Please Don’t Empower Me Anymore

David Healy, MD
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Editorial Note:  This is the second part of a series on Motivational Interviewing appearing on David Healy’s website.

 
 
 

  • Do you know the locations of all the best bathrooms?
  • Do you often take a seat near the exit, just in case?
  • Do you excuse yourself often to use the bathroom?
  • Do you ever skip meals, or avoid certain foods, to avoid multiple bathroom trips?

Those are questions from the Crohn’s Workaround Quiz, developed by AbbVie to promote its blockbuster biologic drug, Humira, for Crohn’s Disease.  I took the quiz online, and passed with flying colors.

That’s odd, because I don’t have Crohn’s Disease, thank goodness.  I’ve got a much less serious condition called Irritable Bowel Syndrome.  It can give you many of the same symptoms as a mild case of Crohn’s disease (mainly abdominal cramps and diarrhea), but without the structural damage to your intestines seen in Crohn’s and its cousin, Ulcerative Colitis.

So I was surprised to find myself aceing the Quiz—and warming up to this website that “understood” how frustrating my little gut troubles could be.  Maybe I should . . . Ask My Doctor?  She knows about my symptoms, of course, but maybe she just isn’t taking them seriously enough.  Maybe I’m not either.  Maybe I should at least sign up for more information. What’s the harm in that?

In Touch with Me

Welcome to the dark side of Pharma marketing – and its favorite new persuasive technique, Motivational Interviewing.

The Workaround Quiz was put together by a team at Intouch Solutions, a Chicago ad agency.  They didn’t know squat about Crohn’s disease, but clearly they knew plenty about Motivational Interviewing – and their Quiz won them an AdStars Award from Pharmaceutical Executive magazine.  Here’s how they did it:

The first step was to convene a focus group of people with Crohn’s and listen closely to them.  That’s how the ad agency learned about all those coping tactics, from knowing where to find a reliable bathroom, to knowing when to pass up the pizza.  They then realized they had a problem: “The patients initially believe these behaviors mean they are managing their Crohn’s disease well.”  In other words, they’re satisfied with their current setup – maybe even proud of their ability to cope.  This was bad news for AbbVie.

To sell Humira, the ad team would have to “help them realize” how big an impact these tactics were having on their daily lives – and that really effective treatment ought to make them unnecessary. “We work on pushing them to desire a change in treatment, because now they’re expecting a little bit more, and then we follow that with explaining how Humira could be the solution,” Marty Caniff of Intouch explained.  “And then we drive them to the doctor.”  In classic M/I fashion, she was leading them in the direction AbbVie wanted them to go, while letting them feel it was their own idea.

In the Best of all Possible Humiraverses

What’s the problem?  Humira, like other new biologic drugs, has a lot of hazards.  It’s a TNF inhibitor – a powerful immune suppressant that can leave you vulnerable to a host of illnesses you would otherwise be able to fight off, from tuberculosis and pneumonia to serious fungal infections.  “TNF” stands for Tumor Necrosis Factor, which also helps your body combat the growth of cancerous cells.  In rare cases, inhibiting TNF can lead to cancer, as it did for this woman who took it for psoriasis.

That’s why the official FDA label for Humira warns doctors that it is only for “adult patients with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy.”  These patients have often been hospitalized for internal bleeding, had surgery to remove parts of their intestines, and tried multiple drugs without much success.

The problems described in the Workaround Quiz don’t resemble those experiences any more than a bad cold resembles pneumonia.  They’re typical of mild or episodic Crohn’s, for which there are plenty of safer options. For patients like these, the FDA says, Humira is clearly not worth the risks.  It also may not be worth the $1,500 – $2,500 per month cost of treatment, which has patients emptying their savings accounts and battling their insurance companies.

For AbbVie, on the other hand, every new Humira user is a new revenue stream worth thousands of dollars a year.  Worldwide sales of Humira topped $10 billion in 2013, keeping it in place as the best-selling drug in the world.  They recognize the key to its growth is “an ever-expanding list of indications” that go far beyond its origins as a drug for severe rheumatoid arthritis.  Part of that is investing close to $200 million per year in consumer advertising.

Ask your Doctor

That’s where “driving them to the doctor” comes in.  The brochures I got from AbbVie urged me to take my Crohn’s disease seriously, even if I only had symptoms “every once in awhile,” and to ask my doctor about Humira.  They also featured a Doctor Discussion Guide to help me prepare for my next appointment. If that doesn’t do the trick, AbbVie will even provide me with my own personal Patient Advocate who can teach me how to “communicate effectively with my doctor.”   My newfound discontent with the status quo won’t go very far unless I can convince my doctor of my need for “change.”

In effect, now that they’ve used Motivational Interviewing on me, they’re teaching me how to use it on my doctor.  Among the details I should be ready to share, they say, are the frequency and severity of my abdominal cramps and my exact number of “soft or loose stools” per day.   I’m not likely to know that those are the lead questions on the two most common rating scales (CDAI and HBI) used by doctors to classify Crohn’s as mild, moderate or severe.  But my doctor may – and AbbVie certainly does.  They’ll make sure that I’m talking her language, without even realizing it – telling her what she needs to hear in order to feel comfortable moving me from “mild” to “moderate,” and writing me that Humira script.

In other words, they’ve talked both of us into doing exactly what the FDA wanted to prevent: using a very  expensive and risky treatment when there were plenty of safer options.  It would be illegal for an AbbVie sales rep to give my doctor that advice.  But if it comes to her as her own idea (or better yet, from “really listening” to her patient), all’s well.  Doctors are permitted to prescribe drugs off-label for any purpose they think is sound.  They can even prescribe Humira for a stubborn case of Irritable Bowel Syndrome – and I’m willing to bet it has happened.

Before rushing to judgment on this Crohn’s Workaround campaign, though, I wanted to hear from someone who actually knows what moderate-to-severe Crohn’s Disease is like.  So I asked Ken Spriggs for his thoughts.

Ken is a patient activist who blogs at diyehr.com.  He’s had Crohn’s Disease since his teens.  In recent years he’s gotten it under control without medication. He eats an anti-inflammatory diet and lives a low stress lifestyle. He sent me this satirical take on the Crohn’s Workaround quiz:

The Great HUMIRA Workaround QUIZ

  • Are you looking to experience your first Anaphylactic Reaction?
  • Do you look forward to autoimmune hepatitis?
  • Would you like to re-experience an old infection?
  • Do you think having mysterious Lupus-like symptoms sounds interesting?
  • Are you looking to acquire pneumonia?
  • Do you know what “Neutropenia” means?
  • Would you like night sweats to keep you up at night?

If you answered NO to any of these questions then THINK TWICE before you “discuss Crohn’s treatment goals with your doctor and ask about HUMIRA.”

Ken mentioned that he’d taken the Crohn’s Workaround Quiz twice – once answering honestly, and once answering No to every question.  He got the same answer:  It may be time to rethink your expectations.  Print out this Quiz and share it with your doctor.

“Having been diagnosed with moderate/severe Crohn’s, I’m the exact person they’re marketing to, and I’m insulted,” Ken added.  “The most repulsive thing about AbbVie’s Crohn’s quiz is how it villainizes the common management techniques that patients use. It’s an exceptionally predatory marking practice. The side effects of Humira can be deadly, but knowing where the closest bathrooms are is just common sense. I’d much rather cope with minor inconveniences than subject myself to the unnecessary risks of drug side effects.”

Teenagers and Brands

AbbVie’s pitch definitely backfired with Ken Spriggs, and I can see why.  Then again, Ken is a grown man who’s been dealing with Crohn’s for almost twenty years.  Many Crohn’s patients are first diagnosed as teenagers.  It’s a time of life when keeping up with your peers means a lot.  For a college kid, it’s easy to imagine the lure of being able to drink beer, eat buffalo wings and take your good health for granted just like your buddies do – without all those lame Workarounds.

That’s an unsettling thought. The extensive Black Box Warning on Humira’s label includes this:

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers including HUMIRA.  Post-marketing cases of hepatosplenic T-cell lymphoma, a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers including HUMIRA. These cases have had a very aggressive disease course and have been fatal. The majority of reported TNF blocker cases have occurred in patients with Crohn’s disease or ulcerative colitis, and the majority were in adolescent and young adult males.

For a few severely ill young men, those risks may be worth taking. But for those who “believe they are managing their disease well,” like the patients who inspired the Workaround Quiz, AbbVie’s suggestion that they need to “rethink their expectations” and consider upping their game could be disastrous.

Come in the Puppet Will See you Now

It’s the very opposite of the health-promotion philosophy that gave birth to Motivational Interviewing. That could be seen as a bit manipulative, perhaps – but if it manipulated people into taking better care of themselves, how bad could it be?  Many people are happy to hire a professional manipulator, whether a therapist, a Weight Watchers program or a fitness coach, to help them stay on track with an important personal goal.

In this case, however, AbbVie has set the goal: to get you on Humira, just as Ford’s goal is to get you in a shiny new truck.  Maybe a new truck is just what you need.  Or maybe you have no earthly use for one, and buying it will break your budget and trigger a big fight with your spouse. It’s all the same to Ford.  Most of us realize this, and can keep our heads when an ad campaign suggests that driving a big red truck is the only patriotic, or smart, or macho thing to do.

In the same way, getting on Humira could be a wonderful idea for some, a tremendous waste of money for others – and a personal disaster for more than a few of us.  But when we enter the world of healthcare, we tend to trust that the conversation will take place on a higher ethical plane than we’d find in an auto dealer’s showroom.  It ain’t necessarily so.

24 COMMENTS

  1. That’s funny. Because I would’ve answered YES to all those questions when I was POLYDRUGGED on multiple psychopharmaceutical drugs that destroyed my GI system and caused me to have multiple blood tests and invasive procedures (2 colonoscopies and 2 upper GI scopes) in my early 20s — all of which came back normal. Never once did the doctors suggest to me that their drugs could be the actual cause of my GI distress (and the plethora of other symptoms I was complaining of).

    When the “treatment” is worse than “the cure” (even though none of those drugs actually cure anything). Now I know I was being poisoned, so it all makes sense.

    Good article and very valid points.

    • Wonderful primer on pharma- drug pushing up close, Dr. Healy.

      My first thought was, ‘What drug, currently on the market, causes problems similar to Crohn’s Disease and is it made by the same company?’

      I just spent ten weeks tapering from a low dose of baclofen for MS muscle spasm in my ankle, and have found myself again now that the agnosia, depersonalization, somnolence, sensory distortion, fatigue, drug-induced rank stupidity, inability to learn, inability to remember numbers for any length of time, poor muscle coordination, photo-sensitivity— BUT WAIT! THERE’S MORE— has dissipated.

      DOCTORS AND OTHER MENTAL HEALTH PROFESSIONALS, should be required to review all medications and possible effects before prescribing ANYTHING. Between my primary care physician and my neurologist, I was on one med that raised blood sugar and one that lowered it; everything I was taking was constipating, including the laxatives; a muscle relaxant was making the spasm and pain in my ankles worse…. and so on. I need to make a chart with some Venn diagrams to illustrate how most of these drugs I was prescribed either ganged up on me with some shared effects or countered the each others’ effects, or created whole new effects in combinations.

      Most of how I was affected by taking AND discontinuing baclofen could easily be misinterpreted as “mental illness”, which is par for the course, in a culture in which every native of NYC is bipolar because of their “pressured speech” and having a rotten day is “major depression”.

  2. Good point Elocin – I’ve had the damned Irritable Bowel Syndrome since childhood, long before I had any psych meds, and I’ve heard this is not uncommon; it might reflect a connection. But surely the meds have to be messing with a lot of people’s guts: the digestive tract is wired into the central nervous system, after all, and there is more serotonin in your gut than in your brain.

    What struck me was how similar the selling pitches are for drugs in very different categories. Right now Takeda is trying to drum up enthusiasm for its new antidepressant, Brintellix, by sponsoring a so-called consciousness-raising effort by the Depressive & Bipolar Support Alliance (DBSA). It’s called Target Zero to Thrive. The idea they push is that “consumers” are rising up and won’t settle for anything less than Remission – i.e. zero “symptoms.” We want innovative thinking, and better services, and oh! of course – new drugs!

    This is what you should want if you are “empowered” – if you settle for mere improvement, you must have low self-esteem or something. It’s the same idea AbbVie pushes to sell Humira. You shouldn’t be content with having your symptoms well under control – you should shoot for zero symptoms. Remission Is Possible!

    Well, I don’t believe in Total Remission. A good part of my equilibrium rests on having realized that I am who I am, and I will never be Polyanna, or the life of the party, or wear a size four. I also think the quest for “total remission” leads to dangerous excesses on the part of doctors. I am wary of being chemically carpet-bombed in an effort to rid me of every symptom.

    I really liked what Ken Spriggs, the guy with Crohn’s, had to say. He’s brought his own symptoms down from being quite disabling, to being a mere pain in the ass. Any sensible doctor should celebrate this with him – not try to get him to take huge risks for some goal of Zero Symptoms.

    • Complete remission from what? Life? To want to suffer no “symptoms” in this age of instant mental illness (see your doctor) is to want to be a robot. But then again, one dystopian theme has slipped into the 21st Century on cat paws—

      “Soma”—

      Hug me til you drug me, baby.

  3. “But when we enter the world of healthcare, we tend to trust the conversation will take place on a higher ethical plane than we’d find in an auto dealer’s showroom. It ain’t necessarily so.” So true, according to my family’s medical records, the purpose of the psychiatric industry is to defame and discredit patients to cover up medical evidence of the sexual abuse of children for unethical religious leaders and easily recognized iatrogenesis for incompetent and unethical mainstream medical doctors. And my subsequent pastors explained to me that I’d dealt with the “dirty little secret of the two original educated professions.” I don’t think the auto dealers have a “dirty little secret” system set up to legally defame, discredit, and poison people so they may aid and abet in covering up sexual abuse of children and their co-worker’s incompetence. What a shame the medical community does. It’s hard to respect such an industry.

    • “I don’t think the auto dealers have a “dirty little secret” system set up to legally defame, discredit, and poison people so they may aid and abet in covering up sexual abuse of children and their co-worker’s incompetence.”
      Well, I’m not sure about targeting families but look up the recent GM scandal. Some people were charged after “causing” accidents which were due to faulty cars. Corporatism at it’s best.

  4. Mischaracterizing Motivational Interviewing (MI). I certainly agree that the sort of disease mongering and drug pushing AbbVie engages in is deplorable. However, this is in no way indicative of the MI approach to patient care. “We work on pushing them to desire a change in treatment, because now they’re expecting a little bit more, and then we follow that with explaining how Humira could be the solution,” Marty Caniff of Intouch explained. In MI there is NO pushing and NO persuasion. See Miller and Rollnick (2013) or motivationalinterview.org. What AbbVie is doing is cheap and dirty persuasion, not MI.

  5. It should have said “Motivational Interviewing, Pharma-style”, I guess. Clearly the drug companies aren’t committed to the same humanistic goals as those who developed this style of counseling. They’re just co-opting a few ideas and turning it into the latest industry marketing buzzword. Here are links to the first article on David Healy’s blog, and another really good one by Maria Bradshaw:

    http://davidhealy.org/motivational-interviewing/

    https://www.madinamerica.com/2013/12/motivational-pharmacotherapy/

    I have to think that real M/I counseling would be at its most ethical AND its most effective when therapist and client agreed on the goals. That’s the opposite of the bogus Pharma version, where the goal is officially “good health” but it always translates into “take our drug” – whether it’s the best bet for improving your health or not.

  6. But what about my “Low T” surely pharma can empower me to keep up with the 22 year olds in the gym. It’s total bull my bench is stuck at 180 and these kids put up 275 like its nothing and they started 6 months ago @ 145 !

    I met a guy that messed with that Androgel and messed him all up in all sorts of ways. I did like that T.V ad for Androgel with all the cranes lifting stuff and the big strong old dudes walking around.

  7. A bunch of people have already made a similar comment. But because it was very frustrating to read a pretty serious mischaracterization, I guess I’ll add my voice to the mix.

    Before I do I want to acknowledge some things so that it does not seem like I’m throwing the baby out with the bathwater. First, I’m not surprised in the slightest that Big Pharma is coopting the language of MI and then totally distorting its foundational principles to suit its own purposes. I’ve shouted obscenities into the air as Big Pharma has done the same with the word “Recovery” and all sorts of other things.

    The spirit of the message in this article is extremely important. Exposing how Pharma seeks to manipulate and twist people into drug use is crucial to creating change. So I’m not ignoring the broader point here.

    However, I also believe in accuracy, and in this case the article has a fatal flaw. The article conflates motivational interviewing with Pharma’s twisted bastardization of motivational interviewing. I have had extensive training with the approach, which is only a resource that may or may not be helpful in a specific context. I’ve also provided training for other practitioners several times.

    Here’s some things you may not know, but need to:

    1. The root aim of motivational interviewing is to explore ambivalence. Ambivalence is when someone feels two different or opposite things strongly. If a person is literally experiencing no ambivalence at all, then motivational interviewing stops there.

    2. Motivational interviewing is about the exploration of ambivalence…..toward a persons OWN change desires. NOT the change desires of a practitioner. Not some sort of manipulative tool to get someone to comply with someone else’s agenda. Someone who says, “I’ve decided that part of me really wants to make x change, but then again another part of me really doesn’t” may find that tools that facilitate his or her exploration of ambivalence (what MI does) are really useful. Or not. But either way, its up to the individual to drive the process.

    3. An absolute core principle of MI from its origin is this: you the practitioner should never make the mistake of being the one to advocate a change as you define it. Instead, through a process of exploring ambivalence and rolling through resistances, the individual can come to clarify whether or not they want to change, what that change will look like, and what steps they decide they will make to facilitate the change. If someone concludes that they do not want to change something, and they have no ambivalence about that, then MI is done. There is no pressure or manipulative advocacy about it.

    4. One of the pioneers of MI, William Miller wrote an article that was published in the Psychology of Addictive Behaviors journal in 2000 called “Rediscovering Fire.” In it, he argued that the single most important factor in a positive outcome (as the individual receiving service defines it) is not the type of service or “treatment” but rather the ability of the practitioner to demonstrate unconditional love toward the person being served. Now maybe that sounds like crazy woo-woo talk to someone reading this. But its pretty hard to suggest that from that foundation Miller and Rolnick somehow then build a set of tools called Motivational Interviewing for the purpose of manipulating and tricking people into doing what they want. That, and the fact that over and over and over again the consistently emphasis that manipulation, coercion or trickery is not at all consistent with MI, or ethical.

    As MI began to be applied in substance addiction treatment, there was – I admit – a bit of a learning process. Early models did feel manipulative, which promoted miller, rolnick and others to produce an absolute slew of materials arguing that this was wrongheaded, unhelpful, and not consistent with their intentions.

    Today, an MI support approach is taught in very specific ways. It is client focused, not practitioner agenda focused, it is aimed at assisting someone in exloring their own ambivalence toward their own desires and resolving that ambivalence, either toward a change they were considering or away from that change – whatever the feel is best for them.

    MI, like every single other thing out there in the wide wide world CAN be perverted, distorted, abused, misused, or poorly practiced. But there is a big difference between saying “these are the premises of MI” and saying “these people are abusing the premises of MI.” Big difference.

    • Thank you, Andrew, and others, for this clarification about MI. I have witnessed that MI is a very worthwhile approach, when it adheres to its foundational principles. But this article also shows how the most well-intended approaches almost inevitably will be co-opted, misused, and absorbed even by the perspectives they seek to provide an alternative to. This can happen both insidiously and innocently, such as when the basic ideas are misconstrued and adapted into an otherwise inhospitable paradigm.

    • I just found out that one of the first line meds prescribed for Multiple Sclerosis— baclofen– is only effective for 1 out 4 people being treated for MS, and the other— amitriptyline is simply not effective. Baclofen can cause such an awful state of agnosia, sensory distortion, and depersonalization; that one would have to withdraw completely from it to see what it did.

      Seems neurologists are being influenced by something other than evidence, and seeing as how both of those neurologists worked in a V.A. hospital and the other (the intern) worked in both the V.A. hospital and a research hospital; one might think they would be a bit more on point as far as knowing what they’re prescribing. Going by the current algorithm appears to be wrong, harmful; and a waste of precious time, money, and well-being. It’s the kind of thing a committee needs to take care of and pass down to clinicians.

    • Andrew,

      I agree with Kermit that this is an excellent, mind blowing explanation of “motivational interviewing.” Given my experience with DSM psychiatry/psychology, I am pretty jaded when it comes to these newer approaches in “mental health,” but I am all for excellent types of self help or help in general that actually help rather than causing more harm.

      Based on what you say, I can see how it can be very helpful when used in an honest, ethical fashion unlike the unethical usage by drug companies that Dr. Healy exposes above. I don’t think Dr. Healy is criticizing MI, but rather, this corrupt usage of the technique to serve their nefarious, hidden agenda.

      As a matter of fact, the way you explain it, motivational interviewing can even be used for self help once one is taught how it works. There are very few decisions or actions in life that don’t cause us ambivalence, cognitive dissonance, approach/avoidance, mixed feelings or what ever terms we use to deal with the fact that there are usually pros and cons for everything we do. Benjamin Franklin suggested drawing a line down a paper and listing pros on one side and cons on the other and making a decision based on what seemed the best alternative.

      Anyway, though your explanation sounds simple, it helped me to see how this idea can help those like me struggling with any issue whether it’s avoiding toxic junk food (mostly prevail), cigarettes (I did quit), drugs, excess anger, procrastination (often driven by perfectionism) and all those other things that appear so obviously negative on the surface while we have subconsciously come to experience such self defeating habits or behaviors as providing some benefit even if only immediate gratification when stressed as opposed to the long term benefits of avoiding them.

      Allen Carr’s books on The Easy Way to Quit Smoking and The Easy Way to Lose Weight brings all these supposed benefits of these toxic habits to the surface so that you are forced to acknowledge and confront them rather than remaining paralyzed into inaction with denial or worse, constant failed attempts.

      So, the fact that you gave me helpful insights into my own struggles with your great explanation of MI, I can see where this could be very helpful, but as you and Kermit say, any abuse of this technique as with cognitive therapy for manipulative purposes will probably cause much resistance, a sense of betrayal and failure of this technique as well as any trust in the practitioner.

      Perhaps adjunct bibliotherapy might help as with David Burns’ classic books on cognitive therapy like, Feeling Good, Albert Ellis and others. Can you recommend any similar books/resources on motivational interviewing that you have found helpful? Kermit?

      • “Benjamin Franklin suggested drawing a line down a paper and listing pros on one side and cons on the other and making a decision based on what seemed the best alternative.”
        Yeah, that is basically the most effective way to deal with any life decisions, maybe + following your gut feeling.

  8. That’s sophisticated commentary on sophisticated marketing.

    Would you say that H.R. 3717 is “exceptionally predatory marketing practice?”

    A TV show last night (Monday 7/7) “Law and Order” the drama script has A man who was magna cum laude in law school. Now he is “crazy sometimes.” He leaves a woman for dead all hacked up. She identifies him. He is an unmedicated schizophrenic. He was stalking nice woman and then his voices order him to kill. He stays on his medicatio for a few months and then thinks he is well and goes of them. When he goes before the judge he asks to be his own counsel and be let go on bail and to have the same deal they offered before. He looks disheveled and auful. His lawyer says he wants him on medication asap. 3 days later back in court he is shaved and arguing law, he speaks very well, (The “medication” is shown to us the viewing audience “work” very well in three days) , We can see him pause in speeking and one eye twitches (we at home see this Schiz contained and controlled inside this madman, like an interbal demonic presence.) He speaks so very well that the judge allows him this time 3 days later to be his own counsel! The DA it turns out had this same Schiz in court before, for stalking, and that time too he was on the Meds and the DA cut a plee bargain and just let the schiz go free ! The people in the city learn of this and want the DA to answer for this terrible plee baragining and letting go of the schizoaffective man who was slating before !

    If only, if only they had given this schizoaffective forced monitored drugging with the “medication” that obviously works so wonderfully well in controlling the madman and containing the madness inside him — then, these nice women would not have had to die.

    Further more a relative had called this DA that freed the dangerous schizoaffective. The concerned sister had tried to warn the DA that the schizoaffective stops taking their meds and when in law school attacked a woman. But the DA was too busy and assumed the relative just called for leniency – not to help warn the DA.

    Thus this TV drama script may have been written by the same groups that plan the material such as HR3717. The messages included in this “independent” mere TV police drama dovetail the HR3717 messages of the importance of the valuable, effective “medications” (tah just happen to be exceedingly lucrative) (and never-mind all the revelations in the news in the last 15 years) forced drugging, and increased funding for inpatient wards and “anosognosia”

    The dirty homeless man, who is in fact a psychotic stalker and killer, turns almost believably into a well dressed, lucid, person — and is able to argue points of law extremely well — in court — three days after restarting taking his meds.

    How great they are at controlling these people and their brain disease/mentaldisord. If only families could be heard. If only all the homeless could be forced to take risperidone and other modern medications – then they wouldn’t be homeless and everyone would be safe. For the love of God- pass HR3717 !

    Law and Order EP21 Pro se (Pro se is a Latin phrase meaning “for oneself” or “on one’s own behalf)
    http://tvtropes.org/pmwiki/pmwiki.php/Recap/LawAndOrderS6E21ProSe

    Dan Burdick, Eugene Oregon USA

    Murphy on CNN Discussing the Fort Hood Shooting and Mental Health Reform
    https://www.youtube.com/watch?v=vNpQvsFOxH8 — 1% need forced “treatment” with “medication”

    Representative Tim Murphy (R-PA) talked about his Mental Health Crisis Act. The bill seeks to improve access to and delivery of psychiatric care for patients and families most in need of mental health services. He also commented on the previous day shooting by a U.S. soldier at Fort Hood, Texas. 
    http://www.c-span.org/video/?318597-5/washington-journal-mental-health-crisis-act

    Tim Murphy
    The “seriously mentally ill” often encounter law enforcement after refusing “medical care.”
    http://www.c-span.org/video/?c4500509/rep-murphy-helping-families-mental-health-crisis-act

    APA’s Dr. Jeffrey Lieberman Praises Murphy Mental Health Reforms
    (Over half of the mass killings that have occurred in the last five years have been from untreated people with “mental illness”)
    https://www.youtube.com/watch?v=RFjBxTNxYEs

    “A lot of these people don’t think anything is wrong with them.” — Need to take “Medicine”
    http://www.cbs.com/shows/60_minutes/video/soGlypvLRzos_I1HQpk7GV5oFP0RZxfM/when-schizophrenia-leads-to-violence/

    Dr. Jeffrey Lieberman shows what “schizophrenia” looks like in the brain
    http://www.cbs.com/shows/60_minutes/video/SOjcoqZPk3G9BWO_sJ6qMZiOIQ9IrWSq/schizophrenia-in-the-brain/

    • It’s a shame that so many people conflate television tropes and plots with being informed; which is why I challenge everyone to play my game of re-evaluation—- it’s easy to play. For instance, if you find yourself thinking that the art and crafts strewn all over your fastidiously clean living room, would scare people who can’t tell the difference between clutter and dirt; ask yourself, “Is this true for Pygmies?” An image of Pygmies hoisting spears in a defensive position should put an end to that thought, and anyone who does come into your house and react as if you lived in a pig sty can be mentally adorned with a spear and hunting attire for protection in your head, while you smile and let them defend themselves instead of rushing around trying to make that guest comfortable by reacting as if your space were truly offensive.

      Another aspect of this game is, “Really?!” So, if you find yourself saying that someone is approaching something like “a bloodhound on a trail”, ask yourself if you’ve ever seen one actual bloodhound in your whole life, much less one on a trail. Sure, you can take for granted that the species’ reputation is well earned, but I bet there are a few useless bloodhounds out there.

      Of course, it’s more fun when two can play, but they have to be two people who are accustomed to thinking out loud together, are respectful of each other, and who laugh every day, when not inappropriate.

      Television is programming even to the most critical observers, it can be easier, I think, to take apart and examine in our heads while not watching it and when we see it reflected in our society.

      Today’s television and film portrayals of “mental illness” and mental crises are, generally speaking, poor and cliche. They’re every bit as unscientific as those old Freudian plots in which a man has amnesia and is struggling against it while being melodramatically haunted; but THEN, he smells the flowers, and remembers that he killed his mother! Whoo! It all comes back to him and he’s restored to sanity.

    • Yes, I’ve seen these disgusting shows too with their fraudulent misrepresentations of the supposed great success of the psychiatry/Big Pharma cartel. But, notice they don’t expose the fact that most such horrible acts are perpetrated by psychopaths/sociopaths/malignant narcissists because it hits too close to home.

      Also, one must consider all the destroyed lives and murder caused by the psychiatry/Big Pharma/corrupt government hacks cartel based on total deliberate despicable fraud, greed and lies. This makes it immediately obvious that their huge deliberate, massive global genocide in the guise of mental or other so called health as exposed in works like The Shock Doctrine and Political Ponerology makes any individual crimes done for any reason pale in comparison. Also, consider all the fraudulent wars like Vietnam, Iraq and others to enable the military industrial complex to aid and abet their crony capitalist pals around the globe to rob the world’s wealth and resources while enslaving the 99% with the big lie of anti-terrorism to rob one and all of their democratic rights and livelihoods. But, it’s hard for normal humans to comprehend psychopathic intraspecies predators with no conscience, empathy, compassion, ethics or shame, need for excitement, sadism and other deadly traits covered with glibness and excess charm as they ferrit out our human weaknesses and strengths to exploit, which is why we are so easily conned and victimized by them until we learn the red flags of their limited manipulative ploys. One can learn about such dangerous predators by reading Dr. Robert Hare’s great books, Without Conscience and Snakes in Suits: When Psychopaths Go to Work; John Clarke’s Working With Monsters or Dr. Martha Stout’s The Sociopath Next Door. For those who don’t like mental “health” labels and fables, just substitute the term “evil” for psychopath and sociopath or other character deficits. There are lots of great examples in the world’s wisdom/religious works. See Dr. M. Scott Peck’s The People of the Lie.

  9. Excellent article; thank you for the community service of articulating the pseudoscience of the medical model of emotional distress.

    My only concern is about the title to your article; you satirize empowerment when this seems like a serious issue in mental health care. Biological psychiatry does substantial harm to the community when convincing the public that emotional distress is biological and beyond the ability of sufferers to affect change.

    Best wishes, Steve

  10. Hi Dan,
    I just read your comment and I’m upset about this too. The one stratagem that hasn’t been tried and I wish was is to see if a class action lawsuit might be filed against the purveyors of such hate speech. Make those who claim that people with psychiatric disorders have a biological defect of the brain prove it in court under a class action tort claim for defamation and libel. Make those who claim labeled people are more prone to violence prove that to a jury. Make those who claim psychiatric drugs are efficacious in reducing violence do likewise. Make those who go up and down as a talebearer among the people pay damages for the unemployment or underemployment they cause.

    The trouble is, where can an attorney or law firm be found with the stones to take such a case? The Bars of most states have considered a person with a psychiatric label to be unfit for admission to the Bar based upon its “Character and Fitness”portion of its exam.

    The claim that one group on the basis of a true or claimed biological distinctiveness may deprive the rights of those they hold their inferiors is what the eugenics movement held. It is what the Euro Americans who enslaved Afro Ameicans held. It is the same claim held by Euro Americans who committed genocide upon Native Americans. It is the same claim that permitted the Nazi doctors to conduct sadistic experiments on Jews and Gypsies in Europe and American doctors who experimented on Afro American men to discover the long term course of syphilis. It was the rationale for the Holocaust. It was the foundation of feudalism which maintained that only those of “royal blood” could own property. It is the rationale for nearly every kind of enslavement, genocide and inequality there has ever been. It amounts to a kind of racism.

    • Vet, this statement of yours amazed me: “The trouble is, where can an attorney or law firm be found with the stones to take such a case? The Bars of most states have considered a person with a psychiatric label to be unfit for admission to the Bar based upon its “Character and Fitness”portion of its exam.”

      Are you referring to the disqualification of someone who is actively suffering from a mental disorder? Or do you mean someone who merely has been so diagnosed at some point in his/her past? If it’s the latter, I can’t imagine that human rights legislation allows such discrimination.

  11. Pharma is now promoting the so-called “preventive medicine” – drugs which treat pre-conditions, which may or may not develop into illnesses in future. Instead of advising people to change their habits you get drugs which were never proven to prevent the development of these diseases and which have ample side effects. It’s a major and dangerous scam.