An Anti-Violence Mental Health Plan


It seems almost every week now that we hear of a mass murder/shooting in the media.  By now the pattern is too familiar to be as frightening as it once was:  An isolated young man, with some ongoing mental illness that isn’t being actively treated, is resentful of his world, buys guns and a lot of ammunition, and kills people until someone kills him.  The response has also become reflexive: Guns should be made less available, especially to people with mental illnesses, and potentially dangerous people should be treated for their mental illnesses − involuntarily if necessary − so they can live safely in our community.  Yet, nothing much changes, outraging the next set of victim’s families and communities.

I would like to propose a different long-term, proactive strategy on the mental health side of the problem.

From a mental health point of view these young men, have two relevant characteristics – their mental illness and their social isolation.  We’ve focused much more attention on their illnesses than on their social isolation. I believe this is because we have a lot more faith in doctors, medications, and treatment than we have faith in relationships and community.  Never mind that these people seem to have a variety of conditions (though it’s hard to make diagnosis on dead people from media reports).  Often they seem psychotic, probably from schizophrenia.  Sometimes they seem socially impaired from childhood, even dramatically so, perhaps with some variant of autism. Occasionally PTSD seems to be part of the problem.  Even though they all seem to have very longstanding problems, we seem to have the belief that if only someone would have gotten them some treatment, especially into a hospital, their tragedy could’ve been averted.

There are plenty of expert psychiatrists willing to tell the media about how effective our treatments are − if only we’d be given the power to force more people to receive them.  It’s unclear if that’s actually true. Some of these young men have received treatment, and seem to mostly have been antagonized by it and further isolated and stigmatized in the process.  Don’t get me wrong:  treatment, including medications, can be a very powerful tool to achieve recovery, but it will never be “the answer.”

Psychiatrists don’t publically share that our treatments mostly only work when we can engage the person in their own treatment and recovery, when they collaborate in the hard work of recovery, and that recovery needs to be an ongoing effort.  (When was the last commercial you saw that said, “If your antidepressant isn’t working, maybe you need to be more involved in your recovery”?)  Maybe mental health workers need to do better at engaging people and collaborating with them and working on goals they think are important.

One of the main reasons we’re reluctant to share our limitations is that we don’t want society demanding that more and more people with mental illnesses, who are uncooperative, be locked up indefinitely in mental hospitals again.  Despite some vocal counterexamples, most mental health professionals have neither the stomach nor the budget for locking up lots of people.  The main reason we’re locking up more people in jails instead of hospitals isn’t because anyone thinks it’s better for them; it’s because most judges were prosecutors and they don’t’ have any budgetary constraints on them.  They have society’s permission to be extravagantly coercive.  Psychiatrists don’t have that permission and we’re not likely to ever have it again.  The judges don’t get blamed for overcrowded, budget busting, inhumane prisons.  Psychiatrists did get blamed for overcrowded, budget busting, inhumane hospitals.

What if instead of heading down this dead end again, we focus on the “socially isolated” part of the equation?  Could we find ways together focused not as much on how to help get people into treatment, but how to help get them into life?  (Notice before we start down this road, that most of the recommended treatments further isolate, shame, and stigmatize the person.  For example, colleges are busy hiring psychiatrists so they’ll know which students to get rid of to “make sure no one gets hurt.”)

Here’s my five step plan for reducing social isolation:

1. Outreach 

Our mental health systems say we’re too overwhelmed with the people showing up to our programs every day to go out and look for more people in trouble.  Therefore, we only allocate resources to share the burden with police of responding to dangerous situations.  (Note that many people think this is a legal requirement – “We can only do something if they’re dangerous to themselves or others.”  I don’t think any state has a law against involuntary outreach, wellness checks, or listening to concerned families.)

There are a number of ways of being alerted to who might be in trouble and isolated.  Usually their family knows.  We could answer the phone when they call and actually go out and meet their family member.  We could use data bases (for example, people withdrawing from college, signing up for unemployment, cancelled weddings, evictions, bankruptcy, loan defaults, jail releases, even gun purchases) to reach out and offer human contact.  We could have “social isolation” outreach teams instead of “call the police.”

2. Engagement

Depending on how the outreach went, we could triage people who are actually socially isolated and at risk into a variety of paths of engagement.  Some would require mental health professionals, but not all.  Programs like Emotional CPR, Mental Health First Aid, and What a Difference a Friend Makes train the general public to engage people with mental illnesses.  Peer outreach workers, who are in recovery from mental health conditions themselves can do outreach.  Sometimes the most pressing need might be for some other specific non-mental illness social engagement – unemployment benefits and a job developer, an educational counselor, a financial counselor, meals-on-wheels, clergy, etc.  If we worked together we could form a sizeable engagement team.

3. Inclusion

These young men have been socially excluded for a reason. They have serious problems. They’ve all experienced far more rejection and bullying than acceptance and inclusion during their lives.  We live in a community that is not accepting and inclusive of people with mental illnesses in the same way we are with physical illnesses.  For them to be included, individuals, whether mental health professionals or not, will have to be part of a “counterculture of acceptance.”  Examples of disability-based inclusion programs are: Compeer, Cornell’s practices of reintegrating students after mental health crisis, 12 step programs, impaired physician programs, Yolo county and other NAMI programs, Project Return self help clubs, etc.  Probably more important, however, would be non-disability based inclusion. (The movie “Lars and the Real Girl” is a great example, so are “midnight basketball” and Big Brother/Big Sister programs.)  The engagement worker would have to be willing to include these people in other parts of their lives and in other roles besides disabled person receiving help.

4. Protection

Risk factors for dangerousness are only predictive in the absence of protective factors (when they’re predictive at all).  Common protective factors include having an income, having a reasonably secure place to live (an actual “home” is best), having a family (it doesn’t have to be a “perfect family”), having other adults in life (romantic partners are probably the most impactful), having a role besides “outcast” or “mentally ill”, and having some active spiritual faith and connection.  Thinks of how few protective factors these mass murderers had.  Once we’ve engaged with people we can work with them on building protective factors.  Mental health professionals can be one of their protective factors, but we shouldn’t be all they have.

5. Strengths-Based Growth

Every person, even mass murderers with mental illnesses and social isolation, has strengths, talents, and personal gifts.  We can help people reclaim and develop their strengths and enrich all of us. (A social worker once told me that her job is to “help people remember what made their heart sing and find a way for them to do it again.”)  The difference between a contributing, valuable person and a frustrated mass murderer may be more in their opportunities, how they look at themselves, and how we react to them, than in their diagnoses. And that’s a difference worth making.

There’s good news and bad news in this strategy.

The good news is that even if we can’t identify the needle in the haystack to find that rare socially isolated, armed, mentally ill person who will actually commit murder, those people accidently included in this strategy are likely to be benefitted anyway (unlike the likely inadvertent consequences of being locked up, involuntarily medicated, terrified, and traumatized).  We’d likely prevent some suicides with this strategy too.

The bad news (besides the problem that I can’t think of a clever acronym for these five steps) is that all of us have to get involved.  We have to be a community that cares about each other.  We can’t just put all the responsibility on the mental health system (no matter how well funded, which it rarely is) to keep us safe.  We can’t say that’s someone else’s kids or “No one is that crazy in my family . . . or my neighborhood, or school , or work, or church.”  We’re in this together.  We can’t just change the channel and see what else is on tonight.  It’s not happening to someone else.  It’s happening to all of us.


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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  1. Hi, Mark,

    I think you’re right about focusing on relieving isolation. It is interesting that the focus is always on the “mental illness” that the person is suffering, and not on the isolation, which appears to be a much more defining characteristic.

    It was interesting how I experienced this article while reading it. I found myself already resisting your message early on as you outlined the various diagnoses these people might qualify for, and then talking about the difficulties of isolation and stigma. Do you think that the very process of calling these things “mental disorders” contributes to the stigma and isolation you want to avoid? I believe there is scientific evidence that this is, indeed, the case – placing these labels on people not only appears to create reluctance to deal with that particular labeled person, but also reinforces the isolation of those who are “different” by defining more rigidly and narrowly what is acceptable. I actually see this labeling process as a part of what creates these isolated and disconnected young people in the first place.

    You also mention that “some” of these young people had received mental health treatment in the past. I’d correct “some” to “most.” Adam Lanza, Kip Kinkel, Scott Harris, Jeffry Weise (Red Lake, MN), the kid from Paducah, KY… the list goes on and on. Many of these were receiving medication at the time they committed these acts, and many others were withdrawing from medication at the time. Others (like Lanza), we don’t have the information on their treatment status at the time of the event, but there is evidence suggesting they may have been taking medication at the time. We know from simply reading the product label that SSRIs and stimulants both can cause aggression and “manic” episodes. I am interested how this fits into your analysis – you seem to have sidestepped that issue for the most part. But regardless of that point, I think it should be pretty clear from the evidence that intervention by the “mental health system” does not appear to have prevented the majority of these incidents, so we have no reason to believe that further such treatment will do so.

    It is in the interests of the psychiatric profession as a whole to minimize such effects as I mention above, but as a change agent, I think it would be extremely valuable if you and folks like you inside the profession would be more direct in addressing these issues. Labeling creates and exacerbates stigma, according to psychiatry’s own researchers. Some of these drugs cause or exacerbate aggression, according to the drugs’ own labels. Receiving diagnosis or treatment does not appear to be reducing these incidents of violence, and may be contributing to it. These are not small issues. How would you respond to this information? Why isn’t there more commentary from the psychiatric community about these things when we hear a national call for more enforced treatment? Shouldn’t the needs of clients and society at large trump the commercial interests of the mental health industry?

    I do appreciate your courage in writing here and standing up to your peers by encouraging some alternative thinking. I hope I am helping prod you to take it to the next level by honestly examining the data on the effects of treatment on violence and speaking truth to power about what I see as the big elephant in the room.

    —– Steve

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    • I looked back over my post to see where I recommnended diagnosing or medicating anyone and couldn’t find it – so while I think there’s alot ot be said about the advantages and disadvantages of diagnoses and medications, I don’t see how it applies here. I’m trying to develop an inclusive strategy that is community wide and not dominated by mental health professionals (or anti-mental health people for that matter) that can hopefully triage people by whatever is engaging to them. My overall point is to begin with relationships instead of with diagnoses or gun control.

      Nonetheless, you bring up an important and, in my opinion, often minimized negative of mental health treatment – the impact of diagnoses, labeling, and being prescribed medications itself – which does have isolating, self stigma, social stigma, hopeless, blaming implications – that can have enormous impacts. We can approach this by 1) trying to decrease these negative reactions and 2) trying to create more positive contexts for helping people and 3) sometimes not doing somehting that might be helpful from an illness centered point of view but damaging from a person centered point of view (for example I once advised someone not to try to push her teenage son to try antidepressants even though I thought it was likley he’d feel better and function better with them because I was concerned that the self stigma, the reaction of his father and frineds and teachers and his resentment of his mother for pushing pills and his giving up on his dreams for the future would all be more damamging than the pills were worth. BTW This is tricky decision making – it appears that the black box warnings on antidepressants for adolescents did lead to decreased prescirptions, but also to higher suicide rates among adolescents – hard to tease out true causality, especially for any individual. Also tricky is that he then “self medicated” with MJ, whihc has far less negative stigma but does have biological negatives too).

      There are certainly biologic negatives of medications as well, though in practice it’s not usually easy to seperate out symptoms and side effects – and many of the posters on this blog have tragic outcomes that they seem to attribute primarily to misinterpreting a side effect as a symptom – and that certainly happens. Using psychatirists interchangeably, in very short time periods, with rare contact and little personal relationships or even busier primary care docotrs to prescribe, as we do in most places, in my opinion, radically increases the chances of not getting the best possible impact from medications (and not avoiding poor impacts) – but no one is doing anything to substantially increase the number of psychiatrists (or other prescribers susbstnatially).

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      • Hi Mark,

        I’m curious how you would justify your statement that ” it appears that the black box warnings on antidepressants for adolescents did lead to decreased prescirptions, but also to higher suicide rates among adolescents” Did you not read
        or did you find some reason to disagree with that? If the latter, could you share your views?

        By the way, I do hope you continue to engage here, and don’t feel too pushed away by people who feel you aren’t radical enough. I think it is important that we sustain dialogue between a diversity of views, examining the evidence for each, so we don’t just become an echo chamber for certain dogmas, some of which might be disconnected from the facts.

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      • I appreciate the reply, Mark. I am glad you acknowledge that the process of obtaining treatment does have potential adverse effects in terms of isolation and stigmatization.

        The part I was referring to about diagnosis follows:

        “Often they seem psychotic, probably from schizophrenia. Sometimes they seem socially impaired from childhood, even dramatically so, perhaps with some variant of autism. Occasionally PTSD seems to be part of the problem.”

        I’d still be interested in your thoughts on the fact that many of the shooters were receiving or had received psychiatric treatment before engaging in their shooting rampages. At the least, I think this makes a good argument against enforcing more treatment as a means of reducing mass shootings, even if many people will balk at examining the possible role medication side effects may have played in many of the shootings.

        Thanks for taking the time from your busy day to respond. I do plan to take this forward in other places to help re-focus us away from the fact that a person may have had a diagnosis (which is very common) toward the fact that the person was socially extremely isolated (which is a lot less common and more closely associated with the characteristics of most of the shooters).

        —- Steve

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      • While I agree with Dr. Ragins 5 Point Plan, there is one missing factor that I would like to highlight: menatal health prevention through emphasis on healthy attachments early in life.
        We need to weave behavioral health into pediatrics to help each human being get off to a positive start through the strength of healthy attachments. I give credit to the leaders in this field: Dr. Dan Seigel, Dr. Louis Cozolino, and Dr. Bruce Perry (among others). We should also note that the stress related to poverty is a key challenge, but that should not stop us from addressing the need for health education and intervention to beign with prenatal care and extend through childhood. Particular emphasis should be placed on the first 3 years of life and the teenage years.
        Healthy attachment is vital and its positive effects last a lifetime.

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    • From what I remember reading in the press one of the events that some claim has pushed Lanza to violence was that his mother wanted to involuntary commit him. Since he had experiences with “treatment” before that sounds like a factor that should be taken seriously. Violence breeds violence and research shows that people labelled mentally ill are on the receiving end of it and often the “mental health professionals” are perpetrators (forced treatment is torture).

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  2. Mark,
    The comments from Steve McCrea, blogger, are incredibly true IMO. I hope you consider furthering Steve’s focus on the how the profoundly negative effects from “labeling and stigmatizing” contribute to the isolation and traumas far too many people today suffer with.

    And yes, absolutely, you are correct ” we’d likely prevent some suicides with this strategy”. My 25 y/o son took his precious life, 30 months ago, as he could not handle the devastating trauma of being horribly diagnosed twice, in 18 months, “psychosis NOS, rule out bipolar one” from the first psych hosp and the second hosp ” bipolar one with severe psychotic features”. My son’s incredibly social circle of peers and his wife could not either handle the ‘diagnosis’ and ‘prognosis’ that the ” experts” gave my son. His young wife, of 20 months left my son for another guy and as the divorce was being completed; and exactly at that point, he took his life.

    Why didn’t the MH system correctly identify that for my son’s developing brain, his ” recreational” use of THC ( today’s potent strains of hybrid marijuana seed producing VERY psycho-active effects) which he tested (+) both toxicology reports were the catalyst for his twice diagnosis of ‘psychosis’ instead of boxing my son into a severe MI when he had never had MH issues all his young life (anything but)? Why didn’t the MH system care enough to identify the adversities he had recently been dealt? Imagine, if my son had not been given the “bipolar” label and instead sent to a drug rehab to learn how to cope with life, and helped to learn how using ANY mind-altering substance can trigger altered reality (both ‘episodes’ he did return to ” normal”). Imagine if my son and his family, had been educated about how recreational drugs create depression, especially cessation, the effects can last many months. No, the “system” just reinforced more trauma which shattered his proud ego. Add in the loss of support he had with his friends and wife because of the stigma from the horrific LABELING. Surely, we, as a society, can and must bring about change starting with indeed, recognizing the elephant in the room.

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  3. Hi Mark,

    Though I agree that psychiatry’s life destroying invalid stigmas like bipolar, ADHD and schizophrenia to push useless, toxic drugs that make people’s lives much worse are a major cause of the isolation and probable feelings of anger, loss of esteem, feeling rightly one is being made a scapegoat as well as hopelessness, wanting to isolate and other problems you cite, I think your anti-violence plan is excellent overall.

    Perhaps if your plan was tried first before the biopsychiatry labeling and drugging demolition enterprise, many of these isolated, angry young men or people might be reached. As Dr. Hickey wrote on this web site, many people wrongly think people are born with good social skills when in reality such skills like others must be taught, especially when children/teens come from abusive, poor, stressful homes and environments. Maybe youth/teen centers or areas (using churches even with volunteer supervisors?) might be a place to accomplish this by encouraging activities where all are/must be included and having experts to notice and tactfully/privately help those who seem to struggle to fit in, get bullied, etc. You probably see incidents like this yourself where you might intervene privately.

    Anyway, I was very inspired by your post and I can see it took a lot of thought and hard effort on your part.

    I think it would work much better if DSM stigmas and toxic psych drugs were delayed as long as possible to see if your plan might be a far better treatment without all the negative side effects while not stigmatizing and brain damaging the person for life. I also liked your article about talking to people with psychosis though you were trained otherwise. I’m glad you are learning from your own experience and wisdom rather then allowing the KOL’s of the APA who sold out to Big Pharma at the expense of their so called patients manipulate you into believing their “drug company inspired algorithms” and “evidence based medicine” with all the “evidence” supporting drug companies’ billions and lining the pockets of politicians .

    Perhaps you could start a volunteer program to try to implement some of these ideas starting on a small scale to see how it goes. I get the impression that you are doing some of this already?

    I appreciate your taking the time to write at MIA and I realize that though we may not always like what you say, I think you are trying to be honest by “telling it like it is” as I said on your post about your input on the Mental Health Act that changed people’s minds about forced treatment. I appreciate your doing this to uphold human rights and not scapegoating the so called “mentally ill” for lack of gun control and other problems. Regardless, I see a warm, caring, compassionate person in you as you share with us your ideal plan despite the many challenges you face daily with low income people with many life challenges and inadequate funding.

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  4. Yes, this is a positive angle to take on a thorny problem.

    I knew a couple angry/isolated young men when I myself was that age. One was a good friend, the other more an acquaintance. The friend would sometimes contemplate shooting up crowds of people just to express his alienation (this was kind of a new idea back then!) The acquaintance actually bragged once of taking a random shot at someone in a pickup truck going by, for no good reason. Both these young men matured without real problems, but they had come close to big trouble.

    I was also an isolated young man at times, but not with the shoot-em-up style of thinking.

    I think young guys like this need to meet up with a culture that can see them as having value in all their eccentricity and different-ness. They often don’t want “help” or “mental health treatment” but they do want connection and respect. If we found out how to connect with them in a good way, I think society would strongly benefit, not just by reducing violence but important other ways.

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    • “The friend would sometimes contemplate shooting up crowds of people just to express his alienation (this was kind of a new idea back then!) ”
      I think this may be much more common than people feel comfortable with expressing out loud. In a way it’s a normal reaction – people fantasize about harming their abusers, others who watch passively or if they feel like no one has their back even everyone in the world. It’s probably impossible to tell which of people like that will ever jump the line from thinking to doing and in many cases having these fantasies or even expressing them out loud may even have a therapeutic effect of getting it of the system. In fact the number of people who commit such violence is really small.

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  5. “What if instead of heading down this dead end again, we focus on the “socially isolated” part of the equation? Could we find ways together focused not as much on how to help get people into treatment, but how to help get them into life?”

    Excellent point, Mark…I totally agree!

    Even though I’m leery of all the psychiatric labels that get increasingly thrown around in our culture these days, there’s one that I think may have some validity/utility with regard to some of these mass murderers: malignant narcissism. I first heard it mentioned in reference to the boys who committed the mass shooting at Columbine. I also got a strong feeling of malignant narcissism (more than psychosis) in what Elliot Rodger revealed of himself in those videos he made before his murderous rampage in Santa Barbara. Social isolation was certainly a strong theme as well, and i wonder to what extent social isolation may be a “breeding ground” for malignant narcissism.

    At any rate, I agree that more efforts should be expended to get isolated people into life (not in a coercive way, though, which can be tricky) rather than looking for “treatment” (which usually translates to medication). Elliot Rodger apparently had plenty of “treatment”, and I believe it was revealed after the fact that Eric Harris and Dylan Klebold were both taking psychiatric medications.

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    • Narcissism is thought to be a response that happens in people who grow up not being appreciated. I can imagine if these guys grew up with parents who either didn’t care or had too much expectation and no praise for them that they compensated by praising themselves as better than others and special. Elliot Rodger looked like that case to me. I don’t think he was really so narcissistic, it was probably an angry facade for feeling rejected.

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  6. I see isolation as being a part of the issue, but nowhere near as important as injustice.

    And while reading this article I was thinking to myself; How would you create a mass murderer? This is something that certain people aim to do. Think about how the Taliban convinces young men (mainly) to become suicide bombers. Yes they isolate them in a manner, but they are interacting with people the whole time.

    What is done though is to bombard them with the injustices being done by the enemy. Show them the bodies of women and children slaughtered by the enemy, let them speak with the family members of those who have been killed.

    The process of radicalising someone does involve isolation, but it is isolation from any other ways of thinking, not from other people.

    Consider this in the context of Mental Health Services. Whats the first thing they do? Isolate you from any other way of thinking. Our way or no way. And Oh have you just been introduced to the injustice of our society. Welcome to the world of drugs and human rights violations.

    Worth thinking about. Study those who create mass murderers deliberately, and then see what they have in common with the Mental Health system. I think it may surprise you.

    Kind regards

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    • Dr. Raglin:

      The first thing they did to my daughter when I brought her to the ER for strange behavior was to isolate her. They put her in a dress that was ‘different’ from anyone else. They put her in a ‘different’ room with no windows and they took away her belongings. When she got frightened, she tried to run away and they reacted by pinning her to the floor, then restrained her with five point restraints while forcibly injecting her with Haldol! This to a person with a known history of being sexually abused! Then, to add to the isolation she was put in a locked unit. No windows, no freedom, just fifty feet to walk down the aisle and back from one’s room to the nurses unit, a ‘locked’ bullet proof station, for THREE MONTHS!! This is isolation in the extreme. She became completely unhinged and has been cycling in and out of hospitals every since. If you want to help people avoid violence, tell your goons and orderlies to NEVER pin young women down to the ground and prohibit restraints for good. Violence begets violence! If you were as sincere as you purport to be, you would immediately denounce a system that legally took away my daughter’s civil liberties, a system which allows doctors to use force, isolation, and restraint without impunity, then when they react with rage or extreme fear, they are further pathologized. People like my daughter are so sedated that they lose their executive functioning. Still, they are cognizant enough to know that they must outscheme their oppressors. They must learn to adopt and use the demeaning language of pathology when referring to themselves, accept daily torture, isolation and forced medication, to avoid additional pathology. No treatment for the trauma of isolation in a hospital is offered. Instead, they are told it is for their own good. B**sh*t!

      People in this paradigm develop Stockholm Syndrome, whereby they must identify with their abusers, and learn to love their oppressors in order to win their freedom. This is done through a systematic process of indoctrination whereby the patient must admit that they have a disease and must, therefore take medication for the rest of his/her life or they will not be discharged. If they are non compliant and they ‘failed’ coming off a medication, this is blamed on the ‘disease’ not on withdrawal effects and used as further proof of their lack of ‘insight’

      This is a crazy making system and although I appreciate your stepping over the ‘other side’ I doubt that your colleagues would treat anything I have to say about this crazy system with anything but disdain and condescension.

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  7. I largely agree with the other commenters. I believe a major part of the problem is the fact we have so many adults brainwashed into believing the DSM disorders are “mental illnesses.” Then these people feel powerful because they can go out and stigmatize (thus isolate) children – and that includes all the special Ed teachers, parents, as well as the psychiatric workers who believe in the DSM disorders. We really need to get away from a society that wants to stigmatize some within, and back to a more inclusive and loving society (such as one that believes in Jesus’ theology, for example). Definitely, the mere existence of the divisive DSM disorders, I believe, is a big part of the problem (especially since they have zero scientific validity).

    And absolutely, the psychiatric drugs do cause suicides, violence, and (bipolar) mania. Read the black box warning on the antidepressants. And I know personally, as a person who’d never hurt anyone (but was considered a “danger” to doctors who were paranoid of a malpractice suit so wanted to discredit me and cover up a “bad fix” on a broken bone, a “Foul up” with Risperdal, and the sexual abuse of my four year old child) that psychiatric drug withdrawal can cause even the least violent people to become violent and psychotic. I actually pushed my mom, when suffering through my drug withdrawal induced super sensitivity manic psychosis.

    I believe focusing on ending the stigmatizing, and resultant isolation, and ending the massive drugging of our children with toxic mind altering drugs would help decrease the violence in our schools.

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  8. “Maybe mental health workers need to do better at engaging people and collaborating with them and working on goals they think are important.”


    How ironic, that line comes from the psychiatrist-blogger who, nearly two full days after posting his blog, has not offered a single response to any commenter. (And, by the way, every commenter, thus far, has been quite civil, while providing very considerable insights.)

    Well, in fact, Mark Ragins M.D. did not reply to any commenter in his previous blog post, ever — nor in his blog post prior to that one.

    According to the man’s brief bio, “His practice has been grounded in 20 years+ with some of the most underserved and difficult to engage people in our community.”

    Again, there’s the irony.

    As I would say, he has, himself become one of the most difficult to engage people in our MIA online community.

    Personally, as he seems incapable of engaging here, in dialogue, I don’t know why he thinks he can presume to blog, as an authority on matters pertaining to the needs for more outreach, in the greater community, at large.

    Imho, considering his complete absence from this comment thread, his blog post becomes more and more meaningless by the hour…



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    • “You’re constantly attacking people from the community.”

      E. Silly,

      That is a really serious accusation. I ask you to, please, back it up, with examples.

      I mean, who, in your opinion, have I attacked? (In my view, I’ve not attacked anyone, but you say I am “constantly attacking people from the community.” Constantly? Wow. As I say, I don’t see myself attacking anyone…)

      If you cannot give clear examples of what you mean, by that, then it is purely your attempting to smear me again, with false accusations — your ad hominem (attacking me).

      And about your saying: “Often you don’t address them directly, but talk about them in the third person. This is not at all respectful.” Often talking about who, in the third person? And, this is a problem for you, really?

      I don’t know what you’re talking about, except if you are referring to my first comment on this thread, where I was referring to Mark Ragins M.D. in the third person, only because he is not engaging in anyone here in comment dialogue! …and (as I pointed out, above) he has not engaged any MIA commenter in any comment dialogue for months.

      Of course, there is no imperative whatsoever — no MIA rule — that requires any blogger to address commenters…

      And, there are other MIA bloggers who do not respond to comments.

      But, imho, because Mark Ragins M.D. is ostensibly promoting community outreach, he should be able to interact, as though a member of this community.

      From the point of view, that he would write about the harms of extreme isolation, I’d think he would be someone who could actually interact with his readers.

      I would think he could offer his most thoughtful commenters just a bit of respect, that way.

      There was a time when he did that, and I appreciated it. (Indeed, was happy to interact with him, in comments.)

      But, afterward, he became a promoter of court-ordered psychiatric ‘treatment’ (see his previous blogs) and simultaneously has become incapable of dialoguing with commenters.

      So, you say “This is not at all respectful,” but, frankly, I did not address my comment (above) to Mark Ragins M.D. because I feel he is not being respectful, by repeatedly failing to attend to his commenters’ questions.

      Addressing someone who promotes psychiatric coercion, who will not address anyone back, who will not dialogue, seems a waste of time to me (and even seems somewhat foolish).

      Again, Silly, about your saying that I am attacking people, I urge you to back up your accusations with examples of what you are referring to. They are serious accusations…



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      • P.S. — In my comment, directly above, I explained, about Mark Ragins M.D., that “he became a promoter of court-ordered psychiatric ‘treatment’ (see his previous blogs).”

        To be clear, I should have inserted the word “outpatient”; I inadvertently left out the word “outpatient” …as I was referring to Ragins’ recently declared support of ‘AOT’ (so-called “assisted outpatient treatment”).

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          • For whatever it may or may not be worth, here’s a further consideration…

            I explained (above, on July 24, 2014 at 1:46 am), that: “From the point of view, that he would write about the harms of extreme isolation, I’d think he would be someone who could actually interact with his readers.”

            Now, upon returning to my perch, in front of my computer monitor, where I find myself again contemplating this entire thread of comments on this web page (as the thread is continuing to develop), I now think to myself, it would have been better had I posted the following line, instead: From the point of view, that he would write about the potential harms of extreme isolation, I’d think he would be someone who could actually interact with his readers.

            There, in adding the word “potential,” I am wishing to emphasize, that, the commenters who posted before me all did a great job of registering their sense of the limitations of Dr. Ragins’ blog post, but there is this one further limitation of his exposition, that I think deserves some amount of scrutiny: It pretty much fails to acknowledge, that some young people actually benefit from being quite isolated, in ways.

            So, maybe, to be more clear, I should not have referred to “extreme isolation,” at all — (maybe) — as I believe almost anything one calls “extreme,” in terms of ‘conditions’ or behaviors, which are discussed, in these blogs and comment threads, on this website, will almost certainly be viewed as requiring some sort of intervention.

            ‘Extreme isolation’ will mean different things to different people who are not aiming to hammer out social policies regarding extreme violence; and I believe, depending upon what is causing ones isolation, no matter how extreme, it need not necessarily need be considered a harmful thing.

            Though it could appear concerning, it need not necessarily be of serious concern; indeed, it could become a great source of creativity for that seemingly ‘extremely isolated’ individual.

            In fact, the more I consider this, the more I think it’s true, that: Unfortunately, calling almost anything “extreme” — especially, when in the midst of discussion about so-called “mental health” matters (e.g., when speaking of “extreme states”), we will make that phenomenon sound as though something that’s quite problematic.

            Again, I am glad that the blogger (Mark Ragins) has, at last, come to engage with his readers. (Some thoughtful engagement with one or two commenters is, imho, much better than no engagement at all.)



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          • Jonah,

            Knowing you to be a very fair and exacting person when assessing others and their work, I think you may have misunderstood Dr. Ragin’s blog on Assisted Outpatient Treatment or AOT you cite above.

            Here is the editorial MIA explanation for the purpose of this article on AOT at its end you may have missed:

            Editorial note: Dr. Ragins sent this in response to an invitation for perspectives on assertive outpatient treatment (AOT) legislation, Such as the Murphy bill. Dr. Ragins states that this brief, which was originally prepared for a board member of Mental Health America of Los Angeles (MHALA), had the effect of shifting the board member’s perspective such that he proposed that MHALA officially stand against implementation of AOT laws. We expect that there will be a full and thoughtful discussion of this blog, however, due to a family emergency, Dr. Ragins will be unable to participate.

            As you can see, Dr. Ragins was asked to prepare this assessment of AOT and if you read the article, you will see he is against it because those administering it run the risk of abusing power and trying to force people to do what they don’t want to do, which can be harmful to both sides he says.

            Dr. Ragins said he wouldn’t want to do AOT himself for this and other negative reasons he cites.

            As you can see from the above editorial comment, the organization, Mental Health America, changed their minds from supporting AOT to not supporting it based on Dr. Ragin’s article. I saw a video of the head of MHA speaking against AOT at a meeting with fascist Murhpy thanks to Dr. Ragins.

            Therefore, I suggest you go back and read the AOT article you cite by Dr. Ragins and the editorial explanation at the end and see if you don’t feel a bit sheepish about branding Dr. Ragins as a fascist AOT promoter when the opposite is true.

            As I said in Dr. Ragin’s other posts, I got over being mad when I realized that Dr. Ragins is just telling it like it is rather than how he thinks it should be. And I think he has been very open to considering new ideas and seeing things from different perspectives.

            I have gained a growing appreciation of Dr. Ragin’s articles and efforts as he continues to think outside the narrow constraints of so called “evidence based psychiatry” and tries to really connect with people he is trying to help.

            Like others, I thought this latest article on how to reach out to isolated people who may become capable of violence was an excellent one that could benefit everyone in our increasingly isolated, alienated society discussed in books like Bowling Alone and others.

            I hope you will check out the above Jonah because as I said, I believe you like to be fair and honest with other people.

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          • Donna writes, “Therefore, I suggest you go back and read the AOT article you cite by Dr. Ragins and the editorial explanation at the end and see if you don’t feel a bit sheepish about branding Dr. Ragins as a fascist AOT promoter when the opposite is true.”


            Please, look at what your are saying.

            You are accusing me of “branding Dr. Ragins as a fascist…”

            Never have I done such a thing. Never.

            And, as far as your saying that you appreciate the man’s work, and you think he has responded well the spread of ‘AOT’ — fine. Those are your opinions, and certainly you are entitled to them.

            Meanwhile, as for your suggestion that I should review his blog post, on ‘AOT,’ all I need do is present here, for your consideration, the 2nd sentence — to show you where I’ve drawn my line, concluding that Ragins is not opposing ‘AOT’; he is supporting it…

            He writes:

            “The time for contentious advocacy aimed at stopping AOT has ended and the time for collaborative advocacy aimed at implementing AOT as well as possible is upon us.”

            Reading just that sentence, it seems fairly strait-forward to me, what he’s up to…


            I’m sorry, Donna, but there is no need for me to reread the rest of that blog; I have already read it once (when it was first posted), and it sickens me, for I believe the time for collaboratively advocacy aimed at implementing ‘AOT’ is never, and the time for contentious advocacy aimed at stopping ‘AOT’ has just begun.

            Thanks for your input.



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          • Jonah,

            When I used the term “fascist” I combined it with “AOT” to have those two words define each other and not you, Dr. Ragins or what you think of Dr. Ragins.

            Anyway, I think Dr. Ragins has a rather hard hitting type of speech that can cause people to misunderstand him.

            I think many people were and are feeling pretty hopeless about the fascist Murphy bill fostered by Fuller Torrey who has been advocating forced treatment for decades. They are now exploiting the many public/school shootings as crimes committed by the so called mentally ill to scapegoat them instead of addressing many other problems like the dangerous effects of psych drugs, lack of adequate gun control, the destructive victim blaming mental “health” system, growing inequality, poverty, oppression, unemployment, sexism, racism, domestic violence, school/work bullying/mobbing, etc.

            Thus, like many of us Dr. Ragins thought the Murphy bill was/is a done deal (and it has many supporters listed on a government site), and he was fulfilling a request on how to implement it if necessary as well as his thoughts on it. I think that’s why he made the statement you criticized as acknowledging we’ve lost the battle; AOT is here, etc. Again, he said he wouldn’t want to do it in his article and exposed many negatives about it.

            You are entitled to your opinion, Jonah, but I think Dr. Ragins is more of an ally than an enemy and I am one of the toughest critics of those on the wrong side as anyone here can tell you including yourself if you think about our arguments about Dr. Allen Frances. You supported him far more than I did and ensured that anything I said about him were exact quotes and as fair as possible in your opinion. Thus, I find your refusal to even reconsider Dr. Ragin’s AOT article in light of what I shared quite puzzling given your usual exacting standards for such research and opinions in my past encounters with you.

            Anyway, I regret bothering you and hope you are not offended by my sincere desire to try to make sure you had all the facts and information about Dr. Ragins’ AOT post before jumping to conclusions.

            Thanks for your consideration.


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          • Donna,

            Thanks for your reply. In accord with your urgings, I have just now finished re-reading the entirety of Mark Ragins’ blog post on ‘AOT,’ and guess what: I am, more than ever before, fully convinced, that I’m quite right to say, that he is supporting and embracing ‘AOT’.

            Of course, he is.

            Indeed, in his concluding paragraph, he is perfectly insistent, regarding his support of it, as he writes: “In putting together analysis and recommendations our advocacy goal should not be to make it seem impossible to implement AOT successfully or to over-regulate it or include “poison pills” to sabotage it. We need to collaborate in an honest attempt to address a variety of serious concerns as we move forwards in implementing AOT.”

            To me, that says one thing: He is appointing himself a cheerleader for ‘AOT’.

            It’s ‘all systems go’ — ‘AOT’ all the way (for Mark).

            How much more clear could his aims possibly be stated?

            Frankly, I don’t know what more to say.

            Oh, wait, I guess I can add these two quick points, about the “Editorial note” at the end…

            First, I think it’s great that (according to that editorial note) someone who read Mark’s analysis of how to implement ‘AOT’ actually wound up voting against implementation.

            But, that said, nothing alters the fact that Mark’s analysis is actually aiming for implementation.

            Second, I hope Mark’s family emergency was not too serious a matter (the “Editorial note” mentioned, that he’d had a family emergency and would not be responding to comments).

            One would think that maybe he could have responded to a few comments, at some point, in the past seven months; but, never mind. (I’ve already pressed that point far enough.)

            Really, Donna, I hope you can please understand, I am serious when I say I wish him and his family well, as I am harboring no ill will whatsoever toward him… nor either, of course, toward anyone in his family.

            I actually think he’s a fairly well-meaning guy (from what I read, in his writings, here, on this MIA website). But, as you well know (and as most nearly everyone who describes himself/herself as a psychiatric survivor can attest, from their experiences with psychiatry): The road to hell is paved with good intentions.

            There are many psychiatrists with plenty of good intentions.

            And, so… I hope you get, that my criticisms of his work are nothing at all personal. Simply, whereas he supports ‘AOT’, I am quite opposed to ‘AOT’, and I am not particularly impressed by his online communications skills.

            (And, I think his “five step plan for reducing social isolation” is a bad idea, especially because it’s all about spreading his ‘psychiatric’ views, which are quite steeped in ‘medical model’ nonsense.)

            Again, Donna, thanks for your input.



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          • Donna, the quote Jonah has posted seems pretty clear — that this guy supports AOT and thinks we’re wasting out time by fighting it.

            Maybe the blog should have been withheld till after the family emergency, it’s a pretty provocative thing to just drop on people and then not be around to (try to) defend.

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        • Believe it or not, I make a genuine effort to just read the comments and not engage in the dialogue because I completely agree with your criticism. Too much of the conversation after these articles becomes irrelevant and distracting. This is a thought-provoking article that merits serious consideration. If it’s to be criticized, it ought to be on the basis of specific offending points made in it (which I didn’t find), not general backlash on the basis that the author isn’t 100% in agreement with the MiA audience.

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          • Steve,

            To be quite honest, I’m baffled by your saying this: “I agree 100%. Thank you for saying that.”

            Apparently, you are saying that to Francesca Allan, who is saying to commenter Silly “I agree completely with your criticism.” If I’m not mistaken, Francesca seems to be saying that she agrees with Silly’s criticism of me. And, that criticism of me, by Silly, is Silly’s claim that, supposedly, I (Jonah) am “constantly attacking people from the community.”

            I think Silly’s claim, as such, is completely unfounded. I have challenged Silly to offer examples, and Silly responds by offering no examples whatsoever. (Silly just says to me we should not speak to one another anymore. I figure, OK, whatever…)

            But Steve…

            I don’t believe I’ve attacked anyone. I was just (in my first comment, on this thread: July 24, 2014 at 12:02 am) being critical of the blogger, in so many ways point out the sheer irony, that his blog post criticizes ‘mh’ workers who are disinterested in dialogue (he comes to saying “Maybe mental health workers need to do better at engaging people and collaborating with them and working on goals they think are important”), yet in the past several months, he had not responded to any MIA commenters, at all. Not even once.

            In fact, those two comments, that he has now posted on this page, represent the first time this year, that he has deigned to respond to any MIA commenters. (Albeit, he has only posted three blogs, this year, thus far.)

            And, just consider: This particular blog post of his is all about promoting community outreach, especially for young men, who may be overly isolated and supposedly potentially violent, so I was considering his recent embrace of ‘AOT’ (he accepts it as a fait accompli), and I was wondering (to myself), about the kinds of young men who might be affected by his “five step plan for reducing social isolation” that begins with “Outreach”.

            I think to myself: ‘Is Mark really capable of knowing the needs of such men? I believe he is talking mainly about those who could be the most alienated and angry youth in the country. He’s proposing a need to reach such troubled youths; and, yet, he seems incapable even of addressing the relatively civil audience, of commenters, here at MIA.’

            Notably, it was just shortly after I posted my comment, which conveyed my concern, that, there he was…

            The blogger proceeded to post two comment replies, here on this thread. He had not done that since last December.

            As you know, one of the replies is to you. Hence, I would think that you might have some appreciation for the obvious catalyzing effect, of my first blog post, in this comment thread (which Silly seems to suggest is an ‘attack’).

            Imho, Kermit did not remove my comment (it remains posted), because he knows it’s not an attack. (It’s a brief critique.)

            And, imo, that critical comment of mine was spot on, at that point, in which I was posting it. I feel that it had a really good effect, after all. (Imho, it got Mark Ragins to engage somewhat, with his MIA readers. Wonderful.)

            I respect your views, always; so, I’m very curious about your reply to the two commenters, above, who are apparently criticizing me. You say “I agree 100%.”

            You agree 100% with what exactly?

            Would be helpful if you could please clarify.

            Thanks in advance.



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          • I thought she was saying we shouldn’t get distracted. Now upon rereading, I can’t say that I 100% agree after all. I do agree that criticism of the author ought to be made based on the points in the article, not on disliking the author.

            I find many of ELS’s remarks to be off-topic and often containing unprovoked hostility, and the presence of an underlying personal agenda is apparent. You can be intense, but I don’t generally find you to be mean-spirited or distracting, and your agenda is very clearly in line with mine and my perception of the purpose of this website. I just think that allowing off-topic comments to distract us is unwise. I’m trying hard to practice that myself, although it is sometimes difficult, especially if inappropriate attacking is occurring. I have asked for some people’s comments to be removed (not mentioning any names), but I have never asked for anything you said to be removed.

            I don’t know if it’s reasonable to criticize Mark for not responding to posts. David Healy almost never responds to any post, and I don’t like his views on ECT at all, but he’s been a bear on the issue of SSRI side effects, and I value what he has to offer. I guess I just take what I can that’s positive and try to make productive comments, and am happy when occasionally an author responds. Mark’s got a life, too. But your comments did have some relationship to the blog, and I was not meaning to critique either them or Mark’s lack of responding in any way. I just think we should stay on the topic of reforming/replacing/ eliminating the current damaging system and not get off into other personal agendas. And again, I am not referring to you in that last sentence at all.

            Hope that clarifies things. I find you to be a very valuable poster and had not the slightest intent to criticize you or your prior posts.

            —- Steve

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          • Steve,

            Thanks for taking the time to offer those clarifications. They are very helpful.

            I think, yes, we are in agreement, on most matters.

            But, about my critiquing Mark Ragins for his decision to not respond to comments for the past seven months, I feel that was warranted, given that his blog post stated “Maybe mental health workers need to do better at engaging people and collaborating with them and working on goals they think are important.”

            Imho, had I read David Healy saying such a thing, I would have been no less inclined to pipe up, point out the irony…

            Again, Steve, thank much for your clarifications…

            Best to you and yours…



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  9. I think Jonah raises a valid concern. Most of the MIA community that comment come from a place of unique perspective. We all have active, busy lives. For those of us that take time to read whichever relevant article(s) on this webzine and respond there should be some acknowledgement, somewhere, regarding germane feedback. The authors on MIA may have limited time but shouldn’t this community receive at least some collective dialogue at least to some of the valid points raised? Dr Ragins offers this 5 step plan to reduce social isolation specifically addressing ” we have to be a community that cares for each other”. And since each of us has been personally harmed ( or watched our loved one egregiously violated by the very system Dr Ragins is a professional within) isn’t it essential this author actively engage with some of the commenters? Otherwise, it feels like business ,as usual, in MH.

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    • Just because some people have the time to spent a couple of hours a day reading and writing comments on MiA, doesn’t mean every blog author always has the time (or nerves) to do it.

      Of course it’s always good when authors can join the discussion, but I don’t think it’s essential.

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      • I do worry about this, in my view reasonalby accurate criticism. I don’t have the time to respond to every reply, or even more than a few of them, so I wonder if I should be participating in this community at all, and to be transparent, this isn’t one of the most important communities in my life and I don’t look at it the same way i look at the Village community where I work daily. Some of the time the people who respond to my blogs are either upsetting to me and/or urging me to be more aggressive than is good for me. I’ve corresponded with the organizers of this website community who reassured me that they’d prefer me to be involved somewhat rather than withdrawing altoghter. They also told me that there are 10s of thousands of members who don’t write at all, but read regularly who are welcomed in the community too. They can change their minds and not post my blogs or you (and anyone else) can make an individaul decision and not read them if I seem too presumptuous. I do read the replies to my blogs though usually not the same day they’re written.

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        • Mark,
          I enjoyed this post. In many ways, you are a roll model for me of a humane, community oriented psychiatrist. I imagine that your relative low level of response in this virtual community is due to the fact that you are in fact engaged directly with those in your actual community.
          For what it is worth, I hope you continue to post here.

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        • I’d think that would be a loss to MIA. I do not agree with you on a lot of things but I found this article, for most part, very interesting. I can also understand why you can get upset by some people’s comments but I think that it may be important to hear some feedback and not only from people who will pat you on the back. And if some of the comments are overly aggressive – well, that’s just the nature of the interwebz…

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      • We invite authors to engage in dialogue, but we do not require it. It’s nice when they can, but to require it would eliminate some of the very people who’s writing we hope to attract.

        On the same line, it’s not appropriate to pose questions that somehow imply that an author is being derelict or evasive by not responding. I think this is dirty pool; akin to calling someone out for a dual, or to defend their honor. We are grateful for everyone who takes their valuable time to participate; nobody should be put on the spot for not having more to give. I think this applies even more for people who have the willingness to take controversial positions or bring up difficult questions.

        The things we discuss on MIA are very, very difficult, on multiple levels. If we are to move the conversation forward, it’s going to involve finding new ways to express difficult things. I think that that is one of the chief contributions that MIA can make; being a forum to craft new language and arguments that will make inroads possible where progress has been obstructed before. Sometimes the people who seem to disagree with us are just trapped in old language and old “language games” relative to the issue, and coming up with new language can loosen the lid on new paradigms.

        I don’t think it’s essential that the author participate in the discussion that has been sparked. Their participation or lack of may or may not contribute to forward movement. But incivility, righteousness, and moralism will stop forward movement every time, IMHO. They give a momentary sense of satisfaction, and short-lived sense of accomplishment, and ultimately leave everyone where they started, and angrier for it.

        We hope to do better on MIA. So we hope to leave judgement and hostility, as justified as they may be for individuals, for other forums to house. Here, people should be applauded and thanked for their willingness to contribute at all, and their contributions should be welcomed and worked with respectfully. To judge a blogger for being unwilling or unavailable to respond to comment is to diminish the graciousness of those who do, as well as to willfully ignore the indecorous treatment many bloggers have received when they did contribute.

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        • “Yes. We invite authors to engage in dialogue, but we do not require it. It’s nice when they can, but to require it would eliminate some of the very people who’s writing we hope to attract.”


          I completely and totally appreciate what you’re saying there, in those lines that I have placed in italics, above. It’s perfectly reasonable of MIA to establish such a policy for its bloggers, imho.


          RE “But incivility, righteousness, and moralism will stop forward movement every time, IMHO. They give a momentary sense of satisfaction, and short-lived sense of accomplishment, and ultimately leave everyone where they started, and angrier for it.”

          Quite honestly, I do my very best, in my MIA comments, to refrain from offering incivility in my comments.

          But, sometimes, what is or is not ‘civil’ or ‘uncivil’ is in the eye of the beholder. (Months ago, you and I shared a very civil discussion, via email, in which we discussed that point, at length.)

          Righteousness and moralism (both) present another matter, really (I think).

          For instance (regarding the matter of righteousness): There is something called “righteous indignation” that can be a very liberating form of expression, for one and all. I will not refrain from channeling that, in my comments, when the spirit moves me.

          As for moralism, that is something I generally prefer to avoid indulging in, for it does tend to turn people off; quite often, it comes off as arrogance.

          However, as I feel very passionately about issues pertaining to medical-coercive psychiatry, and because I do believe that forcing psychiatric brain ‘treatments’ on “patients” is an utterly immoral act, I cannot expect myself (and no one should expect me) to refrain, at all times, from moralizing, in my comments…

          Sometimes, I do moralize.

          Certainly, morality itself (while it is so very subjectively perceived and as it comes in a zillion shapes, forms and degrees of certitude) cannot be considered ‘a bad thing, necessarily’ to include in ones MIA comments.

          Considering that, you are well aware of much of the harm that psychiatry has done to so many individuals, I believe that you and the others who help to run this MIA website (which I greatly appreciate) should be ultimately willing to accept, that some of your readers shall become commenters who will sometimes express, in their comments, both their sense of righteous indignation and their personal sense of morality.

          As a psychiatric survivor (especially, as a survivor of forced neuroleptic drugging), I think it is necessary, for ones healing process, to allow oneself, at times, to address psychiatrists (especially those who promote and/or defend forced ‘treatment’) with a reasonable degree of righteous indignation and moral ‘outrage’.

          Almost certainly, you can come to accept that necessity (I imagine).

          Though, you can, of course, tell me if you feel otherwise…

          And, yes, of course, it is possible that such ‘outrage’ can cross a line, becoming truly uncivil. Again, I must say: I do my best here to refrain from being uncivil, but ‘civil’ versus ‘uncivil’ is subjectively perceived and is a black and white form of judgement…

          Sometimes there are shades of grey…

          I suppose maybe I went (into a grey area) in my first comment, on this thread.

          I am glad to see that the blogger has been prompted to offer at least a couple of comments, in reply to his commenters, so I feel my first comment has actually had something of a positive impact.



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          • OK. Actually all the terms you discuss are ultimately subjective and abstract, but your intention is legitimate.

            I would pose the issue differently. I don’t care if eomebody is “uncivil” to me as much as it bothers me to see the discussion bogged down in a bunch of personal crap. I also don’t want to see discussions diverted with red herrings and ad hominem attacks. If moderators could address these sorts of things someone can call me an mf all night!

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        • “incivility, righteousness, and moralism will stop forward movement every time, IMHO. They give a momentary sense of satisfaction, and short-lived sense of accomplishment, and ultimately leave everyone where they started, and angrier for it.”

          I like civility as a goal, but I agree with Jonah that it’s highly relative and open to interpretation what is considered civil. That’s also a cross-cultural issue, as different cultures have varying tolerance, awareness, and interpretation of behaviors in relationship to each other. Certainly there is a line where behavior can be seen as universally uncivil, but for the most part, it is highly open to interpretation.

          Lack of civility can be subtle and insidious, rather cleverly manipulated with justification. It can also be a matter of how words are received, rather than how they are offered.

          Regarding righteousness and morality, Rev. Martin Luther King, Jr. and Harvey Milk were both very righteous and moral leaders, and those movements broke all new ground and they continue to do so. The didn’t rely on scientific evidence to reach people. They did it by fueling their vision of unity and global cooperation with heartfelt reason, focus, and passion. From what I’ve seen and experienced, this is what speaks most clearly and rings true to the general public.

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  10. I find it interesting in the state hospital where I work that “patients” are never consulted about their “treatment plans.” They are brought in, basically told what they did wrong since the last “treatment plan” meeting, and then they are given goals which they themselves had no part at all in choosing. How can you buy into something and decide to work hard at achieving it when it’s all created by the “experts” and you have absolutely no input in creating it at all? The attitude on the part of the “experts” is that “those people” don’t have the ability or the skills to cooperate in creating and building a proper “treatment plan” so we have to create this for them, for their own good, of course. There are a few psychiatrists who let the “patients” respond but they don’t really pay any attention, this is just paying lip service to collaboration and nothing is ever done about what the “patients” talk about. The team just takes up from where they left off before the “patient” made any responses. So, this is the way people are “treated” in the “hospital.”

    Then, you have the wonderful Community Mental Health Centers. I’ve personally dealt with three of these centers in the state where I live. Only one of the three was helpful to me at all. The other two centers seem to try as hard as they can to not help anyone. I’m not kidding. It takes three or four weeks for them to decide to make an appointment for you and then they do as little as they can possibly get away with when it comes to getting you what you need. I was fortunate and knew someone in high places and they gave me a phone number to call and make a complaint and all of a sudden the second in command at the center was calling me on the phone. It took an absolute act of God to finally arrange six weekly 45 minute sessions of talk therapy. The psychiatrist doing my intake couldn’t believe it when I requested talking with someone rather than the toxic drugs. She actually told me that she didn’t know how to help me if I didn’t want the drugs! Give me a freaking break! My roommate goes to the same place for services and has had four different doctors since the beginning of this year! The psychiatrists never get to know their patients and when they do see them it’s ten minutes and numerous scripts for more drugs. There is no help with housing or incomes or anything else, all they do is drug people right and left. And I don’t want to hear the old statement that they’re overworked. I don’t care at this point. People are not receiving services, people are hurting, and that damned place does everything it can to not deal with people! If I had not known who to call to get that special phone number which resulted in my finally getting some assistance I would have been dead in the morgue on a slab. At one point I made this very statement to them and the person dealing with me gave me a blank look and said, “It’s not our problem sir.”

    So, it’s no wonder that people become isolated in communities who do not give a damn about trying to do anything to help them. I applaud Dr. Raglins in trying to create a better system but there is nothing in the city and community where I live and work that comes even close to providing anything of what he talks about to people who’ve been labeled as “mentally ill.” It’s only a matter of time before we have our own shooter.

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  11. I will be uncivil here, and say that any psychiatrist or anyone else who writes on MIA and defends the terrible system that I and many other MIA readers have been abused by, really doesn’t deserve any more respect than what they show for us.

    I don’t respect the profession that tortured me and took away my childhood. Who will be our next blogger, Doctor Biederman? Am I expected to be nice to him?

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    • I don’t think it’s about “being nice.” Argue against the system. If you think crimes have been committed, make a case for that. If you think ideas are wrong, or perhaps even wrongheaded, say so. But if what you want is license to call people bad names, please find somewhere else to do it. MIA is for the discussion of ideas, research, evidence, and, yes, personal testimony. We believe that it is true that peoples’ personal experiences have been given insufficient attention; that is why we feature personal accounts right alongside analysis of research and philosophical reflections.

      I know lots of people, psychiatrists included, who hold good values, and struggle within a system that makes working in the way they wish to difficult or impossible. Among them are people who think and believe exactly as I do and, perhaps, as you would wish them to as well. They could use help, I think, in finding the words and arguments that will equip them to say the right thing at the right time to make something different happen. The things we talk about can be exquisitely, or excruciatingly, difficult to wrap in words. I know that people within “the movement,” people whom I would think should be allies, can be vicious with each other about word choice. Words, like “recovery,” that ten years ago one could barely utter for fear of being thought delusional, are now accepted to the point that using them pegs people as behind the times. Yet, there are still people who have not been introduced to the idea that “recovery” is possible, let alone the possibility that they should never have been told they were ill in the first place. I know people who have now written for MIA who 12 years ago excoriated me for presenting the possibility of “recovery,” saying I was offering “false hope.” I think that they felt threatened, that I was taking away an identity that gave connection and comfort, and proposing a world that, at the time, didn’t actually exist in a functional way. Now, with a lot having changed, much of it the result of Bob Whitaker, the same people are writing for MIA, saying they were never ill and that nobody should ever go to hospitals. That’s a lot of ground to cover. It was a process. And Bob’s part in that was done without calling anyone bad names. It was done with resolute dignity and respect, and hard work on presenting evidence and solid arguments.

      If Joseph Biederman chose to write a blog here, I would assume that it meant that MIA has gained a position in the world that he felt moved to do it, for whatever reason. That would be a good thing. There would be plenty enough to say in response to whatever case he would make for his actions, without resorting to calling him names. I think that would be wasted space, when there are much stronger arguments against what he has done, and what might be done about it. I think that would be a better use of the opportunity than proving peoples’ worst expectations of MiA readers.

      In the end, none of this is about one person; not you, not him. It’s about the ideas and values that we choose to hold or believe in, and it’s about painstakingly constructing the arguments for them. I think that a lot of well-intentioned people were given very bad information, and put in situations in which they could not get better information, and they did not do differently than they were told, believing it was the right thing. Some of them, it could be argued, should have known better or could have chosen differently. But I know good people who now say; I was misinformed – and now I am grappling with what to do with what I’ve done as a result. I think they need our help, not our calumny. We all suffer from being misinformed in some way, and making bad choices, unless we are enlightened, clairvoyant, and omnipotent. Truth always involves some collective effort; nobody has cornered the market on reality. I think MiA aspires to be a place where new realities can be constructed; this takes goodwill and civility. Name-calling can and should be done elsewhere. This is not about being “nice.” It’s about being adult.

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      • Kermit,

        I have a bit of a problem with this line of reasoning,

        “I think that a lot of well-intentioned people were given very bad information, and put in situations in which they could not get better information, and they did not do differently than they were told, believing it was the right thing. Some of them, it could be argued, should have known better or could have chosen differently”

        Correct me if I am wrong, but people like Thomas Szasz or Peter Breggin were given exactly the say info and yet they had no problem calling a spade a spade. While I understand the value of gaining “coverts” -not only the “value” but the “necessity” of it if meaningful change is to happen- the people who pushed the drugs and “chemical imbalances” should readily admit that they were wrong, personally. Not because of a battle of egos but because up until these people understand that concluding what they did based on the info they had was fundamentally proof of their own failings as human beings, they will be prone to make the same mistakes in the future.

        The parallel can be made with the way the Catholic Church handled its cases of sexual abuse

        “Some bishops and psychiatrists have asserted that the prevailing psychology of the times suggested that people could be cured of such behavior through counseling”

        The notion that the bishops of the 60s, 70s, 80s did the best they could with the information they had at the time is still used by the Catholic hierarchy of today to avoid confronting the problem that said church covered up very evil people.

        I am still hoping that somebody like Allen Frances has the guts to write an op-ed repudiating psychiatry and the model on which it is based (self appointed “mind guardians” voting disorders into a manual than then is used as a bible of sorts). Until that happens, I am not personally moved by what they did coming up against DSM-5. I am happy that they did it, since they gave us a lot of ammunition to confront psychiatry, but I see very little to admire in somebody who from from comfort of his retirement goes attacking psychiatry for minutiae. I see the way Bernard Carroll and Mickey Nardo allegedly criticize psychiatry equally problematic.

        If these three want to really redeem themselves, they should write an open letter asking that psychiatry be disbanded.

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        • I would respond to this similarly to how I did above; it’s a question of where one’s attention is most productively put. As a school of thought that I am becoming increasingly engaged with – “Social Constructionism” – might put it: it’s not about who (or what) is “right” or “wrong,” it’s about where does thinking this way get us? What sort of world does this way of thinking – or acting – create?

          To wit; I would rather put my time into promoting (in woeful reality “rehabilitating”) Szasz’s image than into excoriating anyone for failing to meet my hopes or expectations. Partly because, looking at history, often the people we hold up as models get very little out of it other than our fleeting appreciation, and usually suffer more than they gain. Loren Mosher, it is my impression, other than some moments in the alternatives to psychiatry limelight, was fairly angry and bitter and pessimistic about the “mental health” world for the rest of his life. When Thomas Szasz died the press response was slim to nonexistent, seemingly uncomprehending, often patronizing at best. People are afraid to come out as “Szaszian” in other than the friendliest (and most confidential) of circumstances. And most of the people I know who have taken principled stands have suffered terribly for it; lost jobs and reputations, getting torn apart in the rumor mill, because their message is so jarring to the existing paradigm that those who feel (rightly) threatened are left with little recourse in preserving their sense of balance but to destroy the messenger. And this is real. Good people lose jobs, homes, families, and their lives because they stand up for what is right. I think it’s better to appreciate than than to invest our time belittling others for not doing the same. People have children to feed. Maybe we should help figure out how they’re going to do that when the profession they’ve invested their faith, sweat and hope in turns out to be based on a false premise?

          This is no small thing. It’s real. We are talking about human beings. FELLOW human beings, after all, with hopes and dreams and fears and expectations, who are often surrounded by people who have hopes and dreams and fears and expectations that are dependent on them. They may be misinformed, they may not have the information we would wish them to have, they may not have the priorities we wish they had. And, yes, they may be cold, unfeeling, heartless bastards with nobody’s interest at heart but their own; in which case it’s doubtful mean words will influence them to our side, and probably will do the opposite.

          But, possibly, being shown a better way will. I cannot refrain from paraphrasing Kant: given perfect foresight, a nation of angels and a nation of demons would behave the same, recognizing that their individual well-being depends on it. This is not exactly the same as “compassion,” which, I would argue, is an absolute bedrock requirement if we are TRULY hoping for anything like the outcomes we all claim to hope for. In fact, I’d say, without compassion, the whole game is lost. It’s what we’re asking for – or demanding – from those we disagree with. I would think it reasonable to expect the same from ourselves.

          So, I wonder, what if rather than raise the level of vituperation, we throw our limited resources into real appreciation of that which people have to give? Personally, I would love to see more writing about Szasz, Laing, etc. I would like to see more writing that explores not just the fact that Open Dialogue has good outcomes, but why? What is it that that small band of merry women and men in Tornio are doing that can be learned from and adapted into other contexts, or used to invigorate those qualities as they are found in other contexts?

          What if we really rallied behind people that take the time and effort to write things we agree with, and equally in support of people who take the time and effort to venture their opinion where it might challenge ours? I am not preaching here; this is a question I constantly work on in myself; how might I learn to change fear into curiosity, and anger into compassion? I say this because what I have lost when I have failed to do so is considerable.

          Following on that thought, I’ll say it here; I am commencing on pursuing a doctorate on that very subject (in part), tracing collaborative and dialogical practice to their foundation in social constructionist and other thought, and toying with ideas for generalizing these ways of thinking and working with the construction and arising of meaning [or, as this process might sometimes appear to be when interrupted, psychosis]. In the process I hope to alloy my soul in some manner that will better my chances of reacting to challenge and crisis with a reflex of warm interest and curiosity. For myself, I have so far found this best when I’ve been able to open my mind to those of others not as threats to my equilibrium but as fellow warriors in the war against chaos and entropy. When I stop thinking about who is right or wrong, and think only “what is this person seeing or thinking that I am not,” or “what does the world look like from this perspective.” I am not obligated to agree, and I am at liberty to strongly disagree and argue that a different course of action is required. But in order to live in the world as I aspire to, I must at least TRY to understand why people see things as they do, and understand with compassion why they make the choices they do. It’s not because I’m an angel, and I might be just as inclined to do it if I were a devil; I’m saying I want to do it because, at long last, midway through the journey of my life, I have come to see that this is what WORKS. All other approaches offer fleeting feelings of security and satisfaction, then give way to the reality of an uncertain future to be faced amid fractious factions rather than friends and allies. This is, apart from any other arguments, unappealing to me.

          On the other hand I’ve found that when I’ve looked deeply into the spaces in which diverse perspectives commingle to create living realities, what I’ve found there was the closest I’ve come to experiencing love, safety, faith and hope. For people with traumatic backgrounds (all of us, most likely), those are the scariest spaces to look into; the places where people with their needs and fears intersect. But, sad to say, that’s where we have to go if we want friends, love, jobs, and – if not safety, which isn’t actually guaranteed to any of us – hope.

          I’ve allowed myself a ramble here. But it seemed warranted because, as I am in some way a member of this community, it seemed reasonable to announce that my role is changing, and why. I’m not handling much of the “news” any more, as I’m gearing up to start post-graduate and doctoral studies. Thankfully, Rob Wipond is on hand and bringing new energy to that task (which, admittedly, after two and a half years was wearing thin for me.) But what I can say is that all of this experience has extended and deepened my appreciation for one of the questions that brought me into this in the first place; What exactly is “Open Dialogue,” and what it is good for? I can say; it’s what we strive for here, as it’s our best hope for constructing the reality we hope for, and we must be constantly vigilant against the forces (emotions, “practicality”) that seek to close dialogue down and thereby foreshorten the possibilities.

          That is why we ask for and demand civility here. Not to quell discussion, but to make it possible. Strenuous argument for one’s values is great;

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          • First of all, congratulations on your decision of pursuing a doctorate! It’s wonderful to see people willing to learn more (this links to one of my previous comments that I am certainly not anti intellectual).

            While there is a lot I disagree with in your approach -which is obvious from my previous comments-, there is one thing I agree with you 100% : the need to rehabilitate Thomas Szasz’s image. I have said several times that it is a pity that he didn’t get to live an extra year during which Insel and the APA made theirs Szasz’s main fundamental criticism to psychiatry: what ever is that psychiatry sells, it is certainly not science, thus the notion of the “Myth of Mental Illness” . Willingly or unwillingly, the controversy surrounding DSM-5 helped assure his legacy for decades to come. MIA even published an article that addressed this topic here

            Personally, I have been surprised many times when in trying to come up with my own ideas about why psychiatry is a scam, I stumbled on ideas previously proposed by Thomas Szasz. So after a few of these, I stopped wasting my time, and I did a lot of Szasz reading and, more importantly, Szasz video watching. This is one of his last lectures . Whoever hears him criticize psychiatry so precisely cannot avoid to admire the clarity of his mind and to conclude he was THE INTELLECTUAL GIANT in the psychiatric survivor movement.

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      • It would be truly wonderful to have Biederman or Torrey or Jaffe or someone like that post here and it would be a shot in the arm to MiA that such prominent figures in the establishment wished to engage with us. I can imagine what would happen, though. Some commenters would choose to shriek “Nazi brain rapists, all of you!” or equivalent phrasing. I can certainly understand what drives the anger but the issue is how we’re going to make change. Blindly raging at them just gives them more fodder.

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        • I also agree that I would love to see those folks post here. Man…that would be awesome…but only if a lengthy and sustained dialogue/debate could take place free of ad hominems and calling them out as evil, the enemy, etc. Then a wider public could really see the different views on these issues in a clear way and make their own decisions.

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          • I don’t think any of those three would post here. Not because we would be too hostile (which we might very well be), but because they know on some level that their arguments don’t hold water. Torrey, for instance, knows he has intentionally conflated violence with untreated mental illness, because that forwards his agenda of more enforced treatment, apparently because he feels a family member would have benefited from this. Biederman, of course, was chastised for intentionally manipulating research data to get the “results” he wanted. These guys would be shot down very quickly if required to restrict themselves to a data-focused argument in favor of their viewpoints. They appear more interested in marketing than in truth, and would also not want to give MIA any credibility by choosing to appear here. I could be wrong, but I think they’d find the environment extremely threatening even if we were civil as could be, because they (unlike folks like Mark) don’t really have any interest in finding a better way – they already think they know the way, and are religiously committed to their viewpoints, and the facts be damned. I am sure they see us as dangerous antiscientific zealots out to destroy the tremendous scientific progress that psychiatry has made in the 21st century. The fact that this progress hasn’t actually improved the lives of their clients does not seem to register on these folks’ radar.

            If they want to post, I’d say bring ’em on. But I would not expect them to have a very pleasant experience, even if we are all as diplomatic as we can possibly be.

            —- Steve

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          • On Anger.

            A Samurai returned home from war to find his family had been slaughtered, his home burned to the ground and his crops destroyed.

            He inquired with the local villagers and found out who was responsible. He then tracked the man down. A fight ensued and the Samurai beat the man to the ground, and drew his katana to behead the man. The man laying on the ground spat in the Samurai’s face.

            The Samurai put his sword back into his belt and walked away. People asked him “Why didn’t you kill him?” to which he replied “Because I was angry”.

            Oh how I wrestle with my anger, because I know I am a much more formidable opponent without it.

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  12. Hi Mark,

    I think it’s great that you are addressing the issue of “mental illness” and social isolation as it relates to violence. I also want to say that though I disagree with you on a number of points, I’m glad that you are here and saying your piece.

    Though I agree that social isolation plays a large role in decreasing mental health and potential for extreme distress and violence, I think we have by and large created a system that promotes that isolation. In the last couple decades we have embraced a system that generally treats people in severe emotional distress with heavy neuroleptics. As Robert Whitaker has brilliantly pointed out in his books, the se neuroleptics contribute to worsening mental health and an increase in those on disability. Those on disability then receive small monthly stipends (often between 700-1000$) that is just enough to cover living in a small “SRO”, essentially a tiny apartment.

    Those on disability then tend to go on and off their meds due to the horrible side effects, then cycle in and out of hospitals due to the withdrawal effects of these drugs. Some who experience this merry-go-round become increasingly isolated and violent. The iatrogenic potential for violence due to either the drugs, or the withdrawal off these drugs is something I don’t see you generally address. And yes, add that to social isolation created by forcing people to live in tiny apartments with occasional monthly “check ins” with a provider and you are creating a cauldron ready to boil over.

    So before examining outreach programs, peer support, 12 step, etc….let’s examine the system that folks are steeped in. We don’t need to mop up afterwards. We need to fix the system that is broken itself.

    Anyways, thanks for your words. Even if I disagree with you I really want to see your posts here. It helps further the conversation.

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    • Thank you for stating this so clearly. I was trying to say much the same thing in a post above yours but you’ve brought it all together in a few words. Once again, the system is responsible for much of this isolation and violence but almost nothing is being done to rectify the situation. The system doesn’t want to change and refuses to take responsibility for the problems that it causes. The psychiatrists in the places like where I work do nothing but drug people to the gills and then shove them back out the door with a big bag of the toxic drugs and that’s that. Who gives a fat damn about what happens to people as long as you don’t have to see it or care about it. The system goes merrily on its way, congratulating itself for a job well done. It’s disgusting and extremely disturbing to me as I watch it on a daily basis.

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      • Hey Stephen,

        Yeah- I think if we want to really address “Mentally ill violence” we should look at a very big word in the psychiatric field- non-compliance. God, what an awful word by the way. I don’t have access to pull up the figure right now but I have heard that up to half of people are “non-compliant” with any medication, psychiatric or otherwise. Somehow I imagine non-compliance rates are even higher with neurleptics because of the horrendous side effects.

        But let’s just say half.

        So in a hospital, a clinic or a doctor’s office, someone is handed a bottle of neuroleptics that they are supposed to take every day. These are heavy tranquilizers. And they become quickly habituated to them. Maybe stay on them for a few weeks, a month or two or longer. And then maybe half of them say, nah- these are awful. Dump em. Stop taking them. And then…

        Everything goes to pieces. The withdrawal effects are a nightmare for most folks and tend to cause psychosis, espeically for those who have been susceptible to extreme states. And then some of them get suicidal and violent. “Its the illness” some say. Hell no. You take 300 mg of seroquel a day for a few months and then stop suddenly. See what happens. I’m guessing I would go fully ape shit.

        And maybe they become violent. “Its the illness you see.” No. Let’s address the real issues- Iatrogenically caused violent tendencies.

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        • Thank you for stating this so well. Not one psychiatrist in the “hospital” where I work will admit that the drugs cause horrific effects besides the tranquailizing effect. And when people are brought back to the hospital after going off the drugs they’re told that they relapsed and that this is a sign that they are terribly ill for life. Not one of the psychiatrists will admit that what we’re witnessing with these people are the withdrawal effects from the damned drugs.

          I gave Whitaker’s book, along with the WHO studies, Courtney Harding’s studies, Nancy Andreasen’s (sp.) study, and numerous up to date studies that prove the terrible effects of these drugs on people to the CEO of the “hospital” where I work. To his credit he read every last one of them. He brought them to my office, handed them to me and said, “This is extremely disturbing!” and left. That was over a year ago and I’ve had no other responses since then. No one wants to stand up to the psychiatrists and state the truth. This is the largest of the elephants sitting smack dab in the middle of the room and everyone tiptoes around them, pretends that they’re not there, and go right back to forcing people in the units to take the toxic drugs. I can’t it. We’re hurting if not killing people and we do it as if nothing is wrong!

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    • Honestly, having experienced the psychiatric system myself I am deeply surprised why there isn’t more violence perpetrated by the patients, especially on the staff. It’s seem like the most natural and normal reaction to the psychological abuse, physical torture and dehumanisation.

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  13. Hi Mark
    ‘Violence’ is not something I’ve seen much of in the ‘mentally ill’ communities. But nearly everyone in my work environment has a history of violence. So I think the emphasis on ‘mentally ill’ violence as a problem to society is undeserved.

    The out of character gun violence, homicides and suicides (I can substantiate my own attempts) can usually be traced to the medication – this is why they have black box warnings.

    What I found was, that once I got off the medications, and gained some insight into my own distress and what I could do about it – then the other problems of life sorted themselves out.

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  14. Jonah,

    Thanks for your willingness to reconsider your reaction to the following post:

    Since you were willing to reconsider, I read it again carefully and if you do that, you can see that what Dr. Ragins seems to be saying is that all those pushing for these new AOT programs are sadly mistaken if they think it is just a matter of forcing people to take “medications” or poison drugs that could/would make it work. If you read the article, he cites all kinds of difficult obstacle courses one must go through including the judicial system which can make funding problems worse, the need for housing assistance, comprehensive health care, dealing with trauma and other unique issues of each person and on and on and on about all the potential problems, hassles, necessary increased money, problems with coercion with plenty of room for abuses on all sides that should/must be addressed, etc.

    Anyway, I actually found the whole AOT article by Dr. Ragins funny in a way because he exposed that anyone thinking the implementation of such a program would be easy, free or cheap and other magical thinking is sadly mistaken. It was actually amusing in parts for anyone who has actually run an organization, fight for funding, had to budget, manage people, satisfy the public, politicians, staff, etc. Dr. Ragins also exposed the fact that many people are control freaks who love to coerce other people, but the problem is that there are many conflicting groups who wish to control the same people, money, agencies, legalities, services, etc., so they are in for a rude awakening.

    Anyway, I think the not so hidden message in Dr. Ragin’s AOT article was/is “you’ll be sorry,” and he says he wouldn’t want anything to do with it for the reasons he cites including abuse of power by all those involved that would require policies to avoid like many other potential problems. I may be wrong, but that is my impression.

    I don’t think it’s any surprise that the Mental Health America of LA decided not to support AOT. People are always big on creating grandiose plans, but it is a different story when it comes to funding and implementing such programs and dealing with the many harsh realities involved that I think Dr. Ragins covers all too well.

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    • Donna,

      I must admit, that, without reading this latest comment of yours (and then, afterward, for a 2nd time this evening, reading through Ragins’ entire blog post on ‘AOT’), I never could have understood how it was, that you ultimately came to interpret Mark Ragins’ blog on ‘AOT’ as you have interpreted it.

      Because you do interpret it, as containing what you call a “not so hidden message” that, Mark is supposedly saying (to those who are pushing for ‘AOT’) “you’ll be sorry,” indeed, I can understand why you appreciate that blog post (considering how you’ve interpreted it).

      But, quite emphatically, I must say, Donna, I think you are misreading it, as I don’t read such a hidden message in it, at all. Not in the least.

      Imho, there is no such message in it, anywhere.

      Just look at the last few lines… (I.e., I remind you, that Ragins concludes that blog, “In putting together analysis and recommendations our advocacy goal should not be to make it seem impossible to implement AOT successfully or to over-regulate it or include “poison pills” to sabotage it. We need to collaborate in an honest attempt to address a variety of serious concerns as we move forwards in implementing AOT…”)

      From the point of view, in which I read that blog (now twice this evening), all I see is, here’s man who is playing both sides of the field, saying “I personally wouldn’t want to be involved in it” even as, nonetheless, he’s doing all that he can to advance it, while hoping against hope that his recommendations for ‘best practices’ will be followed by those who administer it.

      Honestly, I see that as rather strange, but it is never surprising to me, to find another strangely conceived proposal coming from a psychiatrist. (The field is notorious for producing countless strange proposals.)

      But, again, I will say, I do get that you view it quite differently.

      So, hey… We can just agree to disagree, this time, and just leave it at that..

      By the way, I always value your passion and never doubt your sincerity…



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      • I think it’s fair for me to say that, based on Dr. Ragins’ personal communications with me, Donna’s interpretation is correct. Unfortunately, as the post notes, Dr. Ragins had a family emergency at the time the blog appeared and was unable to participate.

        Not, of course, that he was obligated to, or necessarily would have said more about his position. I just know that he was pleased that MHALA changed its position on AOT, to “against,” as a result of his advice.

        I think it is a good example of advice that presents the evidence in a balanced way, such that it is credible, but makes the conclusion – for anyone giving the advice careful consideration – clear and obvious.

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    • Mark Raggins post starts with the assumption, that AOT will be implemented anyway and we (you, I’m not in the US) should focus on recommendations how it should be implemented to be less harmful.

      “Like it or not, packaged as Assisted Outpatient Treatment (AOT), involuntary outpatient treatment is increasingly coming to a neighborhood near you. Los Angeles County is nearly ready to begin implementing AOT under Laura’s Law. The time for contentious advocacy aimed at stopping AOT has ended and the time for collaborative advocacy aimed at implementing AOT as well as possible is upon us. Whenever a major new initiative like this is launched, even in its pilot stages, there is the likelihood of more unintended consequences than intended consequences. Here are a series of important considerations for implementing AOT and some concrete recommendations for a collaborative advocacy agenda.”

      I disagree with Mark, that we should focus on a better AOT implementation only, but in demanding “checks and balances” it might get clearer what problems with these laws are and hopefully let the politicians think about it, if they really want to implement it with all the possible consequences.

      I think Donna’s impression of Mark’s blog is an important one, because it’s very likely that these laws are always much more harmful than intended and nearly impossible to implement them right.

      For example in my country there are very high requirements for involuntary commitment (in theory), but often they are just ignored or twisted (like not taking medication is a danger for the person in itself).

      So I think it could be helpful to fight these bills on both fronts or trying to minimize the potential harm. I’m not sure what the best strategy from an antipsychiatry perspective is.

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      • I think the main problem is that many people, myself included, think that there’s no way to humanise this kind of programme or “reduce harm” done by it. Forced treatment has been declared torture by UN and for good reasons. But I can see the perspective of people who are more interested on short term harm reduction rather than long-term political goal of getting rid of it altogether.

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  15. E. Silly,

    I am replying here. Your continuous reference to the “Scientology smear” is getting old and tired. Just more proof of how successful the APA and big pharma have been in their campaign to link all criticism to psychiatry with Scientology.

    The President of the United States, was associated, at different points of his life, with domestic terrorist Bill Ayers, controversial pastor Jeremiah Wright -who baptized of of his daughters and who said pretty awful things about the United States-, controversial scholar Rashid Khalidi and felon Tony Rezko . If none of these associations was a disqualifier for people to listen to “hope and change”, I think that Thomas Szasz’s role as co founder and supporter of CCHR should not be a disqualifier of his message critic with psychiatry.

    I repeat that after reading a lot of criticism to psychiatry from different angles and perspectives, I believe that Thomas Szasz is the intellectual giant of our movement. Chances are high that any argument presented as “new” against psychiatry, intellectually speaking not about errors in drug trials, has already been made by Thomas Szasz himself in his prolific writings and conferences.

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    • “Your continuous reference to the “Scientology smear” is getting old and tired. Just more proof of how successful the APA and big pharma have been in their campaign to link all criticism to psychiatry with Scientology.”

      I’m equally bored by your repetitions. I just linked to the part where Szasz talks about Scientology (in the same video you mentioned). I don’t see references to “Scientology smear”, APA or big pharama there.

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      • Excuse me, but what is that Szasz said there that you find reprehensible? He made it very clear, as it has made in other occasions, that

        – He co-founded CCHR not because he is a Scientologist -for your info he is an atheist who received the Humanist of the Year Award in 1973, – but because CCHR is one of the few organizations there is in the US today that will spend money in lawyers to get you out of a psych ward if you are unlucky to be kidnapped by psychiatry. Fortunately now there is more awareness than in 1991 but back then, when Scientology was smeared by the APA, they were about the only option in town if you needed help to fight institutional psychiatry.

        – As he correctly said, he had been writing about the things he is famous for now for many years before co founding CCHR. Also, that he was given the AHA Humanist of the Year award 4 years after co-founding CCHR shows that the “Scientology smear” wasn’t as effective back then as it is now that big pharma has joined forces with the APA to defend their 80 billion dollar a year psychotropic drug market.

        – Finally, in the US, kidnapping somebody, except when that kidnapping is done by a psychiatrist in a mental hospital, is illegal. Scientology has survived an infinite number of lawsuits and accusations that it is a coercive cult. Either Scientology has infiltrated the criminal justice system at all levels (police, DA offices and judiciary nationwide) , which is a pretty strong accusation for a religion that has few members, or, most likely, many of the accusations against Scientology are unfounded, based on bigotry.

        With this said, I stress that I am not a Scientologist, but I find this innuendo that unless one considers any association with Scientology to be evil that one is also evil quite unfair and intellectually dishonest, especially since nobody asks the same from associations with say, the Catholic Church, that has way more documented cases of abuse than Scientology has in the US or worldwide. Here come a few figures from some random internet search:

        – “60 Percent of Chicago’s Parishes Had Pedophile Priests” “About 4 percent of U.S. priests ministering from 1950 to 2002 were accused of sex abuse with a minor, according to the first comprehensive national study of the issue.” “Sex-abuse related costs totaled $573 million, with $219 million covered by insurance companies, said the study done by the John Jay College of Criminal Justice in New York.”

        The scale of the documented sexual abuses in the Catholic Church and the documented cover ups by the same church in the US pale in comparison to anything that Scientology has been accused of, let alone found guilty of.

        That people continue to insist on “Scientology is toxic but attending a Vatican conference is fine” only shows that prejudice and bigotry trump intellectual rigor and honesty for many in MIA.

        Thomas Szsasz is an intellectual giant. I wish that I have at 92 the intellectual abilities and rigor he displays in that video.

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      • And one last thing. I accept Bob Whitaker’s argument that the reason he doesn’t want CCHR/Scientology affiliated bloggers is a political tactic to protect MIA from the Scientology smear and that gaining friends from the Catholic church is politically advantageous given that church’s political power.

        However, that is very different from intellectually believing, which seems to be your case, that an association with Scientology is evil but an association with Christianity, Judaism, or Islam is “good” because these are better, honest churches. Really? Have you checked the quality of life of people living under Sharia law? What about Judaism that condones the barbaric practice of circumcision and makes its adherents be obsessed with the land of Israel even though most American Jewish immediate ancestors have not lived in Israel? This obsession with Israel, which is also found in Christian churches, costs the United States billions of dollars in aid to Israel each year and political capital in the international arena. I don’t see anybody repudiating Muslim or Jewish critics of psychiatry.

        I find it disingenuous or simply dishonest to think that the “Scientology smear” is a valid intellectual reason to not associate oneself with certain critics of psychiatry.

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      • And I’m bored again.

        The violence, abuse and coercion within Scientology is pretty well documented and this is something which is at the core and facilitated by the leader David Miscavige.

        I find that people who completely ignore the violence, abuse and coercion within Scientology and the aggression towards their critics are not credible when it comes to fighting the violence, abuse and coercion of the psychiatric system.

        I have a hard time to understand why people and organizations voluntarily associate themselves with Scientology. One explanation would be, that they in fact supporting the goals of Scientology, the other, that they are less intellectual giants and more self-opinionated bigots.

        Scientology’s main goal is to destroy psychiatry and the psychs to sell their own unscientific and potential harmful Scientology “mental health” services to as many people as possible and make people dependent on their cult-like organization. This is not something I support.

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        • I am also for entirely legal and peaceful methods confronting psychiatry but I find your position problematic on several fronts :

          – I know that in certain circles, Scientology bashing is some sort of sport and people would spend days speaking of Lisa McPherson. Her case was tragic to be sure, but when you claim that “violence, abuse and coercion within Scientology is pretty well documented” the people who typically make these accusations refer to hearsay and testimony of former members. Now, I am not saying that these former members are lying, but I am saying is that unless you can point to documented instances of criminal convictions, this remains, that, hearsay. When I say that that there are documented instances of sexual abuse in the Catholic church I am saying things like , or . Still I am not hearing people repudiating critics of psychiatry who are Catholic or demanding that we do not try to use that church’s political muscle to our advantage.

          – As an example of nonsensical accusations against David Miscavige is that whatever you think about the man (and I have no opinion because there is little confirmed info about him) , he needs to put up with things like “LAPD Dismisses Leah Remini’s Missing Person Report on Wife of Scientology Leader”. Now think about it, I only see two options here: either Scientology is an ultra powerful organization that is able to influence Los Angeles’ police, DAs and judges, or, most likely, the accusation was baseless. So how much trust can we put on the testimony of disgruntled former Scientology members?

          – Before dismissing Thomas Szasz as a “self opinionated bigot”, I ask you to read his paper “The Myth of Mental Illness” published in 1960, 9 full years before he co founded CCHR and 50 years before Tom Insel / the APA made their outstanding admissions that no so called “mental illness” has been found to be biological. To me that paper remains a jewel of intellectual power and clarity.

          – Finally, I also find very dishonest the line of argument “Scientology’s main goal is to destroy psychiatry and the psychs to sell their own unscientific and potential harmful Scientology “mental health” services to as many people as possible”. Even if that is true, that’s a similar accusation that DJ Jaffe throws at peer support groups who get SAMHSA funding. The Wall Street Journal said “SAMHSA is in the vanguard of the legal advocacy and anti-psychiatry movement that sprang to life in the 1980s, and it continues to waste taxpayer dollars on programs that undercut efforts to help the world’s Adam Lanzas. Known generally as the “consumer/survivor” movement (as in having “survived” psychiatric treatment), this movement largely opposes drug treatment, psychiatric care, civil commitment laws or even the reality of mental illness. SAMHSA pushes the “recovery model,” an approach that puts the patient in charge of crafting his own recovery plan and stresses “empowerment” and coping rather than medical intervention.” Now, does this mean that I should repudiate the “recovery movement” because I am personally against all expenditures in so called “mental health”? Well, no, I am supporting the Barber bill not because I see value in its proposals but because at least does not make coercive proposals more widely available.

          To summarize, I think that you are a perfect example of how successful the “Scientology smear” against criticism of psychiatry has been. When your claims are critically examined, they are easily debunked.

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          • Maybe it is a baby swan.

            In any case, my point remains, you have a clear double standard with shows your intellectual inconsistency. Your standard is not built on confirmed convictions of Scientology as an institution but on hearsay and, I would assume, some sort of fad that is very popular in some circles that like to present themselves are “intellectual”.

            If the standard you apply to Scientology to consider a it a potential ally were to be applied to other religions, none of them would survive said standard. For some reason, you seem to be fine with a joining forces with a church that has actively covered up demonstrated cases of sexual child abuse but you have a problem with a church whose only conviction, as an institution, is in the court of public opinion through baseless accusations like the one against David Miscavige on the whereabouts of his wife.

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          • No I am a Scientologist?

            Of all your innuendos, this is certainly the most absurd of them all.

            I’d say that if this exchange has showed something is your inability to debate rationally the issue of why people should accept as valid the “Scientology smear” promoted by the APA and big pharma.

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          • It don’t care if you are a Scientologist or not. The thing is, if someone is doing all the moves you would expect from a Scientologist (or someone who does the Scientology talk), a rational debate is not possible by definition. They will defend Scientology by all means. There is no way, that I can reply to all the smoke bombs you are throwing into the debate.

            Let the “disgruntled” former Scientology members speak for themselves.


            You don’t have to believe them as you don’t have to believe the “mentally ill” psychiatric survivors.

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          • A new low from you, really.

            I cannot speak for every survivor to be sure, but I can assure you that I have with me,

            – The court order that had me involuntarily committed for committing the “sin” of fearing HIV more than what European psychiatry deems acceptable. You cannot make this stuff up. The people who have seen the order are astonished about how easy it is to have somebody involuntarily committed in the country where this happened to me.

            – A ton of medical records that explain in detail what it was done to me for “treatment”.

            You can be assured that the day I become a public anti psychiatry activist I will make both publicly available to make sure people believe my story and don’t have to trust “hearsay” :). But in any case, many survivors have published theirs so you don’t have to wait to see mine. This is an example of a commitment hearing transcript .

            Similarly, when it comes to the Catholic church here is a list of settlements . If you want to have a copy of the settlements, you can write the respective courthouses to get one. Most of them are public record. In fact, the documents associated to the Los Angeles diocese are here for everybody to see .

            My point is that most of the accusations against Scientology are not based on facts established in the court of law but on hearsay and testimony of disgruntled former Scientologists. It doesn’t mean that they are false, but again, if you are going to discredit a whole faith, you better have something better against them than what already exists against established churches like the Catholic church.

            You have demonstrated during this discussion that you are not very good at having a rational debate. When your unsubstantiated statements are discredited you respond by doubl2ing down on your dogma “Scientology is evil”. You might think that this is “smart debating” but in fact repeating dogmas ad nauseam is proof of the opposite.

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          • I am not a supporter of Scientology. I am saying that you have a double standard whet it comes to criticizing religions:

            – For Scientology you accept hearsay to indict its practices and all of Scientology.

            – For the rest, even when there are systematic atrocities committed by its members and covered up by its leadership, you seem to be fine.

            This double standard is what makes you appear non rational. In addition to support you non rational point of view you went as far as comparing the hearsay of former Scientology members with the testimony of survivors of psychiatric abuse, many of whom can indeed document what it was done to them (us).

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          • E.Silly, you seem to be the one who is not able to discuss Scientology rationally here. cannotsay has rightly pointed out that if you’re insisting that anyone who has any connection with organisations funded by Scientology like CCHR should be excluded from the movement as a potential cultist abuser then you should apply the same standard to people associated with other religions as those are known to have been perpetrating such abuses long before Scientology was founded. In such case anyone who is religious or has ever worked with/attended a conference/received an award etc. from any organisation funded or supported by any church should be excluded and shamed as well. Unless you’re willing to apply a double standard and decide that somehow Scientology’s crimes are so much worse than abuse done by catholic church for instance.
            Btw, just to make it clear – I am not a Scientologist, I am an atheist and I am deeply suspicious of every organised religion. I just don’t see much difference between CoS or Catholicism for that matter.

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  16. Answering to E Silly here to make sure the reply is not lost,

    “In my definition (and country) Scientology doesn’t qualify as a religion.”

    All that is good, but we should not lose perspective. This webzine is still “Mad In America” and governed by US laws in regulations which indeed recognize Scientology as a bona fide religion. It is not my blog either and Bob Whitaker has made it very clear that he welcomes perspectives form all people (even, apparently tone deaf ones about what the Tea Party is in the United States).

    Whichever country you come from, in the United States Scientology is a religion. While this fact alone does not make Scientology immune to criticism, it means that singling it out for criticism in a discussion about psychiatry, which is itself a belief system, specially when the discussion is that Scientology is some sort of competitor of psychiatry, among all other belief systems/religious, is perceived as bigotry. Bob Whitaker has made it clear that his reason to not let Scientology/CCHR bloggers has to do with the politics of psychiatry, which is fine, but the way you have attacked Scientology looks bigoted. It might as well true that at some point the things Scientology is accused of are substantiated, in the same way the Catholic church was for a long time accused of doing things that were only substantiated many years later, but even that should have no bearing on Scientology’s status as a religion under US laws.

    To explain why, we need to look at history and the reason the first amendment “establishment clause” and “free exercise clause” exist. You can read more about it here .

    The practical effect is that many belief systems that are allowed to exist in the United States are banned elsewhere, not only Scientology because the historical lesson learned from mixing belief systems and government is that said belief systems flourish better where there is a complete separation between the belief system and government along the lines of the first amendment.

    Historically, all European countries since the times of the Roman Empire have had (and have) some sort of either “government Church” or government preferred church(es). The most clear example of “government Church” is the Anglican Church. The most obvious examples of government preferred churches are the Christian churches in countries like Germany or Austria that have an institutionalized “church tax” to help fund them. While these governments are “in theory” secular, in practice they favor certain religions over others and put the resources of government (like tax collection) to help fund these churches.

    In the US on the other side, the wall is clear, with the only advantage being the tax exemption status that churches have (and certainly, neither the federal government nor states governments put their resources at the disposal of any church to collect taxes for them; the notion of “exemption” is to avoid taxes which is different from collecting taxes and distributing it to a few churches). The loose way this tax exemption is applied is such that not only Scientology but even the American Humanist Association, a group promoting atheism, was for a long time a “tax exempt church” . Basically, any group of people who proclaim a “belief system” can get it provided they do not use it to commit crimes.

    Now, while Europe was allegedly “religious” during the time most European countries were totalitarian regimes (which few exceptions, the democratization of Europe in earnest started in the aftermath of WWII), as soon as true democratization kicked in, most European countries became extremely secular very fast. Churches today are empty everywhere in the continent. In comparison, the United States is arguably the most religious Western nation. Not only old religious flourish (like traditional Christianity, Judaism or Islam) but the US creates new ones, like Mormonism, Scientology or the Pentecostal sects.

    From my point of view, the only belief system that is right now in violation of both the establishment and free exercise clauses is psychiatry. In fact, I am far from being the first to notice that the DSM is some sort of sacred text for the secular community .

    From my vantage point, any argument about Scientology this, Scientology that is an argument that fuels the interested PR campaign promoted by the APA and big pharma that seeks to assign the label “Scientology smear” to all legitimate criticism of psychiatry (the main reason why Bob Whitaker adopted his policy for MIA bloggers).

    Commenters like you who import the “Scientology smear” from whatever country you are from are basically playing the game the APA and big pharma want us to play. It doesn’t advance in anyway the survivor movement.

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      • Who knows but I have to say the following:

        – I repudiate satanism, and everything it represents -even that satanic temple which is portrayed in the media as a collection of atheists mocking religion- in no uncertain terms. At the same time, Christian teaching, which recognizes the existence of good an evil, says that the right way to fight evil is to do good deeds. The few times that Christians have attempted to fight evil by censoring it very bad things have happened, like the Crusades or things like the Salem trials.

        – Google’s CEO, Eric Schmidt, has addressed several times the topic of censorship in China (for instance here during the Q&A ). He says that he gets asked a lot by Chinese people about what’s wrong about censoring falsehoods. While I do not agree with everything that Eric Schmidt says or stands for, I agree with his answer to the Chinese student: the appropriate response to these falsehoods is more speech not censorship. Information is free; so are people’s ideas and beliefs. Repression only takes “forbidden ideas and beliefs” into hiding, it doesn’t make them disappear. Sunlight and transparency are still the best tools to fight evil doers. In fact, that one of the guaranteed things dictators do after gaining power is to take control of the media tells you how damaging free speech is to those of a totalitarian mindset.

        – As a former European, the set of the rights I am most thankful for from my American citizenship are those contained in the first amendment. If there is a real divide in the understanding of individual freedom between Americans and Europeans, it’s precisely the different approaches to government’s ability to suppress speech, religion or the ability of people to petition the government. In countries like the UK it is still illegal to dishonor the Royal family. Similarly unpopular speech is routinely suppressed through libel lawsuits. The UK is notorious for placing the burden of proof on the defense not on the accusation for said lawsuits. This is why Lance Armstrong sued The Sunday Times for libel and won but he didn’t dare suing any of the American newspapers/media outlets that published basically the same information as The Sunday Times did. Our stronger protections of free speech (and religion) eventually made the truth about him come to light.

        – On the topic of Scientolgy. I have to admit that after hearing/being confronted with the “Scientology smear” a few times, I decided to take a serious look at Scientology. While written in a negative tone, this is probably one of the best resources there is on them . If find their beliefs strange, but then again, my own faith believes that a man can be born out of virgin, do all sorts of miracles (that the Talmud mocks in all sort of ways too ), then die and resurrect to never die again. Not sure which one is more strange except that while we know when Scientology was “invented”, there is nobody around left from the time of Jesus to tell how things happened back then -with the possible exception of .

        My bottom line is this: I am tired of listening to people who believe that bashing Scientology comes from an enlightened state of mind. It doesn’t, specially in the context of psychiatry criticism. Those who gladly use the “Scientology smear” to shut down the debate about psychiatry only prove that the APA and big pharma have had a great success with the smear. We shouldn’t fall for it.

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  17. “We can help people reclaim and develop their strengths and enrich all of us.”

    Be careful who you include in this “we” of yours. It was your colleagues who damaged my brain as a child and have forced me to live with involuntary movement disorders ever since and spend my entire adult life ISOLATED and on SSI.

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  18. I hope one day the “mentally ill will realize the system that is keeping them down, perpetuating and reinforcing illness and stigma. What we really need is strength. We need to realize that trauma is the source of our differences. Our dissociation from ourself and our suppressed memories keep us afraid. Society keeps us afraid and ashamed of our trauma, of our anxiety. This fear of being different can escalate symptoms of mental illness. “Mental illness”

    It is designed to oppress us, take away out power, our voice. There is a cure. It is realizing there are suppressed memories. We have hidden these memories to protect ourselves, but once we realize how past traumas have influenced “symptoms” we can become whole.
    My mission is to find the cure to the Illness that does not exist.

    -Tru Harlow

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  19. “The bad news (besides the problem that I can’t think of a clever acronym for these five steps) is that all of us have to get involved.”

    Dr. Ragins, I have an acronym for you. It involves minor changes in terminology and ordering.


    Reach out (outreaching isolated people)
    Engage (social engagement efforts)
    Nurture (strengthening protective factors)
    Embrace (providing opportunities for inclusion)
    Waken! (reclaiming, reviving, and discovering personal interests)

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  20. “From a mental health point of view these young men, have two relevant characteristics – their mental illness and their social isolation.”
    Honestly, I’m fed up with sticking the so-called “mental illness” label on every criminal out there or treating the criminal actions of everyone who had had a mental illness diagnosis somewhere along the line as causative to the actions. Why isn’t so difficult to understand that some people may have a great deal of social isolation, frustration, unmet needs and feelings of inadequacy to breed resentment towards a certain group of people or even humanity as a whole? But it’s a logical extension of the notion that every negative human emotion and a great deal of positive are a sign of an illness and should be medicated.

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