Looking forward to the Good Ol’ Days

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One of the most remarkable aspects of Robert Whitaker’s (2010) outstanding book Anatomy of an Epidemic was his comparative data that contrasted outcomes for mental disorders prior to the introduction of pharmacological treatments with outcomes for mental disorders after pharmacological treatments became the main, and often only, course of action. I have asked people in workshops to estimate who might be better off – someone diagnosed with what we now call bipolar disorder prior to the introduction of lithium or someone diagnosed after lithium became a standard treatment. Almost without exception workshoppers estimate that the people diagnosed before lithium was available do much worse. Whitaker’s data indicate exactly the opposite. It’s a staggering finding.

The data about depression are perhaps even more mind-boggling. Healy (2004; Healy et al., 2001) maintains that the frequency of depression has increased a thousandfold since the introduction of antidepressants. Would this be acceptable anywhere else in medicine? Imagine disseminating a treatment for tuberculosis and then discovering after the treatment had been in widespread use that the prevalence of tuberculosis had increased by a factor of 1000.

The field of mental health today could be characterized by expanding diagnostic categories that include more and more people who are subjected to treatments that do not cure and, in many cases, do not even enhance recovery. This situation is troubling enough on its own but it perhaps also indicates a more fundamental problem. We seem to be developing a social environment in which difference is not tolerated. Any quirk or eccentricity is now suspiciously considered a sign of a lurking “mental illness” and a mythical state of eternal happiness is relentlessly promoted and pursued at any cost. Life is no longer viewed as a journey of ups and downs but a high-speed, multi-lane highway that travels over the countryside rather than meandering through it. In all of the gains we have made in modern times, have we also lost some of our humanity?

In many ways we are living in a glorious age. There are certainly still important and serious problems to overcome but many people enjoy a quality of life that would have been unimaginable a century ago. We have developed technology that allows us to maintain an unprecedented level of contact with the world around us yet, in some respects, as individuals we may be more disconnected now than ever before. Many friendships and social relationships are maintained in the mysterious and nebulous e-world where, to a very large extent, people can present whatever image they desire. Texting people or communicating with them on facebook is different in important ways from sitting across the table from them in a café. Blogging, as I am doing, would not be possible without the incredible advances we have made in e-communication and there is much to be gained from utilizing forums such as this one to disseminate and share ideas. Blogging sites have given a voice to many who previously would have been silent and so in that sense they are invaluable. We all have an opportunity to learn in environments such as these.

There is much that is good about the modern world and a return to the past would not necessarily be desirable even if it were possible. There are some aspects of today, however, that are not advantageous when compared to yesterday. As already mentioned, many more people are being diagnosed with psychiatric problems than before but we are not developing treatments of increasing effectiveness. While this is certainly true for pharmacological treatments it also seems to be true for psychological treatments. Although we have hundreds of “brands” of psychotherapy available today, it is not clear that the treatments on offer are more effective than previous treatment options. For example, over a span of more than three decades, a meta-analysis of psychotherapy for depression indicates that effect sizes declined until about 1995 at which point they stabilized somewhat (Collins, 2010).

In my book Hold that Thought? Two steps to effective counselling and psychotherapy with the Method of Levels I make the point that each therapy has different techniques and different models for psychological problems that arise. Suppose that three different people went to three different therapists and received three different treatments for depression and they all improved similarly. Could it really be the case that three people just happened to access the specific treatment that matched their particular types of depression? It is much more likely that there is something common going on whenever any therapy is effective.

An important aspect of that “something common going on” involves making a connection with a therapist. It is well known that the therapeutic relationship make a substantial contribution to treatment outcome in psychotherapy. It is less well known why. Qualities such as hope and trust are often discussed but even these are not entirely satisfactory in terms of explaining what the essential element might be. Perhaps the connection that is established allows people to look at those aspects of themselves that they would ordinarily avoid (Carey, Kelly, Mansell, & Tai, 2012) which promotes a fundamental learning and re-learning of who they are and who they want to be within their social context. Maybe if we focussed on promoting this aspect of therapy rather than the elements that make each therapy distinct we might achieve major leaps forward in terms of effectiveness.

The notion of “individuals in context” should not be underestimated. We are inherently social beings and while we can vary on what the “right” amount of socialising is for each of us, the social context is universally an important consideration. Even hermits and others who shun social living are making decisions within the context of their place in a social world. Increasingly we find ourselves in a disconnected social world.

Perceptual control theory (PCT; Powers, 2005) highlights the importance of context by describing a precise relationship between our behavior and the environment. PCT explains how different behavior can be used to achieve the same goal and the same behavior can be used to achieve different goals depending on the context. Booking a table at a restaurant and washing a car can both be ways of communicating affection. Standing on the curb and waving one’s hand could be to hail a cab or to catch a police officer’s attention or to say goodbye to a dear friend.

The crucial point here is that, in order to understand people’s behavior accurately, we need also to consider the environment in which they are functioning at any point in time. So-called “crazy” behavior may indicate that the person is responding to what he perceives to be a crazy environment. Chaotic behavior may, similarly, mean that the individual is experiencing her environment as chaotic.

This principle illuminated for me the common finding that children at school can be experienced differently by the teacher than they are by their parents. I remember as a preschool teacher having parents complain about the behavior of their children yet I found their kids to be complete delights in class. Similarly, some children who seemed to struggle at school had parents who reported no problems at home. These occurrences are completely understandable when the demands and requirements of different environmental contexts are considered.

It is interesting to me that the array of childhood diagnostic labels is primarily social-relational in nature. Labels such as “Asperger’s Disorder”, “Oppositional Defiant Disorder”, “Attention Deficit Disorder”, and “Conduct Disorder” all have something to do with a perceived rupture between the child and the child’s environment. Regrettably, labelling a child with a disorder serves the function of diverting attention away from whatever difficulties there might be in the behavior-environment relationship and places full responsibility for the problem with the child.

Given the social nature of many of the problems children can be labelled with, should we wonder about the developing child’s understanding of social relationships given the long hours many children spend in day-care situations? Sometimes, from before they are 12 months old, youngsters are looked after by day-care centre staff. Regardless of the quality of the staff, or the necessity of this arrangement, we need to consider what children might be learning from a very early age about social relationships and how they are formed and maintained. What connections are they forming and what are they learning from and about these connections? What expectations are they developing with regard to their social interactions with others?

Perhaps we are still in a state of transition. We have developed a new world of e-toys and we are still learning how to play nicely with them. For some people it seems as though the e-world has become a replacement rather than a resource for the social world. Also, e-technology has the capacity to make an enormous contribution to health services in rural and remote locations but, even here, their use needs to be carefully thought through. Where they are used to augment and enhance face-to-face services they are likely to be extremely effective, however, if they are used instead of face-to-face to services they may not be as beneficial as they otherwise might be.

There is still much we can learn from the past when people were, arguably, more interpersonally connected than we are today. Perhaps the quantity of social connections was smaller but the quality might have been much greater. Emailing people is terrific, eyeballing them is better.

Despite all the advances we have made, the best things people can do to look after themselves remain remarkably stable over time: eat a balanced diet, exercise, get enough sleep, maintain friendships and other social relationships, and so on. Life seems faster now that it was “back then” but we don’t seem to be getting anywhere more quickly than we did before. Reclaiming time and taking more of it is perhaps the best thing we can do to get to know ourselves and each other more closely. Family meal times do not only provide nutritional sustenance they provide relational nourishment as well. Sitting around the dinner table talking, laughing, even squabbling as a family, provides an old fashioned remedy to many of the daily strains and stresses of modern life.

We are very much living in a “data age” where people count anything from the number of calories they consume to the number of steps they take on a given day. Perhaps we should also count the number of quality connections we make each day. How many people did I laugh with today? How many eyes did I look into?  In the midst of our superb modernity we need to stay in touch with what’s important. Recognising our place in the social sphere, taking time to connect, and getting to know better both ourselves and those we are close to will help us build lives of meaning and value at a time when the quality and importance of our connections threatens to be eroded.

 

References

Carey, T. A. (2008). Hold that thought! Two steps to effective counseling and psychotherapy with the Method of Levels. Chapel Hill, NC: newview Publications.

Carey, T. A., Kelly, R. E., Mansell, W., & Tai, S. J. (2012). What’s therapeutic about the therapeutic relationship? A hypothesis for practice informed by Perceptual Control Theory. The Cognitive Behaviour Therapist, 5(2-3), 47-59. doi:10.1017/S1754470X12000037

Collins, M. (2010). Identification of real and artefactual moderators of effect size in the treatment of depression. Unpublished Master of Clinical Psychology Thesis. Canberra, ACT: University of Canberra.

Healy, D. (2004). Let them eat Prozac: The unhealthy relationship between the pharmaceutical industry and depression. New York: New York University Press.

Healy, D., Savage, M., Michael, P., Harris, M., Hirst, D., Carter, M., Cattell, D., McMonagle, T., Sohler, N., & Susser, E. (2001). Psychiatric bed utilization: 1896 and 1996 compared. Psychological Medicine, 31,779-790.

Powers, W. T. (2005). Behavior: The control of perception. New Canaan, CT: Benchmark.

Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Broadway Paperbacks.

33 COMMENTS

  1. Without the web, I might have been completely subsumed by psychiatry and one of the medications I’ve taken for MS. It’s the biggest library ever and it’s ever expanding.

    It’s true that the social world on the web is truncated and very limited, but that is to some degree true in the face-to-face world as well. Our lack of community and the degree to which our behaviors and values are forced into the molds of capitalism and business school management protocols leaves us without community.

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    • Thanks for your perspective. It’s true that a lack of community can exist in the world of interactions as well as the world of e-interactions. The web is a wonderful resource and I wouldn’t like to be without it. At times, though, the possibilities on the web (such as online therapies) are offered as alternatives to talking therapy rather than as additional resources and I think that’s a shame. it shouldn’t be a case of “either/or” but “this and that” depending on the person, the problem, and the circumstances.

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      • Hmm. I learned a lot from face-to-face therapy, for the most part, because I took advantage of a lot of schools of thought and quite a few different counselors and even lay counseling.

        The last time I got counseling, it was from a psychologist who specialized in cognitive therapy and it felt like I was there for him to practice his style of therapy more than he was helping me process trauma. It seems that psychology is suffering from a loss of dynamics and maintaining a narrow focus. At this juncture, I’d rather talk with a philosopher.

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        • This is a good example of why options are so important. Different things are useful for different people and different things are even useful for the same people at different times. And for me some of the most important options are informational: learning that there are ways to think about problems of living other than “mental health disorders” and learning that there are ways of helping other than chemical.

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          • I think there is also one advantage of the web counseling – I think it’s way easier for people to open up and talk honestly when they feel like they’re anonymous (of course that’s just an illusion but a useful one). Having a person sitting across to you may feel like you constantly need to evaluate this person’s body language, tone of voice etc. for hidden clues – in the online communication it’s all about what you and the therapist say and it may provide a distance which is needed for someone to openly discuss his/her issues.

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    • I think the interactions and relationships one forms in real world as opposed to internet are simply different. They are not replacements, they are completing. The interactions you form in real world are more often based on chance, on where you happen to live, what interactions your family has, what school you go to etc. They are influenced by how you look, what sex you are, how much money you have etc. In the internet if you don’t want to you don’t even have to provide any of that data – it offers you freedom from these restrictions and the only thing that guides your relationships are your interests, your intellect and ability to express yourself.
      My relationships and connections in the real world are sometimes very different from my interactions on the web and I like it so. I think internet brings me to people I would have never be able to meet and talk so it expands my horizons but it also shows me that there are more people who think like me and share my views – this is very validating though it does create a bubble of sorts.
      I think it’s just important to keep the balance and take what’s best from both worlds.

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      • Anonymity can be an important part of the therapeutic process. Sometimes internet resources can provide this but it’s also possible to achieve in a face-to-face session. Some of the people I work with, for example, tell me that they like the fact they can say anything to me because I’m not in “their world”.
        I think you’re right that there are many good and useful parts to both sorts of relationships and keeping a balance is likely to be a key factor. And what is balanced for one person might not be so balanced for another.

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  2. I have no problem with this article. Nothing to argue about. There are many such articles on MIA now, but I am really not understanding where MIA is going. There are many outlets for articles like this. There is almost no outlet for talking about how to actually change what is being done to people trapped in the “mental health” system.

    People are being abused and damaged by psychiatry in huge numbers. How does publishing articles about the fine points of therapy help to end those atrocities?

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    • Thanks Ted. It’s an important question. There’s certainly a growing number of articles and authors pointing out different problems and different perspectives about the current state of play in the mental health arena. I kind of think that’s a good thing. Lots of different ways of saying similar things has the potential to be helpful to lots of different people. I’d like to think articles such as these help inform people of options so that they are in a better position to make decisions. I also think that the more articles that are produced by a range of people of varying backgrounds, educations, and experiences will help to demonstrate that the tide really is changing with regard to the way we conceptualise and treat mental health problems. It’s changing slowly but it’s definitely changing. A few years ago there wouldn’t have been a forum to even discuss ideas like this. That MIA and other sites like it exist is a very good thing.
      So how does publishing articles like these help to end some of the less desirable practices of psychiatry. I’m not sure. I work with people who think they’ve “got” one or more of the DSM disorders among other things. If articles like these can help them question what they’re being told and maybe seek a different story I think we might begin to see the end you’re asking about.

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        • Hi Oldhead,
          I’m not sure what you mean by “class analysis” and I’m not sure specifically which insights you’re referring to. If you’re asking whether I think social class is important in understanding individuals then the answer is “yes”. Some of the other comments in which I mentioned the importance of context and individual’s perspectives speak to this point.

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  3. I was drugged for concerns my child had been abused. But the medical evidence proves, in fact, he likely was. And I’ve been told by subsequent pastors that the function of the psychiatric industry is to cover up sexual abuse of children for the religions. Is that actually appropriate? I don’t believe it is.

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      • Well, then you’re extraordinarily lucky – I know exactly zero “excellent psychiatrists” and I happen to know some. In my experience there are 2 main classes: people who do what they were told is their job and don’t use their brains and people who are malicious.

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        • That’s a shame. That hasn’t been my experience. I’ve worked in both the UK and Australia and have found that in psychiatry, just like in any other profession, there are highly effective practitioners and others who are not so effective. Some of the loudest voices advocating for mental health reform are, in fact, psychiatrists. Perhaps it’s because of the power the psychiatry profession is afforded that the effects on people’s lives can be so devastating when psychiatrists are ineffective. Other mental health professionals who don’t listen to the people with whom they’re working, who don’t attempt to consider the situation from the other person’s perspective, and who make assumptions about what would be best for the other person can also cause harm. Many other mental health professionals, however, can’t detain people against their will, can’t prescribe medication or ECT, and can’t force people to be treated involuntarily. When these things are used inappropriately by psychiatrists the harm is likely to be much greater.

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          • Yeah, I’m under no illusion that other professions or even other medical doctors are any better statistically. But when I don’t like my GP I can walk out or don’t take the drug. In fact I regularly do that since some idiots prescribe antibiotics for viral infection or want to remove your tonsils every time you see them. Some are not really “bad” they are just not particularly clever or willing to take 5 minutes and think. In my whole life I’ve met maybe like 5% good doctors, the rest are at best OK if you ignore half of what they’re saying or tell them what they should think (usually you have to pretend like it was their idea because overblown egos are very common). Problem with psychiatry is that they not only are just as bad – they are much worse because the whole field is based on a bunch of nonsense and pretty much none of them wants to take a step back and think. Plus there is little negative feedback working on them since if they don’t like you they can lock you up and drug you against your will and don’t have to bother themselves with your feelings and mental/physical wellbeing. If tardive dyskinesia or complete memory loss are “acceptable side effects” then it’s not just bad doctors it’s criminals.

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          • Well said, B.

            I’ve never known an excellent psychiatrist either, and I’ve known many psychiatrists.

            Tim said,

            Many other mental health professionals, however, can’t detain people against their will, can’t prescribe medication or ECT, and can’t force people to be treated involuntarily. When these things are used inappropriately by psychiatrists the harm is likely to be much greater.

            I’m glad you recognize that psychiatrists have powers that other professionals do not. There is, however, no “appropriate” way for a doctor to conduct incarceration, forced drugging, or electroshock. One might also consider how, as an “mh” professional, one’s experience of psychiatric “effectiveness” might differ considerably from the experiences of mental patients.

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  4. “This principle illuminated for me the common finding that children at school can be experienced differently by the teacher than they are by their parents. I remember as a preschool teacher having parents complain about the behavior of their children yet I found their kids to be complete delights in class. Similarly, some children who seemed to struggle at school had parents who reported no problems at home. These occurrences are completely understandable when the demands and requirements of different environmental contexts are considered.”

    Gday Tim,

    I can’t help but wonder if your conflating the subjective interpretation of the observer and the environmental context here.

    For example you describe a situation where a three people go to three therapists. I was having a discussion with someone and explaining that if I go to three doctors in different parts of town with a skin cancer, tests will be done and one would expect that all three doctors would give a diagnosis of skin cancer and recommend treatment paths.

    However, if I were to go to three psychiatrists, I would quite possibly get three separate diagnoses, and recommended various medications for these ‘illnesses’. So whilst the environmental context is most certainly important, the subjective interpretation of each individual therapist is always going to effect how that environment is understood.

    Minus any truly objective test, the problem of ‘behaviour’ is always going to be dependent on the eye of the beholder. This of course is Art, not Science.

    Do you see consistency across therapists with regards diagnoses?

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    • G’day!
      The problem of behaviour as we currently understand it is most definitely dependent on the eye of the beholder. My preferred way of thinking about behaviour is based on Perceptual Control Theory which explains behaviour from an inside looking out perspective.
      There can be some consistency across therapists with regard to diagnoses depending on different facts such as the particular diagnosis being considered. As you point out, the environmental context will also be important. For me, though, consistency is not such an important issue. It’s quite easy to get consistency or agreement between people about various things. Based on nothing more than a date of birth, for example, it would be easy to get quite robust consistency across people with regard to the particular star sign that various people should assigned. It would also be possible to have people consistently identify Santa Claus, the Tooth Fairy, and Mickey Mouse from a line up. Consistency is useful in some context but it’s a red herring when it comes to establishing the legitimacy of a construct. The degree to which a particular mental health disorder diagnostic label is consistently identified should not be taken as evidence that the disorder either does or does not “really” exist.

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    • That should read “how that environment/behaviour is understood”.

      I find this issue of environmental context of particular interest. The Mental Health Act in Western Australia states that an Authorised Mental Health Professional “who suspects on reasonable grounds that a person should be an involuntary patient” can detain that person. When I contested the “reasonable grounds” of a referral with our Chief Psychiatrist he reworded that particular section of the Act to read “The referrer has only to ‘suspect’ on grounds they believe to be reasonable” that a person should be involuntarily detained.

      I don’t know if you can see the substantive change in this, but it takes what is an objective legal standard (suspect on reasonable grounds) and turns it into a subjective interpretation that can not be tested (‘suspect’ on grounds they believe to be reasonable). This of course provides AMHPs with carte blanche to detain anyone they wish without any accountability.

      I am at a loss to understand why the Chief Psychiatrist whose primary responsibility is to protect the rights of consumers, carers and the community doesn’t know what those protections are.

      What was actually done by the AMHP was to omit significant environmental factors, and it made what were perfectly rational behaviours , appear irrational, and thus created the “reasonable grounds” required to detain. So the protections of the Act are easily subverted by the omission of environmental context, and if one makes a complaint to the person responsible for protecting the community, one finds that he is unaware of those protections.

      It then becomes a matter of ones creative writing skills, and has absolutely nothing to do with objective facts as to which ‘illness’ a person has.

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      • “There can be some consistency across therapists with regard to diagnoses depending on different facts such as the particular diagnosis being considered.”

        This was particularly problematic for me. The AMHP started with the intention of making me look mentally ill in order to create the reasonable grounds for detention. He did really well, as anyone who examines his Form would suggest that I was a violent, psychotic, drug abusing, wife beater.

        Of course when I was examined by the psychiatrist and the context of family conflict was included, I was the victim of domestic abuse, with no illness, and my decision to leave my home was perfectly reasonable.

        This type of inconsistency across mental health professionals that results in the trauma of being deprived of ones liberty quite possibly causes more damage than the actual illness a person may be suffering from. I know it was a “major contributing factor” in my attempted suicide.

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        • Part of the problem for me is the “lens” of mental illness that we often have before us in the mental health field when we’re considering the conduct of another person. To step away from that lens and to seek to understand the person, their aspirations, and the environmental contexts they are operating within would move us a long way towards helping people live the sort of lives they would want for themselves.

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          • Precisely Tim. It is a source of amusement to me that people trained in the scientific method fail to test the null hypothesis. Time and time again I have seen people labelled with an illness as a result of confirmation bias.

            Thanks for your comments. My issue with the Mental Health service here in WA only really relates to forced psychiatry, and the use of the corrupt practice of “verballing” being used to make unlawful detentions appear lawful. It is an insidious practice costing and destroying lives, but does make the job easy.

            I have offered our Chief Psychiatrist my services to teach this corrupt practice to staff at our hospitals, given that he is enabling this behaviour by his refusal to act on complaints. I feel sure that like the issue of institutional responses to child abuse, at some point someone is going to actually notice what has been occurring.

            I’m sure you are busy, but if your interested in how this corrupt practice is being used I have posted a thread in the forums entitled “communication breakdown”.

            Good luck Tim.

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      • Context for me is always crucial. Understanding behaviour requires understanding the environmental context in which the behaviour occurs. Different behaviours can be used to achieve the same goal and the same behaviours can be used to achieve different goals depending on the environmental circumstances.

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  5. I had a read through your “communication breakdown” forum Boans. It sounds like you’ve had a really rough time of it. I hope things are picking up for you now. I know there are potential problems with any system but I can’t help thinking that our current allegiance to an “illness” model of psychological distress is a big stumbling block in the path of progress.

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    • Thanks for taking the time to read it Tim.

      Yes a rough time I’ve had, which is to be expected I guess when attempting to have some action taken against criminals being enabled by the state.

      The major problem with the ‘system’ it seems to me is that whilst our laws reflect a community value on liberty, mental health practitioners and our Chief Psychiatrists hold very little value in the liberty of individuals. So little in fact that the attitude is that a person can be deprived of their liberty on some fictitious ‘illness’ that can be fabricated through creative writing.

      I understand why they may feel a need to detain people who the are ‘suspicious’ of, and that there is a liability issue should someone point the finger at another. The ease with which the protections can be subverted by such practitioners, and the zero accountability, to me shows that not only does our society not value an individuals right to liberty, but that the abuse of that right is being encouraged by those charged with the protection of this right.

      Still, we don’t live in America, and whilst I feel like a defacto American who shares the values of “life, liberty and the pursuit of happiness”, this is not shared by many in the mental health system. The laws are actually very well written with protections for the community, the way that they are being enacted, and a lack of accountability is why our mental health services have the reputation of being a total failure to those they are being paid to serve.

      With the Chief Psychiatrist enabling the corrupt, and corrupting the good, what hope is there? So yes, the ‘illness’ model of psychological distress is no doubt a problem, but the enabling of corruption is the real cancer eating away at our society. But it does make the job easy, and save a few bucks.

      Or does it?

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      • I think the ability to live life according to your own, rather than someone else’s, design is important regardless of which country you’re living in or which culture you’ve been raised in. I’d go so far as to say that we’re designed to be autonomous, self-regulating creatures. That’s the reason I think having our autonomy restricted can be so painful.

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  6. Hi B,
    Yes, I think psychiatry as a field is at a disadvantage because of the whole “mental illness just like a medical illness” charade. Mind you, I know some psychologists who have just as much allegiance to the DSM as do many psychiatrists. Training in this model must make it ultra hard to take that step back in order to consider things in a different light. Some do however. Admittedly the numbers of psychiatrists who consider things other than medical explanations are probably small but there’s definitely a change in the air and some psychiatrists are making that change happen.

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    • I don’t find psychologists to be any better as a profession – in fact many psychiatrists I know have a second degree and in my humble opinion they suck at being either. The only difference is that psychologists so far don’t have that much ability to do harm.

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      • Hi B,
        I wish it was different but, unfortunately, there seem to be a lot of psychologists who are just as wedded to the medical model of mental health as psychiatrists. Interestingly some of the strongest opposition I’ve had to my patient-led model of treatment delivery has come from psychologists and yet some of the psychiatrists I currently work with a supportive of it. We also have some strong champions for mental health reform as demonstrated by Peter Kinderman’s recent post but we could definitely do better.

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  7. Hi Uprising,
    You’re right – I probably didn’t need to insert the word “inappropriate” in that sentence. I also agree that a mental health professional’s perspective is bound to be different from the perspective of a mental health patient although it would be a mistake to assume that a mental health professional has never been a mental health patient and so can’t have both perspectives. I’m aware that there have been lots of injustices and acts of inhumanity perpetrated by psychiatry and that definitely requires changing. Only very recently, however, I was working with a person with a long history of contact with the mental health service and very serious problems who was telling me how good his psychiatrist was. According to this person the psychiatrist listened to him, took his concerns seriously, and was working with him to taper him off some of his medication. This is only one small case but it provides me with a glimmer of encouragement that things are changing. Sometimes mental health professionals need hope just as much as other people. 🙂

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    • Thanks for the clarification. Yes, of course a person can be an “mh” professional and an “mh” service user, though one might argue that even someone with such a dual perspective might still have a considerably different take than an individual who has only been on the receiving end of “mh” services. Anyhow, I can see why you found the story of the tapering psychiatrist encouraging. We all need hope.

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  8. Yes definitely. A person who has been both a mental health professional and a person accessing mental health services will have a very different perspective. It will probably be different too if they became a mental health professional after they had accessed mental health services or if they accessed mental health services while they were a mental health professional. People’s perspectives based on their individual experiences will always be different. For me, that’s why it’s so important to make the perspective of the individual seeking assistance the perspective to be guided by. If I could change one thing about the mental health field that would be it. That’s why I called my approach to organising services “patient-led treatment”. I think mental health services might be both more effective and more efficient if the people accessing the service rather than the people providing it did more of the leading. Yep, hope is important. In many ways there’s not a lot of it out there but there is a little bit and that’s a start.

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