Bring Back the Asylum?

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.
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Need Help: About to be arrested for blowing the whistle on Mr. Shearer.

The flag is going up. I have just confirmed I am about to be arrested by the Fort Collins Police for being a whistleblower about Mr. Shearer, allegedly for harassment. For more on what this is about, see this post: …
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Sunshine Act for Scotland Petition Goes Before Parliament a 3rd Time

Dr Peter J Gordon, consultant psychiatrist, first lodged a petition on the Scottish Parliament website, PE01493: A Sunshine Act for Scotland, 29 September 2013: “Calling on the Scottish Parliament to urge the Scottish Government to introduce a Sunshine Act for Scotland, creating a searchable record of all payments (including payments in kind) to NHS Scotland healthcare workers from Industry and Commerce.”
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Finding Rat Park

Countless times in therapy, I’ve told myself that once I am finally able to fully explain what happened, once I’ve finally cried myself to emptiness, once there’s nothing left to give, my problems would go away. This past year, I realized that wasn’t the case. To be truly whole, I can no longer avoid what I’ve long tried to ignore – that I, human, am a social being. By the very nature of whatever evolutionary tick caused my ancestors to group together as they scampered across African plains with “Eat me, I’m prey” stamped across to their puny butts, I am wired to attach. Darwinism at its best.
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In Memoriam: Leonard Roy Frank

  Editors’ Note:  We at Mad in America have all known and loved Leonard. He truly represents the best of why we are engaged in these issues.  His kindness, gentility, and wisdom have touched us all. We are proud, as a …
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Can’t Breathe

As a person who has been psychiatrized, but hasn’t faced long-term institutionalization, I have to accept that I can’t know that level of loss of power and vulnerability. (But I can tell you even short stays are enough to begin to understand.) And to be a person of color with psychiatric labels interfacing with the police? It’s like the perfect storm. (A type of ‘perfection’ that occurs more often than most, given that people of color are more likely to be diagnosed in the first place.)
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MIA Continuing Education: Help Us Get The Word Out

With great regularity, I receive emails from people—“patients,” family members, and mental health workers—who are frustrated by this fact: the psychiatrists they meet, and the larger psychiatric community, are simply not aware of research that questions the merits of psychiatric medications. Many providers, for instance, do not know of Martin Harrow’s long-term study of schizophrenia outcomes. We at Mad in America started Mad in America Continuing Education to produce online courses that will fill in this knowledge gap. And now that we have our first courses up, we need your help.
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Finding the Gifts Within Madness

When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know. But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.” And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.
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Human Experiences in Academic Boxes

What are Extreme Experiences? Other terms for them are Spiritual Crisis or Spiritual Emergency. With the appropriate support many find the experiences profoundly transformative. However, observers or relatives may have different beliefs about extreme experiences: perhaps that a person is having a psychological breakdown or mental health problems, or is psychotic or experiencing schizophrenia.
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Psychiatrists Providing Psychotherapy?

On December 29, Nassir Ghaemi, MD, a psychiatrist and a professor at Tufts Medical Center, published on Medscape an article titled Psychiatry Prospects for 2015: Out With the Old, In With the New? In it, he writes that with the changes in health care “Clinicians can stop pretending that relationship and social problems have to be shoved into a biological-sounding DSM category (such as major depressive disorder or generalized anxiety disorder) and treated with the only thing insurance companies would reimburse long-term: drugs.” So there it is, starkly stated: Clinicians, by which he clearly means psychiatrists, have been pretending.
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The Substance of Substance Use: Talking About Marijuana, Alcohol, and Other Drugs

When I was locked in a psychiatric hospital, I wasn’t able to have much of a conversation with my parents about what was going on. Phone calls were tense and filled with silence, and as I stood at the ward payphone I was so confused and frozen in fear that each call just confirmed to them how lost I was. Every day as a patient centered around the various prescriptions I was on, and like so many people suffering in a psychosis, helping me became a wait to “find the right combination of medications.”
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How Come the Word “Antipsychiatry” is so Challenging?

So here we go again; another meeting with another young person who describes how he is in an acute crisis – you may call it – and is diagnosed and prescribed neuroleptics. He is told by the doctor that he suffers from a life-long illness and he will from now on be dependent on his “medication.” As long as people are met this way I see no alternative than showing that there are alternatives. If that means being “antipsychiatry,” then I am more than happy to define myself and our work in that way.
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Antidepressant-Induced Mania

It is generally recognized in antipsychiatry circles that antidepressant drugs induce manic or hypomanic episodes in some of the individuals who take them. Psychiatry’s usual response to this is to assert that the individual must have had an underlying latent bipolar disorder that has “emerged” in response to the improvement in mood. The problem with such a notion is that it is fundamentally unverifiable.
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How Quantitative Mental Health Turns Oppression Into “Depression”

What are the philosophical underpinnings for what constitutes evidence and how have quantitative approaches so effectively trumped qualitative approaches in applied psychiatry, psychology, and the like? Furthermore, is it possible that quantitative ways of studying human experience may actually promote constricted, myopic views that hurt or oppress human beings? And how does this contribute to a global biopharmaceutical research enterprise reframing the understandable reactions to oppression as being the deficiencies and impairments of its victims?
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Atul Gawande’s Being Mortal

Atul Gawande is a physician author whose work has been published in The New Yorker, among other places. In his most recent book, Being Mortal, he explores the complexity of end of life care. In this blog I discuss why I found this book relevant to Mad In America.
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Do You Still Need Your Psychiatric Diagnosis?

Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and, particularly in the USA, for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? since psychiatric diagnoses have been admitted to be non-valid even by the people who drew them up, professionals should not be offering people the ‘choice’ of describing their difficulties in diagnostic terms in the first place. That would still leave people with the right to adopt whatever explanation suits them as private individuals.
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3 Troubling Reasons Psychiatry Retains Power Despite Lost Scientific Credibility

By their own recent admissions, establishment psychiatrists and major psychiatry institutions have been repeatedly wrong about disorder validity, biochemical causes, and drug treatments; and also, in several cases, have been discovered to be on the take from drug companies—yet continue to be taken seriously by the mainstream media. While Big Pharma financial backing is one reason that psychiatry is able to retain its clout, this is not the only reason. More insidiously, psychiatry retains influence because of the needs of the larger power structure that rules us. And perhaps most troubling, psychiatry retains influence because of us—society’s increasing fears and its expanding needs for coercion.
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ECT for Agitation and Aggression
in Dementia

The International Journal of Geriatric Psychiatry published an article titled Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia,  which concludes “Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management.” But the participants were not a random selection of people taking the drugs in question. Rather, they were individuals selected because of aggressive behavior, most of whom had been taking some or all of these drugs on admission. So it is a distinct possibility that the aggression was a drug effect for many, or even most, of the study participants.
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Resolution for the New Year:
Lay Down the Burden of Proof

It falls upon us survivors to prove that we were damaged, and that we aren’t malingerers or attention hounds or “mentally ill”— if we have any energy amidst the maelstrom to plead our case. Because if we don’t, we risk having our narratives rewritten by others’ “good intentions,” misinformed though they may be by the mainstream narrative. People get weird and pushy about this stuff, both because suffering is ugly and because our truth threatens their worldview.
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Do You Think It’s Real? Responding to Alternate Realities

Everyone has beliefs that seem too bizarre, illogical, or fantastic to someone else to accept. Religious views, paranormal interpretations, political convictions, interpersonal conflicts — all can put us in a category where other people consider what we think to be incomprehensible. We’ve learned to co-exist with different beliefs as one of our most cherished values of tolerance in a multicultural society. That lesson can be key for encountering the different realities that in situations where someone is being called psychotic, delusional, schizophrenic or mentally ill. Respect and support may stretch our thinking, but can be vital to recovery.
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Sara’s Story, My Story

  The following was written last week when I heard of the suicide of Sara Penrod, a 28 year old woman living in Northampton, Massachusetts. I didn’t know her well, but she came to two of my workshops on coming …
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Nitrous Oxide for Depression and Other Hazards of Modern Psychiatry

This week, MIA featured a news item regarding a recent “proof of concept” study conducted at Washington University of St. Louis to investigate whether nitrous oxide, commonly known as laughing gas, was effective in reducing symptoms of depression. Why is this a problem?
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Psychiatry and the Problem of the Medical Model – Part 1

The mental health industry has a lot to answer. The psychologization of everyday life has eroded the range of human experience seen as normal, disempowered people to manage their own life challenges, professionalized helping relationships and undermined the already decaying support structures through which people found meaning and connection, stigmatized people through psychiatric labeling, led to iatrogenic misery from harmful treatments and traumatized already vulnerable individuals through excessively coercive practices.
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Enough is Enough Series: An Hallucinogen for Depression? Psychiatry is Testing Ketamine (‘Special K’) for Depression

The article “Special K, a Hallucinogen, Raises Hopes and Concerns as a Treatment for Depression,” by Andrew Pollack in the New York Times, December 9, 2014, tells how far afield my field, psychiatry, has really gone – that it is even a consideration to use an hallucinogen for the treatment of depression.
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