DSM-5 Statement by the Critical Psychiatry Network

Philip Thomas, MD
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The following statement was posted on  the Critical Psychiatry Network website in the UK on 23rd May 2013.
 

The Critical Psychiatry Network is concerned with the way the controversy over the publication of DSM-5  is being portrayed in the media and by some academic psychiatrists. The issues raised by the DSM are complex and require careful and studied consideration. There are two aspects in particular that concern us. These relate to the portrayal of the controversy as a guild dispute, and the polarisation of the debate as one of nurture versus nature.

1. Portrayal of the controversy as a guild dispute

A number of reports in the media have portrayed the storm of criticism of DSM-5 as a guild dispute driven by professional rivalries between psychologists and psychiatrists. This may have arisen because the DSM is a product of the American Psychiatric Association, and in the UK the debate in the media has been polarised as one between clinical psychologists and psychiatrists[ii]. This gross oversimplification is not supported by the evidence. Many psychiatrists are deeply concerned about the limitations and failings of diagnosis in psychiatry. These concerns were expressed in a recent special article co-authored by twenty-nine Members and Fellows of the Royal College of Psychiatrist, published in the British Journal of Psychiatry[iii] in December 2012.

The paper points out that since its origins in the early part of the nineteenth century, psychiatry has faced a fundamental question that remains unanswered: can a medicine of the mind work with the same epistemology as a medicine of the tissues. In recent decades, there has been a concerted effort to ignore this question and psychiatry has approached the ‘mind’ as if it was simply another organ of the body. It has assumed that problems with our feelings, thoughts, behaviours and relationships can be grasped with the same sort of diagnostic and scientific tools that are used to investigate problems with our livers, hearts and lungs. This model has not served psychiatry well. Whether we like it or not, mental problems resist both explanation in terms of simple causal models and categorization in terms of singular diagnostic categories. Over the last half a century leaders within the profession of psychiatry, academics who have devoted their professional lives to discovering the biological basis of psychosis, have acknowledged that biological and neurosciences have failed to establish the validity of a single psychiatric diagnosis [iv] [v] [vi] [vii] [viii]. Moreover, there are serious doubts about the nature and quality of the evidence for the effectiveness of most psychiatric drugs1 . Apart from their obvious mind-numbing effects, it has not been demonstrated that any type of drug used to treat mental health problems has any specific, or targetted action. The idea that psychiatric drugs correct underlying chemical imbalances or any other presumed abnormality is no more than a myth[ix].

2.  Epistemological polarisation.

We are also concerned about the way that some commentators, particularly from within academic psychiatry, question the importance of environmental factors in understanding psychosis. Many psychiatrists disagree with this position, and find such accusations unhelpful. Psychiatry has always prided itself on being an eclectic profession, one that recognises the importance of holistic approaches to understanding and responding to people who use mental health services. Biological, neureodevelopmental and genetic factors have little role to play in explaining psychosis because they are incapable of accounting for the complexity of consciousness and embodied experience[x].  In contrast, personal narratives of adversity  have a central role in understanding how people cope with, and recover from, psychosis[xi] [xii]. To deny the importance of these factors is to deny the importance of finding meaning in suffering, a prerequisite for recovery.

Our view is that there is an urgent need for a measured debate about psychosis and distress, one that engages with the scientific evidence that a wide variety of experiences of adversity including childhood trauma and racism are linked to the development of psychosis in adulthood [xiii] [xiv] [xv] [xvi] [xvii] [xviii] [xix]. We believe that an important outcome of such a debate would be forms of psychiatric practice that engage fully with the diverse understandings that service users and carers have of their experiences. However, the very nature of mental problems demands that we move beyond positivistic approaches to research and scientific modeling. We believe that there is an urgent need to promote collaborative research with service users about the nature of mental illness itself as well as looking at what helps people in their struggles towards recovery.

Conclusions

The controversy over DSM-5 is not a guild dispute or turf war. Psychiatrists, psychologists, and mental health professionals across the disciplines reject medical type diagnoses like DSM-5 as ways of describing the varied human experiences that we call mental disorders and support ways of formulating these that capture their complexity and diversity. There are many other voices engaged in the debate over the future of psychiatric diagnosis who share our concerns. The Hearing Voices Network has expressed serious reservations about DSM-5, and rightly drawn attention to the importance of the perspectives of experts by experience in the debate about the controversy[xx]. Mental Health Europe, a non-governmental organisation that represents a diverse range of perspectives, including experts by experience, carers and professionals from a range of disciplines has also expressed deep concern about DSM-5 and the future direction of psychiatric diagnosis[xxi]. Many psychiatrists, too, share these concerns, and we will continue to support the need for, and contribute to an informed public debate about the limitations and failings of psychiatric diagnosis symbolised by DSM-5. The DSM is incapable of capturing the full range of experiences of distress in the way that narrative formulation can.

 

References


See, for example, Frank Furedi’s article in The Independent Friday 17th May 2013, accessed at http://www.independent.co.uk/voices/comment/despite-what-the-dsm-implies-medical-intervention-is-not-always-the-answer-to-mental-health-issues-8621109.html on 20th May 2013

[iii] Bracken, P., Thomas, P., Timimi, S. et al (2012) Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201:430-434.

[iv] Robins, E. & Guze, S. (1970) Establishment of Diagnostic Validity in Psychiatric Illness: Its Application to Schizophrenia. American Journal of Psychiatry, 126, 983 – 987

[v] Kendler, K. (1980) The Nosological Validity of Paranoia (Simple Delusional Disorder) Archives of General Psychiatry, 37, 699 – 706.

[vi] Andreasen, N. (1995) The Validation of Psychiatric Diagnosis: New Models and Approaches. American Journal of Psychiatry, 152, 161 – 162.

[vii] Kendell, R. & Jablensky, A. (2003) Distinguishing Between the Validity and Utility of Psychiatric Diagnoses. American Journal of Psychiatry; 160:4–12

[viii] Anckarsäter, H. (2010) Beyond categorical diagnostics in psychiatry: Scientific and medicolegal implications. International Journal of Law and Psychiatry, 33, 59–65.

[ix] Moncrieff, J. (2008) The Myth of the Chemical Cure: A critique of Psychiatric Drug Treatments. Basingstoke, Palgrave Macmillan.

[x] Tallis, R. (2011) Aping Mankind: Neuromania, Darwinitisand the Misrepresentation of Humanity. Durham, Acumen.

[xi] Davidson L. Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. New York University Press, 2003.

[xii] Mancini MA, Hardiman ER, Lawson HA. Making sense of it all: consumer providers’ theories about factors facilitating and impeding recovery from psychiatric disabilities. Psychiatr Rehabil J 2005; 29: 48–55.

[xiii]  Read, J., van Os, J., Morrison, A., Ross, C. (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112: 330–350, DOI: 10.1111/j.1600-0447.2005.00634.x

[xiv] Read J, Perry BD, Moskowitz A & Connolly J. (2001)The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model. Psychiatry;64:319-45.

[xv] Read, J, Bentall, R. & Fosse, R. (2009) Time to abandon the bio-bio-bio model of psychosis: Exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiologia e Psichiatria Sociale, 18, 4, 299-310

[xvi] Boydell. J., van Os, J., McKenzie, K., Allardice, J., Goel, R., McCreadie, R., Murray, R. (2001) Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment British Medical Journal; 323 doi: http://dx.doi.org/10.1136/bmj.323.7325.1336

[xvii] Janssen, I., Hanssen, M., Bak, R., Bijl, V, De Graaf, R., Vollebergh, W., McKenzie, K. & Van Os, J. (2003) Discrimination and delusional ideation British Journal of Psychiatry, 182, 71 – 7 6.

[xviii] Karlsen, S. & Nazroo, J. (2002) Relation Between Racial Discrimination, Social Class, and Health Among Ethnic Minority Groups American Journal of Public Health 92, 624 – 631.

[xix] Karlsen, S. & Nazroo, J., McKenzie, K., Bhui, K. & Weich, S. (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine, 35, 1795–1803. doi:10.1017/S0033291705005830

74 COMMENTS

  1. A great pleasure to read your article which is well articulated and hits the key issues in this debate.

    As an Australian psychologist who opposes the medical/biogenetic model as both flawed and failed, who finds DSM diagnostic labels and the terms “disease, disorder” to be misleading at best and pathogenic at worst, and opposes the cancerous growth in the v”chemical imbalances” myth – it is immensely encouraging to here like mindedness within the psychiatric profession itself.

    Thank you!

  2. Its good to see more psychiatrists speaking out over these issues Philip. I am from England and so am aware of the CPN and many psychiatrists debating these issues over here and in Ireland. However, what concerns me is how much of these debates reach the general public in order to inform and educate them on alternatives to the biomedical model? It seems the only people who are aware of such debates are those within this ‘movement’ itself. Would it not be a possible for all you likeminded psychiatrists to get your heads together and raise these issues in the main stream media and try to get more media coverage, as the BPS’s DCP recently achieved with their Classification Statement? This achieved global attention which I am sure you are aware of and probably appeared as if psychology was speaking out about psychiatry because psychiatry (or some of the profession)did not release a ‘public’ supporting statement to the DCP’s.

    I feel if fellow psychiatrists like yourself spoke out publicly over these concerns then it would offer greater weight to this ‘movement’. I am sure you are aware, this is a very arduous and taxing slog to get both professionals and the general public to take onboard what ‘we’ are saying about the harm of psychiatric diagnosis, drugs and the postivistic way towards treating emotional distress. If those in the psychiatric profession as a collective, targeted main stream media then maybe this would offer greater support to what the rest of us are saying including psychologists, psychiatric survivors, carers, social workers, lawyers etc.
    Just as an example how many people in the UK have heard of the CPN? Again I would say only those within this more widespread ‘movement’. Perhaps it would be good if the CPN released this to the media? Just a thought?

    I would also like to see other psychiatrists contacting the American Psychiatric Association in America about DSM5 (and other DSM’s)and the harm this will create to individuals.

    I wonder if there is a fear of repercussions from fellow colleagues if psychiatrists like yourself go too public about these issues?

  3. British protest against DSM coming up:

    http://speakoutagainstpsychiatry.org/dsm-5-protest-4th-tuesday-june-4-30pm-onwards-at-the-institute-of-psychiatry/

    I wish nurses also got more involved with these debates. You’re quite right that this issue has been presented in UK mainstream media as professional rivalry which it is not. Also, the way it is discussed in new media is not the same as here. That presentation does the people who strived so hard to get to this point a great disservice. Suggestions of CPN getting out in the mainstream is a good idea to help counter this.

    I’ll reiterate something I said on the HV thread, The fact is people increasingly need medics (as in the recent court ruling) as allies to back claims for ongoing support and assistance,so how do we square that in the here and now with politicians who happily withdraw anything if they can get away with it?
    Decent professionals are well aware that diagnosis is complete nonsense but are equally well aware that they need to use it – this has always been the case – but it’s becoming even more necessary, something which needs acknowledgement of in DSM/ICD debates. It’s an uncomfortable reality but these issues need to be faced. There’s already too much division and judgement around who takes meds/uses services/is employed/accepts a diagnosis and why, etc. Many of the people in this position will not be posting here, they’re not even going outside their front door.

  4. To quote from the above article: “The scientific evidence that a wide variety of experiences of adversity including childhood trauma and racism are linked to the development of psychosis in adulthood. Homophobia and poverty are also linked to psychosis, and other forms of mental distress. Or so Mr Bental said when I asked him at a confernece.

    Mental helath nurses, along with many other parts of the psychiatric profession rather like the medical model with it’s diagnosis. They are not very well organised. The same applies to GP’s. There are some wonderful exceptions but not organised groups.

    I went on a short peer support course organised by a mental health day centre that was developed by the manager and a psychiatric nurse. A core part of the course was diagnosis, treatment (ie drugs) and alternatives (ie talking to people).

    Reaching out to various professional, service user and carer groups as well as the general public throught the media is called strategy. We need more of it.

  5. The ‘recovery approach’ within services is a sham, it’s all wrapped around a medical model in the ‘recovery colleges’ where you learn about your illness, take the meds and/or CBT and the ‘alternatives’ are – talking to people, but not within services, and a bit of Bud-Lite mindfulness. People are pushed through a few weeks in a recovery group or college and that’s it their done. Some peer support workers have been required to do far from peer support, but what managers want, but when it’s done in a paid capacity and the rent depends on it, it’s hard to dissent.

    • I agree. The message is always “Recovery is possible – IF you are a good patent and accept your diagnosis and take your drugs and don’t expect to live a normal life ever again.” The focus is still compliance and drugs. The clients are still treated like poorly-behaved children who need to be watched to make sure they don’t get in trouble.

      What I think of as “recovery” means EMPOWERMENT – finding your voice and exercising your rights and telling anyone who tries to stop you to “stick it where the sun don’t shine.” This appears to be the very last thing the bulk of the system personnel ever want to see. As Sean Donovan’s piece clearly shows, they’re actually terrified and confused by anything that looks like a real recovery. It blows away their religious belief system. It makes them look and feel like incompetents. Which, unfortunately, is mostly the case.

      Anyone who is really interested in recovery is interested in empowerment. And the issue of forced/manipulated psych drug use has to be addressed head on. Anything else is lip service.

      — Steve

  6. I disagree Steve, the expectation now is take your meds, be compliant, AND recover! You are expected to recover. Government also expects you to recover i.e. out of services asap and in work.
    Drugs are not the only treatments which are forced here, people are also being forced into PD groups for up to 2-3 years or else they are discharged from the CMHT, and these can be people who were diagnosed as Schizophrenic, on depots, who accept their diagnosis/meds and you would never see them here, but services have no long term support for people anymore, so they get shoved into this.
    Equally, there are brands of recovery outside of psychiatry which are as unhelpful as what services do but in reverse i.e. you’re not allowed to experience enduring difficulties, you’re not truly recovering unless you don’t take meds/use services/are in paid employment and anything less is personal failure. Because recovery as a concept can be wrapped around literally any ideology that’s why some of us have turned away from it because we’ve not yet seen what it purports – being allowed to live as well as you can in the way you need with no prescribed descriptions of what it looks like.

    • Thanks for that additional clarification. That is even more offensive than making someone take drugs, in a way. But you make my point for me – no matter what “helpful intervention” is used, it’s not helpful when it’s forced down your throat (literally or figuratively). I’m in the US, and there are fewer and fewer alternatives to drugs available over the course of my lifetime. I personally lucked out and found an awesome therapist who really helped me start on a new path, but it would have been a way different deal if someone told me that I HAD to see her as well as telling me what I had to do/say/think/feel in order to prove I was “recovered!” I have no truck with anyone who feels they can “prescribe” a particular service and expect a particular outcome.

      It sounds like “recovery” has taken a bit of a different path in the UK, but it still sounds riddled with authoritarianism and force, as well as shame and humiliation for those who don’t “go along with the program.” That helps no one but the people getting their pay at the survivor’s expense.

      Again, I think it all goes back to the initial act of diagnosing someone with a disease just because they don’t think/act/feel the way we want them to. That’s the first act of bullying, defining another person’s reality for them. Once you’ve done that, the recipient/victim of your actions has been sufficiently dehumanized that these other actions become possible to contemplate, when anyone giving it a moment’s thought would realize that they as an individual would never want to be treated that way.

      Thanks for your passionate advocacy, Joanna! I hope I get to meet you one day.

      —- Steve

      • Yes Steve ‘recovery’ has evolved differently in the UK and I would not support much of how it’s become branded and practised within services and I’d equally be critical of NGO’s, free lance trainers and survivors who can also be prescriptive about it – and that’s without a diagnosis!
        I hope we meet one day to.

  7. I think Philip Thomas’ pieces on here are wonderful. They are always heavily referenced and very well done. I applaud the Critical Psychiatry Network’s statement for the most part.

    I get that it is a British thing, this term “service user”. I find it to be an appalling term, just the latest on the euphemism treadmill that began with “mental patient”. I know it is used in regular parlance in the UK. I think people from the UK need to think about how it sounds to readers outside the UK. Let’s look at some of the uses on this page:

    “Psychiatry has always prided itself on being an eclectic profession, one that recognises the importance of holistic approaches to understanding and responding to people who use mental health services.”

    “We believe that an important outcome of such a debate would be forms of psychiatric practice that engage fully with the diverse understandings that service users and carers have of their experiences.”

    “We believe that there is an urgent need to promote collaborative research with service users about the nature of mental illness itself as well as looking at what helps people in their struggles towards recovery.”

    “I’d be really interested to hear where mental health nurses stand in this debate. Arguably they have the greatest potential impact (for good and bad) on the experiences of people who have to use mental health services.”

    The Dictionary.com definition of “service”:

    serv•ice

    1.
    an act of helpful activity; help; aid: to do someone a service.
    2.
    the supplying or supplier of utilities or commodities, as water, electricity, or gas, required or demanded by the public.
    3.
    the providing or a provider of accommodation and activities required by the public, as maintenance, repair, etc.: The manufacturer guarantees service and parts.
    4.
    the organized system of apparatus, appliances, employees, etc., for supplying some accommodation required by the public: a television repair service.

    The dictionary.com definition to “use”:

    use
    1.
    to employ for some purpose; put into service; make use of: to use a knife.
    2.
    to avail oneself of; apply to one’s own purposes: to use the facilities.
    3.
    to expend or consume in use: We have used the money provided.

    The term “service user” is one I’m opposed to because it seems that built in to this phrase, is a wholesale denial of the reality of forced psychiatry.

    This is a video of Canadian detainee Ashley Smith being subjected to a forced injection for the crime of asking to change her female sanitary product:
    http://www.youtube.com/watch?v=Vovv9u0MJaY

    If you can say in good conscience that Ms. Smith is pictured simply “using a service”, then by all means, continue to use this phrase. What would I suggest instead? I’d suggest acknowledging, and building in to your communications, the truth about people using services versus people being forced into psychiatry. The truth is that some people do “use” and consider government psychiatry to be a “service”, and if this is what they want, great, but millions have had government psychiatry forced on them too. Call them “involuntary patients”, “detainees”, “survivors of coercive psychiatry”, call them anything that doesn’t put them in the same box as someone who opened the yellow pages, sought out a “service” and “used” it.

    Maybe the whole thing comes down to how the British view and talk about their socialized government medical system, the National Health SERVICE. It’s a society where joining the military is often called joining the “services”, police forces are called “police services”. It all sounds very Orwellian to me, but that’s just my personal opinion. I just sought to point out how painfully degrading I find it that the thousands of people on home based forced drugging aka “CTOs” in Britain, and the thousands of detainees in locked psychiatric facilities being forcibly drugged are called “service users”. To me, any language which falsely smuggles in an air of volition and choice around the “use” of a “service” needs to be countered by the truth.

    The euphemisms coming out of Britain have perplexed me for some time. Euphemisms are great at hiding reality. Which one of these example phrases best reflects reality?

    I’ll use the British euphemisms first:

    “Jenny was sectioned, now she’s a service user.”

    Now my interpretation of what was done TO, not for, Jenny:

    “Jenny was arbitrarily arrested without charge, detained indefinitely in a psychiatric facility without a court hearing, forcibly drugged, interrogated, forced to confess she was brain diseased, and put in solitary confinement, and led to believe she was now going to be brain diseased for the rest of her life”.

    • Lol, we speak English but at times a different language my friend, our use of language and cultures are quite different but not always what they might appear to be.
      One of our early activists of the 60’s [Eric Urwin, Campaign Against Psychiatric Oppression] said “People are as much consumers of psychiatry as woodlice are of Rentokill”.
      Now ‘consumer’ is a description which has been widely used in the US, Canada and Australia and you could levy the same criticism of that as ‘service user’.
      The term ‘survivor’ was introduced to the Canadian’s by the British.
      ‘Service user’ is used out of ease within research, involvement with service development/operation, and high level committees because that’s what policy makers, service commissioners and funder’s understand, but that doesn’t mean the people involved are automatically tame loonies. It can be a description on paper only.
      Survivors [and some professionals, and our allies] will often only refer to service users to get a foot in the door, get something read, listened to, but how they refer to themselves and others whilst doing whatever they’re doing is another thing entirely.
      I’ve worked with professionals on some [non-drug] research and we might refer to loonies [a word some of us reclaim] but for the paperwork the funder’s are not going to accept loony/survivor/mad person/voice hearer etc. So do we do nothing because of the term?
      If I had the chance to get money from the NHS for an advocacy service I’d happily refer to ‘service users’ as part of the funding bid as a means to an end.
      We can get hung up on language to the point where we can end up telling each other how we may and may not refer to ourselves and our experiences. I support self-definition, so I don’t care how anyone wants to define themselves when it’s of their own choosing.
      I remember in the 80’s when the survivor branch of the NSF [National Schizophrenia Fellowship] which some of us nicknamed ‘National Schizophrenia Front’ [a play on the racist/fascist BNP, NF], would refer to themselves as ‘sufferers’, many of us would cringe.
      Equally I cringe now at some of the airy fairy recovery language about being ‘beyond recovery’, means nothing to me, but I’d fight for the right for anyone to describe themselves however they so choose. I personally favour survivor, psychiatric survivor, loony, mad, but I’d use service user to get an article into a journal read by professionals promoting a survivor defined approach they wouldn’t otherwise hear about if that means they will read it.

      We have to let people use their own descriptions and allow descriptions to be used [when it isn’t their preference] if that helps them to progress some of our aims.

      Terms are also used interchangeably. If you want to question what we use then you could also question the hearing voices movement for its use of ‘psychosis’, that’s a medical model description, but sometimes that word has to be used in order to reach the people we need to reach, it doesn’t mean that using the word is promoting a medical model. Psychosis is routinely referred to by activists even in circumstances when it isn’t ‘required’. We can police language if you like, but how helpful is it.

      ‘Service user’ when it comes to actual service provision is contentious to many, because of course you’re quite right anyone sectioned, in medium/high secure ‘care’, on a CTO is hardly a willing participant. However, neither are those of voluntary status who are told attend this group or do X and if you don’t you will be discharged/all support withdrawn, it’s not only physical treatments which can be directly and indirectly forced. You might think well if the person has a voluntary status they can walk away, why does that have any hold over them – well it does when people have nothing else, as uncomfortable as that may be to many of you.
      In physical health care we are called ‘patients’, in mental health services [formerly psychiatric services] we are called ‘service users’ and nope many of us don’t like that at all, but all our healthcare systems have set descriptions for us. What are you called in the US in your psych services, ‘patients’? Do you feel like a patient?
      Our services most certainly hide behind the reality of what they do with euphemisms, they hide behind all sorts of terms, as do yours I’m sure.

      There are many differences between the UK and US, I know that your psych services are much harder to extricate yourselves from than here for example. Sometimes people really do take something useful from services from an exceptional individual, that must occasionally have happened in the US, I’m certain anyone who saw Peter Breggin as a patient would have benefited. There are of course many many more of those profoundly damaged by psychiatry both physically and emotionally, and the iatrogenic trauma for some has become enduring, but there are others who despite having found nothing useful within services and ‘treatments’ found something else in themselves, found other survivors, found a purpose, solidarity and desire to fight one of the last civil rights struggle they may not have considered otherwise and don’t always regret that fact.

      As for politics and political systems, your country is no better than ours, but let’s not get precious about who’s more radical on the language front because it’s our actions which really count.

      • “Now ‘consumer’ is a description which has been widely used in the US, Canada and Australia and you could levy the same criticism of that as ‘service user’.”

        I could and I do. “Consumer” is just as bad when used to mask forced psychiatry and silence the forced psychiatry survivors. “Client, patient” are just as bad when used to mask reality too.

        “‘Service user’ is used out of ease within research, involvement with service development/operation, and high level committees because that’s what policy makers, service commissioners and funder’s understand, but that doesn’t mean the people involved are automatically tame loonies.”

        I’d never call anyone a “loony” and I don’t seek to get anything from any high level committees, but if you do, I support your right to conduct yourself as you see fit.

        “It can be a description on paper only.”

        Paper can cut. Language that puts forced psychiatry out of sight puts it out of mind.

        “I’ve worked with professionals on some [non-drug] research and we might refer to loonies [a word some of us reclaim] but for the paperwork the funder’s are not going to accept loony/survivor/mad person/voice hearer etc.”

        “Funders” unwilling to acknowledge the violence and horror of forced psychiatry, and allow survivors of heinous human rights abuses to speak freely are not people I see much point interacting with, but that’s just me and I support your right to attempt to achieve whatever you want in whatever way you want.

        “So do we do nothing because of the term?”

        I merely sought to spotlight how ridiculous the term is, when juxtaposed with the reality of forced psychiatry. You and I have different ways of going about things. I would like to convince the public to stop supporting human rights abuses. To do this, I don’t want the public to think of the victims of human rights abuses as users of a service.

        “If I had the chance to get money from the NHS for an advocacy service I’d happily refer to ‘service users’ as part of the funding bid as a means to an end.”

        Again, I support your right to pursue whatever you wish in the way you wish to. Personally when I see an advocacy group funded by government using terms like ‘service user’ I close the website immediately. He who pays the piper calls the tune, and I don’t believe the same governments that show disdain for our human rights are capable of genuine advocacy.

        “We can get hung up on language to the point where we can end up telling each other how we may and may not refer to ourselves and our experiences.”

        I’m not telling. I don’t tell. I’m pointing out I find it degrading, and non inclusive of those who are being coerced, those who are not “using” a “service” or “consuming”.

        “I support self-definition, so I don’t care how anyone wants to define themselves when it’s of their own choosing.”

        The professionals in the Critical Psychiatry Network are legally empowered to force psychiatry on people. They are not defining themselves, they are speaking about a group of people they have immeasurable legal power over. If this piece had been written by a non professional I’d probably not have left my comment.

        “I personally favour survivor, psychiatric survivor, loony, mad, but I’d use service user to get an article into a journal read by professionals promoting a survivor defined approach they wouldn’t otherwise hear about if that means they will read it.”

        I support your right to define yourself as a “service user”. Define me as a “service user”, I support my right to complain that coercion’s reality is being stubbed out with language couched in choice.

        “Terms are also used interchangeably. If you want to question what we use then you could also question the hearing voices movement for its use of ‘psychosis’, that’s a medical model description, but sometimes that word has to be used in order to reach the people we need to reach, it doesn’t mean that using the word is promoting a medical model. Psychosis is routinely referred to by activists even in circumstances when it isn’t ‘required’. We can police language if you like, but how helpful is it.”

        I have issues with all psychiatric language, even the very name the “hearing voices movement” has chosen for its movement. But none of the examples you’ve raised actively hide the reality of forced psychiatry. When it comes to forced psychiatry and language that masks its reality, “service user, consumer”, I plead my case for language that stops giving an air of choice and seeking out, to interventions imposed by force of law. People will either be convinced of my pleading, or not, this isn’t policing.

        “‘Service user’ when it comes to actual service provision is contentious to many, because of course you’re quite right anyone sectioned, in medium/high secure ‘care’, on a CTO is hardly a willing participant. However, neither are those of voluntary status who are told attend this group or do X and if you don’t you will be discharged/all support withdrawn, it’s not only physical treatments which can be directly and indirectly forced. You might think well if the person has a voluntary status they can walk away, why does that have any hold over them – well it does when people have nothing else, as uncomfortable as that may be to many of you.”

        I don’t find it uncomfortable at all. I completely, vehemently reject, any direct equal comparison between poverty and the wish for a service voluntarily that might come with government strings, and actually having the government assault your body. The stark difference between negative liberty and positive liberty couldn’t be clearer than in the youtube video I linked to above. Rebuilding Europe and granting it aid postwar, is different to liberating the death camps. I do not see moral equivalency between freedom from want for a service, and freedom from terror and human rights atrocities.

        “In physical health care we are called ‘patients’, in mental health services [formerly psychiatric services] we are called ‘service users’ and nope many of us don’t like that at all, but all our healthcare systems have set descriptions for us.”

        In physical health care we seek to be patients of a doctor. In government psychiatry, we either seek it out if we think government psychiatry has something worthwhile to offer or have it brutally imposed on us with complete disregard for our humanity and will. I agree euphemisms are everywhere in psychiatry, in all countries.

        “let’s not get precious about who’s more radical on the language front because it’s our actions which really count.”

        It’s not “precious” to point out that forced psychiatry survivors are not using a service and that describing them as using a service is profoundly degrading.

        • I know the difference between those detained under law and those seeking assistance being coerced without the full weight of legislation, but that doesn’t make the latter any less painful for people, I don’t wish to judge what is positive or negative freedom, that’s for each person to define for themselves.
          I wasn’t suggesting you police others language [some do so here] and you have every right to register your complaint at any description, but language isn’t always used to deliberately mask reality and defend coercive practise, it can simply have a practical application without full consideration of its meaning within the context of potential forced treatment. I don’t do committees personally but how many funders are going to come out with statements about what psychiatry does?
          I take your point about convincing the public of the reality of services but ‘service user’ is one of many problems on that front, and possibly not the greatest.
          I won’t cut off my nose to spite my face, I can think of a survivor-led service funded by health which operates on survivor wishes not health service wishes, it’s highly valued, how many funders out there can you go to which are fully untainted? In saying this I wouldn’t even attempt to deny that some funding comes with unacceptable conditions but it’s a judgement call for groups to decide where they draw the line. Drug company funding is pretty much universally viewed as totally unacceptable to take.
          Advocates [whoever pays their salary] on the whole do a good job of defending people’s rights and supporting their wishes. The roles which really have been thoroughly corrupted by funders are ‘recovery’ jobs, where they are expected to dance to the service tune, I wouldn’t touch those with a barge pole.
          We can agree to differ on where we draw the line, what language we use, in what context and why but we do know that anyone under section, and anyone under threat of withdrawal of all support if not compliant with nothing else to access are not willing ‘service users’, it’s for each person to decide what is and isn’t degrading language to them.

          For your information regarding CPN professionals, not all are practising psychiatrists and you’re not aware that some have used the Mental Health Act without forced treatment, I know this for a fact, and it’s possible that some might not detain at all now [we could ask them]. Fact is CPN are allies, and like us, they might not always get it right in how they express themselves but they are fighting for some of what you fight for. There are some ’recovery orientated’ psychiatrists and survivor recovery promoters I would run a mile from, they use all the right language but using the right language doesn’t automatically mean offering what you want. Equally I’ve come across professionals who speak in very medical terms but in terms of their practise have been more creative and innovative than some of their better spoken colleagues. Sometimes language clouds where people are truly at in what they do.

          • “and you’re not aware that some have used the Mental Health Act without forced treatment, ”

            I was aware of this actually, and I condemn it wholeheartedly. Forced psychiatry legislation used to take away the right to say no to anything, is not something I support. If the CPN believes in a law existing forcing whatever they think they have to offer, on people, then they are not for freedom of choice and self determination. What gives CPN the right to force themselves on law abiding people? Even if they aren’t biological psychiatrists? I’d like to see the CPN release a statement on exactly where they stand in relation to the Mental Health Act.

            In terms of the tainting of funding, funding provided by a human rights abusing government probably comes in at the top of the pyramid in terms of taint. The drug industry has no interest in funding any approach that isn’t based on getting drug into people and why would it, so I don’t see that coming up. Religious funding is tainted too. Private benefactors who believe in freedom of choice and are critical of the medical model are the ideal. But it depends on what you’re trying to create.

            I meant negative liberty and positive liberty in the classic Isaiah Berlin understanding of the terms. I’m not talking about feelings. I’m talking about actual force, actual coercion.

            “Advocates [whoever pays their salary] on the whole do a good job of defending people’s rights and supporting their wishes.”

            I strongly disagree. The human rights situation in psychiatry has not been as urgent as it is today since the mid 20th century and might even be more critical because at least in the mid 20th century the public could come to our rescue and see brutality for what it was. Nowadays with a large percentage of the population buying into psychiatric drugging and believing the lies that justify their own drugging and the drugging of their own children the public is becoming more and more converted to the psychiatric religion. In times past, the public could sympathize with those forced into psychiatry, now because so many people are taking psych drugs it is like “I take my psych drugs why would you ever complain about taking psych drugs?”. But until the proportion of psychiatric drugged citizens reaches over 50 percent I can only operate on the assumption that maybe it might be possible to win the battle to strip psychiatry of its legal power in democracies.

          • I apologise my incorrect assumption – would you also be aware that members of the CPN may have also halted treatment imposed by others [meaning the person could choose to die]?
            I’m not totally against the idea of very short term and judicious use of a section with no forced treatment for people at extreme risk, it has sometimes been helpful by putting a pause into the person’s circumstances [that’s not me painting my interpretation that’s feedback from survivors]. That doesn’t mean I think it should be routinely used, nor that I think suicide should be prohibited, nor that psychiatrists should make the decision, but it is something I could agree to being explored.
            Psychiatry isn’t going to be stripped of its legal powers that easily in our “democracies”, it’s those very political systems which want them, we may have to consider a watering down of them initially which is better than nothing.

            Maybe the CPN will issue a statement, and maybe we might both be surprised by their position.

            We have to be pragmatic and work with what we’ve got, sometimes good projects have been funded with tainted money, if we only accept
            “private benefactors who believe in freedom of choice and are critical of the medical model” – how many of those are out there?

            Er advocates can help people get out of hospital, argue for what they need, help with housing, benefits, GP’s, how is that negative?

          • To have to use the statements of people saying that being involuntarily confined was helpful, when they were not allowed to see this as anything but necessary would they want to gain their freedom again; this is as ridiculous as saying that a person under coercion, if he doesn’t state what he’s told he should believe, can give valid evidence in a court of law. To move on and call these people consumers, when they have been forced into treatment (given the amount of coercion, false information, human rights abuses and peer pressure) this is as ridiculous as saying that victims of torture are “consumers.” And then to speak of survivors as if all of this was treating anything valid….

        • –Anonymous,

          Again, I agree with everything. This, in particular, was beautifully put,

          “I support your right to define yourself as a “service user”. Define me as a “service user”, I support my right to complain that coercion’s reality is being stubbed out with language couched in choice.”

          Are we intellectual twins or something :D?

  8. I don’t suppose this will get an answer. Anyway. Regarding “Turf War”. Never underestimate the ability of “Psychiatry” as a profession to hybridise to suit its purposes and shed none of its power.

    Not liking all this being portrayed as a turf war is one thing but to deny that it is, is just hubris imo.

    • Without doubt psychiatry will try to maintain a tight grip on it’s power and will utilise anything which suits [recovery is a fine example], but I do believe many involved in pushing for DSM to be junked are genuinely committed to psychiatry losing it’s power.

    • By that logic:
      -Some people have found detainment with forced treatment helpful;
      -Some people have found ECT helpful;
      -Some people have neuroleptic cocktails helpful;
      -Some people have found Psychiatry helpful;
      -Some people have found (fill in the blank) helpful

      If all truths are equally valid, what are we promoting at MIA? Are we pushing one version of the truth at the expense of others? Are we rightly critized for being arrogant, narrow-minded and intolerant? And if all truth is true aren’t we guilty of intellectuall dishonesty?

      Back to grill my brats are burning!

      D

  9. Yes David, some people have found those things helpful, many more people of course have not. All truths are valued differently, I see that in the UK, and I seem to remember one other poster saying somewhere how we were in danger of a 2 tier system – those who take meds and those who don’t. I’ve seen a widening gap which also includes [alongside medication], those who go to services by choice and those who don’t, those who take state support and those who don’t, those in paid employment and those in voluntary work.
    We could just accept the diversity of people’s truths and whatever they need to do in order to survive

    • I appreciate your response Joanna. Therein lies some of the challenges of MIA (in my opinion). We have very passionate people on different sides of these issues. Allowing for all these disparate points of view to exist here in a respectfull way is to be commended. But what then is our message? Is it a message of the majority (tier 1)? A message of the minority (tier 2)? A message that all messages are equal in their “messageness”(tier X)?

      No, we don’ have anymore Guinness! Damn holidays.

      • I am perfectly comfortable with people having different points of view, truths, whatever.

        What I object to, strongly, and I am an absolutist on this regard is to the notion that some should be given the right to “impose” their version of truths onto others via so called “coercive treatment”, which is codeword for human rights abuses.

        -Anonymous above has done an excellent job describing this to the point that I don’t know if my brain is a transplant of his :D.

          • Joanna,

            This has always been my point of view. What many people confuse is “respect to other people’s ideas” with “immunity to criticism”. I respect everybody’s opinions. That doesn’t mean that I cannot criticize them :D. Respect, in my view, is that I consider them “legitimate” and that I will not call you names for holding them (or if I had the power, which I don’t, to put you in jail for them). It’s an American “first amendment” type of understanding of freedom of speech. I respect that different people see things differently. But I also say, I have a right to criticize you for holding those views.

      • I appreciate yours too David, I guess that’s what I’m putting to MiA; the challenges, contradictions, the uncomfortable, the shades of grey, the non-absolutist positions, the pragmatic, the possibility of compromises we may not like as an end point but as a stepping stone. I’m putting out views and questions and don’t feel certain of the answers.
        For me fighting for freedom will mean different things to different people and if freedom is to mean anything surely it has to include what we might not choose for ourselves?
        Imagine a world where we could each have an advance directive where our specific wishes were followed to the letter.
        I recognise UK psychiatry is easier to escape than US psychiatry, every UK mental health professional I know who’s worked in the US have stated this. Most people who end up sectioned here [excluding those on CTO’s and in medium/high secure care] can get out quickly now because of cuts to services, sometimes within days. This doesn’t make it right or better my point is for some people they have greater fears than being sectioned right now.

        • “I recognise UK psychiatry is easier to escape than US psychiatry, every UK mental health professional I know who’s worked in the US have stated this. ”

          Actually, that is not born out by the facts:

          – UK, consult point 4.2, page 39 “Frequency of involuntary placements / percentage of involuntary placements
          of all inpatient episodes / involuntary placements per 100,000 population
          http://ec.europa.eu/health/ph_projects/2000/promotion/fp_promotion_2000_frep_08_en.pdf

          – US, http://www.volokh.com/files/bernardharcourt-volokh_graph.1.JPG . While this graph will be used by those supporting lowering the standard for civil commitment in the US, it unequivocally shows that the mental hospitalization rates are lower than in the UK.

          That is not to say that in the US psychiatric abuse doesn’t happen, but, we are better protected against said abuse than in the UK. As I mentioned in a previous post, the reason is twofold,

          1- SCOTUS case law dating back to the 1970s that makes so called “forced treatment” difficult and reserved for cases in which there is dangerousness – at least in theory- while in Europe the European Court of Human Rights has endorsed “forced treatment” under the standard “for medical reasons alone regardless of dangerousness”.

          2- Our medical malpractice law which protects patients better than similar laws in the UK and Europe.

          So this is one of the occasions in which I respect you for having that view, but I reserve my right to criticize it with facts :D.

    • or Duane, can survivors opinions about how they want to be supported be regarded as right for them? That makes sense to me, but that doesn’t mean within diversity we can’t challenge each other and work on common ground because even within opposition there can be things we agree on!

      • I’ve got no problem with a person deciding what’s right for themselves.

        When a group of any kind gets together to form a coalition or gain some sort of political ground, debates arise – all sort of views and opinions come to surface.

        And although each of the people in the group are equal and deserve to be listened to and validated, heard, understood…. not all of those opinions are equal, because some flat-out will make no sense to the group. Those are called “bad ideas” by any group that is intent upon survival.

        In short, if we ever intend to get a law passed in Congress that will eliminate forced treatment, we need to hear from those who swear they were “helped” by force, but we do not need to include such langauge in a bill.

        Or, you and others can, while I bow out.

        Duane

        • Duane, some of us would say attempting to eliminate psychiatric diagnosis and forced treatment by itself without considering the wider societal context without seeing how political structures [not party politics] support psychiatric power and hand deliver patients to their doorstep is flawed. You’re less likely to hear from those who have found physical treatments, forced treatment, detainment without forced treatment helpful because they wouldn’t come here.
          What I’ve found is that even within extreme difference there can be points of contact and joint working on specific issues, and at the very least meeting people with different views helps us all in developing how we think and how we put our arguments forward, it’s never a loss. Just as sometimes the people we view as our enemies can sometimes produce a paper which works to our advantage.
          I don’t regret having contact with medically minded survivors [a Schizophrenia org] who you would find utterly alien to you [me too]. There are also groups out there who would contest everything you say and with the backing of their professional guru’s and they are really tough [the PD orgs].
          I don’t regret being effectively stalked in my youth by a relative org’s member jumping up and accusing me of telling people to come off their medication at events I spoke at, because someone else took the time to get to know me and although we had different positions the things we agreed on we worked on. Nor do I regret being publicly goaded and vilified by very medical psychiatrists, what I took from that was when I organised my first event I made darn sure everyone [survivors and professionals] got to finish their presentations, and I wouldn’t allow discussion to disintegrate into personal nastiness and sarcastic gloating, debate had to be about the content of what people said.
          I’ve learnt a lot through difference, although I remain sad at what happens with recovery, the personal denigration you can receive if you don’t say yep that’s my thing and hit the measures of it held up, it’s not as though I’m going to diss anyone’s proclamation of being recovered for themselves, and me saying nope I don’t identify with being ‘recovered’ is of no threat to recovery work.
          I appreciate you having the conversation with me Duane, I truly do.

      • David,

        I would like to see a bill get passed in Congress – one that puts an end to forced treatment; requires fully-informed consent; provides alternatives, to include psychiatric drug withdrawal centers. You’ve heard the dream, (more than once) …

        We are not in the position to begin such a undertaking, and it’s frustrating, because I truly feel in my heart it can be done. But we would have to become pragmatic and build a consensus, with what we would like to see in such a bill.

        This may come down to patience.

        And, having read your comments for many months, I’m sure you’ve got a lot more patience than I do.

        Really.

        Duane

        • I think we have to hold out some hope that those who think forced psychiatry has a right to exist will be defeated. If slavery can end, if Apartheid can end, if Nazism can be defeated, if forced marriage can be eradicated in democratic countries, if gay people can get legal equality, if women can get equality then we just have to assume that even in the middle of psychiatry’s centuries long reign of error the seeds for freedom can be planted and that one day people will no longer have to live in fear of psychiatry’s brutality.

          Happily modern history does have many examples of truly unconscionable, awful, unjustifiable things moving from being seen as acceptable to being seen as unacceptable.

          Slavers, inquisitors, apartheid politicians, brutal husbands, people against votes for women, Nazis (in their own society at the time), antigay bigots, all had their time where people in society respected them and then slowly that changed and such people became pariahs. Today, you can make a living driving needles full of forced psych drugs into screaming, helpless victims and still be accorded respect. When public opinion turns against people who find forced psychiatry acceptable, freedom and human rights will not be far behind.

  10. I’ve done work on harm-minimisation for self-harm, that is offering information to survivors on how to self-harm more safely to help minimise the risks of limb function damage and life threatening damage. HM isn’t solely about plain English anatomy & physiology, ‘safer’ ways of injuring, wound care, minimising infection/scarring, that’s the practical thrust of it, it’s about recognising that people can need to do something and sometimes not want to at the same time, to take some control over the process. HM is also about being prepared for surgical repair or medical treatment i.e. advocacy, prepared letter for staff from any professional supporter stating what helps/doesn’t help, specific treatment preferences [including the desire to not be psychiatrically assessed]. It can give professional supporters a more positive role and is more helpful than prohibition via “contracts”, refusal of support or forced treatment.
    This can be highly contentious with both survivors and professionals, I take the view that if it’s helpful it should be available, and if it became illegal, then I’d have to be a black market operator!

      • Lol David, that’s one word for me, but I reckon others might find another.. but yes I am mostly consistent in that respect.
        I’m not aware of how harm reduction is used in the US, here it developed from survivors and some professionals have supported it. Bit like any approach, from recovery to CBT there are crap ways of using it and respectful empowering ways of using it. At the best, it can mean the difference between a hand or arm which works and one which doesn’t, it can mean the difference between life and death. It can enable a person to take better care, maybe delay, look at additional coping strategies, develop some ‘bottom lines’ regarding medical treatment.
        It’s a deeply humbling area.

  11. I can understand why people would feel pressure to “recover” and not rely on mind numbing drugs and government handouts. But none of these pressures were invented by the critics of psychiatry. Since time immemorial it has been considered a bad thing not to be independent, to not be seen as strong. I don’t look at people with psychiatric labels as some collective. They are individuals with disparate life problems and some will solve those problems and some won’t, either on their own or with help from family or “professionals”. That is just life. Not everyone can live up to society’s expectations. I don’t hold this against them. The greatest barrier to success in life for people with psychiatric labels is psychiatry itself getting in the way, filling their head with hope destroying lies, and body destroying long term drugging.

    I don’t know what a “PD org” is. I think the lingo, needs to be a bit more clear.

    • sorry, PD is the abbreviation here for ‘personality disorder’, and speaking of language ‘hand outs’ is a not a term I would use because it has a negative tone. Most people in receipt of housing benefit and working tax credits are are in low paid work, and are currently being subject to punitive treatment in the UK, along with unemployed people and anyone who’s sick, disabled, distressed.
      I disagree, there is increasing judgement of people who take meds/’use’ services/or receive any state support to not do so from critics of psychiatry in the name of recovery. There are clear examples of outright vilification, and survivor groups often won’t argue against diagnosis while still asserting people’s real need for help and support, and do hold it against them as personal failure. Psychiatry is a barrier I agree, but it’s not the only barrier, we live in societies which only value economic productivity so when people can’t for whatever reason live up to that they are viewed as less than human [there’s increasing evidence of that] and that also helps to deliver people to psychiatry. We have inflexible systems which don’t allow people to live in the best way for them. That’s hope destroying too.

      • “handouts”, “benefits”, “bailouts”, the act of government taking money by force from those who do work and pay tax and giving to others for free will always be controversial. I won’t get into some long conversation about the welfare state and people of different political persuasions will have different things to say about welfare. Since the earliest civilizations and earliest recorded history, and non human primate studies, people who don’t “work” have been stigmatized it has ever been so it will ever be so. I don’t think the survivor movement is engaging in “outright vilification” I’ve never seen this. It’s not a good thing for society that psychiatry’s false paradigm has swollen the welfare rolls in many countries worldwide and it is always good when someone can escape dependence on welfare but I understand not everyone can for whatever reason achieve this. I don’t like the idea of people feeling badly about being such a situation but there are many situations in life where people will feel less than for not living up to ideals: weight problems, appearance, success, romantic lives, there is lots of pressure in the modern world. If someone feels they are ready to move on from welfare and feels capable of it they should do it. If they aren’t ready, such is life, stay on it. We spend just as much on useless wars as on welfare, and in a sea of government spending welfare is always an easy target because it has a human face that is in the immediate vicinity.

        I hear Will Hall’s Madness Radio will do a show on getting of disability welfare this year. I think it is a good conversation to have.

        • that’s pretty revealing of anon and corporate get outs and bank bailouts and state benefits [many of which are taxed] are not the same thing. There has been outright vilification, I have witnessed it from critical thinking allies and survivors in the name of recovery. Government has led an active hate campaign which has resulted in a rise of disability hate crime, and some of this divide & rule [which is more pertinent now] is being reflected in mental health activism.
          Getting off disability benefits is indeed a good conversation to have, unfortunately – no one’s having it and policies actively conspire against facilitating it but as you say you don’t want to get into a conversation about the welfare state.

          • Forced redistribution of wealth, whether it be handing tax dollars to banks/corporations or individuals is still redistribution of wealth. They are not the same things, but they are similar. Corporate welfare, is a phrase for a reason.

            Taxing welfare money is just churning money that was originally in the government’s coffers. Welfare money also gets recouped by cigarette taxes too.

            I don’t know if you’re referring to the Cameron government but data suggest during the Blair/Brown Labour years psychiatry justified incapacity benefits grew immensely and is the leading reason for new applications:

            http://www.bbc.co.uk/news/health-13309755

            It appears policy is actively helping to swell the welfare rolls. I would advise people to get less offended by what other may think of them. I only care what a very select group of people think of me. “Daily Mail readers” seem to rile those in the UK for the comments they leave on any story about welfare. It’s a fraught issue.

          • http://benefitsculture.wordpress.com/2009/11/14/daily-express-1-1-million-moaning-about-stress-and-depression/

            This website about life on benefits in the UK is instructive of the state of the situation all around.

            The establishment of government socialized disability welfare programs pools money that is taken by force and seen as a commons by the people into the task of helping people in need. This necessarily means some taxpayers are going to be unhappy about the situation and give close scrutiny to those on welfare.

            The blog article was prompted by a narrow minded piece in the Daily Express newspaper.

            But the blogger then responds to the newspaper article with this:

            “No one suffering from mental illness has an “easy lifetime”. We face constant struggle in a way that Mr McKinstry is incapable of imagining. It is not a matter of “moral fibre”, it is a matter of brain chemistry (and social prejudice and stigma).”

            Brain chemistry.

            Psychiatry’s falsehoods and the tension of government welfare coalesce to create a huge mess.

            It would have been better to have society develop private charities funded by people who actually care and who believe in the task at hand so much they voluntarily donate. Since society didn’t develop that way, we are stuck with the current situation where competing interests will always be in a constant struggle.

          • Yes there is a forced redistribution of wealth from the poor to the rich, with private companies making money out of poverty and reformed welfare systems not saving money revealing it’s true motivation to be ideological not one based on economics. Thatcher’s years saw a big rise in Incapacity Benefit as people were put on Incapacity to lower the unemployment stats. Blair/Brown introduced Atos, Cameron is merely dismantling the welfare state and the NHS, the Tory dream. The Daily Heil is highly influential as are all the UK media which has been responsible for putting out skewed stats which have been shown to be deliberately skewed. Yes policy is costing everyone more – the failure to build more social housing and control private rents combined with caps on housing mean people end up being moved across the country, sometimes away from their low paid job on tax credits which subsidise corporations refusing to pay living wages. We are spending unnecessary billions to private companies doing assessments proven to be so flawed that most people win their tribunal [again costing millions], even the food banks make money for party donors. Then the ‘Work Programme’, what a joke that is, again making lots of money for private companies and shown to be no better than doing nothing, but we still shell out that money despite it’s utter failure. We pay unemployment benefits to people who are blamed for their circumstances chasing jobs with zero hours, being forced into ‘Workfare’ where the company gets paid for taking them, so the tax payer pays twice over and for what? Forced labour or lose your income of £71 a week and this isn’t slavery? There are going to [rightfully] be more cases going to the High Court, it’s a farce. Workfare is also handy to bring down the unemployment stats

        • “the failure to build more social housing and control private rents”

          I certainly can’t support government telling property owners what rent they can charge. But I have sympathy for your ambivalence toward privatized welfare administration programs, private companies running the way welfare is administered. I think if we are going to have welfare, it should be run by the government not these job agencies etc. I think private prisons are a bad idea too.

          This workfare thing seems an ugly mess but I think it is to be expected that governments will tinker with and constantly reform welfare and attach more strings to it. There is just too much conflict built into government forces being in the charity business. Society isn’t going to stand for no strings attached welfare. Even families and private charities are always going to attach strings to any form of assistance.

          I fully agree with you that governments worldwide shift people to disability to hide the true unemployment rate. That’s a fact.

          • well I can when those 2nd, 3rd and 4th homes are being paid for with public money and way above the costs of social housing, it’s costing a fortune in housing benefit but what choice is there when there’s a national shortage of affordable social housing and remember most in receipt of housing benefit are in low paid work, subsidising corporations with working tax credits.

            ‘If’ we’re going to have welfare, what would you suggest, we go back to Victorian work houses?

            The situation is so dire here that some people have died within days of being found ‘fit for work’ by Atos, the company your country used to have. One doctor publicly resigned recently and hidden footage documentaries have revealed how bad they are. The withdrawal of some disability benefits which enables people to work being withdrawn or made so difficult to renew mean that some people will have to cease working, how can that make sense?

            We’ve had suicides here and admissions to hospital because of welfare policies making it really hard for people to live [both in and out of work].

            Sick/distressed/disabled/unemployed people don’t have a problem with proper assessment, rules and conditions, but that’s not what we have right now, it’s a mess and a mess which is costing lives.

          • “people don’t have a problem with proper assessment, rules and conditions”

            Well various sides are always going to disagree on what welfare rules to have.

            I don’t think the government is buying people 4 homes. Why should people be penalized for investing in real estate?

            The wealthy pay most of the tax in the UK. If you’re talking about housing benefit going to renters paying the mortgages of investors and if we assume the investors originally paid that tax money that became the housing benefits. The BBC:

            “Again, according to the wealth of HMRC figures on the topic, the top 1% of all income taxpayers contributed a whopping 27% of all income tax that year.

            By contrast, the bottom 50% of income taxpayers paid just over 11% of income tax.”

            http://www.bbc.co.uk/news/business-17397199

  12. Great thread guys, interesting takes on the role of critical thinking and the treatment of its apparent dysfunction.

    In his book “Doctoring the Mind: Why psychiatric treatments fail,” Richard Bentall expresses his views about the current “paternalistic” functioning of the medical model of psychiatric care. Such a paternalistic urge, seems to be “symptomatic” of societal functioning, as a collective emotional system, IMO. Consider;

    “In table 3 I list what I think are the main differences between two versions of psychiatric care. Of course, many mental health professionals would perhaps place themselves between the two poles indicated by this table, but this does not mean that the distinctions drawn here are not real and important. Although the poles could be given a variety of labels, I called them ‘paternalistic-medical’ and ‘autonomy-promoting’, reflecting the fact the most important difference between advocates of the recovery approach and those mental health professionals who favour more traditional services concerns their willingness to trust the judgements of the people they claim to help. Table 3. Two visions of the future of psychiatric care Paternalistic-medical Autonomy-promoting Principle advocates Biological psychiatrists; researchers studying the neuroscience and genetics of psychiatric disorders Clinical psychologists, many psychiatric nurses, CBT therapists, some psychiatrists, differences between these two visions. Of course, many mental health professionals would perhaps place themselves between the two poles indicated by this table, but this does not mean that the distinctions drawn here are not real and important. Although the poles could be given a variety of labels, I called them ‘paternalistic-medical’ and ‘autonomy-promoting’, reflecting the fact the most important difference between advocates of the recovery approach and those mental health professionals who favour more traditional services concerns their willingness to trust the judgements of the people they claim to help.”

    Bentall, Richard P. Doctoring the Mind: Why psychiatric treatments fail (p. 270). Penguin Books Ltd.

    I guess, each of us who advocates for a deeper understanding of the human experience, labeled as a mental illness, might consider the age-old dynamic of paternal authority and rebellion, when we participate in an equally age-old “us & them” debate. When it comes to the unconscious well-springs of the human mind and human motivation, are there any absolute truths, or simply subjective “judgments.”

    Perhaps the debate here is moving beyond the need to simply judge others, as witnessed by Robert’s recent use of the term “unconscious” in his discussion on Al Jazeera. It made me wonder if he was having some tingling doubts about the “objectively” obvious causes of a mental illness epidemic, and a societal delusion about the medical approach to troubled minds?

    Alas, too few writers seem willing to explore the unconscious nature of their motivation here, or so it seems to me. What forces of human nature underpin Bentall’s call for an ‘autonomy-promoting’ approach, in enabling an individuals emotional and functional growth? Should we be promoting self-education about the hidden nature of being human rather than arguing about how we treat human beings? Do we take far too much for granted, about our thoughts and written words here, with no thought to our internal development?

    Do we all take the mind as a given, without seeking to understand its development? Do you remember your very first thought, your first fully formed word? Or did you learn to crawl first? Forgetting with time, the “motoric” nature of the mind, perhaps? In my own journey, sensing the rhythmic patterns of my heart and its motor activity, has helped in sensing the impulse to my often paternalistic advice, to others.

    Is your mind really all about, what happens inside your brain? Is there emerging science about the body and its major organs, which ALL play a role in our states of mind?

    Best wishes to all,

    David Bates.

    • you raise some interesting points David and whilst reading I started to think of a friend for whom mutual friends all know that when he is in crisis that he will end up sectioned regardless of whether we get to him asap and stay with him. Some of us have walked all night with him, listened, made tea etc, but what he does appear to want is some sort of ‘holding’ even though that comes with extra medication [he chooses to take some on an ongoing basis], and can also mean a high degree of humiliation and violence by the police and seclusion in the past. Police involvement occurs because of things like directing the traffic as opposed to presenting any risk to others [he wouldn’t hurt a fly], and he himself has said afterwards that he knows the point at which if things continue that it means he will end up on a section.I’m not 100% certain that if there was a non-medical facility he could check into it when he wants to be away from home and cared for. I’d truly like to think he would because on the surface of it, wouldn’t most people prefer that, I would. Some of us have wondered whether pride is an issue for him, needing to be looked for a while but that being excruciatingly hard to state and ask for, or that anything less than forced ‘care’ would be at odds for him as an activist. There is a palpable struggle here, much is not voiced, and it’s really hard when he asks directly or indirectly for his friends to call the crisis team because his expression of distress [labelled as mania] easily gets an admission. Some people have even asked him, ok, if we can’t assist you to keep out of hospital can we help you to seek a voluntary admission instead of being sectioned, but that point at which he knows it’s the ‘point of no return’ always passes. So sometimes the only damage limitation can be if anyone around can get involved in how he is sectioned i.e. advocacy, practical stuff. It’s painful but clearly friends are not able to give him what he needs which is not to suggest that being detained does but somewhere along the line it’s become his only way of saying ‘help’.
      For myself, when I’ve been in a position of needing surgery for an injury I know when I’m forced to see a psych what to say so that I’m not seen as a suitable case for psych treatment, I’ve learnt how not to get caught. After a few times of being carted off in a state labelled as ‘catatonic’ I learnt that when differences in perception were going along a track where I might ‘freeze’ then I could not be on the streets otherwise like my friends direction of traffic it would mean ending up in hospital which is not what I want.
      You’re right to flag up the unconscious, absolute truths and subjective judgement David, our relationships with ourselves is the most fundamental we’ll ever have.

  13. There are better instructive sources of life in the UK than the Express and Daily Mail..I listened to a group of American tourists the other week speak of the Philpot case as though that was indicative of everyone in receipt of any state benefit, and psychiatry isn’t responsible for all the problems relating to welfare.
    Everyone pays into the system, so in the UK unless you are exceedingly wealthy or have a crystal ball and know you won’t ever get sick/distressed/disabled/made redundant, then fair enough to object paying in.

    “It would have been better to have society develop private charities funded by people who actually care and who believe in the task at hand so much they voluntarily donate”.

    I think you’ll find there are more people who do care and wouldn’t want to see their fellow humans have to rely on private charities.

    • “I think you’ll find there are more people who do care and wouldn’t want to see their fellow humans have to rely on private charities.”

      The fact people need to be threatened with prison for tax evasion to fund the giant welfare state would suggest otherwise.

      It’s clear to me private charities care because they don’t fill their coffers at the point of a government gun.

      “Everyone pays into the system, so in the UK unless you are exceedingly wealthy or have a crystal ball and know you won’t ever get sick/distressed/disabled/made redundant, then fair enough to object paying in.”

      Everyone has no choice but to fund the system. It’s illegal not to. Clearly more people could arrange their own voluntary contingencies if they weren’t so highly taxed as well as have more money left to voluntarily donate.

      • pensions [for retired people, including millionaires] are the largest part of the welfare budget, not disability or unemployment, and remember welfare also includes child benefit which people on very good salaries can claim. Even our multimillionaire PM claimed disability benefits for his disabled son and then after he died his policies have seen disability benefits withdrawn or made much harder to hold onto for disabled children and carers.
        Tax evasion rarely results in prison here, ordinary people are chased up for small amounts whilst corporations and the wealthy [including MP’s and peers] can offshore trillions.
        Charities on the whole don’t challenge government that much because many receive government funding. Their ‘care’ would be questioned by many as a lot of them have jumped onto the workfare trough.
        The highest earners and corporations have been given tax breaks, whereas the other end of the population are paying proportionally more. You can pay as much council tax as a low earner as a millionaire.
        British people don’t want your health care system! There’s little desire for insurance schemes here, and your poor don’t fare that well from programme’s I’ve seen here. It’s shameful that relatively rich western countries such as ours have food banks.

  14. “Well various sides are always going to disagree on what welfare rules to have”

    Weasel words, disabled people self-funded, researched and produced their own report offering recommendations but government has refused to engage in any meaningful discourse, they even ignore their own advisors offering the smallest of reasonable changes and charities.

    Buy-to-let landlords [including MP’s] DO have several properties which they can let out for extortionate rates to people who have no choice because they don’t earn enough to get a mortgage or have to claim housing benefit because corporations won’t pay living wages so they are subsidised by government having to pay working tax credits and housing benefits so people can afford to live. Housing benefit can fund these properties so yes they are effectively buying them from the public purse. It’s an absolute boom for property for buy-to-let landlords who can charge 3-4 times as much as councils and housing associations [and with less legal redress and protections for tenants]. The wealthy do not pay most of the tax, not proportionately, the poor are being fleeced. MP’s can earn millions in jobs amounting to full time hours outside of their work as an MP with subsidised catering at parliament, where someone like Ian Duncan Smith who claims to be able to live on £53 a week can claim £39 for a single breakfast, all taxpayer funded, along with their 2nd homes. They have salaries, expenses, 2nd homes and earn on top of that whilst telling disabled people they should work for less than the minimum wage because they are worth less. We have a national shortage of affordable housing but rather than build more government cuts at housing benefit

    For someone who didn’t want to discuss the welfare state you’re doing pretty well anon, much of your thinking would welcomed at the Daily Mail

    • I didn’t want to discuss it but I wound up doing it. I regret it just as all off topic forays into politics on the internet usually wind up we are not going to find agreement on what level of government intervention in life we both see to be acceptable/desirable.

      I don’t believe in using government force to solve every problem in the world. Life has never been completely fair anywhere. The best societies in my opinion are the ones with the most freedom, not the most free stuff. Byzantine red tape and shocking levels of government meddling lead to socialist nightmares and police states in my opinion. I don’t believe in price controls on haircuts, slurpees or houses or cars. I think trade is as old as civilization and can benefit all parties, even if it doesn’t benefit all parties equally, it is the best system we’ve got and I’d hate to live under a government regime where the only thing the citizens didn’t expect government to provide were their Saturday night movie tickets. I think such a utopia is actually a dystopia.

      But I need to learn my lesson not to get so off topic and into political discussions. There is a reason when it comes to government operating as 51% of people forcing their will on the other 49% in a secret ballot. Politics and government is messy because its all about using the brute force tools of government to build someone’s version of utopia, mine OR yours.

      The survivor movement is a big tent and let’s just talk about what we have in common, a desire for psychiatry’s harm to stop.

      • Not off topic at all, highly relevant because mental health is a political issue and as I’ve said before psychiatry doesn’t exist in a vacuum, we can’t ignore the wider political context and how society views disability. As for state intrusion into people’s lives at the moment that is increasing here so clearly it’s a Conservative/Libdem/New Labour nightmare and not a caricatured socialist one.

        As Richard Lewis once said, “I do not believe capitalism is the highest pinnacle of human achievement in social organization. Is this not a legitimate point to be made when discussing where human suffering comes from? And I think examining its shortcomings is intimately connected to our overall struggle against Biological Psychiatry”.

        You can remain focussed on psychiatry’s harm to the exclusion of its wider context, but I prefer to see the bigger picture and address systemic abuse as well because one serves the other.

        Some of us don’t want ‘freedoms’ which equate to nothing more social Darwinism
        http://hiddenmurder.blogspot.co.uk/