Decreasing suffering often means “comforting the afflicted, and afflicting the comfortable.” However, AlterNet’s recently republished Psychotherapy Networker article, “The 14 Habits of Highly Miserable People,” authored by psychotherapist Cloe Madanes, instead appears to have afflicted many of the afflicted. Perhaps Madanes was attempting to afflict those comfortable enough to afford her and her professional partner Tony Robbins, but that comfortable group excludes many readers.
While some of the article’s voluminous reader comments were positive, concurring that many unhappy people have chosen to make themselves miserable, the majority vilified Madanes, calling her: “condescending,” “shaming,” “asinine,” “insensitive,” “pompous, “judgmental,” “violent,” “a narcissistic, manipulative, abuser,” and a long list of even nastier invectives.
In the 1980s, Madanes achieved some fame among mental health professionals as a family therapist who wrote about interpersonal/interactional strategies. In the 2000s, she teamed up with Tony Robbins to form Robbins-Madanes Coach Training and the Robbins-Madenes Center for Strategic Intervention. Robbins—whose estimated net worth is $480 million—has been a guru to the rich and famous and to those aspiring to become more successful; they pay big bucks to hear Robbins’s version of the positive psychology gospel of “you have total control over your happiness.”
While Madenes talks about the benefits of altruism, gratitude and satisfying relationships, it is her sarcasm and lack of empathy for those who can’t so easily be transformed by the Robbins-Madanes approach that enraged people. The reality is that we human beings can sometimes become so trapped by overwhelmingly oppressive forces—financial, interpersonal, and otherwise—that lecturing us into behaving more joyfully only creates more pain. This leads to the first of 10 Ways Mental Health Professionals Increase Misery in Suffering People:
1. Preaching Positive Psychology Attitude-Adjustment Approaches to Trauma and Abuse Victims. Abuse comes in many forms—physical, emotional, verbal, nonverbal and neglect—all imparting the message: You are not worthy of respect and caring. While no small number of Americans have been traumatized by abusive parents or spouses, many more of us are financial victims of the abusive authority of the ruling corporatocracy (comprised of the wealthy elite, giant corporations and their politician collaborators).
The trauma and shame of chronic abuse is painful, and one normal human reaction to overwhelming pain is depression, which is really a “strategy” for shutting down overwhelming pain. Whether one is abused by a parent, spouse, or the corporatocracy, the pain of it can be anesthetized by depression, drugs, and a wide range of diversions.
People beaten down into a state of immobilization do not need positive-thinking advice, as they routinely know what they should be doing but lack the energy to take constructive actions. Condescending advice, which assumes inaction stems from ignorance, creates only more pain. Instead, people need compassion, love, and various kinds of support.
2. Depoliticizing Human Suffering. Madanes’s #1 “habit of highly miserable people” is to “Be afraid, be very afraid, of economic loss.” The reality is that the majority of Americans have every reason to have anxiety over financial loss, as many are already suffering or on the verge of suffering from unemployment, underemployment, a house underwater, staggering student-loan debt, and other financial nightmares.
But Madanes says, “In hard economic times, many people are afraid of losing their jobs or savings. The art of messing up your life consists of indulging these fears.” Are most people in financial misery because they are stupidly indulging their fears? Or do some people, unlike Madanes, have debilitating financial anxiety because they see no viable options?
3. Not Respecting and Not Celebrating Maladjustment. Martin Luther King’s 1963 speech addressed the problem of mental health professionals’ uncritical compulsion for “adjustment.” Here’s an excerpt:
Modern psychology has a word that is probably used more than any other word in modern psychology. It is the word “maladjusted”. . . There are certain things in our nation and in the world which I am proud to be maladjusted. . . I never intend to adjust myself to economic conditions that will take necessities from the many to give luxuries to the few. I never intend to adjust myself to the madness of militarism, to self-defeating effects of physical violence… I’m about convinced now that there is need for a new organization in our world: The International Association for the Advancement of Creative Maladjustment.
4. Medication Abuse. Adults with truly informed choice can wisely utilize a psychiatric drug to catch a night’s sleep after a week of sleeplessness threatens a breakdown. However, wise informed choice is not exactly the standard of care in psychiatry. The high-profile case of Tufts-New England Medical Center (a bastion of the psychiatric establishment) and Rebecca Riley reveals that standard of care in psychiatry includes medication abuse.
Covered by “60 Minutes” in 2007, when Rebecca was 28 months old, her psychiatrist Kayoko Kifuji diagnosed Rebecca with attention deficit hyperactivity disorder and prescribed clonidine, an anti-hypertensive drug with significant sedating properties. When Rebecca was three years old, Kifuji added a bipolar disorder diagnosis and prescribed two additional heavily sedating drugs, the antipsychotic Seroquel and the anticonvulsant Depakote. At the age of four, Rebecca died due the toxicity of these drugs. After Rebecca’s death, Tufts-New England Medical Center, Kifuji’s employer, told “60 Minutes,” “The care we provided was appropriate and within responsible professional standards.”
Investigative journalist Robert Whitaker in his book Anatomy of An Epidemic documents how, for many children, psychiatric medications results in episodic and mild emotional/behavioral problems becoming severe, chronic and disabling ones.
5. Maintaining Drug Hypocrisy. Not only are prescription psychotropics and illegal psychotropics chemically similar, affecting the same neurotransmitters, they are used by people for similar reasons, which include taking the edge off misery so as to function.
In the Vietnam War, some U.S. soldiers used heroin to dampen their misery, and this worried the U.S. military establishment, weakening its resolve to continue the war. But in Iraq and Afghanistan—where according to the Navy Times in 2010, one in six U.S. soliders were taking psychiatric drugs, many in combat zones—since soldiers are being “medically treated,” the U.S. military establishment and general public can more easily deny war-horror realities.
Drug hypocrisy also results in Americans being misinformed about the realities of prescription psychotropic drugs, which makes it more likely Americans casually take them and give them to their children. Moreover, this drug hypocrisy also increases suffering by enabling unfair criminalization and incarceration of people who are medicating themselves with illegal psychotropics.
6. Pathologizing Normal Dimensions of Our Humanity. No different than those religions that shame sexuality as sinful, mental health professionals who pathologize grief, shyness, stubbornness, rebelliousness, and other normal dimensions of our humanity can alienate vulnerable people from their very selves and cause increased suffering.
In 2013, the DSM-5, the American Psychiatric Association’s revised diagnostic bible, patholologized normal grief. In 2008, Christopher Lane (Shyness: How Normal Behavior Became a Sickness) described how shyness became social anxiety disorder. And in a February 2012 AlterNet article Would We Have Drugged Up Einstein? How Anti-Authoritarianism Is Deemed a Mental Health Problem, I detailed how anti-authoritarianism is psychopathologized; for example, in 1980, the American Psychiatric Association added opposition defiant disorder (ODD) to its then DSM-3. ODD symptoms include “often actively defies or refuses to comply with adult requests or rules” and “often argues with adults.”
Since 1980, ODD has become an increasingly popular diagnosis, with an increasing number of these kids being drugged for this “condition.” In December 2012, the Archives of General Psychiatry reported that, between 1993-2009, there was a seven-fold increase of children 13 years and younger being prescribed antipsychotic drugs, and that “disruptive behavior disorders”—which includes ODD—were the most common diagnoses in children medicated with antipsychotics, accounting for 63% of those medicated. Antipsychotics are among the most dangerous psychiatric drugs, causing obesity, diabetes, and “life-shortening adverse effects,” reports the American Family Physician.
7. Absence of Professional Humility. The most important aspect of helpful psychotherapy is a positive relationship between therapist and patient. There is copious research on this documented in Great Psychotherapy Debate, which shows that the nature of the relationship is far more important than any technique. Mental health professionals—like all human beings—have limitations, and they are routinely mismatched with a patient in terms of personality, values, or other significant variables, resulting in relationships lacking affection, trust, and respect.
Because of an absence of professional humility around one’s ability to form positive relationships with all patients, two damaging events often occur when patients are not making progress: (1) a relationship that may consist of a mutual lack of affection, trust, or respect is allowed to continue, and patients become even more hopeless about their ability to make progress; or (2) patients will be needlessly referred for medication, and needlessly risk drug adverse effects. Too few professionals say, “I think the problem is that we are not hitting it off, and you are better off trying to form a therapeutic relationship with someone else.”
8. Creating the Stigma of Biochemical Defect Which Isolates Suffering People. In 2007, the director of the National Institute of Mental Health (NIMH) discarded the theory that an underproduction of serotonin causes depression, but the NIMH and the psychiatric establishment continue to spend billions of dollars trying to prove that mental illness is primarily a brain disease. In the mental health establishment, it has long been thought that reducing mental illness to a brain disease—and minimizing psychological, family, social, and spiritual reasons for emotional suffering—would result in less stigmatization. But is this true?
The Canadian Health Services Research Foundation (CHSRF), in “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma,” reported in 2012: “Despite good intentions, evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” One example is a 2010 study in Psychiatry Research that reported for the general public, the acceptance of the “biogenetic model of mental illness” was associated with a desire for a greater social distance from the mentally ill.
The CHSRF review states: “The evidence shows us that while the public may assign less blame to individuals for their biologically-determined mental illness, the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous. . . .leading to avoidance.” The authors believe that, “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different.”
9. Exclusive Focus on Patients’ Symptoms to the Detriment of Their Humanity. In 2011, the New York Times (“Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”) reported, “A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients.” As the article points out, psychiatrists can make far more money primarily providing “medication management.”
A typical medication management session consists of checking symptoms and updating prescriptions, and patients are usually in and out with a new prescription in five or ten minutes. It’s common for medication managements to be scheduled every two or three months, and patients tell me that during these appointments, the doctor often needs to peek at their files to remember their names. In such assembly-line treatment, there is virtually no chance of a relationship forming, and gone is even the accidental possibility of healing through another’s humanity. And by focusing exclusively on what’s wrong with patients—their symptoms—patients can suffer more.
“Depression is partly defined by, and largely maintained by, self-focus,” reports psychologists and researcher Jill Littrell, and medication management is not the only way that mental health professionals cause greater self-focus and symptom-focus. This problem can also be caused by some psychotherapists, Littrell reports in her 2013 article “Talk Therapy Can Cause Harm, Too.”
What is most helpful for many depressed and emotionally suffering people is morale, healing from trauma, and learning to focus outside of one’s symptoms to activities, external events, and other people. Suffering is reduced by increasing satisfying relationships and increasing self-respect—not by increasing self-absorption. Unfortunately, too many mental health professionals create increased self-absorption, which is often accompanied by increased isolation, dissatisfying relationships, and greater misery.
10. Hypocrisy over Conflict of Interest. Professionals have great power to “maintain their cash flow.” They can, for example, sell patients on the idea that their episodic depression is a chemical-imbalance disease like diabetes, and that they need to be on medication for life. They can sabotage patients’ other relationships by focusing on—and helping exaggerate—minor frustrations with friends or intimates, resulting in patients becoming isolated and totally dependent on the professional.
The professional’s job ceases when treatment is successful, and so professionals who are doing their job well are working against themselves financially. If that’s not a conflict of interest, what is? Certainly the same is true for divorce attorneys, auto mechanics, and others who make a living off the problems of others. This is not to say that many people who make a living off the problems of others don’t transcend this essential conflict and do the right thing—but not if they are in denial about this inherent conflict of interest.
These 10 areas are not the only ways that mental health professionals can increase misery in suffering people. Too often, professionals don’t value emotional crisis as a vehicle for spiritual discoveries and a path to connect to new people. Also, patients not only have severe long-term adverse affects from psychiatric medications but from electroconvulsive therapy (ECT), which continues to be used in America. And there are other physical, psychological, spiritual, and societal adverse effects caused by mental health professionals.
I am often asked, “Don’t your colleagues get angry with you for speaking out on what’s problematic with your profession?” The short answer is not all of them get angry. Those mental health professionals who are embarrassed and afflicted by what has happened to their profession often tell me that what I say helps them feel validated and less alienated. However, it is true that the mental health establishment, including the American Psychological Association and the American Psychiatric Association, which focuses most on maintaining professional prestige is not at all comforted by what I have to say. But isn’t it the job of those who care about reducing suffering and injustice to “comfort the afflicted, and afflict the comfortable”?
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.