-empowering, humiliating, and frightening it could be.

        “Dr. Moffic, you don’t have to agree with many other bloggers and commentators to have a voice here [; but, some] people [have been seriously harmed] by [doctors (of psychiatry) – who,] like all doctors, […] vowed to do no harm while calling their interventions ‘helpful’ [– but] without [having] evidence to back [that] up. [These ‘patients’ were literally forced by such doctors, to become physically dependent on meds now proven to be more or less crippling in the long run; yet, from the start, they were being] told [by those same doctors,] that they lack the capacity to even differentiate help [from] harm).

        “[Therefore, it is hard for them] to not be at least skeptical of [doctors (such as yourself)] who [today wield] the same power [as those] who they feel harmed them.”

        I agree, Nathan. Indeed, it’s hard not be skeptical of doctors who wield that same power.

        But, moreover, I am increasingly inclined to emphasize, that one should, by all means warn friends and loved ones:

        Avoid any doctors who are, still, today, denying the overwhelmingly clear evidence (e.g., as presented in Robert Whitaker’s research), that our society has developed a vast and troubling penchant for accepting psychopharmacological treatments, which may be, many times (or most), unnecessary; for, truth be told, in the long run, such drugs are drastically reducing the average life-expectancy of millions of people, while spawning ‘epidemics’ of lifetime, iatrogenic (i.e., medically caused) mental, emotional and physical disabilities.

        • Jonah,

          I appreciate the criticism of my writing, and I assure you that you are not the first to notice I write really long sentences and don’t proof read so much. I like to think I can fit all sorts of clauses and ideas in one sentence, but as you say, they do end up becoming so unwieldy and hard to follow. Thank you for taking my writing seriously and engaging with it even though it is tough to get through. It is quite a compliment and means a lot. It reinforces that I should be more clear, concise, and better edited, and I will attempt to be more so in the future.

          I also appreciate your breakdown of what constitutes hateful speech. I agree that hateful speech comes down to malicious threat. I do see a lot of angry speech, some irreverent speech, attempts at critical engagement, deeply inquisitive speech, and some off topic posts (I’ll own those) on this forum. Anger, irreverence, and critical engagement have all been strategies to bridge gaps in understanding between people due to differences in power. It took me a long time to disentangle expression of anger from its connotations with hatefulness. I always thought that anger is separating, and by feeling and expressing anger I was experiencing disconnection and hatefulness. I did not want to be/seem hateful, because I know how bad it felt to be on the receiving end of hatefulness. I think people who are marginalized are discursively taught this so that they don’t make trouble to confront injustice and quietly petition for change instead.

          I have learned from organizing that as an interpersonal communication or political action strategy, anger has a lot of benefits. Anger can be used to get someone to stop talking long enough to listen. Anger can call attention to issues that have gone unattended or unheard. Anger is a signal that there has been a lot of hurt and frustration (to say the least) that will no longer be quietly tolerated. Anger can sometimes bridge the divisions of power so people who have been marginalized can be taken seriously. It is not always the most effective strategy (depending on your goals), but it is different from being hateful.

          Perhaps Dr. Moffic also conflates angry speech with hateful speech and judges hatefulness and anger the same way I used to. Maybe irreverence too is seen as overly disrespectful as opposed to cleverly illuminating. It seems that many posters (including myself) have been hurt by how things are in the mental health industry. They experienced feeling silenced or ignored when expressing that hurt to people who have power/authority to make some changes. They were treated disrespectfully by those people all the while the same people they demanded a much higher level of respect. Anger and irreverence are tools to flip or subvert the typical interactions between people who are marginalized and people with power. I guess people who use these strategies can be confused as threatening because they are not typical or expected ways people communicate.

          I suppose there could be more intentional geniality on MiA, but as I said previously, many here are mistrusting or skeptical of folks who share the power to (I like your word) dispossess them as the folks who did dispossess them. People can get friendlier, but like in any friendly relationship or friendship, that can take some time, patience, and engagement.

          Thanks again, Jonah.

          • Nathan,

            You’re welcome; and, thank you for your thoughtful reply. I deeply appreciate your take on the various ways expressed anger and irreverence can be creative in power struggles (and why these mustn’t be confused with hatred).

            My long ago encounters (i.e., consultations over two decades back) with psychiatrists taught me (amongst other things), that: though most psychiatrists are well-meaning, one should not expect them to appreciate anger.

            After all, none whom I met would relate to the kind of delayed teenage rebellion (at age 21), which led to my first “hospitalization”; rather, in a couple of years’ time, I met at least a dozen psychiatrists; all blindly accepted the diagnosis I was given after roughly two months of so-called “hospitalization” and heavy meds which, of course, by the end, made me into a completely subservient subject.

            I.e., these were not people prone to appreciating anger, in any way; meanwhile, I have long felt quite certain, that had I been introduced to a really good, seasoned therapist, who understood the creative aspects of anger, he would have taken the time to sit and listen to me (instead of listening, as my first psychiatrist did, to the panicked accounts of my family and friends – who were purely shaken and baffled by my suddenly rebellious actions).

            Note: Unlike my siblings, I was always referred to, by my mom, as “the easy kid”; at age 21, I had never before expressed any rebelliousness; but, at last, there I was – for various reasons (which still make perfectly good sense to me, today) – smashing a stack of plates, in my parents’ backyard.

            My first psychiatrist, the E.R. psychiatrist whom I was (naively) talked into visiting, the next morning, was only interested in one thing: finding a way to tag me with this (my first psychiatric label):

            “a danger to himself”

            The Emergency Room was the last place they should have taken me; had I been, on the contrary, introduced that day, to a really good/understanding therapist, I’m certain that, I could have established, then and thereafter: “hospitalization” was entirely unnecessary.

            Of course, a well managed ‘Open Dialogue’ meeting would have been no less ideal (and probably perfect).

            (Right now, I’m shaking my head, upon quietly figuring how much trouble that would have save me – and my family – in the long run.)

            Again, thank you for your very thoughtful reply.

            Sincerely,

            J.

        • P.S. – my third paragraph, above, should begin:

          “There was, in this particular thread of comments, one comment that was deleted by the moderator…”

          …my ultimate point there being: in fact, no threat – no “hateful” language – appears in this thread of comments, accompanying Mr. Moffic’s blog entry, nor do I find anything “hateful” on this site.

          Emphatically: I find it difficult to fathom Dr. Moffic’s extremely negative characterization of the tenor, of this (MiA) web site’s discussions.

          E.g., now I see he’s added, that, “These sorts of discussions won’t get psychiatrists to do better, I’m quite sure.”

          So, again, (as with my questioning the prognosis he offered, regarding his IOT “patient”), I wonder: what makes him so sure???

          Personally, I find these discussions illuminating, so I imagine many other readers do – including various psychiatrists.

          Maybe it’s worth noting: someone, in the comments, above offered the following link, to a May 24 psychiatrictimes.com blog post, by Dr. Ronald Pies, entitled, “Moving Beyond Hatred of Psychiatry: A Brave Voice Speaks Out”; and, Dr. Moffic offers his comment there.

          http://www.psychiatrictimes.com/blog/pies/content/article/10168/2076107

          I wonder if Dr. Moffic is confusing the tenor of a quote he sees featured there, with commentary which he finds here??

          For, there we find a tribute to a blogger who claims to have quoted someone, on the Internet, as saying, “I hate shrinks. Shrinks should die. Shrinks are evil.”

          Certainly, that line constitutes hateful language; but, there is no attribution for the quote; i.e., it may be fabricated out of thin air.

          And, even if it was posted somewhere, it bears not the least resemblance to any of the (often, extremely well-reasoned) critiques of psychiatry, which I’m reading here, in the comments of this (MiA) web site.

    • The issue in studies showing efficacy of psychiatric drugs is what is called “effective.” Psychiatry lacks markers of efficacy, just about anything can be called “success.”

      Steve Moffic, I’ve asked this question before: How can injured patients communicate their injuries to psychiatry in a way that the doctors will take them seriously?

      Is it possible, as Bob Whitaker posits, that harm — which psychiatry resolutely refuses to examine — may outweigh benefit?

      Why isn’t psychiatry interested in improving safety of treatment by analyzing where it goes wrong?

      Why doesn’t psychiatry have any mechanisms to review treatment failure?

      Aren’t these ethical issues in psychiatry?

  18. These sorts of discussions won’t get psychiatrists to do better, I’m quite sure. It is also presumptious to assume that psychiatrists haven’t suffered both professionally and personally (do you all not know how many of us have been diagnosed and treated with meds and therapy)? It actually seems that some of you want to take over what we do Is that ethical?

    Harm and benefit is quite complex and is being addressed. Most of our mistakes, if you will, has come from an intense desire to help, not control. We would listen more if the conversation was more respectful and compassionate. All you will get otherwise is psychiatrists who already agree with you.

    I would link the articles that shows how well we do, but I’m afraid they would be criticized anyways. Mr. Whitaker has done the field a great service, and the presentation I saw of his was excellent. I believe he wants the field to improve and does value short-term use of medications at least. We need to build on what he found, not destroy what is still valuable.

    • I believe everyone visiting this site is aware of claims of benefits. Except for those who were forced to do so, it’s those claims of benefits that got every single one of us to try psychiatric treatment.

      Is there any question that in the last 20 years those claims of benefits have been exaggerated and risks minimized by commercial interests in the medical literature and elsewhere? Wouldn’t you expect the fallout of such misinformation to be patient injury?

      (If you aren’t reading http://1boringoldman.com by former Emory psychiatrist Mickey Nardo, you should be.)

      Personally, I would like more measured discussion of issues and no name-calling, but I understand why some people visiting this site are enraged at the sight of a psychiatrist’s name. (New blog contributor Dr. Malika Burman, whose position is very different from yours, has also been attacked http://www.madinamerica.com/2012/05/holistic-psychiatrist-comes-out-of-hiding-2/ )

      Rightly or wrongly, this site is perceived as a place to vent the rage.

      Now to get back to my more central question: Exactly how is harm from psychiatric treatment being addressed by psychiatry? How is psychiatry gathering reports of injury?

    • Dr. Moffic,

      Thanks for continuing to engage. I have some responses to your response.

      “These sorts of discussions won’t get psychiatrists to do better, I’m quite sure.”

      It is not really a primary goal of mine for psychiatrists to do better. My goals are for more people to experience less distress and impairment in their lives and have the freedom and autonomy to meet their basic needs (and hopefully then some) with dignity. How psychiatrists will fit into that, I still don’t know. I would like to talk more about what our shared, more long-term, visioning goals are, so that we could change/design strategies to help us make those goals a reality. Psychiatrists may have a lot of good ideas and be in position to move change. You have had some interesting practical, reform goals yourself. My goals and your goals of “bettering” psychiatry don’t have to be mutually exclusive, but I certainly won’t compromise on pushing for my goals, however psychiatry plays into them or don’t.

      “It is also presumptious to assume that psychiatrists haven’t suffered both professionally and personally (do you all not know how many of us have been diagnosed and treated with meds and therapy)?”

      I never presumed psychiatrists have never suffered professionally and personality due to psychiatric distress and have participated in the same treatments they prescribe. Many I’m sure have struggled in treatments, experienced help/relief, or got worse. We don’t have all that many options in seeking help for distress, and psychiatric care is what often is available (or mandated).

      I do presume that psychiatrists occupy a privileged social role in which they experience societal prestige, no matter where they work can pull high incomes, are considered experts with deference, and have the power to define and treat people against their wishes. I know psychiatrists are people who are embedded in sociopolitical systems like everyone else and deal with all of the other -isms everyone else does and experience emotional distress. In regards to how mental health status is a regulating force in people’s lives, psychiatrists have tremendous power to define and coerce others, in fact their prestige and livelihoods depends on their perceived ability and confidence in doing so, and many people who interact with them (or the mental health industry) are oppressed (or fear oppression) in the process. I do think psychiatrists have to at least be wary of how mental health functions as a regulating system, their role in maintaining it, how they benefit and depend on it, and how they are also stifled by it. For example, I think the current discussions related to DSM5 are a good launching point for mapping some of the systemic/regulating factors of psychiatry.

      “We would listen more if the conversation was more respectful and compassionate. All you will get otherwise is psychiatrists who already agree with you.”

      Again, it is not anyone’s job here to handhold or gently walk people over to understanding. That can be an exhausting and thankless process, one that often leads to a lot of hopes being raised and dashed, and I’ve rarely seen it to be all that effective . I don’t believe I have much power in making anyone else want to listen more or not, I believe that is up to the listener’s desire to engage. I am willing to be and attempting to be as respectful and honest as I can.

      I agree that there is no place for intentional wounding just for its own sake. I also know many in this audience feel like they have been disrespected and treated inhumanely (as opposed to with respect and compassion). Sometimes you have to give some respect and compassion to get some, especially when entering the conversation/space from a privileged/dominant perspective. Coming to a conversation expecting such treatment is a sign of privilege itself, as many people who have interacted with the mental health industry as patients were not afforded such respect and compassion because of their marginalized status. I agree that it would be great if all people came to an interaction from a posture of compassion, but many (myself included) aren’t always in position to do so, and it will take work for all of us to get there.

      “I believe [Whitaker] wants the field to improve and does value short-term use of medications at least. We need to build on what he found, not destroy what is still valuable.”

      As you have also said, “Most of our mistakes, if you will, has come from an intense desire to help, not control.” I believe that. I just don’t judge people’s effectiveness or value on the intensity of their desire to help or not, but on the helpfulness or value that they engender. Regardless of your desire to help or control or not, many feel worse than helped and unjustly controlled, and the evidence of much what was considered helpful has not shown to be so, and many have suffered because of that.

      I think then it is the responsibility of psychiatrists if they want to build/reform psychiatric care as more valuable. It is also the responsibility of psychiatrists to honestly demonstrate the value of their care, as people have to utilize it for it to be of value. I will cite Whitaker’s response to criticism of his book by Dr. Daniel Carlat: “In medicine, those who provide a treatment are expected to have evidence that the treatment is safe and effective. That arises out of the “Do No Harm” principle. Thus, after 50 years, one might think that psychiatry could point to a clear line of evidence showing that its medications improve the long-term course of major mental disorders. But where is that evidence? Psychiatrists reviewing Anatomy of an Epidemic have sought to explain away the book, or criticize my interpretation of findings. However, the field should be able to lay out a very succinct rebuttal.”

      I would be happy to review newer evidence as it is developed. If psychiatrists want honest perspectives from past or would-be care utilizers as they rebuild/reform, even ones who have felt harmed by their participation in psychiatric care, it is up to them to seek out and listen to them (as you have done here) . Many here have made a lot of their perspectives known, it up to psychiatrists to try to understand or not.

  19. Since distinctions between hate speech, anger, sarcasm, etc. are often in the eyes and ears of the beholder, and at times even the courts can’t come to a conclusion on what is hate speech, I’m not going to try to answer that and take the time to find the numerous examples I’ve seen. What should be clear to everyone is that psychiatrists and psychiatry are not welcomed here by many unless they agree virtually completely with those who comment the most. Discussions do not seem to progress very far, and the main points often missed. For example, my main reason in presenting my speech at the APA was to answer a request here, but more importantly to suggest that human rights could be used to help improve things in health and mental healthcare. I also stated that this would not be in my usual writing style, so to bear with it (though some did not). I also do not review what is commented regularly and hence often do not get to answer individual quesitons timely.

    As to the Psychiatric Times blogs and comments, some comments were virtually immediately erased to Dr. Pies’ blog because they seemed quite hateful and similar to many posted here. I don’t many are even reading anything. As to my blogs there, picking out the ones you don’t like or the quotes you don’t like will be misleading to the overall thrust of my writings.

    Finally, the proof is in the pudding. How many psychiatrists do you see either blogging or commenting here? There is a reason, and the reason is not that they don’t want to hear constructive criticism. And, once again, I will remind all that many psychiatrists also become psychiatric patients and get the same treatment most patients receive. How do I know such things? From my multiple blogs, participation in multiple professional list-serves, and leadership positions in psychiatry

    • Steve M., some posting on MiA are taking advantage of anonymity and a permissive atmosphere to be snarky, as is common practice on the Internet.

      However, some of us are trying to have a dialog with you. My feeling is we are all blurring together into one big glob of irrational hostile patientry in your mind.

      You say “These sorts of discussions won’t get psychiatrists to do better, I’m quite sure.”

      As I’ve asked before, how can injured patients communicate treatment failure to psychiatry in a way that will enable psychiatrists to reduce injury and advance the field?

      What exactly is psychiatry doing to gather post-marketing data for the improvement of outcomes and patient safety?

      I do not see patient safety as a priority in any of new APA president Jeffrey Lieberman’s statements. Given the now widely recognized defects in psychiatry’s research base, due to 20 years of meddling by commercial interests, is not remediating patient safety psychiatry’s top ethical responsibility?

  20. I am sorry if my comments have come across as hateful. It was not my intention to do so. The point I am making is fundamental, though, and you don’t seem to be responding to it: this is NOT a question of whether psychiatric drugs can reduce symptoms of mental or emotional distress in the short term. We all know this can and does happen, and that some people need and want that service.

    The problem is that the “story” told to us of what psychiatry is doing is objectively not true. The idea that depression is caused by reduced serotonin levels has been disproved as far back as the early 1980s, as Bob accurately documents in the book. Same with the high dopamine theory of psychosis. I did a thorough literature search in 1990 and found no evidence of improved outcomes for long-term use of stimulants in ADHD. Over 20 years later, the news media has finally caught up and published this news, and nothing has been discovered in 20 years to alter my original conclusions.

    So let us admit what psychiatric drugs do: in the best case scenario, they cause a short-term remission of uncomfortable symptoms, by mechanisms that we don’t entirely understand. They do not treat specific “disorders” – they attack specific symptoms and sometimes make people feel a little better or behave less disruptively.

    As to what causes these symptoms, we need to be completely honest in admitting that WE DO NOT KNOW. In fact, we can not assume that a specific set of symptoms (such as the criteria for “ADHD” or “Depression” or “Schizophrenia” attempt to describe) are even caused by the same underlying situations. The DSM itself says this in its introduction, though nobody seems to read or abide by it.

    Until and unless psychiatry admits these two basic facts, we are not going to make much progress in the area of human rights. Because the right to informed consent is the most basic human right in medicine, which includes the right to decline treatment after a thorough and honest discussion of the pros and cons with a medical professional. How can this right be preserved if we are not honest with our patients about what we are offering them? Answer: we can’t.

    I’m sorry if that makes psychiatrists less likely to participate in these discussions, but it kind of makes my point for me – if the belief in the DSM diagnostic categories and the existence of chemical imbalances (which have been scientifically disproven) is required for psychiatrists to participate in large numbers, haven’t we stopped talking about science and drifted over into the realm of ideology? And how can we possibly have psychiatrists feel comfortable participating in this discussion without abandoning science ourselves? Isn’t that what Bob’s book is all about?

    I understand that facing this is very painful for the profession of psychiatry. But I don’t know any way to talk about it without having you and your profession face the hard fact that you have not been honest with yourselves or with the public about the science or lack of science involved in the DSM and in many treatment plans and protocols. If that’s hate speech, then I am guilty. I just don’t see any way to have this conversation without questioning the theoretical underpinnings that psychiatry has based its practice on for the last 30 years. It is not a question of whether psychiatric drugs help some people and hurt others – it is a question of whether we’re willing to really be honest with ourselves about what the science of the brain and the human mind is actually telling us.

    —- Steve

    • Steve the commenter:

      I resonate in accord, with 98% of all you’re saying here (on June 1, 2012 at 1:11 pm); also, I quite like your next comment (on June 1, 2012 at 4:54 pm).

      I’m in agreement with most nearly all that you’re saying.

      Though, I don’t know why you begin by addressing Dr. Moffic, “I am sorry if my comments have come across as hateful. It was not my intention…”

      I really do not know.

      After all, as mentioned previously (to Nathan, above): I don’t believe anyone has been, thus far, “hateful” in these comments.

      No one has been in this string of comments, at least; but, neither have I found ‘hatred’ elsewhere else, on this site (certainly not hatred of any person/s).

      But, some do hate psychiatry – because of how they feel they have been harmed by it.

      So, maybe Dr. Moffic reads hatred of psychiatry as “hateful language” and “hate speech”; but, as he is a mainstream psychiatrist now blogging on MiA, he must accept the challenge of engaging in discussions with numerous, fully awakened/informed survivors of psychiatric malpractice; naturally, some will be steamed by various aspects, of his mainstream views; and, probably, he’s not accustomed to responding, to such serious dissent.

      (Though, he may be getting the hang of it.)

      Perhaps, he will come to realize that the dissenters themselves are not necessarily in agreement with one another.

      And, Steve, with respect to what you’ve said today, I do strongly disagree, in one regard.

      I question your expression,

      “As to what causes these symptoms, we need to be completely honest in admitting that WE DO NOT KNOW.”

      To be perfectly frank, I will tell you: I bristle at reading that sentence.

      It’s a very common refrain, popular amongst many psychiatrists (and, many “patients” and “carers”);, it represents the ultimate deficit of understanding; and, of course, to not understand something (or, someone) is no crime; but, that deficit of understanding is *not* shared by one and all who engage in discussions of mental health.

      “As to what causes these symptoms, we need to be completely honest in admitting that WE DO NOT KNOW.”

      You mean well as you say that; it is your intent, there, to counteract the “chemical imbalance in the brain” nonsense that’s been debunked so well by Robert Whitaker and others; apparently, many psychiatrists have long known that theory is B.S.; and, you’re simply being honest, with this countervailing, “WE DO NOT KNOW.”

      That sentiment is spoken, most often, honestly, humbly; and, nonetheless, when it refers to ‘psychiatric symptomology,’ it typically reflect the speaker’s failure to *carefully/deeply* study the life of a “patient” (or, some number of “patients”) of mainstream psychiatry.

      Place that same “patient” (or, those same “patients”) in the light of wiser traditions, and you’ll find many (or, most) of his/her (their) mental and emotional sufferings are born of highly tangible causes.

      I.e., most sufferings commonly thought of, as so-called “symptomology” in psychiatry are anything but permanent mysteries, by nature; they can be DE-mystified; at least, that’s been my personal experience and observation over the course of this past more than twenty-five years.

      Truly, any effect I ever experienced, in terms of what was once called “psychiatric disorder,” has had causal roots in phenomena which I’ve come to fathom rather well; and, careful study of *many* other “patients” of psychiatry leads me to believe, that there are, in reality, very few so-called ‘psychiatric symptoms’ which are bound to remain endlessly mysterious, in the face of deep/careful scrutiny.

      Of course, there are vast, incomprehensible mysteries involved in all human experiences; but, I mean ‘proximal cause’ and/or the confluence of causes leading to supposed “psychiatric disorders” are knowable in most instances.

      Psychiatric ‘symptoms’ are the effects of knowable stressors, in nearly all instances.

      Unfortunately, mainstream psychiatry is a system that, for the most part, has long dedicated itself to the denial of such knowledge.

  21. To the other “Steve” et al,

    I don’t know many psychiatrists who ever believed the medications worked by restoring a chemical imbalance to serotonin or dopamine. That was just the best we thought we knew at the time, until we could understand the brain better. Maybe Mr. Whitaker has helped us along, but we are already investigating neurogenesis and epigenetics, and I’m sure that is only one or two other steps along the way of understanding. Those simple explanations were also a way of helping the public to have at least minimal understanding of what we were beginning to understand in the brain, tentative at best, wrong at worse. Furthermore, most all of us knew we were treating symptoms, not disorders. So-called antidepressants, a misnomer if there ever was one, effects many other emotions. Again, the best we could do at the time. Usually, we go for short-term relief, but when symptoms return, especially after 2 or 3 attempts at stopping, then medications tend to be longer term (and this has nothing to do with withdrawal).

    Beyond the medications, most of us know that at least as powerful influence of the medications is our relationships with patients, which in most studies accounts for 30% or more of the improvement when it is a good one. That is relevant here; if we can’t develop good and respectful relationships, I don’t think we will get very far with improving anythings. Ventilative relief, maybe.

    Finally, although our society is tending more and more to discredit so-called expertise, psychiatrists have some. When others presume to know more without the same kind of study, and especially without real-life relationships with patients, that seems worrisome to us, and not because we feel our authority is being usurped.

    • Steve M., I disagree with everything in your first paragraph, which makes the distinction between “what we knew” and “what we thought we knew.” I’ve read Ron Pies at length about this, and it seems like a wiggling out of having been hoodwinked (not to mention the lies told to patients about their conditions).

      But face-saving aside, now that we know what we thought we knew was not the whole story (and we still don’t know much more than what we thought we knew back then), psychiatrists are still prescribing according to the pseudo-knowledge of 10 years ago.

      What we do know (rather than what we think we know) and have always known in medicine is invasive treatment based on faulty research leads to patient injury.

      Now that psychiatry knows much of what it thought it knew was faulty, what is it doing to track and ameliorate the rate of patient injury based on bad information?

    • I agree with Alto that your first paragraph is kind of a wiggle out. You are saying that psychiatrists didn’t know much about how antidepressants work, but psychiatrists told the public that they did and confidently gave them a rationale. they knew antidepressants had all sorts of effects on people not related to depression, and they kept people on them despite having no indication for long term use (besides people start to feel worse when they don’t take them.). Even despite an abundance of evidence to the contrary, as Alto said, patients are still being told that they have chemical imbalances, that these drugs help rebalance and make them not depressed, that they will likely have to be on meds for a long time/life. That’s a big deal. If psychiatrists didn’t believe it, why were psychiatrists so ok with that becoming the narrative. Why are they ok maintaining it as the narrative (as it still is at the APA.) Epigenetics research is a similar medical sounding area of interest that I think is used to make lay people think they can’t possibly know anything near what a doctor does. However, epigenetic research in regards to mental health is still in its very infancy, and making claims about its use for theorizing disorder and application to treatment is at the most preliminary (and worst, bamboozling). Intentionally propagating false theories in hopes it connects people to care or in hopes that it will one day be truer is a way intense desires to help can be turned into a lot of unintended harm. Again, I am happy to review new research as it happens to build a case for new directions in care, but the past 20-30 years of pharmacotherapy research is tainted by all sorts of methodological and ethical problems (some of which you just described) for me to be nothing less than wary of it.

      I don’t have a problem with people using antidepressants as short term relief IF they are told the truth about what is known and not known about them and their use. I think that’s the big issue we are circling here. Perhaps a lot of use just had clinicians who were not good at informed consent and informed consent about psychiatric intervention varies between professionals, but if so, that isn’t good either. I think it is the responsibility of health professionals to show expertise by explaining what they actually know and what they have to learn more about, and support people in making decisions based on truly informed risk/benefits discussions.

      As for relationships/psychotherapy, Kirsch and Turner’s finding show depression reduction of antidepressant medications is primarily (80%) if not exclusively placebo. Again, not a problem as long as people are told (even if they are, people still often do experience short term relief, both from antidepressant and intentional placebos). Psychotherapy research is a whole other issue that I’m happy to talk about. Like drug research, I think that research is similarly biased, ideological, often poorly conducted, that state conclusions that don’t match the data collected. Psychotherapy actually research does a worse job at assessing risk and potential harms than the drug research, because at least in industry funded drug trials there is some regulatory responsibility to collect data on safety. These are some of the reasons I am on leave from social work school. The science is just too poor right now for I think people to ethically call themselves experts based off it and then collect large payments from individuals, government, and/or insurers for doing interventions in clinical situations that they cannot with much confidence predict successes and have little understanding of how to assess and deal with risk. I am impressed by the growing Evidence-Supported Treatment movement, the corresponding interest in potentially harmful treatments, and new research focusing more on therapeutic deterioration and harm. It just isn’t super robust yet.

      • Kinda, but not exactly, Nathan.

        It seems that Ron Pies had to choose between an embarrassing admission before all of medicine that psychiatry was fooled into believing the “chemical imbalance” theory versus looking bad about lying to patients.

        Rather than losing face to other doctors, he chose to argue that psychiatrists were smart enough to know the theory was a fallacy. Since so many of us have heard the lies, he couldn’t deny they’d been uttered, so he chose to explain the lie as an effort to make patients “feel better” about their condition, the reality being “too complicated” to express.

        Win-win for psychiatry! Saves face before medicine and throws patients under the bus!

        Problem is, none of this is true. There are quite a few psychiatrists who deeply believed the “chemical imbalance” theory; papers are still being published defending it.

        The misrepresentations to patients, however, continue.

  22. I appreciate your response and agree that the state of knowledge is always developing. However, even your reply still hangs on the assumption that these “mental disorders” are a result of something wrong with the brain of the “victim.” This is an assumption and not an established truth, and the DSM is built on this assumption and most psychiatric treatment relies on it as well.

    As an example, children with an “ADHD” diagnosis objectively do poorly in a standard classroom setting, and stimulants appear to make such a setting more tolerable to them and to make them more tolerable to the teacher. But good research in the 1970s showed that professionals could not tell these “ADHD” kids apart from “normal” kids when they were in an open classroom setting, while they stood out like sore thumbs in the regular classroom. So is the problem in the child? Or is it in the environment the child is being expected to conform to?

    The same reasoning could be followed for many other “mental disorders.” There are huge environmental variables, such as poverty, employment, religious affiliation, network of social support, relationships, parental bonding, childhood abuse, and on and on, that affect a person’s perception, feelings, and behavior, which are not accounted for in a purely biological or a purely descriptive diagnostic scheme. I work with foster kids. A lot of them are depressed and angry and anxious. Is this because they are “disordered” and need a brain revision? Or is it because they’ve been treated badly and are living in limbo wondering if anyone cares enough to raise them? Isn’t being angry, depressed and anxious a pretty “normal” reaction to this kind of stress?

    So it is the categorizing of people’s distress based on the assumption that all distress is “endogenous” and caused by faulty wiring or some physiological phenomenon that is at the root of our divergence. I see psychiatry following the wrong path because of operating on the assumption that any distress that a patient experiences is de facto proof that they have something the matter with them. I know that not everyone practices that way, but the DSM and current training and practice encourages this kind of thinking and frankly penalizes those who try to take a more holistic approach.

    So I’d like to see some acknowledgement that the diagnostic system itself is a big part of what is misleading psychiatrists and undermining our right to informed consent. If patients are hearing (and believe me, they are hearing this, I hear it all the time) that their suffering is due to some brain malfunction and that these drugs can cure or modify that malfunction, I would submit that they are being lied to. This is an assumption and not a scientific fact. The truth that I want to be told is that diagnoses are social constructions that we use to bill insurance companies, and that the fact that you fit the criteria for “Major Depressive Disorder” tells me very little about what’s wrong with you or what I need to do to help you, or what you can do to help yourself. That’s the big lie, and I haven’t heard you address that one yet.

    — Steve

  23. Maybe let’s look at the brain from a different angle. All that happens to us – food, stress, love,etc, – changes the brain. It is now impossible for us to see exactly how that happens. But we can see some things. We can see how the placebo effect and medication effects both overlap and differ. We can see the brain variations in those diagnosed with ADHD. We can see how psychotherapy can change the brain in those with obsessive-compulsion behavior. Etc.

    Terms like “chemical imbalance” have just been short-hand reflections of one level of what was thought to be happening at one time. Outdated now.

    The DSM is very flawed and there shouldn’t be a new edition until we understand the brain in much more sophistication, and in ways that could parallel what is known about something like diabetes.

    • Hey-Hey wrote:
      >We can see how the placebo effect and medication effects both overlap and differ.

      We can? Isn’t this a confound throughout medicine, researchers having a very hard time designing studies that clarify it?

      >We can see the brain variations in those diagnosed with ADHD.

      Really? You wouldn’t be referring to brain scans, would you? See http://www.danielbor.com/dilemma-weak-neuroimaging/

      Maybe it’s a normal developmental stage? Harold Koplewicz http://bigthink.com/ideas/24218 : “And in fact, most often, we see that hyperactivity disappears as someone gets older. And so when they’re in their late adolescence and early adulthood, that symptom seems to go away.”

      >Terms like “chemical imbalance” have just been short-hand reflections of one level of what was thought to be happening at one time. Outdated now.

      Certainly outdated, because it’s now highly public knowledge it’s been nonsense for 30 years. “Short-hand” for what? No biological theory of mental illness has gotten off the ground. Would it be short-hand for “we don’t really know, there’s a pony in here somewhere”?

Leave a Reply