“But It’s Just the Way Things Are”


My sabattical of last winter has spun off a second one. I remain uncertain of my role as a physician in a society which values pills over personal growth and change.

Last summer, unplugging my life from the “American dream” seemed in order. It’s not easy to make changes with chains and weights in place. It’s not easy to think, decide and move with the financial shackles that are the bones of everyday life.

I sold the long-time family home. I gave away our accumulated possessions. Now I have more freedom to think and work on personal projects. It was a busy and difficult summer. I hope yours was better.

A line from a song I learned in elementary school comes to mind here:

“Freedom isn’t free.”

Now, I get to spend more time watching and walking, thinking and writing. The more I watch and walk, the more I see that things are interconnected, enmeshed together, part of a larger unity.

Please bear with me through another of my rambles. They are connected, as all things and all of us are.

However much I would like to think that the issues in the practice of medicine are isolated to medicine, however much easier the cure if the problem was limited to thoughtless and greedy psychiatrists prescribing cash-cow drugs to innocent patients, I cannot, personally, view the situation as such.

Yesterday, I thanked a bicyclist for riding his bike instead of adding one more car to the polluting mass of cars at the intersection where we met. His panniers and basket were loaded, his backpack filled. He seemed startled when I thanked him for not adding one more car to the pollution. The unending stream of cars coughed out fumes into the five-by-five lane intersection beside us. My husband and I were on foot, one mile into our one-point-two mile walk to a grocery store. Before he rode away, the cyclist thanked us for walking.

We picked this area because it is more walkable than much of America. A lot of our country was intentionally designed to be dependent on the automobile for everyday life. Collusion among industrialists, particularly car manufacturers and fuel producers, led to the destruction of other transportation systems. Over time, our country’s development has continued in this car-dependent fashion. For most Americans, there is no way to get from home to work or to buy food without a car.

I talk to people I meet about global warming, pollution and the financial and health costs of automobiles. According to the CDC, the number one cause of death among all Americans ages 5 to 34 are car crashes. In response, I get a nod of agreement, then a smile and a shrug.

“I know. But it’s just the way things are.”

If anything else were cutting short the lives of so many innocent young people, we would be taking to the streets in protest. Wouldn’t we?

But it’s just the way things are.

Recently, I had a conversation with the medical director of a psychiatric clinic in another town. Since prescribing drugs is now the entire job description of  psychiatrists (and most doctors today), our conversation turned toward the prescribing of drugs.

I expressed my professional concerns about “polypharmacy” (the increasingly common habit of rapidly prescribing multiple drugs to one person), the narrowed role of doctors in the practice of medicine, the loss of other skill sets in psychiatry and my concerns about the toxicities of drugs.

I got agreement, then shrugs and smiles.

“It’s just the way things are. We have to work with it.”

Then I raised my concern about the money issues, how the tactics used in promoting drugs could be leading us doctors astray. I mentioned the drug money that pays for both undergraduate and post-graduate medical education, the drug money funding research, the drug money at the FDA level funding the drug approval process.

His expression became worried.

Because I was trained before the takeover of the psychiatric profession by psychopharmacologists, I’m a practiced observer of human non-verbal communications. I was able to read the thought bubble that hung over his head.

“Suspicious kook. Troublemaker.”

I’ve learned to tame back the rhetoric when I get that “look”. Otherwise, I lose my audience altogether.

The air pollution where I am now is thick along the beach on a sunny weekend. If I walk on those afternoons, I cough for two days after. This can’t be good.

When I mention air pollution to people that get out of their cars to look at the water, I get that look. I’m told that the air is fine here, that American cars run clean, that we’re protected by federal regulations.

Two days ago, I was reminded by a visitor that the U.S. blocks the import of many European-made cars. He would like to buy a German vehicle that is not allowed in this country.

“Of course we do,” I said. “The government blocks imported cars to protect our auto industry.”

I smiled and nodded. I thought we were on mutually agreeable territory.

“We have stricter safety and pollution standards,” he insisted. “Europe has much worse pollution than we do.”

“Funny,” I said. “When I was there last year I didn’t see the orange haze over any town I visited. My eyes didn’t burn. Walking in town didn’t make me cough.”

We had little to say after this. He got back in his big truck and drove away, alone. And he left a swath of diesel fumes behind for me to breathe.

The air is fine, sealed inside the air-conditioned cab of a truck.

I tell people of my concerns about the over-use of psychiatric drugs. I fret aloud about their known and unknown toxicities. I talk about the financial conflicts of interest happening between pharmaceutical companies and government agencies, medical schools and researchers.

Folks nod and agree. Poison drugs are bad. Greed sucks.

But one friend of mine whispered this to me:

“I agree with everything you say. Just don’t take my antidepressants away from me.”


Thanks for reading, thinking and writing.

All the best.





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


  1. “I got agreement, then shrugs and smiles.

    “It’s just the way things are. We have to work with it.””

    That is what I call a lack of Liberty. People, especially the employed, will not “do” anything unless a law tells them to (or NOT to).

    Liberty is an aspect of freedom. Liberty seeks no permission, approval or acceptance. Liberty is the *self-empowered* motivation to act.

    A good question would be: How can psychiatrists utilize Liberty in caring for people? The prerequisite to treating a person is caring about them. When we care about a person, the person becomes important and significant. When a person is important and significant, there is a greater motivation to want to honor and protect that important person’s rights (and well-being). To achieve even this much would be transformative to the point of miraculous, but this isn’t the way things are.

    Laws must be obeyed. Protocols and procedures must be followed. There are no exceptions. Rigid, inflexible, skeletal infrastructures. Concrete. Masonic.

    I have personal issues with the Statue of Liberty.

  2. Our society and economy are not sustainable. Global wwarming is a reality; the temperature will most likely rise 4 to 6 degrees by 2050. Mammalian life any larger than a shrew will be dead and gone before then. We are moving towards a massive die-off of humanity. We may be able to stave off the total destruction of the human race if we begin doing radical measures to lower CO2 emmissions but there will still be massive die-offs.

    We’ve made the projections and we know the end results and what is the response? Exactly what you describe here. It’s like an inertia has set in which will not allow people to deal with reality and work to change things. Talk about a huge helping of DENIAL! Then of course, you have huge groups of politicians who deny all of this and tell people not to worry. Big Business keeps going right on down the same old road and will not allow changes to be made. Look at how it’s trying to dismantle the Environmental Protection Agency. Our government seems to be held hostage by the robber barons who only value makeing profit hand over fist. Capitalism is cannibalizing itself and all of us along with it.

    Frankly, I’m not optomistic about how it’s all going to end. “It’s just the way it is; we have to work with it.”

  3. Alice

    I have found your posts to be very educational and interesting critiques of modern medicine and psychiatry. I have also admired and appreciated your courage and willingness to openly process very personal thoughts about your career crises as well as dialogue with psychiatric survivors about your previous role as a psychiatrist working in locked units in hospitals prescribing medications. Some of these were very tough discussions and you hung in there with great honesty and humility.

    In your current journey I would like to take your pulse on a few questions regarding the state of the psychiatric profession and the movement for the total transformation of mental health care? This would help me and perhaps others to understand what role doctors can play in this movement.

    Do you now consider yourself anti-Biological Psychiatry (as opposed to anti-psychiatry)?

    Would you be in favor of totally dismantling modern psychiatry and and the current mental health system and replacing it with something more humane and progressive?

    Have you thought about joining with a minority of other doctors who share your alienation and criticisms of the current system in order to build organization and struggle that might eventually lead to the overthrow of the current paradigm of treatment?


  4. Alice

    Thanks for answering my questions above. Your answer to Stephen is another devastating critique of our current medical system; it screams out that this system is truly broken beyond repair. You better be careful because you are sounding more and more like a radical who just might end up next to some of us at the barricades. You could play a very valuable role in educating people about what really goes on in the belly of the beast, as well as advocating for drastic changes to this system. I look forward to learning more from you and witnessing your growth in our movement.



    Great post Alice, brave and thoughtful as usual, provoking others to go beyond the usual “us vs them” cause and effect logic which so limits our sense of self and others. I guess its hard for us to adopt a systems thinking approach, even those we may be “intellectually” aware that this is the way of the future, as the brightest minds now tell and show us. Yet it seems just too painful to give up the ““It’s just the way things are,” “reaction” rationalized as intelligent reasoning and acceptance of reality, while remaining unconscious to the thought’s self soothing impulse?

    Perhaps its just the great circle of life and way progress into a meant to be future finds truth in the middle path. Sounds a bit convoluted, I know, yet consider fearless thoughts from the 1950’s which are echoed in new research findings across all science fields, and which a better educated, younger generation may be more willing to embrace than their post world war two great Grandparents were not?

    “Systems thinking?

    Systems thinking, which this research has tried to implement in human relationships, is directed at getting beyond cause-and-effect thinking and into a systems view of the human phenomenon. In the coarse of trying to implement systems theory and systems therapy, we have encountered the intensity and rigidity of cause and effect thinking in the medical sciences and in all our social systems. Man is deeply fixed in cause-and-effect thinking in all areas that have to do with himself and society.

    Systems thinking is not new to man. He first began using it in theories of the Universe. Much later he started thinking systems in the natural sciences, and also in the physical sciences. There was a rapid increase in systems thinking with the beginning of the computer age, until now we hear about efforts to implement systems thinking in many new areas of the applied sciences. The medical model has been one of the proven cornerstones of good medical practice. It is based on cause and effect thinking and the principles of careful examination, the establishment of etiology (cause), making an accurate diagnosis, and specific treatment directed at the etiology.

    The medical model has served medicine and society well for all diseases within the person of the patient. The theory and practice of psychiatry also employs the medical model, and cause and effect thinking. The theory based on the study of the individual, postulates an illness in the patient developed in relationship with the parents or other close family members. It requires a diagnosis and treatment is directed to the patient. The model “blames” the parents for the illness, even though the psychiatrist may deny that he blames the parents, and the model excludes other family members from the treatment process. And so, the medical model created a dilemma when applied to emotional (functional) illness.

    Emotional reactiveness in a family, or other group that lives or works together, goes from one family member to another in a chain reaction pattern. The total pattern is similar to electronic circuits in which each person is “wired” or connected by “radio,” to all other people with whom he has relationships. Each person becomes a nodal point or an electronic center through which impulses pass in rapid succession, or even multiple impulses at the same time.

    One important variable has to do with different kinds of impulses, and each kind exists in a wide spectrum of intensity, and in degrees of importance. A more important set of variables as to do with the way each nodal point, or person, functions within the system. Each person is programmed from birth to serve a certain set of functions and each “senses” what is required or expected, more from the way the system functions around him than from verbal messages that he is free to function as he pleases.

    A predictable pattern is the placing of “blame” for failure to function (cause and effect thinking) and the pattern of either blaming the other or blaming self. Under tension, every person tends either to place the blame outside of self, or within self, or alternate between the two, which is the pattern of cause and effect thinking. If the head of the family unit is calm, the entire family unit can be calm and the system operates smoothly

    When the head goes into panic and transmits panic impulse, the others send panic (mirroring) messages which further panics the head, in a mounting cycle of panic, with poor handling of messages, disorderly and conflicting messages, and increasing paralysis of functioning. There is another variable having to do with the way the family is wired into other families and larger social systems, and into the total system of all society.

    Though man may have gained some knowledge about systems thinking from the sciences, he is still a cause and effect thinker on all things that involve his emotional system.” _Murray Bowen.

    And of coarse I don’t need to remind you and others here what NAMI’s “reaction” was to the fearless thinking of the 1950’s and theories about the human condition, like Bateson’s “double-bind?” “Don’t blame us, screamed……..” in a reasoned-reaction. “That’s just the way it is – in families, don‘t blame us, don‘t you dare “shame” us.” And so the reactive reasoning rolls on, down through the generations, while cause & effect logic looks to the non-shaming-blaming wishful reality of “It must all be genetic – surely?”

    Is it possible that beyond our reasoned-reactions, our sense of “I” & “otherness” which matures into a group sense of “us & them,” that the systemic reality of nature really is cycling its way forward into a meant to be future? Consider this forward to Allan N Schore’s work from the 1990’s “Affect Regulation & The Origin of The Self.”

    “Maturation, with its achievements and failures, is fundamentally determined – and altered – by a vast array of carefully timed neurodevelopment processes that can now be conceived of, thanks to the explosion of new interdisciplinary data, as occupying vaster and more complex, as well as more intricately timed and sequenced scenarios than we could have ever imagined.

    These developmental sequences are determined by a fantastic, almost surrealistically complex choreography that integrates postnatal neural anatomic and neurochemical development so that they unfold in an intricately coordinated series of contacts with the maternal-social-environment.; all in an orcestration of specifically times phases of availability to a holding environment of appropriate, mediating caregiver functions that at first soothe, validate and confirm, and then stimulate, challenge, and encourage , the sequential interventions that appear to be absolutely necessary for neural development – and, as a consequence, the roots of the infant’s emotional development, to occur.

    Upon this depends the unfolding of the neural anatomy of the regulatory centers of the brain, particularly the right hemisphere orbit frontal cortex, which apparently becomes the control center for the regulation and mediation of affect, social relations, and emotional balance, to name just a few of its functions.

    Put another way, if I read Dr. Schore correctly, it is the prefrontal cortex generally – and the right hemispheric orbito-frontal cortex specifically that is most responsible for the establishment and mediation – and even the development of the humanness of the infant.

    What psychoanalytic theory had speculated upon from its very beginnings now turns out to be truer than had been anticipated. As in chaos theory, which states that there occurs an unusual sensitivity to initial conditions, the role of the mothering person with her offspring, which had been all but neglected in the dawn of psychoanalysis. Nobody then anticipated how dependant the infant’s brain was on the mothers care giving.

    In developmental disorder one thinks of psychopathology, insecure attachments and their neuropsychological consequences, affect dysregulation, the onset of personality disorders, and vulnerability to somatization disorders. Developmental psychopathology, which is rapidly becoming a field unto itself, can certainly be understood in no small measure by the concept of the “failed appointment,” that is, failure, whether by chance, trauma, neglect, or inherent genetic programming, for the key neuronal connections to have been evoked at the proper time by the mother-as-appropriate-self object at the appropriate time.

    One certainly must now view such disorders on the anxiety spectrum, such as the disorders of anxiety, panic, phobia, hypochondria, and such trait-state disorders as borderline personality, the obsessive compulsive disorders, affect dysregulation (the manic-depressive-dysthymic spectrum disorders), schizophrenia, and many others as being deeply rooted in one or another form of a neuro-biologically induced disorder of regulation.

    Joseph Palombo, who works with the neuro-perceptual-cognitive aspects of developmental disorders of childhood, including borderline syndrome, calls attention to the presence in these impaired children of a discrepancy between their private, personal selves and their shared selves in terms of a lack of ease in communication. Put another way, these damaged children seem to sense that there is something neurodevelopmentally wrong with them, and they feel a “deep sense of shame” about themselves as a result.”

    Excerpts from “Affect Regulation & The Origin of The Self.” by Allan N Schore.

    And as we cycle forward into the 21st century, is there a new discovery that truly will change everything, in terms of how we understand ourselves, beyond our knee-jerk self-soothing reaction of “that’s just the way it is?” Please consider why ‘The Polyvagal Theory.” really does change everything as we cycle into a meant to be future? Stephen Porges discovery of a third branch to our autonomic nervous system, deepens our understanding of what truly makes us tick, and brings us closer to the systemic reality of nature and beyond.

    Please consider a recent post on my blog;

    “Discovering a Paradigm Shift in Mental Health?

    Understanding the Face-Heart connection, and hidden vitality affects, in human health?

    The paradigm shifting discovery of a “polyvagal” control of the heart, explains just how, those of us suffering from unresolved trauma experience, become locked out of the social system of group survival, in our inability to self-regulate unconscious survival reflexes,
    ie, freeze/flight/fight?

    The theory shows just how “unconscious, spontaneous, social reflexes,” are inhibited in those of us struggling to cope with unresolved traumatic experience, so often diagnosed as a mental illness. In a computer analogy, its like having two distinctly different operating systems, (1) survival, (2) social. If our unconscious spontaneous social reflex functioning is “turned off,” by unresolved trauma experience, we cannot form the kind of healthy human relationships, so vital for our physical/emotional/mental health.”


    And from a near 3000 year old Buddhist perspective?

    “Seeing the interdependent nature of all things, Siddhartha therefore also saw their empty nature: all things are empty of a separate self (ego).
    He realized that the key to liberation lies in the two principles of interdependence and non-self (ego).
    Illuminating the rivers of perception, Siddhartha understood that impermanence and the absence of (ego) are the conditions that are indispensable to life.
    The cause of suffering is the false notion of permanence and of a separate self (ego).
    When we penetrate the empty nature of things, mental barriers are overcome and we are liberated from the cycle of suffering.
    Right understanding, has been handed down by Buddhist tradition under the name of “enlightenment.”

    But what in concrete terms, is Right Understanding?
    Ignorance of reality – the exact opposite of knowledge – is what the Buddha considers the cause of suffering.

    “Brothers, the cause of suffering is ignorance. Because of ignorance, men do not see the reality of life and allow themselves to be imprisoned in the flames of desire, anger, envy, anxiety, fear and despair.” _Buddha.

    But what is reality?
    The definition traditionally attributed to the Buddha is quite clear.

    Reality is constant change!”

    Excerpts from “How to become a Buddha in 5 Weeks,” by Giulio Cesare Giacobbe. In brackets mine.

    Is there a meant-to-be reason for our current malaise? Economic and moral bankruptcy in the name of “its just business – that’s just the way it is?” Or are we on the brink of a major “phase-shift,” to use a term from systems theory, as we cycle our way into a meant-to-be future, that some physicists suggest has already happened? Reality! Its turning out, is truly stranger than fiction?

    When we do pause to feel the “impulse” beneath our egoic sense of “I,” perhaps we get that deeper sense of Jesus statement “I am,” as a reflection on the Cosmic nature of ALL? The Buddha is said to have discovered “The Way.” And is perhaps reflected in Jesus later, cross-fertilized statement “I am the way?” As we stand on the brink of what seems like a looming disaster, at the beginning of the 21st century, are we perhaps, entering the phase shift to a deeper realization, beneath our daily sense of survival, which we label ego?

    Are we entering the maturing phase of species survival, in the realization of no-separation and the reality of God within?

    I hope your continuing your sabbatical with more trips’s down the rabbit hole Alice:)) On this great self-reflective, journey within?

    Best wishes,

    David Bates.

  6. I highly recommend the film “Ancient Futures: Learning from Ladakh.” Ladakh is a place very lately influenced by globalism. The older people have seen an entire modernization that took the elite parts of the world centuries happen in one lifetime. Because it happened so quickly, the people of Ladakh were able to identify some causes and effects. This film looks at how our modern way of life has impacted our community life, mental health, power structures and environment, as well as the all-important feelings of purpose in life and happiness. It is modern life that is killing us in body and spirit.