It has been a year since the Mad In America website launched and I posted my first blog. On so many levels it has been a remarkable year for me. I traveled to Finland and began training at the Institute for Dialogic Practice I have tracked my experiences with neuroleptic drug taper and presented the first year of data at the Institute for Psychiatric Service meeting. At my clinic, we have initiated a new program where peers and professionals work as colleagues and we offer support to individuals who are in acute distress. I have joined the board of the Foundation for Excellence in Mental Health Care and have had the great privilege of meeting my fellow board members.
Much of what has been positive this year has come about from my connection to this website and to Robert Whitaker. I have a deep respect and gratitude for Mr. Whitaker’s work and for the opportunities he has brought my way. I was told recently that some of my colleagues perceive me to be overly influenced by his message. My initial instinct was to respond defensively as if it is a bad thing for a physician to be influenced by a journalist. But on reflection, I took the comment in a different way. It is a correct observation to say that I have been influenced by Mr. Whitaker’s writings. I think he is a smart and critical thinker whose contributions are important for psychiatry. Physicians make a mistake when they do not listen to outsiders. Physicians pride themselves on their belief in the value of the scientific method. Critical to that method is challenge and debate. What has troubled me most in psychiatry over the course of my career has been a diminution of debate. My experience with psychoanalysis was that criticism was often seen as a reflection of a person’s inner conflicts. My experienced with what many of you call “biopsychiatry” is that criticism has been stifled by an overly cozy relationship with the pharmaceutical industry.
I was not sure what to expect of blogging on MIA. I admit that at times I have struggled with critical comments. When I had the impulse to be dismissive of angry and negative voices, I tried to hold back and reflect on the message. You are a smart and well informed audience. I know that many of you are eager to change the mental health system; for what it is worth, you have changed one doctor. I have learned that labels – even when offered with good intentions – can be hurtful. I have realized the limitations and harm that the medical model can have when applied to emotional distress and suffering. Rather than respond to criticisms of my work with the beleaguered thought that I am just doing the best I can under the circumstances, I have begun to think more about how we can change those circumstances so that we are more responsive to the people who come to us seeking help. I understand that individual experience should not be flatly dismissed as meaningless anecdote
I believe your message is reaching a broader audience.
In the winter 2013 addition of “NAMI Advocate”, there was an article by the NAMI Medical Director, Ken Duckworth entitled, “The Sensible Use of Psychiatric Medications”. This was notable to me in its tone of sobriety. He writes about medications, “They may be a key piece of the recovery puzzle, but they are rarely enough to promote recovery alone.” He talks about the need to ask if the medications are actually effective for an individual and if the benefits outweigh the risks and side effects. He addresses at some length his concerns about the over use of antipsychotic medications in children and adolescents. Although many of you would disagree with the basic premise of this article, for me it signaled a shift in NAMI in that it tacitly accepted that medications have their limitations and that they may not be indicated for everyone.
David Brooks, a conservative commentator for the New York Times recently awarded his Sydney Award for the best essay of 2012 to Tanya Marie Luhrmann who wrote “Beyond the Brain”. In discussing the evolution of ideas about psychosis, Brooks writes, “scientists … concluded that schizophrenia was a brain disease. But the drugs that treated schizophrenia as a biological disorder did not work well.”
The Luhrmann article is a departure from the promotion of the simple brain models that so many of us find lacking and gives credence to the powers of social context in the development of extreme states.
I am heartened by these articles. However, my day to day work continues to be a challenge and if I ever have a self-congratulatory moment, I am almost invariably confronted by a situation in which I am not sure how to be of help or where someone points out to me how our system has failed her or a loved family member. Engaging with someone who is in distress but is not interested in getting any help remains the the biggest conundrum for me.
I guess it is good that a premise of Open Dialogue is the toleration of uncertainty because I admit that I leave 2012 with great uncertainty. For the next year, I will continue to listen to what you have to say. Thank you for your contributions. They enrich my life.
