I Wonder if There is Some Axis II Going on Here? Further Thoughts on Muddled Thinking

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1BoringOldMan invited me, after I commented on his site that I was uncomfortable – in a vague way – when he wrote about Schizophrenia, to elaborate.   In several posts (here and here), references were made to “A list” conditions – always including Schizophrenia – that correspond more directly to biomedical conditions than the vast majority of diagnoses in the DSM.  A number of years ago, if I had made a list like that, Schizophrenia would have been included.  But when I do that thought experiment now, my list remains blank.

When I finished my training in psychiatry, it was clear to me that the concept of depression was amorphous.  The kinds of people who would fall into the category of Major Depressive Disorder were so varied  as to make the term almost meaningless.  The various explanatory hypothesis for the causes of their troubles were broad, ranging from childhood trauma to unconscious conflicts to recent life stresses to abnormalities in their neurotransmitters.  I found it confusing and frustrating. Although some of these explanations may be valid, I did not have an accurate way to apply a particular explanation or set of explanations to any given individual.  In supervision and discussions with colleagues, everything was on the table; there seemed to be a problem with quality control.

At that time, I was not as confused when it came to the people I met who were experiencing problems that I label psychotic – hearing voices, having beliefs that did not appear to be true, having confused thoughts.  The conditions – as manifested in different individuals – did not appear to be as varied.  I was more comfortable with the categorizations of Schizophrenia and Bipolar Disorder. I was more comfortable using a disease model to understand their problems. 

Over time, my thinking on this has changed.  The easiest way to express this is that I am now as muddled in my thinking about the nature of psychosis as I am on just about everything else in psychiatry.  After a career of spending my days talking to people who hear voices or have beliefs that no one else shares or have a confused or disorganized manner of communicating, I see more variation among them than similarity.  People who “have schizophrenia” are asocial?  Well how does that comport with the vast social network so many of the people I work with have?  People diagnosed with Bipolar Disorder have episodes of illness interspersed with periods when they are symptom-free?  So how does that comport with the fact that so many of these people struggle to some extent in between their so-called episodes?   I have been told many times by colleagues something along the lines of  “Well I think he has Schizophrenia but he is so social.”  Or, with one of the worst phrases uttered in our field  when a person with, let’s say, psychosis remains troubled in some way after taking our drugs, “I wonder if there is some Axis II going on here?”

But equally important is the observation that the line that I thought demarcated psychosis from other states of consciousness is at best a big, blurry, and indistinct smudge.  This has been an area of curiosity and interest for me for many years.  What is the line between religious belief and religious delusion?  One person I know once said to me when I asked him about voices, “Well doc, I know you don’t believe this but I am not hearing voices anymore. But God is still talking to me.” 

What is the line between political delusion and fanaticism and passionate ideology?   Another person I knew initially thought that the government was communicating with him through the airwaves and he was a covert operative, paid monthly through what others thought were his Social Security checks.  As he “got better”, I found him one day reading a book about the JKF assassination.  It was a book suggesting some conspiracy theory.  Was he still ill?  Is everyone who believes there was a second shooter in the JFK assassination ill? He showed me a picture of  Howard Hunt taken in Dallas in 1963.  Hunt was one of the guys who broke into the Watergate complex during the Nixon administration.  I was obsessed with Watergate in 1973. Was I ill when I was so preoccupied with Nixon and Watergate?  Was I ill when I was convinced that Nixon was involved even before there was full disclosure and then recovered when the tapes were revealed? (Apologies to those of you too young to remember this time.)

Many of us look at the same political system and come away with deeply held but opposite formulations of the situation.  Am I mad when I read the psychiatric literature and come up a different  interpretation than many of my colleagues? I honestly do wonder, when I spend a quiet Saturday writing this, what keeps me so preoccupied while others can walk away and still feel good about their careers in psychiatry. I do not ignore or dismiss that some ideas are more  profoundly disturbing for the individual and those around him than others.  My only point is that I no longer see a line that clearly demarcates sanity from madness.

I used to think I could tell the difference between the voices experienced by someone labeled with schizophrenia and the voices of someone who is experiencing a dissociative episode.  The former, I thought, would be related to some distinct – probably fixed – altered brain state. The latter due to a more transient and reactive state.  The former would best be treated with drugs, the latter with psychotherapy. I even wrote a paper about this many years ago.  Although I still suspect that there are a variety of different kinds of conditions or states which might result in a person hallucinating, I no longer feel confident in being able to make that distinction. I am also not sure they are entirely distinct.  Maybe they are overlapping.  Remember; I admitted to being muddled on this.

I am not someone who finds it useful to make a distinction between the mind and the brain.   In my view, we are talking about the same thing but at different levels of abstraction. What we think, feel, hear, and see is all processed through the brain.  Some of this is easier to  parse out. In my college neurobiology class, I learned from the Nobel Prize winning scientist David Hubel how the brain “sees” moving objects. We saw neurons “react” to the alterations in light.  Of course that is a long way from understanding why we think a particular painting is beautiful but it is a start.  Even before I moved to Vermont, I knew of one of our most famous citizens, Phineas Gage, whose personality changed after a tamping iron was lodged in his brain’s frontal lobe.  This was an early confirmation that things as complex as social comportment and motivation were related to brain function.

I also understand that in all of medicine, the concepts of illness and disease are increasingly amorphous. We tend to think about the clearly defined entities – a strep infection that clears with a 10 day course of penicillin – and forget the many shades of grey.  Many of us harbor pathogens that do not make us sick. There is an increasing focus on the microbiome – the many bacteria that live on and within our body.  Most of them not only do not make us ill but may promote our health.  Even cancer is defined more on a gradient than in a categorical way.  There are many lesions in the body that are not clearly cancerous but are also not clearly normal. The notion that there is a clear line between health and illness in this realm is fuzzy – we all have cells that have a malignant potential but our body polices and eradicates them most of the time.  Yet, to tell someone who is dying of cancer that she does not have an illness or that the condition that is killing her is a construct begs absurdity.

Does this inform us about how we think about psychosis?  Does the problem just lie in a popularly held but antiquated notion of what an illness is?  Is it possible that a complex array of events – genetic vulnerability, nutritional deficiencies, life stress – can culminate in one person experiencing some passing phase of mild altered thinking that will resolve with sleep and support from friends while in another person lead to a sustained state that holds on for months if not years?   Is a state induced by heavy drug use similar to or different from a state that appears to be induced by intense emotional or physical abuse?  Do we really need to understand the workings of the brain to help a person who suffers in this way?  Does our message – that this is a disease – relieve guilt and shame or exacerbate it?  Is it helpful to have psychiatrists? Are we doctors of the brain or of the mind? Do we just confound and confuse?

Although I end up with more questions than answers, there are people who have helped me gain some clarity.  One of them is the British psychiatrist, Joanna Moncrieff. In her books, “The Myth of the Chemical Cure” and “The Bitterest Pills” she makes the distinction between a drug centered and a disease centered approach to thinking about psychoactive drugs.  She has written about this on MIA, where there is also a critique of her recent book.  The disease-centered approach is predicated on the notion that a) we have identified the specific disease or pathophysiology that underlies a particular symptom or syndrome and b) the drug targets that particular abnormality. The drug-centered approach takes into account that a drug has psychoactive effects. Some of those effects may be useful for some people but, if so, it is not because it is correcting a specific underlying problem.  An important advantage of the drug-centered approach is that it is more intellectually honest since we have yet to define any particular diseases or brain abnormalities associated with the various mental states that we label as disorders.  It can also help to protect us from minimizing the problems these drugs cause.  In the disease-centered model, these problems are considered side effects that need to be tolerated in order the treat the disease. In the drug-centered model, we are more likely to consider all of the effects of a drug and then determine with our patient whether these effects  yield more benefit than harm.  The disease-centered model has resulted in our forming the premature conclusion that we understand these altered states, and it has contributed to some of us  being more sanguine about forced treatment because it allows us to think that – rather than just tranquilizing people to contain problematic behavior – we are treating a disease.

Another blogger whose work I admire is Nev Jones who writes at her site Phenomenology of Madness.  Nev and her colleague, Layasha Ostrow started LERN.   Nev writes about her own and her family experiences with – to use her term – madness. One of her more poignant posts is here.  She is so articulate and careful with her language (among other things, she is philosophically trained) that I hesitate to say more and risk misrepresenting her.  She is an activist and a scholar and I find her courageous in her willingness and ability to articulate difficult and sometimes unpopular positions.  But if I were to encapsulate the one point Nev has so clearly articulated for me, it is the concept of heterogeneity.  Any attempt to label just stomps upon the rather vast conditions or states or experiences – words just plain fail me here – that I observe almost every day.  

A friend who has been a helpful editor has commented that I sometimes end rather abruptly.  I fear I have done it again.  As I said, I am pretty muddled.  But this is already pretty long so I hope anyone who has made it this far is not too disappointed.

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

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29 COMMENTS

  1. I appreciate how this post breaks down the difference between the disease centered approach and the drug centered approach. It’s always seemed to me, from my earliest moments researching drugs for my own experimentation, that it makes sense to consider the person holistically, the drug holistically, and all the interactions between the two. To say that any psych drug treats a specific disorder and everything else is a “side effect” seems to ignore the vast majority of what’s happening when I take a drug.

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  2. Thanks, Matthew. The credit for that goes to Joanna Moncrieff. Psychiatrists have no trouble thinking in that way when we think about benzodiazepine drugs. They will make everyone feel relaxed or sleepy – not just those who are anxious or can’t sleep. We are less inclined ot think that way when it comes to neuroleptics or so-called antidepressants but there is no reason why we shouldn’t.

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  3. Thank you for this clarity (ironically). After having spent the last 30 years of my life living, studying, experiencing, suffering through, medicated for, and eventually finding my way off meds and healing from all this mess, I agree completely and resonate whole-heartedly with the muddled-ness of it all. This alone, drove me crazy, in a painful and disorienting way, as I tried to make sense of my experience.

    I think a big part of it, of course, is all the deceit, mythology and general lack of understanding of the human spirit which exists in this field. Attempts at practicing the healing arts and sciences from a place of integrity and self-awareness are grossly overshadowed by all the now well-publicized fiascos of psychiatric treatment and the mental health system, in general.

    This one question stood out to me when I read your article–

    “Do we really need to understand the workings of the brain to help a person who suffers in this way?”

    I’m feeling bold, so I will disclose my own personal response to this, because I feel strongly about it. From my experience of mental health, my unequivocal belief is that no, we do not need to understand how the brain works in order to relieve a person suffering from this kind of chronic pain, whether mental, emotional, physical or spiritual. I believe that trying to understand the brain overcomplicates the actual healing, and that, perhaps, it is this pursuit of understanding how the brain functions in order to resolve these issues of mental health, is what contributes to a lot of the muddled-ness. In my journey, I found this knowledge, while interesting, relatively inconsequential to healing—both, for myself, and for the clients which I now support.

    For me–and I do wonder to what extent this could be generalized, I don’t want to ever make that assumption when I write or talk about my healing—what worked was to understand how my heart had been wounded and spirit broken, and then I focused on healing these in present time. That’s a process that benefits greatly from having safe and trustworthy support.

    Then, I learned my spirit, which is not only more practical, but much easier to learn than the brain. How we learn our spirit is not a universal process, this is where our individual paths lead us to know ourselves. That is our own creativity.

    In the course of all this, my energy calmed down a great deal, and I learned how to become grounded. I learned to quiet my mind—which was a miracle, in and of itself—in order to feel life in a way I never had. As a result of grounding and learning self-compassion, my brain healed from the damage of emotional trauma and medication trauma. With patience and a dedicated desire to focus, my neurons followed suit.

    So that was the shift in focus that lead to clarity and healing–from brain to spirit, via the heart. It’s a whole new world, in that shift.

    Thank you again for this enlightening article. I really enjoyed reading it, rang so true.

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    • Alex,
      thank you so much for the comments and for sharing from your personal experience. I have come to agree with you about what we need to know about the brain. I went to talk last week on epigenetics. The lecturer was almost apologetic that this field sort of confirms what common sense has always told us – heredity, environment all work together to make us who we are. Epigenetics just provides a possible explanation of how that works. the science is interesting but not really necessary. I wrote about this in my blog on the lonlieness data.
      But your report of your own experience is so important and valuable. I think many psychiatrists accept this with some sorts of problems but not alwasy when it comes to psychosis.
      So thanks,
      Sandy

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      • Thanks, Sandy. All info about ourselves–ancestry, cultural influences, for starters–is information contained in energy centers of the body called chakras. When we learn to read these, we can get all our information that ever way and ever will be.

        Ancient healing arts have applied this for generations, as it is exactly where the relevant information exists that we can access relatively easily once we learn how to read our own energy, and that allows us to integrate all aspects of ourselves on our own terms, as is most natural for us to do.

        From this perspective, ‘psychosis’ (misnomer) takes on a different meaning, and it has a practical function, as it is part of our spiritual experience. The experience of multi-dimensional reality–which is what I believe psychosis to be–is not uncommon, but lack of grounding will cause chaos, here. Unfortunately, our familiar treatments, specifically, inhibit grounding, especially meds. Also, too much being in our heads.

        My hope is that one day, more ancient wisdom will be embraced by the mental health industry. The information exists, but our culture tends to dismiss it pretty readily, because it is not hard science. Personally, I believe that is where our mental health field is stuck.

        Thanks for the exchange, Sandy. I appreciate being able to share my views on healing, and redefining these confusing and difficult experiences.

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          • Not sure where on the thread this will appear, but I wanted to respond to you Sandy, that, with all respect, I disagree with you. I’m going to stick my neck way out here and say that I do believe that the taking spirit and heart journey is everyone’s path to healing and well-being. My personal belief is that this is universal.

            For some, it is unconscious and walked with resistance, which is a painful path, but it’s a personal choice, and I wholeheartedly respect that, although I find it difficult to work with people who have made this choice.

            I think where we each differ, and some radically, is in how we find our way to the clarity we seek, whether consciously or not.

            Like I said, I’m simply offering my perspective–which speaks to a lot of people, I’m not the only one with this belief–should it resonate with anyone that reads this. For those for whom it does not, that’s not my business.

            In any event, I do believe we all benefit from being grounded, and that we suffer when we are not. I do believe that is also universal, for what it’s worth.

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          • Hi Alex-
            Thanks for your comments. I do think that mindfulness is a quality that is likely to be universally helpful. My intention is to try to work with everyone who comes through my door. In that respect, I think I need to have more connection to what you are describing (if not personally, then at least being open to it and helping people make the connections they need). At the same time, I want to be able to work with those who, as you say, have resistance to your perspective.
            I am not sure we have a disagreement. I think this is an important topic.

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      • Sandra,

        Thank you for your post. It is good to see people grappling with important questions.

        Can you elaborate your comment “I think many psychiatrists accept this with some sorts of problems but not always when it comes to psychosis.” Here, I believe that “this” refers to the idea that people can recover from psychosis even without there being a biological understanding of the problem. Please correct me if I am mistaken.

        To me, it seems that the key issues is respect. For a person experiencing psychosis, be it caused by abuse, sleep deprivation, drug withdrawal or some unknown biological or physical factor, their perspectives and beliefs are probably a result of trying to make sense of their own experience. What matters is that their experience is genuine, regardless of whether a bystander believes it or not.

        When a person’s experiences are respected by their support system, they are empowered to make changes in their life, make informed decisions about medication, and to influence the course of psychosis. However, if their experiences are denigrated and their judgment doubted, this invalidation can lock them into a disempowered state and make them helpless.

        Regardless of what we do not know about psychosis, we do know what stigma and discrimination can accomplish.

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        • Thanks, Tom Jones.
          In that statement, I was suggesting that I think most psyciatrists would readily accept that trauma, life stress, personal relationships, etc. play a role in causing the various problems people have. But when it comes to psychosis, I think they tend to believe that biology plays a much larger role. That was the context in which I was invited to post on 1BOM. There was a suggestion that there are some core syndromes – psychosis being one of them – that is fundamentally a biomedical problem. I am challenging that contention.

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          • Yes, I believe that schizophrenia and related disorders are far more likely to be attributed to biology. In my intro text, it refers to everything else as “psychological disorders” and then switches to “brain disease” when we get to psychosis.

            Psychiatrists may play lip service to psychological factors, environmental stressors, etc. but they don’t really give them much weight (in my experience, anyway). My psychiatrist attributes my success to Lamotrogine (which I have to take for epilepsy, probably caused by ECT) even though (a) I recovered before I started the drug; and (b) My recovery coincided with moving out of my parents’ basement into my own home. My doctor assured me that “a simple move couldn’t account for it.” That told me all I needed to know about his biases.

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  4. How many people have been diagnosed “psychotic”, and therefore “ill”, for believing that the US government was spying on them? In the aftermath of the Snowden revelations about the scope of the NSA operations, I think that many American psychiatrists should ask themselves how many lives they have ruined by labeling “psychotic” many such individuals. Not to mention that some do see psychiatry as a way to impose political ideology http://washington.cbslocal.com/2013/10/29/sean-penn-tea-party-ted-cruz-should-be-committed-by-executive-order/ .

    Sandra says that in his opinion “mind” and “brain” are the same thing. I beg to differ strongly. And I think that this “belief” that mind and brain are the same thing is the prime reason psychiatry has caused, and continues to cause, so much pain to so many people. The best way to understand this difference is to consider “software” and “hardware” in a computer. In a computer, “hardware runs software”, but software is not the computer running it, even though when a computer runs software, you can certainly see correlates between hardware activity (like billions of transistors of a CPU switching) and software.
    In fact, staying with the NSA story, such correlates are one of the most sophisticated ways to break otherwise theoretically correct cryptosystems https://en.wikipedia.org/wiki/Side_channel_attack .

    But software is not the computer. If you burn a computer that runs Windows, Windows still exists. Even if you were to burn all the computers that run Windows, and burn all the media, like DVDs, that store a copy of Windows, you could still reconstruct it, at least theoretically speaking, from the minds of the people who coded Windows. And even if you were to eliminate these people as well, Windows as an abstract concept would still exist and some other people could in theory reconstruct it. If you eliminate a brain, that brain is gone forever. The majority of people in the world -ie, religious people- believe that the mind continues to live after the death of the brain. I have come to think of government sponsored psychiatry as a violation of the “establishment clause” of the first amendment of the US constitution. The claim that mind = brains, that many psychiatrist believe, is the best example of this violation.

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    • I agree 100% with your comments. No society in the history of the world that I am aware of, other than our own, has ever entertained the idea that humans are just bodies and that there is no spiritual reality or entity involved. What that entity might be is and will probably remain a mystery, but that doesn’t mean it doesn’t exist. Your hardware/software analogy is excellent, but I’d add also that there needs to be someone operating the software, someone who decides which programs to run and what data to enter and what a desirable outcome is. None of this is addressed by the “human as brain” viewpoint.

      Science is in truth a sub-study of philosophy. That’s why people get a “Ph.D.” even if they’re studying science. Psychiatry is based on some hard philosophical assumptions, such as “brain=Mind,” but tries to pretend that they are “obvious” or “unavoidable conclusions,” which is one of the classic sophistries used to slip unverified assumptions into an argument. In essence, they assume a conclusion and then reason from that assumption as if it is fact. And that, specifically, is what leads to the muddled confusion described in the article. Real science clarifies things. “Science” that creates more confusion is false science that rests on an incorrect assumption that the “scientist” is unwilling to let go of. That describes psychiatry to a tee!

      — Steve

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  5. This is a great article, Sandra, but I part company with you on these two points:

    (1) “I am not someone who finds it useful to make a distinction between the mind and the brain. In my view, we are talking about the same thing but at different levels of abstraction”

    (2) “Phineas Gage, whose personality changed after a tamping iron was lodged in his brain’s frontal lobe. This was an early confirmation that things as complex as social comportment and motivation were related to brain function.”

    With respect to (1), I have found mind vs. brain to be absolutely critically when debating psychiatry. Breggin’s analogy of the crappy television show (the mind) not being the fault of the cable connection (the brain) is perfect. Rather than saying the mind and the brain are the same, I think it’s more accurate to say that the mind is “reflected” in the brain.

    And regarding (2), certainly Gage’s experience (and strangely we’re just covering that now in my introductory psych course) confirms that the mind can be changed by changing the brain. It’s a very far cry from that, though, to suggest that all trouble with the mind originates in the brain (which I’m not suggesting for a moment is the position that you take).

    I think it’s very telling that for all psychiatry’s bluster, they are still forced to stick with the term “mental illness” rather than “neurological disease,” at least when they’re talking to their patients or to the media.

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    • Thanks, Francesca. You are correct, we do part ways on this. Where you and I may join again – and where I part wasy with someone like Thomas Insel the Director of NIMH – is that I do not think it is imperative that we decipher the workings of the brain to be able to help people who are in distress. So in that way, our disagreement may be moot.
      Sandy

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      • “I do not think it is imperative that we decipher the workings of the brain to be able to help people who are in distress.”

        Exactly. The vast majority of mental problems come from our interaction with each other and with our environment. The question, “What happened to you?” is infinitely more productive than “What’s wrong with you?” (which, as many on this site point out, pounds people into the ground).

        Attending to our experience and what it means to us is an elegant approach; trying to manipulate the brain – the most complex single entity in the known universe – is a fool’s errand, given the vast amount we don’t know about the brain.

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  6. Curious question: what would happen if muddled thinking was an observed “symptom” in a person (aka patient) and how would that person be treated? Please consider both meanings of the word treat.

    treat (trt)
    v. treat·ed, treat·ing, treats
    v.tr.
    1. To act or behave in a specified manner toward.
    2. To regard and handle in a certain way.

    7.
    a. To give medical aid to (someone): treated many patients in the emergency room.
    b. To give medical aid to counteract (a disease or condition): treated malaria with quinine.

    Thanks.

    Are we doctors of the brain or of the mind? An unbalanced and imperfect combination.

    Do we just confound and confuse? In the worst cases, I think psychiatry / psychiatrists / the “mental” system effectively sabotages and destroys not only a person’s life, but the person themselves.

    I completely agree with Alex.

    I appreciate and admire you Dr. Steingard, and I enjoy reading your entries.

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    • Thanks, mjk. I am not sure if this is a rhetorical question, but muddled thinking (which someone pointed out I use 3 times in this post!) can be considered a symptom. But the subjective nature of this process and the ways in which what are considered “symptoms” blurs into “normal” thinking is one point of my post – or at least one source of my muddled state.

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      • No, definitely not rhetorical.

        If I had muddled thinking, wouldn’t I be told that I need help and to seek professional help? I’d be considered flawed, incompetent, sick, disordered, lesser intelligent and diseased. But if a professional experiences muddled thinking, well – that’s different. You’re not flawed and incompetent, you’re working. You’re not sick and disordered, you’re studying and learning (as if somehow, I wasn’t doing any or all of those things).

        What I’m getting at is the differences in treatment (WHO the experiencer is as opposed to WHAT the experience is).

        You won’t be told that you need help or to seek professional help. You’ll just attend meetings and talks and workshops (work as usual).

        Please don’t think I’m insulting you or any other working professional. I’m not.

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        • I do not feel insulted but I am not sure how to respond. If I went to work tomorrow and was so muddled that I could not do my job, I probably would seek a consulation. If I did not notice the problem, I think others might insist on my seeking evaluation. If I was worried about my clarity of thought, even if others di dnot notice, I might seek evaluation.
          The point I was making is that these states are not categorical. Confused thinking is a subjective experience and is evaluated subjectively.

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          • “Confused thinking is a subjective experience and is evaluated subjectively.”

            But that isn’t how it goes when one is subjected to “the system”.

            Even if there is no major complaint, the “symptom” is still collected as information, lodged on the record and used to formulate a diagnosis and a “treatment” plan. Clinically, in my experience, confused thinking wouldn’t be considered subjective at all, but a sign of some fundamentally flawed / diseased brain. For you, in context of this blog, and your life, muddled thinking is NOT a product of YOUR brain, whatsoever. And I think that is remarkable.

            Muddled thinking strikes me as a potentially very serious symptom. If I was a doctor and somebody used that word to describe what they experience, even though it may not be a major complaint, I would be concerned and I would want to investigate. Of course, I’m not a doctor – I’m just mocking.

            So, I think it really is a matter of WHO experiences rather than what, and even regardless of context.

            Francesca,

            I like to use Deepak Chopra as my favorite example for how people see experiences by WHO is having them.

            Deepak Chopra wrote a book for teenagers and talked about a spiritual manifestation named Baba who stayed with him for 4 days. If I had a spiritual manifestation for 4 minutes, 4 hours, 4 days, 4 weeks, 4 months, 4 years or FOREVER … doesn’t matter how long or what that spirit was (or in what form the spirit appeared). But because it’s ME, I’d be called schizophrenic (not Deepak). Either he is or everybody else isn’t. Why is Jani’s 400 the cat a hallucination and a delusion and Baba is just a spirit who came to bless a beloved, accomplished man?

            What is it about Deepak that he could experience a spiritual presence for four days and not suffer it? And not suffer a psychiatric diagnosis and be put under treatment for his condition? Does he still get visits? Has the Dark Side contacted him? Why isn’t psychiatry VERY interested in Deepak and his experiences? I am.

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        • mjk, I agree with you that far more latitude is given to the middle-class, the educated, the gainfully employed, etc. I know several professionals that would probably meet the criteria for psychiatric labelling but they’re allowed to be themselves because they’re deemed just “eccentric” or “opinionated,” etc. but Heavens, No! They’re not “delusional” or “diseased.”

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          • This is SO true! I saw an article recently about doctors having a high suicide rate. They did not talk about how many had seen a psychiatrist or what percentage were compliant with their meds or were resistant to treatment. They talked about the incredible stresses of being a doctor and how to create supportive networks so that depressed and hopeless doctors could talk to each other, as well as recommending changes in how we approach medical training. No “brain disease” talk when we’re talking about the privileged members of society. It’s understandable that DOCTORS feel depressed. But the rest of us need to buck up or drug up.

            —- Steve

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  7. I think that the only utility in having the labels is to differentiate those to whom the society should give a pass. In the US, everyone works. I think it is helpful to distinguish those who won’t work from those who can’t work. The latter should receive SSI or SSDI. Unlike Szaz, I do want to reserve the death penality for those who were capable of making another choice. If someone commits a crime while laboring under false assumptions, they should be judged by another standard. For purposes of working with people, labels are superfluous. You contract around where they view the problem or need for change. The label adds nothing.

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  8. First, I should state (as a proud Canadian) that I don’t think anybody should be executed, regardless of their state of mind. And distinguishing not working vs. being unable to work is pretty hard to do. An arbitrary psychiatric label shouldn’t be the yardstick.

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  9. Thank you Sandra for this post. I have spent most of the last four years trying to understand my son’s condition. Is he bi-polar? schizophrenic? just sad and confused? born this way? Does he need drugs or better nutrition? Will he ever get better? After four years I still have more questions than answers. It is so good to hear a professional who admits to being confused as well. Thank you for your honesty!

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  10. Hi Sandra,

    since you gave me the link to this article of yours in our brief interaction a month ago, I read it, again. I read you and your husband’s recent interview in the Psychiatric Times that MIA gave a link to in their “Around the Web” section and it made me think of you. I tried to track down a contact email for you on the internet, but then wondered if that might feel creepy…sigh.

    You said you intended to go thru more of my personal blog, but then my wife and I left for Europe and the holidays hit, and I never heard back from you. Maybe you found nothing of interest there, nothing that might help with even a few of your questions that you throw out in this blog and elsewhere…and if that’s the case, then maybe I really have nothing to offer…I can’t get my wife to join me in my efforts to change the conversation on how to approach extreme mental distress issues, no matter how often I beg her, and nothing I have tried on my own for these last 11 years has been accepted by any corner of the discussion on dissociation, ptsd, attachment concepts, mental health, the SO’s place in the healing journey, or anywhere else I have tried to find a ‘home’ for myself. I just, literally, seem to fit nowhere in this world or its internet…and that’s a really hard reality to have to face…

    Our son lives over in Waltham, outside Boston. Sometimes I wish I could stop by your place, even if I had to pay for your time, and just figure out if I really have wasted my life and these last 11 years, especially, as I carried my wife thru all the issues that come from extreme dissociation, thinking I could show the world a better way to approach mental distress. But no one wants to listen…and I’m really running out of hope and strength to keep trying to make a difference.

    I know this ‘comment’ really ought to be in private, but I didn’t know how to get it to you, and maybe you won’t even see it now as this is such an old blog of yours. I do wish you well and am glad there are people out there like you who are brutally honest with the truth…even if you found nothing of any value that I had to share…
    “Sam”

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