It’s the Coercion, Stupid!

David Cohen
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Because of psychiatry’s power to coerce, society gives psychiatric theories a free pass.

Both Michel Foucault and Thomas Szasz dated the beginnings of a distinct European institutional response to madness to the late 1500s-early 1600s. For Foucault it started in France with the creation of the public “hôpital général” for the poor insane. For Szasz it began in England with for-profit madhouses where upper class families shut away inconvenient relatives.

Despite their different ideas on the beginnings of anything resembling a mental health system, both authors agreed that it was characterized by the coercive incarceration of a specially labeled group.

Since its origins, the psychiatric system has coerced its lunatics and madmen and madwomen in madhouses, its inmates and patients in mental hospitals, its consumers and users in the community. (Yes, for a brief moment in the 1800s, British asylum superintendent John Connolly started a movement to ban all physical restraints within his establishment, but it didn’t last long.) The coercive element of psychiatry has persisted despite all changes in treatments, despite all changes in places for treatments. This is the invariant part of psychiatry.

My colleagues Tomi Gomory and Stuart Kirk and I argue in Mad Science: Psychiatric Coercion, Diagnosis, and Drugs that the only constant in psychiatry has been coercion. We also argue that no other treatment can compete with coercion — nothing. According to some psychiatric discourse and doctrine, for those who “need treatment the most,” only coercion makes the administration of a treatment possible. Not to mention that coercion itself has often been called a treatment.

I venture to suggest that most practicing psychiatrists, if pressed, would choose to replace or discard any existing treatment or intervention save one: the power to impose a treatment or intervention.

It seems to me that this coercive function is what society and most people actually appreciate most about psychiatry. That families and other people in crisis can call upon the police to restrain someone acting in a seemingly incomprehensible or dangerous way and have that person taken by force to a place run by psychiatrists is truly where psychiatry as a profession distinguishes itself. It’s the distinguishing service it offers or function it meets as a helping profession (aside, today, for the prescription of psychoactives).

(I hasten to add here that coercion is probably necessary for the survival of a social group, as we discuss in Mad Science, following the insights of author Morse Peckham. The questions are when is it used in a disagreement between parties, and by whom.)

In my view, society’s appreciation — its gratitude — for psychiatric coercion, for psychiatry’s extra- and intra-legal police function, has a largely unappreciated consequence: it supports the so-called knowledge base of that discipline.

That means that without the shock and awe of a coercive medical discipline, the flimsy theories and continually-refuted hypotheses of physiological defects as causes of distress and misbehavior would have to truly fend off on their own in the marketplace of ideas about what ails people, what makes them tick, and how to help them overcome their problems. Psychiatric theories would have to compete squarely against other theories and schools of thought, and it’s doubtful to me that they could do so successfully.

Society’s appreciation for psychiatric coercion subtly, but radically, imbalances the playing field. Because of psychiatric coercion, society gives psychiatric theories a free pass. These theories never need to pass any rigorously devised tests (as we expect other important scientific theories to pass), they only need to be asserted.

Here I am turning on its head the often-expressed idea that society supports psychiatric interventions because people believe that psychiatric theories are valid. And since “evidence” fails to support these theories and the hypotheses derived from them, so the belief goes, one therefore needs to debunk the theories by critical analysis of the evidence and the continual stream of findings.

But it’s the opposite in my view. The knowledge is not supporting the power. The power to coerce is what excuses the lack of valid knowledge.

I’m not discounting the influence of the biomedical-industrial complex, like a fish might discount water. But after decades of engaging in critical analysis of the psychiatric and other evidence, I conclude that there has never been good evidence to support psychiatric theories. Psychiatry has never ever needed scientific evidence to spread its ideas and practices, and possibly never will. Indeed, its top experts can state today that they have found no biomarkers of expertly diagnosed mental disorders and falsely promised the American public for decades that biomarkers were just around the corner.

Let’s face it: No one cares that psychiatric research of the past 50 years failed to turn up one finding of use for a scientific clinical psychiatry. The business of psychiatry continues with barely a pause.

In order to prosper, all psychiatry (and, increasingly, other mental health professions whose formerly distinctive training and theories are slowly blurring into one psychiatrized whole) needs is the social support for its coercive practices.

If so, removing formal coercion from the helping enterprise should be an investment that will yield the greatest actual return in terms of debunking the “psychiatric knowledge base.” Limiting mental health professionals’ option to coerce their patients and clients will open up the “mental health system” to a multiplicity of choices and interventions based on diverse schools of thought.

* * * * *

Note: Adapted from a talk given at Mad in America’s International Film Festival in Arlington, VA, October 12, 2014.

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62 COMMENTS

  1. Hi David,

    Great article.

    I heard one of our community leaders speaking on a panel a few weeks ago, one Professor Patrick McGorry. He claims that the big tragedy of mental health is that an article in the Lancet a couple of years back showed that they (psychiatrists) have treatments that “are as effective, if not more effective, than most of the treatments in medicine. People just don’t get access to them in the right way, in the right culture of holistic care”

    I know how I responded to many of his comments, I’m still wiping the screen of my television. But I wonder how you would respond to such a claim?

    Thanks
    Regards
    Boans

    • Thank you.
      Without knowing just what Patrick McGorry meant by people “not get[ing] access” to treatments (whether they’re not available, or they’re too expensive, or people are diverted away from them by first-line drugging, etc.), it’s difficult to respond clearly.

      It’s possible that Patrick McGorry meant by psychiatric treatments the whole range of interventions–individual, group, social, educational–available in the mental health system, which could make his comment reasonable.

      It is probably true that many people simply do not have access to alternatives to the usual “care,” principally for economic reasons, and secondly because these might not be offered in their community (again for various reasons).

      But, there are so many physical illnesses and so many treatments for them, that I’m not sure what is the accepted effectiveness rate for medical treatments–or if anyone has truly tried to estimate this for the whole range of medical treatments.

      There are various claims that both medical and psychiatric drug treatments are effective for about 70% of those who take them, but these have been refuted, lately, by the large CATIE, STAR*D, and STEP-BD studies: over a year or more, only about one third of people who take antipsychotics, antidepressants, and various other drugs report feeling better or not “relapsing.” (Neither of these studies included placebo controls, however.)

      But the notion of a “culture of holistic care” does sound quite appealing.

      Overall, I believe that less coercion would mean many, many more choices available in society for helping people in distress, because all of us would invest more creative energy and resources in trying to prevent breakdowns and crises that lead to the use of coercive measures. I believe that Richard Lewis makes this point in his recent blog on abolishing coercive treatment.

      • Thanks David,

        I do believe McGorry has good intentions but saw him do a bit of dodging on crucial issues. I have noticed in particular that these panel discussions virtually never discuss the issue you raise in this article, coercion and force. This is no coincidence. I got the feeling that McGorry was dog whistling for more powers of coercion and force to get people into the system and use these treatments he claims are so effective. I may be wrong.

        The other thing is that I forgot to make the comment I set out to make. I gave a copy of Dr Moncrieff’s article “Psychiatric Diagnosis as Political Device” to a psychiatrist a couple of weeks back with the comment “Here’s a copy of the Satanic Verses for you” lol. I think I might give her Chapter 2 next time we meet.

        Once again Thanks

        • Boans : this seems to give more impetus for the campaign against force with no room for excuses and exceptions. Trying to reason with a professional caste whose own members are belatedly admitting that their emperor has no clothes, is not our major task. Directly challenging their right to control as the community of Berkely CA did with regards to ECT is the way to go. It took me an amazingly long time to realize the absurdity of taking marching order from a bunch of couch potatoes.

  2. David,

    Wow (and wow again). Really… wow (three times).

    Somehow, you have just managed to articulate in this blog post of yours (above) the Ultimate Truth, about Psychiatry!

    And, you did it with fewer than 1,000 words — so clearly spoken…

    This blog post of yours is a definite keeper — (wow, again, truly); it’s one to share with anyone who can read English and has at least half a mind to know the ultimate Truth about Psychiatry… because it is so clearly stated.

    I will be sure to do my best, to spread this blog post of yours far and wide — and, in particular, will pass it along (at least, casually) to those ‘mh’ pros, communicating online, who, I notice — despite their claims of being ‘critical’ of psychiatry — continue to defend some supposedly ‘limited’ practice of psychiatric coercion and/or support, in particular, the some supposedly ‘limited’ use, of the direct assaults with drugs (’emergency forced drugging’) that’s sanctioned in every psychiatric “hospital” and in hospital E.R.s (‘Emergency Rooms’) everywhere.

    (I considered myself a critic of psychiatry prior to my actually meeting up with medical-coercive psychiatry, at age twenty-one; but, it was such an assault, as that — and a few more subsequent, similar assaults, in the course of two years’ time — that led me to really understand the nature of the Beast that is medical-coercive Psychiatry.

    (Sometimes, I wonder if anyone can really understand the nature of that Beast without having been clobbered by it — or without having had a beloved friend or relative quite blatantly clobbered and destroyed by it.)

    I sort of wonder how you came to your understanding of the nature of medical-coercive psychiatry; I think you may be somewhat new to MIA? But, your bio indicates you’ve been on this path for quite a while. (After reading your post, just moments ago, I clicked on your name, read your brief bio and discovered that you have posted one blog previously.Your bio is intriguing, and I’m now eager to go and read your previous post — indeed, will do so immediately after posting this comment.)

    Well, maybe I’ve heard mention of your name previously (I’m not sure), but I have not, prior to now, noticed your presence here, on this website…; so, welcome!

    Thanks for posting! …and thus putting the Ultimate Truth of Psychiatry it into such a clear-spoken message! Keep up the great work!

    Respectfully,

    Jonah

  3. Dear Jonah,

    Thank you for this heart-warming appreciation. I’m especially gratified that you find the piece “clearly stated.” To assist people to think clearly, if it can’t be said in plain language, perhaps it shouldn’t be said.

    There is no Ultimate Truth to which I have access! Just some insights and hypotheses gleaned from observations, conversations, debates, and reading… and life. But I have been at it for some time.

    (I’ll be happy to send you some or many of my publications if you contact me directly by email at cohen_at_luskin_dot_ucla_dot_edu)

    • David,

      Thanks for your reply. About “Ultimate Truth”: I strive to avoid latching on to reductionist explanations, in complex matters, yet I do believe there is usually one key factor (or maybe two or three combined) that quite well explains the existence of a society’s ugliest and seemingly most intractable problems, and I believe such factors tend to vary little, from one major problem to the next.

      For example (one such problem now on my mind, as it was raised by MIA blogger Jonathan Keyes, in comments under MIA blogger Richard D. Lewis’s most recent blog post):

      There are “…350,000 people with mental illness in prisons and about 35,000 in hospitals” in the United States. (Or else, as a recent article, on the MotherJones.com website, recently declared, “There Are 10 Times More Mentally Ill People Behind Bars Than in State Hospitals.”)

      How we choose to frame our problems can be the main problem, and often it is; for some frames, though they present real facts, do little more than promote dangerous myths – such as the myth (or myths) of ‘mental illness.’

      I believe there is typically a key factor (or set of factors), the exposure of which, can virtually explode the various myth(s) of “mental illness” that convince folk, that those ‘problems in living’ (as Szasz described) are what the typically assigned ‘authorities’ on such matters say they are…

      Such key factors are what I call the Ultimate Truths, usually having to do with more or less unspoken greed and/or avarice, representing mainly unspoken power struggles, that most of the top players involved are all but agreeing outright, amongst themselves, to brush under the carpet.

      Interpersonal battles will be waged, sometimes to the death – but quietly – usually at the expense of sacrificing innocent lives… as those players strive to become Kings or Queens of their hill; interpersonal battles… politely expressed… and all the while, the lives of innocents are at stake.

      The Kings, Queens (and would be Kings and Queens) smile and say “Hey…,” as their discussions become increasingly circular — eventually trailing off altogether. (They move on to matters more personally satisfying.) It happens continually in family systems — and in whole societies…

      Those Kings and Queens, in Psychiatry, are Emperors and Empresses with no clothes – as are those who hope to replace them…

      Few common folk will ever choose to call their views naked lies, lest they’d wind up inciting a rebellion of otherwise ‘compliant’ identified “patients” of psychiatry. To speak up could also get them deemed “crazy Scientologists” (or else, just plain “crazy”).

      [Note: I am not a Scientologist, nor will I ever be one.]

      Hence, most folk wind up turning a blind eye to this fact, that biopsychiatry, which is based on pseudo science, is an increasingly influential force in our justice system; most folk could hardly care less.

      Indeed, some become champions of that psuedo science, while forever aiming to pass themselves off as devotees of real science — in that realm of biopsychiatry… because, whether or not they fully realize it, they are clinging to and disseminating heaps of B.S. — claiming to promote “mental health” — not so much to help others — but to help themselves… primarily to maintain and gain rank in their existing social circles.

      For some folk, these MIA discussions are mainly political exercises – personal politics – these circular discussions… (Here I am speaking of those who maintain that maintaining some level of ‘medical’ coercion is absolutely necessary.)

      In fact, all that the majority of psychiatrists are doing (whether or not they’ll ever completely realize it) is pretending to be scientific while sharing, amongst themselves, a common desire to control the seemingly out-of-control ‘Other’ (and, though they won’t discuss this, they’re typically fearing nothing and no one more than the ‘Other’ who’s seemingly threatening to take over their own families and maybe even their own minds).

      “TUT” (‘The Ultimate Truth’). I recommend announcing (and celebrating) its exposure, as such, whenever and wherever it is exposed — because it is just too seldom exposed…

      So, though you say you have no access to any Ultimate Truth, but you do (I say), and I encourage you, say “tut-tut” the next time you hear someone aiming to defend psychiatric psuedo science and the coercive policies that it serves.

      That the coercion depends on the pseudoscience and vice versa is The Ultimate Truth, of Psychiatry and it is exposed by your blog post (above).

      Oh, and I have (moments before beginning this comment) finished reading your previous MIA blog post (“ADHD in France and America”). It is quite good, informative; it, too, reads very well (as though a good dialogue or interview). Really, it exposes the pseudo science of Psychiatry very well — and, in particular, the extreme pseudo science of American (APA-approved)Psychiatry.

      I’ll recommend it to anyone who is interested in a cross-cultural view of how child psychiatry is being practiced.

      (While drug ‘treatment’ of “ADHD” is its focus, much of what you’re saying there applies to other childhood ‘diagnoses’ in psychiatry as well – most especially to the ‘diagnosis’ of so-called “childhood bipolar disorder.”)

      (Note: I’d also recommend, to anyone who reads that blog post, read the brief comment discussion below that post. It is interesting. The commenter Tyler expresses what I feel are very genuine and meaningful concerns.)

      Yes, I will email you (if I can just figure out that email address you’re offering 🙂

      (This probably would have been an email had I not been somewhat confused by the email address you posted.)

      Thanks again for the comment reply… and for the invitation to email.

      Respectfully,

      Jonah

      P.S. – At first, I hesitated to post this comment, feeling some might disapprove of it, in ways. Then, I remembered that their disapproval would not be my problem. 🙂

      (I think to myself: ‘Let them disapprove! Let them even say “tut-tut” if they wish…’)

      http://www.merriam-webster.com/dictionary/tut-tut

  4. Hi David Cohen, thank you for publishing your brilliant talk at MIA Film Festival. It was so great to listen to your very transparent presentation and that you so clearly take a stance. That is missing very often missing in professional contexts, and one of the reasons why this website is so important- to “meet” others who have decided to be outspoken and share essential experiences. We do have so much knowledge about what is important in life- for each of us, no matter what we are called or where on the globe we live. This knowledge has to be shown in deeds and actions, so thank you. We hope to be able to invite you to Sweden next year. Your voice is indeed needed!

  5. David, I agree with Jonah…wow. You make such a powerful and key argument, the core of power imbalance via the psychiatric ‘system.’ As a society giving these practices a ‘free pass,’ we are enabling systemic bullying and abuse, albeit unwittingly, perhaps, I’m aware. As a society–and especially in the mental health system–we have too many exceptions for the golden rule of treating others the way we would want to be treated. Thank you for raising the collective consciousness with your brilliant analysis.

  6. Hi David,

    Always a pleasure reading your work. We had coffee once on Lincoln Road in Miami. The major issue I see regarding coercion and Mental Health Care is Economic. Unfortunately the economic foundation of Mental Health seems to sustain itself on coercion. Mental Health Institutions deviate from their coercive practices generally cannot sustain themselves economically.

  7. Thank you for providing us with such an curious perspective on this matter. Coercion has always been the elephant in the room. “The helping enterprise”, when that enterprise was seen in terms of “mental health treatment”, never was a “helping enterprise” as far as I’m concerned. One can’t cure social problems any more than one can solve a medical condition. One can, however, compound problems. Consider the problem of the Gordian knot. As the example of Alexander shows, one can also simplify problems. You’ve got a large segment of the population in flight from freedom. No problem. You simply lift the latch. Now you’ve got a population free to fly. I don’t know how we’re ever going to change hypocritical societies collective mind, but I guess that is something to consider, huh?

    • Don’t like the tone of my comment, but it has to do with whole slant of your post. If it’s societies faith in coercion that would excuse pseudo-science, how do we deal with this matter? As with Ted below, the question for me becomes how do we influence public opinion? How, especially when we are ignored, and when the corporate media isn’t receptive to anything we might have to say, challenge this belief in coercion, in human un-freedom, that makes mince-meat of the scientific method? I think you hit the mark as to what’s wrong. Coercion is behind it all, therefore, the science is lacking, and mostly bias. Challenged by society though, that is one big hump to get over if the public we’d wish to influence is the source of the problem. We’ve got to convince Joe Everybody that Bob Oddbody is an Everybody, too. I guess that such is actually the case, but it can be daunting sometimes anyway.

      • Thank you for your comment Frank.

        I’m afraid I don’t have any valuable insights into “how [to] influence public opinion” besides the usual banalities, although I’m a great believer in the power of art to change hearts and minds.

        Perhaps a committee of 10-15 people from this website could draw a list of extraordinarily creative suggestions.

        But I do know, from Ghandi and King, and of course Alinsky, that very dedicated people influence the public by radically changing their own behavior in line with their clearly stated non-violent principles, no matter the circumstances. By doing so unwaveringly, they attract people to their cause, who try to act like them and in doing so, keep the cause in the public eye. Eventually, public opinion changes.

        • I’m trying to keep from being cynical here. I see those of us who have endured forced treatment as sharing the same struggle as did Gandhi, MLK Jr., and an influence on both of them, Henry David Thoreau.

          Yes, eventually public opinion changes. I think it was much more acceptable to be critical of psychiatry 30 or 40 years ago than it is today. I’m hoping maybe public opinion will change again, and I imagine the law of mutability holds.

          I’m not sure things are quite so bad as you suggest, that is to say, there are critical comments towards conventional psychiatry on almost every web post I encounter. I figure private people are rather like public people, there is an “off the record” “on the record” aspect to each.

          “Life, liberty, and the pursuit of happiness.” Substitute property for “the pursuit of happiness”, and you’ve still got quite a few rights we would protect. “Inalienable rights”? They’re all challenged in coercive psychiatry. I guess they are not “inalienable”, but this is all the more reason to protect them. Coercive psychiatry is one place where none of those rights are protected, and that is all the more reason to do away with coercive psychiatric practices.

          I may be shouting at a wall, nonetheless, I will continue shouting at that wall until it crumbles.

          • Frank: Also as pointed out in one of the recent article on MIA., Psychiatric force is the lynch pin of the profession, and psychiatry currently deforms the potential of the other helping professions.

        • One suggestion regarding public opinion — if we chose a target group of intellectual/political/cultural leaders who are generally cool but just don’t get it when it comes to psychiatry and the medical model (Chomsky comes to mind), we clearly have the “best and the brightest” minds on this site who could expertly and articulately engage them on the issues, publicly, privately, or both. Then we could hope to see their newfound consciousness “trickle down” to their admirers.

          This is not to say that i didn’t notice and appreciate the point that the power of psychiatry to sweep unpleasant thought and behavior (and people) under the rug is the source of its attractiveness to many, not its (pseudo) intellectual underpinnings.

          • oldhead: My 17 year old sn and I are card carrying members of the ACLU. The ACLU is taking bolder stands than in recent years on “national security issues.” My conception is that the ACLU has paid insignificant attention to civil liberties for the involutarily incarcerated in the past, but I am not convinced that they are unpersuadable on the subject. I also attended the Mountain Party Convention (Green Party affiliate) in West Virginia this summer. The topic of staffing problems at the state hospitals came up. I think there is room for the mountain party to expand the repertoire of issue they undertake, including taking a closer look at our county “mental hygiene” commissions. Notice the the that the eugenics era verbiage is still in use.

  8. Thank you for this interesting and provocative piece. I have been thinking for a long time about how to take away psychiatry’s power, and mostly what I come up with is to find ways of making the general public see how (worse than) useless psychiatric interventions are. I do think that people believe, or at least have convinced themselves (not the same thing) that psychiatry does some good, and I can’t see how we can take away the power of coercion unless people stop believing that power is used for good. But I am afraid that you are right, or at least that what we are looking at is a circular belief: psychiatric power is good because it helps people, and psychiatry is helpful and therefore we should let it continue to have its power.

    • Thank you Ted.

      No one in the mainstream challenges psychiatric coercion. No one in the mainstream states publicly that coercion distinguishes psychiatry from every other caring discipline (although again these disciplines are moving in the psychiatric direction). There does not even exist a number indicating how many people are officially coerced psychiatrically each year (perhaps 3 to 5 million?) with the aiding and abetting of the state. This silence, akin to a reverence, is more telling about the importance of psychiatric coercion than any case I could make.

      • I think you allude to another issue in the article – it FEELS GOOD for people to believe that psychiatry’s power is being used for good. It’s the ultimate opportunity for projection – our son’s problem isn’t because we were bad parents or because his school was oppressive and abusive or that we live in a crazy society that makes people feel awful and come up with strange ways to cope with its insanities – it’s his BRAIN that is broken, and THEY CAN FIX IT! Even if they don’t really fix anything, it still fixes the problem of who is at fault, and preserves the idea that given sufficient time and technological know-how, whatever is bothering him can be erased or suppressed or removed from consciousness and we can avoid having to deal with the issues that led to his distress. It is a very comfortable belief system for those in power, and it’s kind of jarring and disturbing when people like us start asking questions about the actual validity of these supposed guardian angels who are going to use technology to make us all feel OK.

        Nobody gets rewarded for saying the Emperor is naked. There are way too many people invested in this viewpoint for a few scientific facts to disturb the social trend.

        I wish I knew the answer…

        —- Steve

  9. Thank you for Mad Science; it is destined to be a classic.

    I agree with most of your article but respectfully disagree that coercion is the main source of legitimacy for psychiatry. Psychiatry is supported by a logical deduction from a false premise; deductive logic is considered stronger than inductive logic. If mental distress is considered a mental disorder, then, by definition, something is wrong with the mental process. Since our culture considers science to be our best tool for understanding the environment, a dysfunction of the mental process is logically considered biological. Biological problems are medical problems; a medical model is our best tool for remedying biological problems.

    However, mental distress is not a mental disorder. Mental distress is considered a mental disorder because we assume that the mental process operates on a principle of neo-rationalism and mental distress is painfully irrational. However, this premise is untrue; mental distress is natural emotional suffering- the normal biology of distressful experiences. Please consider Natural Psychology at NaturalPsychology.org; it explains the paradox of mental distress being painfully irrational while simultaneously also being the natural neurobiology of distressful experiences.

    Thank you again for your community service, Steve

    • Thank you kindly Steve for your appreciation of Mad Science.

      As I tried to point out (too briefly perhaps) in the article, coercion predates the medical model of madness. We chained madmen and madwomen before we believed they suffered from any sort of biological disease.

      Coercion needs no justification, except the coercer’s view that it’s necessary. All sorts of ideologies and views—supernatural or scientific, theological or medical—have justified coercion (in and out of psychiatry).

  10. Thanks for posting this. I enjoyed your talk and wanted to have a chance to re-read it at a later date. This is an interesting hypothesis and I think there is merit to the proposition that society needs something like psychiatry to serve certain functions and the hypotheses of psychiatry came after this need was firmly established. I respectfully reject this one statement:
    “I venture to suggest that most practicing psychiatrists, if pressed, would choose to replace or discard any existing treatment or intervention save one: the power to impose a treatment or intervention.” I have acknowledged that I am a practicing psychiatrist who at times participates in the process of coercing people into hospital settings, I would gladly give up this power.
    But in your talk, I recall you saying that you understand and accept that coercion is a part of any civil society. If psychiatry were no longer the instrument of coercion in the setting it serves now, what do you suggest as the replacement?

    • Sandra Steingard, M.D.,

      You say in your comment to David (on October 21, 2014 at 7:38 pm), “I have acknowledged that I am a practicing psychiatrist who at times participates in the process of coercing people into hospital settings, I would gladly give up this power.”

      A number of questions came mind, as soon as I read what you’re saying there.

      First Q: Besides being a practicing psychiatrist who at times participates in the process of coercing people into ‘hospital’ settings, are you not moreover a practicing psychiatrist who at times participates in the process of coercing people into accepting ‘treatment’ in the form of psychotropic drugs (e.g., neuroleptics)?

      Second Q: Is it even possible to be a practicing psychiatrist who at times participates in the process of coercing people into ‘hospital’ settings without also being, simultaneously, a psychiatrist who participates in the process of coercing people into accepting ‘treatment’ in the form of psychotropic drugs?

      Third Q: With respect to your saying that you are “a practicing psychiatrist who at times participates in the process of coercing people into hospital settings,” what do you mean, as you go on, to say you “would gladly give up this power”?

      (I may be wrong, but it seems to me, as I read that line, there’s something missing. I mean, it seems you could be a lot more clear in what you’re saying here, were you to explain briefly why you won’t give give up that power. I mean, it seems to me you’re suggesting that something is holding you up, keeping you from doing what you say you “would gladly” do.)

      Fourth Q: Frankly, I wonder, why don’t you do what you say you would gladly do, by honestly declaring “I am now giving up this power!”?

      And, about your asking David, “If psychiatry were no longer the instrument of coercion in the setting it serves now, what do you suggest as the replacement?”

      Of course, David can speak for himself in answering that question, but here I am taking a quick crack at it (I hope you don’t mind):

      Psychiatry ‘serves’ a number of settings (i.e., psychiatrists practice psychiatry not only in so-called “hospital” settings); if psychiatry were no longer an instrument of coercion in any of those settings, there would (I believe) be a considerable increased demand for various kinds of ‘counselors’.

      I think that, almost inevitably, a lot of those ‘counselors’ would be designated as ‘mental health’ specialists; however, I’d hope that quite a few of them would not be designated as such, because, personally, I am quite skeptical of ‘mh’ pros of virtually every kind, including ‘mh’ counselors — as they tend, in a pinch, to become subservient to the practice and/or views of psychiatrists.

      So, if there came an end to medical-coercive psychiatry, I presume there’d be a considerably increased demand for counselors; hopefully there could be many counselors whose specialty would be defined not in terms of “mental health” — but along the lines of ‘problem solving specialists’ (they’d be trained to help clients solve ‘problems in living’) or else ‘solution finding specialists’ (to help clients find creative ways of moving forward, in life).

      Some could be social workers.

      Also, if there came an end to medical-coercive psychiatry, I believe there’d still be psychiatrists — only they would not be allowed to impose their ‘treatments’ on anyone.

      So, in fact, I think there could be an increased demand for psychiatrists; over time, there could be increased demand for truly understanding psychiatrists, who’d be far more effective in addressing problems of living, that some clients wish to frame as ‘mh’ issues and some clients would view as requiring help that only a licensed physician could offer; i.e., psychiatry could possibly become a fairly respect worthy profession, if psychiatrists could not resort to coercion, could not impose their ‘treatments’ on anyone.

      At least, that’s what I speculate…

      Respectfully,

      Jonah

    • Thank you very much Sandra for posting your comment and question.

      The direct issue I am addressing, as you understand correctly, is that of psychiatry as the instrument of coercion.

      To replace this instrument, I suggest the police or the military, which in civil society are typically granted the monopoly of force. Psychiatrists who want to coerce can work for the police or the military, and they should wear police or military uniforms. There would be less confusion in people’s minds about what they are there to do. There would also be the expectation that they are bound by the same laws that bind police.

      Since you write that you “would gladly give up this power,” I naturally wonder what might prevent you from doing so.

      In an undated paper, British psychiatrists Pat Bracken and Phil Thomas (MIA blogger) suggested, as one step to tackle coercive psychiatry, “to remove doctors from the processes that lead to compulsory admission,” (1) relinquishing this to whichever other professionals would wish it. I believe this is an admirable suggestion. It recognizes that civil society coerces, but it reminds us that professionals make a choice when they participate in coercive social control. However, perhaps relinquishing this power is, for individual psychiatrists, more complicated than it might seem. In America, the tiny handful of individual psychiatrists who have publicly urged such limits for their peers have been severely ostracized, as you know, though they simultaneously rejected other psychiatric ideas and practices.

      That’s why it would be truly enlightening, truly exciting, if you would consider discussing this in practical terms, from your perspective. I’m unaware of any such discussions in the literature.

      Thus my respectful question to you: Do you (believe that you) have a choice to give it up? Do you perceive constraints, e.g., expected negative consequences like formal or informal reprisals, removal of hospital privileges, ineligibility for certain third-party reimbursement, etc.? Or is it a choice with mainly moral consequences?

      It seems to me that professions like medicine and social work have seldom resisted initiatives to increase their power (like mandatory reporting of confidential information, or committing people to psychiatric institutions). Thus, too few role models exist of professional associations urging their members to limit their power. The only example that comes to my mind is when, in 2003, librarians in several cities in the U.S. resisted the strictures of the Patriot Act (to inform the FBI concerning certain research activities by library patrons).

      1. Bracken, Pat, and Thomas, Phil. (no date). Mental health legislation: Time for a real change. Available from: http://www.critpsynet.freeuk.com/OPENMiND3.htm

      • AAHH! Now you are talking about an important aspect of our ever-expanding therapeutic state. Yes, no professional group has resisted the expansion of its power (or market share). Social workers pushed to achieve health insurance billing privileges in all states, as did the family therapists, and psychologists likewise have been pushing to achieve prescribing rights. And one big reason that psychiatry got out of the psychotherapy business and started promoting biology big time some 40 years ago was the market encroachment and competition from other (cheaper) psychotherapy professionals (psychologists, social workers, family therapists, counselors, etc. etc.). The big question for me in all of this, is are we really healthier and happier as individuals and as a society today with all of these therapists and counselors and doctors running around offering us their various therapeutic wares? Or as I tend to think, is this expanding therapeutic state intimitely connected with the neoliberal ideology (with all of its individualizing, victim blaming, and depoliticizing perniciousness) that dominates our western societies?
        Thanks again for this rerun of your great talk at the MIA filmfest!

      • To Jonah and David,
        When I became a psychiatrist, it was never with the intent to force people into hospitals. I quickly learned that if I chose to work in certain settings and with certain individuals, society bestowed upon me an authority to determine who among us could be coerced into hospitals and coerced into receiving drugs or being restrained. If you look at the practice of most psychiatrists, they avoid this kind of work. For many reasons, I did not.
        For many years, I accepted the constructs of mental illness and within that construct, the imposition of force makes some sense – one is “treating” the individual. This is David’s main point, I think. However, I never took lightly what was clearly an enormous responsibility and authority given to me at a very young age. Of course, others might judge my decisions differently, I do not expect you to take me at my word.
        As I increasingly reject this model, the authority is harder to hold so you ask why am I still here? Fair question and for now, I am taking the utterly hubristic notion that if not me, it would be someone one else.
        But again, to be clear, David’s idea is to turn this power to the police. I will tell you that the police turn it back to us. I try very hard to be circumspect with the authority granted to me. I am clear about, for example the limits of my ability to predict future behavior (for example, violence towards self or others).
        Furthermore, you ask what would happen to me if I refused to use this authority? I refuse all of the time. In fact, most of the forces on me today are to keep people out of hospitals. I do everything I can to keep people out. It comes down to liability – if I determine that someone can be forced not a hospital and that person subsequently harms himself or others, then I bare responsibility for my decision. In that sense, I back away from this power all of the time. The point is, I do not back away 100% of the time so I think it is only honest to acknowledge this.
        David – I believe that you said in your talk that you thought psychiatrists jump to the use of coercion faster than others and it seemed then that you were criticizing the rapidity of response. If I understood you correctly, would you therefore condone a psychiatrist you you determined to be suitably slow or circumspect in using this authority?
        To Jonah- in my current job, my main use of coercion is that I have the authority to force a person into a hospital.There is a separate legal procedure to force people to take drugs and I am not directly involved. However, I think I should take responsibility for my role in the system. In fact, I think any one who offers services but who limits those services to certain people or who asks people to leave or who ever calls the police because a person can not conform his/her behavior to the requirements of that program, is participating in coercion. At the panel on alternative approaches, virtually everyone admitted to doing this at some point.

        • Dr. Steingard,

          Thank you for your response. You explain,

          “I think any one who offers services but who limits those services to certain people or who asks people to leave or who ever calls the police because a person can not conform his/her behavior to the requirements of that program, is participating in coercion. At the panel on alternative approaches, virtually everyone admitted to doing this at some point.”

          To hopefully clarify the nature of what we’re discussing, here I’ll offer you just a couple more questions, regarding that passage, of your comment reply.

          First Q: Do you really believe that “any one who offers services but who limits those services to certain people or who asks people to leave […] is participating in coercion”?

          (Honestly, that does not describe coercion in my view. No. Not at all. On the contrary, that describes a totally common practice, in of many kinds of service oriented businesses. It describes someone being discerning when it comes to deciding whom s/he will or will not choose to serve. There is no implication of coercion there, whatsoever — not at all, in my view. Really, emphatically, I must say, that’s not coercion.)

          (And, to me, it seems quite perfectly understandable, that “At the panel on alternative approaches, virtually everyone admitted to doing this at some point” — if “this” refers to “[limiting] services to certain people” or sometimes “[asking] people to leave.”)

          Second Q: As you are saying “who ever calls the police because a person can not conform his/her behavior to the requirements of that program, is participating in coercion,” I say yes, true, absolutely, that is coercion; however, shouldn’t we presume that, “At the panel on alternative approaches, virtually everyone admitted to doing this at some point” in response to certain perceived ‘imminent threats’ of serious violence from that person?

          When providing ‘mental health services,’ one must (by law) report serious threats of violence to the police; and, indeed, people who work in the ‘mh’ field (even those who practice ‘alternative approaches’ to ‘mh’ issues) may, as some point, wind up needing to call for police help, for a client may be truly threatening to cause considerable harm. (In the course of the careers, of most ‘mh’ workers offering ‘alternative approaches,’ I imagine that happens only very infrequently — if at all — because most of those folk are not in so-called “hospital” settings.)

          In any case, yes, calling the police is introducing coercion; but, it is not at all necessary introducing ‘medical’ coercion.

          I believe we should stick to the topic, at hand — that is, imho, the pseudo-scientific claims of psychiatry (including the sham that is its medical model) and the intrinsically immoral nature of medical-coercive psychiatry.

          For countless reasons (including but not limited to the fact that psychiatry’s medical model is a sham), I believe psychiatric ‘medical treatment’ (i.e., psychotropic drugs, ECT, psychosurgery) should never be administered through coercion or force.

          You speak of psychiatry’s medical model, explaining, in your comment reply “For many years, I accepted the constructs of mental illness and within that construct, the imposition of force makes some sense – one is “treating” the individual.” Then, after a bit of insistence that you “never took lightly what was clearly an enormous responsibility and authority given to me at a very young age,” you continue “As I increasingly reject this model, the authority is harder to hold so you ask why am I still here? Fair question and for now, I am taking the utterly hubristic notion that if not me, it would be someone one else.”

          Ugh.

          Frankly, Dr. Steingard, that doesn’t strike me as a highly principled stance (at all).

          That’s a horrible reason, imho; really, it seems to me (from what you’re saying), you’re working ways that advance ‘treatment’ procedures including ‘medical’ regimens that must totally contradict what you’ve come to believe would, ideally, be ‘best practices’ in your profession.

          Or, maybe I’m somehow just totally misinterpreting your response?

          Well…

          Hopefully, you can realize how your reply is not offering even the least ‘rational’ sense of why you continue to practice medical-coercive psychiatry; at the point that you state “why am I still here? Fair question and for now, I am taking the utterly hubristic notion that if not me, it would be someone one else,” you are basically admitting you have no good reason to continue such work. You could let someone else do it.

          The truly feeble nature of your defense of your own coercive practices of ‘medicine’ (at least, if I understand what you’re saying) just doesn’t compute; I mean, it seems totally at odds with your own stated sense of thoughtfully plying your trade; ethically, it is no defense whatsoever; in fact, it seems a very cynical attitude.

          Maybe some readers will feel I’m being too hard on you.

          You may or may not choose to reply to my comment, but I hope you will do so if I have somehow misinterpreted your words.

          Whether or not you do, I continue to hold out some hope, you’ll come up with a way (sooner rather than later) to completely end your participation in coercive ‘medical’ practices…

          Respectfully,

          Jonah

          • Jonah,
            I read your comments but I am not sure how to explain myself further. I gather I am not being clear. My intent here is not seek approval from you or anyone else but to try to understand what would replace psychiatry. My point about alternative programs is that when the police are called, the person will be taken somewhere. Where do you think that should be? What do you think should happen? I am not arguing with you but seeking clarification. I think that needs to be articulated before others outside of this community will be open to such alternatives.
            (You find my rational for staying in practice to unethical and my responses to be feeble; if it is any consolation to you, I am getting old so one way or another I will not be doing this for too much longer.)

          • Sandra ,
            I’m trying to reply to your last comment to Jonah at 7:20 PM on Oct. 22, 2014 .
            Sandra , if you are leaving the practice of psychiatry soon why not leave with a flourish and totally rebel against the pseudo-scientific juggernaut and help fight for funding for the numerous brilliant ideas outside psychiatry so articulately expressed here all over MIA. Unfortunately up till now as you’ve said studies are suspect concerning psychiatry and modern medicine . Certainly you have read of experiences and ideas from psych-survivors that are not suspect. Why not put your energy into exploring these . Another words go native . No one owes any allegiance to pseudo science . Least of all someone soon retiring . You still have a chance to be revitalized by making a B line straight for the truth without compromise. So what if the guild doesn’t like it . One of the prerogatives and possibilities of of age is the ability to most firmly aline oneself with a just cause without looking back but forward.
            Sincerely, Fred

          • “My point about alternative programs is that when the police are called, the person will be taken somewhere. Where do you think that should be?”

            Dr. Steingard,

            Thanks for your further reply. My answer your question is a bit meandering, but has a point or two worth considering, I think, so…

            Imho, what’s needed, first and foremost, is a signed (contractual) agreement, from each and every client who enters the ‘alternative program’; that contract would be in large print and could be read aloud to each incoming ‘client’; it could go a long way to help the people with the ‘alternative program,’ to mainly avoid calling the police, but, yes, any ‘mh’ pro (presuming s/he is licensed) is obligated to call the police if/when a client seems to be seriously threatening violence.

            (That sort of ‘due diligence’ would be expected of ‘mh’ pros providing ‘alternative programs’ as much any other ‘mh’ pros.)

            (Note: By your saying ‘alternative programs,’ I believe this indicates programs representing alternatives to psychiatry, but maybe it means more than that? Maybe it means these people running the program aren’t necessarily licensed ‘mh’ pros. Maybe they aren’t even pros. Maybe they’re volunteering ‘alternative’ services…)

            I think, ideally, any good ‘alternative-to-psychiatry’ program would, from the start, with each prospective new client, lay out and explain a standard set of ‘rules’ in a contract…

            They’d be clearly detailed parameters, describing what is unacceptable behavior for that program (and, perhaps, would articulate specific expectations of what would be considered self-responsible behavior).

            Certainly, the contract would call for non-violent, non-threatening behavior; it would also articulate the possible consequences of ones failing to live up to those expectations.

            It would explain criteria for being put out of the program — as well as, beyond that, criteria for ultimately calling the police.

            The ‘client’ is thus entering a contractual agreement — including, in particular, his/her recognition and acceptance that, the police will be called in the event of considerable acts of violence and/or any arguably serious threats of violence.

            And, since the goal of the program is to be an ‘alternative-to-psychiatry,’ one thing that would be explained to each new ‘client’ would be, that it is in all ways an alternative to psychiatry; hence, along these lines, there would be, at last, a statement to this effect: If/when we may ever have occasion to call the police to remove a client from our program, we will request that the police view the client just as they would any other citizen — just as capable of surviving time in jail, to await a fair trial — and, of course, just as deserving of his/her day in court — a real court — not a ‘mh court’ (i.e., were we ever to find ourselves needing to call the police, to remove ‘client’ from these premises, we’d do our very best to convey to the police that no ‘mh’ judge need become involved).

            Imho, the very best ‘alternatives programs’ (in terms of being alternatives to psychiatry) would necessarily require contracts of that sort, which laid out a clear sense of having deliberate plans to avoid calling upon any psychiatrist(s) who practice or encourage ‘medical’ coercion.

            Of course, I well understand, such contracts would not appeal to some folk.

            And, note: Personally, I have no use whatsoever for psychiatric drugs, but I think some individuals may have occasion to benefit from short-term use of small doses of certain psychiatric drugs; hence, I could easily picture a psychiatrist who renounces and denounces any and all ‘medical’ coercion being considered, by some ‘alternative programs,’ an allied provider of services.

            Finally, about your parenthetical conclusion, I have heard of ‘talk’ therapists who’ve chosen to never retire; staying vital by enjoying their work, they lived long lives and went on practicing their almost to the day they drew their very last breath.

            If you’re feeling old, maybe it’s what your job is doing to you; perhaps, you could think of retiring from psychiatry yet start a new career, along those lines, as you’ve expressed enthusiasm for the Open Dialogue program.

            And, don’t forget Loren Mosher M.D.,

            “…the therapeutic relationship which is the single most important thing. And if you have been a cop, you know, that is, some kind of a social controller and using force, then it becomes nearly impossible to change roles into the role — the traditional role of the physician as healer advocate for his or her patient. And so I think that that — we should stay out of the job of being police. That’s why we have police. So they can do that job, and it’s not our job. Now, if because of some altered state of consciousness, somebody is about to do themselves grievous harm or someone else grievous harm, well then, I would stop them in whatever way I needed to. I would probably prefer to do it with the police, but if it came to it, I guess I would do it. In my career I have never committed anyone. It just is — I make it my business to form the kind of relationship that the person will — that we can establish a ongoing treatment plan that is acceptable to both of us. And that may you avoid getting into the fight around whatever. And, you know, our job is to be healers, not fighters.”

            Source: http://psychrights.org/States/Alaska/CaseOne/30-Day/3-5and10-03transcript.htm

            Or, maybe go in the direction of personal (life) coaching, as did the retired psychiatrist, Nelson Borelli, M.D.,

            “I have never treated anyone against his/her will, let alone initiate or pursue any civil commitment procedures. When people ask me how I can treat mentally ill patients if am so critical about the mental illness concept, I tell them I do not treat mental illnesses but I treat people who come to me with complaints often attributed to “mental illnesses”. Persons who request and contract with me for my psychiatric service, are, by sociopolitical convention, “mentally well” persons.

            The bulk of the time I spend with patients is pointing at their tendency to try to convince me they are mentally ill, at least partially. In more conventional terms, my service consists in pointing at “defenses”, or in popular terminology, “cop outs”. Many consulters, particularly the public aid recipients, quickly fire me and go to a psychiatrist who “believes in mental illness.””

            Source: http://www.nelson-borelli.com/

            Of course, you can’t go back in time and undo the ‘medical’ coercion you’ve practiced, but it would be great, I think, if — before retiring from psychiatry — you could see your way clear to officially renouncing ‘medical’ coercion…

            You could then stand up, in defense of anyone in your care who wishes to be free from their current ‘medical’ slavery.

            (Much as I doubt you’ll do that, I hold out hope, you could.)

            In my most optimistically wild imaginings, I picture someday (hopefully soon) up-and-coming psychiatrists, though trained in their residency to administer court-ordered AOT (so-called “assisted outpatient treatment”), could be awakened, en masse, to the folly of their chosen professional, by role-models, in the form of elder psychiatrist who’d begin choosing, together, to renounce ‘medical’ coercion…

            I realize that may be a mere dream.

            Respectfully,

            Jonah

          • Here’s my conclusion with a few added words and typos removed 🙂

            …In my most optimistically wild imaginings, I picture someday (hopefully soon) up-and-coming psychiatrists, though trained in their residency to administer court-ordered AOT (so-called “assisted outpatient treatment”), could be somehow awakened, en masse, to all the worst folly of their chosen profession — perhaps, indeed, awakened by role-models, in the form of elder psychiatrists who’d begun choosing, together, to practice psychiatry while yet renouncing all psychiatric (‘medical’) coercion…

            I realize that may be a mere dream.

        • I feel that much of this thread has focused on the usual fear-mongering about people who are deemed “mentally ill” having to contend with police rather than psychiatrists. In regard to that point, if we decriminalized emotional distress (eliminated forced psychiatry), the overwhelming majority of people who are labeled “mentally ill” would have no reason to enter the criminal justice system. There is no other group that can be locked up (whether in a hospital or prison) for behavior that cannot be prosecuted in a criminal court. Most people are incarcerated in psychiatric hospitals because they are presumed to be psychotic or a danger to themselves. Neither of these presumptions, even if they are well founded, are indicative of criminal activity. If someone who is labeled with a “mental illness” does, in fact, wind up being charged with a crime, I assert that such a person will rarely, if ever, be treated more fairly in the mental health system than the criminal justice system. Most people who plead “NGRI” spend more time in psych lockup than they ever would have in prison, and if they are harmed by a guard or another inmate, they will have an even more difficult time being believed. If we want to keep people who are deemed “mentally ill” out of prison, the way to do that is not to lock them up elsewhere- it’s to focus on the decriminalization of drug use and other nonviolent crimes. Not to mention that we need to create more voluntary, peer-run alternatives that people actually want to go to before they even find themselves in the kind of state that currently justifies force.

          • @ TheSystemIsBroken,

            I completely agree with every single word of your comment (on October 22, 2014 at 11:09 pm).

            Respectfully,

            Jonah

          • ‘If we want to keep people who are deemed “mentally ill” out of prison, the way to do that is not to lock them up elsewhere- it’s to focus on the decriminalization of drug use and other nonviolent crimes.’

            @ TheSystemIsBroken,

            I agree with your comment (on October 22, 2014 at 11:09), especially that line, which I’ve quoted and placed in italics, above.

            But there’s a problem that your comment doesn’t address — that is, many people are (for any number of reasons) deemed “mentally ill” after being convicted of a crime and sent to prison.

            The ‘mh’ system (led by psychiatrists) sets up shop in prison systems — so that, upon entering prison or shortly thereafter, each prisoner is “screened” for supposed “mental illness.”

            In fact, prisoners may be “screened” for “mental illness” numerous times, in prison — within a relatively short time after beginning to serve their sentence.

            Being supposedly “mentally ill,” they are prescribed psychiatric drugs; if they take those ‘meds’ dutifully and behave as “model prisoners,” they may be offered shorter sentences, based on an agreement to enter a ‘diversion program’ that’ll keep them seeing a psychiatrist and taking those ‘meds’ after their release.

            Technically speaking, that’s how a lot of supposedly “mentally ill” people get out of prison.

            Imho, they shouldn’t have been in prison, in the first place, if they were convicted of non-violent crimes; but, of course, some were convicted of violent crimes…

            Hence, more stats wind up created, that connect “mental illness” with violence; and, more people with a history of having committed violent crimes wind up at least partially ‘excused’ (including being excused from serving out their full sentences, in prison), based on their having been, in prison ‘discovered’ to be — supposedly — “mentally ill.”

            (Of course, the psychiatrists who run that racket should be imprisoned.)

            Respectfully,

            Jonah

          • One more brief comment here, following up on my two preceding comments, that were in response to the comment (on October 22, 2014 at 11:09 pm) by ‘TheSystemIsBroken.’

            (There is more thought rattling around in my head, and it’s preventing me from going to sleep, so I will say this much more…)

            While my first response to ‘TheSystemIsBroken’ was to state that I agree with every single word in that October 22, 2014 at 11:09 pm comment, and my second response was to emphasize my agreement, most especially, with the second to last sentence in that comment… Now, actually, upon further consideration, that second to last sentence is somewhat problematic, I think, because there are various ways of interpreting it.

            Here it is again,

            ‘If we want to keep people who are deemed “mentally ill” out of prison, the way to do that is not to lock them up elsewhere- it’s to focus on the decriminalization of drug use and other nonviolent crimes.’

            Actually, the beginning of that sentence could seem to suggest that “we” may want to keep everyone who’s been deemed “mentally ill” out of prison.

            Certainly, that’s not what I want to do.

            That it is not what I want to do, is really what I was trying to get at in my last comment (on October 23, 2014 at 12:32 am).

            Really, I do not think anyone’s presumed “mental illness,” of any kind, should ever be considered as some kind of ‘excuse’ for committing violent crimes — nor either as an ‘excuse’ for committing non-violent crimes…

            Which brings me, at last, to this:

            That sentence ends by referring to, “focus on the decriminalization of drug use and other nonviolent crimes.”

            Actually, I am all for the decriminalization of drug use, but I am not for decriminalization of other nonviolent crimes, broadly speaking.

            Simply, I think, with few exceptions, sentencing for non-violent crimes should be dealt with in ways that do not involve prison sentences.

          • Hi Jonah,

            I completely agree with your last comment- I should have phrased my thoughts on this matter a bit more carefully. I do not think that prison is appropriate for anyone who did not commit a violent crime, and I think that when someone has committed a violent crime, that such a person should not avoid punishment because of a “mental illness” label. Other than criminals who simply have no empathy whatsoever, it seems to me that most violent criminals justify their actions to themselves through thinking that could clearly be seen as not based in reality or “delusional,” (ie. “The child I sexually assaulted was acting seductive,” “I had to kill him because he slept with my wife,” “I know she said ‘no,’ but she REALLY wanted me to do it.”). I’m not sure how anyone can distinguish between a “sane” and “insane” murderer.

            Personally, I have been victimized by quite a few different people, only one of whom had a “serious mental illness” label, and I found some of the responses to the assault that this person committed against me to be infuriating (ie. “Well, you know he’s REALLY sick.”). I do not believe that this man’s thinking could have been any more muddled than any of my other abusers, who were constantly justifying their actions in ridiculous ways, such as by insisting that abuse is mainly the fault of the victim. As much as I can certainly have some empathy for someone who, for example, killed because of misinformation he had been told by the voices he was hearing, and I hope that this might allow for a bit of leniency during sentencing, I do not think that we can reasonably argue that people with psych labels are not dangerous and psychiatrists should not have any legal power over their lives while simultaneously insisting that folks with labels should get a free pass on criminal acts because “they can’t help it.” As much as prison rarely reduces recidivism rates, we all agree that there must be repercussions for violence, and I worry about how many people deemed “NGRI” will fail to take any responsibility for their actions and, as a result, commit even more heinous crimes.

            Honestly, I wonder how many people who are deemed “mentally ill” after entering prison are truly done so for the convenience of the prison staff, who save money by replacing guards with chemical restraints (psych drugs). I believe that psychiatry must get out of the business of social control (including through such “diversion programs”), and only has any hope of actually helping anyone if psychiatrists are completely stripped of legal authority and assumed legitimacy.

            Thanks for helping me to clarify my comments on this!

          • Re: Actually, I am all for the decriminalization of drug use, but I am not for decriminalization of other nonviolent crimes, broadly speaking.

            Simply, I think, with few exceptions, sentencing for non-violent crimes should be dealt with in ways that do not involve prison sentences.

            I completely agree with you here. I am for the full decriminalization of drug use, and find it horribly hypocritical that our society has created this strange dichotomy between “bad” drugs that “bad” people must be stopped from taking and “good” drugs that “crazy” people must take (even when they don’t want to) when many of these drugs work in similar ways. Frankly, as long as people are not harming anyone while on any kind of drugs, it is none of the government’s business what substances someone chooses to introduce into his own body. I believe that many nonviolent crimes should not be considered crimes at all, and are really just used for the police to exercise arbitrary power and ignore constitutional rights (loitering, disturbing the peace, public indecency, public intoxication, etc.), but I see a clear distinction between nonviolent, victimless crimes such as these and nonviolent crimes that do victimize people (such as stealing), which should have consequences, but consequences that match the crime and the harm that was done with due consideration for the circumstances leading to it. For example, if someone steals a loaf of bread because he is starving, I believe that providing such a person with resources to help him (ie. food stamps) would be more appropriate than punishment (although I would support such a person being required to use his food stamps to buy a new loaf of bread for the store he stole from), while someone like Bernie Madoff, for example, certainly deserves to be punished for his actions, but I would prefer a punishment such as mandating that he divide all of his savings between the people he victimized and award them at least 75% of any future income. It seems to me that when you deprive others of their rights and safety (through commission of a violent crime), it is justified to deprive you of your liberty (through imprisonment), and if you deprive someone of their financial resources, a more appropriate response would be to deprive you of your financial resources. I really should have used the term, “victimless crimes,” rather than, “nonviolent crimes,” (you’d think I would have learned by now that trying to post a thoughtful response while half asleep rarely turns out well!).

        • @ Sandra Steingard, M.D. on October 22, 2014 at 6:13 am.

          The dilemma you are faced with Sandra is one faced by men in Islam. Following Surah 4:34 men are given the power to use coercion and force if their wives are not obedient. Most choose not to do so, or follow the “least restrictive method”, but the power is always there.

          You can not renounce that power and practice your religion. And it means that even when you see others abusing that power, that you can not intervene, as the ‘clause’ allows them to do so.

          Like our brief discussion about the subjective nature of “emergency” in another thread, this also applies to the term “strike her”.

          I understand the position you find yourself in much better now.

        • Thanks Sandra for your reply.

          It appears therefore that coercive activities are part of your professional identity, something that evolved and strengthened over time. But they’re also something which you could give up if you wished. Your livelihood wouldn’t be threatened.

          Doing something distasteful or against your principles because if not, someone else would be asked to do it, seems to me to deserve more critical analysis on your part. It may be understandable the first time you’re asked to do it, but after a while I believe you should be extricating yourself from the situation for good. (Of course most things are easier said than done.)

          The discussions below, from Jonah and TheSystemisBroken, are on the money I think. The criminal justice system does have, in principle, different ideas about what constitutes an offense and how to deal with an accused person, than the psychiatric system. In practice,however, both systems have morphed into a larger social control system, much like it was 120 years ago, so of course your own disavowal of coercion might not, in the immediate, make a difference to most of the coerced. But it surely would set an example to the rest of psychiatry. It would say that one does not need to make the practice of coercion part of one’s professional identity. Otherwise, you’re agreeing with my suggestion (despite stating that you disagree), that most practicing psychiatrists would give up any intervention except coercion.

          To the extent that your own practice and livelihood does not depend on maintaining your occasional coercive activities, and to the extent that your practice is representative of psychiatric practice in the U.S., then your explanations provide, for me, some evidence that psychiatric physicians choose to coerce, they are not forced or compelled to do so. Thus I call on them, as their colleagues Szasz and Borelli and Breggin (and Mosher?) and Bracken and Thomas and others have also called on them, to relinquish coercion.

          I believe that intellectually, this would “free their minds” — and the minds of many other people throughout society — to entertain vastly more possibilities about what they could do as helpers, and what all of us could do. The so-called “medical model” would become just another culture of healing, not the law of the land, pursued or practiced only by those interested in it.

          • With all due respect, the medical model is already just another culture of healing. People make other choices all of the time. I support choice and I try to be explicit that I meet people within a certain construct. While I appreciate you and others giving me career advice, I have tried to explain that this is not about me. I get it that I could make other choices. This type of response seems to be a distraction from my core question – my core question of what to do with people who manifest extremely disruptive behavior and who decline so-called alternatives? You said in your talk that all societies need to utilize some form of coercion. I am interested in understanding how you would want to see this manifested if tomorrow all psychiatrists were to refuse to coerce anyone to go into a hospital.

          • Thank you Sandra for keeping the discussion on focus. If tomorrow all psychiatrists were to refuse to coerce anyone to go into a mental hospital, we would probably have to push people away from requesting room and board in mental hospitals.

            Involuntarily hospitalized people present with many different kinds of problems, and many different varieties of disruptiveness. I’d like to take some time to characterize these differences, and propose in the near future in these pages how to replace involuntary mental hospitalization following a bold move by a morally renewed psychiatry.

          • Thanks Sandy, I really respect your engagement on this difficult topic and your honesty.

            Like you, I thought David was not accurate when he stated that “most practicing psychiatrists, if pressed, would choose to replace or discard any existing treatment or intervention save one: the power to impose a treatment or intervention.”

            In my experience, psychiatrists are happy to be able to replace coercion with other things like for example simply being able to persuade people to accept treatment.

            I think it is wrong to focus on coercion as the ultimate problem here: because really coercion and the giving to psychiatrists of the power to coerce is just an effect of something more essential, which is the fear of madness and the fear of possible harm to the mad person themselves or to others, and to some extent fear of harm to the social order, as a result of madness.

            I think what is really needed is finding ways to help the public fear madness less, and to see the ways that coercion (and drugs) are often counterproductive rather than helpful, and to help them see that there are better ways to respond to madness and distress.

  11. Dr. Cohen,

    Thank you for the work you and others did at Vatican in the summer of 2013.
    (Pontifical Council for Health Care Ministry – The Child as a Person and as a Patient: Therapeutic Approaches Compared).

    As a Catholic, and a dad, this was an event I had prayed for (for years):

    https://www.madinamerica.com/2013/04/vatican-to-hear-debate-about-psychotropics-for-children/

    I am so grateful for all that you did to bring awareness to not only the Catholic Church, but people of *all faiths*, by this event.

    With gratitude,

    Duane

  12. The dilemma as far as I see it is when those of us working as “professional helpers” declare that we want to do one thing and then do something totally different. I know it is to ask for a lot but still if people in the system feel like it is very hard to do what the system ask for, how come they stay? It is a rethoric question since of course there are very many answers to it, but still it is worth talking about it and hopefully to try to be as honest as possible. If the reason is money, status, living a comfortable life, it would be very good to say so. Instead of pretending as if the reasons are something else, as for example “I wish to help the other one”. It is such a big issue and I myself am at times a “pretender” and not very honest all the time, but still it is important to try to find ones own motives instead of focusing too much on the other one. Systems are created by people and it also means that people have a possibilty to change systems.

    • I think people who work in the system find it very hard to be true to thier ideals.

      It heartened me this weekend to meet some people from anarchist trade unions who were organising people working in the social care sector. I think workers need a lot of support to resist bosses who want to impose coercive psychiatry on clients

      • John: During my encounters with involuntary hospitalization, I encountered two auxilary staff who demonstrated a degree of nonjudgementalness. I am not sure of the degree of interaction these individuals had with psychiatrists in the work place. For example, what advice they were given in dealing with me.
        Also one cogent point addressed here, is the deleterious effect of psychiatry on the other helping professions. When my job status was up in the air three and a half years ago, and I was also experiencing psychiatric iatrogenesis, I sought out a talk therapist. I also was a counseling student at the time, and you could say that I had an otherterior motive. I wanted to see how the process worked. The clinical psychologist accepted me as a client despite my psych. history-on a prior occasion, my psychiatrist made me a marriage counseling appointment over the phone and told the therapist that I was on two psychiatric drugs as a professional courtesy heads up.
        The psychologist always asked me for updates on my psych. drugs, but the interaction was different than the pyschiatrists’ angle on things. She seemed sympathetic to my annoyance with my psychiatrist and helped me to get a leave of absence from my stressful work situation due to titration issues from Zypreza. But her reasoning was a little circular when it came to my adherence to the psych. drugs. Her position was that since I was taking them, that I must be for some tangible reason. I think a little more to the truth of the matter was, that I had been indoctrinated into the system against my will.
        About a year prior to this I had run into a Nurse Ractchetesque character in the form of a professor in the counseling program. She had no patience for my budding anti-psychiatric position. At first, she would comment to me as an aside telling me that the interjection of my personal experience into the online discussion in the introduction to mental health class was non-germaine and uncalled for. But the assignments and discussion continually begged the question, so I continued to post. (I only received two cases of feedback from fellow students). At one point, the professor blew up at me online in front of the whole class-insisting that yes, forty years ago state hospitals were awful, but that was essentially the bad old days. Any way, I remarked that my experience was from 22 years ago. I soon dropped the class and eventually drifted out of the program with 24 credits. I should have known something was up from the first day of class. It seemed that she already had some devoted acolytes, who took it upon themselves to cheer on the great progress and enlightenment brought on by modern psychiatry. Having known what I know now, particularly the fact of the director on NIMH own admission of the lack of biological markers for mental illness and the criticism of the DSM V from all directions, I would have stood my ground. As things currently stand, I may not be through with the college yet. I think that this was a blatant act of discrimination that needs to see the light of day. I did not go into the class with the idea of creating an I gottcha portfolio, so I was not compiling evidence as I went, but I still remember the basic perameters of the event.

  13. Some people feel a need to have power over others and become somewhat addicted to it. That is, they become “drunk with power.” I wouldn’t expect them to give it up easily at all, especially when it is part of their job description.

    • Then there are those that hand their personal power over to others, and then rage from their feelings of powerlessness, cuing ‘the power’ to force them into submission. It’s a terribly vicious downward-spiraling cycle. Hard to believe that a very few people are getting so rich from all of this, but that does seem to be the game being played.

  14. A special thank to Frank Blankenship and Eugene Epstein for focusing on the imperialist commercialist sociopolitical power systems in which a super-minority class immorally rules and shapes oppressive living and work conditions on the majorities. Far to little attention is paid to what many in the ‘helping professions’ know for a long time: oppression, abuse, segregation function embedded in the larger exploitative ‘imperialist/colonialist’ proprietors’ political regiments and their propaganda of double-think, disappropriation, win-or-whip/e out practices. Mary Bolye and Jacqui Dillon from the UK, the critical/radical psychologists from USA, nearly ALL LAMIC critical psycholgists – in the tradition from Marx to Fanon – AND some of the survivor collectives all over the world address the issues of the im/moral violence of feudal-neo-imperialsm and its structuring legal, commercal and poltical forces as being detrimental to practical and moral healing from real distress and severe abuse and oppression. The question of property and power, the exploitative and socially destructive forms of appropriation, is the one hidden away. I always found it typical that psychiatry’s total oppressive power is closest to the military and all forms of inquisition: control and punish disobidience, even n distress and psychoaffactive uproar-in-conflicts-with-overwhelming oppression. In contrast to many Western leaders and thinkers of ‘self-ishness’ and ‘individuals freedom for the pursuit of property’ – in accordance with the values and poltical practces of the 1970s, 1980s survivor collectives and other liberation movements – in my view much more collective-democratic practices, co-operative properties, ideologies of fairness and sharing in mutual dependancy as well as in reciprocal socio-psycho-cultural capabilties are needed. Indeed, it is rugged imperialist exploitation and oppression, embellished in individualist ideology of ‘the Western winners take it all’, and their post-colonialist capitalist partners in exploitation and oppression.
    What I would wish for: that the immoral power abuses interforced within severe distress and affective uproar, mental wild-rides be exposed as dependent on the structural violences. Nevertheless psychiatry stepped in, historically, to transform was in Europe was known as social mass pauperism and despair problem, into pathologies of some neuro-nature, and pathologization and coercion are two sides of the same ‘sword’ (rather than coin). I am rather looking forward to same conceptual paper written by Jan Wallcraft and Kim Hopper about capabilities in social contexts the refuel concepts about empowering collectives in communties. That is pretty much steps in the direction of collective social and cultural change with legal and political implications. And there are amazing examples as the Bapu Trust in Pune/India or the West Mass Recovery Learning Community to live some of the collective capabilities building. This is to communicate hope and relevant alternative practices and not be stuck with anti-psychiatry and anti-imperialism only. Creating places of non-oppressive soldarity must not wait for an abolition of governing feudal imperialism, poltics of democratic betrayal, and their polices, military, media, prisons, psychiatric powers (all run in corporate interests). One of the truth we could tell, to replace the psychologists taking over formulation of people’s problems in de-politicised and de-cultured convinient cognitive-behavior-in-fixed-contexts ways, is the raising of the awareness of the oppressive and frightening and alienating (pseudo)moralities, betrayals and historical oppressions as they crucially interfere with severe distress and uproar of the dis/embodied, terrorized feelings, senses… in menacing and alienating realties. If it is power abuse that makes people go mad, certainly power abuse by whatever class of experts sustaining the abusive forces and hierarchies in power can not be liberation for solidarity. Of course not, the ideologies and practices are exactly the opposites, control, oppression, coercion, ideologic brain washing. That is why I don’t want psychiatry as a player in efforts of liberation in solidarity and fight for collective and interdepency informed rights. All psychiatry pushes goes against the main collective healing practices and solidarity values, as psychiatry – and I am afrait CBTpsy as well – is part of the imperialist powers named before and uses all their techniques and requirements.

  15. David, This is not about psychiatrists, rather, psychiatry in general, It’s a human rights issue. Why is physical, mental, and social coercion a general practice in our culture? Force, and manipulation, are part of the human experience. Is it really necessary? What is the best way to remedy it? How do we define controlling a diminished state without using excessive force? There are so many other ways to help a person with diminished capacity without using force. Psychiatry is unacceptable in my opinion, and is inhumane in it’s nature. I cannot say that I agree with using coercion to satisfy an agenda that involves abuse of human rights. Capitalizing on people’s misfortune because they have been abused is not a cure. When social conformists are uncomfortable, because they stuffed their feelings, this does not clearly rationalize coercion. The idealization that books and diplomas and printed money determines who we are, or whether or not we have any human rights is “insanity”. I have witnessed so many aspects of “psychiatric” treatment that were plain and simple human indignation. Why not use a humane, and reward based system to help vicims of domestic and social disease? Maybe because the system pays top dollar to hide the underlying cause of physiological trauma, to build “Empires”. I’m outraged that so much cash is paid out for pencil pushers and educated coercion. Do one, or the other. Help a person, or treat them using inhumane tactics. You cannot heal a broken spirit by continuing to break it. When all is said and done, it really is about dominance, power and capitalism. Not healing. My life has not been helped through psychiatry. My life has been sustained through acts of human decency and kindness. Not Judgement, or control. If someone is sick, whether it be the heart or the head, why treat them like an disposable commodity? I choose not to comply with social norms because I don’t claim them and they don’t claim me. When I “had” a son, if he threw a tantrum in public, I let him. Even if he acted “Crazy”. Even when he flopped all over on the floor at the store, it only took one episode for him to realize that he was free to do that. And when he was finished, he picked himself up and came to me, and he was just fine. “Normal” people who witnessed this thought it was an irresponsible parenting tactic. But it only happened once. No coercion necessary! You think you own whatever land you land on The earth is just a dead thing you can claim But I know every rock and tree and creature Has a life, has a spirit, has a name You think the only people who are people Are the people who look and think like you But if you walk the footsteps of a stranger You’ll learn things you never knew you never knew.

    • Miss Empowered: It seems to be that both of us took psychiatry’s best shot and we are still ticking. My sense is that this is not the case for most people, and when some poor soul cracks under the shear force and weight of so-called help, we need to step forward and insist on public oversight and intervention into the institution of psychiatry.

    • This is truth with which I can resonate. Capitalizing on misfortune, further breaking a broken spirit, domestic and social disease, high priced bureaucrats concealing truth, building an empire from all this. To me, that is what I would call ‘an extreme state,’ and it is systemic and extremely dangerous.

      Thank you for sharing your crystal clear vision of the reality of the situation. Decency and kindness is, indeed, what heals, and which also maintains a balanced, healthful community. Where did they go?

      Imo, the solution to how best to heal would be to find these qualities again–along with integrity–embody them, and expand them. It helps to begin by being kind to ourselves. It’s not easy being kind in today’s fear- and rage-based world, where lack of kindness is what is so heavily practiced and where certain acts of force and violence are justified by those who feel they have–or should have–some kind of ‘control’ over others.

      But it’s a journey to take, an excellent focus with which to begin healing anything, not just in ourselves, but society, at large. We’re far away from this now, but it’s not impossible.

      • Great comment Alex.

        I agree with everything you say in it and particularly appreciate these powerful lines,

        “Capitalizing on misfortune, further breaking a broken spirit, domestic and social disease, high priced bureaucrats concealing truth, building an empire from all this. To me, that is what I would call ‘an extreme state,’ and it is systemic and extremely dangerous.”

        However, I feel it’s important to point out, that many folk (possibly the majority) first encountering psychiatry, are not broken spirits.

        (I myself was certainly not a broken spirit when I encountered it.)

        Many, upon first meeting up with psychiatry, are quite like the child described by MissEmpoweredByNonPsychiatry — perhaps, momentarily troubled, but in no way broken.

        Though I was legally an adult (twenty-one years old), and that did create special challenges for my family, I was quite like her son, whom she described as acting “Crazy” …suddenly throwing his first-ever public tantrum.

        Obviously, he was not a broken spirit, at that time (far from it).

        Nor was I, at age twenty-one, when I chose to take a stack of cheap plates and frisbee them, one by one, at my parents’ garage door…

        (I had never previously behaved as the ‘rebel’ in my family; only, my adopted siblings had.)

        So, yes, the system (of psychiatry) is designed to attract ‘broken spirits,’ but it is also designed to appeal to the most influential ‘leaders’ in conventionally oriented family systems, who have discovered that one of their own is seemingly ‘out-of-control’ and/or is apparently just ‘not himself’ (or, ‘not herself’) and is coming to more or less directly challenge key aspects of what have been long-held consensual ‘truths’ in that family — and thus is threatening the status quo hierarchy of relationships, in that family system.

        I was in no way a broken spirit when I encountered psychiatry, but the system (of psychiatry) that I encountered (at age 21) was clearly designed to ‘treat’ me as one; and, it was precisely that system, which you’re describing.

        It was designed to perceive my spirit as ‘broken’ (this completely mistaken view of me appealed to my family, as it ‘justified’ their view that I absolutely ‘needed’ psychiatry); moreover, the psychiatric ‘treatment’ I received was determined to break my spirit — no question about it.

        I was ‘treated’ (first, in the E.R. and in two different “hospital” settings, thereafter) in ways to break my spirit. This was perfectly clear to me, beginning with the first forced drugging (in the E.R.) that began my ‘treatment’ regimen.

        Like you, I got a lot out of reading MissEmpoweredByNonPsychiatry’s comment.

        I read it a number of times — and finally Googled her last lines (which probably should have been sandwiched in quotation marks), reminding myself that they’re from a Disney song, in movie that was once a favorite of my daughter…

        See: http://psychcentral.com/blog/archives/2013/08/03/a-few-valuable-life-lessons-from-pocahontas/

        That makes MissEmpoweredByNonPsychiatry’s comment no less meaningful.

        Respectfully,

        Jonah

        • Thanks, Jonah, you’re totally right, I misspoke, here. What you describe is in some ways similar to my experience, too, that I was not ‘broken’ when all of this began for me, but more so very conflicted and confused.

          I wanted support as I tried to sort things out for myself. I never threw anything, but I felt like it every moment, and because I wasn’t raging as would have probably been healthier for me, I resisted and instead, I became disabled from harboring inside of me volcanoes of anxiety. So by not externalizing my rage, I suffered from extreme self-punishment. Do you think they might be two sides of the same coin? I do relate to your family dynamics quite a bit.

          Even though I actually entered the system voluntarily, this is the first thing that was communicated to me, that those of us there were ‘broken,’ in various ways as you recount. Aside from all the coercion, the indoctrination/brainwashing was blatant.

          One group facilitator walked into the room on my first day in this one social service group, and wrote on a white board: DIS-ABLED. I kid you not. And we spent an hour discussing how we were no longer ‘abled.’ ???? That was certainly not my intention when I turned to the system for support and HEALING!

          And it was downhill from there for a good long while. I fought hard to not internalized this, but the effect on my spirit was no good. I struggled with all of this until I finally woke up to the reality of that world–and the world in general–so well-articulated by many here on this website. It was such a relief, and so amazingly healing, when I learned the truth about the economics and politics of all this. Completely changed my self-perception, in a way that was only healthy for me.

          Of course were I to do it all over again, this is not, in any way, to where I would turn for support, but I came from societal indoctrination. After all, I studied psychology and did an internship, so I believed in all of this at one time. Lessons learned!

          This is actually healing to me in the moment, reminding myself of all of this, thanks to your comment. Shifts my perspective a bit in present time. Thank you.

          I always appreciate your extremely thoughtful use of language, you’ve been an example to me in this regard.

          Your story always moves me so much because it is easy for me to see your spirit and feel your heart as you describe your journey and experiences. Such powerful clear truth there. Aside from being an example of truth, I also feel you’re an example of personal power, from the heart. I really appreciate and admire that so much.

          I’m pasting what it says here underneath the Pocahontas quote from the article you posted here. I wasn’t familiar with this—never saw the film—but I loved what I read and wholeheartedly agree with it and do my best to live by it (always learning and expanding, here), so appropriate, especially these days:

          “’We are all connected to each other, in a circle, in a hoop that never ends,’ she says. When we let others into our lives, individuals who may see the world through an alternative lens, we learn more. Even if we don’t see eye to eye, we could still listen and acknowledge contrasting perspectives, opinions and beliefs.”

          • Alex,

            Thanks for your very kind words. I appreciate your comment expressions — including your use of words — and deeply respect you for how far you’ve traveled personally (and for how far you continue to travel); that is, you’ve clearly traveled far, in the direction of embracing and embodying your own discovered truths; and, in becoming always more certainly a person wholly true to himself, you set a good example for me and for others.

            Regarding this question (about what led to your first encounters with psychiatry),

            “I wanted support as I tried to sort things out for myself. I never threw anything, but I felt like it every moment, and because I wasn’t raging as would have probably been healthier for me, I resisted and instead, I became disabled from harboring inside of me volcanoes of anxiety. So by not externalizing my rage, I suffered from extreme self-punishment. Do you think they might be two sides of the same coin?”

            Do I think they might be two sides of the same coin (as in, being roughly similar to the emotional and/or family-dynamic conflicts that had led to my being introduced — the hard way — to psychiatry)? lol

            Absolutely, yes, in a way… (At least, I can relate to the anxiety you’re describing.)

            I would never have chosen to see psychiatrist, had I not been pressured by family and friends, to do so, after I’d smashed all those plates…

            Actually, I was totally skeptical of psychiatry, by that point — was, essentially, at least as ‘antipsychiatry’ as anyone I knew, at that time…

            However, lead up to that time, I had been, occasionally, consulting a certain therapist.

            I.e., prior to that time that I’d chosen to throw those plates, at my parent’s garage door, I was ‘in therapy’ off and on; and, I can still well recall, my #1 reason for choosing to go to therapy, in college, was that: I had come to experiencing (ever since high school) a kind of near-constant ‘free-floating’ anxiety (it was then, to me, ‘unexplainable’).

            My therapist was a very well-meaning person, but her chosen style was entirely non-directive, so our ‘sessions’ got me nowhere…

            I would eventually quite going to her — having come to presume that all my anxiety was nothing more or less than the function of my ‘artistic’ sensitivity to the historical ‘age’ I was living in.

            I came to conclude, that it was ‘just’ the effect of my sensitivity to the then-ever-present Cold War threats, of nuclear annihilation…

            (There was, then so much ‘Super-Power’ sabre rattling, in the news — and related, quite horrifying films depicting ‘nuclear winter’ …on TV and in the theaters.)

            I would increasingly focus upon those threats (eventually, 24/7), and my anxiety, as a result, grew worse — of course.

            Albert Einstein had famously said “We shall require a substantially new manner of thinking if mankind is to survive.”

            I went in search of that new way of thinking — in order to hopefully survive those threats, of nuclear winter.

            Though I liked my therapist, and she did, on occasion, offer me bits of good practical advice, I did not share with her the extent of my fears of nuclear war; and, I got no sense from her that she could ‘teach’ me what I needed to know, in terms of a new way of thinking…

            At last, I wound up attempting to write a novel, featuring a considerably more ‘entertaining’ (fictionalized) version of myself (his sense of all my ‘nuclear anxieties’ were, in some ways, comical).

            I projected myself into that character, my story’s protagonist — a young psychiatrist; he could be very serious, in ways… and would, in the end (i.e., by the last chapter) reject his own chosen profession, psychiatry — especially, all the nonsense that it represents in the criminal justice system…

            Note: From the time I was a kid, I had been deeply struck by such powerful impressions of Institutional Psychiatry, as had bee offered by films such as “One Flew Over the Cuckoo’s Nest” and “Frances” (which came out when I was in college0; but, like most folk, I thought those were depictions of past transgressions, on the part of Psychiatry.

            I was mainly aiming to opposed the ‘forensic psychiatry’ that’s practiced in our legal system — especially, what I believe is the insanity of the “insanity” defense.

            I really had no understanding whatsoever, back then, about all the ‘medical’ harms that were still being caused by psychiatry.

            When I smashed those dishes, I was (I knew) ‘acting crazy’; and, I guess, arguably, then, when I smashed those dishes, I may have been, unconsciously, calling for a more thorough understanding of psychiatry — a direct experience of it.

            Thus, I stumbled into my own personal ‘education’ regarding the nature of forced psychiatric ‘treatment’ — and thereby gained much subsequently raised awareness, of what has been, indeed, the ongoing ‘history’ of such harms…

            I consider myself very fortunate, having prepared myself, in advance, to reject psychiatry; my unfinished novel remained instructive for me; but, I would not have consciously wish for such encounters…

            Such experiences, as I experienced, with psychiatry, were not the worst that psychiatry has to offer; but, on even my worst enemies, I would not wish those sorts of experiences, which I had…

            No one should have to learn of such things irl — ‘in real life’ (the hard way).

            Respectfully,

            Jonah

          • P.S. — Alex, sorry for all the typos. I probably should have gone over my comment before posting; usually, I do that…

          • Your post is totally clear, no worries re typos. I think we all miss that edit feature!

            I, too, very much appreciate your kind words.

            Specifically my reference about two sides of the same coin were to the self-punishment and rage. While there can be so many reasons why these exist, they are two common responses to chronic abuse, oppression, and injustice. Perhaps these would qualify as ‘extreme,’ but they can be quite reasonable under the circumstances. And I feel they are the result of human expression of pain, when it is not being heard or recognized.

            (Although I had to learn to speak the truth of my anger in the moment, rather than stuffing it. My health was deteriorating in every way by not expressing my anger. I had some pretty serious guilt programmed in me, on top of it, so I really put myself in an emotional straight-jacket).

            I think it’s reasonable to ‘act crazy’ in crazy-making circumstances. Everyone does it, and it’s human. For some (many?) of us, family is our first crazy-making system. Hard for a kid to make sense of this, it just feels TERRIBLE. I’m not slamming parents, either. I’m not a parent, so I wouldn’t be so presumptuous. Plus, parents were kids once, too, with their own share of confusion as they were growing up.

            But I’ve been parented, and I know what feels right and helpful to me and what feels bad, hurtful, and downright sabotaging. I just think that raising awareness about how families tick is a really good start to getting to the heart of the matter, here, regarding extreme emotions that wind up hurting us. Who knows, that may be part of your mission, since you are a parent!

            I just had this thought about the double-sided coin as I wrote the comment before this one, thinking how ironic that we have these nonsense labels which do all this harm and make things worse, based on these different emotional responses, and really, it’s all the same thing, at the core–a response to crazy-making family dynamics. Of course there are other forms of trauma, but imbalanced family dynamics are insidiously powerful, and often not recognized for what they are.

            Once we do see and own this, then a lot can be done to move forward and heal, step by step, layer by layer, as you have described. I love your process, looking at yourself from various perspectives, distancing, and creating compassionate stories of truth around your experience. How I process takes me down the same road. It’s an ongoing experiment, how we grow and evolve, and exactly how we teach ourselves new ways of thinking. Beautifully creative healing! It’s exactly what I advocate.

            One last thing, then I’m offline for the rest of the day–I think you talk about something that is so important when you talk about fear of world catastrophe. This energy is actually in the collective now, so we’re all feeling it.

            One thing I learned from some teachers is that when we feel fear in the collective, the most healing action we can take for ourselves and others is to realize that we create our own reality, and if we can find our way to connect with our deepest faith and really trust our process while focusing on that which makes us feel better than fear (even indignation is better than fear, although if we can find our way to feeling hope, even better), then we are raising the energy of the collective and, in essence, shifting reality. It can be a mind-bender, but it’s fun to work it. I’ve seen hardy results in my own life.

            Thanks for your wonderful sharing and dialogue, Jonah. Enjoy the rest of your day! Over and out…for now.
            Alex.

  16. This is an excellent piece. I second everything that’s been said here. I’d like to add that right before I entered the System back in 1981, I had spent 10 days in the Moonies. I’d been brainwashed by them, but I was able to leave on my own. For those of you who may not recall, the Moonies were known to be a religious cult that used brainwashing techniques to recruit its members and keep them loyal. These techniques were almost identical to those used on POW’s in the Korean War and in many other imprisonment situations. I wrote a college research paper in 1980 on the Moonies without revealing in the paper that I had had real-life experience as a Moonie. I told myself, “I’ll never fall for something like that again.” But in 1981, I fell for shrinkage. I was a fully brainwashed member of the MH System for over three decades. Yes, the System uses the same brainwashing techniques that the Moonies used, including isolating its members from society, heavy-duty “lecture”-type introductions where “confessionals” take place in order to “break” the inductees, keeping newbees separate (you can’t talk to each other or you will trigger each other and you will interfere with each other’s treatment plans), monitoring of all activities, monitoring of conversations with the outside world, censoring of incoming media such as magazines, newspapers, etc, possible drugs in food, high sugar food, sleep deprivation, guilt tripping, anyone outside of the cult is the devil and anyone who leaves will never recover. If that ain’t coercion totally perfected, I don’t know what is. The System had great models to fashion itself after. May those of us that see the truth now declare, loudly and clearly, that the Emperor was naked all along.