Pandora’s Box

Alice Keys, MD
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This morning I remind myself to point my eyes forward. I tend to want to re-do the past and try to make bad things “never have happened”. I know how well this doesn’t work. Some days, I wish the Pandora’s box of pills had not been opened. I want to go back in time and slam the lid closed.

I wish I had known the direction of this train and yanked the emergency brake and stopped it, back when it first began. I imagine that I could have thrown myself under the wheels to make it stop.

Then, I remind myself that martyrs are dead people. Being alive means I’m here to help design and build a new future. I can’t un-ring this bell.

My studies and recollections of history help me gain a more balanced understanding of where I am and how I got here. However, constant focus on the past impairs my ability to correct my forward direction. Focusing on where I went wrong and what’s wrong now, doesn’t give me new destinations.

In my search for direction, there’s a “quirk” in the human cognitive operating system I must remember. I was taught about this by my hypnotherapy teachers of long ago. During information processing, our big brain ignores negative modifiers such as “not” and “un”. What this means is, that when a doctor tells me “this won’t hurt”, my brain immediately goes on the hunt for “hurt”. It bypasses the negative modifier and finds “hurt”, even when this is not what I meant to say.

Imagine when you first drove a car on a twisty mountain road and looked down over the edge of a frightening cliff. You thought, “I don’t want to go over that cliff”. These thoughts tugged your hands on the wheel in the direction of the precipice and the car swerved closer to the edge.

Pointing my attention to the path I want to be on, helps keep me on it. Obviously, I need to know the cliffs are there. Not knowing about the danger is dangerous.

Even the word “free” is tricky to use in goals and plans. It seems like it should be a good word for these purposes. Except “fat-free” has me studying the label to look for the fat.

The word “free”, implies imprisonment, struggle and fights. I was taught a song in public school during the second grade that begins with the words “freedom isn’t free”. The next lines are “you have to pay the price, you have to sacrifice, for your liberty”. In my mind the word “free” is associated with unavoidable wars.

Visualize a battle and it will come. If a fight is what I want to have, this is easy to make happen. Incautious use of words can bring about wars I do not mean to have.

Whenever I catch myself focused on what I don’t want, I redirect my attention to make lists of what I do want. I make clear, specific, written goals. I read them every morning while I eat oatmeal.

“I don’t want to be fat” may be a good place to begin a search for a goal. Unless the focus is shifted to specific positive goals like “I want to be able to bend over to tie my shoes” or  “I want to comfortably walk around the block”, my powerful mind will paddle away to look for fat and find it for me.

I know pharmaceuticals are dangerous, profit-driven commercial products. I don’t want to prescribe them. But I learned from our country’s “war on drugs” that the policy of “just say ‘no’ to drugs” backfires.  Saying “no to drugs” drags our focus back to drugs every time we say it. If my goal is to “just say ‘no’ to fat” then I will always find fat around my middle to say ‘no’ to.

When I tell a colleague that I don’t want to prescribe psychiatric drugs, the conversation invariably shifts to “What about in this situation?” or “How about for a patient like that?” and “What if there’s a really, really good reason?”

How I set my goals is very, very important. The words I use matter. A lot.

If I want a war on psychiatry and psychiatric drugs, I’m certain to find one. If I want to break free of domination by behemoth multinational profiteering corporations then I’d better go straight over there and chain myself up to one.

A social worker in Portland Oregon wrote to me last week. He said that maybe someday, “over the rainbow”, we can put together a pro-education, pro-psychotherapy, pro-case management, pro-socialization, pro-creativity, community-based clinic. Wow. This is a guy that understands how the mind works in the process of goal-setting. And he has great ideas.

I’ve heard lots of great ideas since Robert Whitaker invited me to write for his “Mad in America” webzine. I love the reply section at the end of each article. I didn’t notice it before I agreed to write. I wondered, at first, if I was supposed to reply to those comments.

What the heck. I found the click button and wrote back.

Through these conversations, I discovered a thriving and diverse community of thoughtful individuals. I’ve met people from around the country and around the globe that I’m unlikely to have known otherwise. I’m impressed by the energy, the ideas, the warmth (and heat) in our conversations. Some people focus on the things we must avoid. We need these voices so we can know where the cliffs are. Many have already found and created better options for some who have been labeled as “mentally ill” and categorized as requiring a lifetime of medication.

These complex discussions include those that make us aware of the dangers and also those with a broad range of ideas for the future. They give me hope that all of us can find directions to move in for a better future. There is room at this table for everyone. All our voices together can be one voice for hope.

Hope was the spirit found in Pandora’s box after all the troubles were released upon the world. I hear a lot of hope in the conversations which happen here.  

Thanks for reading.

Alice

 

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39 COMMENTS

  1. Alice, I worry about you. Judging by the titles of your posts, you are feeling very down. (I also understand how difficult it must be for you to do this soul-searching in this medium.)

    I’m sure you know in your rational mind that your career doesn’t have to be over. You can practice psychiatry ethically.

    As you can see, patients believe there is a large issue of guilt and responsibility for patient injury among psychiatrists, yet each individual psychiatrist has a hard time seeing how he or she made the mess and what to do about it.

    Mickey Nardo posted a beautiful apology to patients on behalf of all psychiatry here http://1boringoldman.com/index.php/2012/02/20/no-further-comment/

    He says: “I was a Silent Witness to something pretty rotten, and I didn’t take the time or put in the effort to scope it out. So I share in the shame.”

    Dr. Nardo retired from a prestigious position at Emory and quit the APA in protest before he had to go into pharmaceutical psychiatry. He’s spending his retirement taking apart studies to find out what — and who — went wrong, partly to make amends for the rest of his profession.

    If you haven’t been reading 1boringoldman.com, you might find a fellow spirit there.

  2. That song you learned in second grade, “Freedom isn’t Free,” was from the Up With People show. I was a part of a local and regional cast back in the late ’60s.
    _ _ _ _

    There’s a conversation in the Landmark Forum about driving a car with your eyes only on the rear view mirror… watching the past like it will help you “see” where you’re going in the now. Only when you let the past be in the past (where it belongs) can you actually make choices about the Now that’s creating your future… the possibilities you’re creating for that future.

    In the domain of psychiatry, what possibilities do you see? What can be invented Now as a new possibility? Something to live into!

    Tell us here in MIA.

    -Keith

  3. I think it’s actually helpful to consider questions from the psychiatric mainstream like: “How would you help person A if not with drugs? Person B if not with locked hospitalization? Person C if not with restraints?” I worry that the psychiatric mainstream won’t take the alternatives movement seriously enough if we can’t clearly articulate what those alternatives for people in intense crisis states would be.

    I appreciate the exploration on this website and elsewhere, not just of avoiding current psychiatric harms, but also toward better approaches for helping people in various kinds of distress and crisis.

  4. Alice,

    I do my best to keep some things simple (laregly because so much of this is so complex).

    I visualize what I would like the world to look like/be like for our two sons… (this may explain some of my passion).

    And I remember what my Scoutmaster taught us when I was a kid in the Hill Country – “Leave the campsite cleaner than the way you found it.”

    So that’s what I do.
    I visualize a better place.
    And do my part to help clean things up.

    And although I may come across as mean-spirited, deep-down I’m still that kid from the Hill Country.

    Duane

  5. I am hoping that you can speak, perhaps in a future post, to those of us who did go on meds a long time ago. And people who are doing at least semi-well, emough of the time- or at least, would have a lot to lose if suddenly we stopped taking our meds. For those financially independent (or on disability) this might not be an issue- just take a few months until your brain adapts. But for those of us who are trying to keep jobs or raise kids or whatever, what do we do?

  6. In his book “Just like someone without mental illness only more so” Mark Vonnegut, a doctor himself, writes: “There is something very pure-and easy to screw up-about trying to do the right thing without doing harm” and I think that is something everyone should keep in mind. In my experience coming off meds is something very difficult if you don’t know what you are doing. One needs 24 hour help and support. It certainly can’t be done over night and even when off the medication it takes months, even years for your hormones to rebalance not to mention all the psychological trauma of being sectioned and labelled and forcibly drugged

    • So very true. Tapering someone off multiple medications is simple in theory but complex in real life, as you run into all kinds of twists and turns for a particular individual.

      It really needs a doctor’s attention. In the meantime, I guess we have the Internet.