Guidelines for a Thoughtful Discussion

Robert Whitaker
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Back in December,  when I decided to turn madinamerica.com into a webzine, I envisioned it as serving several purposes. I wanted to create a regular news report of research findings. I wanted to provide a forum for people to tell of what helped them get well and stay well. Finally, I wanted to recruit a diverse group of writers, who would write about psychiatry and ways to improve our current paradigm of care, which, as readers of Anatomy of an Epidemic know, I believe is a failed paradigm of care.

This is a big subject, one that I think should command the attention of our entire society, given how profoundly psychiatry shapes our society today. I wanted to have people with lived experience writing here, social workers, psychologists, providers of services, journalists, ethicists, psychiatrists and other physicians.

We are slowly working toward that goal. And as we do, I have become more convinced than ever that it is important that this site invite and welcome bloggers who may have quite differing opinions about current practices and how to make things better. That is the only way to stir a robust “dialogue” about this subject.

Posted comments by readers are an important, essential part of that discussion. In fact, it is an aspect of this site that I particularly like. I very much enjoy reading what people have to say in response to a blog, and in response to other people making comments.

At the outset, I decided to not screen comments. People could post their comments and they would appear instantaneously. One reason for that is that I believe in free-wheeling discussions, and, second, I hadn’t figured out, in my own mind, what sort of comments might hinder, or shut down, the discussion.

But now I think I do. We encourage readers, if they disagree with the content of a blog, to say so and to express their reasons for why they disagree. Readers should make an argument, point to facts, and tell of personal experiences (and hopefully in a calm, measured way.) All that is good. However, what shuts down discussion is when a comment attacks the person (rather than what the person has written), or seeks to personally discredit the person. This is true whether the comments are directed toward the blogger, or toward someone else commenting on the site. People commenting on the site shouldn’t worry that they will be personally attacked for their views.

And thus my conclusion: The comments’ section has a very simple goal, which is to further discussion,  and if comments distract from that goal, and instead serve to stifle discussion, then they are not helpful.

So this will be our new policy. Comments will still appear instantaneously. But if we find a comment that is attacking the blogger personally, or another commenter personally, we will pull that comment, and we will do so for an easily understood reason: the comment is not serving the purpose of adding to the discussion, but rather shutting it down. And when that happens, all readers of this site lose.

70 COMMENTS

  1. Very nice guidelines for civilized discussion. I appreciate that you identify “personal attacks” as the only reason for commenting to be staunched. We can all think differently about the issue of Psychiatry and Mental Health…and we can all wisely respect viewpoints that may differ from our own.

  2. Think as we think – do as we tell you to do – anything else is unacceptable – we will decide what is okay emotion, debate, and speech.

    Sounds a lot like the psychiatric model of today, doesn’t it.

    Selective censorship for the appeasement of those supposed intellectual elitist

  3. I wonder if Mr. Whitaker would like to clarify the comment policy:

    Hypothetical: let’s say Charles Nemeroff or Joseph Biederman left a comment on psychiatric topic or other posting here; does this new policy now forbid others from commenting on their factual histories, actions, views, & writings in response?

    Or another hypothetical; a Mad In America blogger post something here what may appear as a somewhat mundane topic; yet this same blogger has a long history of other controversial views and writings; are those views and writings now off limits in the comment section?

    Or does this comment policy only apply when someone complains?

    I smell lawyers

    • I’m not seeing the problem D?

      “Readers should make an argument, point to facts, and tell of personal experiences.”

      If it’s a “fact” that Biederman accepted funding from Pharma, than make the argument. If it is factual that a blogger has posted opposing, controversial blogs elsewhere, make the argument and point to the link.

      I can’t see how you move the discussion forward thru personal attacks. If you can make that argument I’m certainly willing to listen.

  4. I think the guidelines for comment are reasonable, although I also think the decision about when a robust argument looks like a personal attack is a very subjective one.

    But I have a different concern. When this site started adding bloggers who support rather than question the status quo, I was very disappointed. Medical model, pharma-related opinions dominate this field – people with those perspectives have hundreds of other outlets to publish their views, while those of us who hold alternative views are still ridiculed or shut out of the general discussion. Personally, I do not come to this site to read the kind of mainstream views on “mental illness” that constantly bombard me in my daily work – I come here to read about the various ways people are thinking about and researching alternatives to the status quo.

    • Yes Darby, I feel the same way. Perhaps Bob can respond to this. As you say, there are plenty of places where we can hear/read/see the “establishment view.” Personally, I need a place where alternatives to that established view are espoused and I think espoused exclusively. Again, out of respect for Bob, I’d like to see what he and others say about your important point.

    • I think having a two sided discussion is important. We need an actual debate and the disease model people have so far been unwilling to respond to the research we talk about. If some of them start to respond on this site, then maybe we could have this debate. Personally, I don’t think there’s much evidence on the other side, but if people can try to put forth that evidence and then we politely present the opposite site without personal attacks, maybe some people can start to see truth.

    • I agree with you and I think you’ve stated it very well. This is one of the few places you can go to read about alternative things to the usual mainstream conversations about experiencing mental anguish and the disconnect that can happen to people enduring such. Thank you for putting things so well.

  5. Thanks Bob. When I heard (probably on your website) of the Open Dialogue experiment in Finland, I thought: that’s not just a model for care about individual people in crisis, that’s a source of inspiration to handle a lot of difficult disagreements or controversies between groups too: letting every voice be heard with all groups present and respected in the same forum, and I hope that’s what madinamerica will be. Having a specialized webzine for people with a specific mindset would be encouraging ideological polarization rather than scientific discovery. I am myself convinced that psychiatric drugs are overused. But let’s do a emphatic role-reversal experiment: everybody that assumes the psychiatric establishment is delusional should treat that establishment with the same empathy and patience that they recommend for the treatment of delusional individuals. And IMHO, everybody that assumes the psychiatric establishment is purposefully manipulative, and purposefully making people worse is doing a personal attack. To reformulate, IMHO, accusing mainstream psychiatry of lying (as opposed to arguing its guidelines are not supported by the evidence) should be considered a personal attack on the majority of its members, and should not be acceptable on madinamerica.

  6. “And IMHO, everybody that assumes the psychiatric establishment is purposefully manipulative, and purposefully making people worse is doing a personal attack. To reformulate, IMHO, accusing mainstream psychiatry of lying (as opposed to arguing its guidelines are not supported by the evidence) should be considered a personal attack on the majority of its members, and should not be acceptable on madinamerica.”

    Most definitely…Bob should invite the APA in to monitor the site for unacceptable speech & comments…this site needs to make sure no one is offended….especially main stream psychiatry…that would be like attacking a medical deity that has has proclaimed itself on occasion second to God..

    Of course, someone would have to be living in a dark closet or on a far off planet with no outside means of communication to not make the rational & evidenced assumption that the psychiatric establishment is purposefully manipulative, and purposefully making people worse…maybe you are not unaware of the pharmaceutical industry influence…the ghost written research…the wide spread corruption & greed…the vast marketing machine being employed…& the targeted smear campaigns waged against those that would dare question the psychiatric establishment’s holy grail…

    But then again…this comment could be construed as a personal attack and should be removed under the comment guidelines..

    • There is a part of me that responds to what you write here. I work in a state hospital where the only method of treatment is the toxic drugs. Only two psychiatrists out of all the ones who work here try other methods, like actually talking with and listening to their patients. They are constantly attacked in very vicious ways by the other psychiatrists. They are ridiculed to no end and are made teh butt of many jokes, not only among the psycihatrists, but staff in general. I work in Admissions so I get to meet a lot of the people as they are admitted. It breaks my heart to watch people who were vibrant in so many wayswhen they came in, do the thorazine shuffle out the door at their discharge. So, it is very difficult for me to listen in a nonjudgmental way to what the biopsychiatrists want to tell us. It makes me feel like I’m sleeping with the enemy. I hope that this is not construed as a negative or attacking post. But I feel the passion and emotion in what you’re stating. Thank you.

  7. First, I want to thank Darby Penney for saying pretty much what I was going to when I read this.

    I want to address Stanley Holmes comment which states:

    “And IMHO, everybody that assumes the psychiatric establishment is purposefully manipulative, and purposefully making people worse is doing a personal attack. To reformulate, IMHO, accusing mainstream psychiatry of lying (as opposed to arguing its guidelines are not supported by the evidence) should be considered a personal attack on the majority of its members, and should not be acceptable on madinamerica.”–Stanley Holmes

    This is highly concerning considering Mad in America hosts fantastic journalists and authors such as Carl Elliott who exposed the Dan Markingson CAFE Seroquel trial gone bad (Dan killed himself and there was a question of ethics of Dan being in a drug trial without true informed consent); Alison Bass who wrote the book “Side Effects” who also called out Stan Kutcher in Nova Scotia a co-author of the infamous PAXIL 329 study that said SSRIs were not a danger to teens, it was publshed with ghostwritten allegations and many professionals have called for the retraction of the PAXIL 329 study–consequently it was Kutcher a psychiatrist who had the article retracted in the Coast when they interviewed Alison Bass about the Paxil 329 connection. The Coast did agree to that retraction. Carl Elliott recently had an article retracted from Slate, regarding stem cell research, Cell Tex and a bioethicist who was in question regarding conflict of interest with a journal publication and more.

    On this very blog this headline from earlier in April by fantastic advocate and attorney Jim Gottstein the one who is responsible and one who I consider a hero as a result–of getting the Lilly Zyprexa documents made public–the very documents that prove with their own documents, how Lilly KNEW and buried data knowing that antipsychotic caused weight gain and diabetes. That very drug caused grave harm to MY CHILD, and knowing the truth is now what fuels my writing. I write with a goal of transparency within the industry, all of the industries involved in the mental health system. The drug industry, the professionals and more.

    Bob’s own book questions the medical model of psychiatry and we all know in America psychiatric care is based on medications, and the doctors who prescribe those–yes–are predominantly psychiatrists.

    An Opportunity to Walk the Talk — Occupy the American Psychiatric Association May 5th in Philadelphia–by Jim Gottstein

    If Mr. Holmes believes what he writes in his comment then none of those well-respected and award winning authors, journalists, attornies and advocates would not be welcome, including Bob himself, on this site!

    Mark Foster who writes from “the frontlines” was fired from his job for questioning the system on his blog. He questions the medications, he questions everything we all do as advocates who have witnessed serious harm to others done by psych meds and the professionals who prescribed them. Not all of the doctors did purposeful harm, some were also in fact duped by the drug industry with the buried data and more.

    But the facts are out more than ever, the transparency is being demanded by Senator Chuck Grassley who has been a catalyst to change the way pharma does business in exposing the money paid by pharma to doctors, and we also now have the invaluable Dollars for Docs tool to use.

    What I want to say to add to Darby Penney’s thoughts above, is that when I read this policy for commenting and seeing the influx of doctors writing on this site, it began to feel as if there once again was no place for the survivors, the people who have (some silently in the background)scraped themselves up off of the pavement, flown under the radar, got off meds and literally ‘survived’ a horrific ordeal, one that I often say is a crime against humanity.
    When I began researching the Zyprexa documents that Jim Gottstein brought to public attention, I was shocked and floored. What happened to my child was in fact a crime. My child was a victim of a marketing plan carried out by a drug company VIVA ZYprexa–“5 at 5” (5mg at 5pm) that was sold by pharma reps to doctors when they made office visits with samples. That is all documented in the file after file of internal documents.

    Knowing this as my background, understand what I felt when I saw a place like Mad In America begin to have all sides so to speak become bloggers, and some defenders of the very profession and industry that harmed my child as well as countless others in the mental health advocate world. I am not the only mother with a harm done to child story.

    What this policy brings up for me is the SILENCING of people with a psychiatric label or diagnosis, and the ones who broke free from having those.

    It brings to mind all of the people I have met over the last decade (hundreds) within the system, and some who I witnessed being graphically silenced…forcibly injected–FOR BEING LOUD and expressing themselves. I speak of one woman in a locked psych ward years ago, who wanted to call her attorney and she was denied the use of a phone, all of this in front of me as a visitor. She started to cry, become upset, tried to tell the staff which drugs made her feel what way–she self-advocated the best she could–and 5 male staff approached her, she was tossed face down, restrained with disposable restraints and given an injection–against her will–she sobbed at my feet, and this is what I will never forget seeing.

    That woman is who I think of when seeing restraints on a commenting policy on Mad In America.

    It also reminds me of how commenter Duane Sherry was banned to a corner on the Shrink Rap psychiatry blog, when they told him to take his links and comments and hit the road, he was unwelcome there, they didnt want to hear his “rants” any longer on a psychiatry blog. His “rants” are alternative medicine informative comments! What’s wrong with that? they found everything wrong with that. I wrote a post about it to give Duane Sherry an open-ended space on my blog to write whenever and whatever he wants.

    If the injured people, the advocates of injured people cannot openly express themselves at the Mad In America blog, then once again, as Darby Penney pointed out, there is no place for their VOICE.

    After 6 long years I still long to hear my child’s voice, the one where she questioned her doctors, questioned the Zyprexa she was on, and demanded to go off of it due to the diabetes alert she read about herself. She was then bounced into adult locked psych system, traumatized and silenced, literally. Only a few words here and there. I am her only voice, I know her, and I know where she has been and what she has seen, and I will not be silent, I will not be censored by the very profession that silenced her.

    Thank you for the space for this opinion, and I do wonder as I write if this will in fact be published, I hope so.
    We know too much information to turn our heads to the truth, which is out there, more comes out everyday.

    What I feel can happen as a result of a policy like this is a silencing of the very people who have become witness to the harms, or been harmed, and I feel they may no longer feel this is a safe place for them to share those intimate stories, that professionals NEED to hear. Instead we get to read the professional’s side to the story here–of all places! This is not the Mad In America I was hoping for–I remember when Bob was censored by a government agency, we all wrote about it in support. It was those writings and comments sent in that placed pressure to allow him to speak again—SAMHSA.

    Keep up the good fight Darby and others commenting here.

    • Thanks for bringing the subject of lawsuits. I do believe that accusations of malevolent intent are eventually a matter for a court of law. I hope that website will promote discussions about when it is appropriate to involve courts, and report on successful and unsuccessful attempts at eliminating psychiatric abuse (it does exists) through courts of law. Lawsuits can also sometimes be appropriate for neglect rather than malevolent intent. In any case, I believe comments attributing hidden malevolent intent based on race, profession, beliefs about madness causes or beliefs about cures, mental illness diagnosis, should all be equally censored in public forums.

    • Stephany,

      Thank you for your support during the marginalization on Shrink Rap.

      Bob,

      I understand what you are saying in terms of personal attacks. I only hope that this site will continue to be a place where those who were injured by conventional practices, and/or have family members who were are able to express their hurt.

      Many of us not only want to have a healthy dialogue, but want to see reform take place. And I think it would be fair to say that the same folks on this site would welcome some real reconciliation.

      I will do my best to follow the guidelines you set up. Thank you for the forum.

      Duane

  8. I would like submit that this new comment policy has come about do to a single comment by a single commenter.

    The commenter responded to a psychiatrist posting in the comments section on a blog post; whom the commenter made a personal observation that this psychiatrist seemed or appeared to be playing both sides of the fence so to speak. That was the commentator’s opinion.

    So the commenter left verifiable information & a link about this psychiatrist open public record & some related/possible COI (conflicts of interest). The commenter believed (opinion) others should be able to excess that pertinent information to properly evaluate & weigh this psychiatrist stated views being expressed about the post.

    Some of this psychiatrist followers & supporters called this an ad hominem attack. An opinion they are fully entitled to express in my view. I don’t happen agree with their evaluation (besides them making some personal accusations without evidence or substance). It’s a debate, a comment section, & emotions/opinions tend to get heated….it’s the nature of the beast so to speak..

    But then this unnamed person complained and leveled legal threats against Mad In America…

    The comment was then removed/retracted supposedly until some fact checking could be done.

    And now there is a new comment policy…

    • With all due respect, what does inner-transformation have to do with a comment section policy that was created after comments have been censored? and deleted?

      I believe their is more to the story than a new comment section borne out of wanting a “civil” discussion.

  9. A few thoughts: 1. I widely agree to Darby’s comment above. That said, I’ve wondered a lot lately why you would give the mainstream the opportunity to voice their opinions not only in the comments, but even in their own blog posts on this site, too, and I’ve assumed that it was for the reasons you mention above. And actually, I think your reasons are reasonable, they too. Especially if one takes into consideration that you, at least in public, first and foremost are a journalist, and thus, by nature so to speak, interested in getting as many different viewpoints on a certain matter as possible, and report them — or letting people report their viewpoints themselves — without taking sides yourself. I’m not a journalist in that sense, but I’ve attended a few workshops about how to do journalism, and the first thing we were taught was that it is imperative for good journalism that there are no “good guys” or “bad guys”. That there are just different viewpoints, which are presented as neutral as possible for the reader to discuss.

    2. If I step out of my survivor-ego, I can’t see how giving the mainstream the opportunity to voice their viewpoints here, too, would be damaging in any way. Those who disagree with the mainstream, which includes me, do have valid, factual arguments at hand to challenge and also disprove its arguments, not least thanks to your books. On a purely factual level, the mainstream doesn’t really pose a threat to anybody. BUT…

    3. …I also say “if I step out of my survivor-ego…”. I’m not a saint myself, but I cringed at a few of the comments on a recent post on this site. What I saw happening was the same that I’ve seen innumerable times happen at psych wards and in other settings involving psychiatric staff and their “patients”: there’s a provocation from one side — usually it’s the staff approaching the identified “mental patient” as exactly this, the identified “mental patient”, which means in one way or the other violating the person –, and almost inevitably you will see the other side react to it, i.e. showing “symptoms” of “mental illness”, which then in its turn has the staff react with more “treatment” interventions, and so on, and so on, until somebody has the clear-sightedness and wisdom to stop reacting, and thereby break the vicious circle everybody is caught up in. Stop reacting doesn’t mean doing nothing. It just means no longer reacting unconsciously from the place of the victim, or the survivor in the case of the mentioned post. I cringe at watching people react unconsciously from the place of the victim, because this is what the mainstream labels “mental illness”, and unfortunately each and every time somebody reacts this way, they kind of confirm the mainstream in its opinions. Just like the guy who reacts to being committed by physically attacking the staff who tell him he can’t leave the “hospital” confirms the mainstream in its viewpoint that “the mentally ill” are potentially dangerous, and need to be locked up and force “treated” to keep society safe. BUT…

    4. …truth is that the guy physically attacking the staff, as well as the comments I mention that I cringed at, also have to be seen as acts of self-defence, and I think it is a little naive to expect a different reaction from a readership that to a great extent consists of severely traumatised people, who never got the chance to work through their trauma, but in fact often were severely re-traumatised by the approach to them, which the mainstream represents. The reactions you saw to the specific post shouldn’t have come as a surprise to you at all. To the victim, to the survivor, the mainstream does pose a very real threat. And…

    5. …last but not least, quite a few people, me included, might argue that the mainstream approach itself makes excessive use of personal attacks on people, and that these personal attacks also are present in the specific post in as far as the author claims that there is such a thing as “mental illness”, “insanity”, which certain people do suffer from. To declare someone “insane” while there is no objective way to prove the correctness of such an accusation, can be viewed as a personal attack. And it doesn’t become less of a personal attack just because it is a culturally accepted thing to do for a certain profession. In a way, the author of the post, and whoever else it is who insists on calling certain people “mentally ill” and “insane”, do repeat the name-calling that goes under the term “diagnosis” in the system, and the reactions we’ve seen can hardly surprise anybody who’s had a closer look at a) the nature of psychiatric diagnoses — especially the non-existent science behind — and b) what trauma does to people. One might say that psychiatry itself by denying people real help, and instead re-traumatising them, has created the reaction we’ve seen: as you make your bed, so you must lie on it.

    • Thank you for the best post that I’ve read about all of this. As a survivor myself, I have a very difficult time dealing with biopsychiatrists and their almost all-powerful control that they have of almost everything. Why was anyone surprised at the responses that were posted after that psychiatrist made his statements? It’s very difficult to sit and talk rationally with these people when I see the harm that they continue to do to people each and every day in the hospital where I was once a patient and am now staff.

  10. I have seen good web groups implode because of just one or two starting up some personal attacks/comments that have escalated out of control. Before you know it, a group mentality ensues, and suddenly the group is divided. This is human behavior.
    I completely agree that simple basic rules need to be in place. Though sometimes ruling from the subjective, I firmly believe the journalist integrity of the host~which has earned him enough awards in higher places~should be acceptable policy here.

    Psychiatry has traumatized me and my family, by killing my brother. We must engage in good, common sense, responsible debate with psychiatry no matter how harmful it has become, because after trying for years, I have come to the conclusion we cannot afford to waste energy believing we will ever abolish it; we can only reform it from a cogently argued position. Wasting energy attacking psychiatrists is less time spent reforming psychiatry.

  11. Commenter “deleted” stated:

    “But then this unnamed person complained and leveled legal threats against Mad In America…

    The comment was then removed/retracted supposedly until some fact checking could be done.

    And now there is a new comment policy…”

    Is this true? is this the reason because if that’s the case, this is bigger than personal attacks category…

  12. When psychiatrists shout down and boo people like Robert Whitaker and Richard Bentall and don’t listen respectfully and with an open mind to what they have to say, they are acting in a disgraceful manner; why should it be ok for us to act in a similar way? Can’t we answer a point forcefully without getting abusive? Like Marian some things that were said made me cringe. Like PC I believe that psychiatry will not go away. I hope it will change and finish by doing a good job- eventually.

    • I agree that it is unlikely for humanity to ever stop its scapegoating and silencing of those who challenge society’s at any time as desirable defined self-image. Psychiatry has emerged out of the need of a society reluctant to face its own dysfunctionalities to place the blame for challenging behavior with the challenging behavior itself, and fix it, i.e. make it stop. Today, psychiatry does an excellent job, better than ever before in its history, at this, the task it was assigned by society. People even ask for diagnoses and “treatment” themselves. Something that would have been unimaginable just half a century ago. And everybody is convinced, nobody any longer doubts, that, of course, psychiatry is here to help people in emotional distress. Well, it is not, and has never been, historically. And it lacks any basis to ever be able to fulfil the task of helping those in emotional distress. Psychiatry understands itself as a medical speciality. Medical professionals deal with medical conditions. Emotional distress is not a medical condition. This is why, although psychiatry has made huge progress scapegoating and silencing (diagnosing and treating) challenging behavior, the outcomes for those showing the challenging beavior, at the same time, have deteriorated remarkably. So, the question is, for society, what do we want? Do we want to help people in emotional distress, or do we want to help society also in future to rid itself from any behavior that challenges its self-image. We can’t have both. We can’t help people in emotional distress, and at the same time continue to scapegoat and silence these people. If we as a society succeeded in changing the system in a way that people in emotional distress were really helped, this would mean that there would be no more place for psychiatry as a medical speciality anymore. It would mean that other professions, better equipped to deal with emotional distress, would have to take over and replace psychiatrists.

      • I’m not making broad sweeping erroneous judgements, because I’m not talking about individuals, but about psychiatry as an institution. I’m aware that quite a few individuals who choose to work in the field are well-intentioned. I’m not referring to these individuals (although not even the best intentions always prevent mistreatment; cf. Wolfgang Schmidbauer, “the helper syndrome”). I’m referring to the field as such, and its history, among other things, what kind of a society, what kind of a culture, what kind of world view psychiatry is a logical consequence of. What psychiatry so far has done, in ever more sophisticated ways, is to shut people up. The labels have always been used to defame and degrade people. Why on earth do we need to say “schizophrenia” for instance, when “severe personal crisis” (cf. Loren Mosher) can do the job, and is understandable, also to the “patient”, and without mystifying the experience to him/her, and alienating him/her from his/her own experience? We know that there are no two people who experience “schizophrenia” the same way. The word doesn’t say anything about the individual experience, and thus it is worthless, unless the purpose is to defame and degrade (and to alienate and disempower), in which case it is invaluable.

        I haven’t said anything about the pharmaceutical industry. The mistreatment of the labelled by psychiatry hasn’t started with the advent of drug “treatment” in the field, and looking at historical psychiatric interventions, I can’t find any I would not call “mistreatment”. To apply medical interventions to something that is not a medical condition almost automatically makes for mistreatment. Anything that labels the carrier of the symptoms of society’s collective dysfunctionality “dysfunctional” — “diseased”, “disordered”, whatever of that kind — actually is mistreatment.

        As for the examples of interventions you mention here and elsewhere on this site that aren’t dominated by drug “treatment”, I’d argue that they do not prove the indispensability of psychiatry. We do have neurology and neuroscience to provide whatever technical knowledge we think, we can’t do without.

        I recently attended a very inspiring talk by Pat Bracken. Pat Bracken has the humility and wisdom to acknowledge that we haven’t yet understood the human mind in its entirety, that we possibly never will understand it in its entirety, and that we do better in not assuming that technology, medical or other, and no matter how advanced, ever will make us understand the human mind in its entirety. When I read your description of the interventions you bring up as examples of psychiatry’s excellence in helping people in distress, what I read is a lot of technical (medical-technical) terminology. You even write in a comment on Steven Moffic’s recent post “REsilience”: “Yes. we used ‘computer language’ teaching kids.” The human mind is not a computer. That we have created the computer in our own image doesn’t mean that we are computers. It doesn’t tell much about our own nature. It only tells a whole lot about our culture, about the somewhat limited, indeed impoverished, cultural understanding we have of our own nature.

        Interestingly, even Pat Bracken, who is one of the sharpest thinkers in the field, has a blind spot when it comes to the justification of psychiatry, although, when asked what this justification would be, he can’t come up with any that is beyond question. The point he, too, misses (because he loves medicine, which is really sweet, but… ) is that the moment psychiatry moved away from practising the Enlightenment’s purely technological understanding of human nature, or the human mind, that can be broken and in need of fixing like a machine, a computer for instance, and started to engage in healing relationships, which is what Pat Bracken stands for, in healing society’s collective dysfunctionalities, it wouldn’t and couldn’t be psychiatry anymore. Because psychiatry is the result of this positivistic, technical world view, and it represents the very essence of it.

      • I only want to get rid of the fake psychiatrists, the ones that I refer to as biopsychiatrists. Real psychiatrists are the ones who believe in and practice some form of talk therapy and there will always be a need for this. However, I agree with you in that biopsychiatrists are only doing what we really want them to do, police society so that we don’t have to deal with the messy things about who and what we are as a nation. We seem to have lost our moral compass, if we ever really had one in the first place, and we don’t want to deal with the results.

  13. Personal attacks are always over the line in debates. On the Web, they tend to derail conversations. They drive away interested readers.

    A site that permits personal attacks is soon discredited as a source for intelligent conversation. No one is left to post except the bullies.

    Unmoderated forums always tend in this direction.

    Simply because, for example, someone you don’t like might post here does not justify a public recitation of every sin he or she may have committed. Whether that information is called for depends on what the post says!

    Refute what someone says in a fair way. Personal attacks are playing dirty. (Personal attacks on allies make no sense at all.)

    Ultimately, it’s the site owner’s call what kind of content he wishes to publish. Bob invites people to contribute articles, show respect for his efforts.

    • Altostrata,

      I would politely like to ask you to give some of us some latitude with what it is we have to say, especially if it does not violate the guidelines that has been established by Robert Whitaker.

      There have been times when I felt that you were editing my comments. For instance, wanting me to use the term “chemically dependent” rather than “addicted”… asking that I “please stop using that term.” I have seen some other instances from fellow commenters.

      I politely ask you to allow some of us the opportunity to speak, as long as our speech meets the ground-rules.

      And I would appreciate it if you would listen to my conern, without having both of us get in a screaming match online (the last thing we need right now).

      I will do my best to follow the guidelines on this site, and would appreciate it if you would take my request in good faith.

      Duane

      • Duane, my disagreeing with what you have to say is not censoring you.

        If I observe the direction of your argument is weak or counter-productive, you are free to ignore what I have to say and continue in the same vein if you believe it advances your credibility.

  14. I hope I can answer some of these questions, comments, and will continue to respond as more come in.

    a) Please note that none of the comments in response to my post have been deleted. Everything here is okay, and I think it is fair to say there are comments sharply critical of me here. But this is fine, because they are all opinions relevant to the main point here: how do you foster a spirited discussion, open it up to a wide variety of voices, make room for criticism, and yet, at the same time, make this site a forum for thoughtful discussion.

    b) I think my instincts are clear. When I set up this site, I was advised to ask people to register who wanted to comment, and to review the comments. I did not do this, as my instinct is certainly to invite a free-ranging discussion. So I certainly am not motivated by a desire to censor anything.

    c) As a result, I was not very prepared for responding when some of the comments turned personal in kind. I hadn’t thought this through, and I set up the these guidelines for going forward. As Katie notes above, it was in fact an evolving concern, rather than occasioned by one specific event.

    d) I have only deleted a handful of comments, out of 3000 or so we received, and I am not even sure how I would have handled those I deleted with this new guideline in mind. But that is the past, and now I have a policy for going forward.

    e) If Joseph Biederman or Charles Nemeroff left a comment on this site, it certainly would be okay for other commenters to tell of facts related to their financial conflicts of interest, ethics, etc. As David Ross notes, there are facts there to report. But I would urge commenters to let the facts speak for themselves; comments written in a calm, measured tone always have more power.

    f) Several writers above have noted that if personal comments begin to fly, the website can begin to take on a nasty tone, and that drives away readers, bloggers, etc. That is one of the things I am trying to protect here: If the tone of the comments can be civil in kind, then you can have a nice vigorous discussion of opinions, facts, etc. But if it takes on a nasty tone, then the comments section is no longer serving its purpose, and the website and its readers are the loser for it. I am, most of all, trying to preserve a civil tone here, while allowing for a variety of opinions, etc.

    g) As for why this site seems to have now “mainstream” bloggers, I think most of the writers believe that psychiatry needs to be reformed, and some would say dramatically so. But if you want to have a community that is thinking about reform, it is very helpful to that thinking process to have voices heard from all along the spectrum–from those who perhaps think the status quo is okay to those who would urge radical reform. If you don’t have that, you can end up with a site that preaches to the choir, so to speak, rather than really stirs people to think things through. And the fact that this site may be spurring such discussion, between say psychiatrists with more mainstream views and survivors who can tell of being greatly harmed by psychiatry, is a good sign, in my opinion. I can read in comments made in these posts of people who are changing their minds about some things, and in some ways learning from each other.

    But think of this example: We have one writer, Jim Gottstein, writing of a post about “Occupy APA,” and then we have say a more mainstream post, one that mostly defends currrent practices and thinking. Isn’t it a good thing that you can have one site where such posts can intersect? The discussion is much more robust, invigorating, challenging.

    h) Finally, I think my personal experience is helping me see it in this way. Today, I spoke to NAMI in Los Angeles. Many people in the audience were not happy with my talk. I often find that in many venues; there may be a number of people who are not happy with me, or threatened by my talk. I have spoken to psychiatrists’ groups who feel that way. But isn’t it good that the leaders of NAMI in Los Angeles took this risk of offending their members by inviting me? It opens up a new dialogue, at least for some people in the audience. Whenever I go into settings of this sort, where many in the audience may not be happy with me, and I see in such moments a hope that a new conversation can emerge in our society, one that does tell of a much better way forward.

    I suppose I am now rambling. The point is that I want to have as liberal a commenting policy as possible, but I want to nurture a civil tone that helps nurture continued discussion, rather than inhibit it. And I am stumbling along trying to figure out how to do that best, and in this moment, these are the guidelines I came up in an effort to nurture a helpful discussion.

      • I attended a NAMI meeting once and paid 10 bucks to hear the offensive Fuller E Torrey tout his pro-med BS and tell the audience that Haldol was an anti-viral drug capable of preventing the virus he thinks causes Schizophrenia and helping the symptoms. He said he wished he had his sisters cat’s brain in his “brain collection”; and he showed a power point presentation showing how the virus is spread thru the food chain….need I say more. My point is the NAMI group had NO other speaker. Not one rebuttal allowed and when I asked him why he thought Haldol, an antipsychotic was an anti-viral? he said he did not know.

        I was not impressed with this NAMI group presenting him as “the foremost authority on Schizophrenia”. They loved his speech, they did not like my questions.

        I’m glad Bob could speak at their conference too, yet I doubt many people really listened. They are a pro-med treatment organization for families, and promote coercion treatment, note the sponsors at that meeting were Risperdal maker J&J-Janssen and Latuda maker Sunovion.

        Where NAMI goes–goes Pharma and that is the bottom line.

        The mental health paradigm of medication based care in America is alive and well with pharma funded and backed groups that claim to be for “the patients” when in fact they are not (NAMI).

      • I agree, I’d love to hear what goes on behind the scenes at NAMI.

        In any situation where it seems there are hardened opposing positions, there are always soft edges where one can make allies.

        I perceive NAMI as severely conflicted internally. There must be some people there, maybe a lot, questioning the status quo.

  15. Thank you, Bob, for “stumbling” around this point of civil discourse. I am most comfortable reading about people who are as radical as I am in their opinions about the status quo. But I have truly learned from people here who do not share all of my views.

    Over the past 5 years or so, I have begun to see a big difference between those who have a financial interest in the business of the status quo and avoiding liability and those practitioners who are struggling to help people in a broken system. Those practitioners can learn from us and are grasping for anything that will help the people they work with. They are conscientious and deserve a civil forum. I believe we can teach much to those who want to learn, and we can learn, too! Let’s build some bridges and “convert” more choir members by not labeling everyone in such a divisive way.

    Compassion goes a long way toward healing between people. Our compassion is NOT deserved by the people seeking to gain from the current system – and those are usually the legal persons (corporate interests). Anyway, it helps me to see the people who care (though I may think they are misled) as very different from the business of harm an illness.

    Thanks again for this forum. I am very hopeful that, together, we can create some movement toward better days here.
    Lowry

  16. Bob,

    Regarding the comment policy, I was thinking you might want to add a disclaimer like many bloggers have that states the comment section, and the articles and views contained within are not necessarily views of the website Mad In America or the site owner (Whitaker). It’s pretty common for sites to have disclaimers, and that way it is clear that your hosting of comments or other writers is not an endorsement or a reflection of “Whitaker, Inc.”

    Example:http://www.blogherald.com/2007/10/01/does-your-blog-need-a-disclaimer/

    “WPThemesPlugins’s disclaimer is pretty basic and covers most of the protection a blog may need.”

    “All data and information provided on this site is for informational purposes only. wpthemesplugin.com(insert Mad in America here) makes no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis.”

    And I would expand it to clarify that the comments in the articles are content written by readers, which are their opinions, and this site is released from all liability regarding reader comments; and the personal opinion and views or comment content are not reflective or endorsed by Mad In America.

    Just a thought.

    • Stephany,
      Your suggestion of a disclaimer won’t work because presumably one of the goals of this webzine is civil and enlightening discourse. It would be like opening an cultural and educational center and letting it out on occasion to topless mud wrestlers. The venue might attract more mud wrestling fans, but its intended audience would leave in droves. The owner of the venue sets the tone.
      …Rossa

      F.Y.I. I only recently removed the comments filter from my blog, with a message to avoid profanity and be respectful. This doesn’t mean readers can’t strongly disagree with each other. You would think comment writers would self-moderate, but many of them don’t. I have only ever refused permission to one commenter, but I’ve hada to lightly slap a few on the wrist.

      • What made me think of the disclaimer, was that there are currently over 40 blogger/writers on Mad In America, with a diverse message being sent out that way, there is bound to be disagreements or heated discussion, not unlike when people leave comments at NYT, Forbes,The Street, et al

      • That disclaimer is the given in Web forums. Limits to the Web publisher’s responsibility have been decided in the courts (cf Craigslist controversies).

        It’s up the the site owner what style of discourse he or she wishes to support and what type of readership is desired.

        I’m really glad Bob has set out his expectations. I fully support civilized discourse that includes mental health professionals. They’re going to be on the front lines as agents of change in medicine.

  17. I always tell my kids that it’s OK to label behavior but not the person. I think it’s totally fair to say “There is strong evidence that Joseph Biederman’s clinical statements showed bias that is related to his collaboration with his pharmaceutical company supporters,” after which, you would provide said evidence. This is different from saying “Joseph Biederman is a pharmaceutical company shill with no personal integrity and should be banned from further clinical trials due to his lack of ethics.” Even if the second statement is true or supportable, it does not further the discussion and distracts from the purpose of the website. If we stay away from ad hominem attacks, and instead focus on attacking the person’s arguments or credibility with known facts, the comment threads will function much more effectively and be more interesting and valuable to read. I certainly hope the former statement would pass muster with Bob.

    —- Steve

    • Thank you Steve,

      As someone who was the subject of one of the pulled posts, I can agree. I have a personal history that is easy to criticize: I’ve suffered from a mental illness (although I’ve always found it ironic that I’d be criticized for that by people who otherwise advocate on behalf of patients), which has led to some poor choices in my past. Unfortunately, this includes petty criminal behavior which led to an agonizing eight-year ordeal with my state medical board. Oh, and I’m also married to an employee of a pharmaceutical company. I love her dearly, and although I don’t always love what she does, I can see the place for her and her profession in the practice of psychiatry.

      All of the above facts have drawn much attention from a small number of readers here, and on my own blog. But despite all of the above (or, in many ways, because of it), I have tried to fight the status quo in psychiatry, to argue for more humane, thoughtful care, to help draw attention to the truly “bad apples” among us, and to minimize the influence of the pharmaceutical industry in our work. Unfortunately some readers fail to recognize that and, instead, persist in digging up dirt that they can sling at me for no obvious reason than to see me cringe or run away.

      I don’t run away, though, because I don’t want comments like these to stifle discussion on an issue about which I am, personally, very passionate. Nevertheless, I wonder how other forward-thinking individuals who might happen to have an MD behind their name (or, heaven forbid, a public history of something not “perfect”) would feel about entering a forum in which people are ridiculed not for their ideas but for past acts that were entirely unrelated to those ideas.

      • I am the commenter that said you were playing both sides of the fence so to speak. As that might not be the most accurate description, i still feel that sites like the Carlat Psychiatry Report are not stinging enough in their critique. Maybe that isn’t the aim of the site. Nevertheless, as “An Unbiased Monthly Covering All Things Psychiatric”, i do not see articles about brain damage and permanent side effects caused by some of psychiatry’s most popular drugs. Maybe i have to be a subscriber to see these, but i feel these are very important articles and would provide a great service if they were open to the public and other medical professionals for free. Secondly, while i am sure you are trying to change psychiatry for the better, the whole edifice of psychiatry and its relation to the pharmaceutical industry is based on, for lack of a better word, fraud. The drug studies are manipulated all the way down to the people the companies choose for testing. The FDA is pretty much a subsidiary of PHRMA with an operating model that seems to put little emphasis on public safety. As well as the rampant publication bias and ghost writing in your journals. What i see coming from sites like yours is essentially piecemeal reform when what is needed is a whole new paradigm of care. What we ultimately need is fundamental change as soon as possible. Because for every day that pressure is not being applied. Professionals within medicine not vociferously speaking out against the atrocities being committed. And for the status quo to continue, patients are getting maimed and killed.

        • Scott,

          At times I DO feel like I’m playing “both sides of the fence.”

          On the one hand, my role with the Carlat Report provides me with some freedom to promote what you call a “new paradigm of care.” We do feature articles on the ineffectiveness– and dangers– of psychotropic medications. We recently featured a brief review of Mary Ellen Copeland’s WRAP system. And we are always pushing for more honesty (and less corporate influence) in the research of new drugs and their promotion to doctors.

          On the other hand, the day-to-day work of a psychiatrist is , unfortunately, still grounded in a very biologically minded view of mental illness (see “Troubling Times” by Alice Keys posted here on Monday). Any desire to change psychiatric care for the better must take this into account. (Dr Carlat and I both know that very few people will read our newsletter if we don’t talk about drugs!) And medicine is so highly institutionalized and regulated that any “revolution” won’t happen anytime soon, especially if that change emerges from within the profession. For instance, I would be unable to work in many current psychiatric treatment settings if I insisted on practicing the way you and I both think is best. So I’m trying to go my own way, write and talk about it, and hope that others catch on.

          In the end, it’s a fascinating– and frustrating– time to be a psychiatrist. I think the field WILL undergo a sea change during my career. The only question is, in which direction?

          • Ironic! Dr Steve Balt to speak with Dr Daniel Carlat at the APA meeting in Philly 2012 in a workshop titled “Psychiatrists and the new media–gaining control of our specialty’s public image” (along with the docs from the “Shrink Rap blog)

            Very intriguing, the thought of how the psychiatrists will elaborate on gaining control of their image!

  18. I think, Mr Whittaker, you are creating one of the best online communities I have found. A few limits on the type of comments allowed is unlikely to do much harm.

    I hope that some of this lively and sometimes wonderful writing translates into real world action. It would be interesting to hear if it has.

  19. Robert,

    We Texans have an old expression we like to use –

    “Dance with the one that brung ya.”

    Many of us who have been injured and/or have had family members who have been injured by conventional psychiatric methods (the psycho-pharmacoligical, medical model) have spoken highly of your work for many years… I have told more people about your books and website than I could count…

    And I would like to take a moment to say, “Thank you.”…
    For remembering the ones you intervieed along the way…
    For telling their stories… for giving those in the research you cite a human face, a human heart, a human experience.

    You danced with those who brought you.
    And I am grateful for all you’ve done.
    As are countless others, around the world.

    You’ve given us some guidelines.
    But I’m not concerned.
    Because I’m confident you will remain the same Robert Whitaker.
    Searching for science, looking at data, but never forgetting the people behind the research…

    Few people ever have the opportunity to truly change the world.

    You did.
    And you have.

    Gratefully,

    Duane Sherry

  20. This might be slightly off-topic, but I wanted to respond to one comment I saw here:

    “We can’t help people in emotional distress, and at the same time continue to scapegoat and silence these people.”

    This is an important point, but I think it’s one that can easily trip up a lot of well-meaning people, and may be one reason (if I may generalize) why mental health professionals are so baffled that we’re angry with them.

    People may sincerely want to help us reduce our emotional distress. But it’s too easy then for them to view it as “success” when they don’t have to see our emotional distress as much, when they don’t have to hear us talk about our emotional distress as much! People can misunderstand whether we’re actually experiencing less emotional distress now, or whether we’re simply getting better at hiding it.

    There’s a subtle (or not-so-subtle?) influence for well-meaning people to want to see us “looking better”, which means (subconsciously?) discouraging us from letting them see how much pain we’re still in, because that might make them think that we, or even they, are not doing a “good enough job”. People don’t realize that wanting to see us “looking” better can sometimes unintentionally perpetrate shame, a disappointment in us (and themselves) that we haven’t gotten better yet.

    Actually going with us into our emotional distress and working through it together, can be difficult, painful, time-consuming, and not very pretty. This is difficult territory, one that requires tons of empathy, patience, and courage on the part of people who are in the role of “helpers”. But it’s crucial for everyone to draw a distinction between “looking better” on the outside (which can make us feel ashamed of our distress and simply try to hide it better), versus experiencing real emotional healing and growth from within.

    This might be a good topic to explore in more detail, how sometimes mental health professionals perpetuate shame without even realizing it.

    • You said a mouthful! I agree that the current approach focuses on minimizing any overt expression of distress (or even high degrees of excitement, for that matter) that might make the clinicians, educators, or others working with the client uncomfortable. It’s the classic Freudian “countertransference” reaction – “you need to stop acting that way so I can feel better.”

      Real success in helping people heal seems to come from learning to be comfortable with the client’s discomfort, to sit with the pain and experience it with them so that it becomes safe for them to talk about. Identifying the emotional distress as the problem rather than looking for the underlying causes can make the provider and sometimes even the client feel temporarily better. Unfortunately, as Bob has clearly shown us, it’s the wrong path to follow if we care about the client’s long term welfare is really our focus.

      —- Steve

      • If it is research, or guidelines for “best practice”, or whatever else it is you look at of psychiatric publications, what you’ll find in it is an almost exclusive focus on “symptom reduction”. “Quality of life” is hardly ever mentioned. This although there are innumerable people who have an excellent quality of life while also experiencing “symptoms”. Maybe the helpers should shift focus, from “symptom reduction” to “quality of life”, i.e. from their needs to those of the person in distress. (I believe I was the commenter who wrote what philroy quotes above.)

  21. I agree wholeheartedly with your post Duane and that Bob Whitaker has exemplified the Texan exhortation to “Dance with the one that brung ya.”.

    Like you I believe that Bob’s work is a catalyst for change, that has long been needed in the psychiatric system. The time is right for a shift and a transformation, using all the resources to hand.

    Guidelines are useful for giving us direction, someone needs to be at the helm. And it will still mean all of us pulling together. It’s great to be part of the team.

    Regards, Crhys

  22. Wow! In some ways this discussion reminds me of Grade-School. Remember: when a friend would say if you are friends with___, I can’t be your friend. As I remarked about this issue on twitter:

    “IDK seems like bullying to me not so much free speech, as poor judgement. Believe me I’ve done it–I’ll do it again. IN MY HOUSE.”
    “or on my blog—the thing I don’t get apparently no one does anything right, @ mad in so why even engage? looking for a fight? IDK”

    I have always said and written from my gut—not always popular to say the very least, but doing so enables me to look myself in the eye when brushing my teeth, and to sleep when I lay my head on my pillow.

    I appreciate the fact that my Op-Ed was published on this site. I also appreciate that Bob was willing to edit it. In order to be published it needed to be edited by someone other than myself—I am a shoot from the lip sort of gal; which works for me in my own house, so to speak—yet I am aware that it isn’t everyone’s cup of tea—and so it is not necessarily the best way to deliver a message that some may not yet be aware of, or willing to to hear.

    That said, I share some of the criticisms/opinions voiced about some of the bloggers who have participated on this site; but I believe this issue is a WE issue, not an US and THEM issue. It seems to me that it would require a certain amount of ground rules such as have been laid out in this post. How this is perceived or interpreted by any party is a choice.

  23. As big a fan as I am of Robert Whitaker, I cannot approve of this simply because what is offensive and what is an attack on another person can be interpreted so differently and will only lead to discrimination. It would be myopic of us to accept Mr Whitakers comments with out loooking at its implications. It is like political correctness, in that no matter what linguistic mischievousness you camouflage it with, what specious arguments you proffer in its favour, it is a tyranny that exudes intolerance of different modes of expression and opinions that essentially do us no injury, apart from the metaphorical harm done to us psychologically, which is a price we all have to pay for freedom, anything else being inimical to tolerance and liberty, and also to truth.

    It is a form of gratuitous behavior control, which also implies thought control in the long run, and leads to a general climate conducive to preoccupation not with saying what you want to say but saying what is considered proper, so that I can’t call a psychiatrist who administers forcibly into a person’s body a legally sanctioned rapist, which might cause a lot of offense and be construed as a personal attack, yet nevertheless I can defend the grounds on which that opinion rests, believing them to be essentially cognate practices. This, in my opinion, is one of the rocks on which your argument founders because sometimes you have to attack people personally because it is true and the truth must not be made to answer for infractions of rules that serve to suppress it.

    Another problem to me is that some people’s opinions are so polarised that to expect civil discourse is perhaps unrealistic, especially when their discrepant interests have resulted in so much suffering as is the case with coerced patients vis a vis their coercers. I see no reason why rpae victims or metaphorical rape victims should have to make concessions to the feelings of those who show far greater disregard for the feelings of the people they abuse, a disregard far greater than any words, no matter how scurrilous. It is not their righteous indignation we should be seeking to oppress but to give it a medium for expression without the imposition of dictates that could serve to impede the understanding of others’ realities. Deference to the proprieties of conversation could result in just more oppression for already badly oppressed peoples I’m afraid, marginalizing the emotional realities that may impart far more truth than can be distilled into verbal form.

    Of course, this should not be applied selectively. If a psychiatrist wants to personally attack me through words by saying I am a ‘paranoid schizophrenic’, then I will countenance that.

    The comment of Stanley Holmes, where he talks about people like myself who aren’t that stupid as to buy into the prelapsarian delusions peddled by the mass-audio visual media (I am a student of human nature, not Hollywood cinema), perfectly illustrates my point. He would rightly interpret most of what I say I think as a personal attack. Are you going to ban me?

    Psychiatrists generally and their supporters deem anything that doesn’t harmonize with their interests to be lese majeste. Mr Holmes, I don’t need to accuse psychiatrists of lying, I can prove it! Organised psychiatry wasn’t simply ignorant of tardive dyskinesia, it self-servingly lied, compounding the suffering of people by blaming it on their unproven diseases. The problem is, many psychiatrists don’t just lie to others, they lie to themselves, so they aren’t even aware they are lying. If I think psychiatrists are lying, you’ve another coming if you think I’m going to be sensitive to your feelings, especially when organised p$ychiatry has a long and ignominious history of torturing, tyrannising and abusing people that bespeaks such a monumental disregard for people’s feelings, for the human implications of many of the people you deal with.

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