At the Door of the Sausage Factory


Robert Whitaker’s book, Anatomy of an Epidemic, has provoked all manner of responses.  Some outraged, dismissive, but many supportive and relieved to hear the clear voice given to concerns that many have had for years.  To keep the momentum going the website (, was established and greatly enhanced over recent months.  I find that I read the blogs and news daily.  It has become a “go to” spot to find information consistent with what so many of us have known the evidence and our personal experience to show.

While many of the blog spots focus on the untruths of chemical imbalances, the problems with psychiatry, Big PhRMA, etc. there has not been as much focus on where we go from here or “next steps”.  Let’s agree that the story Bob and others are telling is true.  What do local systems of care do with this information?  How do we go about undoing a mental health system whose fundamental assumptions are false?  What’s the best way to remake a system of care based on what we do know?

It is to this end; Bob has graciously agreed to allow me to post about the work going on in Ashland County Ohio.  I have the great pleasure of working for what Ohio calls a “Mental Health Board.”  Boards represent all 88 counties in the State and were statutorily created to be the local, planning, funding, monitoring and evaluative bodies for federal, state and local mental health services.  In short, Boards are in a position to make a difference.

What I hope to show over a series of postings is the work our specific Board has started, how we’ve done it, where we may have gone right and wrong, and where we think we’re headed.  We’re hopeful that other policy makers with similar roles in other states who also have become convinced of the evidence written about by Bob will be able to find use in what we’re doing and apply it to their local situation.  We understand that what we talk about will not “fit” for every system of care and some things you may just find silly.  I look forward to reading the comments to see just how silly you think we are!

I understand for some this blog will have little to no appeal and that’s fine.  Not everyone can be interested in the same things.  We need the passion of the recovery stories, the advocacy blogs, the news stories and spotlight on international efforts.  Bob has done a nice job giving voice to many perspectives.  However, I think we need a blog for those interested in making administrative and policy changes too.  We need ideas about how to pay for services that really work and are respectful of a person’s choices. We need to talk about fee-for-service versus capitated systems, productivity and paperwork.

In short, we need a blog to talk about how to make the mental health system “sausage.”  For the uninitiated, yes, it really does smell that bad.  We really do have to consider local, state and federal guidelines/mandates even when they seem to be counterproductive.  Consideration has to be given to a County’s local politics, quality of provider network, degree of motivation for the changes we’re trying to bring about, etc.  For those of you experienced in making the “sausage” that is mental health policy, I hope the blog can serve as a way to share recipes and invent new and creative ways to bring about the change we all seem to be seeking.

Related Items:

Corinna West
Why Can’t They Hear Our Truth? We Have a Cure
What a new role for psychiatrists might look like
How entrepreneurial thinking can improve mental health advocacy
Why We Need Mental Health Social Entrepreneurship


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Thanks for adding a practical voice for local action.

    If you look at “the system” as a whole, it seems impossible to change, it’s too big and too pervasive.

    If you look at local initiatives, you can make a difference in your immediate surroundings. If enough people do this, it affects “the system.”

    Looking forward to your posts.

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    • Normally, I’m right on board with local action.

      The best government is local – where real changes are made, and seen, and appreciated – with involvement, interest.

      The mental health system however is a different matter, due to the fact that Constitutional rights are involved; and due process is being ignored, routinely.

      Therefore, the matter of what changes need to be made is one of national interest, and will require federal legislation. In much the same way as the Civl Rights Act of 1964.

      As a member of MindFreedom International, I have written countless letters to state officials on behalf of people over the years (through the MindFreedom Action Network). Most are dismissed, with a quick replyl from a bureaucrat.

      Until we make certain that Constitutional rights are protected, we will exhaust ourselves with each and every case. We need to get a bill passed into law, in the same spirit of the Civil Rights Act and Americans with Disabilities Act.

      I’ve had the opportunity to work with my friend, Dr. John Breeding in Austin at our state capitol with state legislation. Others have done the same around this country… But we need to begin to take that same energy, time, committment to the federal government, so that we can put this matter to rest, once-and-for-all.

      As Jim Gottstein points out, these incarcerations and forced druggings fly in the face of the 14th amendment; there is simply no due process involved; it is being ignored.

      We need to see not only the “least restrictive” clause of the ADA enforced; we need to see the “most therapeutic” programs take root.

      But this will not be done by the states unless there is a mandate to do so. The Treatment Advocacy Center, the NAMI groups and others have too much power, and have been heavily influenced by the pharma companies and the conventional wisdom (or lack thereof) of conventional psychiatry.


      The first question for legislators will be, “Well, if the conventional treatments don’t work, what does?” This is where we can show “evidenced-based” research in the areas of counseling and integrative medicine.

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  2. I recall reading a news post on this site a couple of months ago, about a review that’s being done in Illinois of all mental health policies in the state that have been predicated on a “biological” understanding of mental illnesses.

    A similar initiative should be done across all states…that is the kind of independent review which is really warranted.

    I’m not sure if that’s similar to what you’re doing, but it would be very interesting to know how such reviews progress.

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    • It’s a piece of the pie Anon! We’re trying to introduce the same language in Ohio. Our State Department Directors released a memo to the field that included the following two statements regarding a recent decision to combine the Departments of Mental Health and Addiction Services:

      “Mental illnesses and addictions are both biological brain disorders with genetic and/or
      neurobiological factors”

      “Both addiction and mental illness are diseases of the brain that can be treated successfully. It
      makes sense that treatment services for people with these illnesses are coordinated”

      That’s a bit of what we’re up against in Ohio! Appreciate everyone’s comments.

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      • When people are using words like biology in such a narrow-minded way, I have come to the conclusion they are in fact using a different language than me. Then the only way to maintain a dialogue (and have them listen to a counterview) is to translate my view in their language, even if their language is conceptually poor. Here is what I would answer to your directors:
        We all agree mental illness and addiction is biology, but so is talking, that’s a biological process involving muscle cells. Now, recent research is showing that we can modify the biology of the brain by the biological process of talking:

        That study says: “In most studies that compared pharmacological and psychological interventions (with the exception of Goldapple et al.,38) the effects on cerebral metabolism were rather similar.”. Since we have one biological cure with no harmful side-effect called talking (and neuroimaging is a definite non-subjective proof it is effective), shouldn’t that biological treatment be preferred over drugs with side-effects.

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        • This is helpful Stanley. We’ve come to the same conclusion regarding communication. It’s a bit like Motivational Interviewing with these folks. We try to understand the language they use and work within it to make our points. We’ve gotten too many blank and glazed eye stares when we use “recovery” language.

          I heard a quote the other day that seemed relevant to the challenges we’re facing. “It’s not that (insert person, institution, etc. here) is stupid, it’s just that they know so many things that aren’t so.” Cheers.

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          • Thanks for mentioning Motivational Interviewing. I did not know about it, and it looks very interesting.

            “Motivation Interviewing” made me think about an important criteria in evaluating therapies (there are so many of them): it’s useful to look whether one would find that method inspiring for use in normal interactions with colleagues, friends, children (including in a symmetric way having people apply it back to you). If a proposed therapy is only applicable for people in distress (like permanent labeling or lifelong treatment), there is good reason to think that it causes more harm than good, and makes recovery less likely.

            I guess I am just describing above one possible criteria to define what is an empathy-based therapy (by definition: it can be used with anyone, including State Department Directors).

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        • I think this approach is similar to POW camp prisoners being forced by Commmunist brainwashers to keep repeating their lies unit it broke the person down.

          This is what psychiatry does to so called patients. They force them to totally betray their humanity by “admitting” they have the so called mental illness/stigma forced on them by a so called mental health expert and to take their poison drugs or ECT forever.

          There was that famous experiment whereby a group of NORMAL people were sent to different psych wards. They said they were hearing voices of just one word they gave. From then on they acted normal. All were labelled schizophrenic except one with bipolar. All their normal behavior such as writing was attributed to their so called mental illness like “writing behavior.” They were not allowed to leave until they admitted to their “mental illness” and agreed to take their meds. Patients there caught on that they were fakes, but those in power never did.

          This “experiment” exposed the farce of psychiatry and so called normals vs abnormals, so the psychiatrists were embarrassed but furious and demanded that the person doing the experiment send more people to psych words and he agreed.

          The psychiatrists triumphantly ferreted out about 40 “normal” people and confronted the experimenter. He then told them he never sent anyone. This would be funny if it wasn’t so horrific, dangerous and Kafkaesque.

          Just visiting a psychiatrist will get you a bogus stigma and toxic drugs per Dr. Peter Breggin, TOXIC PSYCHIATRY, so let’s give up the pretense that this is anything to do with mental or any other kind of health let alone survival.

          Also, historically, appeasement with totalitarian dictators has never worked as Churchill was wise enought to see before World War II.

          I do not like this approach of pretending there is any truth in VOTED in DSM stigmas and their bogus, predatory eugenics claims. I think it is a lesson in futility unless this whole evil biomedical model of psychiatry is toppled.

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          • I agree. I’m not going to continue to use their “language” no matter how much their eyes glaze over. Motivational interviewing can be used in some very underhanded ways; I know it sounds great but it can be put to some bad uses. It’s interesting that the “patients” caught on right away to the fact that people were posing to be patients but the psychiatrists didn’t, probably because they are such a big bunch of know it alls, for the most part. Like you, I will not pretend and use their language.

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          • Words and language are very powerful things. Without language humanity would probably not exist today. To ancient peoples words were power; you didn’t let your enemies know certain words since that would give them power over you. In the ancient world you didn’t give your name to strangers since that would give them power over you. This is why God is never actually called God in the Hebrew Scriptures. When Moses asked him who he was he got kind of stuffy and said “I AM Who AM, Who Caused ALL THINGS To BE,” also known as Yahweh. Observe how powerful the language of biopsychiatry is and the power it holds over us with it’s three hundred and some labels found in the great and mighty “Bible” of psychiatry, all praise and glory be to its name! Because of this power, I choose not to use their words but to fashion my own ways of speaking about emotional and psychological anguish. It is time to claim our own power, and I don’t think it will be by using their vocabulary, since this places us back into their hands.

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      • I believe this a DELIBERATE LIE pushed by the power elite with a right wing agenda. These are the same EUGENICS theories of psychiatry in the 1930’s that led to dehumanizing those stigmatized as “mentally ill” to rob them of all human rights to the point of psychiatrists gassing patients to death (euthanasia) IN MENTAL HOSPITALS in Germany before and after Hitler came to power. These same eugenics LIES were then used to target other groups like Jews, gypsies, blacks and on and on creating the Holocaust, many other ethnic cleansings and other horrific abuses against the so called “mentally ill” to this day so that everyone and anyone can be targeted. Psychiatrists moved their murder apparatus to the concentration camps in Germany and directed operations for mass murder there while making the same selections for death as they did in mental hospitals. Since this horror is continued now in a more covert way, it needs to be exposed LOUDLY AND CLEARY as to what is really being done rather than allowing the latest perpetrators the pretense that they are pursuing “mental health, “behavioral health” or other euphemisms to target, stigmatize, dehumanize and destroy certain people/groups for profit no less.

        I believe that people in power advocating these lies about bogus DSM stigmas or addictions being biological and genetic should be exposed as pushing evil eugenics lies/theories to target/prey on certain people to profit from their emotional distress, trauma or life crises.

        Perhaps that sounds drastic, but consider what has happened in history when people were brainwashed with the vile lies of inferior, subhuman groups that could be robbed of all their rights and very lives in the name of Darwinian EUGENICS. I think people get the point with this word, so the word EUGENICS should be used whenever any liar makes claims of bogus stigmas/prejudices being biological. Such narcississtic PROJECTIONS say more about the stigmatizer than those they stigmatize and maybe their brains should be checked for bad genes!!

        “First they came for the Catholics and I did nothing,

        Then they came for the Union Workers and I did nothing

        Then they came for the Jews and I did nothing

        Then they came for me and there was nobody there to speak for me.

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      • Here in Texas, John Breeding and I met with a Senate Committee chair prior to a public hearing on a propsed bill… He asked us, “Now what’s the difference again, between a psychiatrist and a psychologist?”

        The problem is that some of these mental health bills are mixed into busy agendas at the state level. The Texas legislature meets only every two years. And if they get something wrong, it becomes law until it can be amended.

        How important are these laws?
        We had one that would have allowed a police officer to immediately take someone to a psychiatric hospital if they were spotted near a crime scence, the officer had “reasonable suspicion” that they were somehow involved, and had a history of “mental illness”.

        This is what we’re up against in each of the states. Some bills fortunately never make their way out of committee, but others are quickly passed, especially toward the tail-end of the legislative sessions… They have lots of work to do – in the areas of public briges and tollways; state university tuition rates; appropriations – they have a full plate, and the only thing they know about “mental illness” is what they’ve been told by NAMI, and other “do-gooders”.

        This is why we need to get a good bill sponsored, lobbied, and passed in both houses, and signed into law.

        We may not be in a spot to do so right now.
        But with (roughly) one in ten Americans and antidpressants; one in five on some form of psychotropic (one in four women, higher rate); with the DSM task force on the move for expansion; with the targeting of service members and veterans; the fallout we’re seeing in our nursing homes with seniors; with all the “side effects” (effects) of these drugs; with the disability numbers going off the charts – we cannot afford to wait much longer.

        IMO, with all the challenges our nations faces – wars on several fronts; unemployment rates at record highs; national (state and local) debt – nothing compares to our nation’s biggest challenge – a chemically-dependent (addicted) people cannot be healthy and prosperous.

        It is, IMO the biggest challenge we have ever faced as a country.


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        • And once these state laws are passed, each person within the mental health system must meet the statutory requirements set forth by the law makers; even if these are in violation of the Constitution.

          “Mental health law” is often a slap in the face – to some of our best, and most successful disability law – the Rehab Act of 1973(along with its many amendments in 1986, and later)… Certainly, the ADA, (including some good case law that was built – to make certain people with disabilities were provided “access” to public transportation, education, and employment opportunities; The state VR and Independent Living centers need to begin to uphold the spirit (and letter) of these laws, when it comes to “inclusion” and “least restriction”.

          There’s no law like “mental health law”.
          It is a slap in the face to those unfortunate souls who are told they need to “be compliant” in order to qualify for state services.

          And the state service system tosses up their hands, and says they are following state guidelines (far too oftent, “statutory requirements”).


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          • I apologize for leaving so many comments. Last one, quicly –

            Correction – obvious mis-use of the term “statutory requirement”.. I’m tired, and angry.

            Re: Further comment on Mad in America

            I do not see the purpose of continuing to point out the failure in the existing paradigm, without organizing to change it.

            And the well-meaning, noble efforts to do so are simply IMO, not enough.

            If (when) there is a real committment to transform the system; once-and-for-all, there are some folks out there who know how to get in touch with me.

            In the meantime, I’m bowing-out.

            This has been a long, hard struggle over the past seven years…

            We need to get this done.
            And in spite of all the noble intentions, it is far too little.

            We don’t have time to waste.

            I know I don’t.
            I’m 55 years old, and not getting any younger.

            Again, if there is a real interest, please send an email or cell phone through David Oaks (MindFreedom), Jim Gottstein (PsychRights), or Dan Stradford (Safe Harbor).

            My best,


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        • And for what it’s worth.
          I’ve been doing my best to get this vision off the ground.

          By contacting my Congressman, and both Senators… when the idea was dismissesd, I contacted Representative Ron Paul, and U.S. Senator Chuck Grassley.

          I’ve spoke numerous times with David Oaks and Jim Gottstein, several others – who were supportive, emotionally… So, I put in lots of time on the computer, cell phone, with letters to people I thought might be interested, at the grass roots.


          So I guess wer’e in this local, county, state effort for some time to come.

          Should we ever have a serious committment on the part of survivor groups; counselor, therapists; integrative medical practitioners… please let me know.

          But one person cannot do this alone.
          And so far, all I get is “We need to do this at the local level.”

          Not enough.
          It’s not gonna get the job done!


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          • Duane, your passion is evident. We need more like you. I think a strategy that is coordinated and working at multiple levels at the same time, might have an impact. This website and others are a testament (I think) to changing public and professional attitudes towards the misinformation and outright falsehoods that have been pushed for forty years. I know you don’t want to hear it takes time, so I won’t say it. Just know pioneers like yourself have and are continuing to lay groundwork benefiting future generations.

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          • “Should we ever have a serious committment on the part of survivor groups; counselor, therapists; integrative medical practitioners… please let me know.”

            Hi Duane
            I feel your pain.
            I am 52 and tired too. It wears on a person like water over a rock… anything can be simply wore out.
            It is one thing for the people who’s lives continue on relatively “normally” to take their time still employed and free of mental torture these drugs and withdrawal bring. I know I am leaving out a lot and I am guessing you are a survivor from your passion- I know one of my own when I see them… there are too many ramifications to list- just wanted to qualify the narrow view of this post and let you know I KNOW… not only your sense of urgency but the tendency to despair at the foot dragging.
            After losing half a life supposedly the best years to this and likely crippled by after effects and the thoughts of injustice still ongoing. I find it all but impossible to walk away. I have tried countless times. I have a feeling you are still here.
            In my fantasy there is a place of rest for us a evening of the score where the system simply changes now the others “know” and we get to walk and live whatever years we have left in healing environments…pampered gentleness fitting to those who have been at war and tortured…war hero’s if you like who made it home. Given the status of ones who have in battled recognized the enemy… and come back to tell all of what we know… invaluable information to future generations and the rest of humanity.
            In this fantasy knowing the truth would end he war. Sadly it does not work like that and there is no guarantee this war will ever end even tho the truth is known.
            You have to think those how hold the power are the ones we are at battle with and they have always known the truth. The will to harm has always been there. Don’t be fooled into thinking otherwise. They have the will to do great harm. They are still there feeding daily and it will take an sustained effort by all those listed in your post to make any change. Including people like us.
            There needs to be a dialogue that is face to face between all these factors… to plan a direction. Action needs to be taken on all fronts.
            I don’t know where we really fit in.. and believe me I know you want to get on with your life..I do too. So have the rest you need but I think you will be back reading this post adding your sense of urgency that I too feel.
            Thank You for you Efforts!

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        • I agree. With every little child who is put on psychiatric drugs, you pretty well can say that they’re going to end up being on the SSI roles for the rest of their lives. We know this and yet psychiatrists and family doctors are allowed to keep drugging children to oblivion, making sure that they’ll always be on these drugs and that they will never learn skills to get them employed and off the disability rolls. I can’t believe that parents even allow this in the first place, but then, many of them are in foster care and we know what happens to them there. You are absolutely correct; this is the largest problem facing us today and most of the American public doesn’t even realize it. We keep putting 850 adults and 250 children on the SSI roles seven days a week!

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      • David,

        Perhaps you could consult with David Oaks at Mindfreedom and use the same tactics as they did to force “State Department Directors”/psychiatry to admit that they have no evidence whatever that bogus DSM stigmas have anything to do with biology or genes. I also believe that those promoting dangerous, unproven, prejudicial eugenics theories that have continued to dehumanize and destroy certain targeted people and groups should be confronted and exposed for what they are really doing. Also, perhaps a marketing, publicity campaign should be done to enlighten the public about the consquences of bogus eugenics in the past and present especially with regard to the so called “mentally ill.”

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        • Donna you bring up a good point I was planning to discuss some blogs from now. Mr. Oaks is a great speaker but he’s not the right speaker for every audience. We’ve found it very important to 1) Understand the audience, 2) Understand the speaker and what he/she can bring to bear and 3) Understand what we’re trying to accomplish by bringing them together. For example, when we meet with primary care physicians and try to influence them we will bring in someone like Dr. Mark Foster. If we’re trying to influence consumer/survivor efforts in a State, maybe Paolo del Vecchio. We need to take on the Psychiatric establishment? You bet Dr. Breggin or Grace Jackson are great choices. Thanks for bringing this up, strategic planning around speakers is well worth the time.

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  3. Sausage Factory? It is a “Crazy” factory, the mental health system produces crazy people. The crazy have to take medicine . The medicine makes them crazy. Who pays for it? You would think who ever is paying for this would want better outcomes. Where do they (the ones that pay) get their information from? From those dispensing the medicine ( not drugs). It is a perfect system.

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    • I think the “system” is getting the exact results they plotted and wanted in the guise of “mental health.” Their lies are so transparent, it is obvious that the sheer force of power and money are driving this latest human holocaust.

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      • The drug companies set out years ago to accomplish exactly what we are dealing with at this very moment. And they invited the psychiatrists to get into bed with them becuase it gave these people the chance to call themselves “real doctors” and it increased the money coming into their bank accounts. There are psychiatrists today who once did talk therapy but gave it up for more money and their stroked egos. They admit that they miss really interacting with people but they can’t go back to the old days because their lifestyles are based on their being in bed with Big Pharma. They made their beds and now have to lie in them. Anyway, the results we’re dealing with didn’t just happen, they were carefully orchestrated years ago to achieve what we’re mired up to our necks in. Donna is correct; it is money and power that are driving the system we must fight. If we don’t take a stand now, the only people not “medicated” will be the CEO’s of the drug companies and the biopsychiatrists!

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  4. I really think that an OFFICIAL alternative to the locked ward and meds should be set up, financed by governements, so that there is a “proper choice”. Those who want meds and believe in the broken brain theories -a lot of patients actually do-could use the old services. The rest could look for a safe haven in a new approach to tackling peoples’ distress and breakdowns. At the moment such a thing does not exist. Both services should share resources 50/50 and then see what happens.

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    • Soteria houses across the nation are the answer but no one will fund them. They would save the taxpayer tons of money in wasted taxes going to the present system. Also, it would give people with “histories” in the system opportunities for employement in these homes. But then, you would have very little use for the actual biopsychiatrists and Big Pharma, so this idea doesn’t have a snowball’s chance in Hell of ever getting implemented. Congress won’t back something like this because they’re pockets are being lined by money from Big Pharma.

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  5. Here is a talk by Bob Whitaker on Eugenics posted on this web site currently. It shows how many fraudulent ideas and theories along with funding by the wealthy contributed to eugenics to justify the position of the higher classes or power elite and the devastating dehumanizing, murderous consequences for those stigmatized by psychiatry as “mentally ill,” blacks, Jews and other minority groups.

    It is a very enlightening talk and I urge everyone to watch/listen to it. It is excellent and a good source of information to confront those covertly promoting these dangerous lies today and their real motives. Also, see Bob Whitaker’s blog article on the taint of eugenics in Dr. Insel’s research goals for the NIMH he directs. Since all the other lies promulgated to deceive everyone that bogus DSM stigmas are “biological, genetic or chemical imbalances” have been exposed as the fraud lies they are, those in power are now using the recent focus on the genome to generate more lies to maintain the status quo and business as usual with psychiaty/BIG PHARMA/government eugenics if you examine the nefarious relationship between Dr. Insel, Dr. Charles Nemeroff and BIG PHARMA.

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    • Thanks for this link Donna. I encourage others to watch it. Many of us are familiar with Robert’s latest book, “Anatomy of an Epidemic” but my first experience was “Mad in America” That was a real “wake up call” for me in that he does a masterful job of describing the historical events/context in this county that explains how we got to where we are now. There are several pages in Mad in America about eugenics and the mindset of some to distinguish between one group of people from another. Isn’t this still so prevalent today? Those in power, when it comes to the mental health system, often make policy, fund services, and push laws based on their beliefs of another group with far less power. How else can we explain forced ECT? Involuntary commitments both inpatient and outpatient? One group with more power dictates the behavior/thoughts to another with less.

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