The “Mental Illness” Paradigm:
An “Illness” That is out of Control

Paris Williams, Ph.D

May 2, 2013

For those of you who haven’t read this recent story in the New York Times, I highly recommend it. It is essentially a woman’s (Linda Logan’s) rich and moving autobiographical account of her struggle with “bipolar disorder.” The main message that I imagine most people will take away from this story is that the current mental health care system has some real problems — especially with regard to the often cold and dehumanizing way that “patients” are treated—but that the general paradigm from which this treatment model has emerged is simply not to be questioned. In other words, Linda has clearly adopted the “mental illness as a lifelong brain disease” paradigm and has personally identified as someone who has such a “mental illness.”

Anyone who knows my work will know that I have a real problem with this paradigm, believing that it generally causes much more harm than benefit (though I don’t discount that some people do believe that they experience some benefit from it). So, what is it then about this story that grabbed me? I recognized that if we read Linda’s story while holding a different paradigm (i.e., a different basic set of assumptions) than what she intended, then this story reveals in plain sight what I believe are some of the most fundamental issues at the heart of this epidemic of “mental illness” that so pervades our society.

What is this basic shift of assumptions? Linda clearly frames her story within the “mental illness as a lifelong brain disease” paradigm (what I’ll refer to simply as the “mental illness” paradigm). What if we shift to a significantly different and in many ways more “common sense” paradigm? What if we let go of the concept of “mental illness” altogether and adopt a very different set of assumptions: (a) Human beings (and indeed all living organisms) strive continuously towards a healthy, enjoyable existence; (b) moving towards and maintaining such an existence requires that we find relative peace with certain dilemmas that are inherent within our existence (e.g., death, loss, personal identity, balancing autonomy and relationship, balancing freedom and security, finding meaning, etc.);  (c) the more difficulty we have in finding relative peace with these dilemmas, the more we suffer; and finally (d) some individuals, for various reasons and at different points in their lives, are particularly vulnerable/sensitive/aware of/challenged by these dilemmas and are therefore more prone to experiencing intense suffering associated with them. In other words, I’m suggesting that we return to Linda’s story after trying on a different lens—one that allows us to see those conditions we generally refer to as “mental illnesses” as instead the natural manifestations of an individual’s struggles with the fundamental dilemmas inherent in simply being alive. So we make the shift from a “mental illness” paradigm to an “overwhelmed by natural human experience” paradigm. What I find particularly interesting about Linda’s story is that she’s clearly narrating it from the “mental illness” paradigm, and yet allusions to this latter paradigm are practically bursting through the seams.

So with this paradigm shift in mind, let’s look more closely at some of the overarching themes in Linda’s story and compare just how different the methods of support and outcomes are likely to be when acting from each of these different paradigms.

The “mental illness” paradigm creates a self fulfilling prophecy of actual brain disease:  Linda gives a rich account of a descent into increasingly overwhelming thoughts, feelings and perceptions, and she provides an equally rich account of the intensive psychiatric “treatment” she received in parallel with this descent. This journey into increasing disability began with a blend of feeling overwhelmed by the life she had created for herself (giving birth to 3 children while simultaneously pursuing a Ph.D.) and powerful existential insights, especially into personal identity, death, and loss. Feeling overwhelmed by the intense “psychic pain” associated with all of this, she turned to the only support mainstream society really encourages for this kind of thing—she accepted that she had a “mental illness” and checked herself into a psychiatric hospital.

From this point forward, we learn that two major streams of events play out in parallel with each other—Linda surrenders her mind and body to doctors who “experimented with about 100 different combinations and dosages of medications,” becoming essentially a living test tube in their hands; and she experiences a downward slide into increasing physical and mental disability and even periods of florid psychosis (profound disconnection from consensus reality). And yet, incredibly, Linda never draws a link between these two—the intensive drugging on the one hand, and the increasing disability and chaos on the other. She does describe some disturbing “side effects” of various drugs, but she has clearly bought the mainstream narrative that all of her overwhelming experiences were merely symptoms of her “illness,” and that even though there are some unpleasant “side effects” to all the drugs she’s been given, they almost certainly prevented her from becoming much more “ill.” In other words, the possibility that the intensive drugging itself may have seriously worsened her condition doesn’t even seem to be a consideration.

Let’s take a moment here and look at the research. Robert Whitaker (in Anatomy of an Epidemic) and others have compiled extensive literature reviews suggesting that the kinds of chronic “depression” and “bipolar disorder” that we see today were apparently much rarer before the introduction of psychiatric drugs. What we call “depression” was apparently transient in the large majority of cases, with “relapses” were also relatively rare. And the more extreme forms of “bipolar disorder” that seem to be so prevalent today were also much more rare. The prevalence of such disabling bipolar disorder was seen only 1 of 5,000 to 20,000 individuals prior to the introduction of psychopharmacology, with 75% to 90% of these individuals going on to experience “good long-term functional outcomes.” And now? We find that 1 in 20 to 50 individuals experiences such disabling bipolar disorder, with one 33% going on to experience “good long-term functional outcomes.” This is an increase of between 100 and 1,000 times the prevalence rate since the introduction of psychopharmacology, and among these individuals, a greatly reduced likelihood of full recovery. In addition, it’s been shown that the use of antipsychotics can ironically increase the likelihood that someone will experience psychosis in the first place or move from a transient psychotic condition to a more chronic course (this is discussed in Whitaker’s Anatomy of an Epidemic and in my own book, Rethinking Madness).

So, knowing all of this (this research comes from multiple peer-reviewed sources and is readily available), how can someone as educated as Linda not even entertain the idea that the “treatment” itself, which most likely included all of the aforementioned types of psychiatric drugs and more, may very well have played a major role in the radical deterioration of her condition?  “100 different combinations and dosages of medications,” she said. Think about that for a moment. By acting from this entirely unfounded assumption that Linda and others who experience such crises must have some kind of brain disease, we attempt to “treat” the brain, which is of course absurd since we don’t even know what the heck it is that we’re treating. So we flood an individual’s brain with an array of highly toxic chemicals designed to make it through the brain’s natural blood-brain barrier and impact this extraordinarily complex and fragile organ in a ridiculously blunt and haphazard manner, and we call this “treatment.” Can we really be surprised that such treatment so often results in converting natural and transient crises into lifelong chronic “illnesses”? The terrible irony is that while it seems very likely that such crises are not the manifestation of a lifelong brain disease, the standard “treatment” actually ensures that this fantasy becomes a reality. After receiving such treatment, there’s is no longer any question about it: Now, you do have a chronic brain disease.

Actually, I don’t blame Linda for not making this connection. The tragic truth is that our society has become so entrenched in the “mental illness” paradigm that many (and perhaps most) people now consider alternative perspectives a kind of ignorant quackery. And yet, if we do make this little shift in perspective, moving away from the “mental illness” paradigm to the “overwhelmed by natural human experience” paradigm, I can’t help but wonder just how much more easeful and enjoyable Linda’s and many others’ lives may have been…  just how clear the absurdity of such treatment would become to anyone who took the time to consider it…  just how much more frequently people would stand up to such treatment and say enough is enough…  just how much rarer stories of such devastating demoralization, dehumanization, and intoxication would become.

So, if we act from this different paradigm that I’m presenting here, then how do we go about offering alternative support for someone who is in so much “psychic pain” that they’re seriously considering taking their own life (as was the case for Linda) or possibly even causing serious harm to someone else. Well, the current m.o. is to apply the kind of “treatment” that Linda received—a person overwhelmed by feelings of hopelessness and powerlessness reaches out for support, and what do they get? They’re stripped of any last remnants of hope and self-empowerment and provided with a new set of problems in the form of substance dependence and the particularly disempowering “mental illness” paradigm as a means for making sense of their troubles.

I admire Linda for recognizing her potential for self harm and finding the courage to reach out for support, and yet just imagine if she had a very different kind of support available to her—the kind of 24-hour “suicide watch” support she felt she needed but without all the dehumanizing, disempowering and intoxicating baggage that generally comes along with this. This is not a difficult thing for our society to make readily available—we already have successful models of peer-run residential homes and other types of homes that could function in this way (such as Soteria-style homes), and families and friends themselves could offer such support to loved ones in times of need. The cost of providing such places of refuge is certainly much less than the cost of psychiatric hospitalization—there are simply no excuses as to why we don’t have such places of refuge set up in every community and readily available to anyone who needs them.

And what about other kinds of support? Well, if we operate from the “overwhelmed by natural experiences” paradigm and recognize the innate wisdom within all beings that continuously strives for health and wholeness, then we can let go of the “I’m an expert, I’ll take over and fix it” role and instead explore ways to support the person’s own inner resources and honour their own wisdom and self agency. This is akin to supporting the growth of a plant. We can’t force a plant to grow or even to heal, but what we can do is provide it with healthy soil, adequate water and sunlight, and then stand back and trust in its own innate wisdom. Likewise, when a person is in distress, we can work collaboratively with that person and explore the ways that this person may not be receiving adequate nourishment, and look for potential “toxins” in their environment that may be restricting their growth. And along with this, we don’t attempt to reduce their distress to problems in any one realm but recognize that many different realms work together to contribute to the wellbeing or distress of an organism—psychological, physiological, relational, environmental, spiritual, etc.

And who knows, there may be occasions where some psychoactive chemicals may provide some benefit, but rather than pretending to “correct a biochemical imbalance,” we name the drugs for what they really are—not “anxiolytic” or “anti-anxiety” medication but drugs that will numb you out for a while, maybe help you sleep; not “antipsychotic” medication or “mood stabilizers” but drugs that will tranquilize you and really numb you out and make it difficult to remember what your problem was (perhaps); and not “antidepressants” but… well… uh… occasionally effective placebos(?) Let’s face it. Drugs are drugs, whether illicit drugs or psychiatric drugs. And what have drugs been shown to do time and time again? When effective, drugs provide some degree of short term relief and benefit but nearly always at the expense of significant long term harm. Sometimes that short term benefit may seem to be worth it, but let’s be honest with ourselves and not forget to look at the big picture.

The “mental illness” paradigm interferes with our own natural resources and innate movement towards healing and growth:  Linda’s story comes across to me as yet one more example (an excellent example, actually) of a person who experienced a natural though clearly precarious existential crisis—something that seems to be a hazard that goes along with being particularly sensitive and open in the midst of the “madness” of contemporary society. In her case, the existential dilemmas associated with death, loss, meaning, and personal identity appear to have been particularly potent.

The literature throughout human history is loaded with accounts of people who go through such crises as a gateway into a profound positive transformation and a much richer, more meaningful and more enjoyable life; and it’s also loaded with accounts of people who have a very difficult time integrating these profound truths and who go on to suffer greatly as a result of it. And when we look closer at this literature, we find that certain models for understanding these experiences are more conducive to successful integration than others. In particular, honouring the deeper truths that are so often unearthed within such crises and acknowledging the potential for positive transformation resulting from them has clearly led to much better outcomes in general than perceiving such crises as the manifestation of a diseased brain (I discuss this in great detail in my own book, Rethinking Madness). And yet we continue to perpetuate the very harmful “mental illness” paradigm, with all the toxic treatments, hopelessness, and self fulfilling prophecies that so often go with it.

The emerging “anti-stigma” movement provides a particularly ironic and tragic example of just how entrenched the “mental illness” paradigm has become in our society. This movement is supposed to embody the spirit of offering a more humane kind of support for individuals struggling with such crises and reducing the stigma and hopelessness that these people generally experience. And yet this very movement generally goes to great lengths to perpetuate the “mental illness” paradigm in spite of the strong evidence showing that this paradigm actually seriously exacerbates stigma—both stigma and fear from others as well as internalized stigma and the intense withdrawal and hopelessness that this so often entails (this is more thoroughly discussed and referenced in Rethinking Madness).

Even the “mental illness” paradigm, as harmful as it is, has a difficult time squashing our fundamental drive towards health and wholeness:  One final aspect of Linda’s story that I was struck by was its offer of yet another excellent example of the resilience of the human spirit, something I never cease to be amazed by. I’m inspired by how far Linda has apparently come in reconnecting with her creativity and her aliveness in spite of all that she’s been through—in spite of her own intense struggles with the dilemmas of existence, in spite of the horrendous “treatment” she and her poor brain have received, and in spite of continuing to live with the “insidious tumour” of having taken on the identity as someone with a lifelong “mental illness.” I’m also inspired to see that in spite of having been inculcated into the “mental illness” paradigm, she’s developed creative ways to integrate some of the deeper existential issues that I believe were probably at the root of her distress in the first place—especially her sense of going through a kind of disintegration and reintegration of her “self” at a very core level. I’m grateful for Linda’s willingness to share her story of courage and strength in the face of such devastating confusion and deep personal insult.

Use of the term “mental illness” itself contributes to the entrenchment of the “mental illness” paradigm:  So, considering its ongoing lack of validity and the enormous harm that it causes, why has the “mental illness” paradigm becoming so entrenched in our society? While I’m sure that there are many factors contributing to this (see the section below), I believe that the term “mental illness” itself is one of the largest culprits (as Szasz and others have previously pointed out). A concept that is more appropriately used as a metaphor (the mind being “ill”) has somehow become interpreted as a fact. Implicit in the term “mental illness” are two problematic assumptions: (1) that the mind (our subjective experience) is nothing more than an epiphenomenon of the brain, and (2) that unpleasant, disordered, or anomalous experiences occurring within one’s mind, especially when the catalyst for these is not so clear, must imply some disease of the brain. Looking more closely at the first assumption takes us down a bit of a rabbit hole that I don’t want to take the time to diverge into here, but the second assumption is where I believe we really get into serious trouble and is one that can easily be discredited. If someone experiences fear due to a threat, or sadness due to a loss, or confusion due to a new insight, of course we would find it absurd to consider these the manifestations of a diseased brain. But we also know that extreme and unusual subjective experiences can occur from causes that are less clear, such as what may arise from trauma, childhood abuse, or otherwise being overwhelmed by various core existential dilemmas. And unfortunately, it is these times when the catalysts are less clear that we are so quick to evoke the term “mental illness” and head down the path fuelled by the assumptions associated with this term (i.e., that the brain must be diseased in some way and then treated as such). And as discussed earlier, once we head down this path, the “treatment” is likely to actually create a genuine brain disease. So what we find, then, is a positive (self-reinforcing) feedback loop between the increasing use of a flawed and oxymoronic concept, “mental illness,” and the increasing prevalence and the illusory validation of the “mental illness” paradigm within our society.

The “mental illness” paradigm—an insidious cancer:  I find it interesting to turn the “medical model” language of “mental illness” back onto itself and consider this entire “mental illness” paradigm as acting like an insidious cancer (the difference in my use of the term “cancer” here being that I’m readily acknowledging that this is just a metaphor). Cancer is essentially what occurs when a cell of an organism “forgets” its role as a member of a larger whole and turns against the organism, becoming consumed only with its own reproduction. Using this metaphor, we can say the “mental illness” paradigm fosters this turning one part of a whole against itself. We see this taking place interpersonally between members of our society as we develop ever increasing fear of those labelled “mentally ill,” and we see this taking place intrapersonally as we develop ever increasing fear and suspicion of our own “unusual” or “extreme” subjective experiences. We see signs of this cancer spreading throughout nearly every branch of contemporary Western society—our schools and education systems, our media, our government policies, our way of trying to make sense of ourselves and others’ experiences and behavior, and of course our health care systems. We also notice that this type of cancer thrives particularly well on a diet of greed, fear and ignorance—greed (enormous financial incentive to many in the pharmaceutical and mental health industries), fear (especially our fear of uncertainty, preferring an understanding that is clear although flawed to having to make some peace with mystery and the unknown), and ignorance (just think of the daily bombardment by massive amounts of misinformation coming at us from almost every angle).

So what do we do about it?  What will it take before we (collectively speaking) finally recognize the enormous harm being caused by this cancer that we have somehow set into motion? And once we do become aware of it, what do we do about it? Perhaps one good strategy is to attempt to starve this cancer of the ignorance, fear and greed that feeds it. We can strive to overcome our ignorance with education and critical thinking, and we can work towards developing qualities that act as effective antidotes to our fear and greed—qualities such as compassion for ourselves and others, a quality that naturally arises when we recognize the very challenging existential dilemmas with which we all must struggle; tolerance for perspectives, experiences, and behaviours that are different from our own; tolerance for our own challenging feelings and experiences; an appreciation of the interconnected web of which we are all a part; and an appreciation for the basic wisdom that exists within all of us that continuously strives towards health and wholeness.

Interview with Paris Williams

Paris Williams, Ph.D

Rethinking Madness:  With the rare perspective of someone who’s experienced extreme states from both sides — as a psychologist/researcher and as someone with lived experience — Paris draws from multiple perspectives to explore what it means to be “mad” in a “mad” society.

The “Mental Illness” Paradigm: <br />An “Illness” That is out of Control Comments RSS

43 thoughts on “The “Mental Illness” Paradigm:
An “Illness” That is out of Control

  1. Thank you for taking the time to write this your first MIA blog, Paris. I am sending it out to family members many of whom draw some comfort from seeing my son Luke’s years of anguish and his death as being the result of “mental Illness.” I have been puzzled how to respond to them, not wanting to take away anything that comforts them but feeling ill at ease with their explanation. Your perspective, clear and honest, written from a deeply compassionate and wise heart, carries the more tragic but also hopeful truth in a way I have not yet found.

    • I would like to echo Louisa in haring my gratitude for your clarity with regard to the harm wrought by accepting the mental illness paradigm and your compassion regarding the millions of us who have bought into this paradigm, seeking healing and relief from intense psychic pain. I think the survivor and anti psychiatry movements can inadvertently heap shame upon shame for those who have already suffered greatly.

      I also appreciate your recognition of the tremendous resilience of the human spirit. Linda’s story is a beautifully written triumph of the spirit (and the abiding love of her family, another unexplored theme). That she could reclaim her eloquent voice and a growing sense of self in the face of such extensive trauma and toxic over medication is nothing short of miraculous.

      And Linda has “come back” with eyes still wide open to the fact that life does present seemingly irresolvable deep dilemmas. We are born to die. We will leave our children parent less. They may well leave us childless (particularly as we medicate them at earlier ages and given our increasingly unhealthy culture). We will suffer losses big and small throughout our lives. Sometimes these losses will feel unbearable, particularly if we lack robust social support.

      An entire world religion emerged 3,000 years ago (perhaps all religions stem from this dilemma) to address this profound fact: suffering is an intrinsic part of life. But so is joy, and love, and meaning, and connection, and transformation and growth. If we try to numb one, we risk numbing all.

      It strikes me as a bit audacious and, yes, deluded, that in a little more than half a century, we have come to believe that medicine can eradicate suffering. A rabbit hole harder to escape than denial and distraction, our previous “go to” drugs of choice.

      But even then, we can slip the gauntlet, as Linda’s remarkable story shows. Ours is the work of ensuring all of us can slip it, because far too many don’t under our current diseased paradigm.

      • Thank you, Jen and Louisa, for your kind words. I agree with you, Jen, that the crux of this whole issue is suffering, a universal experience, and our response to it. And I believe that what we see in industrialized western society is an extraordinarily unskillful response to suffering that is unprecedented. We have somehow arrived at a cultural myth that we’re supposed to be “happy” all the time, and any deviation from “happiness” or having thoughts or belief outside the norm suggest that we may have a “mental illness.” And of course once we respond to this fear by naturally reaching out for support from our socially sanctioned mental health care system, then… well, you know the rest of the story. I have no doubt that we could learn much from our ancestors who’ve explored much more skillful responses to suffering–particularly with regard to developing more sustainable and compassionate ways of working with suffering–our own as well as others.

        Paris

  2. Linda has clearly bought into her diagnosis, and so have most of the people who commented on the article. At what point does she plan to stop thinking of herself as “mentally ill?” If she still considers herself “mentally ill” after all those years of treatment, well, the treatment was a failure because it didn’t encourage her to get well on her own terms. I notice that she often refers to wanting to get back to her old self, but without the insight that perhaps the her old self wasn’t working. The crisis happened for a reason, and affords all who undergo one an opportunity to forge a new self. But, as Linda herself notes, psychiatry wasn’t interested in walking her through herself.

    Many of my favorite quotes about building the self come from Hermann Hesse:”Not everyone is allotted the chance to become a personality; most remain types, and never experience the rigor of becoming an individual. But those who do so inevitably discover that these struggles bring them into conflict with the normal life of average people and the traditional values and bourgeois conventions that they uphold.”

    Marian Goldstein once wrote “People labelled with “psychosis”/”sz” usually don’t reconstruct, but construct, as there is nothing to reconstruct. People labelled with “depression”, “bipolar”, “anxiety”, etc. reconstruct.”

    • Just to clarify and prevent misunderstandings: I don’t think anybody ever is the same after a crisis, one or the other kind, and I don’t think it’s the meaning of a crisis, one or the other kind, the meaning of life in general, that we should go “back to normal” achieve a state of unchangeability, of perfect stability in this “normality”. But what I see, more often than not, is that the emotional development of people labeled with “psychosis”/”sz” has been interrupted and brought to a halt even before these people ever had a chance to develop a sense of self, while most people labeled with other psych labels at least had a chance to develop some sort of sense of self before whatever experience/trauma put an end to that development, too.

      • Hi Marian –

        I whole-heartedly agree with this ->

        “I don’t think anybody ever is the same after a crisis, one or the other kind, and I don’t think it’s the meaning of a crisis, one or the other kind, the meaning of life in general, that we should go “back to normal” achieve a state of unchangeability, of perfect stability in this “normality”. ”

        There is never any going back, not for anyone, crisis or otherwise. We are all constantly changing, building and revising, testing the parameters of our hearts and the details of our identities, adding, subtracting, balancing and erasing.

        While we can’t go back, we can’t help but to carry elements of our past experiences with us. The slate is never completely clean.

        I wonder what new words for crisis we could come up with?

        Life? The trials and tribulations of personal evolution?

        As for the development of the Self, I know that among the splintered boards of my ill-built ship, I found my Self.

        It was that Self that tore the white sails into flags of surrender and then, thinking again, re-fashioned them into wings to wear while dancing on the shipwrecked beach.

        It was that Self that set the charts on fire and re-drew the shape of the world as a wave.

        I think that even in the midst of trauma, the Self still develops. It’s still there. We don’t just stop growing because we get hurt. Our growth may be distorted in accomodation of and adaptation to wounds, but we are always in the process of becoming.

        I guess these are just a different conceptualizations (file under ‘abstraction’) of what Self is and how it relates to so-called extreme states.

        Thanks for being sensitive to misunderstandings about experience and meanings and I apologize if I seemed huffy. Sometimes 2d text-type can muddle the tone of communication.

        Given my personal relationship with concepts of “psychosis” and “reconstruction”, I did feel like I wanted to say simply, “That’s not how it is for me.”

        …and that’s okay. How it is for me doesn’t have anything to do how it might be for somebody else.

        Hope you have a good night!

        • Faith, I couldn’t agree more. The self doesn’t stop developing. Eventually, it’s the self that brings about crisis in an attempt to have us realize that who or what we’ve been so far was built upon who or what others expected us to be, not who or what we really were. But if you’re forced to deny, or at least repress your true self, and asked to, instead, identify with a false self, constructed according to others’ expectations, the process of becoming more and more conscious of your true self automatically is interrupted and brought to a halt. That’s what trauma does to people. If it didn’t, if traumatic experiences couldn’t prevent us from integrating our true self in our consciousness, crisis wouldn’t occur.

    • Yes good point Rossa and quote from Marian Goldstein about constructing, starting from scratch in a sense, from a new place after the breakdown of the old life. I’ve had psychosis on 3 occasions, to do with childbirth, menopause, life transitions. All my family has had similar, life transitions, from one place into another by way of the psychiatric system. Nothing to do with mental illness or biomedical models or brain chemicals, except when they pumped us full of psychiatric drugs.

  3. One day I am going to write 20,000 words on the difference between a paradigm as used by Doctors and metaphors as used by lay people.

    Their will be a 100,000 word appendix on the subjective nature of what is and isn’t a disease including of the course the entomology of that word.

    This will be my legacy…that and my collection of bottle tops…

    • Good question. I always find it somewhat of a delicate balancing act trying to use language to point to experiences or concepts without getting too attached to specific terminology. I suppose my way of holding all of this is recognizing that we each develop and modify a particular set of constructs that we use in an attempt to make sense of our experience and to understand the world, and then we use language as a way to try to share and communicate these constructs with others. It gets really tricky when we try to use language to point to these fundamental constructs themselves–words such as “paradigm” and “health.”

      When I use the term “paradigm,” I’m using it to refer to a particular set of constructs (both cognitive and affective/experiential)that is used to make sense of a particular concept or realm of being. I sometimes use this term in broad sense, such as an individual’s “personal paradigm” or a “cultural paradigm,” and sometimes in a more specific sense, such as an individual or societal paradigm with regard a concept such as “mental health” or simply “health.” I think it’s important to be careful here and try to avoid getting bogged down in abstract philosophical discourse while forgetting about what’s really important–connecting with our values and trying to meet our basic needs.

      So back to your question, I personally hold the concept of “health” as representing the degree of one’s ability to meet one’s basic needs and make peace with the basic dilemmas inherent in being a conscious, living being. I also recognize that for any living organism, being “healthy” is contingent on many different factors and different realms of being–psychological, physiological, relational, environmental, spiritual, etc.–and along with this, recognizing that all living organisms actually hold multiple “identities” simultaneously–as an individual, as a collective of millions of different microorganisms working symbiotically to make up this individual (our cells, etc.), as a member of one’s family, one’s society, one’s ecosystem, the entire biosphere, the entire cosmos… There are so many different levels/realms relevant to the concept of “health” that when you stop to really think about it all, it can become a little overwhelming. But thank god for a deeper wisdom (call it “life” or “organismic wisdom” or “spirit” or “God” or whatever suits your fancy) that seems to aspire towards health on all of these different levels.

      So, from this perspective, the challenge for us humans seems to be learning how to direct this highly conscious and powerful mind/brain that we’ve developed towards working in harmony with this deeper wisdom rather than in direct conflict with it (which currently seems to be the predominant attitude that has taken hold within our society). We’ve certainly got our work cut out for us(!)

      I appreciate your willingness to explore these ideas more deeply.

      Paris

      • @Paris

        Thank you! I agree with you when you wrote:

        “I think it’s important to be careful here and try to avoid getting bogged down in abstract philosophical discourse while forgetting about what’s really important–connecting with our values and trying to meet our basic needs.”

        What I would say is their is a time and a place for philosophical discourse. I feel it is really important that we have intellectual bedrock behind us when we move to practicalities because it clarifies where we draw our legitimacy.

        For instance medicine draws upon the tradition of empirical science where we draw upon personal experience as a legitimate form of knowledge in the tradition of Descartes “I think therefore I am”. The subject matter is the method. We need this behind us or at least it really helps imo.

        The debate between Chalmers and Dennet about the nature of consciousness is not entirely irrelevant to us. I lean towards Chalmers philosophically…fwiw.

        It’s not unsurprising that you see health as a concept that applies at the societal level as opposed to the doctorly approach that applies a functional fitness model one person at a time. These are at root profoundly philosophical questions that have real world consequences when we start to question what “health” is.

        In the UK we have a NATIONAL Health Service and public health promotion is funded by the government. In the U.S. their is little to know equivalent as they take individual (doctorly approach) rather than a collective approach. Our philosophy and values inform us as we engage real world practicality….

        Thanks again…I feel it’s worth teasing these things out sometimes…

        • @…poet

          “Our philosophy and values inform us as we engage real world practicality…”

          Who defines our philosophy and values? Who has the privilege of determining what the meaning of “health” is? Who is deemed legitimate and on what basis?

          Are we empowered to make our own meaning, or do we trust the institutional experts?

          How are paradigms created and who gets to create them?

          How does the UK NHS and public health campaign define and communicate ideas about “health” and “mental health”?

          What is the relationship between the NHS and initiatives like this:

          http://joinmq.org/about-us/background/

          @Paris

          Is alignment with deeper wisdom a basic human need, a human right? Do conflicts between our processes of deeper wisdom and our constructed/imposed lives contribute to the distress that is often labelled “mental illness” by the authorities of meaning?

          (Sorry about all the questions…sometimes it is nice to write in question form, rather than in answer form.)

          • I agree those are the right questions.

            Legitimate power flows from legitimate knowledge. The challenge to have our knowledge recognised as legitimate so as to address power imbalances as I am sure you agree.

            How the question “what is health” is answered is important because it answers the question what is a health service for and what should it do, what is its core business. Traditionally doctors are the group who are presumed to have the most legitimate knowledge and therefore legitimate power and hence control what health services do.

            In the UK the challenge to doctor power is as old as the foundation of the service itself. Doctors unions opposed the setting up of the National Health Service, how it was achieved in the face of that opposition is a story a canny political operators who drove a wedge between hospital doctors and family doctors. To long and involved for this post but suffice to say the questions in play were exactly the ones that you posted.

            Senior civil servants in the Department of Health are more likely to have degrees in Philosophy from Oxford than say physics of computer science for good reason.

            Hot topics of conversation of the National Institute of Clinical Excellence are about social and distributive justice not about the latest drug technology as one might think.

            As far as mental health services are concerned they are at root as biologically driven in practice as anywhere else. From a public policy perspective and who gets a say it is the usual suspect of Professional Bodies, Royal Colleges, think tanks, (this is a left leaning one http://www.jrf.org.uk/publications that has some clout, the one you link to looks like a tiddler) provider organizations, strategic purchasing bodies and so on.

            The extent to which the survivor perspective impacts all of this is hard to quantify. What I would say is that it is not totally irrelevant, and probably effects the wider discourse more than one might think.

            I could write more on the history of the links between the UK and US survivor movements pre-internet and their respective impacts not least on each other but it would be beyond the theme here. Perhaps another time. I am sure your insights would be greater than mine in anycase….

  4. While it is a fact that modern medical treatment for transient psychological crises can and often does induce permanent, life-long and severe mental problems,(“modern psychiatric treatment is the illness that it purports to cure”, R.D. Laing), I suspect that there are many situations where the mental illness model and therapies are useful and effective. I don’t think it’s an “all or none” situation, in other words. We have, however, taken an approach that is useful in rare and specific instances and applied it to widespread individual, existential crises with catastrophic results. As you have effectively argued, the impact of the current, mainstream treatment for mental illness is having tragic consequences of epidemic proportions. We need to change the way we think about this. Thank you.

  5. Thanks for this. I got much from your wise book, and from your account (paragraph 3 above) of a sensible explanation of mental and emotional suffering. This piece makes available to “casual” readers a lot of what your book set out in concrete detail. I hope readers here will be moved to read your book too.

  6. Profound good sense during hard times. Empathic intelligence tends to lose its value and becomes harder to find as economic scarcity puts the screws to society — broken people seeking to break others. People get no less than mental illness diagnosed/pathologized for voicing the same ideas which Paris Williams has shared here — the critical understanding.

  7. Thank you for such a great explanation of “mental Illness”. The paragraph about what the drugs really do is the clearest and best description of psych drugs that I have ever read. I will be e-mailing this to my friends and relatives. Thank you!

  8. Thank you for your compassionate, thoughtful and detailed response to this woman’s sad story. I, too, read it a few days ago and was really struck by the damage done for so long by those she went to for “help.” Sadly, her story is only one of thousands, perhaps millions around the world. Words such as yours will, hopefully, change the way our society thinks about these issues.

  9. Great post and now I want to read your book. I’m reluctant to read Linda’s article because I find people’s obedience to the traditional pseudo-biomedical system so frustrating.

    For myself, I had two long experiences with the psychiatric system: the first wasting 3 years of my life, the second consuming over a decade. Both series were precipitated by depressions and, in both cases, my life circumstances clearly weren’t conducive to emotional health.

    No psychiatrist ever explored any of this, of course. Oh, no, I suffered from a chemical imbalance, I was diseased, I was faulty, I needed drugs and would be on them for life. In both cases, aggressive and harmful treatment for those depressions brought on mania and thus it was “discovered” that they had triggered my pre-existing (but latent) bipolar disorder. This new diagnosis led to even more drugs and hospitalizations, of course. The simplest and most obvious explanation was overlooked: Perhaps they had CAUSED my bipolar disorder.

    Even now, as a voluntary patient, I have to put up with the patronizing and belittling attitude of my caregivers. I told one of them recently that I was enraged at the years I had stolen from me. His response? “It wasn’t the system that stole those years, Francesca, it was your illness.”

    At times, I get so discouraged I want to give up. Psychiatry’s not a science; it’s a marketing empire.

    • Thank you, Francesca, for your courage and willingness to share yet one more tragic example of someone simply wanting peace, reaching out for support, and finding themselves swept away into a confusing hell…

      And to add to the tragedy is that most of the people involved in offering such “support” probably really believed that they were doing the best thing for you. As they say, the path to hell is often paved with good intentions…

      Paris

  10. Excellent article Paris! I’m sending it everywhere. I hope you’ll be around as a dissenting voice for the whole APA event this month in your fair city.

    BTW, I saw this article the other day, and it seems to me that the researchers’ advice about the term “bullying” is at least as applicable to “mental illness”.

    http://www.usatoday.com/story/news/nation/2013/04/30/bullying-american-educational-research-association-schools/2124991/

  11. Hi Paris,
    Grateful, as always, for your tremendously important contributions to “The Movement.” Reading this NYT piece a few days back was simultaneously saddening and invigorating for me. Saddening, because I see a woman so held back from her human potential and human spirit by a completely flawed and degrading identity of “Bipolar”; invigorating, because only three years ago, I would have felt inspired by her courage and poignant account of “life with Bipolar”, and been completely identified with her message. Her struggle for selfhood was my same struggle during my “Bipolar” years, and I feel profoundly thankful and lucky that I found a way out of that life sentence. Just three years ago I was just like Ms. Logan! How crazy (a word I love because it’s non-medical, non-psychiatric, and human) is that! My journey out of a “Bipolar” life has been nothing short of an awakening— to my Self, to my human spirit, and to a sense of connectedness to the world around me— and it makes me so sad that this smart, creative, unique woman has to be held back because of a industry-constructed, false paradigm of “mental illness”, and that undoubtedly, as you said, all those years of “treatment” have caused her significant damage. Thanks so much, Paris, for effectively capturing the fundamental dilemmas of this paradigm, and for offering a humanized way to look at things!

    In solidarity,
    Laura

  12. Thanks, Paris,for spending some time with Linda’s story, considering it within the broad context. I appreciate Laura’s recognition that at some point, many psychiatric survivors had some degree of belief that they had a “mental illness.” Of course, people invest in these ideas to varying degrees and for various reasons.

    I have a feeling that Linda Logan will probably be drawing some new correlations in her thinking about her story, what caused what and why.

    As for the Goldstein quote re: reconstructing and constructing per labels and experience,
    because I am a person who has experiences that are considered to be on the psychotic spectrum and who also strongly identifies with processes of construction and deconstruction, reconstruction, I feel compelled to say that capacity to reconstruct depends on what you are putting back together and how it got taken apart in the first place.

    Theinarticulatepoet will explain it all in their book.

  13. @Faith

    You wrote:

    “on the psychotic spectrum and who also strongly identifies with processes of construction and deconstruction, reconstruction, I feel compelled to say that capacity to reconstruct depends on what you are putting back together and how it got taken apart in the first place.”

    Wise words. Worth considering that process of construction and destruction, reconstruction is something that those labeled “sane” do ALL THE TIME and no one bats an eye lid. Do people not make themselves up as they go along? Everyone reinvents themselves from time to time…don’t most autobiographies really belong on the fiction shelf…

    We know the truth…

  14. Truly wonderful! This essay contains perhaps all of the essential concepts necessary for the makings of a conceptual platform that revolutionizes the ways in which communities respond to (or perhaps more correctly don’t think about) what is commonly called “mental illness.” And all of the essential concepts are so well articulated in your piece!

  15. Paris,

    Once again, I’m struck by the combination of your down to earth analysis of the problems with the medical model and your deep wisdom and understanding about what people need to get through profound emotional and existential pain. One way I look at all of this is to see each of us as a small part of a much larger system, that is way off course. Some of us are suffering, for good reason as we see corporate power corrupting governments and destroying our environment; as we witness various systems of power hurting ourselves and other people, whether it be family relationships between parents and vulnerable young children or governments, misusing power and dropping bombs on people. Sanity requires a response from us as we witness such pain and sadness. Yet, those of us who suffer are labelled the problem, diagnosed with brain diseases and even put on medications against our will shutting us up and adding insult to injury. We have much to learn from our own and others’ suffering: both about ourselves and about what’s wrong in the world.

  16. Paris

    This was a great essay and critique of Biological Psychiatry’s cancerous paradigm of so-called treatment, however I found parts of the last paragraph disappointing.

    “So what do we do about it? What will it take before we (collectively speaking) finally recognize the enormous harm being done by this cancer that we have somehow set into motion?”

    First off, while I believe in personal accountability I think the use of the second “we” in the above sentence is misdirected when it comes to identifying who is mainly responsible for the sick nature of the paradigm ruling over us. “We” the people did not create or set into motion Biological Psychiatry’s medical model; we are the victims of these oppressive institutions and the powerful forces who run them. We need to be clear on this. I hope you will re-clarify your thinking on this point.

    Secondly, when it comes to the question of where do we go from here?: your emphasis is on “education and critical thinking…” and “developing qualities…” of a positive nature “within us that continuously strives towards health and wholeness.”

    I also believe “education and critical thinking” is vitally important to our movement as well as many of the individual values you propose to emphasize. Both of these points should represent ONE powerful leg upon which our movement runs.

    The other leg not mentioned (and vitally necessary) is the critical role (SECOND LEG) of decisive political action confronting the system of Biological Psychiatry. This takes individual transformations to the level of collective action.

    Yes, WE NEED TO KNOW THE WORLD INORDER TO CHANGE IT. Educating people will help arouse more people to take action.

    But. WE ALSO HAVE TO CHANGE THE WORLD INODER TO KNOW IT. Each time we engage the material world in action we will know it better and thus be more educated and more aroused in greater numbers. This dialectic of KNOWING AND DOING represents the spiral development of revolutionary change.

    As a movement (in its early stage) we clearly have enough knowledge and desire for change to be doing both more education AND more direct action.

    Paris, could you please clarify your thinking on these points? Your writing style and analysis is excellent and I sense you are an activist as well. Do you agree that we need more organization and action at this stage of our movement?

    Respectfully, Richard

    • Excellent points, Richard.

      I really like the concept of a knowing/doing dialectic. Another very similar concept that I like is the meaning/experience dialectic, the idea being that if we get too stretched towards either side, we can run into difficulties–either all meaning with little grounding in direct experience, or all raw experience without processing it and deriving meaning.

      My main intention in my article here is to focus on the harm caused by the “mental illness” paradigm, and to lay a foundation for an alternative vision, but as it was already getting fairly long, I didn’t want to dive into specific actions in line with this vision–a topic for many more articles by many of us and hopefully ongoing rich discussion. There are already many people and groups doing really good things in this direction–too many to name here–and yet it’s clear we have to do more. I believe that action from a clear core set of values is important, however, which is why I attempted to lay a very basic framework out in this regard–focusing on education and critical thinking, and taming fear and greed while cultivating tolerance, compassion, and mutual respect for each other’s choice and freedom.

      I also hear your desire to separate the powerful industrial forces, with their ramming the “mental illness” paradigm down ourthroats, from the collective “we.” I certainly do acknowledge these forces. However, I also believe that in order for real change to occur, “we” the people need to take on the role of responsible, educated consumers. Every dollar we spend is a vote which says “I agree with or buy into what you’re selling.” So, in many ways, “we” are very responsible for everything that goes on in our society. By not educating ourselves and thinking critically, by not taming our own fear and greed, it is “we,” the masses, who maintain the status quo. If we want real change, I can’t imagine it’s going to come from the forces who are thriving on the current system. It will have to come from “us,” the masses–we’ll have to break out of the trance of feeling like powerless sheep and explore creative ways to take our power and responsibility back. Easier said than done, I know. But the first step starts with people like you and others here on this forum–encouraging people to discover their own truth and take the steps toward real action.

      In solidarity,
      Paris

      • Paris

        Thanks for your clarification. I agree that:

        “It will have to come from “us”, the masses, we’ll have to break out of the trance of feeling like powerless sheep and explore creative ways to take our power and responsibility back.”

        However, I disagree with parts of these statements:

        “So in many ways “we” are very responsible for everything that goes on in society….By not educating ourselves and thinking critically, by not taming our own fear and greed, it is “we”, the masses, who maintain the status quo.”

        In many ways these kind of statements can easily fall into “blame the victim” type thinking as well as obscure the oppressive class nature of our society.

        People stuck in poverty who comprise the underclasses in our society represent some of the largest sections of the masses who are victimized by Biological Psychiatry. Look at all the kids in the inner city or in foster care who are on brain damaging stimulants and antipsychotic drugs. Look at the fact that single parents immersed in poverty and unable to fully control their children are often forced to make “Sophie’s choice” like decisions that allow their children to be labeled and drugged in order to receive disability money for survival, especially since the welfare system was overhauled in the 90″s.

        People who are beaten down on a daily basis in this class system do NOT have the same opportunities to become educated and learn to think critically. The blame for the terrible choices mentioned above should NOT be shared equally between the oppressed and oppressor.

        The slaves were NOT equally responsible for slavery because they did not rise up and overthrow the system sooner. The plantation masters were smart enough to not allow their slaves to learn how to read and become educated.

        Today, while no one is (in theory) denied the right to be educated or learn to think critically, the systemic nature of a class society has a way of creating the kind of extreme distress of daily survival that makes it very difficult to have the ability or capacity to learn and engage in political activism.

        Even people more educated from the middle classes have been brainwashed in very sophisticated ways to accept the paradigm of Biological Psychiatry. Many who write on this website have discussed the fact that they themselves ultimately chose to take psych drugs or enter the psych ward of a hospital. Was this really an “Informed Choice.” I think not.

        So my main point is this: in this historical era of class based society, I believe there is a necessary value in having an “us vs.them” when assigning responsibility for the oppressive nature of the status quo.

        People need to be educated about the true nature of this system, including who runs it and what their stake is in maintaining the current inequalities. To obscure this in any way is to deny the oppressed the tools of their own liberation.

        That being said, I do think those of us creating a movement for liberation must be prepared to constantly interrogate ourselves regarding out own thinking and behavior. We have all been raised within a culture of oppression and have been negatively influenced by this ideology and practice.

        We cannot build a successful movement with revenge being our motivation; we must have a vision and a daily practice of a truly humane alternative to the way things are. It is a constant battle (especially for those of us who have had more opportunity and privilege) to not write off “the sheep” and seek escape in the consumer nature of capitalist society.

        I do believe that despite the extreme difficulties confronting the underclasses in our society and the sophisticated forms of brainwashing and “buying off” of the middle class, that if we persevere with education and activist struggle we can defeat Biological Psychiatry as part of a broader liberation movement for transformative change on a planet wide basis.

        In struggle, Richard

        • Once again, very well said, Richard. You’re opening a complex but extremely important topic here, and I have so much I’d like to say about it and so much I’d like to hear from others about it, and yet I’m thinking it would be more appropriate to center this around an article/blog that specifically focuses on action and activism. Would you be willing to submit such an article?

          In the meantime, I can’t resist going ahead and responding with a few of my thoughts here:

          I am in full agreement with you regarding the importance of acknowledging the roles of power and privilege, oppressors vs. oppressed, etc. And I completely resonate with the frustration you express of finding yourself entrenched in such a dysfunctional and harmful system…

          … AND I believe that, generally speaking, within a given oppressor/oppressed system, the oppressor(s) maintain their power over the oppressed because the oppressed continue to give it to them. This is one of the fundamental tenets of the “nonviolent resistance” philosophy. Typically, the oppressors gain their power (often in the form of wealth) directly from those that they oppress—generally by manipulating them with fear (if you don’t do such and such, then you will pay such and such a price), greed (if you DO such and such, you will receive such and such reward, even if the reward is only life), and ignorance (maintaining confusion and a general sense of hopelessness and helplessness). Whether or not a certain group of oppressed individuals has any direct responsibility in having become the victim in the first place, the cold hard reality is that they’re in that position now. And they’ve most likely been conditioned to identify with that role and unwittingly play their part in perpetuating this particular dynamic (e.g., by believing that they’re helpless and believing that resistance is futile, if nothing else).

          This is not an attitude of “blame the victim” at all. Rather it is simple acknowledgment that a harmful and imbalanced system has come into being, that all members of that system play important roles in keeping that system going, and that any change to this system is unlikely to come from those who are benefiting the most from it. I completely agree with you that making such change can appear extremely daunting when those in power have SO much power, and those who are disempowered have so little hope and are kept in so much confusion. And yet if we remember that the oppressors reap their power directly from the oppressed, and that the oppressed often do have at least some degree of freedom to refuse to cooperate and refuse to perpetuate the system, we find that there is the possibility for real change. We’ve seen this time and time again throughout our history–with the abolition of slavery, women’s rights , civil rights and worker’s rights movements, the downfall of apartheid in S. Africa, coming out from under the English thumb in India, etc., etc.

          This kind of movement is generally quite messy, usually involves tremendous courage and sacrifice by many individuals, and arguably may never really ends but can perhaps best be seen as an ongoing dialectic dance that is simply an outcome of our inherent tendency to perceive a ‘self’ (myself, my group, my species, etc.) as distinct from an ‘other’ (other individuals, groups, species, etc.). And the more rigidly we experience such a self/other or us/them split, the more intense and common such struggles are likely to be.

          My own personal values around working towards such change consist of recognizing the humanity and suffering in not only the oppressed but also in the oppressors. After all, their thirst for power is typically spawned by their own fear, greed and ignorance (especially ignorance in the sense of not being willing or able to sincerely connect compassionately to the suffering that their actions are inflicting upon others). In many ways, I see these individuals as the most disturbed and deeply suffering of all. So I believe that if we want to change the current system towards one that is more in line with values such as basic freedom, equality, compassion, tolerance, etc., then those of us who want to take on the role of activists will have to connect to these values within ourselves and act from there. This means being very clear and firm in resisting continued harmful and disempowering behaviour, while also not losing sight of the humanity of those carrying out such behaviour. How would this look? Well, fortunately we have excellent role models such Frederick Douglass, Rosa Parks, Mohatma Ghandi, Martin Luther King, Jr., Cesar Chavez, Dorothy Day, etc., who have striven to act from this place. While anger and even overwhelming outrage towards one’s oppressors are certainly understandable, working towards a revolution with these as our foundation is likely only to lead to at best a flip flopping between the oppressed and the oppressors—our history is full of such flip flopping revolutions, and where has that gotten us?

          One final point I want to make here: I do acknowledge that we have in many ways an unprecedented challenge on our hands with regard to our mental health care system. Some harmful systems can become particularly entrenched when the oppressed are profoundly disempowered –such as what we find in the case of the oppression of animals and other species, of children, and of those who are imprisoned either physically or psychologically (i.e., via the use of psychoactive drugs and/or via trauma). The two latter examples are clearly at play here within the mental health system. Fortunately, these types of systems very often have a “third” essential group of members—those who are not directly the “oppressors” nor directly the “oppressed” but whose participation is nonetheless required to keep the system going. These are typically the “willing consumers.” In the case of the mental health system, this is the vast majority of the population—because most of us who have the ability to do so don’t take the time to educate ourselves about the harm caused by the psychiatric/pharmaceutical industry, we generally allow it to continue, with our general support of harmful policy (or at least our general lack of resistance) and our direct financial support as so many of us buy into the story that real peace and happiness will be found in a pill that we can buy from them. I believe that if the majority of us really got it—if we really understood the epidemic that Robert Whitaker writes about so well, the rampant destruction of childhood and fulfilling lives, the enormous disability and burden on taxpayers, that we most likely will not find lasting peace in a pill—then it seems to me that this system would simply have to collapse. I’m grateful for people like you, Richard, and so many others I’ve met who are doing great things in getting the truth out there and for opening up this kind of important dialogue.

          Paris

  17. Well said Richard. We need to start doing something tangible with our current ample source of knowledge and desire for change. As you stated, spreading knowledge and desire for change will increase the likelihood of political action – and changing the world via political action will help us know the world and contribute to the dissemination of knowledge and desire for change.
    As long as we don’t go too far in the direction of absolving ourselves from our contribution to the current status quo or self-responsibility – I agree with your first criticism.
    Overall, I think this essay by Paris might articulately lay the groundwork for the creation of a platform of demands and goals. And also articulately lay the groundwork for the creation of a conceptual paradigm which we try to keep all of our efforts in accord with and consistent with.
    Best,
    Greg

    • Thanks for sharing a little bit of your story. I hope you’ve been able to connect with some people who can support you in this process. Although it can often be difficult to find peers and professionals who offer real support in this regard, they are out there. I’ve been compiling a list of such resources on my website:

      http://www.RethinkingMadness.com

      …click on the “Resources” page.

      Best wishes in your journey towards a healthier life,
      Paris

  18. Hi Paris,
    I appreciate your strong trenchant and eloquent critique of the medical model–particularly of the bio-medical model.

    I did not have the patience to read the original NYT article carefully
    but as usual I think on the basis of a gloss that the author left out the environmental/interpersonal variables that would make possible a coherent narrative construction as an alternative to “I was mysteriously stricken by a biochemical disorder.”

    But you don’t comment on one of the salient aspects of the article. The author thinks she is advocating something revolutionary– but arguably because she accepts the medical model her suggestion for an alternative narrative account becomes inevitably tragic, although not catastrophic. It is really–whether she knows it or not–a revival of the old Freudian paradigm combined with bio-psychiatry. I don’t mean the original Freudian model. I mean the ego psychology that reigned when I began graduate school in 1976. It’s the humanistic veneer that makes her revisionist strategy seductive and dangerous in its appeal. She wants to recover “the self” in her paradigm but she never questions the medical model’s premise that the self is defective, or is a victim of aberrant biochemistry. So she’s advocating a slightly more humanistic version of the bio-medical model. She wants to save it by humanizing it.

    She writes, “Some in the mental-health field are beginning to recognize this need {to recover the idea of the self in psychology].. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it. ” She assume “mental illness” is a reality.

    I deconstructed this model in my writings on psychoanalysis in the late 1990s. Psychoanalysis is a secular version of the myth of original sin, derived NOT from Jesus but from Augustine in City of God. The idea that the soul was tainted with original sin was the basis for a fear and guilt culture that ruled Europe for centuries.(See Jean Delumeau) By 1970 it was thoroughly assimilated into neo- psychoanalysis, the basis for the medical model of 20th century before bio-psychiatry became dominant in the early 90s. The self is defective, the ego is marked by a “basic [structural] fault.” The person is “MENTALLY ill.” The self will never fully recover from its defects, and “schizophrenics” are the sickest–the doomed… I could go on and on… I believed that–mostly. But it was my attraction to “schizophrenics” that was my saving grace,that led to my break with the medical model in 1985. In 1987 my first essay, a critique of the disease model, was published. I had been an Apostle for Psychoanalysis, I am ashamed to say, for 8 years. Then I became an apostate in mid-80s, after I discovered family therapy. When I joined the Eastern Christian Church in 1994, it was because I was attracted to its theology– I discovered that to my surprise it repudiated original sin from the start.(I was eventually disillusioned—after 4 years– by the Church’s conformity to modern culture.) To use biblical language: The soul is created in God’s image. It remains whole, even after the Fall. It is not responsible for the Fall although it lives with the consequences. In secular terms the self is not rendered defective
    by parental misdeeds–or today by biochemical imbalances. There are no biochemical imbalances. Furthermore the self is whole. The person is not mentally ill. She may be wounded but not diseased, not defective. The greatest healers are those who have been wounded.These are not empty tropes–they capture existential truths about the human situation.

    I still think the Laingian/Perry construction provides the basis for an alternative narrative that covers many if not most people labeled psychotic.It is isomorphic with the Christian mystical ideas I formulated above, as well as those of the neo-Hindu philosopher/yogi Sri Aurobindo–as well as many other spiritual traditions. Its virtue is it explains madness in non-reductionist spiritual terms, instead of invoking the tropes of disease and defect.It is a good Mad Pride formulation.It refutes the root metaphor of mental illness.

    In the course of growing up the self will confront obstacles–these often trigger crises that plunge the self into the waters of chaos, dislodging it from the ground of truths or self-confidence it thought it had permanently conquered. The crisis often triggered by interpersonal events is the initiation of a potentially regenerative process that will have a positive outcome, if it is treated as an opportunity. If the person is not captured by psychiatrists and drugged into a state of torpor. But the self grows through death and rebirth–that was the insight Laing and Perry brought to the understanding of madness. This is a simplification of the spiritual model but John Weir Perry explicates it in detail with all its nuances in his books. The point is that there is a teleological nisus towards growth and wholeness, which entails cycles of death and regeneration.But it tends towards the maturation of the self–in Jungian terms toward the creation of the Self. It is a spiral, not an eternally recurring cycle. I would posit this is true of humanity also–and thus now we are undergoing our most serious evolutionary crisis as a species.

    Anyway my point is the author thought she was advocating something revolutionary–the recovery of the idea of self in pathological processes. She claims “this is a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick.” This is not a sea change.It’s the same medical model that dominated in the 1970s when psychoanalysis was blended with bio-psychiatry. It’s a trap that should be rejected by Mad activists.
    Nor is the approach I advocated above a sea change, although it is the basis for an alternative paradigm— rejecting the disease model and affirming the WORTHINESS of the self is the sine qua non for any psychology that does justice to our existential worth as spiritual beings.

    A sea change can only take place when we confront what I called above the crisis of humanity. That is another topic, one I discuss in my current book, The Spiritual Gift of Madness. Many mad people are suffering because they are canaries in the coal mine–they are the first to sense the ecological crisis that endangers our survival. Many of them don’t want to become adjusted. Their only option is to become “creatively maladjusted” (as MLK Jr advocated)to a plutocratic society ruled by a tiny elite–the 1%– whose dominating concern is the pursuit of ever more money, an elite that regards nature as a resource to be exploited, thus bringing us to the edge of ecological catastrophe. I argue that many of the mad can play a critical role in helping to resolve the crisis of humanity. I believe that many have a calling to become agents for redemptive transformation,catalysts for messianic change. For unless we make this change, unless we make the leap to the next phase of our growth process as a species, there is little chance of saving the biosphere that has been our home for millennia. The earth may endure but not as our home. The mad are gifted because they have had a vision of a new age, a vision they can seed in the collective imagination of humanity. As Paul Levy, an author and former mental patient whom I interviewed for my book put it. “When we consciously put our sacred power of dreaming together, we generate a power that can change the dream we are having and literally change the world.”
    Seth Farber, Ph.D, author of The Spiritual Gift of Madness,,http://www.amazon.com/The-Spiritual-Gift-Madness-Psychiatry/dp/159477448X/ref=sr_1_1?ie=UTF8&qid=1367953344&sr=8-1&keywords=farber+gift

    • Hi Seth,

      Thanks for sharing your perspective and valuable insights on this. I appreciate your calling attention to Linda’s discussion of the “self.” I agree with much of what you say about that–I intentionally avoided going into this topic as I wanted to emphasize what I thought were some of the more serious direct harms of the “mental illness” paradigm while not writing an essay so long that it would turn off potential readers.

      I agree with you that Linda’s reflections show a half step towards a more humanistic paradigm while also leading to some potentially very problematic conclusions. While I am all for allowing each of us to explore our own understandings of our deepest existential and/or spiritual nature, I personally resonate most strongly with the nondual traditions which suggest that there really is no permanent “self” at all—that what we experience as an “I” is in perpetual flux and flow, and that the root of our suffering actually comes from attempting to cling to a solid/secure/permanent sense of self in the face of such ephemeral conditions (I discuss this in much more detail in my book, Rethinking Madness).

      Linda said, “For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill.” Well, based upon the nondual perspective, transformation is a given, and it is our resistance to this transformation that is so problematic. I believe that what so often gets labeled “mental illness” arises from our resistance to such change/transformation, and strong resistance is most likely to occur when we experience our beings attempting to transform in a particularly powerful way. So my conclusion (and it sounds like you and I are on a similar page with this) is almost diametrically opposed to that of Linda—such deep transformation of the “self” is actually a sign of the profound health and wholeness within our beings, rather than being a sign of “illness.” When we find ourselves in a situation that is no longer tenable, this deep wisdom of being (what I like to call “organismic wisdom”) naturally aspires to initiate a transformation into a more sustainable way of being. And it’s difficult to deny that so many aspects of contemporary society are entirely unsustainable, which is where I find one of your insights particularly poignant–an argument could definnitely be made that it is often those we consider “mentally ill” who in some ways are the “healthiest” in the sense that they represent beings who are attempting to transform from being a “well adjusted” individual in a crashing society to a “creatively maladjusted” individual with real potential to work towards a more sustainable vision for all of us. “Hear hear” for messianic sensibility.

      Paris Williams

  19. Paris
    Yes we are basically in agreement– your third paragraph is right on target.
    I don’t go as far as the Buddhists though. I would differentiate between the ego and the Self, as Jung for example did. And s do Estern forms of mysticism and Aurobindo’s qualified non-dualism.
    I don’t really think Linda is advocating a slightly more humanistic model–just one with a humanistic veneer. Notice Paris how the psychiatry establishment and the press responded to THomas Szasz in the last 2 decades? If he was ever mentioned it was to point out how bio-psychiatry proved him wrong. (Which usually then hinged upon the ostensible efficacy of their drugs.) Yet they never stopped using the term “MENTAL illness.” So my point was Linda seemed to want to bring back the “damaged” self to set it along side of the biochemically disordered self. That’s no progress! That does not restore self-worth to the person undergoing a spiritual crisis. The entire project of modern psychiatry from psychoanalysis to bio-psychiatry is profoundly misanthropic and it can’t be patched up—it must be repudiated and replaced with a genuinely humanistic model.
    Best, Seth

  20. This article has been discussed on other forums, and someone requested that I include one exchange here:

    The commenter said:

    I very much agree with you that normal human suffering has become medicalized and over-treated with medication. However many people are relieved when their cluster of symptoms has a name and a medication that helps them feel better even if it is a temporary band-aid. And there are many people whose brains function in a way that makes it difficult for them to function well in their lives. As a psychotherapist I respect whichever paradigm my client adheres to and we go from there.

    And my response:

    I appreciate your willingness to respect your client’s own beliefs, AND I also believe that there’s a place for encouraging the client to be willing to be open to exploring alternative explanations, especially when the belief that they hold may be particularly harmful.

    For example, I worked with a client once who intermittently heard a voice telling her that she must not drink any fluids. She believed this was the voice of God and that she must obey this voice or face God’s wrath. At one point, she was found behind the vehicle of her car pulled over by the side of the road, passed out and close to death from dehydration. I encouraged her to explore alternative understandings of this experience and belief system—for example, considering that the source of this voice came from a source other than “God,” perhaps from a dissociated part of her own personality or an introjected embodiment of another person or message in her life. She was actually surprisingly open to looking at alternative and possibly more helpful understandings, and clearly benefited from this work.

    Let’s look at another closely related (hypothetical) example that is more closely related to the “mental illness” belief system. Let’s suppose you meet a new client who is obviously quite ill. You discover that she’s developed the belief system that her emotional suffering is due to a kind of virus and that the only way to get rid of the virus is to ingest a certain amount of drain cleaner every day. On one hand, she does seem to be experiencing some relief from certain psychological “symptoms,” probably due to the well known placebo effect. On the other hand, it’s quite evident that she is experiencing other significant adverse effects due to the toxicity of the drain cleaner. Would you simply “respect” this belief system, or would you encourage her to explore alternative understandings?

    This example is very similar to what we find within the “mental illness” belief system. Most of the psychiatric drugs used are very toxic, having many very adverse effects associated with them, including making it more likely that a transient condition will harden into a more chronic one (see Robert Whitaker’s “Anatomy of an Epidemic” or my own “Rethinking Madness” for a more thorough discussion of this). There is evidence that much and perhaps most of the positive effects of these drugs are due to a placebo effect or simply some kind of a “numbing” effect. We also have significant evidence that the “lifelong brain disease” belief is very harmful to many people, acting like a nocebo (the opposite of a placebo), in that it’s likely to lead to hopelessness and the general likelihood of a self-fulfilling prophecy.

    There is a major difference between the “mental illness” understanding and the example I gave above—the former is generally socially sanctioned and backed by most of the “authorities” in the field, in spite of the continued lack of evidence. Does this mean that we should simply allow our clients to hold onto this belief system unquestioningly, without encouraging some critical exploration? My own thoughts on this are pretty clear. As a clinical psychologist committed to the wellbeing of my clients, I would consider it a failure in my duty and frankly in violation of my profession’s code of ethics if I didn’t encourage some kind of open minded and critical exploration upon discovering that my client is harboring a potentially harmful belief system. To clarify, this doesn’t at all mean that I would attempt to force them to adopt a different belief system, but that I would simply encourage them to look more closely at the evidence, their needs and values, the harms and benefits of strategies and behaviors that have emerged from this belief system, and work from there.

    Paris Williams

  21. Hi Paris, what an awesome article ! – what i love is that you’ve picked up on the insidious entrenchment of ‘mental illness’ and how it permeates even the de-stig campaigns. I pick up on this kind of stuff all the time, but my comments about it so often fall on ears that have ‘mental illness’ ear plugs so firmly shoved in them that the message cant or wont be heard….such is the risk and fear of jumping into the unknown without the pre-designed ‘mental illness’ paradigm to simply explain it all as a brain disease. Ditching the medical model paradigm in the face of greed, deceit, power imbalance and a society where so many believe in ‘experts’ over their own instincts can only happen when people have access to education and critical reflection – and at the moment many just don’t get exposed to this at all. There is such a need for a network of consumer peer support groups that don’t just replace one paradigm with another, but that validate and compassionately invite people to explore what their lives might look like if they questioned all they currently accept as ‘fact’ . Of course this is a hugely scary and brave thing to do…and we are all at different stages of that journey; so we need to find ways of helping each other. I’ve envisaged a network of ‘radical recovery’ groups for ages now but don’t really know where to start – any ideas ??

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