My “Head in a Bucket” Metaphor

Alice Keys, MD
308
154

“How could I not have known?” This question has been asked of me, as a psychiatrist, with regard to prescribing psychiatric drugs. All those problems. How could I not have known?

This question, when asked only of psychiatrists, comes with less-than-flattering assumptions.  The thought that “not knowing” is a psychiatrist affliction implies that psychiatrists either have a brain that is different from other people or that they have dark hidden motives driving their lack of awareness.

Making these assumptions about psychiatrists could block collaborative relationships, especially for any person with a history of paddling in the “mainstream” of mental health care.

Broadening this question to encompass all people, rather than just psychiatrists, can give us a better understanding of how we all got into the situation of using drugs with more risks and less benefits than we were initially taught.

Since I believe that all kinds of people working together will be required for the necessary transformation of mental health care, I’m willing to take the risk and explore one possible answer to this question:

“How can any person not have known?”

This question, originally asked of me as a psychiatrist, mirrors questions that arise in my mind when I watch people engage in behaviors with well-known risks.

Here are three examples:

Cars are the number one cause of death among Americans up till the age of 34. Forty-thousand Americans die every year through the use of cars. We still drive a lot.

Despite the known risks of eating fast food, over twenty percent of Americans eat fast food on a daily basis.

Tobacco has mandated health warning labels on every package but people still use it.

It’s as if the information about risks doesn’t make it to the decision-making center of our brains.

So this question is not only about psychiatrists. This question relates to one of the basic thought processing functions we all share.

I have a metaphor that helps me understand how this could happen to anyone, how anyone could “not know”. My “head in a bucket” metaphor for information sorting reflects the sense I get when I think about this question.

It seems to me, some days more than others, as if everyone wears a bucket over his head. This is a substantial bucket with a variety of sizes and shapes of holes drilled through it. Some sizes and shapes of information get through. Others don’t make it past the bucket to the eyes and ears and into the brain. Some chunks of information must be the wrong shape or size to get through.

This head-bucket, with all its variety of holes, is part of the cognitive operating system we’ve all inherited.

From an information gathering and sorting perspective, one job our brain has to accomplish is filtering out unnecessary information. You would be swamped in data if every sound and flicker of light were allowed into your head every moment.

This filtering process includes assignment of relative value to information. This way your filter will be able to let in important information and keep out the dross. Emotional content is one key to assigning value to categories of information. Emotions help decide how inclusive or exclusive a hole needs to be on your filter bucket. For example, it’s important for a person with a bee sting allergy to avoid bees. Bees can kill, so bees are scary. This person will notice anything bee-like in the environment.

Our drilled head-bucket filters out information for us like a champ. It blocks anything out that doesn’t match our beliefs and lets in what does. Yours does it. Mine does it. Everyone’s head-bucket does it.

Einstein noticed this. He said “It’s the theory that decides what we can observe.” I would say that it’s the holes in the invisible bucket I wear over my head that decides what I can observe.

But how do these holes get drilled in our buckets?

This answer has been known by educators, leaders, and marketing wizards for a long time. Cognitive therapists know the answer, too.

The word “belief” can be used for each of the holes that are drilled through our perception-filter head-buckets. Repetition causes belief. Emotions power the drill.

We have holes drilled by parents, teachers and advertisers. We accumulate other holes in our head-buckets through life experiences. Some, we drill using our own private repetitive thoughts. This last way to get beliefs, by drilling them on our own with repetitive thoughts, can be a curse or a blessing, depending on how we drill them.

Control over the creation of our beliefs is wielded by anyone with a way to get repeated messages to us; media owners, teachers or our own selves.

Emotions power the drill. Any emotion will work. The stronger the feeling, the more drill power. An ad that annoys you works fine. So does one that’s burns with sex and longing.The bigger the hole in your bucket, the more similar information is allowed in.

We live immersed in repetitive marketing messages. We smell marketing messages when a deep fryer or bread oven vents into the grocery store. Our world of paid advertising drills our holes and hones our beliefs for us.

Here’s something to keep in mind about this head-bucket reality-filter of ours. Each one of us believes that we are more immune than other folks to the big-bucks marketing; too smart, too self-aware or too quick on the mute button to be effected. I thought so, too.

And we may mistake our filter holes for the truth. I have.

People have products to sell.  The people that own the marketing drills sell access to those drills.

We’ve voted away government money for medical research and teaching hospitals. These are now funded with pharmaceutical dollars. Selling out medical research and education to drug companies would be like letting fast food chains feed our kids in school cafeterias or allowing them to pay for our text books. This would create a public health nightmare.

When you talk to a psychiatrist, remember that the high-end drills have been there ahead of you. There may be no hole through his bucket for your shape and size of message. You’ll have to change the shape, size, direction or velocity of your information. It still might not get through.

Please. Remember that you wear a filter-bucket on your head too. Your belief holes were mostly drilled for you by others. Some of the holes in your bucket could be a little off. Mine were. I’m sure that some of mine still are.

How could I not have known?

The real question is: How could I have known?
Related “In the News” Items:
Schizophrenia Outcome Still Better in Developing Countries
DSM-5 Field Trials Fail to Compare New Diagnostic Criteria with DSM-IV Criteria
Incoming APA President Emphasizes “Positive Psychiatry”
Antipsychotic Drugs and Relapse
Weak Field Trials Scuttle DSM-5 Diagnoses
Benzos Quadruple the Risk of Suicide in Schizophrenia
DSM-5 Retreats from Some Controversial Diagnoses
Ethics Complaints Over DSM Filed With the APA

Support MIA

Enjoyed what you just read? Consider a donation to help us continue to produce content, provide up-to-date research news, offer continuing education courses, and continue building a community for exploring alternatives to the current paradigm of mental health. All donations are tax deductible.

$
Select Payment Method
Loading...
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Donation Total: $20.00

308 COMMENTS

  1. I don’t ask this question only of psychiatrists. I also asked it of my family practice doctor for prescribing me the toxic drugs. I also asked myself how I ever allowed myself to be so misinformed and so led by the nose by the drug companies through the media. I became informed through a long and difficult process and finally disabused myself of the myth that these drugs are helpful. For a tiny fraction of people they just may be, but we all know now that they aren’t helpful for most of us. We now know that they cause great harm. People aren’t forced to eat fast food, smoke tobacco, or drive dangerously. These certainly are all choices. For the most part, people in the system are not given the choice as to whether or not they want to take the toxic drugs or not. They are forced by the biopsychiatrists and the courts to shove these things down their throats, all the time knowing how badly they make a person feel, how numb they make us emotionally, how awful they make us feel inside to the point that we kill ourselves to make that feeling stop. People are given no choice nor are most of them given all the facts about the drugs they’re being forced to take. There is no real informed consent; people are just told that they will take these drugs or else they won’t get out of the hospital or they will have someone come to their house and forcibly give them an injection. It goes on and on. So, I do have to ask the question of many people in the system, not just psychiatrists; how did you not know. I didn’t know in the beginning but I became informed. I believe that if you’re going to prescribe these things to people that you have to have researched as well as you possibly can all of the information that’s out there about them and not just what you may want to know or assume about them. I’m not attacking you but I really do want to know and your blog really didn’t answer the question for me. Why are so many professionals, and not just psychiatrists, and the American public, putting their heads in the sand and avoiding the reality of what really is? How could you not have known?

    • I am appalled.

      I understand institutional indoctrination.

      I get a crippled system.

      But, if you have the capacity for critical thought, for independant thinking and fo0llow-up, are you suggesting that med school will not let you in? Or will kick you out, if you ask a truely challenging type of question???

      What, exactly, influenced your prescribing decisions? Being taken to some high-falutin’ free-lunch, by a personnble,attractive drug rep, who told you how great the “newest, whizbang, little blue pill” would cure all the past things that did not work? That the FDA has passed it with flying colors? Didja get some free pens????

      Excuse the vitriol, but it seems I am about to suffer full respiratory collapse – and I will not go to the ER, because my file has a scarlett letter on the front – and I will not be treated for my medical problem. No. I will wait, for hours, and hours, and hours, because I am crazy. Because the big fat scarlett “I” on my file, and I and, “under observation,” because ya know, I guess they will think it is all in my head, and when I decide to leave, I will be tackled, and put in the shit smearing ward. Without my physical medical conerns attended to, until I pass out.
      Prediction based on my past experiences.

      I hope I get my timing right.

      Enjoy your pens.

      • Margaret, I understand your feelings. I had to recently go to a med clinic, well I felt I should, it wasn’t completely necessary. But, I had a cyst, turned out to be a sebaceous cyst on my head. Top of my head. And I couldn’t do head stands, when I did yoga. It says online to put a heating pad on it, and this will melt the hardened wax which the body then can take care of. Either I got impatient or this didn’t help, or maybe I should have started doing that way before the cyst got as big as it was before I did something about it. Anyhow, I went to the med clinic for it, and had it removed.
        This first visit was completely terrifying, because I had to sit there and not know whether I would get into trouble because I’m not on “medications.” And, I actually never worried about this before, but reading all the horrifying stories of people who simply go to emergency and seem too distraught and end up being forced on something that doesn’t help them (and being made ward of the state)…. This is terrifying. http://gaia-health.com/gaia-blog/2012-05-05/psychiatry-loss-of-rights-by-diagnosis/ is just one link. I know dozens of people in the mental health system, and they simply fell into it, and there never really was anything wrong with them, they just fell into it rather than getting true help. There doesn’t seem to be any sense to it other than pretension. I mean, you can misunderstand what someone says (and when there’s gossip around about you this is way to easy to do) and they use it as material to make out that you might get violent. I found out I actually was disassociating from such gossip, and it was confusing me even further. So, I learned to completely disconnect from such people, without any feeling of loss or resentments. I could go on quite a bit with how ridiculous people respond, it’s simply like racism. That person has a genetic flaw and could become violent (same as those people of that race are dangerous or inferior). And I’m quite baffled that the references to Hitler or eugenics, in regards to this aren’t more understood. And it’s none of us wielding the power of the courts to have people force injected, to have them lose their freedoms and to have them lose their health and their life expectancy. One would think that those who do have those powers, when they see they are compared with such behavior in a way that’s not off sync, that they might consider what they do with the power they yield.
        Anyhow, back on track. I was soooo, I mean SoooooooooooooooOOOOOOOO scared sitting having to wait to see the first doctor, just to find out what kind of a bump I actually had on my head. I do A Course in Miracles and had to repeatedly relax myself and repeat over and over that when I allow myself to invest in fear I am investing in it, and as an energy it is a two sided sword and goes both ways: to what I’m scared of and me. I literally was sort of frozen in time even going over what might happen to me and to not to invest in hatred, whatever happened, because I believe that our thoughts were there before time and space, remain free of it, and what happens to us depends on what we think more than anything that’s “objective,” that predictable or not; or even reasonable in many ways. The whole time I was going through this, there was part of me that just simply remained terrified, which is alright I guess, because then I’m at least aware of how much I might allow myself to invest in fear. And now, two years ago, I had fallen and sprained two wrists, and went to the med center to make sure there were no breaks. I can get rather talkative with people behind counters and such, and simply mentioned that I didn’t like doctors, that that’s not where I go for my healing necessarily. Well, this woman I said this to, when I had to walk through the hall her desk was facing to get to another room gave me such a look: squeezing her eyes at me into a pinch determined that there was something there that needed attention. And sure enough, I’m just talking with the man who did the x-rays, which all went smoothly and friendly, and when he went out into the hall for a second, she was asking him: “was he bothering you and stuff a lot?” Well, I hadn’t been, but you never know with these people. Anyone in such a situation and stressed out can get pretty annoyed. Thankfully, I wasn’t. I imagine that this lady could look in her little computer and see that I also have a scarlet I attached to my record and take out her little what’s-wrong-with-people-that-have-this-diagnosis manual and start editing what’s going on as if she’s free to exert her fantasy on reality. All because they can’t sit still and SOMETHING needs to be done about SOMETHING or they’re not able to feel safe about their fantasy anymore.

        Well, I have to tell you that I’ve been blogging here on this site from an asylum, I have to give unspecified favors to an attendant in order to be allowed access to the computer (the only thing that makes me feel normal), and I’m not allowed to use my real name. Apparently this nurse from two years ago knows some people at the med center, and they finally got me. If I am found out I’ll be given a round of shock treatments and force injected for months. In the mean time the bump on my head has gotten to be as big as a marble, and they’ve told me that pills are better than yoga. It’s extremely difficult for me to blog here. I have to quietly repeat what I’ve read, and have devised signals that help me review what I’ve read and how to respond. All this because of the medications preventing me from being able to think clearly. To respond with one post in a coherent manner, something I used to be able to do within a half hour or so, now takes me days of work. I also have to spend time blocking all of the angry thoughts that could be considered personal attacks on psychiatrists, and have acquired a visible twitch from this, or is this because of the medications and I’m projecting, and need to let go?

        Of course, the last paragraph is not factual…..
        The cyst was removed and I can stand on my head again.
        However, the truth doesn’t have to be factual.

        http://www.youtube.com/watch?v=nL6m9dRHteM

      • Margaret, I understand your feelings. I had to recently go to a med clinic, well I felt I should, it wasn’t completely necessary. But, I had a cyst, turned out to be a sebaceous cyst on my head. Top of my head. And I couldn’t do head stands, when I did yoga. It says online to put a heating pad on it, and this will melt the hardened wax which the body then can take care of. Either I got impatient or this didn’t help, or maybe I should have started doing that way before the cyst got as big as it was before I did something about it. Anyhow, I went to the med clinic for it, and had it removed.
        This first visit was completely terrifying, because I had to sit there and not know whether I would get into trouble because I’m not on “medications.” And, I actually never worried about this before, but reading all the horrifying stories of people who simply go to emergency and seem too distraught and end up being forced on something that doesn’t help them (and being made ward of the state)…. This is terrifying. I know dozens of people in the mental health system, and they simply fell into it, and there never really was anything wrong with them, they just fell into it rather than getting true help. There doesn’t seem to be any sense to it other than pretension. I mean, you can misunderstand what someone says (and when there’s gossip around about you this is way to easy to do) and they use it as material to make out that you might get violent. I found out I actually was disassociating from such gossip, and it was confusing me even further. So, I learned to completely disconnect from such people, without any feeling of loss or resentments. I could go on quite a bit with how ridiculous people respond, it’s simply like racism. That person has a genetic flaw and could become violent (same as those people of that race are dangerous or inferior). And I’m quite baffled that the references to Hitler or eugenics, in regards to this aren’t more understood. And it’s none of us wielding the power of the courts to have people force injected, to have them lose their freedoms and to have them lose their health and their life expectancy. One would think that those who do have those powers, when they see they are compared with such behavior in a way that’s not off sync, that they might consider what they do with the power they yield.
        Anyhow, back on track. I was soooo, I mean SoooooooooooooooOOOOOOOO scared sitting having to wait to see the first doctor, just to find out what kind of a bump I actually had on my head. I do A Course in Miracles and had to repeatedly relax myself and repeat over and over that when I allow myself to invest in fear I am investing in it, and as an energy it is a two sided sword and goes both ways: to what I’m scared of and me. I literally was sort of frozen in time even going over what might happen to me and to not to invest in hatred, whatever happened, because I believe that our thoughts were there before time and space, remain free of it, and what happens to us depends on what we think more than anything that’s “objective,” that predictable or not; or even reasonable in many ways. The whole time I was going through this, there was part of me that just simply remained terrified, which is alright I guess, because then I’m at least aware of how much I might allow myself to invest in fear. And now, two years ago, I had fallen and sprained two wrists, and went to the med center to make sure there were no breaks. I can get rather talkative with people behind counters and such, and simply mentioned that I didn’t like doctors, that that’s not where I go for my healing necessarily. Well, this woman I said this to, when I had to walk through the hall her desk was facing to get to another room gave me such a look: squeezing her eyes at me into a pinch determined that there was something there that needed attention. And sure enough, I’m just talking with the man who did the x-rays, which all went smoothly and friendly, and when he went out into the hall for a second, she was asking him: “was he bothering you and stuff a lot?” Well, I hadn’t been, but you never know with these people. Anyone in such a situation and stressed out can get pretty annoyed. Thankfully, I wasn’t. I imagine that this lady could look in her little computer and see that I also have a scarlet I attached to my record and take out her little what’s-wrong-with-people-that-have-this-diagnosis manual and start editing what’s going on as if she’s free to exert her fantasy on reality. All because they can’t sit still and SOMETHING needs to be done about SOMETHING or they’re not able to feel safe about their fantasy anymore.
        Well, I have to tell you that I’ve been blogging here on this site from an asylum, I have to give unspecified favors to an attendant in order to be allowed access to the computer (the only thing that makes me feel normal), and I’m not allowed to use my real name. Apparently this nurse from two years ago knows some people at the med center, and they finally got me. If I am found out I’ll be given a round of shock treatments and force injected for months. In the mean time the bump on my head has gotten to be as big as a marble, and they’ve told me that pills are better than yoga. It’s extremely difficult for me to blog here. I have to quietly repeat what I’ve read, and have devised signals that help me review what I’ve read and how to respond. All this because of the medications preventing me from being able to think clearly. To respond with one post in a coherent manner, something I used to be able to do within a half hour or so, now takes me days of work. I also have to spend time blocking all of the angry thoughts that could be considered personal attacks on psychiatrists, and have acquired a visible twitch from this, or is this because of the medications and I’m projecting, and need to let go?
        Of course, the last paragraph is not factual…..
        The cyst was removed and I can stand on my head again.
        However, the truth doesn’t have to be factual.
        http://www.youtube.com/watch?v=nL6m9dRHteM

  2. I have asked myself more than once those questions since 2008 when I became directly involved with psychiatry. Before then I thought: psychiatrists are doctors, intelligent, well-educated people, they want to help people in distress they know what they were doing etc. Reality hit me straight in the face when they nearly killed my son with their antipsychotic medication and I thought then all the doctors had gone mad. How could that have happened?
    Firstly, the doctors I had to deal with, didn’t know how to listen, they didn’t have time for it.They thought they knew better than I what had happened.
    Secondly they all had been taught the same thing at medical school and instead of being open-minded and using their common-sense they religeously and blindly sang from the same hymn sheet. They were so endoctrinated that they were unable to think out of the box. What I was telling them just didn’t make sense to them, so they changed my story to fit their own beliefs. I suppose when you go to medical school, you expect to be taught things that have been proven to be true.
    Thirdly, at least here in Britain, once out of hospital the Hospital consultant psychiatrist doesn’t see you anymore. There is no continuity in care. He doesn’t see the ugly side of the medication he has put you on. The GP is the one who is supposed to deal with your side effects and, in reality, hasn’t much of a clue how to; nor how to get you off those antipsychotics safely either. Meanwhile the psychiatrist working on the ward gets the impression that there are no side effects to speak of to their precious medication and continues to live in blissful ignorance. I hope things have changed since 2008 although I read now and then articles which make my mind boggle Some psychiatrists are still burbling on in the same old way.

    • I think you’ve stated the existing problem very well. Many of the psychiatrists refuse to listen to what anyone has to say, especially the person experiencing the mental and emotional anguish. They fail to remember that every morning they put their pants on one leg at a time, or their skirt or dress on one leg at a time (I have no idea since I’ve never worn a skirt or dress but whatever), just like all the rest of us. They refuse to acknowledge that the person they’re dealing with is the only real “expert” on their own life. I suspect that a lot of this comes from the fact that many of them consider the people they’re working with to be less than they are. I was actually sitting with a person being admitted to the state hospital where I work who made the mistake of telling the psychiatrist who was going to be their doctor on the unit that he didn’t like or appreciate what the doctor had just said. That psychiatrist yelled, “I don’t care what you like or appreciate!” And because he was the psychiatrist his behavior was concered acceptable. If I’d done the same thing as the psychiatrist I would be fired on the spot because my behavior would be called disrespectful and less than acceptable. Thanks for your posts.

  3. I think subsuming the question, “how could psychiatrists not have known,” into “how could any person not have known,” misses a big point. Psychiatrists are of course not immune to all sorts of the biases that any person experiences, but they are trained and expected to investigate and check their biases. One way people have learned to do that is to use scientific methodology critically to examine assumed causation/associations and make changes to protocols and investigate further when data suggests inconclusiveness or surprising findings. As you say, the public failed to fund teaching and research (I certainly agree), funding was replaced by industry funding, and then science was biased by industry motives, I still don’t buy that doctoral level clinician scientists (as psychiatrists are and a designation from which they exert a lot of influence) cannot critically investigate strange research methodology and conclusions that are not based what data suggest. I suppose many did not question because they were so excited by false findings, some really do not have the research skills/interest to even effectively review published literature, and some were not willing to rock establishments in fear of losing jobs, prestige, sense of helpfulness/purpose, and income. These are all understandable (though sad) possibilities really based on everyone’s unjustified trust in medicine, people who practice medicine, the scientific knowledge production and dissemination process as it stand today. I’ve written more about the failures of medicine, government, and the public in regards to the acceptance of bad science here: http://thoughtbroadcast.com/2012/02/09/measuring-the-immeasurable/#comment-3696

    These elaborations on your two questions ultimately fail to answer what I think is are more pressing and useful questions now. Instead of focusing on why psychiatrists didn’t know about harms of their practices, we can look to the present. What do psychiatrists know now? If they know of harms, shoddy science, poor efficacy, and large cost of their treatments, what are they going to do about it? Are they going to change their practices in anyway? Are they going to do better science?(DSM5 field trial data points to terrible methodology and poorly written diagnostic criteria that many agree would lead to greater exposure to harmful treatments that lack reasonable benfits/risks ratios.) Should people seeking support for distress trust psychiatrists/medicine? What would make psychiatrists more trustworthy?

    These questions concern me more at this point, and I have not really seen much answers to these anywhere.

    • I agree that “subsuming the question, ‘how could psychiatrists not have known,’ into ‘how could any person not have known,” misses a big point. Psychiatrists should know becuase these drugs are the tools of their trade and they have a professional responsibility to know what the drugs they give people actually do. The avergae person on the street doesn’t have thta same responsibility.

  4. When taking at face value the studies done by pharmaceutical companies, those studies from the last 30 years showed that most psychotropic drugs would usually only help 10-20% of the patients. Where or by who did that conclusion from pharma studies got distorted into: “a common problem with mental treatment is patient compliance” and “mental illness is easily treatable with drugs”, while doctors were provided repeated evidence by pharma itself in each of their studies that 80% of drug patients would only get side-effects.

    I wonder if you could be more specific about what doctors in general don’t know or don’t say:
    – doctors don’t know numbers-needed-to-treat of the drugs they are using? (or similar effectiveness numbers)?
    – doctors don’t think the patient should know about the trade-off/uncertainties involved in their treatment, or have a say in choosing their treatment?

    I do believe most doctors are genuinely caring (and they have a long scientific training), which is why I would be curious to more precisely identify the mechanisms where information got lost/distorted after being published in medical journals (whether the published information was correct or incomplete or manipulated is another question, I am mostly concerned that the results of medical journals does not match what is told to patients). Should we teach more math in high-school, in medical school?

  5. this is an interesting metaphor Alice and I am sure it will generate lots of comments!
    I am not a psychiatrist but am a Master’s level ‘clinician’ with decades of experience in the mental health ‘system’. i’ve only recently (in the past 10 years) had the courage/maturity to really question the ‘status quo’ within the system. I’m one of those who used to believe the ‘schizophrenia is like diabetes’ mantra simply because that is what i was taught/told and almost everyone used THAT metaphor as a means to convince people to take their medications!! I have guilt about being so UNinformed but am also mindful of how difficult it is to change popular beliefs and/or long held understandings of things.
    i love this quote as I think it sums up some of our human experience and may explain a bit of why we sometimes have our head in the sand!
    “It’s what we think we know that keeps us from learning” (Claude Bernard)

  6. It is about marketing being given more money than science. The science has said that good social support is more important than any drug and that horrible, scary things drive people mad. But marketing dressed up as science is what has driven this.

    It took me a long time to have faith in what I believe, that the drugs cause more harm than good in most cases and that what people need is social support. I had to do a lot of reading, go to a lot of conferences and check all this out with my own personal experiences of talking to people in distress and seeing what helped along with looking at my own life before I could sally forth into public debate with confidence.

    I was lucky, I had some training and some experience and I had read a bit before I met my first seriously mad person and found out that compassionate understanding worked and it was obvious that the drugs did not. An awful lot of those Dr’s and other staff have been taught that it is dangerous to offer compassionate understanding to people hear voices or are experiencing things that might get them diagnosis of schizophrenia or bipolar. So they never see the things that counter what they have been taught at college, got employed to do and hear all around them at work. that is an awful lot of indoctrination that would need to be countered to change most professionals minds.

    That is why I think this is not a one at a time sort of struggle. It is about being organised, finding allies and working out what small or big thing can groups of people do to challenge big pharma and mainstream psychiatry.

  7. One of the last forms of authority which remains largely unchallenged and unquestioned is medical authority of any kind, no matter what the speciality. Psychiatrists don’t really get a lot of specific training anymore, since psychotherapy is out of favor. They’re basically taught that the meds are great and how to use the DSM. I’m not a psychiatrist, but in talking with a number of interns and residents, this seems to be the gist of their training for psychiatry. It’s really kind of frightening to me how uninformed they are about so many things. However, I don’t think this absolves them from doing their own research and questioning and digging into things to see what really is going on and what really happens. Let’s face it, they’re not trained to question much of anything and if and when they do they get the boom lowered on them. If they continue to question, they don’t go very far in the profession. However, once again I will say that I don’t believe that this absolves them from trying to know more. After all, they have people’s lives in their hands and are responsible for their well being. Many of them are not doing a very good job at all this at this point in time.

  8. Your bucket analogy is just like how cells in the body work. The “holes” are specially designed to let the right “signals” in and keep out the wrong signals. Nature is exquisite in that sort of design, refined over eons.

    So, given the analogy, and that the metaphor is actually working the way it should… what’s missing? Are we drilling the wrong holes? Maybe we should put the drill down, and leave Nature’s own holes be… learn to use the perfection of what we are/have?

    Or are we just mis-feeding the bucket… or we’re starving and will let any nutrition in, even if it’s killing us (like drinking salt water when adrift in the ocean).

    How can we create a nutritious environment for our buckets? And how can we clean our buckets of all the crap stuck in some of our holes? Bless and release it, so to speak. We do this on a cellular level when we release trauma. How can we do that on a mental level, too?

    Keep writing, m’dear!

  9. Alice you could have known the same way many of us have known for decades- by taking seriously the warnings of fellow psychiatrists like Jung, Perry, Laing, Menninger, Mosher, Silverman, Szasz, Breggin, Dan Fisher, Peter Statsny David Healy and many more. Why did you ignore tiheir clear warnings?

    • Perhaps, Michael, in the case of Laing and Mosher at least, the part of the warning that some heed is that they died frustrated and at least a little bitter. Sure; they had the satisfaction of seeing the beauty of their beliefs realized for a time, but frustrated at the reception they were met with moving forward.
      Szasz, as lauded as he is by us, is a pariah in his profession. Healy is a pariah even on this website. Stastny soldiers on, and I won’t speak for him, but I know it’s not easy. It’s a lot to ask someone to take on the mantle of the people you mention. It’s no mean task. To create a space where the kind of work their beliefs imply is embraced and sustainable is almost a magic trick. Dan Edmunds wrote today (in a response to a query on his blog) about his short-lived therapeutic community running out of funds, and sustaining his med-free clinic out of book sales and his own personal investment.
      Dan Fisher, coming from the “peer” side of things, finds brilliant ways to mobilize that interest; but as for creating services for people who are not yet identified or don’t wish to be identified as part of the “peer” movement; if you charge enough for it to be sustainable in a system that won’t support it, you are pilloried as mercenary by the people you need as allies. And everybody arrives at the door exhausted of spirit and treasure by the system we decry, asking to have the wrongs righted without having to spend more.
      So maybe it’s a matter of which warning people heed at a given time. How many times, and how hard, do we expect any one person to beat their head against a wall? I know beautifully intended, spiritual and holistically-minded people who went to psychiatrist school to be one of the ones who changed things, only to emerge beaten and bedraggled, with kids to feed and educate, and little margin left. Their spirit may be willing, but their too, too solid flesh is weak.
      I say this, Michael, as you know, as someone who is wont to dive in heedlessly if there’s a chance of making good on the promise of the names you mention. But I am not constrained by college debt or the potential loss of a license, tenure, the kids’ college fund, or anyone’s respect. What I lack in stature I make up for in stealth.
      Even so I have empathy for people who have something to lose. I (and many others, yourself included, I believe) really appreciate Alice putting herself and her process out on this website. To suffer the slings and arrows of outrageous criticism, standing out in the open with a bucket on her head, deserves a moment of appreciation.

      • Kermit, I’m responding to Alice’s archetypal question that is haunting a vast number of psychiatrists today. It is a core question now, because of the looming judgement of psychiatrists in the court of public opinion that has been greatly stimulated by Bob’s- “Anatomy of an Epidemic.”

        Alice’s question- “How could I have known?” has prompted me to attempt to answer it.

        The question is one that may be heard asked by a psychiatrist in a court room, if it hasn’t been heard already.

        I have a friend who is a very caring child psychiatrist who I can imagine might be having a recurrent nightmare that she wakss up from in a cold sweat. In the dream she is in court, standing before a judge, trying to explain to him why it is not her fault that the psych drugs she has been prescribing have caused one 8 year old child to hang himself, a toddler to have died of an overdose by negligent parents trying to get her to be quiet so they can sleep, and the third, a teen boy on Prozac who stabbed and killed his best friend.

        As you know, all of these tragic deaths really have recently happened, and the courts have ruled that psych drugs were a factor or fully responsible. Psychiatrists have been punished.

        The handwriting is on the wall. I have a friend who has decades of experience as an advocacy lawyer who predicts it is only a matter of time until the Justice department escalates it’s oversight of the dangers of psych drugs, given the recent huge J&J Risperdal settlement.

        He ststes clearly that many of the practics of psychiatry, such as the wholesale drugging of toddlers and children, ECT of children and forced ECT and meds on adults,- all qualify as human rights abuses.

        MIA blogger Jim Gottstein says they are human rights violations too.

        I believe that more psychiatrists are heading to court and the defense of-
        “I was only doing what the APA guidlines and the drug label warnings said was OK,- this child’s death is not not my fault!”- has already proven to be a losing defense.

        • The Nazia on trial at Nuremburg tried the old,”I was only following orders” plea and it fell on deaf ears all the way around. They were hung by the neck until dead. As a nursing home chaplain I got the wonderful and great privilege of ministering to one of the lawyers who tried the Nazis at Nuremburg. I doubt that he would let psychiatrist escape if they tried this excuse on him!

      • Alice gets more than a moment of appreciation from me Kermit, and already has in other posts- I admire her courage and caring heart a great deal. As they say where I’m from- “I’d share a foxhiole with her anytime!” meaning I count her as a comtade in the struggle.

        And when she asks a serious question of us like-“How could I have known?” I believe it deserves an honest answer – for what ever my answer may be worth.

        • It is probably easier to see the errors of psychiatry if you have had a breakdown yourself at some time in your life and recovered. The fact that I had had one myself helped me to stand up to my son’s psychiatrists who thought they knew it all

  10. This raises another interesting question: are doctors scientists? Someone commented that doctors have a lot of training in science. I’d have to say that I question that to a degree. I think doctors have a lot of training in the conclusions of prior scientists, but not necessarily so much in how to conduct their own experiments. It seems to be more a matter of the current orthodoxy spreading their views and expecting their trainees to jump on board. Real science is about skepticism, about questioning your own conclusions, about always seeking to know more and to see things differently. Something is regarded as “true” only when it’s been rigorously tested, including rigorous attempts to find a flaw or contradiction or a better explanation that fits the facts.

    It is obvious that psychiatry as a discipline does not apply this kind of rigorous scientific training to their concepts. The whole idea of a “chemical imbalance” has apparently been solidly disproven, at least as far as serotonin for depression or dopamine for psychosis, as early as the mid-1980s. But rather than reconsider their paradigm, they have chosen to bury this information or state that “further research will validate our theories.” Same with the long-term outcomes for stimulants. It’s been known since the 80s that there is no long term benefit for stimulant-treated “ADHD” kids. But the statement is always, “We have not yet demonstrated a long-term effect.” Well, if you haven’t demonstrated one, from a real scientist’s point of view, we have to assume there is no effect until proven otherwise.

    The point of science is to remove the bucket. I think the analogy is very appropriate, and I am glad Dr. Keys has gotten hers off of her head. But most of psychiatry is very attached to their particular brand of bucket and are not really looking at the science. I think they call the DSM the “psychiatric Bible” for a good reason – there is a lot more in common with religion than with science.

    The assumption that all doctors are scientists is one that we can no longer afford to make. It would appear that most of them are neither skeptical nor open-minded and are married to their theories. Understanding that may be critical to your survival!

    By the way, I so appreciate Dr. Keys’ candor and personal vulnerability in posting here. So I’d like to respectfully ask you a question: if the bucket is the problem, what do you suggest is the best way to remove the bucket from the heads of those who seem to believe their particular bucket encompasses all of the reality they are willing to experience?

    —-Steve

    • I mentioned that psychiatrists are considered doctoral level clinician scientists. I think given their actual training and how many psychiatrists practice, I don’t think psychiatrists are particularly well trained in research methodology and critically engaging the scientific literature (particular in psychological/behavioral sciences). I think doctors are given a lot of deference for their supposed scientific knowledge. In some ways this esteem/prestige afforded doctors helps in healing processes due to enhancing placebo, but ultimately it undermines quality science, gives doctors inflated senses of power/helpfulness, and disempowers/dupes patients who are taught/expect to trust physicians. Psychiatrists have a limited quality evidence base to draw from in regards to effectively explaining and alleviating distress, but that does not stop them from having several elaborate fictions and unsubstantiated theories of etiology and overconfidence in treatment methods available.

  11. Alice, Thanks for a great post. I want to say I really respect and value your writing this blog. Not everyone has the guts.

    And it’s exactly like you say: we’re all wearing a bucket. Society-sized ones, too. In hindsight, it’s easy to say we should have known, but how could we have? We knew the scientific literature. I can’t see what else a psychiatrist or anyone (other than a cutting-edge researcher) could reasonably be expected to have done other than looked at the relevant scientific literature. Nobody assumed the system could be so corrupted you couldn’t trust the big picture in the peer-reviewed literature. So now it turns out we really should have — but at the same time, it really is insane.

    So a huge thank you, Alice, for doing this. I’m not a psychiatrist, but you make me feel I’m not all alone. I had no idea either, and we’re all in this mess together.

    • It isn’t only about being misinformed by the relevant scientific literature but rather the “turn a blind eye” approach of ignoring the obvious signs of the severe side effects caused by psychopharmacology. Where does the research literature state that stimulant medication to treat ADHD can cause the “unmasking” of early onset bipolar? It doesn’t but that is the myth generated by the psychiatric community. Set the record straight instead of making excuses!

    • I don’t have any training at all in medicine. I taught myself to read studies in psychiatry, through PubMed and a medical dictionary.

      It wasn’t too long before I realized the medical literature was total nonsense. Many of the studies defy their own internal logic. Conclusions are presented that are not supported by their own data!

      It became very obvious to me that much “research” in psychiatry was nothing but infomercials.

      It’s hard for me to understand why an MD could not see that the research is garbage. Anosognosia?

  12. It’s every professional’s responsibility to identify and admit the liabilities and limitations of his/her ‘knowledge’. As an ex-patient I can say, “We don’t know for sure…here are some possibilities” would have gone a long way. Doctors only needed to admit that they practice in a field of study which, like all other fields of study, has ALWAYS discovered and revised its narrative, dispensing old “truths” and inventing new ones.

    It’s unbelieveable how many times I was told, “your medications could not possibly cause ‘a’, ‘b’ and ‘c” but depression, fibromyalga and chronic fatigue syndrome do…so…here are more medications, and try some ritalin to keep you awake.”

    Peoples’ lives have been forever changed while doctors cashed their checks. Psychiatric survivors live with damaged brains and bodies. Many must wake up every day knowing that years of our lives have been lost to bad medicine. So, quite honestly, I feel okay with doctors working through a little guilt.

    I must say, it’s maddening that you recruit sympathy on this site, and liken yourself to the patient. I have worked hard in life, personally and professionally, to listen to people, to connect with them, to investigate truth, to be honest about what I know and what I don’t. I work hard to look beyond the simple answer and its promised shiny object. It’s a decision.

  13. Recently, a psychiatrist in Vancouver, BC spoke at a conference for families of people diagnosed with schizophrenia. She told the audience that since having her own son diagnosed with schizophrenia, she has learned that the meds don’t work for him and have done him harm. This has led her to change her practice: she tries to listen to her patients as if they were equals in their knowledge about their “symptoms” and she no longer encourages meds.

    Is that what it takes? If so, shame on doctors for not exercising their powers of observation, smarts and compassion when treating other people’s sons and daughters; for not reading the lists of conflicts of interest on research articles (or reading about the subject at all?); for missing the inequality built into the psy doc and patient and “consummer” relationship.

    Usually, when I hear the other person’s side I can get it. But this I really don’t get. My only other encounter with this degree of bucket blinders has been in conservative religion amongst male leaders granted special authoritarian status they and their communities believe to be bestowed by god. It’s pretty dangerous for lay people. Especially the kids.

  14. Alice,

    Thank you for this very thought provoking post.

    As with some of the other comments here, whilst I think society overall does need to re-think their “buckets”, the onus to remain objective and *know* what they’re talking about surely lies on the professionals who insist that they alone have the answers, due to their specialist training and knowledge.

    My experience of the psychiatric profession was one of blinkered thinking on the part of Doctors, and an automatic dismissal that anyone (myself, my family or my friends) could possibly know the reasons behind my distress, let alone how best to treat it.

    I was repeatedly told that I had to be on medication “for the long term, if not for the rest of (my) life”. On the basis, that my depression is caused by chemical imbalances in the brain, and like a diabetic, I need antidepressants, just like a diabetic needs insulin. A profession on my part of faith that this was correct, was pretty much a condition of my discharge from hospital.

    If clinicians are going to be afforded such spectacular powers over fellow human beings, to curtail their human rights and deprive them of their liberty – they owe people like me a duty to actually *know* what they’re talking about. In other words, if they don’t really know the answers or the causes, then they have no legitimate authority for locking people up on the pretext that it’s for their own good.

    Everyone has their own buckets. But the entire concept of being a specialist profession, is that you learn how to discard/see through it. To date, I don’t see that psychiatry as a whole has any interest in doing so.

  15. Hmm … Thanks, Alice, for another thoughtful piece.

    As to many of the commenter/responders … I think we give too much credit to ‘science’, and are still, collectively, prisoners of the Enlightenment.

    In the realm of social interactions, there is actually very little ‘science’ worthy of the name. And for all sorts of reasons, good, bad, and indifferent.

    It is very difficult to get ‘gold standard’ studies in medicine (or any other human field) for ethical and other reasons. It is very difficult, even today, to get truly ‘randomized’ trials, much less double-blind, for what should be obvious reasons. Many health professionals already have their own practices and experiences, which suggest to them one or another ‘treatment’ is worthwhile, and so do many patients. Neither professionals nor patients wish to be ‘blinded’ or ‘randomized.’

    Hence, regardless of good faith, very difficult to get decent studies of large enough size to generalize. Compounding this is our general impatience – we want results sooner rather than later. For many treatments and procedures, we simply -cannot- know long term effects until … the long term. This means if a drug or other treatment hasn’t been around at least 40-50 years, we simply -cannot- know the full range of effects.

    This is why it is generally estimated that LESS THAN HALF of all medical treatments do not have any scientific evidence to back them up.

    This is 1 reason why, with different testing standards in Europe, far fewer new drugs get developed & approved than in the US.

    This will come as a shock to many here in the US, as evidence-based evaluations are underway in a more meaningful way – I expect many standard treatments to come under criticism, and if we stick to our guns & insist that we not require insurance to pay for undocumented procedures, we will have far fewer treatments done.

    The shock will be that – as with many of us – we want health professionals to ‘do something’ to help. The answer much of the time really is ‘we don’t know, in a scientific way, what might or might not help.’ And many of us – patients & professionals – really don’t like that answer. We -want- to ‘do’ something.

    And so, we do the best we can with the information then available. Even if some have questioned any particular drug, or treatment, the -fact- is, there is very little science to back up a ‘one-size-fits-all’ approach. Numerous studies suggest that for many people, some drugs and some talk-type therapy is most effective. For some, just drugs are best. For others, just talk-therapy is good. And for some, sad to say, none of the above.

    No doubt we all know 1 or more friends or family who have tried numerous drugs, various counselors, etc., and nothing has seemed to work. This is true in physical medicine as well.

    Hence, in a very real sense, actually -no one- can know, for sure, whether or not any particular approach, medical or otherwise, might or might not work.

    From a scientific viewpoint, we are all guinea pigs for any particular approach, with a sample size of 1.

    • That is why there should be a dialogue between doctor and “patient” and the” patient” should have the ultimate say in what is going to happen to him/her. There should be trust and openness and not condescension, half-truths or downright lies as it so often happens. Maybe these things should also be taught in medical school.

  16. Great post, Dr Keys, and great responses by all.

    However, as a young psychiatrist, I would take issue with one statement: “When you talk to a psychiatrist, remember that the high-end drills have been there ahead of you. There may be no hole through his bucket for your shape and size of message.”

    This may be true for many psychiatrists (or, to Stephen Boren’s point, to most doctors of any specialty), but NOT for those of us who are just starting our careers. We, for the most part, have not been corrupted by drug-company money (although our teachers have, to be sure). We’re also, in general, idealistic enough to try to do the right thing by our patients. We’re also closer to our college stats & psychology coursework to know unreliable diagnoses when we see them!

    The problem is, psychiatric specialty education is a funnel or blender (or maybe a woodchipper is a better metaphor?) which takes brilliant, engaged minds and processes them into bland automatons on the other end. And our job prospects bear that out: most jobs just want us to prescribe, while keeping people dependent on us and our system.

    [In the interest of full disclosure, I’m searching for psych jobs right now so I see the employment landscape first-hand. Also, I’m on my way home from the annual APA conference, where I’ve unfortunately been surrounded by bucketheads all week.]

  17. Alice, I’m very disappointed in your post and your rationalizations about the responsibility of individual psychiatrists.

    There are only a few dozen drugs in the psychiatrist’s armamentum. Most psychiatrists have their favorites and prescribe the same few drugs day in and day out, all day long. The least they could do is be knowledgeable about them.

    Adverse effects of the drugs are described in the package insert, in the PDR, on countless Web sites, and in FDA bulletins. There’s no excuse for specialists not to know about them.

    Psychiatrists, particularly those who call themselves psychopharmacologists, tend to be quite arrogant about their expertise in medication. Yes, I am generalizing. It’s a rare psychiatrist who admits we really don’t know much about these drugs and what they do. It’s a rare psychiatrist who admits he or she has harmed a patient.

    “There may be no hole through his bucket for your shape and size of message” — you mean no shape for a patient’s report of an adverse effect? Must be that doctor never expected to talk to a patient.

    It’s the psychiatrist’s business to know about the adverse effects of the drugs that are his or her bread and butter. Yet something other than patient safety has been made more important to the psychiatrist. Perhaps you can consider what that might be.

    Personally, I am unmoved by the argument that psychiatrists have their heads in buckets like everyone else. They are not like everyone else. Psychiatric training is supposed to enhance cognition regarding human behavior. Given this enhanced understanding, psychiatrists presume to not only pass judgment on the emotional, behavioral, and moral fitness of others but to remodel their brains by any means necessary.

    Oh, psychiatrists have their heads up very special buckets, all right.

    • A few years ago, I wrote (for my own enjoyment) a “Patient’s Bill of Rights,” one item of which was a statement that each patient deserves to know the precise (or presumed) mechanism by which each drug will help his/her condition. I never used it or distributed it because it seemed sort of pretentious– like “I know how these meds work and other docs don’t”– but I’ve come to realize that if we doctors actually stop to THINK about what we’re doing and why, the practice of psychiatry might look very, very different.

      • Steve Balt has approvingly linked to E. Fuller Torrey pro forced drugging propaganda on his blog (scroll down this page).

        I would ask Steve Balt if he is in favor of forced drugging and laws that allow us to be forcibly drugged in our own homes ie Laura’s Law.

      • Dr. Steve, even if patients knew the precise mechamisms how drugs work (and we don’t know those), it still would not answer why someone is distressed/impaired (mechanisms of psychopathology). Giving mechanisms of action for drugs to patients that imply unsubstantiated etiologies of pathologies is misleading. Also, as you say, it makes doctors seem pretentious in that they act is if they know what is actually hapenning (without doing any tests to confirm drugs or psychosocial interventions are “fixing” or changing “diseased” neurobiochemical mechanisms).

        If anything, doctors can only inform people (and themselves) of outcome literature: the likelihood and extent that an intervention will provide relief/help beyond placebo, and a description, likelihood, and extent of known risks, and disclosure that many risks are not yet known. Focus on pathoetiology and mechanisms of treatment are at this point unfortunately primitive and underdeveloped at best and downright fictitious and misleading at worst. A big, honest “I don’t know” related to these issues would be welcome by many until you know more. Until then, stick to the limits of knowledge that you have, outcome data of a range of quality from which to discern value of treatments beyond risk.

        • This is what I was told, about drugs as well as ECT, “We don’t know how it works, we just know that it DOES work for many people.”
          They went on to say, “otherwise you’re a hopeless case and you’ll never amount to anything.”

          Akathisia, the TORTURE side effect was dismissed with equal aplomb. I might as well have been an annoying gnat.

          And like I said in another post about TD, don’t worry, the benefits outweigh the risk.

          That line is also used in regard to other drugs, such as all the current fads of cholesterol lowering drugs, HRT until about six years ago, cox2 inhibitors, the list goes on and on, until the patent runs out and the lawsuits are settled.

          It’s not just psychiatry.

    • Altostrata,

      Well said! I am still too wounded and angry from 15 years of harmful psychiatric care to engage psychiatrists directly but I am hoping to heal enough to do so. In the meantime I am grateful to you for putting so many of my reactions to Alice’s piece into words.

      Thank you,

      Sonia

    • AltoStrata, I have your read your commentary and visited your site and I would like to thank you for the daily efforts you make in educating and assisting those of us who are struggling through the nightmare that is SSRI withdrawal.

      Speaking as someone who is now on her third attempt in six years to free body and soul from the debilitating effects of these poison pills (without wreaking further havoc on my professional and personal life), I completely empathize with the impatience and frustration that you feel for those in the medical profession who profess ignorance around the effects of these medications.

      In the past year I was lucky enough to finally find an M.D. who recognized that I should have never been “medicated” in response to normal feelings of depression that resulted from a traumatic life event and who has been and continues to be very kind and and supportive in assisting me through the titration process (now down to 36.7 at the rate of 0.05 mg. a day–yippee!). She told me that despite the fact that anyone who has picked up a newspaper in the past five years would know of the dangers of SSRI “discontinuation syndrome” she is alarmed by the number of doctors in her professional sphere who continue to willfully deny both the side effects of these drugs and the illness that so often results from withdrawal.

      Dr. Keys may think that you come at the sorry state of affairs of psychiatry/big pharma with a big stick Altostrata, but we are dealing with a big, ugly problem and sometimes anger/passion/persistence is the impetus needed to push for reform. Most game changing activism and advocacy has grown out of feelings of disgust and disillusionment with broken systems. In any case, I personally don’t view your commentary as angry, simply a logical, rational response to illogical, irrational behavior.

      While it may be very difficult for a psychiatrist to come to terms with the fact that his or her profession has greatly contributed to the mental and physical harm of many women, men and children, those feelings of embarrassment or shame or guilt can surely be managed far more easily than the daily debilitating and sometimes life destroying effects experienced by those of us who have erroneously been prescribed psych meds. If we as “patients” can slog through the muck that has been made of our lives and find the strength to start over, I’m hoping that the best of the M.D.’s can step up, remove “the bucket”, and do the same. There are exceptional people in every profession and far better to work towards being an exception than to keep your head in the bucket and maintain the rule.

      For a concrete example of game changing real life action, for those psychiatrists who wonder how to begin again and move away from the med model, over half of my doctor’s practice is comprised of patients she helps to get off of medication. She is also studying for additional certification in integrative medicine so that she can better evaluate for nutritional deficiencies that can contribute to poor mental health.

      Back to my original point, again, Altostrata, I thank you and I thank Mr. Whitaker for turning on the high beams and shining a light of the road to freedom and recovery. One day at a time, one step at a time.

      cheers,

      Ruby

      • Thanks very much, Ruby.

        Your doctor sounds like one of the rare ones! A .05mg decrease per day to protect your nervous system is very, very enlightened. (We call this a micro-taper.)

        I’d very much like your doctor’s contact info. You can write me at survivingads at comcast dot net.

        • Altostrata,

          Yes with the help of a steady hand on the syringe and the support of methylated folate 5-htp and fish oils I’ve found that the 0.05 micro-taper is the least life disrupting of the methods that I’ve tried. Cold turkey and the mega and medium tapers were a train wreck for me and I honestly thought I would never, ever get off of this drug. It’s a slow process and on those days that I feel especially well I reduce by 0.1 but that’s the maximum that my poor receptors can tolerate without bringing on the brain zaps, dizzyness, nausea and huge mood swings. It will take me more than a year to be drug free at this rate but I feel this is my best chance for success and I’m grateful to have found something that works for me. Little by little I feel my health is being restored–no more massive bruises on my arms and legs, no more rashes on my back, my metabolism is slowly returning to normal, I can finally sleep again and I’m starting to feel more like the me I recognize instead of the agitated, hollow shell that I and those close to me came to know as SSRI v.1 zombie person. What a long, strange trip it’s been! One thing I’m certain of at this point, if I can survive the effects of this drug I can survive anything that life throws my way without the assistance of medication.

          I’m sure my doctor would be an excellent resource for you. I’d like to phone her first and let her know of your interest in case she gets inundated with calls and wonders where they are coming from. I’ll be in touch soon.

          Best regards,

          Ruby

          • Ruby, you sound like my psychic twin.

            That’s exactly how it is. Our nervous systems become sensitized by these drugs, and can tolerate only incredibly small decreases in dosages. (Right now, I’m tapering Lamictal by .01mg every 4-5 days, and I still feel it.)

            Your doctor is brilliant. I would like to correspond with her, if possible. Please give her my regards.

            PS If you have a chance, please visit my site and post your story here http://tinyurl.com/3o4k3j5

            One of the purposes of the site is to document the need for individualized tapering.

  18. Alice,

    I agree we filter our thoughts and feelings through our experiences, and none of us is unbiased. I also agree that we are all human, and it hurts us all when any individual or group is treated as “other” – as you say, we have more in common than not in common.

    But there are important differences between psychiatry and others in “mental health” – in who did the drilling in their buckets, where they chose to drill, and what’s needed to change psychiatry’s buckets. Not facing these differences will defeat any effort to fix the drug problem.

    Psychiatrists are the most thoroughly indoctrinated in PhARMA’s and bio-psychiatry’s myths. It’s virtually impossible to join your profession (or remain in it) without “going along” with the myths of medication. That is not nearly as true of social workers, LCPC’s or PhD psychologists – it is becoming more true these days of us too, but it certainly wasn’t 16 years ago when I got my MSW, and it’s still strongest in psychiatry. Think Loren Mosher, Peter Breggin, Grace Jackson.

    For decades, the smartest people in psychiatry have not even been psychiatrists. They have been PhARMA executives and marketing strategists. They have a strangle hold on psychiatry, in subtle and blatant ways saying, “Do it our way or lose your income.” Read Healy’s Pharmageddon, pp. 224 – 228: he was present at a meeting when the Royal College of Psychiatrists considered putting up “firewalls against pharmaceutical influence.” Healy reports this from a PhARMA rep who was there:

    “”When it came to issues like our asking for the data from clinical trials, (the most senior figures in British medicine) would not be putting their knighthoods on the line to insist upon access to raw data … Within academic psychiatry alone, he went on, there were twenty-five senior figures in Britain each earning in excess of $200,000 a year out of links with industry… And finally, we clinicians all needed to note that 40 percent of British life insurance policies were invested in the pharmaceutical industry. Whether we liked it or not, we were shareholders in the industry, and rocking the boat would not be in our interest.”

    PhARMA has for decades been one of the top two most profitable industries in the world. They have the largest lobbying force in the U.S. – more than one lobbyist for each member of Congress; they pay 40% of the FDA’s drug approval budget; they fund about 80% of all research; they track the prescribing practices of every doctor in the U.S.. They spend $40 billion a year on research, and $60 billion on “promotion.” Their detectives dig up dirt on those who oppose them (at least if they seriously get in PhARMA’s hair); they are ruthless and overwhelming in legal battles (think the Wesbecker case); U.S. psychiatry’s enmeshment with PhARMA make’s England’s look like child’s play (think Martin Keller’s $800,000/year income from PhARMA and Study 329).

    In short – Theodore Dreiser (I think) said something like, “It’s hard to get a man (woman too, of course) to understand something when his (her) job depends on his (her) not understanding it.” Psychiatry, far more than other “mental health” professions, is in that position. That needs to be acknowledged before real progress is possible.

    I am not a defeatist. I have spent decades as a community organizer and, later, as a guerrilla resister to the excesses of the “mental health system.” I think we first need to change your bucket analogy, which is still in line with bio-psychiatry’s fatalistic orientation. It seems to assume we start out dense and our learning largely depends on others drilling holes in toward us.

    We are eminently social beings, and other people are key to our development. But I see the bucket another way: We are born with minds wonderfully open to all kinds of information and feelings, eager and able to learn and grow. It is our exposure to the pain, anger and limitations of the adult world that begins to construct the bucket. Adults do build bridges to us too, but they also force us to shut down large areas of our understanding in order to survive in the world they inherited and constructed.

    The struggling adults around us started out like we did. But they inherited the struggle of our species – the only species that came into this world really physically unfit to survive on instinct alone, and needing to develop our intelligence to flourish. That is a huge task – just think – in all human history, it’s only been 130 years since we learned bacteria cause infection; the average life span in ancient Greece was just 35 years. Now, in some parts of the world, large numbers of us are born into physical and cultural environments where the fine tuning our minds crave and need is a realistic possibility.

    We come by our painful inheritance honestly. The trick is to focus on the amazing resilience, intelligence, cooperation and love that humans inherently possess to have survived and flourished as we have. We still carry tremendous scars, but we have a wonderful future if we will take it.

    We need to regard each other as inherently reachable, inherently eager to make connections and broaden our understanding. The great “organizers” of history have, against great odds, continued to believe how good we all are, and have powerfully communicated that to large numbers of people. They assumed that inside each bucket was someone eager to drill their way out to meet us – their assumption was the best “drill,” and it encouraged others to drill out as fast as they could too. That is, they inspired people. Mandella, Ghandi, Martin Luther King, Roosevelt, Churchill.

    It is great that individual psychiatrists are thinking and speaking, as you are; and it’s happening more and more. But it will take a movement and real sacrifice, over many years, to fundamentally change what is wrong with the paradigm that allows and encourages the abuses we see now in psychiatry.

    Thanks for your good thoughts and efforts. I look forward to more.

    • Alice’s “Call Me ‘The Doctor'” versus “My ‘Head in a Bucket'” — as good an illustration of cognitive dissonance as any. Both can’t be true at once.

      Correct, we’re all chimpanzees dressed up in suits. Psychiatrists undeniably share human biology with the rest of humanity.

      Yes, propaganda is persuasive. That’s what it’s designed to do.

      Pharma made fools of psychiatrists, but not everyone was gulled, as Peter C. Dwyer noted above. Giovanni Fava published “Long-term treatment with antidepressant drugs: the spectacular achievements of propaganda” in 2002.

      The ethics of the Good German argument etc. have all been hashed out. “I was blinded by advertising” — well, that’s not gonna fly.

      You either get to be a scientist of the mind or a dupe. If you’re a dupe, you’re not the expert you thought you were. If you’re The Doctor, you’re stuck with that guilt-inducing responsibility. Which is it?

  19. On day one of a psychiatric rotation in med school, future shrinks see innocent people who have been denied any due process, detained without trail, who are subject to vicious forced drugging assaults. The future shrinks accept that this is moral and right, and peep in to these people’s confidential medical files without consent, treat the detained persons as learning tools against their will, and accept that this person should be tortured just for the thought crime of believing they ARE Jesus rather than believing IN Jesus.

    • Anonymous,

      You do have a good point there. Despite my optimism regarding young psychiatrists (in my comment above), I must confess that in my last place of employment, the first-year trainees learned more about how to argue (and win) a due-process hearing, and how to write a reimbursement-worthy note, than how to communicate effectively, empathically, and compassionately with a patient. That skill was possessed by some, and not by others, but it sure wasn’t taught, encouraged, or valued.

      • The point is that psychiatry forcibly tranquilizes the person accused of being brain diseased, BEFORE any due process hearing, (during the hold). The point is further, that this is just one of the many ways in which it is never a fair fight in any so called hearing.

        I’d further add that unless a human being is willing to stand up for the accused’s right not be defined as a ‘patient’ then clearly the message of human rights is not getting through.

        “the first-year trainees learned more about how to argue (and win) a due-process hearing, and how to write a reimbursement-worthy note, than how to communicate effectively, empathically, and compassionately with a patient.”

        If I’m ever caged and labeled by one of your first year trainees, I won’t be interested in them ‘communicating effectively or with empathy’ with me. It will be meaningless in light of their human rights abuses.

        If you cage someone on the basis of their non-criminal behavior and thoughts, and if you forcibly drug someone’s brain on your faith based belief that they are brain diseased diseased, you’re a human rights abuser. Period.

        The first and foremost communication we would like psychiatry to hear from survivors is that when we say NO, we mean it.

        There must come a dawn in society where citizens are free to choose whether to entangle their lives with the pseudoscience that is psychiatry or not, much like we can take or leave chiropractic.

        Coercion is unreformable, unconscionable, and completely evil.

        You spoke on your blog Steve Balt of ” the extreme animosity from the anti-psychiatry crowd”.

        You need to seriously come to understand the difference between anti coerced psychiatry, and anti psychiatry. To be anti abortion is to want abortion to be illegal. I don’t want psychiatry to be illegal. I want psychiatry being forced on people to be illegal.

        I just want to feel safe from you and your profession Steve. If you have the power to coerce me, I don’t feel safe.

        I really do love how you call a paltry hearing you have no option but to turn up to in a forcibly tranquilized state, after a couple of days of enduring forced drugging assaults and being denied phonecalls, a “due process hearing”.

        I’m pretty sure the founding fathers didn’t have such a monstrosity in mind when they set about framing the constitution.

        What do you call an adversarial legal situation where the party in legal jeopardy trying to plead for their freedom has already had their very thinking organ assaulted by the party fighting to take away their freedom?

        A kangaroo court ‘hearing’ where the dominated party already has forced neuroleptics coursing through their veins.

        • He linked to the disgusting propaganda website http://mentalillnesspolicy.org/

          in the following blog post…

          Steve Balt said:

          “Psychiatry should not be a tool for social justice. (We’ve tried that before. It failed.) Using psychiatric labels to help patients obtain taxpayers’ money, unless absolutely necessary and legitimate, is wasteful and dishonest. More importantly, it harms the very souls we have pledged an oath to protect.”

          He linked to (Forced) Treatment Advocacy Center propaganda material when he said the words “unless absolutely necessary and legitimate”.

          All readers of these blog comments should be aware that psychiatrist Steve Balt considers the threats to your liberty to be found at E. Fuller Torrey’s pro forced drugging “policy” page.

          • Anonymous–thanks for bringing up the horrific agenda promoting Fuller Torrey and the website that promotes drugging of patients, forced drugging and forced OUT patient drugging ran by TAC. Torrey is a dangerous influence touted as an “expert”; he is behind a propaganda machine that sounds as if they “care” but in fact they promote articles that depict violence in “mentally ill”.

            Here is an article that explains what Fuller Torrey is all about and it is not to benefit patients!

            http://www.fair.org/index.php?page=1064

            From the article:

            “As president of TAC, and executive director of Stanley Research, Torrey is a man with a mission: to force people with schizophrenia and manic-depressive illness into involuntary treatment. Once considered the patron saint of the family advocacy movement, his clamor for involuntary outpatient treatment in the last five years has dimmed his leadership and threatened the coherence of the movement he helped shape (Mental Health Weekly, 2/19/01).

            Torrey explains his obsession with forcing people into treatment–it even crept into testimony about homelessness before the House Committee on Banking and Financial Services (3/5/97)–by discussing a unique category of “untreated” people with schizophrenia and bi-polar disorders, a category he created that remains unrecognized in both government and academic research. These folks, he says, are responsible for 20 murders a week, 1,000 a year.”

            Anyone IMO who promotes Torrey and his sidekick Jaffe are not pro-patient.

          • My guess is that all participants on this webzine want forced drugging to disappear from our society, including Steve Balt. That is our common ground and why we are talking to each other.

            There are differences of opinion on how this can be accomplished, and on whether this can happen quickly, or whether it will take some time, and on whether there is a viable alternative right now to replace forced drugging.

            Right now, people are thinking about alternatives to forced drugging. Forced drugging is sometimes abused, but its original rational is to be used for people who are cognitively impaired to the point they don’t recognize the authority and role of law enforcement, or don’t recognize that the presumption of innocence does not mean their liberties cannot be temporarily restricted, or don’t recognize that law enforcement mistakes (or misinterpretation about probable cause) can only be pointed calmly, and usually only arbitrated later in front of a judge, rather than by trying to physically oppose law enforcement orders.

            Those cognitive impairments used to be answered by physical force from law enforcement, and forced drugging was considered a more humane method. Now people are coming with solutions based on people trained to be emphatic, calm, and calming even in the presence of extreme emotions. When those empathic skills are not sufficiently present to calm down such an out-of-control situation, what is law enforcement supposed to do?

            I think forced drugging will be better fought by understanding why it exists and proposing alternatives (and fighting in courts its abusive usages), rather than by just wishing it away, or condemning all possible usage.

          • Forced drugging is what happens when people are discharged from psych hospitals every single day. Some have court-ordered medication compliance adherence written into their discharge plan. I think people may not understand that no one discharges from psych hospitals OFF of medications.

            The phrase “forced drugging” can sound complex, but in fact it is actually status quo for hosp discharge.

          • Any instance of a psychiatric drug going into somebody’s body by physical force, or by threat of taking somebody out of their home or off the street to a place where it is legal to use physical force (orders to take drugs), counts as forced drugging.

          • I’ve been inside 4 in WA state and they all d/c with medication plans, many are court-ordered where the patient has a 90 day window of time to comply “or else” and the “or else” part is if they stop taking their meds, the case managers et al can testify in mental health court against them, using that to re-admit them. I’ve had to sit in mental health court for over a decade and have heard a lot over the years. This is also where I knew I would always sit on the other side of the room from NAMI parents who would sit in court and complain their adult children were off meds and they wanted them locked up…and while sitting in the waiting area, parents were always shocked when their adult child’s attorney would come out and tell them their child refuses to see them. Because the parents were their to testify against their child.

            My adult child is no longer part of that–and when she was, I went to court to testify on her behalf, as HER voice and state she would not want to be there, and I did this, so she would not have to endure the court scene which is undignified, and usually if not always in favor of the prosecuting team (the doctor/hospital). At times, this was a grueling experience, and where I saw many people w mental health labels suffering for many reasons, and they always got sent back to “lock up” (plea for discharge denied).

            Who can ever imagine this exists? many people have no idea this goes on.

          • Even in places where people are not forced to take med’s by court order, more often than not it is a requirement to get any other services. If you don’t take med’s, you don’t get housing, if you don’t take med’s you don’t get any psychological treatment. And of course even if they are not forced, when it is very largely the only thing on offer what choice do they have. It is either take the med’s or have no treatment at all, as no other treatment is offered. I have NEVER met a person who didn’t want help, I have also never met a person who wanted the help they were recieving. But you learn, you either take what they give or you go without. Hardly an informed choice.

          • I know a child on ritalin. I expressed doubt as to the benefit of it (he was still a hyperactive pain to most of the teachers but was fine with the teachers he liked, I could go on giving a psyco-social explanation of his behaviour but you get the picture – i was the lowly teaching assistant). His head of year said he would not be allowed in the school if he did not take the drugs.

            That is a kind of force, not an absolute legal sanction but still quite a sanction.

            I know a mother of someone diagnosed with schizophrenia who had a nurse phone her up in the evening to check whether her son had taken his meds and pressuring the mother to take the son to go to the late night chemist to get some.

            That is some kind of force, even if not directly forced drugging.

          • Exactly. I don’t know where Alice lives but it sounds like some kind of nice fantasy land. People are discharged from the hospital where I work with forced drugging in place. If they don’t comply they can lose what little they have, which isn’t much in the first place.

          • Stephen,
            I live in a different state that Dr. Keys. I have never been “forcibly drugged”, and all but the first of my experiences in the psych machine were voluntary.

            However, when I was in pain, psychological, physical, spiritual, and sought help from “professionals”, once I signed myself in, I was stuck in a place where pharmaceuticals have replaced straight jackets, and treated as if I was not only crazy but stupid, for a minimum of three days.

            Once you sign in you can’t sign out. I called 911 from the unit phone, which they all got a laugh from, although they took away my phone privileges. I survived, and now I look back and laugh too.

            The “forced drugging” for me was the cycle of being on meds, trying to get off of them and then going into REBOUND, which to the professionals is RELAPSE. I believe they honestly didn’t know the difference.

            As for the “how could I have known?” we all bought it, it was the big “breakthrough” and it was held out as HOPE.
            I held onto that HOPE, ignored the red flags, ignored my intuition, went along with it because it was ubiquitous, and still is.

            It is a culture, all the way from the streets to the psych units– we want a quick fix for problems for which there is no fix, and I have searched for someone in my state who could help me get off benzos. There are no alternatives around here, never have been. And my scarlet letter follows me, too.

            They were still Freudian when I was first hospitalized, right on the cusp of the transition to all-drug and ECT treatment.

            As for my current attempt to get off of benzos, I am doing it ALONE. I have support from benzobuddies, and have to remind myself how far I have come from Paxil, Thorazine, Depakote, Clozaril and on and on.

            My PCP writes the Rx’s and doesn’t question why the dosage is going down. (She’s “compliant”.) She also doesn’t care, which is fine with me.

            Considering the attacks on Dr Keys, I hope she continues to be as caring and responsive as she has been so far. I wish I could shout, “She’s on our side, guys! She’s listening!”

            Other shrinks*, even here on MIA, have been more defensive and simply move the conversation into safer territory.

            Thanks to Robert Whitaker, we are all on the edge of a TRUE “breakthrough”. It won’t be simple, it won’t be easy, but (I) thank God, it is happening.

            *funny how we now know our brains were literally being shrunk. Like I said, Ya gotta laugh.

          • I find this slightly distasteful. I know someone who is on a community treatment order and forced to have depot injections, which she does not want and objects to on health and human rights reasons. She is on the CTO because she was found in her house, not eating a lot, looking a bit scruffy and not going out much.

            She kicked a psychiatrist once (now don’t all cheer), it was several years ago and because the psychiatrist put her on depot injections. This is now on her notes and taken out of context. She is not a danger to herself or others, when at her most distressed she needed someone to sit down with her and have a cup of tea and a chat (ok, maybe she needed that everyday for a week or two, but you get the picture), not years of injectable major tranquilisors.

            There are people who worked with people who were angry, violent and disruptive who did not use drugs. They have a track record of success.

            One I know worked with murderers in a therapeutic unit in a prison. Drugs were used, but by consent. When he started loads of drugs were used, after he got going hardly any were used. People on the unit were treated with dignity and respect, as far as this is possible within the confines of a prison.

            As far as I can see the evidence that these drugs, either forced or not, reduce violence is lacking. Without that we are looking at a medical system that tries to control people with drugs based on custom and history rather than evidence or any real concern about public safety

        • Stanley Holmes I find your response sickening.

          “on whether there is a viable alternative right now to replace forced drugging.”

          Freedom replaces forced drugging.

          Forced drugging exists in the first place because of a long history of psychiatric coercion, based on psychiatry’s unproven beliefs about the brain.

          We aren’t ‘walking together’ if you feel it is justified to terrorize people with forced drugging.

          Who are you calling ‘cognitively impaired’? It’s a cop out.

          • Let me say that I found some content on the mentalillnesspolicy.org website disturbing too (I should have read it more before my first reply). And I happen to disagree with most mental illness conceptions from E. Fuller Torrey. I strongly believe in the recovery concept (which implies I believe in at least some conception of mental illness).

            In fact I probably went out of subject. I admit I was seriously disturbed by the claim that Dr. Steve Balt is not pro-patient. My view is that this claim is difficult to maintain if you take the time to read his blogs (I personally don’t consider that linking to a website is equivalent to endorsing all its contents).

          • stephany

            I read your link and concluded that Torrey is dangerous. He’s Kevorkian-like in his ghoulish brain collecting, and just as much of a sociopath.

            My doctor’s office has a new form stating that any blood, fluids, body parts, tissues etc that are removed in the course of a procedure are no longer the “property” of the patient, but belong to the hospital or clinic.

        • “Dr. Steve Balt is not pro-patient”

          I never said Steve Balt is not “pro patient” whatever that means.

          You’re putting words in my mouth.

          I merely pointed out the forced drugging lobbyists that hang around and comment on his blog, and that Steve Balt links to forced drugging lobby (TAC) material approvingly.

          Oh and I’ve taken the time to read hours of his blog. Going back more than a year. It says it right there in his ‘philosophy’ section that he believes

          ““To be sure, there are cases in which a person’s suffering is so profound, and so obviously rooted in physiological dysfunction, that aggressive measures must be taken to treat the disorder.”

          He believes in physiological function that cannot be demonstrated. He also believes in ‘aggressive measures’.

          I’m glad Stanley that you disagree with ‘most’ of what Torrey has to say. The fact you evidently still believe some of Torrey’s lies is what’s worrying.

      • Steve Balt says in his philosophy section of his blog:

        “To be sure, there are cases in which a person’s suffering is so profound, and so obviously rooted in physiological dysfunction, that aggressive measures must be taken to treat the disorder.”

        If it’s so ‘obvious’ Steve, how about you show us some evidence of physiological dysfunction. Also Steve, I think by you linking to E. Fuller Torrey’s propaganda that you mean the ‘aggressive measures’ to be forced drugging? am I correct?

        The problem with psychiatry is people who think ‘so obviously’ is enough to stand in for actual evidence.

        • Further:

          DJ Jaffe, Torrey’s full time propagandist has left many positive comments on Steve Balt’s blog. It seems Steve Balt is DJ Jaffe’s kind of psychiatrist.

          DJ of course is this guy…

          “Others at TAC have acknowledged that the focus on the violence of the mentally ill is in part a cynical ploy to encourage funding for treatment. “People care about public safety,” TAC publicist D.J. Jaffee told a workshop at the 1999 meetings of NAMI. “Once you understand that, it means that you have to take the debate out of the mental health arena and put it in the criminal justice/public safety arena.” He had earlier advised a local New York advocacy group (SIAMI Newsletter, Vol. 9/12, 1994), “It may be necessary to capitalize on the fear of violence.”

  20. Here is part of Fuller Torrey’s Op-Ed that ran in The New York Post regarding Kendra’s Law:

    “Kendra’s Law is proving to be what its authors designed it to be: A safety net protecting the severely mentally ill and the communities in which they live.

    While they have yet to fully embrace the promise Kendra’s Law brings to the state’s most vulnerable, we hope these well-intentioned yet misguided civil libertarians eventually recognize that defending an individual’s right to remain psychotic is mindless.”

    http://www.treatmentadvocacycenter.org/index.php?option=com_content&view=article&id=574&Itemid=197

    That’s who Fuller Torrey is, he is someone who believes schizophrenia is an airborne toxin that we all are subject to breathing in, and he said when I heard him speak in person that we are ALL exposed and some “get sz and some don’t”. He equated bipolar and SZ as being the same thing, and he called the antipsychotic Haldol an “anti-viral” and when I asked him how he could call Haldol an anti-viral? he said he did not know. Though from that POV, one can deduct that a virus born “illness” can be treated with an anti-viral…Schizophrenia and Haldol. The man gave me the creeps.

  21. Unlike Stanley Holmes (above) ” fighting in courts its abusive usages”, I believe forced drugging in and of itself is an abuse, a human rights abuse furthermore, and I believe that simply by virtue of all humans being human, they are entitled to human rights.

    There is no picking and choosing the instances in which a human rights abuse is justified. Each and every person who has been assaulted with forced drugging, had their human rights abused. Each and every person has the right to not be assaulted, and each and every person has the right to decide what happens to their own body, not to have their body turned into an object to be altered by force by mindless biological psychiatry fanatics.

  22. I’m human TODAY, I’ve been human every day of my life. I deserved human rights then, and I deserve them today.

    For someone to essentially say to us that ‘oooohh we would like to in principle work towards a day where you can have human rights’ is a sickening cop out and is unacceptable.

  23. One of the things that most people don’t realize is that it’s not just psychaitrists who are killing people with their toxic drugs. Thousands of people will die this year from meds prescribed by doctors of all kinds. The FDA is not doing it’s jub to protect us from bad drugs and doctors are not researching enough, and Americans flock into doctors’ offices every day, demanding some pill to take care of their woes, aches, and pains. I’m not absolving doctors of any specialty from responsibility, but the real and true culprit is Big Pharma. It controls the media, it controls the education of psychiatrists, it controls the APA, it controls the scienfitic journals were studies don’t get published unless they agree with “shove more meds down peoples’ throats,” it controls the polliticians making the laws used against us. The real question is not how we stop the psychiatrist from drugging us, but how do we got real power over the drug companies which are totally out of control at this point. Many psychiatrists need to be “defrocked” and sent off to find other kinds of employment, there is not doubt about this. But if there was some control over the drug companies these damned toxic drugs wouldn’t be handed out to psychiatrists in the first place and they’d have to make an honest living of having to really and truly listen to their patients, instead of dismissing us as “having no insight into our illness.”

  24. I haven’t read all of the above posts, so I’m not sure if anyone else mentioned this, but there certainly were publications that detailed the inadequacies and inaccuracies of bio-chemical etiological theories of psychosis and of evidence on the usefulness of medications since at least the 1960’s. Some of this information was in Bob’s book. Particularly, Bert Karon’s book Psychotherapy of Schizophrenia: The Treatment of Choice, which came out in 1981, included a substantial discussion of these topics. I say this not to point fingers or to lay blame, only to make the case that this data was out there for psychiatrists to examine and that many chose not to do so. The casting out of psychoanalysis from medical psychiatry, which began during the 1980’s, likely has much to do with the tendency of psychiatrists to ignore or view with disdain much of this material. The simultaneous rise of pharmaceutical influence on the discipline of course played a huge role, as well. Nevertheless this contrary evidence has been there all along, seemingly of more interest to many of those caught up in the mental health system than to many of those tasked with running it.

    • Exactly! And it seems that the only people paying attention to it were the people who are trapped in the system! This is what I’m trying to get at; why did no one else pay attention to these things? If “patients” could get their hands on it, why couldn’t everyone else. People have to make choices. I understand perfectly why some psychiatrists prescribe pills rather than do talk therapy; they’ve grown accustomed to a particular level of lifestyle. I do believe that many of them turn a blind eye to the effects of the drugs that they perscribe and they refuse to listen to their patients. Not every psychiatrist does this, obviousely Alice is not one of these or she probably would not be posting and dialoging and scrutinizing and questioning. But way too many of them do; I watch it happen four days a week and I see the detrimental ways it affects people in their care. If they refuse to stop using these drugs on people then perhaps they do need to consider changing professions, since as doctors they vowed to do no harm. I had to change professions twice because I felt I could no longer work at them in good conscience because of changes that took place in my understanding of things. I had to stop teaching Religion in Catholic high schools because I felt I was expected to propagandize the kids rather then help them learn how to make intelligent decisions about their own faith lives. I had to leave chaplaincy work because I’d always been a Buddhist at heart and not a Christian. I was a wolf in sheep’s clothing for fifteen years and finally had to quit, even though I was a pretty good chaplain. So, I know how difficult it is to change what you do for a living. Why are some of these psychiatrists allowed to keep harming people. This is all that I want to know. I don’t hate them, I don’t want to hang them by the neck. I just want an explanatio as to why they are allowed to continue harming people when anyone else responsible for doing such things would be put in prison or fined heavily. It seems like everyone wants to dance around this issue rather than deal with it. I appreciate Alice’s efforts to reform the system, even if she’s just one, tiny person. Better to light one candle than to curse the darkness. We all must do what we can in our own ways to not only reform this broken system, we must carry out a revolution to totally change it. Too many people have died and are dying as we all sit here posting. Sorry that I’m not as erudite and good with words as everyone else. I too am searching for answers to what I consider are some very important questions. It is interesting to note that Alice’s blogs get more attention than almost all of the others, so something right is apparantly happening here.

      • I think that one reason Alice’s blogs get so much attention is the quality of the dialogue she both invites and sustains. She consistently engages with in a respectful way, and is clearly engaging in her own process of discovery as well. It’s the kind of discussion this site was created to host; not merely to advocate from one side or the other, but to engage in inquiry where the various perspectives meet, and see what evolves.
        When I’ve been on teams that were gnashing their teeth at a psychiatrist, my call has been to not do what we were angry at the psychiatrist for; being so certain of our own point of view as to cut off all other options from consideration.
        Of course, it’s hard, and I’ve spent a lot of time walking off anger after conversations with psychiatrists, sputtering with incoherent rage at the casual dismissal of other perspectives. It was the presumed weight of evidence, or at least hegemony, that the psychiatrist seemed to enjoy that raised the anger.
        But on this website the bias skews the other way, and Alice has so far been the MVP MD as far as willingness to see where that goes. I’m not sure how long she can keep up a conversation with so many people, but her effort so far has created a lot of good for all of us.

      • “Why do psychiatrists refuse to listen?” is the key phrase here. I kept begging my son’s psychiatrist all night through in my head “Please, please Dr A you could help him if you’d only listen” He was a nice man, he meant well and yet when I tried to speak to him about my version of events it was as if I was talking gibberish to him and all he came up with was “leave it to the experts”

  25. Fuller Torrey used to have a very good understanding of the patients point of view.He also wrote an excellent book about homeless people that was very timely, following the evacuation of the State hospitals which coincided with the end of the Vietnam War.

    He went off the deep end and was on 60 Minutes carrying brains around in buckets and explaining how he would make history by slicing them up and finding the cause of schizophrenia.

    So he went from understanding the human mind to dehumanizing it.

    The brains were in buckets, not jars, although he did have that tell-tale mad scientist look. No holes in the buckets that I remember.

  26. Alice said: “It will take all kinds of people, maybe even the occasional psychiatrist, to get this boat turned around.”

    Excuse me? In my opinion, it is the ethical *responsibility* of psychiatrists to turn the boat around.

    I spend most of my daylight hours doing what psychiatrists should be doing, supporting people in tapering gradually off psychiatric medications. I really, really wish doctors would step up to the plate and do this.

    Having to clean up after doctors — well, it’s not a pretty sight. I’ve contacted hundreds of psychiatrists asking if they will help patients taper slowly. I’ve gotten responses from about 20.

    So who is going to do this, Alice? What does the existence of a couple of dozen patient Web sites to get people off psychiatric drugs say about the sense of responsibility that physicians bear patients?

    Openmindedness and tolerance? All very fine, but talk is cheap. Action in the real world is what I’m looking for.

  27. “The real question is: How could I have known?”
    ..
    You could have known if you were deprogrammed from the entire system. Then all things like this would be clear to you.

    If you were like myself -if your personality was somewhat fragile, dysfunctional, didn’t work and gradually broke down. Then if like myself, you developed full blown schizophrenia, episodes of pure madness, experienced social and material deprivation, abuse and poverty, ending in then sent to the phantom zone on emotionally deadening meds for two years…and then after all that you if you found a way to become emotionally alive and functional with the help of some others, then I pretty much guarantee you , you will be cured of your socialization, you will become a ‘tabla rosa’ again like a new person, your ‘Sockpuppetry ‘ your programming, your brainwashing will shatter, and you will become a clear-thinking human being without an identity dysfunction.

    Alas! This is the only method I know how to deprogram humans. I don’t think it is so great. I can see clearly the identity disease infesting society, but I have not known of any methods by which to cure it. I can make many suggestions though, such as living in a foreign country , spending time in meditational retreats etc, but there is no guarantee.
    When I became alive as myself,a full personality, at the age of 30 one of the the first things I understood was that I was fundamentally different than almost everyone else,including those who ‘cured’ me, in respect to identity. At first I was very under-confident in challenging other about this and it took years of experience to be able to verbalize what this ‘thing’ was all about.
    We live in a system which is fascist, murderous, tyrannical, ruthless and exploitive from the top down. It exists and is maintained because the population is socialized and propagandized into a state of “induced identity dysfunction” or “induced identity disease”. They cannot extract their own identify from the identity of the system. They cannot oppose the system, because the system is internalized in themselves. For instance people try to think about economic problems by using misleading paradigms with which they have been socialized by the media of their rich exploiters. They are missing critical paradigms and the paradigms they have are distorted.
    The entire population needs mass deprogramming, I wish the aliens would please take them to mars , get the job down and then return them. If a population want to be free they will have a zero tolerance for oppression and they will thrown down their oppressors immediately. Zero tolerance for oppression is like the need to breathe – you reject oppression like you reject death and to the death.
    But compromised identities do not want to be free – they don’t understand freedom both personal and material.
    It is very sad.
    ..
    The buckets are in a much larger system of oppression that goes to the root of identity. Propagandists misuse the natural tendencies to CORG and BIRF. Many thing go on here in this identity process – people are taught to empower themselves, their egos, with illusions and to support evils that provide those illusions. They are indoctrinated to think that they actually ARE other things that they are not. They are indoctrinated to transfer emotions from one thing to the other without critical inspection or challenge, they are taught to avoid to confront, challenge or change, they are taught to make secret pacts with the powers that be – support their evil and they will get a slice (paltry though it may be), they are encouraged not to see the horror of the system they live in, they are whipped by happy face fascism to avoid the perception and the actualization of the negative, to avoid the resilience of enduring the real. They are taught to avoid and abhor their negative emotions when it is quite natural for accepting human being to enjoy and even relish all their negative emotions and differentiate between the emotions themselves and the events that cause them.
    ..
    The society is seeing a level of evil never before achieved in social and propaganda control due to technology. The masses are under propaganda and socialization assault 24/7 – almost no one escapes. Every aspect of all lives is being invaded and harnessed to the wheel of fascist controllers. The controllers are no longer even relevant, the system itself becomes stronger than the controllers.
    Everything will get worse, even as you are thinking it will get worse it will have already become worse because what is going on is hidden and obfuscated for the public consciousness. Only we can hope some kernal of light will be preserved somewhere by a few, and hidden somewhere to survive the coming dark ages.

    How could you have known?
    Understand that there is a ‘system’ and that the system is not you. Vomit it all out. Everything. Everything you have introjected from birth to now. Purge your lives!
    And rebuild.

    All social problems can be so easily solved, The world can be a paradise. It’s so easy. But people have been taught to not WANT it to be a paradise, therefore they actively prevent it from being a paradise.
    Slice the Gordian Knot by understanding the sword of pure power. Clear away the propaganda and the cobwebs. The world is the way it is because the people in power want it that way and the masses have been socialized to want it that way as well. The masses are the extensions of the egos of the powerful.
    Break the bonds and cut the strings.
    I am one of only a very few. Before the internet I hid who I was and thought I might be the only one. I knew I was in a system that didn’t want people to be cured and that to be cured was in worse social standing than to either be normal or ill. To be cured is to be a ghost in the system, something that is not supposed to exist.
    The system and the people in the system get what they want, they get what they desire. If they don’t want the ill to be facilitated to become well,then that’s what they get and have gotten.

    • Damn! I wish I could write like you do! You are powerful and I’m glad that you discovered the internet and claimed yourself becuase you are mighty. Yes, you are different and that is what is so wonderful. I’ve felt different all of my life from the time I was a small child. As a kid I woke up one morning and said to myself, “It’s okay to be different, even if you’re the only one of your kind in the whole world!” I’ve met a few others but you’re the first one I’ve “met” who can write and use words this way. Thank you for your post. I hope you come back here and continue to post because you have a way of hitting the nail right on the head, straight on. I agree with all that you stated. What ideas do you have for helping to change all of this craziness?

  28. “The real question is: How could I have known?”
    ..
    You could have known if you were deprogrammed from the entire system. Then all things like this would be clear to you.

    If you were like myself -if your personality was somewhat fragile, dysfunctional, didn’t work and gradually broke down. Then if like myself, you developed full blown schizophrenia, episodes of pure madness, experienced social and material deprivation, abuse and poverty, ending in then sent to the phantom zone on emotionally deadening meds for two years…and then after all that you if you found a way to become emotionally alive and functional with the help of some others, then I pretty much guarantee you , you will be cured of your socialization, you will become a ‘tabla rosa’ again like a new person, your ‘Sockpuppetry ‘ your programming, your brainwashing will shatter, and you will become a clear-thinking human being without an identity dysfunction.

    Alas! This is the only method I know how to deprogram humans. I don’t think it is so great. I can see clearly the identity disease infesting society, but I have not known of any methods by which to cure it. I can make many suggestions though, such as living in a foreign country , spending time in meditational retreats etc, but there is no guarantee.
    When I became alive as myself,a full personality, at the age of 30 one of the the first things I understood was that I was fundamentally different than almost everyone else,including those who ‘cured’ me, in respect to identity. At first I was very under-confident in challenging other about this and it took years of experience to be able to verbalize what this ‘thing’ was all about.
    We live in a system which is fascist, murderous, tyrannical, ruthless and exploitive from the top down. It exists and is maintained because the population is socialized and propagandized into a state of “induced identity dysfunction” or “induced identity disease”. They cannot extract their own identify from the identity of the system. They cannot oppose the system, because the system is internalized in themselves. For instance people try to think about economic problems by using misleading paradigms with which they have been socialized by the media of their rich exploiters. They are missing critical paradigms and the paradigms they have are distorted.
    The entire population needs mass deprogramming, I wish the aliens would please take them to mars , get the job down and then return them. If a population want to be free they will have a zero tolerance for oppression and they will thrown down their oppressors immediately. Zero tolerance for oppression is like the need to breathe – you reject oppression like you reject death and to the death.
    But compromised identities do not want to be free – they don’t understand freedom both personal and material.
    It is very sad.
    ..
    The buckets are in a much larger system of oppression that goes to the root of identity. Propagandists misuse the natural tendencies to CORG and BIRF. Many thing go on here in this identity process – people are taught to empower themselves, their egos, with illusions and to support evils that provide those illusions. They are indoctrinated to think that they actually ARE other things that they are not. They are indoctrinated to transfer emotions from one thing to the other without critical inspection or challenge, they are taught to avoid to confront, challenge or change, they are taught to make secret pacts with the powers that be – support their evil and they will get a slice (paltry though it may be), they are encouraged not to see the horror of the system they live in, they are whipped by happy face fascism to avoid the perception and the actualization of the negative, to avoid the resilience of enduring the real. They are taught to avoid and abhor their negative emotions when it is quite natural for accepting human being to enjoy and even relish all their negative emotions and differentiate between the emotions themselves and the events that cause them.
    ..
    The society is seeing a level of evil never before achieved in social and propaganda control due to technology. The masses are under propaganda and socialization assault 24/7 – almost no one escapes. Every aspect of all lives is being invaded and harnessed to the wheel of fascist controllers. The controllers are no longer even relevant, the system itself becomes stronger than the controllers.
    Everything will get worse, even as you are thinking it will get worse it will have already become worse because what is going on is hidden and obfuscated for the public consciousness. Only we can hope some kernal of light will be preserved somewhere by a few, and hidden somewhere to survive the coming dark ages.

    How could you have known?
    Understand that there is a ‘system’ and that the system is not you. Vomit it all out. Everything. Everything you have introjected from birth to now. Purge your lives!
    And rebuild.

    All social problems can be so easily solved, The world can be a paradise. It’s so easy. But people have been taught to not WANT it to be a paradise, therefore they actively prevent it from being a paradise.
    Slice the Gordian Knot by understanding the sword of pure power. Clear away the propaganda and the cobwebs. The world is the way it is because the people in power want it that way and the masses have been socialized to want it that way as well. The masses are the extensions of the egos of the powerful.
    Break the bonds and cut the strings.
    I am one of only a very few. Before the internet I hid who I was and thought I might be the only one. I knew I was in a system that didn’t want people to be cured and that to be cured was in worse social standing than to either be normal or ill. To be cured is to be a ghost in the system, something that is not supposed to exist.
    The system and the people in the system get what they want, they get what they desire. If they don’t want the ill to be facilitated to become well,then that’s what they get and have gotten.

  29. Last night I finished David Healy’s Pharmageddon. I urge everyone to read it. Healy writes with the canny knowledge of someone who has been on the inside and can think like the marketing whizzes who’ve engineered the “holes in the buckets” that allow only PhARMA-friendly information to easily register with psychiatry and our culture. To see how we all got to this point, read Healy. (I know he wrote an inexplicably rosy account of ECT too, but he’s also taken courageous stands against PhARMA and taken his lumps for those stands).

    But marketing genius doesn’t explain everything. As my prior post (quoting Healy) points out, there’s MONEY. Psychiatry’s blindness is shaped by money. Psychiatrist Daniel Carlat admits it in his book Unhinged:

    “If I did therapy exclusively, I would have to take a 40 – 50 percent pay cut. Most psychiatrists, like me, choose a psychopharmacology practice.” (p. 194)

    Moreover, most psychiatrists depend on the psychiatric establishment for their jobs – and the establishment won’t employ psychiatrists who demote medication from it’s privileged perch. Healy isn’t totally anti-drug, yet he lost a post at the University of Toronto for stating the obvious – that SSRI’s don’t really work all that well. Loren Mosher was pushed out as head of Schizophrenia Studies at NIMH for advocating psychosocial interventions. Grace Jackson was pushed out because she wouldn’t prescribe, and then she had to spend thousands defending her license. Peter Breggin had to defend his license too.

    Some, like Alice, who are willing to take some heat for their views, can create positions where they are relatively freer of these constraints. But that is not a choice most psychiatrists are either willing or able to make.

    So there it is – money and jobs. They make it a whole lot harder for most psychiatrists to see what is easier for LCPC’s, social workers, some psychologists and other thinkers to see. A problem can’t be fixed unless we look it in the eye; psychiatry won’t do it – but we’d better, if we want to succeed. PhARMA’s marketing is a huge factor, but psychiatry embraced the hype for its own reasons too: the psychiatric establishment jumped with enthusiasm on PhARMA’s train as a way to wealth, hoped-for prestige within medicine, and hegemony over the “mental health” establishment.

    It’s also worth remembering that physical cures for mental problems have long been a fond hope of many – not for venal reasons, but because “it’s physical” is historically the default reaction when we become desperate over mental problems that seem intractable, not readily explained by psychosocial factors. Well meaning people throughout history have mortified the flesh, drilled holes in heads, almost drowned, cold wrapped, metrazol shocked, insulin coma-ed, lobotomized, ECT-ed, and drugged people. Sometimes because of sadism, but often out of anguish over suffering they feel helpless to prevent, hoping the physical would work.

    It’s easy to see how, following the miracle drug discoveries of antibiotics and polio vaccines, and the general ascendancy of “science” in our lives, something as sanitized as taking pills could hold such hope for those who desperately want to relieve mental suffering.

    But hope isn’t a substitute for reality; and the reality is that the psychosocial, the vast permutations and combinations of billions of individual human brains interacting in pairs, families, groups, religions, nations, is far more complicated and promising – and far less scientifically explored – ground in which to find answers to our mental problems. PhARMA spends $60 billion a year on research – what would we learn if even $10 billion were devoted to psychosocial research.

    Lots of digression here. The long and short of it: PhARMA’s brain washing is big; money and jobs are big; the longing for the simplicity and clarity of a physical answer is big. And nobody should have to wear a hair shirt about their own past blind spots. We are not born with buckets on our heads, and we can still think with each other.

  30. For anyone ever forced to take psych meds, or committed against their will to a psych hospital this is why DJ Jaffe is a dangerous agenda projector:

    http://www.patrisser.com/family/Jaffe_Turn_Over_Furniture.htm

    How to prepare for an emergency

    by

    D.J. Jaffe

    “Sometime, during the course of your loved one’s illness, you may need the police. By preparing now, before you need help, you can make the day you need help go much more smoothly. There are three things to do.”

    “the fact is that some families have learned to ‘turn over the furniture’ before calling the police. Many police require individuals with neurobiological disorders to be imminently dangerous before treating the person against their will. If the police see furniture disturbed they will lusually conclude that the person is imminently dangerous.”

    The bottom line is Fuller Torrey and TAC and associates are not Pro-patient, they promote articles and stories about violence in mental health patients, they feed the media hype and the stigma that mental health patients are violent, they back legislation that removes freedom of choice such as forced (court-ordered) medication compliance and more.

    This is Mad In America where people who have been harmed and discriminated against, held against their will, forced to be strapped to gurneys, injected with antipsychotics against their choice can have a voice–and mine is from the perspective of seeing these atrocities happen to my child. Once you see a child strapped to a gurney with a spit shield attached, and the wrist’s being cut from straps too tight, you tend to have less tolerance for ppl like Jaffe or Torrey, and their agenda.

  31. Any interaction with a psychiatrist can quickly turn coercive if you don’t watch yourself. They are by virtue of their powers, among the most dangerous agents of government power you can come across in your life. People must learn to withhold any information from them which can get them locked up and forcibly drugged.

  32. ‘She is not a danger to herself or others, when at her most distressed she needed someone to sit down with her and have a cup of tea and a chat (OK, maybe she needed that everyday for a week or two, but you get the picture), not years of injectable major tranquilizers.’

    Not to much difference between this and physical murder.
    Here is a way to simulate the med experience:
    “Blink your eyes.”
    That is two years or twenty years on meds. In order to have time and memory a person needs to have an emotional life.
    ===>
    I was at a supposed community meeting. The only purpose of that meeting was to threaten the out-patients there with CTO’s. There was no sharing of experience in the ‘talk’ or discussion. It was a dictation to prisoners. The person doing the psychic police work was in a newly created district position in which the medial system was expanding it’s influence and control over a wide area.
    If I am NOT in NAZI Germany of 1939, then just exactly where am I? What’s the difference?

    ===>

    ‘There are people who worked with people who were angry, violent and disruptive who did not use drugs. They have a track record of success.’

    Anger and aggression are very under-rated and unfairly dis-respected. It’s the propaganda of the oppressor – ie ‘don’t fight back’.

    We don’t live in a fair and just society – it’s more like a mass prison camp under propaganda assault and mindwashing 2/7.

    Better angry than vacant, better angry than depressed, better angry than dead.
    Health is being integrated and using what we got, not restricting ourselves to please social fascists or allowing them to dictate standards of ‘success’.

  33. The science and the criticism have been around right from the start. You could have known, looking at it. You could have wondered, become curious, and investigated. Given the controversy that always has surrounded psychiatry. Indoctrination in med school, and drug reps cornering you may play a role. But others have been through med school, and have found themselves cornered by a drug rep, every now and then, and still, they’ve wondered, become curious, and investigated.

    Cognition, the rational mind, indoctrinated or not, facts and data, studies, intellectual knowledge, biased or not, isn’t everything. Although our culture hardly is aware of anything else to exist, it’s nothing but an infinitesimal part of our being. And when you are restricted to live in your head — “Cogito ergo sum”– the bucket will always keep you from… Well, not knowing, but from being able to move on to faith.

    I was at a hearing about deaths in psychiatric “care” last Tuesday: “Why do labelled people die on average 25 years earlier than the general population? What can we do to prevent this?” Among the presenters, there was also a colleague of yours, contributing with two short talks. In her second talk she focussed on bureaucracy and regulations making it almost impossible for staff to do their work properly. You might say, this was probably the worst choice of slant she could possibly have given her talk, with an audience consisting of, primarily, family who have lost somebody to psychiatry, and survivors. When she’d finished, and gone back to her place, a friend of mine, a survivor, horribly mistreated and traumatised by the system, came pounding, placed himself right in front of her — and he’s a huge guy, and when he’s angry you’re not in doubt that he is — and, pointing his finger at her, shouted: “This is not about your working conditions! This is about human rights!!!” And what did she do, far away from home ground, with no restraints and/or Haldol at hand? Well, she cowered on her chair, her head bent, and her arms over it for protection. The “expert”, the authority, the professional in the field of, well actually, being, in the field of existential suffering, who’d just given the most self-confident and self-complacent presentation on psych staff’s impossible working conditions. Unable to recognise, never mention deal with, existential suffering, with life, when it stared — and shouted — her in her face. Terrified.

    Existential angst. Dizziness of freedom. If someone can’t muster the courage it takes to opt for free falling, they’ll inevitably choose deadness. The same deadness you don’t need science, facts and data, studies, cognition, rationality, intellectual knowledge to be able to see in the eyes of the psychiatrically drugged. But if you choose deadness, you choose to live in eternal fear of life. With your head bent, and in a bucket, with your arms up and your hands holding on to the bucket, for protection, cowering on some chair, if it’s at a hearing at the Danish Parliament, at your office, at home, wherever. And you choose to live in denial.

    Even if you’d known, you wouldn’t have been able to see it, the obvious, the obvious absence of life. You couldn’t have allowed yourself to look, and face your own terror. It takes a certain amount of suffering to overcome the fear of this terror, and muster the courage to opt for free falling. The truly sad thing is that our culture’s dizziness of freedom in its desperate attempt to protect itself from this freedom has declared it a disease, and those, who are suffering enough to find the courage inside themselves to make an attempt at free falling, diseased. The cure for this disease is deadness, and, since the body is a metaphor, eventually also death. In a pill.

  34. And while we are on the subject of forced drugging, and how many patients are coerced or court-ordered to take the meds; let us not forget about true informed consent. How many patients were seriously told of the side effects of their drugs, or given the choice in which one they were placed on? Inside the psych wards I have heard patients begging docs to remove certain meds because they already had a bad reaction to it–and they were not heard. One woman was upset, wanted to call her attorney..the louder she got is when the staff came out and did a forced floor restraint and injected her w a B52. She sobbed, she was wailing that she wanted to call her attorney and it never happened. She sat on the floor in a puddle of tears, at my feet. It was atrocious treatment that I wish I did not witness, but I have witnessed it.

  35. The bucket. the holes are called “schema”. these concepts are actually well researched in behavior chain analysis. One kind of schema, is called a “narrative”, is essentially how an individual translates the rules, or expectations of culture to one’s personal conduct. advertising and marketing operate within these principles.

  36. Alice, I appreciate your essays and your continued presence and openness on this website. It takes fortitude that not everyone has. I for one want to keeping hear more from the perspective of those psychiatrists who want to convince other psychiatrists just how messed up modern-day psychiatry has become (even if I might not always agree with point X from psychiatrist A, or point Y from psychiatrist B, or even point C from survivor Z). Okay, the following got a little long…!

    Some researchers & writers tend to think that our frontal cortex is the most “evolutionarily advanced” thing around, and that for most people, it’s our frontal cortex — so-called rational thinking — which is in charge the most. But because the frontal cortex has changed so much in a relatively short (evolutionary) period, and has gotten much less time to work out its new kinks and oddities, I wonder if it’s also the most fragile, and most subject to the whims of the much longer-established self-regulatory and emotional apparatus (i.e. limbic system & brain stem) below it.

    But some researchers have begun to notice more just how often we can get things wrong, even major things. I read that for people who have spent years nurturing certain beliefs, and have strong feelings about those beliefs, if they hear evidence against those beliefs, it can often paradoxically strengthen the beliefs intead of weakening them! This is an unfortunate side of human nature. How do we best change people’s beliefs (about psychiatry) if our arguments against it can paradoxically strengthen those beliefs? It’s a hard problem.

    About a year ago I got into a kick reading books such as:
    – “Wrong: Why Experts Keep Failing Us— And How to Know When Not to Trust Them”, by David H. Freeman
    – “Mistakes Were Made (but not by me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts”, by Carol Tavris & Elliot Aronson (I love that title!)
    – “Sway: The Irresistible Pull of Irrational Behavior”, by Ori Brafman & Rom Brafman
    – “How Doctors Think” by Jerome Groopman

    On the more medical research front, one well-known article is:
    – “Why Most Published Research Findings Are False” by John P. A. Ioannidis.

    More specific to psychiatry (among many, of course) is:
    – “Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?” also by Ioannidis. (Full text of both of these articles are easily found online.)

    As the “Effectiveness of antidepressants” article suggests, psychiatrists have been potentially exposed to more than a thousand studies purporting to show effectiveness of antidepressants. They have paid dearly — in time, money, effort, and dedication — to learning and “strongly believing” what those journals and their own instructors kept drilling into them over and over.

    And if psychiatrists dare give up (some or all of) those beliefs, they risk losing the life they have invested so much in. If they keep prescribing drugs, they get to keep their jobs, their house, their familiar mostly-comfortable life, etc. Even if they get sued, they can use (and fervently believe in) the fact that they were using “accepted medical practices” as defense against any allegations of “malpractice”. But if they fall too far outside of those “accepted medical practices”, then they’re on their own; they risk more loss from lawsuits, they risk losing their medical license, their income, their familiar way of life, etc.

    I think that human beings in general use too much short-term thinking, and this can influence psychiatry. When a psychiatrist gives a patient a drug, and some patients seem to get better, the psychiatry education makes it easy to attribute that to the drug (as opposed to the placebo effect, or “regression to the mean”, etc.) And if a patient abruptly goes off of a drug, the patient sometimes does worse, which the psychiatrist easily attributes to how well the drug had been working. It’s the short-term presumed-cause-and-effect events that tend to make the biggest impression on us. And if a psychiatrist sees even a few of these (“they did better when I put them on drugs, and worse when they went off drugs”) events, it just solidifies this simplistic short-term belief, and hardens them from considering alternate possibilities that involve a longer-term perspective. Getting psychiatrists out from that won’t be easy, when they have invested so much of themselves in believing in it for so long.

    And while I think that anger can sometimes be a useful motivating force, it can be too easily misunderstood by many people, including psychiatrists. A person may very legitimately be very angry for what psychiatrists and psychiatry have done to them, but many psychiatrists would just be completely baffled by so much anger from someone “they’re just trying to help”. There are unfortunately lots of psychiatric labels available to be applied to people who are legitimately angry for reasons that any given psychiatrist just doesn’t (or isn’t yet ready to) understand. I’m not sure if more anger will change their minds, or if it just solidifies their existing beliefs. (“Yet another poor soul who lacks insight into their condition!”)

    And most people, (especially?) including psychiatrists, can’t handle too much distress in the people they see. They think their drugs are diminishing that distress, but in most cases it’s just suppressing (or oppressing) the distress. I’ve often felt that practitioners were (in effect) saying to me “We want to help you with your problems, but we don’t want to have to actually see them or deal with them!” It’s a hugely common cognitive error for doctors to assume that suppressing the visible appearance of distress (sometimes via implicit shaming) is the equivalent of alleviating that distress.

    Maybe it won’t go out with a bang, but a whimper. The pharmaceutical companies appear to be slowly giving up on new psychiatric drug research. The existing psychiatric drugs are gradually falling off patent, which means there’s no motivation for the big drug companies to keeping marketing them so hard. Maybe it will slowly fizzle, hopefully replaced with better healing modalities (and not yet another oversimplistic approach that just harms and shames us in new and different ways).

  37. Interesting use of metaphor and analogies of self interpretation, in these last two posts Alice?

    In reflecting on humility you used the metaphor of a pond, muddy water and the flow of tears to articulate internal sensations.

    Here you use “objects,” a bucket, a drill and the mechanical nature of drilling holes to articulate your mind’s sense of knowing?

    Do these object analogies really ring true for you? Is this an example of our taken for granted learning of a language overwhelming dedicated to describing the external world?

    The pond & muddy waters seem to capture the actual fluid nature of our internal world far better than a sense of objectivity the mind prides itself on “knowing?”

    I make the comments because this type of mechanical logic seems to typify the categorizing of the human condition in the DSM, and why when I experience psychosis and that overwhelming sense of oneness so common to the experience, I’m not sure if its me or the psychiatrist who’s dissociating from the nature of reality?

    “How could I not have known?”

    Perhaps because its a myth that we are intelligent, rational and consciously self directed creatures, not driven by the immediate needs of self preservation?

    Perhaps years ago you simply didn’t need to know, as securing self preservation, ruled each day as it does for all of us? Perhaps we are all guilty of acting more unconsciously than we care to admit to?

    When we think in object oriented terms, are we really embracing the reality of our own nature, or distancing ourselves from it, with a sense of cognition that is becoming increasingly insane?

    Powerful psychotropic drugs for two year old’s, surely the height of insanity?

    Art has a way of expressing the nature of reality that logic misinterprets, especially when the logic is taken for granted.

    If I lay here
    If I just lay here
    Would you lie with me and just forget the world?

    Forget what we’re told
    Before we get too old
    Show me a garden that’s bursting into life _Snow Patrol.

    Whats a metaphor really for Alice? What do words really describe? Keep unpeeling your union.

    Take care, Alice:))

  38. I don’t just see this as Psychiatrists. Equally though I don’t see the examples given as relevant.

    We acknowledge the dangers of driving, and our laws reflect this. Within Australia massive changes have been made to our licencing and learning driver laws to reflect the dangers. We regulate it, and we make safter cars and safer roads and attempt to change driver behaviour.

    No one says that tobacco is good for you. Again within Australia our laws are becoming tighter all the time in regard to this. You can no longer smoke within 10 metres of the doorway of any building, under covers in public spaces, you can’t even smoke at bus stops, let alone any other form of public transport. The age of legally being allowed to smoke has increased, advertising has been banned, and the packets are changing, not just for photo’s and health warnings of dangers, but now also to plain packaging, and it must be offensive as the tobacco companies are taking a high court chanllenge on about this one, saying it is illegal for hte government to do. Equally tabacco is being increasingly taxed to make it more expensive, and government funded quit programs are now for everyone and every prodcut that could help.

    Much is being done to help with binge drinking, fast food and the like. Our primary (elemtary schools) now often have gardening and cooking classes so children learn to prepare the food they have grown. This is being rolled out with government funding.

    Now consider psychaitry. I don’t just blame the doctors. I question how it is we have given one profession so much power over others and how we have not asked questions. But this is not just about the current medications and brain disease paradigm of care. From reading Mad in America it is easy to see that NOTHING has changed in relation to psychiatry. The weapons they use to torture people may have changed, but there viewpoints have not changed. They have the EXACT same arguments today as they had 200 years ago. That blood letting, burning, whipping, drowning therapies and the like were all good for us, and it was our defective brains that made us request not to have them, not that they actually hurt us. They were medical treatments for medical conditions!! And it was our diseases that made us not understand the theraputic nature of the treatments. Nothing has changed in there perception of things.

    Equally though it is not just psychiatrists and not just medications. For me personally Cognitive Behavioural Therapy is one of the most abusive treatments I ever experienced. For me I would outlaw it long before I outlawed medication. It is also beyond me as to how psychologists have become so dependent on something that goes against there training. Psychologists do extensive study on child development, something Psychiatrists do not have, but need. BUT in the final years when they start learning treatments – therapies all previous training goes out the window and now they view everyone has having defective thinking if they do not think like them. Now they claim to be able to change the world with thinking classes. They totally forget that thoughts are ALWAYS based on experiences. If you don’t like how someone is thinking you need to change the experiences, not tell them they think wrongly. But they at most believe that if you tell someone that they are thinking wrongly they will be able to create those new experiencs for themselves??!! And of course added to that is the positive thinking brigade and everything will be cured by thinking positively. Perhaps you need to give someone something to think positive about first!! Yep, a homeless person will find themselves a home by thinking positively!!

    And of course we now have peer workers, chosen because they are deemed to have been cured enough. They then come in and tell people how to fix themselves, simply by telling them that is you just did what I did you too will be cured like me!! A person who experienced drug induced psychosis tells a person with a profound level of dissociation due to be the most profound child abuse that all they need is the same medication and thinking classes that they had. They tell them that if they just do what they did all will be cured for them as well. Supposedly a person will feel better having someone with a totally unrelated experience and with NO training at all telling them how to follow the doctors instructors. A blind person does not require someone who has been cured of blindness telling them how to live. In fact the whole concept that somone who has been cured of something can tell those going through something slightly similar how to live is beyond all comprehension, but when it comes to mental health, nothing should suprise us.

  39. Dr. Keys, this back and forth has me wondering, are there other areas of medicine that involve involuntary treatment? Or where the power of the courts can be brought to bear to coerce treatment? If someone is diagnosed with high blood pressure, obesity, or diabetes are they forced into various treatments?

    If not, how is it that we view the “care” prescribed to persons diagnosed with mental illnesses to be so vitally important they should be forced to receive it, regardless of what they want?

    PtM

  40. Hello. I’m not a psychiatrist, but I’ve suspected for the past ten years, while navigating through the mental healthcare system in my attempts to help my son, that the use of antipsychotics is toxic and dangerous.

    More than a suspicion, all along I’ve had a gut feeling, one which I was told to ignore by psychiatric professionals, that there is a better way to approach treatment than using antipsychotics.

    I am reminded, for some reason, of remarks I’ve heard from psychiatric professionals.

    “You must abandon everything you’ve ever believed or felt about what it means to be a Mother,” a well-respected and experienced social worker once said to me, regarding how a parent goes about convincing a son or daughter that antipsychotics must be used, whether he or she wants it or not, aka forced treatment.

    “You have to abandon your Motherly instincts if you want to help your son.” (quote by a treatment team’s psychiatrist) I once asked that particular psychiatrist what she thought about alternative methods of treatment. She said she wouldn’t waste her time reading about any and also thought it, “absolutely absurd,” that there are people who, “go as far as to call themselves survivors.”

    I wondered how she could practice psychiatry, without at least considering the other avenues of treatment, as well as what seemed to me, her complete dismissal of any research indicating that antipsychotics are dangerous.

    Fortunately, my son was blessed with a lone psychiatrist during the crisis that prompted the remarks I quoted. The doctor saw him as a full human being, perhaps lost in this world, but who needed a kind environment. He told me, that based on his knowledge, as well as having spent time talking and getting to know my son, that he could very well live a much healthier and longer life without antipsychotics.

    I was grateful that doctor was the one they had assigned to my son. The outpatient psychiatrist who said she would never take time to research treatment outside of using antipsychotics, was outraged. She said it only enforced my son’s belief that he could live without antipsychotics, which he can.

    This happened several years ago, so I guess, honestly, I just don’t get it why so many psychiatrists haven’t been suspicious and/or investigating things when it comes to the negative effects and adverse events in the use of antipsychotics.

    How could you have known? I would think by reading, researching and keeping up with the latest news and cutting edge research, but that’s just one person’s view.

    I hope I have not strayed too far, nor crossed the lines of a civil dialogue. I really appreciate your article and views.

    As to the metaphors used in this post, I have to agree with a few others here, which is that in psychiatry, choices in treatment are rare. I think that’s the main difference. Personally, I can’t wrap my mind around how psychiatric treatment is like driving and smoking cigarettes.

    Thanks for a thought provoking post.

    • I think many psychiatrists (and others) refuse to consider evidence contrary to what they have been taught because, to do so might reveal to them the harm they may have caused many people, and unleash feelings of guilt and betrayal to those they had trusted. It unveils what appears to be a “massive paranoid conspiracy theory” within their educational and professional lives (which is what a lot of people think that Big Pharma indeed is).

      It’s easier for many people to maintain the tension of cognitive dissonance and refuse to consider alternate explanations for the things happening right in front of them, than to allow themselves to see a different truth and risk falling into their own painful emotional abyss.

  41. I have a friend who is going through a stressful time who took antidepressants for awhile, not forced to, but bought into the thinking. He is in withdrawal and keeps looking for an “alternative” by which he means a “natural” cure.

    Preferably something that comes in pill form.

    So here we go again, with wanting a pill solution for problems that are human, situational, and spiritual.

    Millions of dollars are made by sales of supplements and so called alternative and natural cures. These are just as bad as big drug companies, no more regulated, and many times just as or more harmful.

    These companies/institutions/ groups whatever should not be let off the hook, either. (Think of the weight-loss industry and all the death and destruction from medical and non-medical treatments gone wrong.)

    I just finished reading “Overtreated” by Shannon Brownlee. It was written before the healthcare debates of 2009, so it’s somewhat outdated. I would recommend it for anyone who wants to see that this problem is not just in psychiatry.
    Another book is “Overdosed” by John Abramson, along the same lines.

    I’ve one way off topic here. Sorry for that.

  42. What utter nonsense! This article starts with a comparison that’s not valid. Driving a car is something that a person generally does because our society makes it necessary or convenient for survival or a decent life. Tobacco and fast foods are things people use for their own personal reasons or convenience.

    Psychoactive drugs are things that psychiatrists give to others, not things they use themselves. Psychiatrists are the gatekeepers to these things, or at least, should think of themselves as such. Instead, they push them on others.

    It is the psychiatrist’s job to know what these things do. It’s the psychiatrist’s job to know what harms they produce. It’s the psychiatrist’s job to find out how they affect the patients.

    This is not an issue that can be absolved by trying to compare the pushing and forcing of drugs onto other people with the personal choices people make to use harmful things. That’s specious and self-serving.

    A cute head bucket analogy doesn’t prove anything beyond an ability to portray an issue in the wrong framing. Surely a psychiatrist knows that you can prove nothing through analogies. They’re good for explaining a concept, but they do not document its validity.

    As answer to the author’s final question, How could she have known? The answer is simple. She could have known by looking. Others have done so. Had she written the article as an apology, it might have been acceptable. Instead, she wrote a piece that said, “Golly gee, it’s not my fault that I’ve done horrible things. I was just doing what all the other shrinks do and profit from. How could I have known? Just look at my clever excuse.”

    • Excellent. As an instructor, if I don’t know the answer to something, I will be honest and look it up! I found that in my experience with prescribers, they do not admit they are wrong. I have been blamed by prescibers for their mistakes (What do you mean you’re only taking 100mg of that!?— My reply– that’s what you told me- you asked me to reduce my dose). Physicians also seem to get defensive when I tell them my educational background in experimental psychology (I don’t deal with clinical psych– but am well trained in research methods).

  43. Car safety?

    I expect that physicians and other prescribers be held to a higher standard than the automobile industry or fast food restaurants. The comparisons you provide are moot.

    In addition, clinicians (whether psych or other) are typically not well trained in research methodology. This is not the fault of individual MDs or others because clinical work does not focus on lab or research work. I go into physicians offices and I ask the tough questions. I have been trained in research methodology and I ask for data– any sort– aside from “personal experience”. Not that this experience is not valid– it’s just far from the objectivity typically found in research. Yes, there are many drug trials that are funded by drug companies– but usually, these studies are easy to point out and should be taken with a grain of salt. There are Universities out there that can afford drug research– those are the publications to focus on. This site is a great way to get in touch with better research.

    I’m tired of people falling for research that is poorly done– it’s akin to saying that store brand shampoo is any better or worse than a similar shampoo–based on “studies”.

    Maybe prescribers should get over this “how could I know?” mentality and focus on changing and learning as much as possible– and getting the word out to fellow prescribers. Yes, this will take time– but it could also save lives or at least improve people’s lives.

  44. Dr. Keys – Thank you for writing this article which starts a much needed conversation. So many have replied eloquently and covered this topic in depth.

    I just want to emphasize that you please do NOT trivialize the severe damage and the trauma that coercive psychiatry, forced drugging and ECT have on human beings.
    Minds and bodies and lives are ruined, sometimes forever by these practices, while psychiatrists merely suffer from having a ‘bucket on their head’.

    Thank you for listening,