What a new role for psychiatrists might look like

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People have been wondering on this site lately if there is still a role for psychiatrists. The short answer is maybe, if they can learn from us survivors. Currently, their best role would be to help people come off medication. Since they are allowed to prescribe medications and psychologists are not, we do still need a few around until this is changed. When and if psychologist are allowed to prescribe, psychiatrists will need to redefine their profession – these are my suggestions for how they can do this.

Principle # 1: Full disclosure: My thought is that psychiatric medications are best compared to painkillers: sometimes people need a short term temporary relief from their emotional distress. But the relief should come with full knowledge that the medication does not fix the problem, may worsen the problem, and should most likely be used short term. This complete disclosure might solve some of the problem, but maybe not, since opiod painkillers are theoretically prescribed with all of this information but still are one of the leading sources of prescription deaths.


My memorial collage for Al Henning who died of depression. If he had known of true mental health outcomes, he may not have given up.
My memorial collage for Al Henning who died of depression. If he had known of true mental health outcomes, he may not have given up.

Principle #2: Fully activated service recipients: Many enlightened doctors have told me, “I tell my patients all of those things and they still say, ‘I don’t care, just fix me, doc.'”  Here is Wilma Townsend from SAMHSA’s Wellness Initiative saying this tackling this passivity is very important. And several of my friends have talked about when they were viewed as passive patients like that but came out of that role.

This might even include doctors selecting patients who are ready to work on recovery instead of maintaining an illness role for the rest of their lives. This is the opposite of what is currently done, where doctors say, “Do what I tell you or I won’t treat you.” The message might be, “Question everything, including me. That’s how you recover.” Check out the National Empowerment Center’s archived article by Judi Chamberlin, “Confessions of a noncompliant patient.”

Here are a few other possible roles for truly medication optimization informed psychiatrists:

        • If they learned how to help us honestly use medications as a tool and with an evidence base (short term only with full informed disclosure), they could be a valuable partner in handling emotional distress.
        • People who are on many meds and need to taper slowly need help getting smaller and smaller doses prescribed. Currently, most of the famous medication critics are on speaking tour and don’t have time for patients. Doctors who learn this information and know how to find patients who want it will have a busy practice ahead of them.
        • Doctors who have learned basic biochemistry can use this to analyze the true literature sources just as we have done and start publishing their thoughts and conclusions. It doesn’t take much funding to put together a report of 10 or so case studies. There’s really not much more than this in the medication withdrawal academic literature currently and we desperately use doctors to pitch in here. Or anyone else.

          My Cloudscapes collage as tribute to my friend and Olympic team training partner Brenda Day, who died from her fear of accessing mental health services.
          My Cloudscapes collage as tribute to my friend and Olympic team training partner Brenda Day, who died from her fear of accessing mental health services.
        • Doctors would be the best people to start UnDiagnosing Emotional Distress. People look up to the authority of doctors. The doctors I have heard talking about UnDiagnosing people have done a lot of good.
        • It only takes 12 doctors to make a “board.” We could make a “Board Certified Medication Optimization” credential.
        • Doctors can start advertising by how little medications they prescribe.
        • Doctors can monitor their recovery outcomes and start advertising with those results. If the Open Dialogue program can get 82% recovery rates just by switching people from a disease model to a life situation model, than doctors who do this in their practice can start adding up some impressive numbers. It would only take 5 or so case studies of 20 or so patients with 80% recovery rates for someone to sit up and take notice. Especially if the survivor community was behind this doctor with some social media efforts.
        • Psychiatrists could actually collaborate with psychologists again. In my whole career as a mental patient, this only happened once.
        • Psychiatrists could hire peer specialists instead of nurses or physician assistants and give people their initial 3 consults with a peer. I bet this could cut their patient load in half because an educated peer could tell people they didn’t really need to see the doctor.

So, if we can figure out a way to ask psychiatrists for help in a way that doesn’t demonize them, we’d be a lot more likely to get some help. But, doctors need to listen to us, too.

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24 COMMENTS

  2. Where have you been all these years? I am going to print your article and share it with the Director of Clinical Services at the state hospital where I work as a peer guide. We have a terrible return rate for patients here with some of them having up to thirty stays. All that most of the psychiatrists do here is demand that people take the meds. I was a patient at this very hospital and the people who helped me the most were the therapist, a BHW who was also a survivor, and many of my fellow patients. My psychiatrist is a nice guy but very paternalistic and there were times that I told him that I would be the driver of my own car and care and not him. His mantra was “Take your meds!” I recovered despite him and with the help of the people who were willing to listen to me. I told someone this morning that I know that we could stop the rate of returning by patients if they would give me a group of peer workers and a group of good talk therapists. We could do a better job and truly walk with people towards recovery. By the way, recovery is not a word that you hear used here at all, not even during the month dedicated to recovery. The “r” word is a nasty word. Sorry for the long post. Thanks for a great article.

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  3. SAMHSA, the entity that promotes drug paradigm and censored Robert Whitaker http://bipolar-stanscroniclesandnarritive.blogspot.com/2010/10/our-government-censored-robert-whitaker.html

    It just seems that everyone is out to make money from mental illness, on different levels from different people, but here it is again in this article linking to the sale of a writer’s t-shirt.

    Call me a purist, but there are far too many writers and bloggers with pay pal buttons and things for sale for “helping” people in mental health distress.

    My personal blog was designed for myself as a outlet due to the harms witnessed by me in the mental health system as a mother of a child harmed by psych meds; and it does not now and never has ever been monetized.

    What’s up with that?

    It was bad enough seeing NAMI thank their pharma sponsors on tote bags at one of their conferences (i’ve got a photo)everyone has their hand out.

    I do understand that Corinna does write with a business model attached to her work, as I have read the blog.

    Refreshing for me would be finding a site that doesn’t have an income attached to it. When I read articles that have a side message of makiing money from it, I tend to discard the information.

    Just my opinion.

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    • Stephany, the way our site would work is that you would post articles and if people liked them, they could call or book appointments with YOU. You could charge whatever you want, including $0. Then you could help people escape the mental health system as your own business model.

      Our business would take a small hunk to stay afloat, pay our programmers, and keep growing the business. It’s going to be a network of all the psychiatric survivor bloggers who want to maybe start earning a living from their blog. It will also have very open and honest financial disclosures so you can see where our money is coming and going.

      I went to an incredible event last weekend called Startup Weekend and got free help for three whole days from programmers, mentors, legal advisors, and business people to come up with some mockups.

      There are Startup Weekends all over the world – You should pitch an idea to them, too, if one comes close to your local community, or drive to one. Many of the participants here in Kansas City’s Startup Weekend came from out of town. http://startupweekend.org/firsttimer/

      I think we’ve been waiting for 40 years for government and charity to bail us out and it hasn’t happened yet. Do you have any other suggestions how to eliminate the current system and build a new system? And non profit models just aren’t as sustainable as those which can pay their own expenses. It will be important to use some kind of scaled or barter system to make it affordable for people who can’t pay.

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  4. Let’s see if I’m getting this right! Please feel free to correct me if I’m wrong…you are already using the “Mad In America” site and your column to promote/advertize an ongoing for profit business (in the form of products & services) that target readers….

    And you are further proposing the creation of a for profit blog clearing house so to speak, hooking in selected advocacy blogs/writers so that You “Our business would take a small hunk to stay afloat, pay our programmers, and keep growing the business.”

    So, basically taking or creating a business out of what is already freely available web blog content; moving this content & the authors to your proposed site & charging them a fee to do.

    I would assume you would have total control of this site; including what content goes on it, and who advertizes there..

    This honestly brings many ethical questions to mind that I won’t try delving into with any great depth today….

    Doesn’t your idea sound a lot like what’s happening already with Industry controlled sites…Psych Central & Psychology Today do it…inviting lots of content from their carefully selected & approved sources….then marketing that content on pages filled with advertizements (including all those corporate pharmaceutical advertizements & related others) ..I’m sure that’s quite profitable…but what does that do to the messages being shared…?

    Call me a Puritan, not unlike Stephany above…but I tend to prefer reading advocates & their shared message when they are not tied one of those proposed for profit overseers.

    I honestly can’t think of a single valid reason I would want to sign onto something like what your proposing personally….I happen believe or have the opinion that it somehow cheapens the message, movement, and sets a bad precedent..mirroring that corp. strategy (supporting and funding sites that will parrot their message). Isn’t that what were actually trying to change & get away from…

    We have already painfully seen & experienced what the lust for “Greed”, “Profit” & “Power” has done to medicine, scholastic research, science & medical journals, psychiatry, the so called evidenced based science model, the main stream media, & those supposed advocacy organizations like NAMI, DBSA, CABF, just to scratch the serface of this mammoth sized problem..

    I’m interested in what others think or have to say about the “for profit marketing” of the survivors movement & the sale of patient advice done in the way you’re proposing.

    who knows….maybe you can sway my opinion…. 🙂

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    • Almost everything that gets done involves some money for somewhere. Where the money comes from and to whom it goes has something to do with what that thing looks like and what it does.

      I think there is room for different kinds of things, with different kinds of cash flows. That is the only way to have a heterogeneity of viewpoints. It is a myth to think that anything might be completely objective. It is even a myth that any one type of financial structure would be completely representative of the truth, whatever that is.

      I think there is room for all kinds of different things. When the material is made available by the good graces of a website’s founder, for instance, then it inevitably represents that person’s view to some degree. If the readers pay, then the website owner is thinking perhaps a little bit more about what they want to read.

      I like Corinna’s point about setting up services that take back ownership; of media, of services, from moneyed interests – be they charities, governments, benefactors, whatever. When the people who receive services pay for them, then those providing the services know to whom they are looking for approval. If someone else pays, as is necessary for many people who cannot, something else happens. In my experience it doesn’t always turn out well for the people to whom services are being provided. Sometimes yes, sometimes no.

      There’s room for all kinds of enterprises. Some will do good, some less so. No one of them corners the market on that. I’ve seen charities labor on unaccountably; their dismal outcomes shielded by money that is separate from the service that people actually receive, and perhaps even ratcheted up by dire need that the charitable service may unwittingly cause. The people who work in non-profits are just as interested in the preservation of their own well-being as anyone else, and just as susceptible to rationalizing away failure in their drive to maintain the status quo. I have also seen for-profit enterprises think very carefully about what they were doing and deliver excellent service in very creative ways.

      There is no one way to do anything.

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    • There’s a difference between social entrepreneurship and a strictly for-profit businesses that I’ve explained in previous posts here. No one has to participate in my business unless they want to. Totally voluntary.

      I’m not just promoting my business, I’m promoting this entire approach to business as our success with charity and government approaches has been limited. It’s time to look into some creative, new approaches and solutions, and social entrepreneurship in many fields has done this.

      The US and the health care fields are just a bit behind the curve on picking up social entrepreneurship because of structural barriers that don’t exist in developing countries. Better mental health outcomes in developing countries is not an accident, and this is not the only thing we can learn from these countries.

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  7. Great post Corinna, thanks very much.

    I agree with Kermit that there has to be a range of options for user/peer led mental health services or businesses. In terms of funding or paying for what happens. The saying goes that whoever ‘pays the piper calls the tune’. It’s up to each of us to be discerning in either what we pay for or the tune we play.

    For me, I need to be free to say and do what I want. This is seen as unpredictable and scary by folks, even more with the user carer population than with the governmental powers. Being radical can mean exclusion from every table some of the time and from some tables all of the time. It makes life interesting. Which is good. A boring life is to be avoided at all costs.

    Regards, Chrys

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  8. Oh Corinna, oh dear oh dear. I’ve been a mental health professional for nearly 40 years and I know this: Of course some medications are for shorter term use, but some people need longer term help, and without the medication end up encarcerated for their or society’s safety. With the meds they can lead a normal life. You make the common mistake of assuming that all meds are bad and psychology can help all. Not so. Both medication and psychological support have their place. It’s the combination of several types of specialist support that really makes the difference. The most important thing is to involve the person with the problems and to design help taylored to their individual needs.
    People – don’t listen to anti-medication rants, or anti-anything rants. It’s what works for the individual that matters.

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    • If this was an anti-medication rant, then just keep doing some research, keep asking questions, glad you found this site. You’re going to have to come to your own conclusions about whether short or long term medication use has a better evidence base. It will take you a fair amount of research to convince yourself one way or the other. Remember, first do no harm.

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      • “”There is some truth in what you are saying. There should be a CHOICE though and so far there hasn’t been a lot of it. It has been “one treatement for all”: “medication!” by force if needs be.””

        Exactly Alix. Which leads to a question David. How do you support your clients who wish to stop taking medication?

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        • There was no support availabe when my son came off his medication behind doctors’ backs- God knows I looked high and low. The only support he got was me who was there for him 24 hours a day and advice from Will Hall on the internet as well as Peter Breggin’s books which encouraged me not to give up. I would have gladly paid if help had been available by people who had been through it themselves. In 2008 psychiatrists still assured me that you just stopped the antipsychotic medication: there was no such thing as withdrawal symptoms.

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    • I would like you to evidence what you say with some long term outcome studies.

      There are some professionals who have worked as long as you have that don’t use medications at all and some that use them collaboratively with patients using low dose regimes for a short a time as possible. They both seem honourable and from what they say effective. But prescribing policies need to be based on more than personal anecdote. They need to be based on outcome studies, that can then be illuminated by personal anecdote.

      The studies I have read about and my personal experience leads me to the conclusion that most people can be helped without drugs providing you are prepared to put in the immense amount of work that seriously distressed people need. I am not quoting the studies or my personal experience, I can if asked but won’t here and do sometimes have such conversations.

      What I have written does not read like a rant to me. It reads as a short account of how I have reached my conclusions about the role of medication in relieving serious mental distress. However I don’t think it what works for the individual that is the only thing that matters. Prescribing policies and societal attitudes are formed by much more than what matters for the individual. And if a practitioner does not believe in medication they may well try harder to reach and understand the person in distress than someone who believes that drugs should be used almost every time.

      Someone who believes in using medication as a, “Last Resort,” may reach that point sooner than someone else with the same belief (ie my last resort may only be half way to your last resort).

      Indeed individual practitioners prescribing policies vary considerably and vary from country to country, as do the way distress is diagnosed (Bipolar is a more popular diagnosis in the USA than in the UK, where schizophrenia is a more popular diagnosis for similar symptoms for example). So it is not a matter of what works for the individual it is also what the prescribing physician believes in, which in itself is a cultural construct.

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    • I think that people need a choice about what their treatment is. I don’t see much of a choice being given to the people I work with. I also have one other question. If the meds are so great and wonderful, why isn’t the recovery rate of people taking them better than what it is? Antidepressants end up causing bad depression over long term use for most of the people taking them. The new antipsychotics cause TD and other horrible problems over tong term use. Doesn’t sound like a great success story to me.

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  10. My mother was on a depixol injection for 20+ years up to her death at 68yrs in 1998. It was a 3 weekly jag, the first week she slept well but by the last week hardly slept at all, as the drug had left her system. She had a shake because of it.

    Although her life was OK, she still smoked (dying of lung cancer), had anxiety and was limited in confidence. She deserved better but believed the ‘experts’. I don’t.

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  13. Corrina,

    You have some good ideas for what “new role” psychiatrist may have – particulary, in the area of drug withdrawal and “un-diagnosis”. Both.

    I would like to see psychiatrists (who have expertise) search for and treat underlying physical conditions, because oftentimes, this is the key to finding out what’s beneath a “mental illness” –

    http://discoverandrecover.wordpress.com/category/root-causes-of-mental-ilness/

    I do think, however that there will be plenty of competition from doctors who are well-versed in integrative medicine.

    As far as your making money for the work you do.
    I say, “Don’t sweat the small stuff.”
    Obviously, you work hard.
    And it seems fair that you’re able to make some income from what you do. It hardly sounds like you’re involved in a get-rich-quick scheme, or selling out to drugmakers!

    Keep up the great work!

    Duane

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