Editor’s Note: After Allen Frances and Robert Whitaker spoke recently at the Society for Ethical Psychology and Psychiatry conference in Los Angeles, where they had a brief debate, Frances wrote to Whitaker suggesting that they should continue this debate in print. They do so here. Whitaker’s response follows Frances’ post.
Allen Frances writes:
I have had two recent debates with Robert Whitaker — in October at the Mad In America Film Festival in Boston, and in November at the International Society for Ethical Psychology And Psychiatry meeting in Los Angeles. Both were spirited and interesting.
Bob and I agree on lots of things, but disagree on what are the biggest ethical and clinical problems facing our field and what needs to be done to solve them.
Let me trace where I see our agreements and disagreements and express the hope that we can find increased common ground.
1) On The Role Of Psychiatry
Bob is one of the most eloquent and well-informed critics of psychiatry, and certainly the most influential. He views the American Psychiatric Association as a powerful and corrupt organization that is largely to blame for spreading a misguided medical model that results in widespread inappropriate psychiatric treatment.
I am no defender of the APA and have harshly condemned its incompetence and financial conflict of interest in producing a rushed and poorly done DSM 5. I have recommended that DSM should become a public trust, not an APA publishing cash cow; that APA has lost any credibility as guarantor of the diagnostic system; and that it should lose the DSM franchise to a new neutral, broader based, more competent, and not financially interested entity.
I also agree with Bob’s critique that the APA drifted away from its original rounded bio/psycho/social model and instead has promoted an excessively biological, medical model of care. And I agree that it became far too dependent on drug company money — although this has improved considerably in recent years.
But I disagree with Bob’s interpretation that APA is powerful enough and clever enough to have sold the world on the bio/medical model and excessive drug treatments. Instead, I see the APA as a hapless, sad sack organization — not very powerful, and not at all clever. The APA’s only real power is its control of DSM and even this is greatly overestimated because the harms of DSM mostly come from its misuse by powerful external forces. APA is an easy target, but a useless one. I maintain that we could disband the APA altogether and the world would change very little.
The real gorilla in the room is Big Pharma. The drug companies are rich, are powerful, are clever, and are highly motivated to spend billions of dollars selling ills to push pills. Big Pharma’s massive marketing campaign has convinced the public and doctors that life’s everyday distresses and problems are really undiagnosed mental disorders caused by a chemical imbalance requiring a pill solution. Some people in APA helped promote this view, others opposed it — both were largely irrelevant. The effective marketing muscle is all with Big Pharma — on TV, in magazines, on the internet, and with beautiful salespeople in doctor’s offices. And Big Pharma has succeeded in taking most of psychiatry out of the hands of psychiatrists — 80% of psychiatric medicines are now prescribed by primary care doctors, often after 7-minute appointments for patients who don’t need them.
Bob and I strongly agree on the goal of reducing over-medication, but disagree on the method. He thinks this can be achieved by taming the power of psychiatry. I think fighting the APA is a pointless distraction. The only meaningful way to contain the quick-draw craze for medication is to end all direct-to-consumer Big Pharma advertising (allowed only in the US and New Zealand) and all marketing to doctors. This strategy of ending marketing propaganda worked to contain previously impregnable Big Tobacco — it could also work also to stop Big Pharma and to protect people from pills they don’t need.
2) The Role Of Medication
Bob accepts that medication is occasionally necessary, but reads the literature in what I believe is a one sided way that emphasizes its harms and minimizes its benefits. Bob believes that medication can often be replaced by empowerment and psychosocial approaches.
I couldn’t agree more with Bob that medication is used way too often for people who don’t need it, but my clinical experience, research experience, and reading of the literature convince me that it has an essential role in stabilizing people during what are often risky acute psychotic episodes and also in reducing the risk of relapse. Bob and I agree that many people do well in the long term without medicines, but I believe it is risky and clinically unsound to argue against medication for people in the midst of an acute episode of psychosis.
The testimony of many people I have met at Hearing Voices and Mad In America is convincing evidence that they themselves did not need the medication they were prescribed and did much better without it. This accords with my own experience with hundreds of over-medicated patients — ‘deprescribing’ has often resulted in marked improvement. But this doesn’t generalize to everyone. No one size fits all and there are people who desperately do need medication and do terribly without it.
Which brings us go what I believe is by far the the biggest ethical problem facing all of us — the fact that at least 300,000 people with severe psychiatric problems are inappropriately imprisoned and more than 250,000 are homeless. These are not common criminals, as Bob seems to assume. The closing of 600,000 psychiatric beds during the last 50 years, without the provision of adequate community services and housing, has resulted in a barbaric criminalization of the mentally ill.
This has been exacerbated by the “broken window’ policing policies that have spread from NYC to many jurisdictions across the country. The theory is that major crimes can be prevented by increasing the sense of order in the community and that this is best done by rigorously arresting people who commit even the most minor offenses. The burden falls heaviest on the severely ill who are usually picked up for nuisance crimes — stealing food, shouting in the night, sleeping on a park bench — that could easily have been avoided if they had a place to live and adequate services and treatment.
Cops are forced into being first responders because services are so thin. They have learned not to bother taking the mentally ill to hospitals because there are no beds, no services, and only a useless appointment in the distant future. Jail seems like the only option and leads to the horrible coercive abuses. And sometimes the outcome is even worse. Cops are scared of those amongst the severely ill who are psychotic and agitated. All too often this results in pulling a gun; sometimes it results in death.
So I heartily support Bob’s crusade against over-medication when it is inappropriate, but worry that it can be harmful when extended to those who really do need medication to stabilize symptoms that will otherwise get them into prison or on the street. My guess is that if Bob spent time in emergency rooms, prisons, and with the homeless, he would probably agree with me on the individual cases. It is always easier to recommend against medication in the abstract than when faced with people having real life psychiatric crises. And we can all join forces in supporting adequate housing as the first and necessary and uncontroversial step.
3) The Role Of Involuntary Treatment
Bob and I agree on the crucial role of empowering people with psychiatric problems. I have written for 30 years about the need to negotiate treatment decisions, allowing patients to choose what suits them best among all available options. Tom Szasz’ courageous crusade against involuntary treatment was absolutely on target when 650,000 people were involuntarily and inhumanely warehoused in state hospitals. But times have changed dramatically. Things are a lot different now that 90% of those beds are closed and there are ten times as many patients in prisons as in hospitals. It is now much harder to get into a hospital than to get out of one. Hospital stays are about a week; prison can go on for years.
And prison conditions for the severely ill are degrading and outrageous. They don’t do well with prison routine and disproportionately get dumped into solitary confinement — which can drive anyone crazy and is devastating for those who start out with compromised reality testing. Many slam against the walls or smear excrement all over them or are medicated into zombie-like states. There are 200,000 prison rapes each year — and those with psychiatric problems are most vulnerable. They are also frequent victims of physical abuse.
So I heartily support Bob’s goal of empowerment, but think he has the wrong target. Psychiatric coercion was once the overwhelming threat, but now the primary fight must be against the cruel criminalization of mental illness and the much more horrible coercion that follows from it. Psychiatric coercion is rarely necessary when there are appropriate services available and should be used only to prevent the much worse coercion imposed by prisons.
Bob is probably too modest to recognize that his is now one of the most powerful voices in the country, influencing both attitudes and policies. My plea is for him is to use his mighty pulpit to advocate for the most vulnerable and neglected and coerced people in our country- those with severe psychiatric problems who are inappropriately imprisoned and homeless. Sad to say, it is now police and sheriff associations that are the biggest supporters of increased mental health funding to accommodate the desperate needs of the severely ill. Shouldn’t Bob and Mad In America be refocusing its attention on the real and horrible coercive prison and street experience of today rather than continuing to fight the battle against the psychiatric coercion of the past. And how about going after the real engine of over medication – the powerful drug companies that profit so ruthlessly from drug peddling.
Robert Whitaker’s Response
In his post, Allen Frances raises these four points for discussion:
- The importance — or relative non-importance — of the American Psychiatric Association and academic psychiatry in creating the system of care we currently have.
- The role of psychiatric medications.
- The imprisonment of people with mental illnesses and homelessness among this population.
- Involuntary treatment.
These are big topics, but I’ll try to cover them one by one.
1. The Power of the APA and Academic Psychiatry
My own thinking about this subject during the past several years has been refined by the time I spent as a fellow at Edmond J. Safra Research Lab on Institutional Corruption at Harvard University. The lab, under the direction of Lawrence Lessig, has fleshed out a framework for investigating instances of “institutional corruption” in our society, and I have spent the past two years co-writing a book that looks at the behavior of the American Psychiatric Association — and academic psychiatry in the United States — through this lens. My co-author is Lisa Cosgrove, a psychology professor at the University of Massachusetts Boston who, among other things, has done research on the influence of pharmaceutical industry on psychiatry. She has been a fellow at the Safra lab for several years.
In our book, which is titled Psychiatry Under the Influence: Institutional Corruption, Social Injury and Prescriptions for Reform (to be published in April), we focus on the behavior of the APA and academic psychiatry since 1980. This is the year that the APA published the third edition of its Diagnostic and Statistical Manual, and this is the moment that the APA adopted a disease model for categorizing psychiatric disorders.
That was a fateful decision, and it certainly wasn’t one made by pharmaceutical companies. The APA did so for a variety of reason; there was a scientific impulse behind that move, but it also served the interests of the APA as a guild, which was in competition with other professions for patients at that time. And as the authors of DSM III admitted, most of the diagnoses in the manual were to be considered hypotheses, as they had yet to be “validated.” The thought was that research would eventually prove that the diagnoses told of “real” diseases.
However, once the APA published DSM III, it began regularly conducting “educational” campaigns that were designed to sell this new disease model to the public. And the story that the APA came to tell was this: psychiatric disorders were known to be brain diseases; psychiatric researchers were making great progress in identifying the biology of mental disorders; these disorders were often “underrecognized” and “undertreated;” and drugs for these treatments were quite safe and effective.
The chemical imbalance story brought all of these story-telling elements together. The etiology of many mental disorders was now apparently known, and psychiatry had drugs that fixed those abnormalities, like insulin for diabetes. That was a story that told of a remarkable scientific advance. The drug companies then exploited that story to sell their drugs, but it was the APA and academic psychiatry that provided it — and the larger disease model story — with a scientific legitimacy.
This story-telling fundamentally changed our society. More than ten percent of our school-age children are now diagnosed with a mental disorder and one in five adults now takes a psychiatric drug on a daily basis. And this might all be fine if the disease-model story told to the public was grounded in science. Unfortunately, science was in fact telling a very different story.
The story told in the scientific literature was this: Research was failing to “validate” the DSM disorders; the chemical imbalance hypothesis had not panned out; and the etiology of mental disorders remained unknown. Prozac and the other SSRI antidepressants provided little benefit over placebo for those with mild to moderate depression; the atypical antipsychotics were no better than the first-generation antipsychotics. Meanwhile, long-term studies of drug treatments for ADHD, depression, and schizophrenia were failing to find that the drugs provided a benefit, with outcomes for the unmedicated patients in the depression and schizophrenia studies better than outcomes for the medicated patients.
That is the “corruption” that has so harmed our society: Since 1980, the APA and academic psychiatry have not fulfilled their public obligation to tell us what science has been revealing about their disease model. As a result, our society has organized its treatment of psychiatric disorders — and its policies and laws in this domain — around a false story, a story of a disease model that had been validated and of drug treatments that are quite effective and safe. While the pharmaceutical industry has surely played a role in telling that false story, it is psychiatry as a medical profession that has given it public credibility.
Thus, my disagreement with Allen Frances on this first point. He sees the APA as “a hapless, sad-sack” organization and thus as mostly an innocent bystander, with the corruption arising from a powerful pharmaceutical industry. I don’t know whether the APA should be considered as a “hapless” organization, but I do know this: Our society has looked to the APA and academic psychiatry as the medical institution that should govern our societal thinking about psychiatric care. Yes, the pharmaceutical industry is a powerful force, but it is the medical institution that is seen as the “trusted” authority by society. And if our system of care is a mess today, then that failure ultimately can be traced back to the APA and academic psychiatry for telling a story that benefitted the field’s guild interests, but was not a faithful record of science.
But here is where I agree with Allen Frances: The APA has lost its credibility as “guarantor of the diagnostic system, and that it should lose the DSM franchise to a new neutral, broader based, more competent, and not financially interested entity.” I couldn’t agree with that more. Our society needs a new “public trust” that will give us a new “diagnostic manual” for thinking about psychiatric disorders. The current DSM manual should be thrown out (much as NIMH director Thomas Insel wrote not too long ago), and a new multidisciplinary group should take on the task of drawing up a new one.
2. The Role of Psychiatric Medications
I wrote about this at great length in my book Anatomy of an Epidemic. And here is my disagreement with Allen Frances on this point: I don’t think the problem is simply one of “overmedicating,” which makes it seem that that when people are “properly diagnosed,” the drugs necessarily provide a clear benefit. I think that science is telling our society that the medications do not meet that standard of “efficacy,” and thus our use of these drugs needs to be fundamentally rethought.
Here is a quick summation of the “evidence base” for psychiatric drugs. In short trials, there is evidence of the efficacy of these drugs (at least to a certain extent.)
There also are people who do fine on them long-term, and will attest to that. However, over the long-term, I believe there is clear evidence in the scientific literature of the following:
- Antipsychotics, antidepressants and benzodiazepines increase the chronicity of the disorders they are used to treat, and increase the risk that a person will become “disabled”.
- Stimulants fail to provide a long-term benefit to children diagnosed with ADHD, and thus, once their risks are considered, do more harm than good over the long-term.
- The cocktail of drugs given to bipolar patients is associated with a notable worsening of long-term outcomes, particularly in terms of how patients function.
Given that evidence base, I believe that protocols for prescribing the drugs need to be dramatically changed. The protocol for using antipsychotics in the Open Dialogue approach in northern Finland provides a model to emulate. Try to minimize immediate use of the drugs in first-episode cases (and thus employ other non-drug treatments first), and if the drugs are used, try to minimize long-term use. The protocol in northern Finland is best described as a selective-use protocol, which has produced outcomes markedly superior to our own, and thus there is an “evidence-based” rationale for using the drugs in this way.
Allen Frances writes that he thinks that I “read the literature” in a “one sided way that emphasizes its harms and minimizes its benefits.” Here is what psychiatry can do to prove that is so: It can point to the research that shows the medications improve long-term outcomes, and improve the functioning of people so treated. I published Anatomy five years ago, and I am still waiting to hear of such evidence.
Frances also writes that the solution to “over-medicating” of the American people is to stop direct-to-consumer advertising and industry marketing of the drugs to doctors. That would be a good step, but I think the real solution would be for the APA and academic psychiatry to incorporate the long-term outcomes data into their clinical care guidelines. If they did so, I think they would find compelling reason to dramatically alter their protocols for prescribing these drugs.
3. The imprisonment of people with mental illnesses (and the problem of homelessness.)
I almost don’t know where to start here. I think we lack even a language that can discuss this problem in a sensible way.
First, let us start with a broad perspective. The United States imprisons its citizens at a higher rate than any other country in the world (according to a 2013 study.) We make up five percent of the world’s population and yet our citizens make up 25% of the total world population of prisoners. So the problem we are talking about here is not just the “imprisoning” of the “mentally ill,” but a problem of a society that imprisons people at a grotesque rate.
Second, the term “mentally ill” today is such a vague, imprecise term that it lacks any real meaning. The APA, through its DSM, has set up such broad definitions of “psychiatric disorders” that more than 30 percent of Americans are said to suffer a bout of mental illness each year. Unwanted behaviors — oppositional defiant disorder and ADHD in children, substance abuse in adults, etc. — get classified as mental illness. Given such definitions, one would expect that a high percentage of people in jail and prison could be said to suffer from a diagnosable mental illness. In fact, it is hard to imagine that there could be many inmates who wouldn’t qualify for a DSM diagnosis. My point here is this: When we hear that our jails and prisons are filled with the “mentally ill,” I honestly don’t know what that means.
However, I don’t doubt that there are “mentally disturbed” people in jails and prisons, and that many got there for “nuisance” crimes. But, given the imprecise definition of “mental illness,” I don’t think we have a good sense of how many such people we are talking about. It would be nice to see research that looked at how many people were diagnosed as “severely mentally ill” before being arrested.
In addition, any inquiry into this problem should look at these two questions. Many of our prisons today are run in a very harsh manner. Inmates are isolated for long periods of time. Such treatment could turn the most sane person mad. Is this part of the reason we have so many “mentally ill” in prison? In addition, those who run prisons know that if inmates are diagnosed as severely mentally ill, that makes it possible to put them on antipsychotics, which will make the inmates easier to manage. Is this part of why we hear that so many inmates are mentally ill?
Third, psychiatry’s concern about the imprisonment of the mentally ill is being used by advocates of forced outpatient treatment as a Trojan Horse. The advocates for forced treatment in outpatient settings (such as the Treatment Advocacy Center) argue that forced drug treatment would prevent the mentally ill from ending up in prison, and thus their legislation, which in fact curbs the civil rights of citizens in profound ways, comes cloaked in the rhetorical garb of “humanism.” If we are going to have an honest societal discussion about the shame of imprisoning the “mentally ill,” then it needs to be completely decoupled from that legislative agenda.
Indeed, an argument can be made that the growing imprisonment of the “mentally ill” is yet another example of how our drug-based paradigm of care has failed us. The use of psychiatric medications in our society has exploded over the past 25 years; there is great societal pressure put on people diagnosed with schizophrenia or bipolar disorder to take their medications; and yet we now have this problem of hundreds of thousands of “mentally ill” in prisons and jails.
However, I do agree with Allen Frances on this point: Any effort to remake mental health care in this country needs to include a focus on what can be done to help the multitudes of poor people and disenfranchised people who show up in distressed emotional states in emergency rooms and homeless shelters, and the eventual routing of many such people to jails and prisons. But, in my opinion, if we want to find a solution, we should focus on providing housing, social support and jobs that help people lead meaningful lives. If we want to reduce the number of people said to be mentally ill and in jail, then we should focus on reducing poverty in this country. Substantially raising the minimum wage would, undoubtedly, be a good first step in addressing this problem.
In short, forced drug treatment isn’t an answer to the “prison” problem; creating a more just and supportive society is. I also think we could borrow a page from the Quakers in the early 1800s. They built moral therapy asylums for the “mad”, with the idea that such refuges — where people could be near nature and were to be treated in a kind, humanistic way — could, with time, help many people get well. Such places would surely be a good alternative to jails and prisons, where inmates today may be isolated for 23 hours each day.
Forced Treatment
I don’t think that “psychiatric coercion,” as Allen Frances writes, is mostly a thing of the “past.” I think that psychiatric coercion, in subtle and less subtle forms, is more of a problem than ever. We have the subtle coercion that occurs in schools, when teachers and administrators urge certain parents to get their children treated for ADHD. We have the dramatic expansion of the prescribing of antipsychotics in situations that basically lack consent: to foster children, to prison inmates; to “mental” patients in hospitals; and to older adults in nursing homes. Finally, we have the passage of state outpatient commitment laws that, in essence, force people to take antipsychotic medications.
Indeed, ever since the popularization of the ADHD diagnosis and the arrival of the atypical antipsychotics, psychiatric coercion has been on the march in our society, so much so that it hangs like a cloud over our society today. Such coercion is a marker for a fearful, less-free society, and thus if we want to list important battles to be fought today, I would argue that the fight against this expansion of “psychiatric coercion” should be at the top of the list.
I am thankful to Allen Frances for stirring this discussion/debate. In essence, it goes to the heart of what we are trying to do with madinamerica.com, and that is bring these fundamental issues to light, and hopefully make them better known to the public.
Such an important debate. I’d like to express my hope that the response in the comments will be equally spirited, interesting and focused on the issues.
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Super interesting debate. In order to comment properly with all the seriousness this debate deserves, I would have to address every single point of it and there are so many! If I were to do so, my comment would be 4 times longer than this article :-), but, unfortunately, I have no time for this.
My quick general impression that these two insightful and analytically thinking people really shouldn’t have any disagreements at all because they both see different aspects of the problem correctly. Each of them over or under emphasizes one aspect of the issue over another, when each aspect, in fact, has its own unique role and is organically connected with the others. I wish I had time to elaborate on specifics..May be at another time after the discussion kicks off.
I have to say though that I like Frances’ overall tone better that Witaker’s. It sounds much friendlier and inviting for a future dialog, while Witaker sounds much more defensive and guarded :-). Frances outlook also feels more grounded, which is, of course, not to say that his perspective is overall more accurate. Like I said, they both see different parts of reality correctly, but those parts have to be put together to make one big more or less accurate picture. My personal impression is that Frances is more willing to put the pieces together and to find common ground for collaboration and I like this attitude better because it reflects my own.
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I would like to suggest that “collaboration” is only a good word when the project that one is collaborating on is a good one! When it is something destructive, (like providing drugs that the best evidence suggests are likely to make things worse) then any such collaboration can be simply evil.
I think too many people in the mental health field value being agreeable with the establishment over and above acting on their responsibility to notice when people are being harmed. I’m happy that Bob Whitiaker is “defensive” or “oppositional” or however you might want to label it, and prefers calling out bad ideas to “collaborating” with them.
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Would you say the same thing if what these men were debating was something history had already publicly acknowledge was bad/evil/harmful instead of something it doesn’t yet want to admit to? Would you want to be or follow a “collaborationist” in Nazi-occupied Germany? Would you look up to someone who wanted to collaborate with the KKK ? What about someone who thought that Jim Crow laws were a great “collaborative” middle ground between slavery and freedom?
I think Robert Whitaker is so well-spoken and dead-on in this debate so far. His points about the entire discourse we have been hearing in the mainstream about the “tragedy of the mentally ill in jail/prison” were so great. It’s just a trojan horse, and I’m glad I’m not the only one who sees that!
Whitaker has actual values. Frances… well, maybe he does, but I will never trust that guy. He’s too deep in it. It made him. Whitaker came from the outside and that allows him to see more clearly and with less clouded ethical/moral vision.
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ugh, sorry, typo: that should read “Nazi-occupied France.” Althought Germany could still work, too, I guess. But you wouldn’t call that a “collaborationist” I don’t think.
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I have to agree with Bob that Alan Frances is working pretty hard to absolve the APA of responsibility for creating the DSM III et. al. in support of the pro-biological agenda. Admittedly, it is the pharmaceutical companies who have the funds to drive the point home so effectively in the public mind, but without the tacit or explicit support of the APA, their arguments would be much easier to see as the hucksterism that they are. A great example is “Social Anxiety Disorder.” This “disorder” was clearly targeted for creation and marketing by the pharmaceutical companies (most notably GlaxoSmithKline, makers of Paxil, if I recall correctly), but despite it’s non-scientific and tainted origins, it still made it into the DSM IV under Frances’s leadership. Frances makes good arguments to remove the DSM from APA control and to stop DTC drug marketing, but he’d be more credible if he would acknowledge the role the APA has had in creating this disaster.
I was actually struck by the degree of agreement that does exist between the two, and would hope that these overlaps could form the basis for some more positive conversations regarding shared goals, but I don’t think it can happen without substantial acknowledgement of the corruption that exists in the psychiatric community. Admittedly, most of the local on-the-ground doctors are as much dupes as the rest of society, but they are supposed to be the ones protecting us from this kind of danger. If the APA changed its tune and started making more rational and nuanced recommendations regarding the limitations of drug “treatment” and the variety of other approaches that have been found to be effective, and also supported the honest dissemination of literature on the down side of psychiatric drugs, instead of always standing up to defend against the “unscientific and irrational antipsychiatry element,” there might be some hope for progress. But I’m not holding my breath….
—- Steve
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I was very pleased by Bob’s comments, and I think he very much got to the heart of the matter. And that is that the APA is a corrupt organization that does a great deal of harm in our society.
I think Allen Frances is probably the slickest and most effective apologist for his profession. He makes no pretension to be other than that. He has a kind of politician personality which serves this role very well.
In other writings, he has openly said that psychiatry is shooting itself in the foot with enterprises like DSM 5. Of course, he says nothing about his own role in creating DSM-IV, the content of which is different only in (small) degree from the new version.
I for one am not interested in saving psychiatry, to say the least. I am happy to see it start to self-destruct, and I want to do anything I can to speed up that process. I am not interested in having someone like Frances put his arm on my shoulder. His stance of trying to sound “reasonable” doesn’t impress me. Of course, someone trying to defend his profession would act like that, trying to disarm the rightful anger of psychiatry’s critics.
Once again, thanks to Bob Whitaker for his work here and elsewhere, and I can hardly wait to read his new book.
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Me too…looking forward to the new book with great anticipation!
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You hit the nail on the head Mr. Chabasinki.
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Ted: Brand Francis is like Brand Obama. Both are sophisticated methods to suppress dissent.
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Thanks, Ted, for saying what needed to be said ver concisely. I’m kind of amazed when I hear some people in the movement embrace Allen Frances as if he is an ally. He clearly is not.
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Exactly Ted. Exactly. Enough of this preening and sycophancy. History, science, and reason all confirm the fact that psychiatry has been, is, and forever will be (until it is eradicated), one of the most evil, coercive and destructive forces known to man. “Saving Normal” is a book that is greatly inferior to Gary Greenberg’s “The Book of Woe.” The phrase “ethical psychiatry” is a misnomer, or more so, a complete contradiction in terms. Frances and others like him have the audacity to feign compassion for suffering souls, the homeless and imprisoned, while simultaneously promoting measures that will ensure the increase of suffering in each of these categories. Down with the APA. Down with Big Pharma. Slay the Dragon of Psychiatry.
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Yes – If medicine is to have a role in madness, it shouldn’t be lead – the anaesthetist shouldn’t be in charge in the theatre of mind – other disciplines are better suited.
What I think Bob and Allen both need to do is look through some other lens on this – Foucault for example portrays this as a symptom of an industrialised society where the ‘self’ is fabricated by social forces (“normal self” is the water fish swim in and are unconscious of) – we are all a little out of touch with reality – the ecological disaster should provide ample evidence that mechanised society – the Empire – is a menace. Then look at Wittgenstein’s attraction to Spengler’s Decline of the West – “Even in Brahms I can hear the machine” – and his claim that he (Witt.) was writing for 100 years hence (in 1930) when “culture” might be returning. In Indigenous cultures ‘self’ is centred in Other (heteronomy not autonomy)- and the dialogicity of Seikkula etc – shows this return of responsivity as the path out of madness – The Jedi showing this path are appearing – the Empire continues to convince you that its risk management processes are not a protection racket……But the move from the cartesian-kantian empire to the Wittgensteinian-Levinasian culture is gathering momentum, and we look for outcome monitoring as accountability rather than process adherence. enough – this key is getting to large for you to weild….
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Either / Or
Prison / Forced Treatment
Says Who ?!
http://www.discoverandrecover.wordpress.com/mental-health-freedom-and-recovery-act/
Duane Sherry, M.S.,CRC-R
Retired Counselor
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Exactly. False dichotomy, that’s all it is.
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I really appreciate this article and appreciate the work that both of these men are doing. I understand that all these issues are important and must be discussed. As I was reading, I kept tripping over the words mental illness. There it was again and again. I’m a grandmother and it’s been almost 50 years now that my work of caretaking human beings has taught me about human wellness and how it happens. It’s the job I had and my life’s work and I’ve learned it well. As a women studies independent scholar, I learned the history of the professions involved here are most often done by people who really have no experience in how human wellness happens in a daily application of one’s life. Worse, money and power and the institutions go back as far as the 1600’s. 400 years have produced today’s results. It’s just ALL so incorrect in the structure and basis. Mental illness term itself hardly is useful except as code and stereotype. One size fits all models are a mechanism of control in quantity rather than an efficient way of bringing people to wellness in quality. So as I read the article, I just kept thinking that what not start from scratch? Why not begin a movement of human wellness rather than a model to fix all the human unwellness that rides close to failure as it has done so for centuries already? I know we are all caught up in a large tangle of human relationships and it isn’t easy to untangle. But I just had to put my thoughts down. It is so encouraging in a desert of such massive harm to have at least a bit of rational discussion addressing it and I couldn’t help but want to jump in and say in my own way, MORE MORE MORE. Thank you.
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Well said!
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Very well said Karendee. I am writing a thesis paper on the dangers of overdiagnosing and overmedicating mental illnesses and I cringe at the use of the phrase mental illness but cannot find any better term that people will accept.
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Your proposal is the REAL BEGINNING of where and how the true solutions need to be found!!! I couldn’t agree more. It’s called a true paradigm shift at its very root. Our language itself confines and limits the terms and basis of the “debate” to those particular parameters which are off to begin with. I sense this is also at the root of what both men are courageously arguing from even within themselves despite their “disagreements”. I honor any form of dissension that is rooted in the heart and one’s own sense of integrity. I am new to Allen Frances so can’t speak much on him, but appreciate his courage to speak out. We need more insiders like him to call things out from the inside, and this is never an easy task. As to Robert Whitaker, I do know more about him. His contribution is profoundly important, extremely informed, empathetic, wise, compassionate, and well-grounded. His voice – absolutely revolutionary. It is because of him that we are even opening up the dialogue and/or debate at all. He is truly exceptional and rooted in an unflinching integrity and courage, his leadership long-awaited and overdue. And I’m with you, as we join in in the discussion, I think the female voice/perspective needs to be considered as it does exactly what you are saying -calls into question the very premise and terms of the argument itself. Thank you for your adding the wisdom and experience of your voice to all of these important voices.
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I think that Francis counts on the difficulty that confronts dissenting voices in our very depoliticized culture, and so barely tries to shade the condescension in his expressions regarding those who want their rights protected in something other than a paternalistic way.
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well said. I agree with you on that one.
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Question for Allen Frances. If the APA isn’t as influential as you claim regarding the DSM, why is a condition like sleep apnea in there when that has nothing at all to do with mental illness? Now if psychiatrists were routinely screening people who come to them with sleep problems for possible sleep disorders, that would be one thing but that definitely is not happening. If I am wrong, tell me what percentage of psychiatrists refer their patients for sleep studies. Anyway, as much as I hate pharma, they had nothing to do with this one.
Regarding the long term effectiveness of psych meds, I agree with Bob Whitaker about showing us the evidence. And sorry, stating that because of a psychiatrists’ clinical experience with the meds being effective, this proves that it is. Uh no, that is what they call in scientific circles anecdotal evidence.
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“that is what they call in scientific circles anecdotal evidence”
Great point.
https://pbs.twimg.com/media/B2fwsJ-CEAEplzQ.jpg
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Very interesting point regarding the anecdotal evidence that man compiled in that link which reminds me about wanting to elaborate on my point.
Only psychiatrists it seems are allowed to claim that anecdotal evidence is valid while if “peons” like you and I attempt to do it, we are taken to task big time and accused of not being scientific. It seems like a very unfair double standard particularly when psychiatry refuses to provide the scientific evidence that Bob asked for regarding long term effectiveness of psych meds.
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Great points about psychiatrists’ “clinical experience.” How can they trust their own clinical experience, when “patients” have so many incentives to lie to them? If mental patients want to taper off psych drugs, then oftentimes they need to lie about what they are doing in order to avoid escalating coercion from psychiatry, because they need ongoing prescriptions to execute the tapering. Patients always have an incentive to lie to psychiatrists about voices, visions, “unusual beliefs,” suicidal thoughts, self-harm, etc, in order to avoid an escalation of psychiatric coercion. If mental patients want to get away from psychiatry, whether in the setting of a psychiatric prison or a more subtly coercive “outpatient” situation, then they have every incentive to pretend the psychiatric “treatment” was useful to them. (Not to mention the very real phenomenon of medication spellbinding or, of course, the placebo effect, and how either or both can influence even a grateful psychiatric patient’s self reporting.) Thus, when psychiatrists trot out the line about how they prescribe according to “clinical experience,” I think there is – in the most charitable view – some self-deception going on.
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Ignoring sleep disorders makes me wonder how they can sleep at night.
Duane
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Thanks Duane.
I don’t mean to sound like a one issue person regarding sleep issues but I am very angry that this continues to be ignored and people are suffering needlessly.
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Sleep deprivation is at the top of this list of considerations for “psychosis” and other serious “mental illnesses” and treatment for conditions such as sleep apnea deserve attention. As always, AA, I’m glad you’re part of MIA.
Duane
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Sleep deprivation (5 nights due to anxiety over multiple stressors) seemed to bring on my 19 year old son’s ‘psychosis’ last summer…and when we helped him through it, partly by helping him get back on his sleep schedule, he recovered and has been fine for 5 months now…no hospitalizations and other than a few nights of benzos…no more meds…psychiatry does not allow for this kind of “recovery” according to Allen Frances’ approach…he indicates that acute psychosis must be treated with meds….this is certainly not always the case!
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Truth in Psychiatry,
Congratulations on saving your son’s life!
MIA has a number of chronicled articles on sleep:
http://www.madinamerica.com/?s=sleep&submit=Search
Duane
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I’ve heard an interesting hypothesis about psychosis: that it is what happens when the brain mixes up dream with reality. Completely “normal” people can experience psychotic states upon sleep deprivation and lack of sleep is known to switch off parts of the brain to a sleep-like state. Maybe lack of sleep or disrupted NREM/REM sleep patterns can be responsible for at least some of psychotic experiences? Stress, especially chronic and related to abuse is known to influence sleep patterns…
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do you know the story of why sleep apnea IS in the DSM? I dont’, so I’m just curious.
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Great question for which I don’t have an answer. But I will put this on my list of things to research to see if I can find out why.
Truth, regarding your son’s situation, many psychiatrists have sadly decided that all severe conditions need meds and that simply is not the case. I would love to see a truly unbiased study that proves this is so but I suspect it doesn’t exist.
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I think that downplaying APA’s role in the current situation would be disastrous. Frances is effectively making psychiatry out to be the victim in all this, when the drug companies couldn’t have achieved the market penetration they have without the APA’s very active support. This support was consciously given with the aim of increasing psychiatry’s credibility and power as a MEDICAL specialty with all the credibility and prestige that entails. It didn’t just happen, it was a strategy that psychiatry adopted in full consciousness and in full co-operation with drug companies.
Psychiatrists collectively and individually have have made millions of dollars and inflicted lives of drug-filled misery, or worse, through its co-operation with pharma. That behaviour continues unabated as evidenced by the burgeoning number of people sucked into the ever-increasing range of diagnoses in the DSM that have been created solely to feed profits directly back into the pockets of both psychiatrists and the drug companies.
Until and unless psychiatry comes clean and very loudly and publicly dissociates itself from pharma and stops protecting, endorsing and prescribing drugs that have been shown to be dangerous and ineffective, forming an alliance with it would be an act of treason against all humanity.
Were organizational psychiatry honestly to step up to the plate and redress the harms it has perpetuated, help people get off the drugs, and refuse to support dangerous/sham treatments, then an alliance just might be productive. I see many wonderful doctors among the MIA authors and can only imagine that they are horrified by the behaviour of their colleagues and so am aware that a germ of this idea is already alive in individual doctors.
However, the first and most important step in addressing a systemic problem is often acknowledging its extent and existence, rather than minimizing and avoiding the reality to save face.
My reading of the above is that Frances is not yet willing (or able, perhaps) to even begin to see psychiatry’s (and/or perhaps his own) role in the problem.
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“Psychiatrists collectively and individually have have made millions of dollars and inflicted lives of drug-filled misery, or worse, through its co-operation with pharma.”
If a physician is prescribing drugs he needs to be aware what these drugs do to the client. There is no way psychiatry can say they are blameless for over drugging. It’s right before their eyes. Its ridiculous when non medical people can tell a person is drugged out of their gourd and that person’s odd behavior is drug induced.
I wish I didn’t know this but I do. I wish I never stepped into a psychiatrist’s office. Fact-less speculating diagnoses. One day the general public will know the dangers of psychiatry and the sham of DSM.
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Exactly Aria.
My mother could see these drugs were causing bit time harm but the psychiatrist couldn’t? Unfortunately, I was too spellbound by the meds to believe her.
By the way, when I told my former psychiatrist that I wished I had never set forth in a psychiatrist’s office, he started asking about my mood. I shut up pretty quickly and learned to give him minimal information during the rest of my visits.
Dr. Frances, with all due respect, is in big time denile regarding the harm psychiatry has caused people.
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My friend who is a druggie knows more about psych drugs, illicit and legal and their side effects than any psychiatrist or even legitimate doctor I know. And surely he uses more precautions when taking them.
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There are so many drugs out there now that most doctors can’t keep up with knowing about all of them so they rely on what the drug reps tell them. And of course, we all know that the drug reps are motivated to tell all kinds of whopping lies because their jobs and bonuses depend on them getting as many doctors to prescribe the particular drugs that they’re pushing on them as they possibly can. This is why so many drugs get prescribed to people off label, because the damned drug reps suggest that one drug is good for this and another drug is good for that, and all the time there’s not one bit of scientific backing for anything that they’re telling the doctors. I hope that the lowest levels of hell are reserved for drug reps and psychiatrists who continue to dose people to the gills with the toxic drugs when they know what the damned things do to people.
Some of the most interesting interviews I’ve ever listened to are those where the drug reps confess the crimes that they’ve committed for the drug companies that they worked for. You can hear a couple of these on Madness Radio where Will Hall interviews a man and a woman who were once drug reps. One guy was the head honcho for a drug company in a foreign country; he has some really interesting information about how he pushed things. The big question that I always have is why doctors listen so enthusiastically to these people in the first place rather than doing their homework. They want to use the excuse that they don’t have the time to research on their own but my response to this excuse is that perhaps they need to see fewer patients so that they can give better quality of care to the people that they do take care of.
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The Emperor has no clothes – and more and more people are saying so.
I have seen several articles on this site about debates between Allan F and other people who are critical of various aspects of psychiatry. Bob W is the latest and the one most based in epidemiology, ie the statistical study of long term outcomes of psychiatric treatments plus a good grounding in how how these treatments really work
Francis always asks for people to consider the middle ground and says he is against extremists. His critics then use science to seriously challenge his views to which Allan Francis has no answer.
The prison argument is a red herring. It is about poverty and the power of the prison buisiness. Deal with those and a lot of the distress will disapear. Substituting pschiatry for prison is to avoid dealing with both these problems and thus shows that Francis wants, in this issue at least, to continue psychiatry’s function of making sure no one looks at why people are distressed.
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“So I heartily support Bob’s crusade against over-medication when it is inappropriate, but worry that it can be harmful when extended to those who really do need medication to stabilize symptoms that will otherwise get them into prison or on the street.”
It’s a common argument that somehow omits the fact that most people who enter the system are put on meds and either stay on them with no benefit at all or stop taking them abruptly going into supersensitivity psychosis “treated” with more drugs, different drugs etc. I don’t know if there are people for whom the drugs are the only chance to lead a normal life but I have yet to see any convincing evidence of that.
It reminds me of a recent case of a “schizophrenic” guy who was to be executed for killing his spouse’s parents. While I agree that was barbaric to begin with (death penalty in general and imposed on someone who committed his act during a psychotic episode specifically) it was of course followed by the calls for more treatment. Well, this person was in “treatment” and on meds and it did not stop him from committing the act and getting entangled in a sick parody of a trial.
When do we stop advocating for the same policies that don’t work. “If it doesn’t work you need more of it” is a bad argument for state violence, coercion and psych meds.
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“I have written for 30 years about the need to negotiate treatment decisions, allowing patients to choose what suits them best among all available options.”
How that “negotiations” work in practice:
“Are you staying voluntarily or do we have to commit you and put it in your file?”
“Will you take the damn pill or do we have to restrain you?”
That’s all the “treatment decisions” people are allowed in the coercive system. Only a complete elimination of force will change that, otherwise there will always be abuse.
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I think my main problem with Mr Allen Frances’s argument is that he’s building a straw-man and a false dychotomy here. If we don’t allow psychiatry to coerce and drug people than they all will end up abused in prisons. It’s justification of one form of abuse by the existence of another form of abuse, one broken system with another.
Maybe one should work to abolish all forms of coercive treatment in psychiatry (or psychiatry as a whole) AND radical reform of the justice system and prison system. There are models for both – all that’s needed is political will to follow them.
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B: You have hit the nail on the head. while the actual freedom of movement may be greater in the “hospital,” than the prison, the stigmatization that results from the “diagnosis,” is more soul shattering than a criminal record.
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“the stigmatization that results from the “diagnosis,” is more soul shattering than a criminal record.”
So very very true. Having the words mentally ill in your medical charts will automatically cause physicians to dismiss what you say.
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“So very very true. Having the words mentally ill in your medical charts will automatically cause physicians to dismiss what you say”
……or use it as further evidence of your “mental Illness” if it doesn’t exactly reflect their preferences or beliefs!
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The majority of non psychiatric doctors treated me terribly when they saw (didn’t know my psych diagnosis was in my med chart). I couldn’t understand why, they had just met me for the first time? I requested copies of office visits and saw my diagnosis underlined in red. The only way I could ever been seen again as a human being was to re-xerox my records and hand carry them to my new docs. Suddenly I was treated nicely, the same me with clean slate and not one new doc ever mentioned me being depressed or needing psych drugs. Prejudice against people with psych labels is wide spread.
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True. After I became the mental patient every time I went in with any complaint the first thing the doctors asked was about my mood. I must surely be psychosomatic right?
I am truly surprised that in spite all of it being “mental patient” is not a risk factor for violence – the treatment you get as one almost calls for it.
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Maybe!? Psychiatric hospitals are literal prisons. Psychiatric hospitals are phoney hospitals. All you need is a dictionary to figure that one out. What kind of “hospital” imprisons people? Oh, I know the answer to that one, a psychiatric hospital. What kind of “hospital” treats people by injuring them? Oh, I know the answer to that one as well. It’s a psychiatric hospital again. Alright, if injury is not “punishment”, what is it? Oh, I know. Psychiatric treatment. If you’ve got an adding machine you could do some injury accounting sometime. I suppose it is all supposed to add up to “disability”.
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I like how you put that. It is really laughable when you think about it, that they pretend that a place that imprisons people is not a jail, and that injuries are not a punishment.
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Frank
You’ve got that right!
There is nothing therapeutic at all about a “mental hospital.” They love to talk about “treatment” and “treatment plans” none of which the actual “patient’ gets to have a hand in creating. Psychiatrists are the only doctors who can force people to follow their “treatment” and “mental hospitals” are only places to hold people until they conform with the drugging and are turned into human zombies. “Mental hospitals” are the only hospitals in the entire world where the “patients” are discharged in worse condition than when they were admitted. No choice, no control, no voice, and living behind locked doors on units where the staff often see themselves as nothing but guards and not behavioral health workers is what psychiatric hospitals are all about. As you stated “Psychiatric hospitals are literal prisons. Psychiatric hospitals are phony hospitals.”
And how do I know this? Well, I spent two and a half months as a “guest” in one of these wonderful “psychiatric hospitals” and now I work in that very same “hospital.” I feel like a member of the French Resistance working against the Nazi Occupation. As a peer worker many of the “patients” see me as someone who has gone over to the Dark Side but little do they know that my purpose in being here is to dismantle the entire structure from the inside. I work in Admissions and one day an army veteran who was being admitted to Forensics told me I should be ashamed of myself for consorting with the enemy. I asked him what the first rule of the battlefield is and when he said that the first rule of the battlefield is to never leave your wounded behind I looked him in the eye and said, “That’s why I’m here, I’m determined to not leave the wounded behind!” The look on his face was all I needed to know that he understood my purpose in being here. But it is an almost impossible task.
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To me, the most relevant issue at this time is what Bob points out about the ambiguity of what we mean by ‘mental illness.’ That phrase is a sticking point, and has become contentious on many levels. On this website, I’ve been called on the carpet for actually believing that such a phenomenon exists at all, but I am flex with this. To me, it seems reasonable that this would be open to myriad interpretations. And, indeed, there would be a plethora of reasons that a person might find themselves out of balance, ungrounded, depressed, dissociated, etc. Main point for me about that is that everything heals so whatever I would call ‘mental illness’ would not take on any political implication or social stigma. For me, personally, when I did live with a diagnosis, it was not that big a deal, until others began to project their own stigma onto it. Then, it became catastrophic to my life.
Frankly, I believe it is relative. Two people can be face to face with each other, each one thinking the other is ‘mentally ill.’ It is so subjective, overall.
Predominantly, when we talk about ‘mental illness’ and ‘disability,’ and the relationship of these to social justice and fairness, I think more of power vs. powerlessness, rather than ‘mentally ill’ vs ‘mentally healthy,’ whatever either of those would mean. More often than not, we seem to use these terms as an indicator of being outside the norm in a way that is shaming and belittling, which already sets up an unjust imbalance, from which marginalization is inherent. For whatever reason it occurs, being de-valued by a 1) family and/or 2) society will have a devastating impact on a person, causing them to suffer until they retrieve their sense of self, impervious to the opinions of others.
Psych hospitals and jails are filled with people who, somehow, lost their power, whether by sabotage from another, self-sabotage, or sabotaging social conditions. To me, they all seem like different sides of the same triangle.
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Right on! Alex!
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I do appreciate the debate but I think it’s hard for Allen to be objective about the APA and his contribution to the mess we’re in. The DSM IV was his baby and he’s acknowledged that it “created” several “epidemics” including ADHD, Autism and Bipolar.
I do agree with him about the direct to consumer marketing piece. Bob mentions that it would be a good “first step.” I think it would be much more than that and would love to see it happen. It’s hard to over-estimate the impact on “the story of mental illness in the US” these commercials, articles, billboards, etc. have.
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Allen Frances wrote:
“I see the APA as a hapless, sad sack organization — not very powerful, and not at all clever.”
I’ve never yet seen a psychiatrist who has a clue of their image in the eyes of the average citizen, whose attitude ranges from reverence, fascination, distaste, and fear to helpless fury and mute withdrawal, depending on the closeness of the relationship. “Hapless” and “not very powerful” my foot. Think of Inquisitors in the middle ages.
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Mary: I read Szasz’s The Manufacture of Mental Illness several years ago. I believe what I experienced was nothing less than an inquisition.
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I think they DO know how the average citizen sees them, or why else become a psychiatrist in the first place? Many people might enter it out of a desire to help people, but many just want a high-prestige (and high-paying) job.
It’s the same reason the APA ever tried to use a disease model for mental illness in the first place– they wanted the society and everyone in it to “respect” them, they wanted to seem more “scientific” and like a “real” medical specialty.
And, btw, in a culture like ours (hierarchical/authoritarian, with huge power imbalances) respect generally does mean “fear, reverence, fascination, distate, helpless fury” and all the rest of it. that’s just a fact.
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And really, when you stop and think about it, even though it’s a phony medical specialty, it’s the easiest of all the branches of doctoring to take up. Even the specialty of dermatology, which most doctors joke about, are actually real doctors who have to work for the money that they make. As a psychiatrist you don’t have to be very smart, you get to drug people with impunity, you don’t really have to listen to your “patients” and you don’t get called to the hospital in the middle of the night for emergencies. You make lots of money, can live in gated communities, drive gas guzzling SUV’s, send your kids to private and very expensive schools, and your ego can be puffed up because you get to strut around as a “doctor.” And you don’t have to do much at all for any of this.
Of course, neither can you have much of a conscience or be in the habit of looking yourself directly in the eye in the mirror every morning. But those things are of no real importance, are they?!!!!
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This sort of talk breaks my heart. I’m a medical student at Harvard in my final year. I’ll soon be deciding on a specialty. I’ve been more or less at the top of my class here; I’ve worked hard to keep my options open. I went to medical school because I wanted to work with the homeless and tormented, and those I see as least fortunate among us. I’m fascinated by the intersection of the brain and the culture in which we live, so I’ve liked the idea of doing psychiatry quite a bit. I’ve seen psychiatric treatments have dramatic effects in turning around people’s behavior and attitudes almost overnight, and I like being able to take the time to speak with my patients (rather than just “treat-and-street” them as is the unfortunate case in many other fields). I come across comments like this, and it just makes me sad to think that despite all the time and hard work I’ve put in (and believe me, it’s a lot of work), I’ll just be thought of as a greedy quack by so many in society. It’s ironic, actually, that you feel the way you do about psychiatrist incomes, since I’d give up a massive amount of expendable income if I choose psychiatry relatively to almost any other specialty, including primary care (since our healthcare system reimburses for procedures, which psychiatrists don’t do). All I want is to be able to build relationships with people who struggle with addictions, disorganized or disturbed thinking, and emotions that get in the way of living the kind of life they want to live. It’s sad to see that if I choose to enter a field where I think I might be able to do that well, there are people who will automatically think of me as evil.
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wflewis,
I don’t doubt your experiences but you have to understand that many people on this site have have been through horrific atrocities by psychiatry which your colleagues keep blowing off and minimizing. I think if you experienced a similar type situation, you would feel just the same way.
Anyway, you might want to do a search for a search for Dr. Sandra Steingard, a psychiatrist who blogs on here and perhaps contact her. I think she could offer you some great advice.
Best of luck to you.
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wflewis,
I hope you do go into psychiatry and become a ‘critical’ ‘psychiatrist. A very wise psychiatrist who has great empathy once told me that she was able to engage in all sorts of discourse with users or survivors of psychiatry because she could see the ‘pain’ behind the anger, and realized how much they had suffered. Another critical psychiatrist – Pat Bracken – writes that the most exciting thing to happen to psychiatry is the rise of the user/survivor movement and he feels collaborating with users/survivors is the way forward for psychiatry. I believe the ONLY reason why psychiatrist are considered by some to be ‘evil’ is simply because people are so afraid of ‘psychiatric power’ (See Pat Bracken’s 2012 article on ‘Psychiatric power -a personal view).
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Hi WFlewis
I am interested when you say you have seen psychiatric treatment make dramatic effects changing attitudes and behavior almost overnight. What do you mean by that?
For have you asked how the person receiving treatment is actually feeling and… Do you even get an honest answer? Because when you are locked inside force medicated you tend to say what you think the people ‘treating you’ wants to hear. Psychiatry has a tremendous power it can blithely ignore human rights and completely get away with it. It is the only medical speciality which actually shortens people’s lives on average and even kills patients and not be accountable! It is the only medical speciality that can say it is scientific yet has no locus no idea biologically speaking of what is going on yet insists it does and gets away with being based on pure scientific myths! I have to say I find psychiatry fascinating from a sociological point of view but I do not under estimate it. For underneath its aura of medicalized help lies also a chamber of horrors that stretches far back into history and sadly continues unabated today.
I too hope that if you choose to go the way of a psychiatrist you become a critical one. There is much literature written by your colleagues who are critical who dare to say the emperor has no clothes on 😉 I hope you find their books interesting and may I suggest my own thesis looking at how people labeled schizophrenic actually experience their drugs. A question that is virtually never asked. https://diskurs.kb.dk/faces/viewItemFullPage.jsp;jsessionid=F96650E745A829E7622944364BDEE581?itemId=diskurs%3A69033%3A1&view=EXPORT#contentSkipLinkAnchor
I wish you luck and really hope to meet you one day as a colleague and not just another typical psychiatrist 🙂
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Hi Mary – Could I suggest some shading to the perceptions of psychiatrists’ mortal plight that Francis tries to sell us on? Seeing psychiatrists take on ego deflation is something else. It reveals that many of them are constantly dealing with that awful threat called come-uppance. When I was compliant but not the believer, the more perceptive doctors and I picked each other out and with no further adieu discussed what-if’s about what could happen like psychosis, taking my word for it I didn’t know the whole of the experience. We totally agreed on leaving the label in doubt as equals, and any rate as unrepresentative of my needs vis-a-vis them, since I was taking charge of what to think. I had luck like that with maybe a dozen doctors over twenty or so years. These men and women undoubtedly understood that my next step once managed care and physician rotations and career moves next ensued, would again mean immersion in the whole bungled up mix of neglectful malice. I believed that they were considering whether I’d be alright looking out for myself without them as the doctors. The other kinds of doctors, generally: (1)those who don’t know how to see past the collateral damage to get a private moment with their patient or client working effectively, and are concerned or afraid of hurting people or them hurting themselves, but don’t know how to innovate, (2) those who want not to slip in the ranks and get their come-uppance, the ones that all the little elves of the hospital back up when they want some authority, too.
Over the years, the more perceptive doctors really punctuated my experiences less and less, and the other two types, the Making-do types and the Anosognosia-Titrator types were it. This is in my region of the Mid-Atlantic states, where now there are pretty much three or four hundred physicians that act either like order-followers or tyrants. The last genuinely friendly face I saw among them was from elsewhere and lasted in the med-check mill where I had to see her about three weeks. It’s the education of them at this point, added to everything else that shows us no reforms are coming unless in legal fights.
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I think Bob Whitaker did a great job on his argument with Allen Frances. I do however take issue with him on one point though. I think he has been looking at moral management through rose colored glasses. Yes, it was not biological reductionist and, yes, it did believe people could recovery from whatever it was that brought them the pass they found themselves in. All the same, those refuges he refers to were actually prisons, if psychiatric prisons, in themselves. Moral management engendered the asylum building boom that went along with the 19th century mental health campaigns of Dorothea Dix and others. Those campaigns and the asylums that went with them lead to a huge increase in the population of people in the asylum system between the dawn of the 19th century and that of the 20th century. Those Victorian monstrosities, the Kirkbride asylums, may have been in rural and outdoor settings, but they were no picnic. One could refer to them, as I have done, as the lunatic version of “nigger town”. Illustrating the severity of the matter, all you have to do is look at the cemeteries of these institutions. Burying a person, because of shame no doubt, under a number rather than a name is no way to memorialize the life of a human being. The idea of deinstitutionalizing folk from federal prisons and jails just to reinstitutionalize them in psychiatric prisons is not a particularly good one. Intolerance and nuisance crimes (stupid laws) are a big part of the problem here. Moral management, although an early reform movement, was not voluntary as far as inmate/patients were concerned, and as such, it still represents a form of psychiatric oppression.
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Frank: I believe, if I am not mistaken, that St. Elizabeth’s is a Kirkbride, as was Weston Hospital in West Virginia, which changed its name back to Transallegheny Lunatic Asylem when it went out of business and was bought up by a private developer.
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There were a lot of them, particularly up north (Willard, Greystone, Trenton, Hudson River, etc.) One thing Transallegheny got right is that they conceal true horror stories. They still do. Every Halloween people can get a spook tour of the institution I was first held at. They seem to know innately that these places hid ghoulish secrets. People talk about eugenics and lobotomy. Eugenics may have followed moral treatment by some time, but you can’t say the asylum boom it brought with it didn’t push things in that direction. Then there was the civil war way before PTSD became an official DSM label. One Flew Over The Cuckoos Nest may have been fiction, but it parallels what took place in so many of these places, and as far as it goes, what continues to take place in many institutions today.
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“One Flew Over The Cuckoos Nest” is the best and most accurate description of a psych ward I’ve ever seen. It’s truly “being sane in insane places” and the most crazy of us all hold the keys to the place.
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Thanks to Bob and Allen for debating these deeply important issues. I want to address Allen’s piece first.
I applaud Allen for directing a lot of his critique at “Big Pharma” and their advertising and marketing efforts. Yes I agree that this is absolutely important to address and reform. However, Big Pharma would not have the power to influence without the help of the APA and the DSM. Without the DSM, Big Pharma marketing would not be able to wrap itself in the cloak of scientific legitimacy. Truly the two are wedded and Big Pharma would lose much of its power to influence if the DSM was seen as lacking scientific underpinnings.
As tothe role of medication. Again I applaud Allen for recognizing that overmediction is deeply problematic. However he differs in that he would reserve medication for those that are acutely psychotic. Strangely I would agree but not for the reasons Allen may say. Sadly once a person has become habituated to antipsychotics I would guess the leading cause of psychosis is due to med changes and abrupt tapers. Because of this the humane thing to do is to suggest returning to taking psychiatric drugs as a way of curtailing florid psychosis. This does not imply that a person is essentially “mentally Ill” or needs meds for some chemical imbalance…but simply needs a safer and slower taper off very potent drugs. I would also reserve the use of drugs for short term care as we are already seeing that long term use are leading to worsening prognosis and health. I think it is key that Allen acknowledges this.
On the third point I think Allen is addressing a really important point. We have shifted from having around a half millions psychiatric hospitabeds in the 50s to having around 50000. Hospitals are generally turn mills to get people in distress back out the door. Prisons have taken up the role of long term “care” which is abysmal and torturous. Both options are awful and we need to revamp better possibilities for those in distress via humane non medical respite, housing first, community outreach, and non medical wellness programs designed to offer healthy non-drug options for helping those in distress. What I cant abide is Allens support for outpatient treatment. He must know that these drugs cause worsening prognosis and physical health. Why support their use as any form of “care”? I would hope Allen would become a leading critic in disavowing this practice understanding what he knows from longitudinal studies done by Harrow and others.
Anyways, though I disagree with you on a number of matters I appreciate you taking the time to debate and discuss these issues.
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On a deeper note, I think the key issue to resolve is why we have shifted towards 20 percent of people (in America) taking psychiatric drugs. A back of the napkin estimate would mean that 60 million folks are taking drugs for emotional distress. They are not generally getting these drugs from psychiatrists. They are mainly getting them from their GP. I don’t think many of them are interested in whether they meet a DSM-V diagnosis. They want relief from symptoms, and doctors, the AMA, the APA and pharmaceutical companies are saying that drug based therapy is an evidence based and generally safe way to manage distress.
If we want to get to the heart of the matter, the question becomes less about psychiatry and more about the role of drug based amelioration of emotional suffering in modern society. There are many culprits, and that includes us as a society that wants a quick fix to complex emotional pain. If we want to unwind this “epidemic”, we have to not only point fingers at the medical establishment and Big pharmacy, we have to choose as a society to employ healthier methods for working with our distress. We have to not only choose a slower, healthier path, we have to acknowledge the role of systemic racism, classism, poverty, food politics, industrial agriculture and quick-fix thinking at the root of our suffering.
These are complex problems not easily solved by
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Jonathan,
The problem is that if you ask doctors who want to prescribe meds yesterday for high cholesterol, depression, and high blood pressure yesterday about the possibility of trying non drug means to resolve the problem, they look at you like you are a space alien and start trying to make you feel guilty for not being a compliant patient. That is why I don’t feel it is fair to blame patients for wanting a quick fix. Some do but not everyone does and unfortunately, they get zero support from doctors who think drugs are the answer to everything.
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AA
You are absolutely correct. Many doctors of all specialties today expect you to be totally compliant to their demands and wishes, even when you know that what they want is detrimental to your well being. Who are you to disagree with them, the mighty and all powerful doctor?!!!
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Allen, I don’t observe a lot clinicians and researchers speak out during the height of their careers, when they have the most to lose. Most, like you, wait until they have already secured the financial rewards of retirement before they have a change of heart or make even tepid criticisms against the status quo.
When Jim Gottstein, founder of Psychrights leaked the Zypexa memos that made it possible to effectively launch a class action lawsuit for fraud against Eli Lilly, Jim lost everything, because of a lien against his personal property. That is what happens to people who fight corruption and risk everything to do the right thing.
I’m personally familiar with push back. When my uncle, an MD, (and a Quaker) provided free medical services at a clinic founded by the Black Panthers in the seventies, his phone was tapped. When my dad, a WWII combat disabled Veteran and Dean of Students at PSU, let student organizers use his office to lead a protest against the Vietnam War and personally objected to the CIA recruiting students in an office down the hall posing as a ‘Middle Eastern Studies’ program, he was blacklisted from academia and had to change careers.
As a person growing up in the seventies, I learned that the wheels of justice move slowly but they move at all because some people answer a call that is higher than providing security for themselves and their families.
I hope you consider how privileged you are to ride on the wake of a major historical paradigm shift created by people who willing to make great personal sacrifices. In the future, it may be safer for clinicians and researchers to come out of the closet instead of being ‘closed door allies’ but until that time comes, my respect is reserved by those who pay the highest price for shifting the poles of this important debate.
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Well said madmom I agree with your comment and think that some people become turncoats when it’s safe to do so.
Here’s to all of these folk who stand up for what they believe in, regardless of the cost.
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I deeply agree with the comments above. I find it difficult to see how come Allen Frances did not realize far Before how damaging the DSM system is, not just the latest version.
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An interesting debate. While Bob never goes far enough for me, there is no question but that in my mind, if we are thinking of winners and losers, he wins the debate hands down. With DSM-III, Frances’s immediate predecessor as DSM chair very clearly brought in and masterminded a medical model. And it did this on the basis of conjecture and a process of lying that borders of fraud. And so Bob is quite right to both blame the APA and worry about their power.
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I am the mother of a severely ill child who knows first hand that coercive treatment is alive and well, and perpetrated for the most part, by well meaning people in a misguided system.
Thank you Robert Whittaker, for shining a clear light on the real issues that keep getting pushed aside. I have been so distressed reading Allen Frances’ posts to the Huffington Post which don’t seem to consider the possibility that medication could harm some of the severely ill.
In terms of medication and forced treatment
HOW CAN IT BE EITHER LEGAL OR MORAL TO FORCE MEDICATION ON ANYONE, WHEN AT THE VERY LEAST, IT IS NOT KNOWN WHETHER THE MEDICATION WILL ENHANCE THE LONG TERM RECOVERY OF THAT PARTICULAR PERSON, AND AT THE WORST, MAY CAUSE HARM, AND MAY BE PREVENTING THE `NEUROPLASTICITY’ OF A PERSON’S BRAIN FROM HEALING ITSELF.
Dr. Frances, for the severely ill patients on AOT, the ones who do not recover fully after they are forcibly medicated, how do you justify their treatment in terms of `FIRST DO NO HARM’ ?
`Forced safety’ needs to be separated from `forced medication’ and there needs to be places for people in acute psychosis to go to be safe. where they are not also going to be forced to take medication that may or may not harm them further. If there were these places, then surely the prisons would not be so full of the severely mentally ill. Forced medication should not be the tool used to decrease prison or hospital visits, homelessness etc, or to manage behaviour;’ I imagine the negative affects alone that can occur with medication -apathy, sedation etc.- would be enough to reduce the number of people who are in prison – So certainly forced medication can only be justified in terms of whether or not the medication promotes WELLNESS in a person, For myself, if I had the choice of going to prison-without getting forcibly medicated – or of staying out of prison and being medicated which resulted in disability, worsening of illness or cognitive decline – I would choose going to prison.
As a parent, several stories haunt me. These are stories of people who became or remain severely ill for years and years while being kept on medication. Among these stories are ‘Dorothy’ who Torrey writes about in his book `Surviving Scizophrenia’ who sits for decades -presumably medicated- politely nodding but with a`paucity of thought’, even though Torrey explains this same woman ‘recovered somewhat’ from an earlier pscyhotic episode without being on medication. Whittaker’s story of ‘Lost in Seattle’ – the teenager who only started to have symptoms after medication and has now been lost in her own world for years- how do we know how these people would have fared without medication……I guess we don’t and that’s the point….please Dr. Frances remember your oath to FIRST DO NO HARM when you think about whether or not forced medication is ethical.
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Right on Sa! I’m with you! My daughter was never the same after being forcibly medicated, restrained, isolated and diagnosed! The horror of the isolation and the terror of the restraints and treatment itself drove her mind deeper into a shattered, and disassociated collection of voices and personalities. It took me a while to wake up and smell the roses. I think the spell was broken when one of her shrinks wanted to shock her while she was at her most vulnerable; while she was catatonic. Over my dead body!
Today, we are supporting her brave efforts to weave a narrative of her life together that can support the existence of new voices and personalities, integrating them into a cohesive whole that embraces, past, present, and future, with the least harm to her integrity, dignity, and cognition.
She is not out of the woods yet, she is still subjected to daily propaganda and is institutionalized. After the violent initial attack against her by the mental health system and the daily grinding harm of institutionalization, it will be a long journey back to recovery.
Don’t those psychiatrists, with all their arrogance learn anything from their patients? We parents have learned loads from our daughter. For one, always question the status quo when it comes to mental health ‘treatment’!
One has to work THROUGH the symptoms, not suppress them. Plunge through the darkness to the other side. One has to know the limits of sedation, when to medicate and when to let the emotions free.
My daughter is aware of her ‘madness’, she has loads of insight, and she is experimenting with techniques including mindfulness to weave together the shards of her former self. If only she had experienced her break from reality in SF during the seventies and could have been a resident in Loren Mosher’s Soteria House!
I totally agree with you that we need sanctuaries for our children and we are going to have to organize, even resort to civil disobedience to squash this wicked tradition of forcibly medicating children, making them chronically ill and dependent!
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Madmom,
Thanks for your comments. I wish you and your daughter courage and strength and hope to read about her positive outcome in the future!
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Very well said! If we’re concerned for people’s safety, we should help them be safe, but how is that in any way related to forcing them to take drugs for subjective conditions when the drugs may or may not have a positive effect even in the short term, and may have devastating effects in the long term? Those two concepts need to be COMPLETELY DIVORCED! Concern for someone’s safety is NEVER a reason to forcibly drug or shock them, or even to force them into some kind of talk therapy. If safety is the issue, then that’s what we should focus on resolving, not on “treating” spurious “mental health” conditions that are voted in and out of existence by a bunch of well-off elitists with massive financial conflicts of interest.
—- Steve
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I wanted to add something to my earlier post so am hoping this will appear under it.
About prison and focusing on alternatives:
After rereading this debate, I realized that in the same way I am very frustrated about how Dr, Frances does not seem to listen to what people are saying about the harm of medication over the long term, nor provide any evidence as to why he feels Mr. Whittaker’s reading of the literature is one sided; perhaps on his side Dr. Frances feels frustrated and not feel listened to about his point of the horrific situation that the mentally ill face in prison and on the street.
I just wanted to add that although I don’t have personal experience of the prison system, after caring 24/7 for a severely ill child , I am someone who CAN well imagine that prisons could be full of severely mentally ill people who either don’t have the support of loved ones, or whose loved ones can’t support them for all sorts of reasons, including the dis-empowerment of families that can result after children are treated in the mental health system.
If our child did not have intensive support, he would likely have had no hope but to end up homeless or in prison, and I can well imagine if he ended up in either of those places, he would have suffered horrific abuse, and even more discrimination than now.
So if we were thinking of a productive way forward, I believe we must all focus our energies on creating programs that provide alternatives to AOT, prisons, and homelessness in all states so people truly have choice of treatment. Once people have choice, imagine the possibility for ongoing long term studies comparing the effectiveness of meds to those who choose the nonmedicated approach. Finally we could get definitive answers as to how, when, how much and to whom medication is most likely to be effective. Finally we would have a chance to replicate the studies of open dialogue.
People who do well on medication and our fearful of their lack of logic during a crisis, could write up contracts with their loved ones to ensure they would receive the medication they would want to be given during a relapse.
Safe places for our children and adults would not be more costly than our current medical system. Our child currently costs the system nothing but is a huge cost to our family. Having some support such as people providing support in our home, have a `safe’ place to take our child when the burden is particularly heavy, or even funds to set up a ‘safe room’, open diaolgue approach, respite, soteria houses – all of these things are possible,
Once my child is better -that will be my mission – to promote these services. Are there people out there who are able to start the work now?
As a parent I am very pragmatic and I don’t care if this happens within or outside of the mental health system – whatever is the quickest route to provide safety without forced medication for people. I shouldn’t have to give up what I see as my child’s ‘best hope’ for long term recovery because I am afraid of safety in the short term. I want my child to have a fate like ‘Katherine Penney’ or like the mother 0f ‘Mary Copeland” not like the teenager in ‘lost in Seattle’
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I forgot my final point which is to say, Dr, Frances, that if any of the arguments from the debate with Mr. Whittaker can sway your opinion about forced ‘treatment’ in all its forms, and if instead you could loudly support an evolving system that includes both safety and choice – I believe you would have enormous power to effect great change.
(And finally I want to apologize for using specific examples like ‘lost in Seattle’ – that teenager could well be doing much better now, or will be in the future and I certainly am routing for her recovery – so sorry to her loved ones if any of you happen to read this site)
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“People who do well on medication and our fearful of their lack of logic during a crisis, could write up contracts with their loved ones to ensure they would receive the medication they would want to be given during a relapse. ”
That would in fact be the most helpful. Anyone who is down with being coerced to drugs or even just taken to safety against ones will at the moment of distress while experiencing psychosis should be able to give a pre-consent specifying who, when, to what extent and for how long has the right to restrict this person’s freedom.
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Hi Sa, I enjoyed your successful writing here. Specifically, you made a good articulation of the point you were driving at. You got this point right, that all the focus is off the facts of known treatment benefits. Your approach to the questions behind that appealed to me especially in how you showed the difficulty facing anyone trying to highlight the point of whether we even know what works, given how the reformers evolve their position to keep that concern as just some afterthought. Like for the next DSM meeting? You bet.
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If we really want to “save normal” as Frances suggests in his book, we need to start by eradicating that which produces every abnormality in the American, and indeed the global psyche. In other words, eradicate psychiatry altogether. Whitaker is obviously a hero in this battle who has been able to ingratiate himself with some of the cunningest men in the industry, but whose voices should we listen to the most? Should we listen to the voices of academicians and pseudo-physicians, or to the voices of those who have actually endured abuse from inside of the system? Politicians and policy makers, backed by Big Pharma can triumphantly tout their solutions for what they deem to be the problems of the masses, but if anyone needs to be diagnosed it is the psychiatrists themselves. Only a person (or a group of people) with severe mental impairments would claim to be able to identify, categorize and codify, the problems of the masses. Certainly it has already been suggested that the only diagnostic category that should exist in the next DSM is not ADHD, ADD, MDD, Bipolar Disorder or Schizophrenia, but the dreaded PSDDDD: Pseudo-Scientific Delusional Disposition to Diagnose Disorder. Don’t worry though. Even though this biological brain disease is endemic to almost all psychiatrists, pharmaceutical company CEOs, and members of the APA, there is a proven cure for this disease. The disease is not caused by some mysterious chemical imbalance of the brain, but by a an actual deformation of the soul. What should be prescribed to those who suffer from PSDDDD? A healthy dose of their own euphemistic “medicine.”
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PSDDDD?
Wow, I didn’t realised but all my psychiatrists suffered from that :D.
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While as people who know me know I am in no way opposed to Whitaker and the points he makes, I do take some exception to the implication in this:
“We make up five percent of the world’s population and yet our citizens make up 25% of the total world population of prisoners. So the problem we are talking about here is not just the “imprisoning” of the “mentally ill,” but a problem of a society that imprisons people at a grotesque rate.”
But we also have the resources and an ecomony that supports building prisons and hiring people to work in them. I’m sure that if the rest of the world had the resources, they’d lock up a whole lot more people than they currently do. This also ignores the probable fact that in many countries in the world there is no real due process, and people often face corporal punishment that may or may not involve their government at all. “Bride burning” in India and Pakistan is a good example of this. Nobody knows for sure how many times it occurrs, although some estimates are in the thousands per year.
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We have the resources and economy to imprison people? Really? I would think that we had better things to be investing in, but maybe you think otherwise. I think, as far as this matter goes, Whitaker makes a very good point here. Are we expected to take pride in our size of our prison populations? You tell me? Ditto, our psychiatric prison populations?
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We’ve also got a very high homicide rate in this country, but it goes along with gun culture, and the scapegoating game. Should anybody go “gun crazy”, all you have to do now is blame “the crazy”. The “mental illness” excuse, the insanity defense, permits all sorts of mayhem. You can’t control “the crazy”, but you can keep the government from taking away your arsenal.
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Perhaps you missed my point. My point is not hat it’s economically prosperous to lock people up, (although it is an has created millions of jobs that otherwise wouldn’t exist) but my point is that we built these prisons and so of course we are going to use them. In countries where they don’t exspansively build prisons like we do, it’s not like they don’t do so because they have less “crime” or because they do nothing about it; my whole point is that those countries/cultures are punishing their “criminals” in different ways, not that they are going unpunished or that they have less crime, which is what it seemed that Whitaker was implying in that quote.
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These other countries don’t have such a racial problem. Seems like the industrial prison system is a new Jim Crow…
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Many other countries do indeed have racial problems, as well as religious and political conflicts that often lead to war and even genocide.
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But “crime” is relative, it’s not an absolute thing. Being a “criminal” doesn’t mean the same thing in France in 2014 as it did in the USSR in 1936. You seem to be suggesting that there is some baseline, perhaps “natural,” but definitely ewuivalent level of crime in all countries, regardless of their laws, cultures, and contexts. I can’t see why this would be unless you think that crime is “natural,” just as some researchers use arguments about a “consistent across time and cultures” rate of “schizophrenia” to suggest that it is just “natural,” and therefore biological.
What defines crime isn’t some essence of “wrongdoing,” crime is only what the people who managed to have the most power and influence have decided to label and prosecute as crime.
A country that has laws like the “Three Strikes” laws, and is thus happy to send people to prison for stealing a sandwich when starving, or that has sit-lie laws that criminalize homeless people merely existing in public, or that has very strict parole violation penalties, which basically makes associating with people you know illegal, you have a country that is producing criminals at a higher rate than a country that does not criminalize those things. And all that’s not even bringing into it the War on Drugs issue, which is so huge.
Why are you so concerned to suggest that the USA doesn’t differ at all from other countries in the amount of crime it has, anyway?
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If that money was spend on things that actually prevent crime: social housing, educational programmes for kids and youth, fighting unemployment, reasonable law enforcement (not Ferguson style), etc there would be little need for prisons.
It’s what your priorities are…
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JeffreyC
I think I’d be absolutely mortified if one in four of my countrymen/women were locked up!
I’d be marching in the streets and demanding answers from my politicians as to why so many potentially productive and valuable souls should be languishing behinds bars rather than making their unique contribution to society…..and why my taxes were being wasted keeping them there.
Stats like that indicate very significant social issues and, in fact, a very real lack of due process and natural justice for a great percentage of the population.
The home of the brave and land of the free seems not quite so free….
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Too many people may be locked up in this country, especially for non-violent crime….
But for the sake of *accuracy*, it’s not 1 in 4.
It’s 1 in 142 – in jail, prison.
And it’s 1 in 32 total – not locked up, but in the system, ie parole.
It’s not 1 in 4, for the sake of *accuracy* –
http://usgovinfo.about.com/cs/censusstatistic/a/aainjail.htm
Duane
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correction, 1 in 32 (roughly 3%) – in prison or on parole
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Jeffrey was accurate in saying that 25% of the world’s prisoners are in the US. But the later comment in the thread about 1 in 4 citizens in the US being in prison was not.
I did not mean to single-out the commenter, but only to bring clarification. Also, apologize for the number of comments.
Duane
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“I’m sure that if the rest of the world had the resources, they’d lock up a whole lot more people than they currently do.”
Nope. Norway has sh**loads of money and it doesn’t do that. It’s about the mentality in the system.
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I’m glad this debate happened. I respect Allen Frances for reaching out to this community and trying to establish common ground. My impression of him is that his APA connections do blind him to the role of APA in the current state of affairs. But it’s good to hear outside voices in dialogue with this community and I think we need more of that 🙂
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I have yet to hear from any psychiatrist, whether it be apologists for the APA like Allen Frances, or from any other of my many more critical psychiatric colleagues, as to what it is exactly that the profession of psychiatry has to offer, AND what it is, that is unique to psychiatry alone (as opposed to the various therapeutic technologies of psychologists, social workers, family therapists, community workers, etc. etc.), other than dangerous and damaging psychotropic medications and the pathological labels of the DSM. The profession of psychiatry is indeed suffering from a very deep identity crisis, belittled by other medical specialties for its lack of evidence-based rigor, and with the collapse of the biological mythology, no longer able to justify its dominance among the various mental helping professions. Psychiatry’s last identity crisis, back in the 1970’s, which was largely due to the challenge posed by other less expensive professionals to psychiatry’s dominance within the psychotherapy market, led to the biological reinvention of the psychiatric identity.
So my question for Allen Frances and all of his psychiatric colleagues is this: What is a psychiatrist without his medications and diagnoses and what is it exactly that he/she has to offer people in need and our society? (N.B. As I ask this question, I hear the voice of David Cohen whispering the word “coercion” repeatedly!)
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Historically, whenever any oppressive institution comes under criticism and intense struggle to remove it from history’s stage, there are always system apologists who attempt to promote desperate justifications for preserving and rescuing it from its ultimate demise.
In this case Allen Francis appears to be playing that role by still having one foot firmly planted within Biological Psychiatry while dangling a few toes in half baked efforts to reform that which can never be reformed.
I have used the following definition in prior blogs and comments :
“Biological Psychiatry is the wedding of genetic based theories of so-called “mental illness” with the American Psychiatric Association and other leading psychiatric organizations in the world, together with the pharmaceutical industry, and the major training institutions for psychiatry.
The APA is an essential force within this institution and shares equal responsibility with Big Pharma and the training institutions for modern psychiatry. They all work together in a symbiotic relationship; each depending on the other for their existence.
Stopping direct advertising for psych drugs will do little (at this point in history) to stop the oppressive power and control exercised by Biological Psychiatry. In Australia there is no advertising of drugs; is there any less of a problem with the drugging of millions of people and the rampant use of force and coercion on vulnerable individuals labeled with “mental illness?”
Within our culture of addiction legally prescribed mind altering (psych) drugs have now become deeply imbedded in our collective psychology of dependency. The withdrawal syndromes alone (for all categories of these drugs) provide an absolute guarantee of returning customers aside from their actual and perceived effects (temporary or otherwise) on psychological well being.
As horrible as jails are in this country can anyone truly prove that they represent a worse alternative than what modern forms of “treatment” offer people in today’s world. At least in jails people know beforehand exactly what they are getting.
Richard
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I cannot agree more with your last comment Richard. It reminds me of work I did years ago as a streetworker, working with drug users in southern Germany. Many experienced long-term users told me that, when given the choice, they would rather go to jail than to enter rehab, because at least in jail they could make decisions autonomously, while in rehab the therapists ruled autocratically.
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Criminals are at least afforded protection from ‘cruel and unusual punishment’, under the 8th amendment.
People locked in psychiatric facilities have no such rights. Held against their will; subject to massive neuroleptic drugging, ECT; isolation and seclusion… without having been convicted of any crime. Go figure.
Duane
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i think it’s a little strange to say that stopping direct-to-consumer advertizing would do little. It may seem little, but no one is suggesting that it be the only tactic that will alone stop Big Pharma & biopsych. What we are saying is that it would make a significant difference in a certain area, and that it should be considered. It would also be (relatively) simple to do.
Like all people in power, psychiatry does depend on a large amount of coerced “consent” and misinformed consent from the general public. You are focusing on people who are forced to take drugs, and those people are suffering, but that doesn’t mean we should ignore the massive amount of everyday people who agree to go on psych meds because they swallowed the biopsych marketing line, largely via direct-to-consumer Big Pharma marketing.
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I agree 100%. DTC advertising has been a huge part of creating the culture of “meds” that is so prevalent today. People come into docs or ERs looking for the pill that is going to make it all better, and continue to have faith in the docs despite disastrous failures because they’ve been told over and over that their problem is a “chemical imbalance in the brain.” Of course, we’d have to handle the APA as well, but DTC advertising is a big part of the problem and should definitely be banned, not just for psych drugs but for all of them.
—- Steve
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Thank you Bob for answering so eloquently the points Allen Frances makes and as always you are so well versed in the research, so solid, so secure that I completely agree when Allen writes that “his [Bob’s voice] is now one of the most powerful voices in the country, influencing both attitudes and policies.” However that is pretty much all Allen and I agree upon.
For if psychiatry was such a poor victim, blundering around pulled by the nose by big pharma, would they not have risen up, put on their battle garments and joined us in righting the wrongs of drug induced horrors on poor hapless people? Would psychiatry not have opposed rather than joined big pharma if they were truly interested in scientific validity. Would they not today be out their apologizing for all the harm they have been ‘forced’ to subject their patients to in the name of big pharma?
No I am sorry I just do not buy the poor victimized APA tihsllub, just as I do not buy into Allen Frances ‘s new role of trying to make out he is critical of psychiatry. After all as Ted Chabasinski writes, Allen lead DSM IV and five is more of the same, just a tad more ridiculous. Yet by advocating a middle ground saying drugs do play a role and it is not ‘us the psychiatrists at fault, we are but ‘sad sacks’ clutching the DSM bible in our hands trying to survive the manipulations and ministrations of big pharma’, he and others like him become dangerous. Dangerous because the apparent ‘new’ voice of reason saying “just like you we have be mislead by big pharma, but now we are aware of that and can medicate properly…” Means they can carry on as usual. This is clearly seen in the ever increasing numbers of people on drugs especially our children who are being groomed for, in many cases, a life time of medication. Thus this middle ground effectively means that the use of drugs will be given a new lease of life despite the fact that it has become known, thanks to Bob, that they are so harmful and that their apparent way of working is based on lies. Lies which have, by the way, been created by psychiatry and mutually supported by themselves and big pharma.
I for one will not be letting up on biting the Achilles heel of psychiatry and psychiatry’s new Voice of reason will not be fooling me. Power is never given back it must be taken back and we are many who are doing that. However I do feel optimistic when psychiatrists like Allen start singing to a new tune as it indicates the foundations of psychiatry are truly cracking as it becomes utterly clear psychiatry is in a huge crisis. However this puts psychiatrists between a rock and a hard space so there will be much focus on attempting to fill in these scary cracks for as Eugene Epstein asks Allen Frances and all of his psychiatric colleagues: “What is a psychiatrist without his medications and diagnoses and what is it exactly that he/she has to offer people in need and our society?”
I won’t hold my breath while we wait for an answer
Allen writes about the number of people in prisons who are so called mentally ill whatever that is supposed to mean. Personally I think that just as we lack a language for this situation as you write Bob I also believe it is much bigger than this and is part of the present day structure of the societies we are building up. This superb TED talk
http://www.ted.com/talks/richard_wilkinson?language=en
looks at the effects of inequality and explains in many ways the other aspect of what happens when poverty and insecurity are part and parcel of wealthy societies were the gab between rich and poor is huge. USA and the UK introduced the world to neoliberalism which supports and sustains inequality and sadly this has spread like a cancer to many other countries. This “each man to his own” has tremendous consequences not just for those who are labeled insane, but for our whole planet as we put wealth and status above all else. Oh and a healthy portion of “you are poor? Your fault.” So naturally if there is a market in imprisoning vast numbers of people and calling them mentally ill it will be exploited. And guess what? It is.
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I deeply agree with Olgas comment, just to add that as far as I have seen and experienced there are more professionals than psychiatrists who would need to stand up and take a stance. In words as well as in actions.
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Much appreciate Bob Whitaker’s clear arguments and wonder if they are arguments against psychiatry, that is for the abolition of psychiatry. I have stated the same point Eugene Epstein is making – in my words that psychiatry’s neuro-genetic-models of ‘mental’ diseases is a flawed science fiction and a categorial fallacy. I conclude that ‘treatments’ based on false neuro-imbalance- models, but also those rooted in articifial neuro-cognitivist schemata-models, can only do harm. Mind, emotions, beliefs, practices don’t and will never originate in ‘single brains’ nor ‘cognitive schemata’ and thus are not ‘treatable’ as ‘brain or neuro-cognitive diseases’.
The classical psychiatric diseases have not just been observed in ‘institutions of depersonalizing neglect and oppression’, they have been shaped by their dehumanizing procedures, as Goffman described in Asylums. This is not to say people were not experiencing distress, despair, confusion, affectively altered mental states before their incarceration. It is to emphasize that the ‘total institution’s abuse and neglect’ was the abhorrent anti-relational and anti-social situation of abjection (Kristeva) that shaped classical psychiatric disorders with schizophrenia at it’s core/for.
I just want to state clearly that there are no psychiatric severe and chronic mental disorders outside of hierachical psychiatric institutions of severe neglect and oppression. This is my strongest argument for the abolition of ALL medical psychiatry, I agree with Bonnie Burstow on the need of abolition.
This leaves the social/societal and political obligation/responsibility for
– Support for people overwhelmed by real social life problems and/or the consequences of abuse, violence, victimization, oppression, and, nowadays, severe relational neglect and isolation
– ‘Eco-social alternatives’ that do actually work by providing a safe relational environment equal to ‘sane and supportive’ relationships, listening, dialogues AND ‘organic and respectful practices’, incl. making crafts, arts, music, care for animals, healing with/in nature:
Open Dialogue in Social Networks and NAD, Bloom et al Sanctuary, Family Homes in Sweden, Healing Farms in the Netherlands, Bapu Trust in Pune/India, Recovery Learning Communties as in Western Massachusetts, Community Psychology in the Real World Groups as in England, and many more
– Eco-Social Alternatives grounded in COLLECTIVE values and procedures of ‘democratic participation’ in shared responsibility in community groups (as named above) where EVERYONE is an equal person and takes and gives, as described first and famously by Judi Chamberlin in ‘On our own’
– In contrast, known since the 1960’s/70’s, ALL hierarchical and categorizing/pathologizing/othering institutions, be them in hospitals, containing-houses for clinically produced chronic mentally harmed, or day centres’ run in controlling and belittling ways for the clinically produced hopeless and re-victimized, are prolonging re-victimization and dullness/helplessness,
BUT some people as Lauren Mosher, Luc Ciompi with Soteria, E Podvoll
with Windhorse, and, in my view, above all Franca and Franca Basaglia have been pioneers for allowing people to re-relate organically, socially AND practically in diverse communities they are part-takers in and part-givers to.
Since the late 1980’s the Hearing Voices Movement and the Trialogue in German speaking countries, with NAD & Open Dialogue in Scandinavia have been creating respectful, participatory social meetings, exchanges with active contributions of ALL – be them seen as psychotic from the outside – participants. HVM, Trialogue, Open Dialogue have ‘proven’ that democratic collective gatherings with dialectic co-production of reflections on extreme experiences in lived social contexts are understandable, shareable and do provide education on human social souls predicaments and struggles. Understandable for all participants and in all people’s lives, incl. mental health professionals freed from their own psychiatric mental prisons.
As Carina Hakansson writes, and I hereby wish to document, many people all over the world have been standing up and collectively created ‘sane and supportive’ spaces for co-being and collaboration, where each gives and takes with some initially confused or affectively highwired and some from the beginnings more relaxed in their ordinary lives.
I conculde that we need different Psychosoicalcultural Sciences and use locally adequat, socially and relationally informed evaluation procedures and standards to document dispersed and relational, organic/embodied and practical co-healing and co-production of all participants over time, as Jaakko Seikkula and Tom Arnkil write in ‘Open Dialogues and Anticipations, Respecting Otherness in the Present Moment’, as feminist, disability, survivor and indigeneous researchers, engaged in community practices, have been documenting over more than 30 years, because we learn, revise, evaluate what, who and how matters only as socially and practically related and engaged ‘collectividuals’ (Anna Stetsenko, 2013).
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Hi Ute Maria, can you please clarify a bit about your as I understand it anti psychiatry approach and at the same time pro Open Dialogue? as far as I know Jakko Seikkula dn many other Open Dialogue people claim that change has to be done inside psychiatry. best wishes, Carina
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Hi Carina,
Sincere apologies, I am not able to explain why Open Dialogue in Social Networks is said to be an medical psychiatric treatment. I see not a single conceptual nor social nor practical familiarity/sameness with medical psychiatry and its neurogenetic hypothesis since Kraeplin and until DSM 5.
What I learned is that R D Laing saw himself as a psychiatrist, whereas Cooper coined the expression anti-psychiatry which Laing rejected.
Franco Basaglia literally invented community psychiatry – in the 1970s – and eventually kept the professional title of psychiatrist. Interesting enough Franca and Franco Basaglia were inspired by the philosophers Heidegger, Merleau Ponty (phenomenology) and Sartre (existencialism).
We need keep in mind that multi-disciplinary discussions on the nature and politics of humanity and madness were part of scholarly, incl philosophical, thinking in the 1960s and 1970s.
This is in stark contrast to the managerial preference of rigid experimental psychiatry and its modelling of mental aka brain diseases artificially reduced to causal pathways of neuro-chemical mechanisms dominant since the 1990s. Nowadays to support medical psychiatry is to support artificially construed mechanistic models of (human?) mental illness in a circular argument and thus to support harmful treatments based on these scientist assumptions – a categorial fallacy as I wrote above as no human experience nor mental capacities can never be reduced to neuronal functions.
Just found an amazing short documentary on Franco Basaglia and the liberation of the mad from the institutions with English subtitles on youtube. This clearly shows what was then liberation in psychiatry has been subject to a terrible scientistic counter-revolution in the last 25 years. So the claim of psychiatry is not the same in the hopeful times of Laing and Basaglia as in today’s repressive scientific and politcal ‘climate’. (Climate is not the right English term, I mean political realities of neglect, exclusion and coercion legitimized by the institution of academic psychiatry, at least in US, UK, Germany…)
Short documentary on Franco Basaglia – liberation of the mad from the mental institution – a wonderful historical and ethical reminder https://www.youtube.com/watch?v=kIOvqgD7Iw4
Warm wishes
Ute
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I don’t understand how Frances can just not ever seem to address the fact that made Robert Whitaker famous, which is that the science itself proves that psychiatric medications are dangerous, and actually make things worse for people long term.
As someone above me said, without their drugs psychiatrists are nothing… without that, we do not need them, as we already have healthcare and social workers, talk/behavioral therapists, and families, friends, and political activists. What does Frances think psychiatrists are offering us that we need so badly? We don’t need you, Allen Frances and the APA. WE. DON’T. NEED. YOU.
(You only need us, so you can make money off of us)
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“The United States imprisons its citizens at a higher rate than any other country in the world (according to a 2013 study.) We make up five percent of the world’s population and yet our citizens make up 25% of the total world population of prisoners.”
Couple imprisonment with the rate of felony convictions as these drive joblessness and hopelessness. So the only way to survive is with a diagnosis and drugs that become the band-aid for survival.
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I’ve drawn a good bit of fire at Mad in America in previous debates, for suggesting that while debate is a useful initial step, it is is not enough. At the risk of seeming a skunk at the wedding, I’m afraid I must in conscience add this footnote again.
From reading the exchange of views between Frances and Whittaker — and the commentaries which follow — it occurs to me that for many of those who commented here, no “solution” is acceptable that does not vindicate their experience and social viewpoints in total and without ambiguity. For them it seems to be “my way or the highway.” Coming from people who have been dictated to and harmed by mainstream psychiatry, this desire for moral vengeance seems at least a little ironic. Are you that certain of your moral purity? Do you want vindication or deep social change? The two might prove to be mutually incompatible.
In the real world of societal politics, unambiguous outcomes in major social issues simply don’t happen. Examples abound, but one that comes quickly to mind is the emancipation of slaves. A hundred and fifty years after the US fought a civil war costing hundreds of thousands of lives, we are STILL struggling to define a more just and non-discriminatory society. The civil war didn’t decide those issues for all time, regardless of who nominally won or lost. In an issue as fundamental as psychiatric mythology and abuse of power, can we rationally expect a less uncertain outcome? I rather doubt it. The revolution is going to be messy if it happens at all. So we need to deal with the reality, not the wishful thinking.
That said, there is a missing piece that I’d encourage Frances and Whittaker to address in a sequel: go talk to each other in person and come back with a list of possible elements of an action plan to enact real change. I realize that you (and your critics in the commentaries) will not agree on every step. But give us a menu of choices that individuals might get behind. Without programs that can enlist the engagement and resources of other people, what we end up with is an endless talk therapy session that occupies space and attention without really moving anything forward.
Likewise, concretely what would the commentators propose to DO that’s different from what has gone before, or that the authors have outlined? Who does it? Who pays for it? Who gets sued or picketed or prosecuted, for what offenses? How do alternatives for the alleviation of human distress actually emerge? How does mainstream psychiatry die in less than another two generations?
The devil is in the details.
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To refuse to admit a mistake is to make it twice.
Whitaker has found much evidence that long term use of psychiatric drugs make patients worse.http://robertwhitaker.org/robertwhitaker.org/Antipsychotic%20drugs%20and%20chronic%20illness.html
Psychiatry refuses to admit they are making people worse.
I do not think Frances and Whittaker have any common ground to start a discussion.
IMO The solution starts with money, where does it come from, and where does it go.
The Government that pays for the drugs and the psychiatric help should demand the money back and stop paying for services that do not work, but the government representatives that approve the expenditures is full of doctors who believe in a chemical lobotomy.
Like a bunch of drug dealers being asked to stop selling/pushing drugs onto their clients.
“The people want the drugs, or the people need the drugs” the drug dealers would say.
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Have you not been listening (reading) very closely? Because many people have given suggestions as to what to do. E.g. end direct-to-consumer marketing, get rid of the DSM, get rid of the entire idea that mental illnesses are “medical diseases,” give social and economic support and aim at social and economic self-determination for people, give therapeutic support a la open dialogue, hearing voices meeetings, etc. Address the prison-industrial complex, capitalism, racism, patriarchy, and enfold egalitarian values into our day-to-day practices in treating other people and their distress.
As for your question about how alternatives for the alleviation of human distress will actually emerge, you make it sound as if none have. They have already. Pscyhiatric survivors,various communities around the globe, and critically-minded mental health service workers have already developed them, we have seen them work… we aren’t dealing with a lack of ideas or alternatives, we are dealing witih a lack of societal and economic support for those ideas and alternatives.
We are dealing with, in fact, a system of entrenched powers that will punish you for even attempting them. So, yeah, it’s not our failure, it’s theirs. We aren’t afraid to name the perpetrators.
How does mainstream psychiatry die in less than another two generations? Just like “mentally ill” patients have died throughout its long history– from lack of resources, lack of attention, lack of prestige, lack of trust, and lack of power. Cut them off. Cut their resources off. Cut off their funding, their social prestige, their legal power, and their ability to produce research anyone takes seriously (although they’ve sort of already done the latter to themsleves, or at least begun the process).
I think you’ve sorely mischaracterized most people here by saying that it’s a “my way or the highway” attitude, and that we are only after totally “pure” or “total” or “definitive” changes that put our supposedly anti-psychiatric-fascist views into action. Look at the history of our consumer/survivor/ex-patient movements and tell me that we are unwilling to work with the reality of where we as a society are at, or where people are at, or unwilling to work within the system. Look at the peer movement, the recovery movement, so many of our efforts were within or at least collaborating with the existing system, for reform. Soteria was NIH funded, but they pulled the plug and turned their back on the huge success that it saw with treating its community-members. So tell me, how well has that reformist strategy worked out for us?
Everyone here is morally outraged because we have experienced moral violence by this system. That doesn’t mean that we only want whatever utopias we have imagined and nothing else., but how can you pretend that it is somehow unwarranted for us to be angry and morally outraged when we have been victimized for profit? How?!
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There is the debate, above, on the MIA website. There is no debate at the university in the town where I reside. This university has a strong pharmacology department, a strong psychiatry department, and a whole lot of silence. I think the debate belongs in schools of higher education, too. Education is the first priority here, and that education is not happening in these corporation friendly universities that hold a premium on selective ignorance. I don’t think we need to be talking about “mental health” programs. We’ve got tons of those as is. I think we need to be taking about how “mental health” “care” as usual is taking lives. We need to be talking about how some of those “mental health” programs are implicated in this homicide. In so doing, we might be able to save a few lives. Sure, there are far and few alternatives available, but these people are almost completely unaware of those as well. On a simple A B C basis, people need to know that a problem exists before they can even imagine coming up with a solution. Either people don’t know, or they’ve got a vested interest in the ignorance they are cultivating. Regardless, some kind of discussion, when it comes to these very serious matters, beats silence hands down. Especially as silence only represents more poor physical health and death.
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There are many attempts going on to find real alternatives to psychiatric “treatment,” and a lot of them are being discussed on Mad In America. I think it is a mistake to assume that somehow the profession of psychiatry is needed and must be preserved.
Those of us who have been on the receiving end of psychiatry know how destructive it is. To say that we must keep psychiatry until there is a completely different system in place is not a good argument. For one thing, psychiatry does all it can to see to it that real alternatives don’t get funded. Creating a better system while getting rid of the old one go hand in hand.
Of course psychiatry isn’t going to be instantly done away with. Powerful and destructive institutions don’t just give up. But if one’s position is that such institutions should just be “reformed,” nothing will change.
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Re: “no ‘solution is acceptable that does not vindicate their experience and social viewpoints in total and without ambiguity. For them it seems to be “my way or the highway.”
I disagree.
Due process rights are guaranteed in the constitution; taking this debate to a higher level. The answer to ending forced (so-called)”treatment” is to demand that these rights are upheld for people who’ve been diagnosed.
This may be *less complicated* and *more difficult* than we imagine.
But it’s not a decision that requires *consensus* by those who continue to violate the constitution. It does not require some sort of national referendum. It requires making sure constitutional rights are upheld. Period.
Not complicated.
Not easy.
Duane
http://discoverandrecover.wordpress.com/freedom/
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So well put, Duane!
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Slavery didn’t end by discussions with slave owners – it ended by a bloody war. I don’t know what you’re suggesting here but approaches proposed by psychiatric surviviours are kind of mild compared…
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I was struck that the two did have quite a bit of overlap, and I actually do agree that starting on where they did agree might actually lead to some beneficial changes. But I don’t think an alliance between Whitaker and Frances is going to make things very different.
Political change is difficult and never clean, and people do what they do sometimes for not the most moral purposes. I guess my answer to your last question is that what we need to do is to make it not profitable for people to adhere to the brain-drug-coercion model of “mental health treatment.” People usually act as they do because they benefit from doing so. This whole “movement” toward using drugs is clearly driven by unimaginable profits. Take the profits away and the incentive is gone.
How to do that is indeed a challenge.
—- Steve
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Steve, if I may, I’ll tag a brief second-round thought to your comment, addressing in part the concerns of others who responded to my original remark.
In all candor, folks, I still hear a lot of discussion, but no real plan for effective action. It is not enough to debate. Debate changes little. And it is not enough to say that psychiatry can be killed by denying money to abusive practices. Reality is that Big Pharma practically owns the FCC and the US Congress through the corrupting influence of campaign contributions. The money folks aren’t going to do the right thing or withdraw from the argument. Change won’t happen until they are legally bludgeoned into compliance or bankruptcy.
Big Pharma will need to be successfully sued by large classes of people several times on grounds of misrepresentation, fraud, bribery and gross negligent harms to patients. Those lawsuits are not going to happen by magic, even if a lot of people agree on principle. Getting Big Pharma out of the pockets of Congress will need organization and years of funding to support multiple legal teams. The process might resemble attacks on Big Tobacco — and it could easily take as long.
So I’ll ask again: Who will lead the charge? Who will organize and fund major legal attacks on corrupt organizations like the APA? If it’s not the people here, then who is it?
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Maybe this will help:
wolf-pack.com
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true enough, but if people slowly moved en masse away from psychiatric treatments and narratives because the culture was undergoing a massive shift in consciousness about these issues, it WOULD have an effect on Big Pharma’s bottom line.
There are legal angles, which you seem focused on. There are social and cultural angles, which a lot of us here are engaged in within our communities (I would wager). There are alternatives angles, which a lot of us are also working on.
You’re the big PhD & MIA author, not to mention a wealthy white man in the global North, so let’s return the question to you. What are those of YOU with insitutional power, who are critical of psychiatry, going to do to lead the charge? Why aren’t you offering to collaborate with us on making a difference, putting a plan into action, and moving ahead, instead of raining on everyone’s parade and saying how hard it will be? We all know it will be hard. We all want to fight it nonetheless.
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Mortal, I’m not leading the charge — in part because I don’t know enough about fund raising or grants or law. But also in part because I get poked in the eye by people who call me names every time I suggest that without ongoing organization and funding, this debate leads nowhere.
You are at liberty to call me “the big PhD & MIA author, not to mention a wealthy white man in the global North”, and to dismiss my input in the zero-sum game called “us and them”. That’s partly what I was talking about when I used the phrase “my way or the highway.” You know NOTHING about me, but you feel comfortable using that kind of broad brush to dismiss whatever constructive input I might offer. You don’t know or care that education was my ticket out of the urban hell hole where I grew up as a scared white kid on black streets. Nor do you know that I’m already walking the walk that you suggest, by supporting and advocating for thousands of chronic face pain patients as a site moderator and author in other venues. I’ve seen the damage that can be done by the side of psychiatry called “psychosomatic medicine”, and I’ve been advocating for overturning that unsupported mythology.
I’ve offered my thoughts on what an action program might look like in other discussion threads here at Mad in America, and on the Global Summit for Diagnostic Alternatives. I did so acknowledging that I don’t have all the answers, and inviting others to do better. What I got back was a ration of cr*p for not being one of the self-identified activists who think they can just wave their arms and magic will happen because they’re righteously right in principle.
Mortal, you make it darned hard to cooperate and seek common cause. Especially when you won’t fill in the many blanks between the problem as you see it, and enactment of solutions for that problem. That’s somebody else’s job, I suppose. Well then WHO??? It certainly won’t be me, considering my reception here.
Regards
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…..how “mental health ” “care” is taking lives .
This last week my eye doctor mentioned to me that a psychiatrist was recommending patients of his to go see a friend of her’s that was a doctor of Chinese medicine who used acupuncture and herbs. None of his patients ever returned to see the psychiatrist as all were helped by the doctor of Chinese medicine. Some time later the doctor of Chinese medicine called the psychiatrist to ask why he wasn’t sending him any more patients . The psychiatrist replied , “I have to make a living .”
Also this last week I went to visit an old friend in a nursing home . He’d already been there for almost 10 years was “diagnosed” with Touretes syndrome in his youth and other stuff later. Some of his poetry was as good as any written by anyone anywhere . He has” tartive dykinsea” and what looks like “parkinsons” he’s deaf (hearing aid being repaired ) and trapped where he is . He’s become used to this being his home. The staff says he doesn’t go out anymore . He also used to do comedy . There are 4 people in his room each with enough space for a single bed a dresser , a serving table on rollers and a TV on the dresser. He gets $4 a day to spend and usually buys candy. Ben is 72 years old.
Across from him lives David . he’s 62 years old . He was an orphan and has no family anymore or friends that visit him . During a conversation with him I found out he had no winter clothes and therefore couldn’t go outside . He said he used to weigh 600 pounds but now weighs 270 . I made it my mission to get him some winter clothes , he wore size 3X . His social worker couldn’t find anything in his size. I spoke to a therapist in the hallway and told her David didn’t have a winter jacket. She said , “So what either do I”. She was wearing an insulated vest , I asked,” do you have a car “? She said ,” Yes I do.” I said don’t compare yourself to David . I went from resale store to resale store until I found some winter clothes David could wear and go out in. He did have a girlfriend in the nursing home . He was trapped there . He said he could only get aid if he stayed there living in the home.
I had gone for a 2 week visit to see family and friends in
Chicago and suburbs . I’ll be returning to the Oregon coast in 2 days .
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wow, Fred, heartbreaking stories. Thank you for going out of your way to help people. I hope soon our society as a whole will step up, but until then people like you are much needed.
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mere mortal , Thanks for the encouragement. I feel fortunate to have come out from under psychiatric oppression and would like to see as many people as possible gain their freedom .
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Fred, you’re an inspiration.
I’ve said to many people quite often in the past year that I was done with dialoguing about these “mental health issues,” and wanted to move on to simply continuing to manifest my life, my way. I’ve been posting on MIA for a couple of years now, gaining further clarity and validation for the horrendousness I experienced all throughout my comprehensive journey through the mental health world, and it’s felt good, allowing me to feel complete with my experience and the information I drew from it. It’s all really helped me to grow tremendously, and for that I am grateful.
It’s been hard to complete, like a sticky habit. These issues had been such an inherent part of my life for so long, but to me, personally, it is no longer relevant. Although it was really such an awful experience to deal with all of this for so long, that if I don’t turn my focus away from these frustrating (to me) debates, my energy will drain from constant splitting.
For my own well-being, I am once again attempting to pry myself away from all this to move forward into a new light. I send out these words like a beacon, hopefully to encourage and support others…
I’ve been a psych student, a clinical intern, a client, a social worker, an advocate, a ‘peer educator,’ an activist, a healer, a teacher, and a filmmaker—all in the name of ‘mental health and healing.’ I went from taking ‘psych drugs’ for 20 years, culminating in a grand total of 9 during that last year, to being completely free of these drugs, and fully detoxified. I also sued a vocational rehabilitation agency for discrimination, and won.
Eventually, after years of learning to own my experience fully and releasing the trauma of it all, like sandbags of dense energy, I found my freedom.
Like you, Fred, I also want as many people as possible to know their freedom, as well as their inner peace, their power to create, and their infinite stream of abundance. The world would be a truly remarkable place, if only…
Many blessings to you for your tireless compassion.
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Fred,
Thank you for being part of MIA.
Duane
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stop forcing drugs on innocent children (and adults)…get Big Pharma to figure out how people can get off these meds!
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Well said– trouble is there is no getting off these drugs– don’t you get it– they’re worse in withdrawal adversity than any street drug/or combination out there. you go mad going on them and going off them– that only leaves going back to them–(usually involves incarceration and a new set of poly-pharmacy)or staying on them– funeral-ed out– on funeral drugs– sleeping/tired/ alienated– especially the one month jab– the only way i can see to withdraw is to go from 20 mil/ one mil at a time each month/ to zero/– coupled with ongoing therapy, counseling, support, and a sense of value/worth by the with-drawer either working part time–or studying part time. The other way would be to go to a neuroleptic/psychotropic- withdrawal clinic– run by psychiatry—–:-)– /and psychologists /to keep “them” honest and real.
http://www.psychminded.co.uk/people-with-schizophrenia-not-taking-antipsychotics-more-likely-to-recover-states-research/
Thanks for a great article.
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Here’s another new article: “Decarceration of u.s. Jails and prisons: where will persons with serious mental illness go?”
“Decarceration (decreasing the number of persons incarcerated in U.S. jails and prisons) has begun. It is estimated that more than 350,000 persons with serious mental illness (SMI) are among those incarcerated in the United States and that many thousands of them will probably be among those released. Currently, the prison population in general is being reduced as a consequence of concerns about overcrowding and of policies and programs such as reclassification of drug possession, which would affect many persons with mental illness. Court-ordered diversion and changes in sentencing guidelines are also serving to reduce prison populations. In recent years, the mental health system did not have to manage as large a number of persons with SMI, especially those who were among the most difficult and expensive to treat, because many of them were incarcerated in jails and prisons. Now, with decarceration and the release of many such persons, the mental health system may be expected to assume more responsibility for them and should be prepared and funded to meet their needs. This population of persons with SMI needs structure and treatment that, depending upon their individual needs, may include 24-hour supportive housing, ACT and FACT teams, assisted outpatient treatment, psychiatric medication, and psychiatric hospitalization.”
Perhaps at least part of this story from Allen and Torrey can be seen as a tactic to get more power to psychiatry by telling people these stories of all those mental ill people in prison (in USA). “Let’s start about housing, they don’t even have houses to live in.” The power they want is more ACT, more forced medication, more funds, etc.
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Sorry, here’s the link: http://www.ncbi.nlm.nih.gov/pubmed/25492076
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