I’ve been thinking a lot about George Saslow since I came south to take a timeout and think. I miss him. A lot. Dr. George Saslow was my guiding light after I moved to Oregon in the middle of residency training and became lost.
I came to his door referred by an old friend of his, my neurology mentor at Tulane. I knocked one afternoon and said, “Dr. Sam Trufant sent me.” These were the magic words. George Saslow smiled and opened his office door. I had found the guide I sought for the remainder of my training years.
Dr. Saslow was an amazing physician. When he was forced to retire at sixty-five by federal mandatory retirement laws, he went off and started a new department of psychiatry in Oregon where there had been none. When the people working on the Manhattan Project started having “stress issues” while developing the atomic bomb, George was the guy they called in to help sort things out. By the time we met, he was professor emeritus and active on the Psychiatric Security Review Board. He provided me an anchor from which to navigate the second half of my psychiatry training.
Sometimes I imagine that George would know what to do if he were still alive today. Then I remember what he thought about the changes that were happening, even back then, in the mid-eighties.
I talked to him about the changes he and I saw; the replacement of psychiatry education with psychopharmacology training, the infiltration of “prescribing” as a substitute for medical care, the loss of public funding of the state medical school and hospital and subsequent privatization, the closure of state hospitals and the first waves of patients abandoned to live “under the bridge”.
“Things are not going to get any better,” he told me. Back then, I wondered if he might just be a crabby old man. But now, having lived the past 25 years since our regular meetings, I see that he was the voice of experience and history, a skeptical enquirer, a lifelong student of human behavior and a talented visionary. Or maybe I’m just a crabby old woman now.
I often wonder what he would think about it all today, what he would do about the condition of the practice of medicine. More than anything, I long for leadership and guidance. I keep looking around, but see no one who’s in the position to provide this. My colleagues are head-down, occupied in the trenches, bailing the ocean with their teaspoons. They are caught up shoveling pills at patients as fast as they can in an effort to stay ahead of the time choppers nipping at their professional livelihoods. The younger ones have no idea that things were ever any different. The older ones take their marbles and leave.
What would George do? Every day I wonder. Then I remind myself of a favorite saying of mine: “If you ever need a helping hand, there’s one on the end of each of your arms.”
Dr. Saslow was a cognitive and behavioral therapist by inclination, so by professional heredity, I am also one. He believed in the miracle of changing one’s life for the better, one behavior at a time. He understood the power of words to create the world.
So, I take out my laptop and write again.
I’ve been sending my email missives out to a slowly growing group of friends and professional colleagues since I left Portland last fall. I’ve sent travel logs, personal updates, thoughts and feelings and the occasional professional rant. I am certain there are email boxes that have a special spam filter with my name on it by now.
I have had professional rants for years, but usually just talking rants during the slow spells of crisis work and rants when I walk in the mornings with my quiet-natured husband. I’ve always been prone to doing research projects when I’m perplexed, all the way back to medical school. Whenever I’m bothered by the idea of this medical treatment, that nutritional hoax or this social condition, I bury myself in the books. I get excited when I do research. I tell anyone and everyone that will sit still for five minutes what I think this week. I would probably hate someone else for doing this.
Now I’ve been given a great gift, the gift of a wider audience. In the past week I’ve had more different people read me than I’ve ever had in my life. I’m exceedingly grateful for this opportunity. Now, when I sit down to think and write, I know that there are a few more people at the other end of my pipeline.
Even though I still feel lost and leaderless in an overwhelmingly broken medical system, I am reassured when I see that there are others who have noticed that all is not well in our first world paradise of high-profit, “evidence-based” pharmaceutical products.
This endless flood of overpriced pills is poisoning our patients, busting our healthcare budgets and killing the practice of medicine.
And, like George, I fear it’s not going to get better soon.
Um – am I mad, or are you describing the end result of deregulated capitalism?
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Um. Why Yes!
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John,
In my opinion, unrestrained capitalism has been a big factor in getting us where we are. But I am not a political scientist. I seemed to have missed much of high school civics class where we were supposed to have learned the whys and wherefors of our fine and free government system. Capitalism does what it’s supposed to do very well: it makes a few big piles of money (capital) from small piles of money. The more unrestrained and deregulated things are, the better it is at this. I have wondered for a long time if a system which has as it’s bottom line the goal of collecting a few big piles of money is the best route to building health care, education and human services sytems. Probably Capitalism is good for something, right? Oh yeah. Making a few big piles of money out of little piles of money.
Best always,
Alice
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There is a dynamic that I read about just after the credit crunch. It goes like this: the bank lends money to a company and asks for it back with interest, so the interest means the bank gets richer – repeat loads of times and those piles of money build up. Use some of that pile to lobby the government to de-regulate so that the bank can make more money and use some more of it to advertise to the public to encourage them to take out loans the repayment of which, with the interest, makes the bank even richer which enable them to pay for more lobbying and more advertising.
There is more analysis in the evolution of the credit crunch but when I read it I realised it was the same dynamic that influences climate change denial and lack of sufficient government action and also the take off of the biological model of mental illness and the mass drugging of people with mental distress.
It takes more than this of course, it also takes valuing money over truth (or in other words, bare faced greed).
But when I read the analysis I finally understood what all these anti-capitalists had been on about and why it was important to my life and the life of my friends.
There is another aspect here: the more the differential between the rich and poor in any country the larger number of people who are classed as mentally ill (also the larger number of teenage pregnancies, the more crime, more alcoholism, more drug addiction etc etc). Social inequality creates misery.
So capitalism creates mental distress which the capitalists then sell drugs to us which make us ill and make the drug companies money and distract from the real causes of our problems
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John,
Wow. Good job with this. There is nothing I can add here.
Frightening. Where does one shove a stick in the spokes to stop the wheels from turning? Or do we have to wait for the wheels to come off the bus naturally?
Thanks for the interesting and thoughtful conversation.
Alice
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HI Alice
well I think the idea of yours of campaigning to stop direct to customer advertising is one such stick.
It will not be one stick that is needed. It is about talking it over and finding lots of actions that different people can take. Some need to be actions that lots of people can take (mass promotion of badges saying, “Recovery starts with non-compliance,” and, “TLC not ECT,” for example and seeing if on -side workers will wear them), and others that only a few can take, such as taking legal actions through the courts or serious political lobbying.
But this webiste is a handy tool to talk it over and encourage each other. it is only by talking it over and encouraging each other can we hope to create a big enough force to have a significant effect.
So good luck with all your work.
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John,
Yes. Of course. There are so many things that need to happen here, many tasks for many hands. And I only feel I have a “one in a million chance” of making a difference for the better. But, as Sir Terry Pratchett said,”One in a million chance things happen all the time.”
Best,
Alice
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One need not shoot for that one-in-a-million chance. No effort is lost. Each person adds their mite towards the tipping point.
For example, Alice, if you can get some of your colleagues to read Anatomy of an Epidemic — not all will appreciate it, but maybe one person will. And that person will tell another, etc.
Changing one doctor’s mind is a small but significant contribution. Each one, teach one is a fine project.
If we look at the system as a whole, it does indeed seem impossible to change. But all complex systems change in patches, not all at once. The patches start small and grow. Eventually the patches coalesce and then you have visible change.
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Altostrata,
Thanks for the encouragement. I am spreading the word every day. Likely I am designated as spam in some former colleagues’s email filters. I tell them to read the book and give them links to MIA. I talk to people on the street. Anyone that will stand still and who shows the slightest interest gets to hear about it from me.
Best,
Alice
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I would have to say that right now we are operating not in a capitalist system but a fascist/corporatist system. As for the direction of psychiatry, psychiatry is going to continue to lower the threshold for “mental illness” and subsequent drugging because that is where the money is and that is where the fascist state wants it to go. Just like the absurd oppositional defiant disorder for kids, psychiatry is going to make a similar disorder for adults who don’t bow down to their corporate masters. This is where psychiatry is heading.
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Scott,
I don’t know the right words for the system we are lost in right now in our country; whether it’s capitalist or corporate or fascist. I’ll leave the labels to those who know. I do know that things have gone seriously wrong. I’ve been watching the threshold for “mental illness” and for drugging people go down and down and the net grow wider and wider my entire professional career.
I read recently of public elementary schools where 40% of the children are being “treated” with drugs for ADD. When exactly did a relatively uncommon “disorder”, well-treated with social and behaioral interventions become drugging of so many kids? When did everyone who has moods that change during the course of a day (everyone human) and people who get angry (everyone human) become candidates for drugs?
I am regularly horrified by the lists of medicines that patients come out of hospitals on after a three to seven day stay. I have been told that the hospital docs are under pressure to get people out fast so the next ones waiting in the ED can come in, a bed shortage issue. This makes no sense to me.
Psychiatry is not “heading” there. We have arrived. Oppositional defiant behavior in adults translates into bipolar disorder.
Thanks for the clear headed talk. We need a lot more of that.
Alice
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in the UK where things are not so bad, but still pretty stupid, I wrote the BBC about a radio programme which was discussing Adult ADHD and pushing ritalin to treat it. They asked the psychiatrist whether this was, “Medical Creep,” he said he eliminated other diagnosis such as depression, anxiety and personality disorder. The radio station accepted his answer.
The symptoms of adult ADHD are not being able to concentrate sometimes, being a bit of a thrill seeker and not achieving your full academic or employment potential.
Thrill seeking can be a way of avoiding difficult feelings, not being able to concentrate may mean that you are trying to concentrate on something you don’t want to do either because quite frankly the task bores you or because you have some fears around the task. Not fulfilling your potential has numerous causes, including fears from your past making it hard to concentrate on getting your career or academic study together.
This is rubbish. So I wrote to the radio station (BBC Radio 4, the most prestigious and intellectual radio station in the UK) saying that they had not entered into proper debate on this issue and were drug company stooges. I am still having the conversation by e-mail and may (If I can muster the enthusiasm, I have trouble in fulfilling my potential and sometimes prefer to read a good book or spend time on website like this rather than sticking to the task in hand – irony alert, just in case you didn’t notice) put in an official complaint.
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John,
I like to hear from you. It really gets me going with new ideas. Diagnosis “creep” is a misnomer. It seems to me more of a diagnosis “flood” here.
Stay with us. Plus write the radio stations. Plus read books. Plus eat well and exercise and have fun with friends. These are all necessary to your “human potential”. Human potential is so much bigger than the “task at hand”. It’s all important.
Thanks,
Alice
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“the closure of state hospitals and the first waves of patients abandoned to live “under the bridge”.
I’ve been subjected to state hospitals, I will take under the bridge please. Not that I am all too used to having my wishes respected.
And just in case anybody was wondering, forcibly drugging people and forcibly electroshocking them, and forcing psychiatry’s stigmatizing and misleading labels on them, and locking people in solitary confinement, which is what State Hospitals do, cannot be reformed, cannot be made better.
Under the bridge unmolested, or forced into psychiatry by the government. I’ll take the bridge.
I was traumatized for life by state hospitals.
I’ve just seen your biography page on here…
“But I came home at the end of each day with a smile. It was fun to work on the locked psychiatric unit. “
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Now I’m really intrigued at a further look at the author’s biography page here…
This is what Alice Keys says in her bio.
“But I came home at the end of each day with a smile. It was fun to work on the locked psychiatric unit.”
http://www.madinamerica.com/author/akeys/
Many psychiatric survivors read MadInAmerica.com
Many of these survivors of human rights abuses had anything but ‘fun’ when they were captive and being forcibly drugged and labeled in locked psychiatric units.
I’d like some context or further depth to this please. I’d like to come to understand what was so ‘fun’ and smile inducing about the locked psychiatric unit you chose to work on.
I mean, I’m someone who almost loses my lunch at the thought of doing to people the kinds of things psychiatrists are asked by the system to do when they choose to work in these coercive settings. I’ve been on the other side of forced psychiatry, and I wouldn’t wish it on my worst enemy. It’s a completely alien thing to me, to even hear someone describe locked psychiatric units as ‘fun’ places.
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Anonymous,
Please read my post with regard to your earlier commentary. I hope this will clear up some of your questions. One additonal thing: At that time, residents in training had no choices about where they went for training. You signed up and awaited a “match”. Once you got the “match”, the program you were assigned to put you where they wanted yo to work. I had a little leeway as per timing but no choice as to the venue. I was not looking forward to the psychiatric rotation at the time as I was a neurology trainee. I saw it as “something to get over with” so I could get on with my career path as a neurologist. The happiness I felt working there was unexpected. I genuinely enjoyed spending time with my patients there. I still enjoy working with mental health patients.
Thanks again for writing. I have no idea how the things I write strike people unless I hear back. I hope this clears it up for you. If not, ask more.
Best always,
Alice
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I do appreciate your good faith discussion and willingness to listen and respond. I do.
I can respect you as a human being, but please understand I don’t believe in your profession’s belief system. I don’t share it. I live in fear of your profession’s belief system being forced on me as it has been in the past.
In my personal morality, I would never make a choice to make a living using locked doors on people who are not criminals, or drugging, or electroshock of any kind on non-consenting individuals.
I don’t respect the choice to do so. I don’t believe society is justified to hand such a contentious and bitterly disputed profession a monopoly on forcibly rendering unwanted ‘help’ to people. I don’t believe psychiatry gets to define what is ‘help’, and I don’t believe those who use force to ‘help’ can justify the amount of lives destroyed in the process.
Again, this is so very very hard to navigate, and I am not meaning to sound hostile. I do appreciate your desire to communicate and I think people can learn from two people so poles apart in beliefs talking to each other.
I have been locked inside psychiatric units. I have been forced into the patient role against my will. I have been ‘owned’ by psychiatrists who signed papers declaring that I had no right to own my own body any longer, nor was I worthy of the freedom to live free in society for a period of time. I am sure they used the language ‘my patient’ to refer to me, among their colleagues etc, and maybe even at home when they relaxed after work while I was still caged.
But the possessive nature of that language ‘my patient’ upsets me whenever I hear it, because I consented to be nobody’s patient. I don’t want you to stop using the phrase ‘my patient’, I’m trying to give people a sense of the dimensions on which forced psychiatry poisons everything. And while I may have legally belonged and been owned by that psychiatrist, I will never acquiesce and accept the forced definition of our degrading involuntary slave relationship as that of doctor/patient. I don’t consider what goes on in psychiatry to be real doctoring of real diseases.
And I don’t think you’re correct in saying under the bridge and state hospitals are the only choices available.
There is a third choice, it involves self reliance, resilience, and self actualized recovery, which usually involves sloughing off the lies psychiatry has filled someone’s head with.
I survived alone, from my own skill and strength. I am not holding out for some ‘improved service’ or solution provided by another person. I seek only my human right to be let alone.
I’m happy to say I’m recovered in spite of psychiatry, however at any time the people willing to force people carelessly into psychiatry using commitment laws, could crush all I have worked to achieve. This scares me. It scares me to know there are so many professionals out there willing to use force to force their beliefs on us.
The story of recovery is the story of cleaning up the mess psychiatry makes of people’s lives.
I will never agree that a person not guilty of a crime belongs in a situation where they lose their freedom. And I will never agree that a profession which cannot prove brain disease deserves the right to forcibly enter the brains of every citizen if that profession ‘declares it an emergency’. It’s the most vile, abhorrent thing to me. I seriously cannot respect a psychiatry that forcibly alters the brains of people against their will. It is a human rights atrocity worthy of imprisonment, I believe. I believe psychiatry’s powers to forcibly drug and shock should be outlawed and I believe those who assault the brains of the non-consenting ought to be prosecuted and put in prison. I believe it is a serious and heinous crime against human dignity to forcibly drug or electroshock a person. I believe these crimes look even more pathetic and cruel when psychiatry readily admits it cannot prove a thing about the targeted person’s brain state, nor can it prove real disease. Truly sickening.
My position is that I know what human rights abuses I would be asked to carry out if I were to train as a psychiatrist. This is another of the many reasons I would never become a psychiatrist. I am a conscientious objector.
I believe that pushing people around who are not criminals, is a grave abuse. I believe pushing a convoluted and contentious belief system of putative ‘brain disease’ down people’s throats when they are enduring their lowest hour, when they are experiencing extreme stress and breakdowns, is an atrocity.
I believe no means no. I believe in 2012 most people who work in coercive psychiatry are die-hard believers in biological psychiatric theories and that they can easily dehumanize those they are paid to forcibly drug by telling themselves that the person they are about to assault has a diseased brain.
I also believe that when I use the word ‘assault’, it is not strong enough. I believe there is assault, striking somebody, then there is sexual assault, and then there is the deepest and most profound invasion of the most intimate organ in the body, the brain. That is how serious this assault is. I believe my brain is the temple of my personhood and humanity, and I will resent until the day I die that my government allowed the guesswork profession of psychiatry to rape my brain. It was the ultimate betrayal.
If you can be shocked and rethink psychiatry and your careers after reading Bob’s books, shouldn’t those assaulted by your profession be at the forefront of your minds? and those who will be assaulted tomorrow? force and coercion in psychiatry and the terror and the harm done by them should be one of the top issues discussed on this blog. Unfortunately it is not. Psychiatrists freely made the decision to get involved with psychiatry’s belief system and practices. I didn’t. Millions like me didn’t.
As investigations of the research are debated back and forth on this website please remember, psychiatry represents to many people, especially those robbed of a choice by their governments and forced into psychiatry, psychiatry to many is DEMONSTRABLY the most destructive force ever unleashed on their lives and bodies. The pain and loss so many live with, the toxic anger at the injustice of this, is forced psychiatry’s legacy.
This post is speaking broadly above of course, and I’m not specifically talking about you, Alice Keys by any means.
I shouldn’t have zeroed in on your comment. I understand your explanation of your experience with those detained in the New Orleans VA unit as you described.
I just wish more broadly across this blog there was more acknowledgement of psychiatry’s daily human rights abuses.
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Anonymous,
Thanks for listening to my explanation with regard my comment on the old happy times (“fun”) that lead me to my professional career choice. I believe that work and career choice is best lead by good feelings. It stinks to have to take jobs that are not happy places to be. I’ve done it. People do it every day.
I don’t believe in ALL my profession’s belief systems either. You’re in good company that way. Most of the folks writing and reading here also do not believe in them ALL. Welcome.
I’m glad to hear that you have found your “third choice” path. The “two paths” I referred concerned some less fortunate people I have known who perhaps have less resiliance and self-reliance abilities than yourself. All humans are not equally capable all the time.
Everyone is at their own place on their own path. Everyone.
There are those who would like help and support managing life for a time. Some people I have spoken with would like there to be a safe haven for them away from the streets, even for a while. I think safe housing should be available to everyone regardless of any “psychiatric diagnosis”. It is irresponsible as a society to leave people living on the streets who don’t want to be there.
As a physician, I have referred to people as “my patient” and shall continue to do so. I am honored by “my patients” when they likewise refer to me as “my doctor” or “my psychiatrist”. I’m a doctor. I have patients. It’s the deal I make with people and they make with me.
I’m sorry you’ve had such bad experiences. I’m glad to hear you of your recovery. The story of your recovery is one that can give hope to others coming along.
Warm regards,
Alice
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“I’m sorry you’ve had such bad experiences. I’m glad to hear you of your recovery. ”
Thank you. I’ve pondered for a long time, on how one can have anything other than a “bad experience” when one is subjected to forced drugging and forced labeling and forced indoctrination into psychiatry’s dogma.
If some people out there want a place to go, it should be self evident that if it requires taking away their legal rights to get them to that place, that they really do not want to go to that place. But I’m all for voluntary participation in psychiatry if that’s what someone wants. Just as I am for voluntary sex, and voluntary marriage. If force is used, as in forced drugging and forced electroshock, it becomes a human rights abuse.
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Good morning Anonymous,
I agree. I can’t imagine a “good experince” that involves “forced drugging and forced electroshock” or “forced” anything for that matter.
Best always,
Alice
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Anonymous,
Thanks for adding your post to the discussion. The only way we can hear all sides of the story is if people like you speak up.
Yes. The hospital I did my psychiatric training in during the early 80’s sounds a vastly different place than your current experiences. We did zero ECT. No forced drugging. There were a lot less drugs in play then. People stayed long enough to benefit from the alternative the therapies provided: OT, PT, art therapy, group therapy, individual and fammily therapy. Respectful treatment. A calm atmosphere. Although the doors were locked, most of the guys were voluntary, most of the time. There were times we had to keep a close eye to keep someone safe. It was the Veteran’s Hospital in New Orleans. I think that most of the time, the guys (mostly men) that stayed there were okay about being there. What I found “fun” was developing warm relationships and seeing people go back home in better condition, better able to cope, than they came in. It was a pleasant and hopeful environment to be a part of.
I’m sorry that things have devolved to the point that “under the bridge” beats care. You are not the first I’ve heard this from. I’ve heard stories from the over crowded and understaffed state hospitals. They are not easy places for anyone. I have worked hard to keep people out of hospitals for years. I’ve also worked in downtown shelters and seen people come in having been assaulted while living outside. Women and young people with disordered thoughts are very vulnerable to being preyed upon by the more “capable” folks that live outdoors. It’s a rough life. I’m sorry these are the choices available. I hope we can do something to change it.
I’m sorry if my use of the word “fun” sounded flip or heartless. That happy feeling was genuinely what caused me to make the shift, that feeling and the hopefulness of the times, the great guys in the wards where I worked and the staff.
Best always,
Alice
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Like Anonymous, I must admit that I’ve been flabbergasted at the words “fun” and “smiling” mentioned in context with working at a psych ward, a locked one into the bargain, me too. I’m also flabbergasted reading your comment here: “As a physician, I have referred to people as ‘my patient’ and shall continue to do so. I am honoured by ‘my patients’ when they likewise refer to me as ‘my doctor’ or ‘my psychiatrist’.”
I wonder, how would you react if somebody, and I imagine you’ve been in this situation, asked you to, please, not refer to them as a “patient”, as sick, since their own definition of themselves and their experience was everything else but that of being sick? Would you respect that wish? Would you respect the person’s right to define themselves and their own experience?
I work as a counsellor at a crisis center, and many of our clients, which we simply refer to as “citizens”, have been, and often still are, in contact with psychiatry, they identify as “patients”, suffering from a “mental illness”. When they come to us, they usually expect us to have the solutions to their problems, to be able to “fix” them. The helplessness in these people is profound. It is often more profound than that of a new-born baby. They’re completely infantilised, or “patientilised”, used to the “expert”-helpers taking their lives into their hands, and run it for them. Just like a parent, who, instead of facilitating personal growth and independence in their kids, exercises totalitarian control over their kids, not giving room for them to be. The result is eternal “patienthood”, chronical “illness”, chronical helplessness and inability to take responsibility for oneself, one’s own life, which means complete dependence on others.
I haven’t met anybody yet, who was psychiatrised, who hadn’t experienced the mentioned parental totalitarian control in one or the other way, to one or the other extent. How do people, kids or grown-ups, learn to take responsibility? One thing is for sure: they can’t learn it as long as others keep them from taking it, for instance by referring to them as “patients”, whose tool for decision-making, for taking responsibility, doesn’t work properly (why they need to be locked up, and have others take responsibility for their life). Telling a person in emotional distress that they are a “patient” is telling them the same thing all over again which they were told by those (usually their primary caregivers/parents) who initially didn’t allow them to be, which resulted in their problems. This time with the authority of the by society recognised “expert”, not just that of the parent. Devastating.
So, one of the first things I do whenever I meet the first time with one of these people, and something that I continue to do as long as necessary, is that I stop them immediately when they use the word “patient” about themselves, and start to talk about their “illness”. I have no problem whatsoever with somebody referring to themselves as a patient when they suffer from a physical illness that in one or the other way has an influence on their body. We don’t use our shin bone or our pancreas for decision-making, and no one would question and disrespect someone else’s capacity to make decisions on behalf of themselves because the person has a broken leg or suffers from diabetes. But the moment I declare the tool for decision-making (and it doesn’t matter if I believe in organic brain disease or hold psychoanalytic/psychological beliefs about a disordered mind — the brain is the tool of the mind) diseased or disordered I have set the scene for disrespecting the person. Referring to people in existential distress in terms of “patient” is the linguistic manifestation of this disrespect, and it is the justification for the exercise of more and more, not less, of this disrespect.
The vast majority of the psychiatrised people who come to our crisis center have also a very hard time letting go of identifying as the “patient”, and accepting that this role was attributed to them by others because of these others’ needs, not because of their own, so that actually they don’t need to be the “patient”. I don’t feel honoured if these people refer to me as an “expert” (I’m not an MD, so it’s not “doctor”). I feel deeply concerned, and I do whatever I can to make them understand that, no, I’m not the expert, they are, and all they need to do is understand this, and there’s no limit to what they can achieve. What makes me smile, and is fun to me, is to watch people understand it, walk out of not just the locked ward, but the system all along (which includes me), holding their head high, having shed the label of “mental patient”, or even, in those cases where the person never has had “insight”, without ever having taken it on.
Since this is the internet, and it’s nature doesn’t allow for fine-tuned communication: this is not to attack you. It’s a different view, from a different perspective, reached through a different experience, and maybe you’ll find it worth thinking about. I hope so.
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Marian,
Thanks for your thought provoking response.
I’m glad to hear you also have “fun” at work as I do. It sounds like the things that make you smile are what make me smile. I also enjoy upbeat co-workers.
I DO introduce myself as “Dr. Keys”. In crisis work, where I rarely have the opportunity to see the same person twice, it’s important to let people know who I am and what my role is. They see so many providers at one visit. It can be confusing. Especially as a woman doctor with a big smile, they are uncertain if they’ve gotten to the “real doctor” yet.
I suggest they may call me Alice, if they prefer. I ask them what they would prefer to be called.
But I am an “old school” physician trained by old school physicians. The doctor/patient relationship is one of mutual respect and trust. I feel okay about that.
Everyone doesn’t have to agree on everything here.
Best always,
Alice
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Without any disrespect to any particular doctor, I think it is pretty obvious that psychiatrists stop practicing anything approaching real medicine the day they graduate.
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Doctoro,
With the same respect you offer me as a “particular” doctor and psychiatrist, I disagree. Making conclusions about an entire group based upon one quality held in common (in this case, completing psychiatric residency) is plain old, garden-variety stereotyping.
I had a friend long ago who used to say to me “I don’t like doctor-types” and “I don’t like psychiatry-types” and assert unpleasant qualities they all shared. He would then carefully make noises to exclude “present company”. I have also heard similar remarks made with regard to members of racial groups, ethnic groups, socio-economic classes, psychiatric patients, pretty much every group one could put together and call a group.
What seems obvious from one position may be less so if you stand somewhere else.
Thanks for bringing your energy to this discussion. Making things better for everyone will take all the energy we can get together. Isn’t it nice to know we don’t all have to agree on everything here?
All the best,
Alice
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With the medicalization of normal experiences, each of us is encouraged to think of him or herself as a patient, helpless in the face of problems, and in need of care by an authority figure.
This is in the service of making us all consumers, in this case, consumers of psychiatric services. It makes the economy go ’round and ’round.
I’ll allow there may be a small number of people who have been made truly helpless by conditions that might be identified as psychiatric and are in need of special care (whether medical or not is debatable).
But it concerns me when a doctor says she has to provide psychiatric treatment when people ask for it. What if the person has been overly influenced by advertising, believes he or she has a psychiatric illness, but does not?
What if whatever problems the person has can be resolved by lifestyle changes rather than a psychiatric diagnosis? What does the doctor do then?
It seems doctors providing psychiatric care need a range of diplomatic ways of saying “no” to such patients, for their own good. (Of course, the doctors would need to be able to identify true psychiatric conditions as well — which is a huge problem.)
I do not understand why psychiatrists cannot refuse to provide a DSM diagnosis or write a prescription for someone who doesn’t warrant one. It can be done. I’ve been refused antibiotic prescriptions by internists a number of times, on the grounds the condition did not warrant drug intervention.
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Altostrata,
Psychiatrists can and do decline to make psychiatric diagnoses and decline to prescribe drugs. I did this a lot. There is chart “coding” to be done in medical records. This coding must be completed for medical-legal and insurance reasons. There is a code for “no psychiatric diagnosis” and codes for life circumstances and medical conditions that cause symptoms that look psychiatric. There are a lot of “non-psychiatric” “diagnoses” codes to choose from to fill in the little boxes.
Nine (or more) of ten people that I see these days that walk in the door saying they have “bipolar disorder” do not. The drugs sold to treat this are heavily marketed and the symptoms are vividly displayed by actors on television all day long. “I’m like just that lady on TV” they tell me. “I know I have bipolar. I know that’s the medicine for me.” They are in effect “coached” with the symptoms to display for me by the television marketing. The prevalance of this disorder has sky-rocketed in the past ten years. As ENORMOUSLY expensive new drugs are brought out for sale, the criteria are bent and bent by the marketing reps. Other psychiatric symptoms are dragged into the treatment pile for the new medicine till everyone qualifies for it. There are drugs that cost over a thousand dollars a month being marketed for bipolar disorder today IF the person is only on “monotherapy” (one drug).
Remember, the cheap drugs are not on TV. Frequently they are not in the “PDR” (Physicians Desk Reference), an enormous drug marketing catalog that only lists prescribing information if the company pays for it. Most folks think this is a reference book. It’s a marketing device.
I have developed what I hope to be polite and diplomatic ways of saying “no” to these requests for psychiatric diagnoses and the drugs that go with them when they are not warrented.
Keep writing.
Alice
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Exactly, Alice!
Perhaps that’s the sort of talk a psychiatrist might give to, say, a local medical society, how to say “no” diplomatically to patients who request but do not warrant psychiatric medication.
I believe right now they’re throwing out prescriptions because it’s easier than saying “no” — and they mistakenly believe adverse effects are trivial.
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Altostrata,
I think doctors are very, very busy. It takes time, at least a few minutes to say “no” and explain why in a polite manner.
I spoke to a neighbor yesterday who’s wife is a primary care doc. She just saw 27 patients in one 8 hour day, 5 of them brand new to her. I have only seen her outside once in six months. She spends all of her mornings and evenings at home typing reports on patients so that she can spend those few minutes allowed with each person making eye contact, talking, listening and examining them. This is her usual work life. Many of her patients are “psychiatric”. She is head down, bailing the ocean with a teaspoon. To me she’s a hero. What could I teach her?
Another primary care doc I met last spring at an educational conference (not drug funded) told me she sees four patients an hour, all day, every day. This time includes typing, chart reviews, interviewing, examining patients, lunch, bathroom breaks. Four patients an hour. Nonstop.
I think doctors don’t have time to pee, much less provide polite explanations and and make thoughtful prescribing decisions. It’s not that they don’t understand side-effects or are unable to say “no”. It’s that they run all day every day on a too-fast treadmill in the factory-style doctoring institutions that have taken over.
Sorry. I wish I were more hopeful about all this.
Thanks for your thoughtful contributions to this discussion.
Alice
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That is exactly why someone who knows the talking points can help busy doctors do the right thing.
They don’t have time to formulate the “no” talking points themselves.
Teaching talking points is how the drug companies get doctors to spout their nonsense and sell drugs.
This may seem like a small, maybe useless thing to do, but a doctor telling other doctors how to say “no” to requests for psychiatric drugs can go a long way towards stemming overmedication.
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Dr. Keys, my feeling is you’re going in the right direction, assembling a group of people who can support your own growth personally and professionally.
Every doctor who is swimming against the current needs to do this.
Your example will give your more timid peers courage to question the status quo on their own. And maybe read Bob’s book!
This all goes toward better and safer care for patients.
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Altostata,
Thanks as always for your warm support. This give me courage. Better and safer care is the whole point here.
Alice
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There really are other Dr. Saslow’s out there, and they would participate with us if they are made to feel welcome. To over and over focus on what has gone wrong in the past (which of course we should learn from), or to take out of context something which was said that doesn’t sit quite right, won’t help us to progess in a different direction. Let’s talk about how we can make things better together.
All I can personally do is to apologize if I ever hurt any of my patients or taught others who did, but I am dedicated to making things better.
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The past, or today April 26, you choose. Today April 26 there are countless Americans being bullied into taking drugs they do not want to take by soft coercion, countless others being overtly brutalized inside locked psychiatric units. Tonight, tomorrow, and the next day, and next year, people are set to be coerced by psychiatry. This is not some “problem of the past” by any means.
Do you support the right Dr. Moffic, for people to say no to psychiatry? Do you think it okay to force people into psychiatry?
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Steve,
Thanks for your response. I am actively reaching out to people I know and inviting them to read Robert Whitaker’s book and join the discussions here. I welcome everyone who wishes to talk to the discussion table. There is so much to learn from all sides of this matter.
I don’t mean to dwell on the past with historical material so much as help understand how well meaning people could have gotten where we are today. I’ve lived through and watched changes unfold around me without knowing what it would mean for us all.
Thanks for your support.
Alice
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No, of course I don’t think people should be forced to take psychiatric drugs. The only exception, which would be quite rare, is if a life seems to be in real danger. I always give my patients a choice of medication, psychotherapy, excercise, and/or other options, and I tell them what I think might be best for want they want.
As I’ve said and written, I do know that people are being forced when that is not necessary. There indeed are many, many problems in our health and mental health systems.
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“The only exception, which would be quite rare, is if a life seems to be in real danger. ”
I’m sorry sir, psychiatric drugs don’t have a monopoly on the ways to save a life that is in danger. I didn’t know that a life being in danger was a ‘brain disease’.
If you are referring to someone’s life being in danger because a suspected criminal is about to commit a crime, there is always the police and the criminal justice system to enforce the laws against endangering life.
If you are referring to self harm, I can only point out that many people would argue they own themselves and have a right do to themselves what they like, and that psychiatry seems rather lax in its efforts to police slow, long term self harm.
I would further add that in the realm of forced psychiatry, where declarations of dangerousness are made not in a court of law subject to the rules of evidence, but behind closed doors, and are made without any separation of powers, that is, the person who accuses someone of being dangerous is the same person who then strips that person’s rights away.
I would also point out, that being distressed in a dangerous situation, is no reason for one’s government to force someone into psychiatry of all things. Why psychiatry? why not force people into some other solution?
You have just told me you support the forced administration of major tranquilizer drugs as a means of rapid behavioral control. What is wrong with other means of self defense? like physical restraint? tasers? handcuffs? If forced psychiatric drugging really is the gold standard for ‘saving lives’, why don’t cops carry around syringes full of haldol? Would you agree that breaching the blood brain barrier seems a little more invasive than cops physically restraining someone on a bridge? Would you agree that using psychiatric drugs to incapacitate a potential criminal seems like overkill? or even that taking away someone’s liberty BEFORE they’ve committed a crime is also overkill?
Why is it justified for YOUR profession above any other incarnation of ‘help’ to be forced on people?
Why is it okay for the determination of ‘life being at risk’ to be made by a member of your profession? and without any immediate judicial oversight or the right to an attorney? as is the case with involuntary ‘holds’?
How can you justify solitary confinement, isolation, the denial of phone calls, attorneys, and the forced drugging of someone labeled ‘dangerous’ by one government psychiatrist?
Why is your claim of ‘seems to be in real danger’ acceptable? In other areas of government force, it is not what merely ‘seems’ but what ‘is’, and is testable in evidence that is the driver of what happens.
I don’t agree that forced psychiatry is rare. Unless you feel that the locked psychiatry units are empty ghost towns, with tumbleweeds rolling through them.
“I do know that people are being forced when that is not necessary. ”
Do you seriously expect people to feel safe when psychiatrists are pretty much the sole arbiter of what is and when it is necessary? Aren’t we all merely at liberty UNTIL a psychiatrist takes that liberty away?
I honestly do not see how you can justify forcibly altering the brain of somebody just because you label a situation life threatening? we are not talking about bleeding on the brain here. We are not talking about a life that will surely die if that brain is not intervened upon. We are not even talking about people for whom you can provide evidence of genuine brain disease. Why should they lose the right to own their brains?
Is that the takeaway? dare become suicidal and automatically forfeit the right to own your brain? I think that is what is happening here. The hubris of biopsychiatry is most on display by its reserving the right to force itself on everyone in a situation labeled an ’emergency’, when in reality there is no logical justification for the government to be responding to situations of ‘dangerousness’ with your particular profession and the current version of the way it practices.
Why psychiatry? of all the various things to force on someone? all the myriad different solutions and versions of help? what gives biopsychiatry the right to reserve the right to enter the body of any citizen in the land by force?
To recap, I think your above answer amounts to a kind of ‘no I don’t believe in forced drugging’, (except when a psychiatrist deems it necessary). And the public is just supposed to feel safe and hope they won’t be one of the people forcibly drugged.
Another serious question for you sir,
Do you support the concept of a new law whereby adults could sign advance directives that would protect them from involuntary psychiatry in all circumstances? An iron clad living will that could never be overturned by a psychiatrist?
I hope you answer my final question here, I’d really like to know.
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I am sure George would be very proud of you today.
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Patrice,
That one brought a tear to my eye. Thanks.
Alice
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I’m sorry, and won’t comment further, but I’ve had police kill my patients, while I know of none that I have killed, nor committed suicide in 40 years of practice.
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People are killed in emergency psychiatry settings not involving police all the time. There are many ways to die on involuntary psychiatric hold. Forced drug overdose, asphyxiation while being physically restrained for the sole purpose of forced drugging and not in response to actual self harm behavior etc…
Not to mention the people who are made suicidal by the devastating trauma they go through in psych wards at the hands of the things being done to them.
Psychiatric violence begets more violence. Coercion begets more suicides.
I’m not suggesting for a moment you’ve killed anybody personally. I note also you’re an academic psychiatrist and not a state hospital psychiatrist who deals in these sort of scenarios regularly.
Thank you.
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Anonymous, Sometimes people need drugs. My son was given haloperidol to stop him walking out of A&E traling his drips. He was totally lost in his own world thinking that the police had implanted a microchip in his brain. It took only 15 mn in his case for the medication to work and the voices in his head to stop. This said, it was the psychiatrists’ fault that my son was in this state in the first place but it is a long story. Nevertheless the Haloperidol was a life-saver at the time.
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A set of laws that you claim has provided a benefit to your family, is the same set of laws that destroyed my life.
This is what you call an impasse.
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There is no set of laws that will fit everyone because we are individuals and our breakdowns are due to different causes. Also, I had to help my son off those meds behind doctors’ backs as soon as he was out of hospital because by then they were not helping anymore they were paralysing him mentally and physically and the doctors couldn’t see it, the blind lot and, of course, they didn’t listen.
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Alix,
Your son is very lucky to have you.
Alice
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With all due respect, there are set laws, the commitment laws, and I am very firm in my position that I should not have to lose my rights, just so that it can be made easy for your son to ‘conveniently’ lose his rights at the time desired by you.
It is one thing to get a guardianship on your son (it would affect only his rights), it is entirely another thing to ask society to have in place a system where my rights are at risk because pesky due process would cause delays in forcibly drugging your son.
In order for your son to be ensnared in the commitment laws, the snare has to be set wide, others do pay the price for yet others to be rendered some subjective ‘benefit’.
I’m glad your son is ok. I’m not glad that a system is in place to quickly have a doctor sign a piece of paper and have all his rights removed, the reason for this is because it makes it very easy for my rights to be removed too.
Please understand I completely understand you didn’t invent forced psychiatry. I am just pointing out, in order for the law to take away the rights of your son, other innocent people inevitably get caught up in those laws.
I would prefer not to be caught up in those laws, the cost is simply too high to me. I fear I will not survive if I am ever ensnared in these laws again.
I think it is very important and high time society had a debate about this. Who do we listen to? the people who say they were ‘helped’ by the laws allowing their children to forcibly drugged, or the people destroyed by the laws? what is an acceptable number of lives destroyed, in order to ‘save’ someone else?
All I want is to feel safe from the actions of my government. I want to feel safe knowing that I haven’t committed a crime, and I will not lose my rights.
Unfortunately, me having my rights protected, would make it harder for a doctor to take away your son’s rights too. So it is an impasse as I said in the beginning.
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Anonymous,
You’ve laid out the fundamental flaw in the “beneficence” justification for coercive medicine brilliantly. Thank you.
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There are many ways to die on involuntary psychiatric hold, and in psychiatric “care” in general. Not least, there is the obscured way of having one’s life expectancy reduced with 25 years by drugs that cause real physical illness. The thing is, being reactions to life, psychiatric “symptoms” are signs of the psychiatrised person being alive. How do we get rid of these “symptoms”? Well, it’s obvious, isn’t it?…
When it comes to suicide, Dr. Moffic must have been very, very lucky. In Norway, the suicide rate among psychiatrised people is 100 times that of the general population. Some people off themselves when they’re told they suffer from a chronic brain disease, and won’t have a future other than as a “mental patient”, some off themselves because of the drugs’ “side” effects, which they can’t stand anymore, while no one listens to them, and helps them get off, some off themselves as a direct reaction to the drugs’ “side” effects, namely akathesia, some off themselves because they can’t stand the dehumanisation and torture they experience at the hand of psychiatric staff anymore, and so on, and so on. Lots of very plausible reasons. One thing is for sure, a statistical and empirical truth: psychiatry doesn’t save lives.
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Marian,
Thanks for your thoughtful post and the energy you bring to this discussion. We have to hear about all the issues in our current medical system to find our way home together. We have a lot of work to do.
I hope to hear more from you.
Alice
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I don’t think you understand what I am trying to say. I actually agree with you on the whole. I certainly don’t think the law should take your or for that matter my son’s rights away
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Alice,
It is deeply moving to read your blogs and learn of your inner struggle with the state of psychiatry, health care in general, and our culture’s strong bias for quick fixes. There is no doubt we have some mountains to climb in this paradigm shift so many have come together to create work to usher in.
The despair you express, ironically, is not unlike the despair of those of us who have struggled (or watched a loved one or friend struggle) with a mental health challenge. Recovery, change, transformation can seem utterly hopeless and out of reach. No pill or provider can light our way out of this dark place. Ultimately, hope and a little faith in the possibility of change must light our way, usually held out to us by friends and family who believe in us before we are capable of doing so. Little progress can be made in recovery until we courageously choose hope.
This choice is perhaps the hardest choice we can make. And one some of us may have to make daily for the rest of our lives. But it is so worth it.
There are so many people who have made this choice, who have held the hope for others, and who have worked very hard for many decades to bring recovery and hope to others. Many of them are contributors to this site. And countless others quietly choose hope every day.
Perhaps your way out of professional angst is not unlike this recovery process?
Your compassion, wisdom and eloquence could be such a tremendous voice for hope if you turned your lens toward it.
There is hope. It can and does get better. But it is hard work. That is the task at hand. Bringing hope to our professions, those we serve, and most importantly, to ourselves when we have lost our way.
So glad you are taking time to breathe and nurture your own transformation.
Wishing you peace and hope.
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Jennifer,
What a lovely, strong and pure voice you bring to the task at hand. I agree with your thoughts concerning the similarities between the recovery process of an individual and the recovery process of the medical profession.
Indeed, it is a spark of hope that recovery is possible which brings me here to write. The process of sharing our various truths and experinces with one another to awaken the sleepers among us and to open the path to unity of spirit is essential to recovery of such an enormous patient. 311 million Americans is a lot of people.
Thank you for your message of hope.
Alice
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You are most welcome. I can’t be reminded enough! This is an important place to find it. Grateful for Robert, you and all who have joined the conversation here.
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We can accelerate the process of changing attitudes towards biopsychiatry and the medical model among the American public if we can find a way to tap into the outrage factor. Anatomy of an Epidemic had that factor, as did Ken Kesey’s One Flew Over the Cuckoo’s Nest decades ago.
One thing that predictably generates outrage among the American public is the thought that their money and tax dollars have been wasted. We could benefit from a reputable academic study to produce a quantitative estimate of the total economic cost of harmful psychiatric medications and their iatrogenic effects. I think there is enough data out there to draw up reasonable economic estimates.
A quick Google search shows that in the last few years, between $25 – $29 billion were spent annually on anti-depressant and anti-psychotic classes of prescription drugs. This corresponds to roughly 1% of the $250 trillion in total annual U.S. health care spending. This is small change, but if you start to add up drug expenditures since the early 1990s plus estimates of the cost of side effects, SSDI and lost productivity, and present that in light of the scientific studies questioning drug effectiveness, we could enhance the outrage factor.
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Mary,
I like this a lot.
Thanks for the review of the financial budget end of pharmaceautical products. There is nothing like budget bottom lines to get the attention of policy makers. This could be a great selling point for legislation to ban advertising of all drugs to the public.
If we soften the market for the enormously expensive brand new drug at the patients’ end, it will save the government a lot of money.
The Federal government is the largest third party payer of health care costs in the USA through the medicare and medicaid programs, Veteran’s administration and the military medical services. Simply making the choice of a $4/month drug (that’s been around a long time) over a new and less tested $2000/ month drug easier for all physicians would add up to costs savings at the Federal budget level.
$4 drugs are not marketed. At all. To anyone. The overall demands for drugs would eventually fall off with more longer term costs savings.
Patient ardent demands for their entitled “right” to have the newest and hotest (most marketed, most expensive, least tested) drugs can be hard to dodge for a doctor. This is actually easier when the patient is uninsured. Especially if the doctor’s office refuses to carry “free” samples (hooks to get patients on the spendy drugs. No one “samples” the $4 meds). You simply point out the price tag and a $4 drug becomes worth a try.
Sad but true. Economic arguments speak loudest and are the most convincing at the level of policy makers and at the level of individuals.
We have to find more clever economic arguments.
Thanks,
Alice
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“for life circumstances and medical conditions that cause symptoms that look psychiatric.”
So this is your belief? that there are two separate problems in this world, ‘life circumstances’ on the one hand, and then things that are ‘psychiatric’, and above you call for cheaper drugs as a good thing. Why are you even drugging people’s brains? you can’t even demonstrate biological pathology.
I think any taxpayer dollar spent on psychiatric drugs is a crime and a waste of money.
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Doctoro,
I listed these two cateories, life circumstance and medical conditions, as examples. They are not intended to be an exclusive list. Sorry for the misunderstanding. If you want the entire list, read the DSM.
I see stopping public ads for pharmaceutical products as a way soften “consumer” demands for all prescription drugs. A move toward use of “cheaper drugs” is a rationale to nudge policy makers to move along in direction of outlawing advertising to the public. Budget cost savings is one thing policy makers will listen to.
I appreciate your energy,
Alice
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To me, Doctoro’s question seems pretty clear: do you believe that anything but life circumstances makes people suffer emotionally? Or, put in a different way: do you believe that there is emotional suffering, that is not caused by life circumstances (but for instance imbalanced brain chemistry)? Sorry, but it’s hard for me to believe that you really didn’t understand the question. Why not answer it? Why fudge the issue, which this is not the first example of? As somebody who wants to help people in crisis you should know that this kind of response is one of the ways how communication gets dysfunctional, potentially driving people mad (whoever would be dependent on you).
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Marian,
This question ventures into the realm of philosophy for me. All human condition is “life circumstance”. If there is such a thing (I have not seen it proven) as spontaneously, random “imbalanced brain chemistry”, then it, too, is a “life circumstance”. Therefore, as Buddha once put it so nicely, “Life is suffering.”
If you’re asking if I, personally, am of the opinion that there are “chemical imbalances in the brain” that just sort of happen and that can only be corrected by taking more chemicals, I would say “no”.
Since there is no one “dependent” upon me as their physician at this time, may I assume I am not responsible for “driving people mad” (as you put it) today.
I love these discussions. They keep me thinking.
Alice
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Mary, this is a good point. However, the counter-argument will be the (highly hypothetical) enormous cost of mental illness, costing the economy jillions in lost work days yadda yadda yadda.
The argument has to come back to the efficacy of bipsychiatry in reducing those jillions.
As for the cost of adverse effects, there is some info emerging in public health studies about iatrogenic damage, such as http://www.onmedica.com/newsarticle.aspx?id=a984b136-c486-43ca-983c-d31023f890f9
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Altostrata,
I like idea of looking at public health costs and disability payments numbers. These have skyrocketed with the “epidemic”. These are line item dollar amounts on a politician’s budget. I agree with you that human costs with regard to issues like safety, efficacy and suffering are immeasurably more important than dollars. However, political policy makers look at the dollar costs of a specific line item on their budget spread sheets. For the most policy change effects, talk to their spreadsheets. I bet that one of the pressures that forced legislation to get tobacco and liquor ads off television were the health care costs from the consequences of tobacco and liquor use. Once an individual’s financial resources are gone, medical and nursing home care falls to the Federal government’s budget. This is bad for the Feds but good for big pharm.
These are the kind of conversations that can lead to effective strategies.
Thanks,
Alice
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Altostrata,
Yes, establishment types will claim that those costs would have been incurred anyway due to “mental illness”. Keeping that in mind, the analysis would have to identify costs in excess of an alternative approach. For example, if previously self-limiting conditions like depression and schizophrenia became chronic due to the use of anti-depressants and anti-psychotics, then the costs of drug treatment, SSDI and lost productivity in excess of average illness duration in the self-limiting period could be counted. Or, as Alice pointed out, the excess cost of new brand-name drugs above that of cheaper generics and older options with the same level of efficacy.
Of course, these kinds of economic studies are extremely hypothetical and, in my opinion, highly dubious. But that’s how public policy debates are fought.
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Mary,
It seems a shame to me that human suffering and findinf ways to alleviate human suffering are not in the equation when public policies are debated. It does seem to always boil down to money.
Alice
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Mary, I sure agree with that!
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Correction – annual U.S. healthcare spending is $2.5 trillion, not $250 trillion.
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Dr. Keys,
For the current mental health situation, the solution is more support networks and holistic treatment centers.
Support Networks:
http://discoverandrecover.wordpress.com/category/support-networks/
Holistic Treatment Centers:
http://discoverandrecover.wordpress.com/category/holistic-treatment-centers/
The support networks can be put together for minimal cost, relying on peers, for instance. The holistic treatment centers help people heal, recover, thrive (as opposed to life-long “illness management”)
Duane
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Duane,
Absolutely. Building support networks will work for a lot. So much of our culture is without these. We are left living life as “individuals”.There is no precedent in the history of the world for the level of social isolation and lack of extended family realtionships before about 150 years ago with the advent of the industrial revolution. Social isolation is now the every day “norm” but not “normal”. A life of isolation is neither biologically or psychologically sound for humans. Of course, there are introverts (up to half the population) who function better with contemplative time alone. I don’t suggest everyone has to be “out there” all the time. But people do need relationships to thrive.
One of the reasons that community mental health centers work less and less well has been the draining away of support networks they once provided; art groups, socializations centers, classes, etc. There are people now who’s only contact with community mental health center is occasional 15 minute “meds only” contact with a “prescriber”. It’s difficult to imagine how this can benefit. This is expecting prescription to do an awful lot. Relationships heal and support.
I like the Soteria House model of Dr. L Mosher as one approach to helping people in crisis situations. I’m sure there are experts in this area that can speak more fully to this topic.
Thanks for your input here.
Alice
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Dr. Keys,
We seem to see the greatest success in the programs that offer a safe place, along with human contact, without pre-concieved ideas about “mental illness”.
Unlocked units.
Inclusive enrironments.
Listening, caring.
Hardly “medical”.
These types of programs seem to be the most “therapeutic”.
We saw this with Dr. Mosher’s ‘Soteria’, where the staff were not conditioned (beforehand) to understand “schizophrenia”…we see success rates of 85% percent with ‘Open Diaglogue’ in Lapland (as pointed out by Daniel Mackler, CSW and Robert Whitaker; and we will continue to see enormous continued success if truly begin to embrace these very simple, very human concepts.
People tend to recover when they feel they are loved and accepted, just as they are… And when they begin to understand their own suffering as a very human condition, they can begin to move beyond it, in a spirit of hope.
We make all of this so much more complicated than it needs to be. We need to stop doing the things that don’t work, and begin doing the things that do work.
“Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat.” – Mother Teresa of Calcutta.
Duane
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Duane,
Thanks for writing more about Soteria and Dr. Mosher.
In our culture, we are starved for human contact and communication. Mother Teresa said it righter than I ever could.
Check out Bob Nikkel’s post from yesterday. He gave me a better understanding of how community mental health was cornered into the medical model (at least in Oregon) through the changing funding streams. It has always pinched me to be cast in the role of just a “prescriber” when I have other skills and gifts.
Thanks again. It’s always a pleasure to hear from you.
Alice
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