Are Some Psychiatrists Addicted to Deference?

Michael Cornwall, PhD
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One of the subtle but underlying factors that keep the great divide active between psychiatry’s medical model of human emotional suffering, and the alternative paradigm that challenges it, is the existence of a class system based on meritocracy, that accounts for some of psychiatry’s rigidity in considering an alternative paradigm position. The credible research that supports such an alternative view is often ignored, which is inconsistent with the scientific method that psychiatry claims is the legitimizing foundation of it’s theory and practice. I’m offering a partial explanation of why such valuable research is ignored.

My remarks here are based on working side by side, everyday for over 30 years with my friends and colleagues who are psychiatrists. Some of them seemed to suffer from what I would, in good nature at times describe to them, as an addiction to deference!

Most Psychiatrists come from middle class backgrounds and have accomplished a huge feat to get an MD and to practice psychiatry. They are accorded deference in a professional hierarchical class structure based on merit, that reflects another way that our classist society stratifies itself.

Their daily and decades long experience is that every nurse, secretary and other mental health professional in every clinic and hospital, will defer to their judgment and authority, due to their status and more advanced degree and license to practice medicine.

The medical settings where they work positions them at the top, in terms of pay and status and authority- and the huge power to prescribe medical treatments that are exclusive to their profession. Sometimes these treatments can only be done on a doctor’s order- such as ECT, forced and voluntary medications and restraints.

Having worked along side psychiatrists everyday for all these years, I can only say they have always been shocked when I did not defer to them.

They would want the last word in every decision about every treatment they authorize or drug they prescribe with “their patients”- as they proprietarily call consumers, because they believe their license requires them to take sole responsibility for the quality of care given.

When necessary I would not give them the last word. I hold my obligations to the people I serve as an ethical and sacred trust too.

From decades of experiencing psychiatrists reactions to me when I would professionally, and while showing them all due personal respect, not defer to them about decisions that effect the consumers I served, I learned that a huge obstacle to the honest debate that non-psychiatrists would have with them, is caused by the fact that such questioning of a psychiatrist’s theory, research and practice is so often experienced by them as impertinence.

In those 30 years I was almost always the only professional I knew who openly and consistently would not defer to them if need be. It slowly occurred to me, that a regression to the psycho-familial grips a great many psychologists and other professionals in the field, when faced with the psychiatrist’s expectation that they should defer.

The old adage that children are to be seen and not heard, feels like the unspoken message, and in fear of surrogate parental anger, a child-like regression seems to block some adult care givers from speaking up with psychiatrists.

There are real time consequences for other professionals challenging the psychiatric authority that claims an absolute position of superiority in the meritocracy hierarchy. That hierarchy replicates the power dynamic we experienced with our parents.

In addition to serving consumers 40 hours per week for 30 years, I believed that part of my service as the elected president for 16 of those same years, of my 250 white collar union mental health staff unit, was to embolden co-workers to question authority and stand up for themselves and the rights of the consumers we served. As human rights activists, we needed to do that with mental health system administrators and politicians as well.

Sadly, only a handful of my co-workers were consistently able to speak truth to power.

So, if you are a psychiatrist reading this now who probably never has experienced any response but being deferred to for the reasons I have given, you may feel like the psychiatrist who glared at Bob Whitaker all through a presentation Bob was doing, that I heard him report about at a conference.

As I heard Bob’s telling of the story, it went something like this- the glaring psychiatrist approached Bob after his presentation. Bob was hoping for a forthright exchange about the research issues that he had offered for consideration. The psychiatrist instead said something like- “I came up to tell you that I am not interested in your ideas or to discuss them with you- I just want you to know this Mr. Whitaker- I do not like your attitude.”

This exchange with Bob, captures the feeling tone of all of those times I would respectfully challenge the stated opinions of psychiatrists, as for example, when I witnessed them telling many consumers I served in therapy, that they had a life long, genetic based brain disease, that would require them to be on medication for the remainder of their lives.

First things first. Don’t defer to anyone who says what you do not believe to be true.

Related Item:
Anti-Authoritarians and Schizophrenia: Do Rebels Who Defy Treatment Do Better?

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117 COMMENTS

  1. This is why I believe that they need to be facing criminal charges. Nothing else is ever going to help this. The evidence needs to be put forth that they have unnecessarily harmed or killed this number of people, including children, coupled with the evidence that they have no excuse for not knowing this BEFORE they did it because of how they just simply scoffed at the research data. Collectively, they have the lives and well being of many millions of people, including millions of children, in their hands. They don’t have a right to sit and play reindeer games and protect their ego and prestige while people needlessly suffer.

    • I agree! I would also add that many psychiatrists I’ve had the misfortune to be under the thumb of obviously got something out of, dare I say enjoyed, controlling and abusing people. These types are never going to stop, unless someone stops them.

    • Precisely.

      “drug they prescribe with “their patients”- as they proprietarily call consumers”

      Proprietarily is the most brilliant word for it. I wish I had thought of that word.

      I also have a huge disgust at word ‘consumer’. Calling a human being who has been locked up without due process or trial, without an attorney, shoved in solitary confinement and forcibly drugged a ‘consumer’, is akin to calling someone from a third world forced marriage a ‘consumer’ of wedding rings.

      If I’m a ‘consumer’, than a duck soon to be made into Foie Gras, is a ‘consumer’ of force fed corn.

      The reality that so many of psychiatry’s subjects are forced to submit to psychiatry and dominated legally by psychiatry makes even uttering the ‘consumer’ word without pointing this truth out, a betrayal of the survivors of such brutality.

      • I hear you Anonymous. What do you feel is a better word- survivor? But that would only apply to people who believe they have been harmed and/or coerced by psychiatry wouldn’t it? Some people want to be called consumers because they say it empowers them to be identified as free agents with rights to pick and choose the mental health services they decide on receiving just as they decide which other health services they recieve. I would appreciate your thoughts on this.

        • It couldn’t be more simple. If you CHOSE psychiatry, and continue to CHOOSE it you’re a consumer. If you have it forced on you’re not a consumer. Foie Gras. And it’s never a matter of ‘believing’ one has been coerced. There is usually a legal paper trail to unequivocally prove it as on objective historical fact. Person A was forcibly drugged, here are the ‘medical’ records. This isn’t like ‘believing’ you were abducted by aliens. It’s a matter of truth, not belief.

          Whether someone chooses to identify as a survivor is up to them. Whether someone IS someone who was coerced is a matter of provable fact.

          • I for one prefer to make use of “psychiatrised person”, “person in crisis/emotional distress”, “crisis-experienced person”. Unless the context allows/asks for “consumer”, respectively “survivor”.

          • Thank you Marion, Does any other medical specialty create such a situation as psychiatry does?- where it is necessary to designate the status of the person receiving sevices based on the amount of coercion and harm that has been done to them by caregivers?

        • How about conscientious objector? Michael, I think it is very astute and empathetic on your part that you chose to write this article now. Nice to see a mental health expert showing compassion for those who have suffered from the bogus medical model of the so called “mental health” profession, which is an Orwellian nightmare euphemism for BIG BROTHER brain washing and torture.

          Some bloggers here don’t seem to “get it.”

        • In the biological medical model of psychiatry, the term, “consumer” seems to be mere tokenism given the lack of informed consent and the violation of human rights if one makes the fatal error of seeing a psychiatrist only to get stigmatized for life with one’s very freedom, civil and human rights at risk forever. I think the system should be best avoided until or unless psychiatry stops being mere agents of social control and punishment for a growing fascist police state.

      • I agree. I will not allow the word to be applied to me nor do I apply it to any of the people that I work for. To say I am a consuder implies that I agree with what is being done. It’s just another attempt to cover up the reality that people are being horrible hurt and even killed.

    • I’m quickly coming to the same conclusion myself. Even the ones who seem to be good people, outside of their psychiatric role, drug people into oblivion and you can’t convince me that they don’t know about the horrible effects of these drugs. They would rather keep their prestige as “doctors” and line their pockets with the big bucks, rather than admit that we need to do something different for people suffering anguish. As my grandmother always said, “The road to Hell is paved with good intentions.” So, even the nice ones need to be prosecuted. the only ones I’d exempt are the onese who actually do something useful, like talk therapy, or some alternative to the toxic drugs.

  2. Dr. Cornwall,

    As a rehabilitation counselor (retired), we were taught:

    – To “value the rights of individuals with disabilities to live independent, integrated lives”

    – To “strongly commit to the concepts of holistic counseling, full inclusion, and empowerment”

    I took those things to heart in my work.
    And I’m glad that I did, because I have wonderful memories of having worked with some incredible souls!

    Be well,

    Duane

    P.S. Your post reminds me of a quote I’ve never forgotten –

    “People do not care how much you know until they know how much you care.” – John Maxwell

  3. Michael,

    Very good points. In my experience, much of this attitude stems from the staunch belief in neurochemistry to explain nearly every aspect of human behavior, and the (blind) faith in psychopharmacology to change it. Moreover, psychopharmacology remains the one true domain of the psychiatrist, which we are unlikely to relinquish anytime soon.

    As they say, “a theory that explains everything explains nothing.” But that doesn’t keep some psychiatrists from correlating every behavior or utterance– no matter how minor– to a neurotransmitter, a receptor, or an ion channel. I always challenge my peers (and, especially, my students) to approach patients without this neurobiological bias and to come up with alternate explanations for what they see. After all, this IS, as you point out, the scientific method.

    Unfortunately, for many, this exercise is virtually impossible.

    • Thanks for your important comment Steve. The underlying, neuro-biological, genetic causation theory of psychiatry can be questioned if it’s not held to as a dogma as you say. All the treatment practices logically flow from that paradigm. They are more in question than the underlying medical model theory because of their human impact no doubt. But we need a viable, competing causation theory if we are going to really change those practices. I worked to have that conversatiion in my blog- Respondoing to Madness With Loving Receptivity- and I think I will take it up more specifically in my next blog called- “If Madness Isn’t What Bio-Psychiatry Says it is, Then Whais It”‘ I’d very much be interested in your input.

    • Psychiatrists’ arrogant attitudes predate the current intellectual trends.. Remember frontal lobotomies, forced insulin coma treatments, and refrigerator mothers? The attitude doesn’t stem from a staunch belief in anything other than a sense of superiority and entitlement.

      • Thank you Mary. Robert Whitaker wrote a couageous blog here called- “The Taint of Eugenics In NIMH Research” that links the overt eugenicist practices of lobotomy and forced sterilization in the United States, with our current situation where a more subtle expression of a belief in the defectiveness of some people’s brains is still operative.

        • I don’t think anyone really believes in the current eugenics lies used to commit the latest crimes against humanity to target and destroy certain people and groups with impunity for profit and power. This is just the latest con game of the psychopaths pulling the strings behind the scenes globally to cause untold human suffering as explained in the books, POITICAL PONEROLOGY and THE SHOCK DOCTRINE.

          I believe that this has been and remains a DELIBERATE LIE and it needs to be confronted directly since this lie is so obvious and transparent as to the motives behind it. The consequences of not challenging eugenics lies were most hideously exposed in the World War II Holocaust. This horror is being repeated right now in the U.S. in just more covert ways as with Soviet Russia and other totalitarian states who used psychiatry to do their dirty work.

          I get upset when people talk here as if these bogus eugenics theories should even be tolerated never mind catering to the perpetrators as god like beings when they are really the opposite.

          Other hate speech has been targeted for what it is and eliminated from public discourse, so anyone using boguus, dangerous eugenics hate speech in the guise of “mental health” should be exposed as the latest instigators of crimes against humanity. Just because a so called doctor perpetrates such lies, it doesn’t mean he deserves any more tolerance than the thug trying to hammer your head to steal your wallet.

  4. Very good points, Michael. I have also been wondering why individual psychiatrists seem to lack real self-assertiveness or self-definition. (This is as opposed to bullying their patients and staff.)

    They say they know what they do is wrong but then can’t see any way to act differently. For example, acceding to a patient’s demand for medication when they know the patient’s condition doesn’t warrant it — because it’s easier than saying “no.”

    Since when are psychiatric drugs elective?

    My conclusion is that psychiatrists need hierarchical, authoritarian structure and are afraid to show true autonomy themselves, coloring outside the lines. They also want others to stay inside the lines themselves!

  5. It’s interesting that there is such a focus on psychiatrists as the evil pro-pharma ones. This problem exists across the full range of physicians. For example, my primary care doctor pushed me toward taking cholesterol-lowering medicine despite no evidence they do any good. On the contrary, they made me feel weak and damaged my liver. Fortunately, I read about them and discovered the truth. Even pointing this out to my doctor did not sway him. He still wanted to continue them. As long as big pharma is controlling the literature and educational materials of our doctors, we will have this problem.

        • I recently saw a patient who has been on at least 7 psychotropics in the last 3 years, all prescribed by a (well-respected, I might add) local internist.

          She said that he admitted “I’m researching this as we go” and would look up medications on his computer during her appointment to treat her “bipolar” symptoms. Needless to say, after a thorough evaluation in our psychiatric clinic, the diagnosis of bipolar disorder is now strongly in question. Moreover, no medication ever did anything for her and she is now off all medications and in therapy.

          Sadly, this is the state of much of modern pharmacopsychiatry. Michael is right: Big Pharma may indeed have corrupted psychiatry, but they have absolutely muscled themselves– unopposed– into other disciplines like primary care and internal medicine. This is where the REAL money is made, and where no one even THINKS to inquire about the evidence base or the efficacy of the intervention.

          • I just realized that if Big Pharma was “unopposed” in their invasion of non-psychiatric disciplines, they really didn’t need to “muscle” themselves in.

            Sorry, poor choice of words. But you get the idea. 🙂

          • Thanks again Steve. That is a really telling example of non-psychiatrists diagnosing and prescribing psych meds.

            I really wonder if MD’s like the internist ever went to any in-service trainings put on by fellow MDs who are psychiatrists who taught them how to diagnose and prescribe psych meds? I guess not, if in his case he admitted he was researching it as he went along.

            I wonder if the only input about making psych diagnoses and prescribing psych meds for all these MDs- from pediatricians to cardiologists, comes from drug reps?

            It is hard to believe so many MDs make themselves so vulnerable to malptactice litigation by practicing outside the scope of their experience and training. But they are doing it in huge numbers.

            I don’t believe they were trained by psychiatrists to do it.

    • Though regular or real medical doctors may have been conned about the need for Statins for too many people, at least they were dealing with high cholesterol in blood levels that could be proven and could be a risk for heart disease.

      Psychiatry, on the other hand, uses pseudoscience to create their bogus disorders to push lethal drugs that give anyone taking them a chemical lobotomy with lots of deadly, life destroying effects. Unlike psychiatric stigmas, being diagnosed with high cholesterol won’t ruin your life and one has the freedom to turn it around themselves with diet, exercise and other natural methods and be declared CURED. The same is true of diabetes and other REAL medical diagnoses. Fake psychiatric ones are forever because as junk science they can’t be proven or disproven. There is no comparison between regular real medicine and psychiatry since people can say no to things like statins and choose alternatives while psychiatry and its lethal but useless tortures are forced on people. Real bad analogy!!

      • Donna –

        My comment wasn’t meant to be an analogy. It was to point out that big pharma is behind so much of what is troubling all of medicine today. The idea that a pill can fix anything is scary. New health problems are being created all the time so that pills can be pushed as cures. Who writes the venerable Physicians Desk Reference? The drug companies. Who is behind the DSM? Physicians and psychiatrists are being marketed to and sadly are buying into it. And we too are being marketed to so we can go to our doctors with self-diagnoses and ask for specific pills. This is the true madness in America.

          • My only condemnation of the PDR is that older and effective drugs cease to be found there when they are no longer profitable (i.e. become generic). It’s up to the drug company to contribute the info to each new PDR, and it is to their benefit to only push the newer more profitable drugs.

      • Sure. Originally I was on Lescol, one of the early Statin drugs, as it was cheaper than the newer. Quickly it became liver-toxic, so I switched to Lipitor, much more expensive. Both had lousy side-effects like causing muscle fatigue. It turns out the mechanism of action is to essentially poison the mitochondria in each of our cells, which power the cells. No wonder I felt weak. I didn’t feel like exercising, gained weight, etc. And the only *value* was getting better-looking numbers. No evidence of an actual benefit. There still isn’t, except for some questionable improvement for men who have recently had heart attacks. Run like hell from them. Read about it first if you’re unsure.

    • I agree. Too many doctors of all specialties are arrogant and think that they’re the experts on our lives. I given no respect to any of them until they prove to me that they are worthy of taking care of my precious life. If they are not humble, transparent, genuine, and caring, I tell them thanks but no thanks! The psychiatrist treating me in the state hospital was shocked when I dismissed him from his own conference room. The intern psychiatrist studying under him busted out laughing, which didn’t set well with the senior psychiatrist. I often meet him in the halls since I now work in that very hospital and my dismissal still rankles him a bit. this was three years ago.

  6. Hi Micheal,

    Nice post.

    Where do you work, how did you take up with such a bunch and stay for all these years? Not fun.

    I have not been “deferred to” because I was a doctor at work since 1983 when the first task of my licensed medical career (on a medical ward) of “declaring” a poor soul, “dead”. The nurse asked me “Is he dead, Doctor?” and waited. She knew this to be the case as well as me. State law mandated that I was the one legally bound to “declare” this to be the truth. By law, he was not dead till I said so and the hurse wrote the time on the chart.

    Or maybe I’m so trained by the “meritocracy” that it is invisible to me. One cannot be an accurate anthropologist inside one’s own culture.

    I have had to make the “final call” on some treatment decisions (usually medicines) in a treatment team setting. Most treatment decisions are not mine at all. Half the patients that come there never meet me. Most treatment decisions are agreed upon among the patient and staff.

    Heck, there’s only one guy there that will bring me a cup of coffee (thanks for the coffee, if you’re reading this) and, even then, I have to say please (humor).

    Keep writing.
    Alice

    • I would guess from your name that you’re a woman. Have you ever wondered if the lack of deference you experience might be related to that? Gender does sometimes trump other forms of status.

      Slightly off topic: I had a friend who had been a call girl. She decided she wanted a respectable life and became a hospital nurse. Not only did her income drop dramatically, but she said no john had ever treated her with the kind or degree of contempt she came to expect from the average doctor. And she didn’t talk back–she’d worked too hard for that job to want to risk losing it.

  7. I’ve heard about a few local psychiatrists (and other doctors), “Oh, he’s very good; he graduated from Stanford!” (I live not too far from there.) Based on a modest sample size, my own biased impression is that many graduates from the more elite medical schools are more likely to be convinced of the superiority of their own education, and thus less willing to listen to any ideas that might disagree with it.

    • Philroy, that reminds me that the drug companies were involved with the top medical schools to assure the greatest status for the research they supported thst advanced the development of their products.

      The recent congresssional hearings and scandal at Harvard, where several leading psychiatrists were censured for drug comapny connections, reached it’s peak when Dr. Biederman, the architect of the child bi-polar epidemic was questioned and asked about his status as full professor. When asked what was after full professor in the hierarchy, Biederman said- “God.” The amazed questioner asked-“Did you say God?” and Biederman said-“Yeah.”

      That kind of personal inflation is partly the result of our meritocracy based social system that creates class differences even in the human services field. Even in mental health services, sometimes a sense of professional entitlement reveals a shadowy form of social Darwinism. Sometimes it goes way beyond an inhearant desire to receive deference.

  8. Power tends to get to peoples’ head be it doctors or politicians. That’s why I abhorre the word “expert”. Why don’t you leave it to “the experts?” said my son’s psychiatrist with condescension when I was questioning his “diagnosis” of severe and enduring mental illness”.

      • The Doctors in the hospital I had the unfortunate pleasure of staying in last year were similar. They seemed entirely incapable of thinking that any care outside of the locked hospital environment could be acceptable.
        My family flew from another continent to the U.S. and demanded that I be released into their care. The Doctors refused, they seemed genuinely shocked that anyone could disagree with them (other than me of course, but then I obviously must lack insight, and therefore my opinion didn’t matter apparently).

        When I expressed some doubts on the explanations they provided about the causes of my situation (biological, chemical imbalance, must accept to be on medication for the long term, if not the rest of my life)…one of the Doctors’ got really upset, she just couldn’t handle that someone didn’t “buy it”.

        Their view was that I had to be on medication, and the only place I could be sure to take it was in their hospital.

        …so, I just didn’t take it in the hospital. Pretended to be compliant, and then got out. This unnecessarily adversarial position, makes a complete mockery of what is supposed to be a therapeutic relationship.

        All my Doctors achieved was “false deference” from myself and my family, and once I left, I will never seek assistance from anyone in that profession ever again.

          • Well, the particularly challenging part was keeping quiet…which is just not the norm for me. I’ve always been a very independent and opinionated person…the entire environment went against every grain of my being.

            The strange thing is, that I don’t doubt that the overwhelming majority of practitioners in that hospital genuinely wanted to help. The problem is that they want to apply a one-size fits all approach to everyone, and it results in many traumatizing experiences for anyone who doesn’t fit a particular mold.

    • The problem in conventional psychiatry as I see it, is that it is not inclusive; it is, for the most part, a non-participatory process for the “patient”; it far-too-often pits the psychiatrist against the patient.

      One is in a position of power; the other of adversity. And human beings dont’ tend to handle power very well –

      “Nearly all men can stand adversity, but if you want to test a man’s character, give him power.” — Abraham Lincoln

      Duane
      http://discoverandrecover.wordpress.com/freedom

      • I don’t particularly like that aspect of my job. What you refer to as “power” is really responsibility…responsibility for whatever outcome the patient has. I am very libertarian in my views, and think that laws have placed both too much power and responsibility with psychiatrists. I don’t like the combative nature of involuntary inpatient care; I would rather only care for people who actively–and of their own volition–seek my help. If it were up to me, if someone chooses to live life with delusions, hallucinations or whatever, they should be free to do so, and manage these experiences/symptoms/whatever-you-wish-to-call-them in his or her own way. (Of course, if these things cause the person to act in discordance with our laws, then they simply have the criminal justice system to worry about.)

        In other words, I think people should be free to be psychotic. If someone wants help, I will help them–with open arms–and assist them with what psychiatry has to offer (which I acknowledge is limited, but helps millions — personally, I’ve positively affected the lives of thousands).

  9. Michael, you’re a real enigma to me. Some of your articles, like this one, are just great. But that one on Dionysus or Bacchus or whatever was unintelligible to me! I don’t know how you do it. How can one man be the author of such clarity and confusion? I guess I’ll read the ones I understand and skip the wine…although all this foie gras and wine is making me hungry!

  10. Hm, my first meeting with a psychiatrist was lovely. I was telling him how I was a young gay man who had a difficult relationship with my parents when he told me he was gay and sympathetically referred me to counselling. However other people hated him and saw him as paternalistic. But then I was not psychotic or seriously distressed. Mine has always been the mild to moderate type (mainly, though I have had my moments of utter rage at the slings and arrows of misfortune slung my way).

    Later I accompanied a friend with a diagnosis of schizophrenia and two and a half the recommended dose of haloperidol (with resulting horrific, “side effects”) to his psychiatrist to ask for drug free treatment psychotherapy. This psychiatrist was almost incandescent with disbelief that any one could question his judgement and said he did not think that anyone since Jung had thought psychotherapy was useful for, “Functional disorders like schizophrenia or manic depression.” He literally turned his back on us as he attempted to dismiss us, shocked that anyone should even countenance asking for therapy for someone so seriously distressed.

    This was 1982. I’d read about several people who thought therapy was the best treatment for people with these sorts of diagnosis and indeed my friend responded well to my recently acquired art therapy skills (he was burbling something I could not understand very well, so I asked him to draw it and then asked him to explain the drawing and low and behold it all became beautiful and clear – to me and to him – where upon he calmed down, made a list of things to do and went and cashed his benefit cheque and did the shopping).

    These days in the UK, they tend to not be so forthright in their arrogance. Instead they say therapy is a good idea but that it is counter-indicated for people who have experience psychosis as it might make things worse or trigger an episode, and then they ask if you have heard any voices telling you to do anything and would you like any sleeping pills on top of the anti-psychotics? So their blandishments tends to stop you or your advocate really getting what you want, which is someone to just be kind and understanding for an hour or so a week.

    They’ve studied for years for the professional prestige and that rather good pay rate. They’re not going to give it up just because some flibberty gibbet says, “Hey, look, try being nice to people and finding out why they think the way they do, it works you know.” Beside if you are mad then you don’t know what is good for you, it says so in the law and they have the power to administer that law and who wants power taken away from them? Especially as the alternative is to listen respectfully, and they haven’t been selected or trained to do that (so they’re not very good at it – shh, don’t tell anyone, it might cause a few problems in the staff room down the hospital).

    “Recovery Starts With Non-Compliance,” is what a badge says that a friend gave to me recently. Someone we know took it to heart and staged a naked protest when detained against his will because he did not want to take his drugs. We told him it would not help him but we still visited lots, phoned him up and tried to talk some sense into his psychiatrist.

    We also wrote on someone else,s behalf to their psychiatrist and care coordinator, taking a leaf out of Amnesty Internationals book, asking for her to be allowed to come of her drugs. We also accompanied her to meetings with her workers. It did not work but she felt a whole lot better and is putting in an appeal.

    Another person was threatened with a depot injection once a month or so under a community treatment order but with our support she angrily told them she would not turn up if they tried to make her do that. She got away with pills but is hoping to challenge that and has found subsidised private therapy.

    The system will crumble when enough of us refuse to comply: consumers/survivors, service users, allies, staff, commissioners of services and politicians. And that can only happen when we organise.

    • “But then I was not psychotic”.

      When you even use the word ‘psychotic’ as though it is even a legitimate homogenous medical label that refers to anything objectively medical, you give oxygen to psychiatry.

      Unwanted thoughts and behaviors can be ‘called’ psychotic by those who believe in psychiatry’s interpretation of things, but the simple of act of calling them by that word, is meaningless to people who are not convinced psychiatry’s labels belong on a crisis.

      • You are right. The horrible word, “psychosis” like schizophrenia and now bipolar are meant to degrade, humiliate, separate, disempower, silence, gas light, stigmatize and justify psychiatry’s history of the most sadistic treatments past and present making me think the majority of them are psychopaths or malignant narcissists with their glaring lack of conscience, pathological lying, entitlement, grandiosity, manipulativeness, fraud, parasitic life styles and stunning lack of empathy to name a few of their own traits.

        Physician heal thyself.

      • Um, I sort of agree Anonymous. I’ll think about other ways to describe what I mean apart from Psychotic.

        To me it is a useful term, and it does not mean that psychiatric procedures are justified, but others find it offensive and think it does.

        I don’t see them as unwanted thoughts and behaviours either. I see them as thoughts and behaviours that leave most people confused and often scared, but which can often be understood if someone puts the effort in.

        I have a book called, “Psychosis as Crisis,” that has lots of lovely descriptions of ways of helping people without forcing anything on them or for the most part using drugs.

        To describe how my friend was without using either the term, “psychotic,” or some other similar term I might need a quite long and perhaps clumsy description of how he was, what I felt and so on. I could say he was extremely distressed but there are different types of distress that call forth different responses, for example some people are suicidal or attempting self harm but that calls forth a different reaction from someone who is really hard to understand because of what they are saying or how they are saying it.

        Sometimes movements reclaim words. For example, Mad Pride. I personally say I am a nutter with a diagnosis and everything, but that does not mean that I want a diagnosis or that I think that what services have on offer are of much help to me or my friends.

    • Psychiatrists are not trained in med school these days to do psychotherapy. they have no idea how to go about it. Besides, the old requirement for learning to do psychotherapy was that you had to be psychoanalyzed yourself. I know very few psychiatrists today who would lower themselves to allow someone else to psychoanalyze them. All except for one. A young intern/resident who did the majority of my care while I was in the hospital. He actually sat and listened and talked with me. Some of the hour sessions were spent with me doing the listening as he talked. It felt kind of weird but who was I to refuse to listen to someone who needed to talk, even if he was my own doctor? It was a very interesting but mutual relationship and I have the feeling that both of us profited from our arrangement.

  11. John, you have tremendous insight and compassion. I also believe we can make a difference by lobbying and challenging the status quo. No one should be on antipsychotics for any reason, period. All antipsychotics are derived from rocket fuel, as I read in an article today.

  12. I have always had collegial and mutually respectful relationships with my psychologist colleagues. I have great respect for psychologists, and see them as equals in any mental health treatment environment (I think patients benefit from multidisciplinary treatment teams.)

    The reasons final decisions are usually relegated to the psychiatrist is because that is who is found to be ultimately responsible for outcomes. Doubt this? Wait for a bad outcome and see who is left standing to answer for patient-care decisions. It is always the person with “MD” (or in my case “DO”) after his/her name.

    Being a military man, I’ve always believed in the axiom about responsibility and authority, i.e. that they need to be doled out in equal measures. Whomever will be held ultimately responsible for patient outcomes should be the one with the final authority to dictate treatment. Of course, even though I do make the crucial decisions (e.g. is someone appropriate for discharge), I never make that decision in isolate. The last time I led a treatment team, we would go around the table and get input from everyone ranging from the PhD, to the LCSWs, the RN, and even the rec therapist!

    • What? No peer workers on your team? Would you have accepted their input as being as valid as your own input? I’m not being smart aleck, I am asking seriously. I am a peer worker and there is a movement afoot in the state hospital where I work to put me on the treatment teams of residents I work with. It is not being supported very favorably by the psychiatrists and because of their power it will probably not happen.

  13. As long as we’re talkin’ —

    There was a time, not too long ago, when I took printouts of scientific papers I thought pertained to my then-mysterious iatrogenic condition to various academic psychiatrists. I thought they might read them and we might have an intelligent discussion.

    Not a single one would read a paper. Instead, I was chided for doing research on the Web instead of relying on the opinion of the expert.

    None of their opinions was worth a d*mn. I now know more about antidepressant withdrawal syndrome than 99% of the psychiatric profession.

  14. “First things first. Don’t defer to anyone who says what you do not believe to be true.”

    Michael, this quote could stand alone as it’s own blog. It really is quite profound and empowering, perhaps THE heart of recovery.

    The Buddha, a doctor in his own time, said, “be your own lamp,” which Buddhist scholars understand to mean, “you must light your own way to truth” or, more humorously, “If you meet the Buddha on the road, shoot him.”

    Imagine how office visits would go if the provider always said, “this might help, but ultimately you will have to decide what works best for you. Your are the expert on your life. I’m here to help.”

    ??