Time to Abolish Psychiatric Diagnosis?

Lucy Johnstone

January 1, 2013

I am delighted and honoured to join the distinguished group of correspondents on this website. It gives me the chance to explore a theme that has pre-occupied me for many years  – how can we abolish DSM and psychiatric diagnosis, and what do we replace it with?

Readers will be aware of the huge amount of controversy about the forthcoming 5th edition of DSM, and I am proud that my professional body, the Division of Clinical Psychology (a sub-division of the British Psychological Society), played such a key part in triggering this debate. Its robust dismissal of every single one of the proposed new ‘disorders’ was not based on an extended critique of the inadequate field trials, links to the pharmaceutical industry, low reliability and lack of validity of the categories and so on, alarming though these aspects are. It was quite simply a refusal to accept that these so-called ‘disorders’ can be understood as medical illnesses analogous to cancer, diabetes and so on, and diagnosed and treated as such.

In the words of the official DCP/BPS response, drawn up by the past DCP Chair, Professor Peter Kinderman: ‘Clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences… but which do not reflect illnesses so much as normal individual variation… This misses the relational context of problems and the undeniable social causation of many such problems.’

We have known for a long time that terms such as ‘schizophrenia’ are scientifically meaningless. They are not actually ‘diagnoses’ in a medical sense, since they are not based on patterns of bodily symptoms or signs. Instead, the criteria consist of a ragbag of social judgements about people’s thoughts, feelings and behaviour.  The people who are so labelled may well have difficulties and be in urgent need of help, but this is not the way to help them.

In Biblical times, people were firmly convinced that disturbed or disturbing behaviour could be explained by the presence of evil spirits. No one could actually see them, but everyone knew they were there. We are equally convinced today by the explanation that extreme distress is a sign of, in effect, possession by entities such as ‘schizophrenia’. No one can detect the ‘biochemical imbalance’ or the ‘genetic vulnerability’ that would confirm its existence, but we just know that the ‘illness’ is lurking in there somewhere. Clearly, the reason people hear voices is because they have ‘schizophrenia’. And how do we know they have ‘schizophrenia’? Because they hear voices, of course!

For obvious reasons the DSM 5 debate has been most prominent in the USA, but it also received extensive coverage in the British press. Leading clinical psychologists such as Professor Richard Bentall speculated that ‘…the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.’ Professor Til Wykes warned:  ‘The proposals in DSM 5 are likely to shrink the pool of normality to a puddle.’ Professor David Pilgrim described DSM as ‘a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.’

Meanwhile, critical psychiatrists led by Dr Sami Timimi courageously submitted a petition to the Royal College of Psychiatrists urging the abolition of formal psychiatric diagnostic systems. Asked to comment on the subsequent minor revisions to DSM 5, I stated that ‘The DSM is wrong in principle, based as it is on re-defining a whole range of understandable reactions to life circumstances as “illnesses”, which then become a target for toxic medications heavily promoted by the pharmaceutical industry….The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.’

As we say in the UK, this is fighting talk. Journalists tell me that it has been very hard to find anyone to support DSM and provide the ‘balance’ that their articles require. Suddenly, few people are prepared to mount a strong defense of the current system. In fact there have been signs of disquiet and shifting positions for some time. For almost a hundred years, ‘schizophrenia’ has been ‘the prototypical psychiatric disease’ (Boyle 2002).  In the words of a British psychiatrist, ‘Without schizophrenia there would be no psychiatry’ (Holmes 2011); hence the enormous controversy that has surrounded its definition, aetiology and treatment since the term was coined. Recently, however, there has been some acknowledgement of the evidence for the role of trauma in severe emotional distress with the suggestions for new categories of ‘traumatic psychosis’ or ‘dissociative psychosis’ and so on.

Even biologically-minded psychiatrists are increasingly substituting the term ‘psychosis’ for ‘schizophrenia’  – although a moment’s thought shows that this vague and woolly concept is even less reliable than the one it replaces. In Britain we call this ‘shifting the goalposts’ – defending your position by changing the terms of the debate. But this manoeuvre won’t fool people forever. It is a sign of a paradigm under serious strain, and history tells us that the weight of evidence and public and professional opinion cannot be resisted indefinitely.

It is important to realise how much is at stake. Psychiatric diagnosis underpins the whole biomedically-based model of mental health. Any science needs to be able to demonstrate that it is based on a reliable and valid classification system, in order to develop testable hypotheses and hence the general laws that constitute a body of scientific knowledge. If this cannot be established, the whole model breaks down and all psychiatry’s other functions – indicating treatment, carrying out research and so on  – will be fundamentally undermined. In the words of Peter Breggin (1993), psychiatry would then become ‘something that is very hard to justify or defend – a medical specialty that does not treat medical illnesses.’ And, of course, numerous other personal, professional and business interests depend on the system as it is.

It is not hard to see why the debate about DSM is so heated. It is also not hard to see how fragile the foundations of psychiatric classification are. The disorders are, in effect, voted into existence, and the entire system only survives because a consensus of sufficient numbers of people is prepared to support it. As soon as we reach a tipping point where enough professionals and professional organisations are willing to join service users/survivors in admitting that the emperor has no clothes, it is at risk of collapsing in a heap.

‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong  – scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress.

We already have a situation where the strongest defence of DSM is: ‘We know it’s flawed, but it’s the best we have  – what could we do instead?’ The simple answer is, ‘Stop diagnosing people.’ This would at a stroke render redundant all the well-meaning but (as research shows) ineffective campaigns to reduce the stigma of ‘mental illness’. But faced with all the power and vested interests of the current system, we may need to describe alternatives in more detail. I have some ideas about what this might look like, and they draw on the theory and practice of psychological formulation. This will be the subject of my next post.

 

Boyle, M (2002) Schizophrenia: a scientific delusion: 2nd edn, New York, London: Routledge

Breggin, P (1993) Toxic psychiatry. London: Fontana

Holmes, J. (2011) Book review. British Journal of Psychiatry, 198:79

Lucy Johnstone

Beyond Psychiatric Diagnosis: Lucy will write about ongoing work to replace psychiatric diagnosis with a formulation-based approach whichexplores personal meaning within relational and social contexts. She will also reflect on the challenges of working within biomedically-based services.

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44 thoughts on “Time to Abolish Psychiatric Diagnosis?

    • I kept thinking those same three words – “YES! Just brilliant!” — until coming to the last sentences (which include that mysterious promise for more to come: “with all the power and vested interests of the current system, we may need to describe alternatives in more detail. I have some ideas about what this might look like…”); at that point, suddenly, I could not help but view the entire post as anything other than a nail-biting, prefatory cliff-hanger.

      While I deeply appreciate the author’s spirit of opposition, to psychiatric labeling (she’s clearly on the right track, that way; yes, indeed), and, while I see, from the context of her writing, we have every reason to feel quite confident, that, whatever she offers, in her next post, will be considerably more sensible than any of the ‘wisdom’ that’s provided, by DSM-wielding professionals, sadly, however, the bar for improvement is quite low, in those regards, as the nature of such psychiatric labeling is so extremely inane.

      Note prominently: American psychologists have their own, little-known diagnostic catalogs, which do NOT appeal to me. I own a copy of one of those manuals; browsing it makes me sick to my stomach. Surely, that’s due in large part to my long-time, perfect aversion to the DSM; the psychological manual is different, but it reminds me of that – and how it affected me…

      When in crisis, at age 21, my well-meaning parents, doing their best, at the time, to find me proper help, could do no better than hook me up with an Emergency Room psychiatrist, who was paid, in part, by their monthly insurance premiums. (I.e., he was employed by their ‘health maintenance organization’.) He administered his ‘care’ via DSM guidelines – such that I would be sent, against my will, from one psychiatrist, to the next – until the psychiatric “diagnoses” subsequently put upon me, by the ‘mental health’ branch of our family’s HMO, became nothing less than personally catastrophic markers, socially and professionally. In following years, though I would successfully extract myself from the grip of psychiatry, my life was left in nearly unrecognizable ruins; even now, my life is not nearly what it might have been (nor what I’d hoped it would be and what I know it could have been) had I been offered strictly non-medical therapy.

      Of course, I forgive my parents, their ignorance (they thought I was “ill”); and, I take responsibility for having acted out badly, one night, as a young man (throwing cheap plates at their garage door); my seemingly ‘crazy’ behavior was a mistake; but, I cannot look at my life today and help but be reminded of the damage done, to me (and to my family), in the name of psychiatric labeling. The ‘treatment’ that was put upon me was long ago has ended (gratefully) – but only because I saw fit to ‘run away’ from psychiatry; meanwhile, post-traumatic suffering and damages to my reputation surely persist.

      I am, thus, at the very least, now, fully determined, to speak out, in this way, that I am speaking out, here – for the sake of any would be unsuspecting ‘mental health care’ consumers: If/when you might ever voluntarily seek professional help for any stress-related and/or relational difficulties (or, when you may choose to seek help, toward overcoming unwanted habits) – or, when you seek any help of that general kind, for your kids –, do be absolutely certain, always, to define your issues on your own terms completely; i.e., NEVER hire any pro whom you know is inclined to provide ‘diagnoses’ for non-medical conditions. Psychological labels are hardly better than psychiatric labels.

      That warning is especially important, I feel, because, less and less is there any such thing as full privacy, in life, these days. We live in a time when any and every officially ‘diagnosed condition’ that’s associated with ones insurance company (HMO) pay-outs is increasingly accessible, via computers, the Internet, etc..

      At last, I say to anyone who may be willing to listen: Heed the expression *Caveat emptor* (“buyer beware”); before consulting with any licensed/clinical ‘mental health’ pro/s, think seriously of how you care to be known, by the world at large (and, how you wish your children to be known). I say deal only with pros who encourage people to define their own issues…

      (That being said, I do look forward – with genuine interest and curiosity – to reading the author’s next post.)

  1. Lucy Johnstone, you are my Hero!

    How exciting to read a professional write in very clear terms that psychiatric diagnosis are, to use an English turn of phrase, a pile of pants.

    I especially liked these two quotes:

    1 “We have known for a long time that terms such as ‘schizophrenia’ are scientifically meaningless”
    2 “In the words of a British psychiatrist, ‘Without schizophrenia there would be no psychiatry’ (Holmes 2011)”

    I shall put it in my Quotes to be used book straight away.

    May I say how much I have admired your work on investigating the damaging effects of ECT.

    I very much look forward to your article on psychological formulation as I suspect it will be another bit of demystifying common sense

  2. Hopefully, your excellent, poignant, fact based writing can find a mainstream publication so that the public is more informed. Psychiatry and clinical psychology, in the US, are economic institutions making a massive amount of money for their practitioners. Therein lies the resistance to your reasonable assessment, and the acquiescence and/or aggressive promotion of the DSM of many of the main stream to this ongoing human scourge of ruining individual lives with a diagnosis. I have attempted, for years, well nigh unsuccessfully, to argue for the delusional basis of main stream psychiatry and clinical psychology, relying on false beliefs to promote their business and apparent need to control.

    There needs to be a major revolution in the US to reject pseudoscience and return to what I learned in graduate school psychology was supposed to be, a healing profession, not an economic engine.
    Jasenn Zaejian
    http://relatedness.org

  3. Ms Johnstone,
    Your assistance in further helping the public is urgently requested. Bringing to light the fact that DSM processes have wrought havoc upon the public is but one step. Other steps need to be taken, such as helping voices of those outside the APA/DSM system be heard, and fixing some of the endemic problems created by it.
    Some colleagues and I have been waging a public information campaign since early 2012 to let those affected by the false epidemic of Bipolar (coutesy DSM 4) know about it — and to know about safer alternatives.
    Unsurprisingly since our approach requires no psych drugs, we have no sponsors, and since our approach has no clinical study trial study yet, most of the medical community [are trained to] reject it despite patient families and physicians testifying to the benefits they have experienced.

    We would welcome your call to report about this.

    Ralph Ankenman, M.D.
    Author, book and website: “Hope For The Violently Aggressive Child”

  4. This is an accurate and informative article but I find it somewhat amazing that anyone can write at length on this subject without referencing the work of Dr. Paula Caplan, who has been campaigning against psychiatric diagnosing and specifically the DSM for decades, often at great personal peril. Her recent work with the DSM9, where nine brave souls have filed formal grievances against the American Psychiatric Association for harm caused to them because of the DSM IV, is especially noteworthy and unreported. Others who have been harmed by diagnoses from the DSM can file complaints themselves with templates found at psychdiagnosis.weebly.com.

  5. Thanks for your work in this area. When my son was involuntarily hospitalized, the psychiatrists didn’t know what label to put on him so they just treated his symptoms. This made sense to me. Why do we need stigmatizing labels? Just help the person with their problems.

    • It doesn’t really make sense to me. Treating “symptoms” is like rewording psychiatry’s circular argumentation illustrated in Lucy Johnstone’s, BTW brilliant, article above as “Clearly, the reason people hear voices is because they have ‘schizophrenia’. And how do we know they have ‘schizophrenia’? Because they hear voices, of course!” as “Clearly, the reason people hear voices is because they hear voices. And how do we know they hear voices? Because they hear voices, of course!” If anything, that’s even more nonsensical than the article’s/psychiatry’s version of the statement, which at least pretends that there’s a cause and an effect. Doing away with the labels, while we keep thinking of people, their emotions, thinking, behavior as diseased, “symptomatic”, won’t end the stigma. Realizing that people’s emotions, thinking, and behavior aren’t “symptoms”, aren’t signs of some kind of underlying individual defect, but, like everybody else’s, perfectly healthy reactions to life, will.

      • “perfectly healthy reactions to life,” YES. My god, we need such a radical change in viewpoint, to the point where we see toxic CIRCUMSTANCES as unhealthy, not people’s natural reactions to them. A complete paradigm shift….

  6. Yes, thank you, nix the DSM. It is a socially divisive tool.

    This is where my journey to full recovery and healing began. I applied to my mental health issues what I learned from Carolyn Myss about Chakras and spiritual contracts, and it worked unambiguously. Took time, focus, and an open mind and heart, but it turned out to be the key to shifting how I perceived the relationship between spirit, mind and body. Led to balance, clarity and an entirely new and accessible relationship with myself, my mind, my body, and my life.

    http://www.myss.com/catalog/anatomy-of-the-spirit.htm

    http://www.youtube.com/playlist?list=PL79CB192D606982BD

    I don’t call it ‘alternative’ because I believe this is the, in reality, the core of healing. Certainly, it is an alternative to what we practice now, which it seems most of us agree is neither effective, informed, nor humane—in fact, it is not effective specifically because it is not humane, and, in fact, dehumanizing, ironically enough.

    I hope this information is as useful to others as it has been to me and to those in my practice. No need at all for DSM or anything like that, as this healing paradigm deems it completely irrelevant…

  7. Thanks for coming to write on this website. I wholly agree with the goal of abolishing the current system of diagnosis (especially in clinical practice), as too few doctors understand or care about the difference between reliability and validity, the side-effects of labeling are ignored, and circular explanations about pseudo-etiology are embarrassing (kudos for your writing wit in pointing that circularity).

    I hope that quest will be focused on moving away from the focus on explanations and root cause assumptions to move towards solutions and problem-solving.

    When there is no obvious way to establish etiology with confidence, the best is to acknowledge we don’t know (that explanations are too complex with too many factors for us to pretend to understand what happened, let alone to assign blame in a narrow fashion). It is better to focus on changing ourselves, and familial and societal dynamics rather than retrospectively explain how we got there (there is a difference between life narratives focusing on “objective” descriptions, and dubious explanatory “subjective” narratives).

    I do think that the need for explanations is often by itself a significant source of suffering and conflict, even when the explanations err on the side of psycho-social assumptions (traumatized is itself a label and could become an unhelpful lifelong diagnosis). Accepting that we cannot adequately explain the past or present is a first step in focusing our energy on improving the future.

    Whether problems are biological or psycho-social, we should focus on overcoming them. There is no reason to think that biology is harder to overcome than psycho-social problems, or that even when biology is likely a significant factor, drugs or other “biological” interventions are the only way to alter biological dynamics.

  8. Lucy,

    I very much appreciated your article “Time to Abolish Psychiatric Diagnosis?”

    I have been speaking and writing on these topics for decades, and it is especially gratifying to see the “movement” gather momentum.

    With regards to an alternative to “diagnosis,” my own suggestion, which I used for decades with clients, is simply to describe the problem behavior as specifically and accurately as possible, and preferably in the client’s own words.

    Once again, thanks for your insights, and best wishes.

    Philip Hickey, PhD
    http://behaviorismandmentalhealth.com/

  9. Excellent piece. You know Lucy it is inconceivable in the US that a division of the APA would take a stand against the medical model!

    I presume BPS is the American counterpart to the APA. “Medical” diagnosis is so integral to their identity–even psychologists–that they cannot see it critically. I am a renegade psychologist–I became unemployable in the public sector 20+ years ago because I took a position against psychiatric drugging. I had had post-doc training with leading family therapists. Authentic family therapists (with systemic non-linear perspective) consider labeling part of the problem. Unfortunately the AAMFT has also been coopted or else they would be speaking out against diagnosing.

    What you write is accurate and trenchant:”‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong – scientifically, professionally, and ethically.”

    Your implication is right also.Usually the diagnosers think they are performing a value-free assessment. The social consequences of the label ought to have demonstrated the absurdity of that claim but mental health professionals are so enthralled by their consensually-validated delusional system, that they cannot see what they are doing. Thus they could not see that they were–and still are–a priesthood persecuting heretics. This analogy may be less accurate with the pathologizing of entire populations.
    It might be interesting if you address that in your next paper:How has the pathologizing everyone changed the nature of mental health workers self-image.

    BTW I recommend you read my new book on the mad pride movement (it also includes my Laingian critique of society and view of madness as prophetic calling) The Spiritual Gift of Madness: The Failure of Psychiatry and the Rise of the Mad Pride Movement (Foreword by Kate Millett)
    http://www.amazon.com/The-Spiritual-Gift-Madness-Psychiatry/dp/159477448X/ref=sr_1_sc_1?ie=UTF8&qid=1357184432&sr=8-1-spell&keyw

    Szasz and Laing –and Foucault– showed years ago that psychiatric diagnosis was not a medical procedure. It was, in the words of Sarbin and Mancuso, a moral judgment. Although Szasz had attempted recently to discredit Laing (20 years after his death), their work actually complements each other. Szasz was more consistent and more thorough but Laing went further. Laing saw no reason to define maladjustment to an insane society as “mental health.” Both Szasz and Laing understood the centrality, in those days, of schizophrenia. Now as stated it may have changed with so many people being defined as depressed or bipolar.

    Also since you mentioned schizophrenia I cannot resist quoting Szasz’s trenchant, witty and insightful comments in Schizophrenia: The Sacred Symbol of Psychiatry
    “The symbol that most specifically characterizes psychiatrists as distinct group of doctors is schizophrenia and the ritual that does so most clearly is their diagnosing this disease in persons who do not want to be their patients….When a priest blesses water it becomes holy water—and thus becomes the carrier of the most beneficent powers. Similarly when a psychiatrist curses a person, he turns into a schizophrenic—and thus becomes the carrier of the most maleficent powers.
    Schizophrenia has become the Christ on the cross that psychiatrists worship and in whose name they march in the battle to reconquer reason from unreason, sanity from insanity; reverence toward it has become the mark of psychiatric orthodoxy, an irreverence toward it the mark of psychiatric heresy.”

    Seth Farber, Ph.D.
    http://www.sethHfarber.com

    • Thanks, and I am very pleased to make contact. I have ordered your book and will read it with interest. Szasz is a wonderful source of powerful quotes.

      In the UK, and I guess it is the same in the US, Laing has become almost a taboo figure – only mentioned in the context of the terrible crime of family-blaming that he (allegedly) committed. While it is certainly possible to make criticisms of the man and his methods, his central message, that madness has meaning, is still absolutely relevant. I look forward to reading your account.

  10. Lucy,

    Thanks so much for this piece! I have been speaking these same words to my fellow professionals and even fellow critics in the US for years, but have often felt like the lone voice in the wilderness.

    Many people protest the treatments of psychiatry without recognizing that the diagnostic system is the greater evil, the evil that makes is possible to continue to justify ineffective and destructive and even deadly interventions. Having a label allows us to blame the patient for their own distress and deny any form of social causation, allows us to invalidate their reality with impunity, and also allows us to excuse ourselves when our interventions don’t work or make things worse (you have “treatment resistant depression”). Not to mention allowing a lot of “professionals” and corporations to make obscene amounts of cash off a set of permanent “clients” who are unable to defend themselves or seek an alternative pathway.

    Remove the DSM diagnosis, and the entire edifice of thought comes tumbling down. I’m so looking forward to your next post!

    —- Steve

    • I agre 100% that diagnosis is the foundation and cornerstone of the whole system; nothing will fundamentally change unless or until we abandon it. A couple of favourite quotes that back up this view:

      ‘Diagnosis is the Holy Grail of psychiatry and the key to its legitimation’

      (Kovel J 1981 in D Ingleby ‘Critical Psychiatry’, Penguin.)

      ‘The critique of diagnosis is the critique of psychiatry….Diagnosis locates the parameters of normality and abnormality, demarcates the professional and institutional boundaries of the mental health system, and authorises psychiatry to label and deal with people on behalf of society at large’

      Brown P (1990) The name game. In J of Mind and Behaviour 11, 385-406.

      And another favourite quote, this time from Mary Boyle’s book ‘Schizophrenia: a scientific delusion?’ 2002

      ‘The crucial difference between medicine and psychiatry can perhaps be summarised by saying that whereas medical scientists study bodily functioning and describe patterns in it, psychiatrists behave as if they were studying bodily functioning and as if they had described patterns there, when in fact they are studying behaviour and have assumed – but not proved – that certain types of pattern will be found there.’

      In other words, psychiatrists are engaged in a kind of parody of legitimate medical practice – they use the same words and rituals but are actually doing something fundamentally different.

      Many of my favourite quotes are quite old… but alas, the same arguments still need to be made, and they have never been made better than by some of the earlier critics.

  11. “In Biblical times, people were firmly convinced that disturbed or disturbing behaviour could be explained by the presence of evil spirits. No one could actually see them, but everyone knew they were there. We are equally convinced today by the explanation that extreme distress is a sign of, in effect, possession by entities such as ‘schizophrenia’. No one can detect the ‘biochemical imbalance’ or the ‘genetic vulnerability’ that would confirm its existence, but we just know that the ‘illness’ is lurking in there somewhere. Clearly, the reason people hear voices is because they have ‘schizophrenia’. And how do we know they have ‘schizophrenia’? Because they hear voices, of course!”

    A wonderful essay Lucy, although I’m concerned with the statement “stop diagnosing people,” which does not attempt to explain why we feel that need? Is because we prefer to rationalize our internal motivations, by the obvious observation of responses as “effect” rather than aknowledge the reality of hidden “affects” and their transmission? Consider;

    “In a time when the popularity of genetic explanations for social behavior is increasing, the transmission of affect is a conceptual oddity. If transmission takes place and has effects on behavior, it is not genes that determine social life; it is the socially induced affect that changes our biology. The transmission of affect is not understood or studied because of the distance between the concept of transmission and the reigning modes of biological explanation. No one really knows how it happens, which may explain the reluctance to acknowledge its existence. But this reluctance, historically is only recent. The transmission of affect was once common knowledge; the concept faded from the history of scientific explanation as the individual, especially the biologically determined individual, came to the fore. (p, 1-2.)

    We think that the ideas or thoughts of a given subject has, are socially constructed, dependant on cultures, times, and social groups within them. Indeed, after Karl Marx, Karl Mannheim, Michel Foucault, and any social thinker worthy of the epithet “social,” it is difficult to think anything else. But if we accept that our thoughts are not entirely independent, we are peculiarly resistant to the idea that our emotions are not altogether our own. The taken-for-grantedness of the emotionally self-contained subject is a bastion of Eurocentrism in critical thinking, the belief in the superiority of one’s own worldview over that of other cultures. The idea that progress is a modernist and Western myth are nonetheless blind to the way that non-Western as well as premodern, preindustrial cultures assume that the person is not “affectively” contained.
    Notions of the transmission of affect are suspect as non-white and colonial cultures are suspect. (p, 2.)

    But the denial is not reasonable. The denial of transmission leads to inconsistencies in theories and therapies of the subjective state. All reputable schools of psychological theory assume that the subject is energetically and affectively self-contained. At the same time, psychologists working in clinics experience affective transmission. There are many psychological clinicians ( especially the followers of Melanie Klein) who believe they experience the affects of their clients directly. (p, 2.)”

    Excerpts from “The Transmission of Affect,” by Teresa Brennan.

    Of coarse the rationalizations of life as “cause & effect,’ holds the same need to deny our evoleved nature, just as denial forced a focus on otherworldy Gods & Demons in Biblical times? As Peter Levine points out;

    “However, there is an almost violent schism lurking in our cultural zeitgeist. Lets face it; the fight against evolution by the proponents of “creationism” and “intelligent design” is not really about professed gaps in the fossil records; its about whether or not we are basically animals. (p, 225)

    In fact, the word instinct is rarely found in modern psychological literature. Rather it is purged and replaced with terms such as drives, motivations and needs. While instincts are still routinely drawn upon to explain animal behaviors, we have somehow lost sight of how many human behavior patterns (though modifiable) are primal, automatic, universal and predictable. (p, 231)”

    Excerpts from “In an Unspoken Voice,” by Peter Levine.

    Certainly, there seems to be a great deal of confusion about two very similar words? Effect & Affect? Please consider;

    Madness & The Effects, of its Fear Affect?

    “There is nothing to fear but fear itself” _Franklin Roosevelt.

    A paraphrase of the line “Nothing is terrible except fear itself” by Sir Francis Bacon

    Is fear an Affect! With a contagious Effect?

    Is there an “unconscious,” fear of mad people?
    As if, Madness is Contagious?

    Two simple words, Affect & Effect? What exactly do they mean, and why do they cause so much confusion about the true nature of our mental health?

    Do we now understand the unconscious mechanisms of both fear, as an innate affect and our social need to deny the very existance of innate affects and the primary processes of the body. The body’s evolved nature and the foundational aspects of our self-preservation and therefore our instinctual-intelligence? Consider;

    “The body initiates and the mind follows. Hence “talking cures” that engage the intellect
    or even the emotions, do not reach deep enough.” _Peter Levine, Ph,D.

    It takes a momentary suspension of our normal reasoning, to imagine an unconscious nervous system, mediating much of our everyday social behaviors, as the evolved nervous system we share with all other mammals. As an evolved aid and defense of survival, mammals have an innate ability to feign death as a last ditch, instinct for survival. When there is no possibility of fight or flight, no possible means of escape from immediate and overwhelming threat, mammals escape into a simulated death state. (see: Madness & the Chaotic Energies of The Trauma Trap?)

    Humans share an evolved autonomic nervous system with other mammals, although evolutionarily adapted to our unique needs. If we imagine such human reactions as shock, fainting, freezing in fright or even in the sensations of acute embarrassment, when we feel that desire for the ground to open beneath us. It becomes possible to see a “continuum” of instinctual motivation, in our shared mammalian ability to feign death and the instinctual roots of mental illness, caused by “intellectually” denied, innate affects?

    Innate Affects & how they Effect, Madness & Mental Illness?
    Please consider;

    The Mental Illness Debate & The Nature of Madness?

    http://www.bipolarbatesy.blogspot.com.au/2012/12/madness-effects-of-its-fear-affect.html

    IMO We will abolish psychiatric diagnosis, when we face up to “what we are,” rather than run away from ourselves with a socialized sense-of-self built on the need to deny our evolved animal nature? What is an “affective disorder” like my own bipolar disorder type 1, if its not nature “acting out” just as so-called normality is?

    Consider more of Peter Levine’s realistic approach to trauma and so-called mental illness;

    “Trauma and Spirituality:
    In a lifetime of working with traumatized individuals, I have been struck by the intrinsic and wedded relationship between trauma and spirituality. With clients suffering from a daunting array of crippling symptoms, I have been privileged to witness profound and authentic transformations. Seemingly out of nowhere, unexpected “side effects” appeared as these individuals mastered the monstrous trauma symptoms that had haunted them-emotionally, physically and psychologically. Surprises included ecstatic joy, exquisite clarity, effortless focus and an all-embracing sense of oneness. (p, 347)

    “The life of feeling is that primordial region of the psyche that is most sensitive to the religious encounter. Belief or reason alone does nothing to move the soul; without feeling, religious meaning becomes a vacant intellectual exercise. This is why the most exuberant spiritual moments are emotionally laden.” _Carl Jung.

    At the right time, traumatized individuals are encouraged to and supported to feel and surrender into immobility/NDE states, states of profound surrender, which liberate these primordial archetypal energies, while integrating them into consciousness. In addition to the “awe-full” states of horror and terror appear to be connected to the transformative states such as awe, presence, timelessness and ecstasy. (p, 353)

    Excerpts from “In an Unspoken Voice,” by Peter Levine, PhD.

    Is time for us to grow up a little more, and accept that our social rank & status game, which defines the hierarchical responses of the sainted knights of the APA, is motivated by an instinctual-intelligence?

    But of coarse, we are NOT animals, are we?

    Best wishes,

    David Bates.

  12. We are at an interesting time in modern psychiatry. We are on the cusp of a real transition towards more biological basis of diagnosis but we are just not knowledgeable enough yet to really abandon the old ways. A big part of the problem is getting insurance coverage on things now requires DSM diagnosis so we are often erring on the side of caution using overly broad terminology because the decision has been made that over coverage is better than under coverage.

    I wrote a paper on this in grad school which can be found here: http://bit.ly/ZEzz5y

  13. Hello Lucy,

    I admire you for taking a strong political stance on this subject matter, its much needed. I do have two points to make.

    Im interested to know how you substantiate your position on the shift from schizophrenia to psychosis? You write

    “Even biologically-minded psychiatrists are increasingly substituting the term ‘psychosis’ for ‘schizophrenia’ – although a moment’s thought shows that this vague and woolly concept is even less reliable than the one it replaces. In Britain we call this ‘shifting the goalposts’ – defending your position by changing the terms of the debate.”

    It dont believe its a case of ‘shifting the goalposts’, rather I think its more a case of psychiatry conceding ground to the wins of the consumer movement. Most mental health professionals i’ve seen who perfer the term psychosis to schizophrenia do so because psychosis is about a transitory experience that one can have, and that can pass, rather than a label about a person. You can not say a person is psychosis. It does not make sense.

    My second point is simply: What do we replace it with?! This is a question that puzzel’s me. I dont agree with diagnosis, but what is a alternative?

    • Ah well, the last sentence of Lucy Johnstone’s article says,”But ……….., we may need to describe alternatives in more detail.I have some ideas about what this might look like, and they draw on the theory and practice of psychological formulation. This will be the subject of my next post.”

      Now I’ve read an article by Lucy Johnstone on psychological formulation and it beautifully describes some common sense ideas that can be used by a professional in a way that hopefully helps someone who is mentally distressed. So I’m looking forward to her next article on this website, as I hope you are too.

      The only problem I have is in understanding how it could be used to justify funding for services paid for by healthcare insurers/providers, but I don’t’ think it will be too difficult to work out some suitable assessment system. Preferably an assessment system that is also of benefit to the person who is distressed!

    • I’ve noticed the shift among mh professionals away from “schizophrenia” to “psychosis”, me too. Anyway, which hasn’t changed is the assumption that, whether it’s called “schizophrenia” or “psychosis”, it equals a chronic brain disease. People can’t be psychosis, no. But they can be psychotic. And that’s labelling the person.

      As to what to replace dehumanizing pseudo-medical terminology with, I haven’t read the article John Hogget mentions, so I don’t know if Lucy Johnstone maybe has an even better idea, but I like Loren Mosher’s suggestion: “Why not call it a severe personal emotional crisis? Or a severe psychological crisis?” ( http://www.moshersoteria.com/articles/after-all-these-years/ )

      • The shift to ‘psychosis’ is worth a post on its own – in fact I wrote a chapter about this very subject (‘Can traumatic events traumatise people?’ in ‘Demedicalising Misery, eds Rapley, Moncrieff and Dillon, 2011.) As with so many of the key terms in psychiatry, like ‘biopsychosocial’, it is used in a number of different senses, some of them narrower than others. But all usages convey the impression that the person is suffering from some kind of (probably) biological/medical condition OVER AND ABOVE A NORMAL REACTION TO THEIR LIFE EXPERIENCES. And that is the problem. Why do we make such an assumption, and is it justified? And what are the consequences of framing people’s experiences in this way? I will return to this issue….

        • Actually the central point I was making was more about the fact that language is changing, as a direct result of the consumer movements activity. What the ideals of a consumer-chosen language be was a side point to the positive idea that things are changing. Ground is being conceded, and the movement is changing things. We should be proud of that.

          • Maybe I’m too pessimistic, but while I do see change, I don’t see it happen in the mh system. Yes, they’ve eventually started to talk about “recovery”, for instance. They hardly talk about anything else these days. But how do they talk about it? What has “recovery” become to mean after they started to talk about it? Does it still mean being able to live without this thing called “mental illness”? Well, no, not in the mh system’s interpretation of the word. And actually I regard their colonization of the term even more dangerous than if they’d never started to use it in the first place. Because now, with them hardly ever talking about anything but recovery this and recovery that — “illness management recovery” is the latest fad in Denmark, OMG! — we can’t even ask them to start talking about it anymore. Because they already are talking about it, all the time. So, what more do we want?! I see the same problem with the mh system replacing the term “schizophrenia” with “psychosis”. Where does it actually get us that they replace the s-word with “psychosis” when what is meant remains the same?

          • I agree with Marian (B Goldstein) and think that real change will come without/outwith the psychiatric system. And the ‘psychosis’ label is very irritating, I preferred nervous breakdown, a more general term. So things, to my mind, are getting worse and not better.

            The psych drugs are worse now than the old ones were. The myriad psych labels, sticking like glue, written indelibly in our notes, to haunt us at inopportune moments. There’s a lot of talk about recovery, improvement, change but little actual doing of it.

            Grassroots activism is giving way to top down manoeuvring, giving a semblance of independence but is much more about control and power.

            And yet I am optimistic in the face of it, the hijacked recovery movement, the co-opting of activists, the embracing of government speak. For the psychiatric system has to change, it’s a failed paradigm that neuroscience can’t turn around. The biomedical model of mental illness is redundant and the tipping point is near.

  14. Hi Lucy,

    I got an email today with a link to this article: http://www.wilsonquarterly.com/article.cfm?aid=2196#.UOdW1gXGIzk.email

    or: Beyond the Brain by Tanya Marie Luhrmann

    I was delighted to find your name (which I had just been introduced to with your article here on MIA) as one of the comments:

    Diagnostic categories

    Agree that there are useful aspects of this article…but am bewildered by the author’s uncritical use of the term ‘schizophrenia’ as if it was a reliable and valid category, which it clearly is not. The points she makes are not about ‘schizophrenia’ . They are about certain types of (often but not always) distressing experiences such as hearing voices. ‘Schizophrenia’ is a concept that exists only in some people’s heads, rather like witches or devils – there are no objective confirming signs that can be detected by X ray, blood tests etc. Rather, there is a circular argument that runs: ‘Why does this person hear voices? Because they have schizophrenia. How do we know they have schizophrenia? Because they hear voices.’ Exactly the same logic convinced people in Biblical times that distress was caused by spirit possession. And while we are on the topic of language…. ‘anti-psychotic’ is a deeply misleading and inaccurate example of drug-company rhetoric, since these drugs have no specific effect on ‘psychosis’ at all – and nor was this even claimed when they were first introduced. If we cannot use language clearly and think logically, we will never achieve the paradigm shift that is needed in psychiatry.

    Posted by: Lucy Johnstone | 1/1/13

    I like how you get to the heart of the matter, but how do you know that the schizophrenic has schizophrenia? And furthermore, how does the anti-psychotic get rid of psychosis?

    Very good questions.

    I look forward to reading more of your work.

  15. From my experiences with ‘the mental health system’ I come to the following Recommendations:
    DEVISING EFFECTIVE TREATMENT PROTOCOLS FOR THOSE WITH MENTAL HEALTH ISSUES

    Our current treatment protocols for those exhibiting behaviors associated with having mental health issues are inadequate, and some claim abusive. New protocols are needed where respect for the individual is integrated into the process.
    In order that individuals obtain the best chance of recovery – and leading contented productive life, several changes to the system need to be implemented.
    1. Screen and treat individuals for trauma (numerous non-drug modalities are available, including somatic experiencing, Eye Movement Desensitization & Reprogramming, and others.
    2. Work with client to find out where he/she falls on the personality type grid utilized by the video series How To Deal With Difficult People (by Dr. Rick Brinkman & Dr. Rick Kurshner)
    3. Have client attend workshops on Non-Violent Communications – (the one by Marshall Rosenberg is excellent)
    4. Encourage Meditation
    5. Encourage perception shifting exercises: Cellular Memory Release -see Memory in the Cells by Luis Diaz-
    6. Utilize the Dali Lama’s method of transforming anger. (adapted from The Art of Happiness by the Dali Lama)
    7. Investigate the use of alternative therapies including Craniosacral Therapy and sound Therapy using tuning forks. Those who receive appropriate intervention early have the best chance of optimum recovery, yet nearly all should be able to make at least some recovery.
    8. Integrate the Recovery Oriented Practices by Larry Davidson, Ph.D. as recommend by SAMSHA.
    1. Screen and Treat Individuals for Trauma
    A history of Trauma is common in most, if not all individuals who experience emotional problems. The symptoms of trauma are quite similar to the symptoms lists of the DSM-IV – and soon to be released DSM-V. It is likely that successfully treating trauma would also
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    substantially reduce the symptoms which are the basis for the various designations in these manuals.
    Somatic Experiencing, devised by Peter Levine Ph.D. and explained in his book – Healing Trauma and Eye Movement Desensitization and Reprocessing (EMDR) are two methods which have been established as effective in treating trauma. There may be others as well. EMDR was developed for children, but also highly successful with adults, this method of treating trauma doesn’t require the patient to divulge information about the trauma. While the patient recalls the incident, the eyes are guided in a smooth pattern.
    2. Personality Grid
    The grid used by How to Deal with Difficult People is a simplified system which correlates where a person is on the grid to various types of difficult behavior.
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    Everyone falls someplace along the continuum from passive to aggressive. Likewise, everyone falls someplace along the line of being task oriented or people oriented. Those who have developed the skills to be near the center; as well as having the ability to change according to circumstances, tend to be well adjusted, generally having few problems dealing with people. Those who fall further away from the center tend to have more interpersonal problems.
    Each of these quadrants hat result represents a type of person strategy, or way of coping with conditions. Each has a positive intent as well as a number of difficult behaviors. Depending on where an individual falls on the grid when these two items are considered, various strengths as well as problems tend to occur.
    Ruler Quadrant
    Those in the Ruler quadrant believe the most important thing is to get the task at hand accomplished. They tend to be direct and to the point, decisive, confident, but needs control, and can become dictatorial, and may intimidate and alienate people by yelling, bullying, and arrogantly taking potshots at anyone – particularly when under stress. These people, often in positions of authority, can easily become ‘Tanks’ willing to roll over anyone they see as being in their way. The immediate short term goal is their only concern. Many individuals in this category are very knowledgeable in a certain field, yet they can become so habituated to doing things a certain way, they become closed minded to the benefits of doing things in a new or different way; Know-It-Alls. Another way individuals in this category can become difficult is when they turn into snipers. Snipers cut people down with snide remarks, use sarcasm and are disrespectful – often believing they are giving the person his or her just desserts from a perceived – or actual harm that was inflicted on them.
    Analyzer Quadrant
    Those in the Analyzer quadrant want to get things right. They are attentive to detail, systematic, accurate, factual, precise and organized. They can be indirect and detailed when speaking to others, as well as being stubborn, boring, aloof and unimaginative. They have a need for perfection, and can become silent, negative, fleeing or withdrawing under pressure.
    Analyzers can become chronic complainers, always presenting problems, but never a solution. They can also turn into ‘Nothing People’ where they never speak up, but are resentful of something. It can be a real challenge to figure out what is bothering them. Some can also only be positive about the negative; always saying something isn’t good enough, but never offering suggestions on how to make it better.
    Relater Quadrant
    Those in the Relater quadrant want to get along, and are agreeable, personable, friendly caring, and helpful. They are indirect and considerate, likeable, team players who are loyal, steadfast and patient; but also indecisive, gullible, waste time, passive aggressive, easily submits, accommodates to a fault, and puts things off – sometimes forever. Those in this quadrant are afraid to say either yes or no.
    Maybe is their strong suit. Someone might not be happy if they commit one way or another, so any decision gets put off. They can also become ‘Yes People’; saying yes to everything because that is what they think the person wants to hear. But saying yes doesn’t mean they will follow through. Passive enough to do nothing, nothing is typically accomplished.
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    Entertainer Quadrant
    The Entertainer wants to receive appreciation. They can be creative, warm, charismatic, and energetic. They tend to be direct, but elaborate when talking to others, can be persuasive, optimistic and have good verbal skills. Yet they can be egotistical, lack follow through, and be on the ‘flakey’ side. Under pressure they talk louder and faster, exaggerate, and throw tantrums.
    Some in the entertainer quadrant can become ‘Grenades’ – blowing up at unexpected moments whenever they believe their need for appreciation may be thwarted. Individuals in this category generally don’t have a great deal of in-depth knowledge about certain subjects, but that doesn’t prevent them from becoming ‘Think They-Know-It-Alls, claiming they do. They will parade as experts, but typically make their claims – and give solutions on scant evidence and poor logic
    This video series can be used as an aid during cognitive / cognitive behavior therapies to have clients better understand how these therapies can improve their quality of life.
    3. Non-Violent Communications
    Non-Violent Communication is founded on language and communication skills that strengthen our ability to remain human, even under trying conditions. It contains nothing new, but rather helps us reframe how we express ourselves and hear others. Instead of being habitual, automatic reactions, our words become conscious responses based firmly on an awareness of what we are perceiving, feeling and wanting. We are lead to express ourselves with honesty and clarity, while simultaneously paying others a respectful and empathic attention.
    4. Meditation Meditation has been proven to increase activity in the left pre-frontal cortex of the brain. Individuals with greater activity in the left pre-frontal cortex have been found to be happier and more content than those with a more active right pre-frontal cortex, who have been found to be more likely to display spontaneous anti-social behavior (anger, violence, and withdrawal).i While other benefits also accrue from meditation, this alone should be reason enough to encourage it.
    5. Perception Shifting Exercises Please see the attached information sheet
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    6. Transforming Anger
    Below is part of the coursework I put together while leading an anger group as a volunteer at NNAMHS. It is adapted from the book The Art of Happiness by the Dalia Lama, and I personally found it quite useful.
    Step one
    The first step is to write down what is making you angry. Take your time with this. If you have a lot of things making you angry, pick the one making you the angriest. If you find yourself getting angry as you write, take a break. Go out for a walk or do something you feel calming. Tell yourself, I’m addressing my anger, I’m working to resolve my anger Take the time you need. Then go back and continue writing. Write down all the details about it. When you think you’re done, ask yourself, Anything else? Write it down.
    Step two
    The second step is to ask yourself: Did I contribute anything to this situation? Write down all the contributions you made. It may be eighty percent of the situation, or it may only be one or two percent. Write it down. When you think you are done, ask yourself, “Anything else?” If you think of anything else, write it down.
    Step three
    The third step is to ask yourself, What was the other person’s perspective? Write it down. “What was the other person view of what happened?” Did that other person see some danger to themselves or one of their loved ones? What was the other person’s perspective? Was the other person doing the best he or she could? Write it down. Was the other person in over their head? Was the other person dealing with a new situation? Sometimes it isn’t a person you may be angry with. If you’re angry with God, ask yourself “What was God’s perspective?” Were you being given a challenge to overcome? Are you being requested to improve your life or the lives of others? If the answer feels right to you, it is the right answer.
    Step four
    Anger is a perceived injustice. If you have gotten this far and still feel anger, either you hid something from yourself along the way, or an injustice was done. Anger is also energy stored in the body. It will seek action. It is up to individuals to find ways to release this energy in a way that will benefit themselves and society. MOTHERS AGAINST DRUNK DRIVING (MADD) was formed by parents angry over the death or injury to a child, or other loved one. NAMI was formed by parents and family members who were angry over the lack of knowledge, treatments and care available to those of us with a mental illness. They have changed things. But, more work needs to be done.
    Write down what you can do to make things better for someone else who may be in a similar situation, and then do it.
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    7. Alternative Therapies
    On my recovery journey I utilized numerous alternative therapies. I found a number of these to be quite beneficial. The scientific research, for the most part has not yet been conducted. There are numerous reasons this has not yet happened. The two therapies I believe have the most potential to offer the greatest good in a relatively short time, at minimal cost are Craniosacral Therapy and Sound Therapy using tuning forks. Both of these therapies help to gently increase the flow of cranial-spinal fluid to the brain. I encourage research into these therapies, as well as into the entire range of alternative-complementary therapies.
    8. Integrate the Recovery Oriented Practices by Larry Davidson, Ph.D. as recommend by SAMSHA. Ten Things You Can Do to Be Recovery Oriented, Starting Today by Larry Davidson, Ph.D. For practitioners to fully embrace recovery, many changes are needed that require significant policy, program, and systems reform, which is why SAMHSA and other organizations are calling for a transformation of behavioral health care. However, the need for large-scale reform doesn’t mean behavioral health care providers cannot make important changes in their everyday practice while waiting for broader reform to take place. You’ll be surprised how small changes can make a big difference. Try these 10 steps with the people for whom you provide care. 1. Ask them how they would like to be referred to (first name, last name, nickname, etc.). Refer to them as people, not as diagnoses or disorders. Although doing so may initially seem unnecessary or awkward (e.g., referring to someone as “a woman with schizophrenia” or “a man with an opiate addiction”), talking—and even more important, thinking—about people as “schizophrenics” or “addicts” is disrespectful and not in line with recovery-oriented practice. 2. Ask if there is anything you can do to help them feel more comfortable during your time together. 3. Encourage them to ask questions about the care you or others are providing. To facilitate this question-and-answer exchange, inform them of your treatment plans before taking action (e.g., “Now I’m going to ask you a few questions about …” or “I need to get some information from you so I can …” or “I’d like to set up our next appointment, but first I want to see if you …”). This will allow them to prepare and pose questions at an appropriate time.
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    4. Enhance your service setting so it is dignified and conveys hope and compassion. Decorate the space with art and furniture and play music (if appropriate) that is appealing and culturally meaningful to the people for whom you provide care. Within the limits of your available resources, make the space one you also enjoy coming to every day. Pay particular attention to waiting areas and restrooms. 5. Eliminate artificial and unnecessary rules. These rules have typically been in place for a long time, whether for staff convenience (e.g., “towel hours” in inpatient units) or as a result of stigma. If rules are necessary, involve your patients in their development and communicate the reasons why they are needed to staff and patients. 6. Do not make rules to control patients’ behavior. These restrictions, which are often based on negative stereotypes about people with behavioral health conditions, can result in discriminatory practices that impede recovery. Examples include using “privilege” systems in inpatient units or residential programs, making access to resources contingent on treatment adherence (e.g., “I won’t refer you to supported employment until you take your meds for three months”), and attempting to control what people who are receiving care can and cannot do outside of treatment (e.g., “there can be no contact between group members outside of the group”). 7. Be mindful that the majority of people with behavioral health conditions have a history of trauma. Therefore, when conducting intake interviews, exploring psychosocial histories, and developing care plans, remember to ask people what helps them get through difficult times (e.g., spirituality), what would help them feel safe in your care, and whether or not they feel comfortable discussing their sexuality with you, as all three issues are pervasive human concerns that have been relatively neglected by behavioral health practitioners in the past. 8. Ask them if they know anyone who has recovered from or is in recovery from a behavioral health condition. If they don’t, offer to introduce them to people who have (or provide DVDs with relevant recovery narratives).
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    9. When conducting team rounds, case conferences, or discussions about patient care in which the individual receiving care cannot participate, have at least one person assume the role of the patient/client. Ask that person to try his or her best to represent the patient/client perspective in the discussion. This strategy was first suggested more than a decade ago by Ken Thompson, M.D., when he asked staff to refer to a patient/client they wanted to discuss by using the first name of a staff person in the room. So instead of discussing the case of Mr. or Ms. X, they would discuss Ken’s situation, and the care they were offering him. If this is not feasible, use your imagination to put yourself or a loved one in the person’s place and consider the discussion from his or her point of view. For example, ask yourself: “What would I want from this group if I was in the patient’s/client’s situation?” or “How would I feel about this discussion if we were talking about my son, daughter, spouse, or sibling?” If you already practice these nine things, try this final suggestion: 10. Ask the people for whom you provide care and their loved ones what you can do to better help them, or how you can improve the quality of your care. They will undoubtedly have ideas. After you’ve tried these suggestions, share your positive (or negative) experiences with RTP and its readers by submitting your stories to [email protected]. Dr. Davidson is the RTP Project Director.
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    10
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    i Destructive Emotions: How Can We Overcome Them? A Scientific Dialogue with the Dalai Lama Narrated by Daniel Goleman (pgs. 334-346); The Benefits of Meditation, Psychology today, (April 1, 2003) Colin Allen; Growing the Brain through Meditation, On The Brain: The Harvard Mahoney Neuroscience Institute Letter, Fall 2006, Vol. 12 No. 3

  16. There is no legal power behind the word / term used to identify what psychiatry does, which is ‘label’. But if you change the vow..el and specify that what psychiatry does is libel, you’ve just acquired power, legally.

  17. I am a young Polish sociologist and university lecturer recently diagnosed with “paranoid schizophrenia”. I am so happy to have come across Mad in America website. In my country, biopsychiatry is so powerful that many people with diagnosed schizophrenia believe that they must be on neuroleptics until the end of their lives. The fact that I came off neuroleptics is regarded by many as a dangerous “experiment” !

    When I told a psychiatrist (a guy with a PhD and supposedly a specialist in schizophrenia) that I wanted to come off neuroleptics, he told me that I was highly likely to develop “drug-resistant psychosis” and ECT might be the only solution. Fortunately, the doctor did not manage to frighten me into “compliance”. All the psychiatrists I have come across kept repeating that I had to take neuroleptics for “at least” 2 years.

    I have been having increasing doubts as to my diagnosis since the very beginning. I have been diagnosed with schizophrenia after only one episode of “psychosis” which lasted a month and was caused by strong emotional distress (but this did not interest the psychiatrists …).

    A recent Polish article has simply shocked me. Since 2007, schizophrenia has been more and more frequently diagnosed in Poland. The psychiatrist Andrzej Kiejna from the Medical University in Wroclaw, one of the largest Polish cities, believes that schizophrenia is now more frequently diagnosed because (due to changes in the Polish health care system) if a psychiatrist diagnoses another mental health problem, the diagnosed person has to pay a much higher price for neuroleptics.

    How outrageous ! Who knows, maybe I, too, have been diagnosed with schizophrenia only because psychiatrists wanted me to have easier access to “medication” … And there are, sadly, plenty of Polish people who firmly believe that they suffer from an incurable mental illness and have to take neuroleptics in order to be able to lead a normal life.

  18. I’m definitely in favour of formulation as I’ve always wanted to be able to explain mental distress/madness in plain English because there’s nothing which cannot be described in ordinary language of a person’s choosing, so it might mean a whole sentence or paragraph instead of a single word to describe a person’s distress, that’s great by my reckoning. Anything which moves away from any model which reduces [and that’s not only the medical model].
    The big problem of course is that diagnosis is entwined with all health and social care financial and administrative systems, so the separation of these whilst ensuring those who need housing, income, personal support get it, from getting it without a clinical diagnosis is going to be the major problem politically.

  19. People don’t understand the weight of a diagnosis. I can only do so in retrospect even though I was diagnosed at 13, I didn’t really understand until I was in my thirties. The change in the language of the mediator during my divorce after I noted that I was bipolar. My ex “stated” things. I “claimed” them. It was enough to award full custody of our children to my husband, and when he became vengeful, to tie up the courts for six years that I was not allowed to see them. The biggest realization for me was when I was 27. That was when I realized not everyone has perfect pitch. Since I was 4, I taught myself to play music by ear on multiple instruments and could play back pieces after hearing them. You see, I was Bipolar. I was a problem. My mother thought lessons would be wasted on me so I never realized it was special. I also never did anything with it. The finale was three semesters from graduating pre-law and 40k in loans when I was advised I would never be allowed to sit the BAR. In fact, as I struggled to accept this, I found that I could not even be certified by the state in any profession due to my past. That was I realized the doors had closed all those years ago, and I was simply hearing the echo.

  20. I think labeling is just the surface of a bigger deeper problem, and that problem is the problem of forced treatment. In a free society, where free speech matters, you are not going to abolish name calling. However, if you take away a person’s freedom, you really have done that person a wrong. I think the call to abolish psychiatric labeling as being a diversion from the more serious reality of forced treatment. It doesn’t matter what a person calls you unless they can use that word, label, name, what have you, to take away your freedom. In a total institution, you are not in a free society, you are in a totalitarian system. I think that this concession to tyranny, forced treatment, is wrong, and that it should be abolished. As for name calling, we’ve got a sticks and stones jingle for that. Nobody should be able to take away the freedom of another person because they’ve decided to call that person a name, but it’s not the name, it’s the force that is the matter. Otherwise, it’s just a matter of using other words with other meanings. I say abolish forced treatment. As for free speech, I’m still good with it, even where it is used by medical model psychiatrists. I found my tongue long ago as far as they are concerned. Nothing is going to prevent me from talking back to psychiatry.

    • “In a free society, where free speech matters, you are not going to abolish name calling.”

      Actually, it isn’t a matter of free speech. Nobody has the right to verbally assault and attack. But people have normalized verbal abuse and made it socially acceptable.

      Idiots.

      See? I’m not calling you an idiot, I’m exampling. It isn’t an act of free speech. It is an absolute VIOLATION of free speech.

    • Forced treatment is a serious issue but it is only one issue. I’m glad you found your tongue a long time ago Frank, and I’m always pleased to find others who do so too, but many haven’t and have swallowed the psychiatric propaganda whole.

      Psychiatry is dangerous for several reasons, one being the medicalization of distress. Forced treatment does not cover the issue of people choosing to take serious drugs in the hope they will help them and it does not cover the issue of people in the community taking psychiatric drugs by choice for decades and the issues that drove them mad never being addressed by services. It might not cover children, mainly boys, being given Ritalin, though that is a kind of forced treatment as children have so little power.

      As the women says, this is a multi-level struggle, and if some professionals can blunt the power of psychiatry just a little bit by seriously challenging diagnosis then I welcome it. I for one value her freedom to say it. In her own way she is talking back to psychiatry and for a while got national media coverage.

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