Robert Whitaker Missed the Mark on Drugs and Disability: A Call for a Focus on Structural Violence

Timothy Kelly
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Robert Whitaker extended one of his core arguments from Anatomy of an Epidemic1 in a blog post last week. His argument revolves around the claim that psychiatric drugs are the principal cause of increasing psychiatric disability, as measured by U.S. social security disability claims. But does this really explain the rise in recipients of these SSI & SSDI benefits?

I’ve followed Robert Whitaker’s work since he first wrote about the pharmaceutical industry in the Boston Globe. There’s no doubt that his writing has opened up important discussions about psychiatric medications. At the same time, my own lived experience — and reading of the literature — have led me to different conclusions on core aspects of these issues, including the putatively causal role of medication in increasing disability

In what follows, I chart an alternative perspective on psychosocial disability that calls for the decentering of psychiatric drugs in both public discourse and advocacy. Concretely, I suggest refocusing reform efforts along two axes:

  1. The identification of areas where interests and perspectives align among advocacy groups that may otherwise strongly disagree about the role of psychiatric treatment in recovery.
  2. The intersections of psychosocial disability and poverty, the criminal justice system, and broader socioeconomic and health disparities, particularly among marginalized racial/ethnic/indigenous and/or sociopolitical minority communities.

Some Caveats

In this discussion of disability I intentionally leave aside questions of whether the experiences classified in the DSM52 are most usefully characterized as medical problems, even if they have a biological basis. In my view, the ‘body’ and the ‘mind’ are mutually entangled, and so of course there are physiological processes involved in all human experiences, as well as considerable variability among bodies. The extent to which a biomedical approach is useful or resonant for any given person is contingent on the particularity of that person within their sociocultural surround.  How persons negotiate the meaning(s) of their (our) own experience in relation to different explanatory models is highly contextually specific.3 For instance, using medication does not necessarily imply agreement with a biomedical model,4 just as the efficacy of yoga or mindfulness may be characterized in more biological, rather than spiritual terms depending on context.5 I’d like to see us shift our attention from debates about medications, loosening up polarizations that hamper our ability to work effectively on these issues, towards careful thinking and contextual grounding in fields such as mad studies,6 survivor research,7 medical anthropology,8 the medical humanities,9 and social10 and cultural psychiatry.11

Leading proponents of psychiatric treatment like iconoclastic figure E. Fuller Torrey — who said Robert Whitaker’s writing on big pharma has been “right on target” — agree that overdiagnosis and overprescription is a serious problem, especially among children. That psychiatric diagnoses do not index discreet disease processes with clearly identified etiologies has also been acknowledged by leading proponents of otherwise mainstream psychiatric treatment like Thomas Insel (Director of the National Institute of Mental Health).12 This is also clearly inscribed in the DSM5 which acknowledges that current psychiatric categories do not map onto discrete disease processes with homogenous “biomarkers,” that knowledge is therefore provisional, and the state of the science still limited.In this post, I have therefore opted to sidestep issues that are already relatively well-accepted across academic and activist contexts (such as the scientific and philosophical limitations of psychiatry).

On the other hand, I am deeply concerned about the degree to which the dogmatic anti-psychiatry positions of some are being leveraged at the federal level in favor of The Helping Families in Mental Health Crisis Act. So, even while advocating an emphasis on structurally and socioculturaly informed perspectives and psychosocial approaches, I also feel a duty to make the following statement explicit:

My decades of experience living with “severe mental illness” and disability myself, alongside a family member with even more intense disability, my years of formal academic study and research, critically reading the literature and engaging with a wide range of other persons with lived experiences all tell me there is no question that these experiences are both real and heterogeneous, and that medication is helpful for many people. The question is: for whom, for how long, and how best to weigh the benefits against the risks. My larger point in this post, however, is that there would be a lot more space to develop psychosocial approaches and address broader systemic issues if we decentered medication in these discussions, while also challenging those who would presume to speak for “us” by characterizing our experiences as not real.

The Sociopolitical Contexts of Psychiatric Disability 

That there is a marked increase in reliance on SSI & SSDI and that psychiatric disabilities account for a large portion of this increase is uncontroversial.13  But is psychiatric medication use the primary driver of this increase? I don’t think the evidence supports this assertion.

Here I provide a brief summary of two recent pieces that address this question in interesting ways — one journalistic and one academic — and that provide nuanced positions, well-grounded in actual data.

On This American Life 

Chana Joffe-Walt tackled these questions in a 2013 This American Life piece, Unfit for Work: The Startling Rise of Disability in America.14  The points Joffe-Walt raises at the very least complicate the argument Robert Whitaker put forward in his recent blog post and in Anatomy of an Epidemic.1 Whitaker rightly notes the alarming rise of psychiatric disability over the last several decades. But whereas Whitaker emphasizes the relationship between increases in SSI/SSDI and psychiatric drug use, Joffe-Walt compares the changes across different disability categories over time, and foregrounds their relationship with socioeconomic factors.

It turns out that while psychiatric conditions account for a large portion of the increase in SSI/SSDI claims, they do not account for the largest increase. The largest increase is for conditions described as “back pain and other musculoskeletal problems.”  Joffe-Walt notes that “The health problems where there is most latitude for judgment — back pain, mental illness — are among the fastest growing causes of disability.”  That both of these categories follow the same trajectory of increase should give pause to anyone claiming psychiatric drugs are the principal cause of rising disability rates. One obvious route of exploration is determining whether increases in SSI/SSDI claims for back pain and mental disorders share any common causal factors. This is the approach Joffe-Walt takes.

Joffe-Walt describes how the rate of SSI/SSDI claims have fluctuated with broader socioeconomic trends like changes in the availability of fair wage jobs that don’t require specialized education, the rise and fall of the unemployment rate, and cuts to other social welfare programs.

Joffe-Walt spoke with a physician in an economically depressed area about his assessment of patients in terms of disability claims:

“‘We talk about the pain and what it’s like,’ he says. ‘I always ask them, what grade did you finish?’

“‘What grade did you finish,’ of course, is not a medical question. But Dr. Timberlake believes he needs this information in disability cases because people who have only a high school education aren’t going to be able to get a sit-down job.

“Dr. Timberlake is making a judgment call that if you have a particular back problem and a college degree, you’re not disabled. Without the degree, you are.”

I highly recommend exploring Joffe Walt’s piece, with particular attention to the graphs and figures she provides. How is this portrait different from that painted in Anatomy of an Epidemic? Let’s look to ethnographic work to fill the picture in a bit more.

In The Journal of Social Science and Medicine

Now I turn to a 2014 article by psychiatrist and anthropologist Helena Hansen and colleagues,  Pathologizing Poverty: New Forms of Diagnosis, Disability, and Structural Stigma Under Welfare Reform.15 In this article, Hansen draws from ethnographic fieldwork to map a set of complex relations involving “structural violence” as they play out in the lives of her case study participants in a process she terms “the pathologization of poverty.”

Hansen and colleagues’ paper deepens and further complicates the arguments of both Whitaker and Joffe-Walt.

Like Joffe-Walt, Hansen and colleagues’ analysis foregrounds how socioeconomic factors and changes in policy have shifted over time, and their relationship to increases in SSI/SSDI. But Hansen goes into much more depth in terms of the intersection of disability with gender, race and class. One point that strikes me as particularly urgent is that

“Mass incarceration has led to the systematic exclusion of crucial data on 8–10 million (mostly minority) men who have been imprisoned over the last 35 years, obscuring the true extent of this nation’s worsening health and social outcomes among the poor.”

Like Whitaker, Hansen and colleagues note that iatrogenic effects of psychiatric medications are one dangerous consequence for some.  But whereas Whitaker concludes that medications are a primary cause of the increase in SSI/SSDI, Hansen characterizes the relationship as only one dynamic in a broader network of social marginalization in which “social structures, policies, and institutions devalue targeted groups of non-normative people or discipline them in coercive and subtly subjectivity-imposing ways.”

On my reading, this analysis suggests that the relationship between psychiatric drugs and disability is both highly ambiguous and heterogeneous. Fundamentally, however, relationships between disability, medication use and welfare system dependence are driven by a far more complex set of socioeconomic forces.

Further, stigma too is a complex and context-dependent phenomenon that is at least, if not more, implicated in ‘disablement’ and requires careful attention. Another consequence of overemphasizing psychiatric drugs, is that we don’t attend to the identity work16 and moral negotiation17 — which can have both helpful and/or harmful effects — that persons take up in relation to various discourses of distress and disorder.  The sense of lowered expectations and foreclosure of a richer sense of oneself all too often comes with the experience of psychiatric diagnoses which carry widespread negative associations in broader communities.18,19 At the same time, for others, diagnosis provides a culturally acceptable way of understanding one’s struggles as “real” and nameable.20

Meanwhile, the intensity with which many family advocacy groups militate against psychosocial conceptualizations of psychosis arises from a historical context in which mothers were ‘blamed’ for the intense suffering of their children. It is worth noting that these often oversimplified traumatogenic theories belonged to the mainstream of psychiatry in the not-so-distant past.21  This is an example of what I mean by “moral negotiation.” That is, fierce debates about “brain disease” or the importance of medications are often laden with additional forces that are obscured if we focus only on surface discussions of somatic medication effects.

In addition to charting structural causes of increasing disability rates, another crucial takeaway from these analyses is that context and social identity factors (e.g race, class, gender) profoundly shape the ways in which distress, psychiatric treatment, social marginalization, and disability are experienced. Taking myself as an example; though I experienced foster care, the juvenile justice system, and early-onset psychosis, as a white male my “lived experience” was quite different and almost certainly far easier than it would have been were I a black man living those experiences. It’s quite likely I would be in prison or dead, and not a PhD student writing this blog. This has implications for knowledge claims ‘from’ lived experience, and also suggests where the priorities need to be in terms of leadership development and cross-movement organizing in mental health advocacy. There are some bright spots both in the U.S., and abroad, but clearly much more needs to be done.

Some Ways Forward

Discussions of mental health policy reform should take the broader context I’ve outlined here into account. I don’t think it’s helpful (or accurate) to center debate on the supposed nonexistence of more enduring psychiatric disabilities, or take too one-sided a perspective on psychiatric medications. The effect of this dynamic was evident in a February 12th congressional hearing in which legislators were so busy responding to SAMSHA funding of groups with these positions that they seemed scarcely able to hear witness testimony regarding the importance of a systemic approach addressing such issues as poverty, housing or a contextually grounded public health approach.

Whatever one believes about medications and diagnosis, there is a lot more to psychosocial disability than either of these things address. Anthropologist Kim Hopper has laid out a detailed conceptualization of social recovery that provides an excellent theoretical model for just such an approach.22 Many “evidence based” psychosocial approaches center or include career development and living wage employment, including coordinated care for early psychosis, supported employment,23 and supported education.

Many people on SSI/SSDI are fearful of losing the precarious livelihood their benefits provide, and it is well established that these programs have built in disincentives to exploring and pursuing  meaningful work; in turn a barrier to the social, psychological and economic benefits of fair wage employment.24  Social Security Disability work incentive programs are underutilized and provide supports for folks who are dependent on disability but who would like to explore education or meaningful work.25  The process can be complicated and intimidating, but supporting folks who want to give it a shot through this process is a place where peer support can be utilized.

It should be clear that broad federal legislation on mental health policy that doesn’t substantially center the socioeconomic factors, like the Helping Families in Mental Health Crisis Act, is way off the mark. Those who support the expansion of forced treatment while not engaging data-driven discussions of how forced treatment intersects with the issues discussed above, or while simultaneously opposing social welfare, universal health care, and educational opportunities, cannot in my view substantively claim to be supporting the interests of “the mentally ill” — “severe,” or otherwise.

Likewise, advocates who agitate against all psychiatric treatment, or who deny that psychosocial disability is real, rather than meaningfully addressing the issues highlighted here make a similar error. We can do better.

References:

  1. Whitaker, R. (2011). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. Broadway.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (DSM-5®). American Psychiatric Pub.
  3. Kleinman, A. (2007). On illness meanings and clinical interpretation. Cultural formulation: a reader for psychiatric diagnosis, 69.
  4. McNamara, J. (2013). Inbetweenland. Deviant Type Press.
  5. Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: a review of comparison studies. The journal of alternative and complementary medicine, 16(1), 3-12.
  6. LeFrançois, B. A., Menzies, R., & Reaume, G. (Eds.). (2013). Mad matters: A critical reader in Canadian mad studies. Canadian Scholars’ Press.
  7. Fabris, E. (2011). Tranquil prisons: Chemical incarceration under community treatment orders. University of Toronto Press.
  8. Martin, E. (2007). Bipolar expeditions: Mania and depression in American culture. Princeton University Press.
  9. Woods, A. (2014). 6. Beyond the Wounded Storyteller: rethinking narrativity, illness, and embodied self experience. Health, Illness and Disease: Philosophical Essays, 113.
  10. Metzl, J. (2009). The protest psychosis: How schizophrenia became a black disease. Boston, MA: Beacon Press.
  11. Kirmayer, L. J. (2013). Embracing uncertainty as a path to competence: Cultural safety, empathy, and alterity in clinical training. Culture, Medicine, and Psychiatry, 37(2), 365-372.
  12. Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry, 171(4), 395-397.
  13. http://www.ssa.gov/policy/docs/statcomps/
  14. Joffe-Walt, C. (2013). Unfit for Work: the startling rise of disability in America. National Public Radio
  15. Hansen, H., Bourgois, P., & Drucker, E. (2014). Pathologizing poverty: New forms of diagnosis, disability, and structural stigma under welfare reform. Social Science & Medicine, 103, 76-83.
  16. Larsen, J. A. (2004). Finding meaning in first episode psychosis: Experience, agency, and the cultural repertoire. Medical anthropology quarterly, 18(4), 447-471.
  17. Callard, F., Rose, D., Hanif, E. L., Quigley, J., Greenwood, K., & Wykes, T. (2012). Holding blame at bay?‘Gene talk’in family members’ accounts of schizophrenia aetiology. BioSocieties, 7(3), 273-293.
  18. Schulze, B., & Angermeyer, M. C. (2003). Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Social science & medicine, 56(2), 299-312.
  19. Link, B. G., & Phelan, J. C. (2013). Labeling and stigma. In Handbook of the sociology of mental health (pp. 525-541). Springer Netherlands.
  20. Kirmayer, L. J. (2005). Culture, context and experience in psychiatric diagnosis. Psychopathology.
  21. Hartwell, C. E. (1996). The schizophrenogenic mother concept in American psychiatry. Psychiatry, 59(3), 274-297.
  22. Hopper, K. (2007). Rethinking social recovery in schizophrenia: what a capabilities approach might offer. Social Science & Medicine, 65(5), 868-879.
  23. Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., … & Blyler, C. R. (2014). Implementing Supported Employment as an Evidence-Based Practice.
  24. Rosenheck, R., Leslie, D., Keefe, R., McEvoy, J., Swartz, M., Perkins, D., … & Lieberman, J. (2014). Barriers to employment for people with schizophrenia.
  25. Drake, R. E., Frey, W., Bond, G. R., Goldman, H. H., Salkever, D., Miller, A., … & Milfort, R. (2014). Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work.

* * * * *

Acknowledgment: I’d like to thank Erica Prussing for suggesting readings and framing, and Lisa Wells and Nev Jones for helpful feedback in writing this.

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163 COMMENTS

  1. Really interesting piece Timothy – thanks for the in depth analysis.

    I also think there are intersecting issues that have led to rising disability rates. You mentioned socio-economic issues such as poverty, racial injustice as well as issues such as the tacit “built in disincentives to exploring and pursuing meaningful work for people on disability.

    I would add one more factor to this kaleidocope of reasons for increasing disability levels and that is the profound change in the global food system since the advent of the Green Revolution in the 60’s. I believe that the vast increase in the consumption of the processed form of just a few crops (wheat, soy, corn) and the subsequent massive rise in rates of obesity, metabolic disorders, diabetes and “mental illnesses” also contribute to the great rise in disability rates.

    At the same time, I think the issue of medications is a key part of this discussion. Whitaker has pointed to studies done by the WHO as well as longitudinal studies by Harrow et al and studies done by Wunderink et al that all show worsening prognosis and disability for chronic use of neuroleptics.

    Though these studies may not show that neuroleptics are the definitive reason for rising disability rates, they definitely are implicated as a strong part of the equation.

    I would agree with you however that there are certainly other factors that play into this complex issue.

    Thanks for your detailed thoughts.

  2. I had a lot of trouble understanding this, and I am not sure I was supposed to. I think the writer did have something worthwhile to say, but in spite of my Phi Beta Kappa key and several degrees, I just couldn’t follow it. Hey, I am even a lawyer, and we lawyers really know how to be obscure, but this beats me.

    I also take issue with this nonsense about “dogmatic anti-psychiatry positions.” There is nothing dogmatic about being anti-psychiatry. For me, it simply means that I see psychiatry as a whole to be an institution that does a great deal of harm and very little good. People like E.Fuller Torrey have managed to create this nonsensical idea that if you oppose what they are doing you are beyond the pale. And they have actually frightened a lot of people who know very well how destructive psychiatry is from speaking out. This is just plain silly…but dangerous.

    • I agree with the overly academic style for a popular website and the anti-psychiatry jibe rubbed me up the wrong way too however a broad analysis of what fuels rising disability rates is interesting.

      In the UK some people think the government made it easier for people to get disability payments as a way to reduce the unemployment figures. Now they are pusing people on disability off and this is causing hardship and in some cases suicide.

      A social analysis of disability paymnent is interesting. Whittakers analysis is also interesting, ie that psyche drugs often make people worse in the long run and he seems to have enough evidence to make that a point well worth investigating.

    • Exactly. I am totally anti=psychiatry which does not mean I don’t recognize that one can really feel terrible in his/her own mind and go “crazy” (whatever this entails in terms of behaviour and inner state) nor “deny that psychosocial disability is real”. I simply don’t agree that psychiatry has anything to offer to people who suffer from any mental distress – they in fact make the problem 1000x worse.

  3. I’m glad to see this blog post featured on Mad in America and find there are many points of interest which will require re-reading for consideration. Speaking as both a psychiatric survivor and as a carer of family members, some of whom prefer(red) to stay within the system and on the drugs.

    I think this piece tackles some of the challenges in the mental illness mantra and doesn’t given any easy answers because I don’t think there are any. I can identify with “blaming the mother” scenario and even in the last few years was accused of being a “schizophrenogenic mother” in a tweet by a man who didn’t know me. I had to look it up to see what it meant.

    Three generations of my family have experienced altered mind states due to life transitions and stressors, hormonal events and pain or trauma. Eight of us have been labelled in psychiatric settings because we are sensitive people who feel things deeply and express it outwardly, rather than internalise it and get physical health issues. Therefore the back pain references ring true to me. Also here in Scotland there have been centres set up for dealing with chronic pain. The problem of pain, physical and mental, I think needs more exploration and listening to.

    So thanks to Timothy Kelly for a thought provoking post and for the questions raised.

    • As far as the back pain goes I think there may be a simple medical explanation for it – psych patients as a group have higher rates of sedentary lifestyle (often linked to psych drugs…) and also experience considerable stress. Both are risks factors for muscle rigidity and back pain – I know because I’m personally afflicted and it’s the result of my encounter with the system.

    • By “express it outwardly,” do you mean psychosis? If so, you have nicely explained why it is that those diagnosed with “schizophrenia” are often impervious to common illnesses.

      “Eight of us have been labelled in psychiatric settings because we are sensitive people who feel things deeply and express it outwardly, rather than internalise it and get physical health issues.”

  4. In my son’s case he would have never ended on benefits if he hadn’t been forcibly drugged and rendered totally incapable to fend for himself or to think for himself thanks to olanzapine and other antipsychotics. Once he had managed to get off those drugs behind doctors’ backs, he became his normal intelligent self but had lost totally his self confidence thanks to the treatment he had received at the hands of psychiatrists.
    My niece in Toronto had a very similar experience. She took herself off the drugs but instead of supporting her, her mother went squealing to the psychiatrists and had her hospitalised and put back on drugs against her daughter’s will. And guess what, her mother wants her back on disability. So yes, I think Robert Whitaker is absolutely right in what he is saying concerning psychiatric drugs.
    Also mothers, fathers, the family are often to blame in their children’s breakdown. My husband was certainly to blame in my son’s so called mental illness and my sister-in law is definitely to blame in my nieces predicament because she is a bully and has never allowed her daughter to have any say in anything

    • They wanted to put me on disability payments – the price was I was supposed to be “in treatment” (guess what it entailed…). I decided to take the ostensibly “harder” path of actually trying to get my job back and finishing my PhD and cutting off any contact with the psychiatry. It worked and I’m mostly OK now (save for the major trauma from the torture also known as “forced psychiatric treatment” that was inflicted on me) – working, having a great family life and friends. Have I gone down the psychiatry’s path of death I’d be probably locked up somewhere for murder, not knowing my own name – an awesome collective effect of many drugs they tried to put me on (not mentioning otehr nice side effects like vomitting, narcolepsy, binge eating… I could go on and on and on…).
      I think that as far as psychiatry goes the “rebels” do better as long as they are able to escape the system and not be locked up and forced to take the poison.

  5. While I appreciate that the author raised issues related to the social and economic aspects of disability, he did not acknowledge that these get short shrift precisely because of the hegemony of he medical model. And I agree with commenters who did not like the academic tine of this post, which is not appropriate for a popular website and serves only to create distance between the author and the audience. And the unreflective rant about “rigid anti-psychiatry” views was not helpful in furthering the author’s arguments. It was a nasty cheap shot.

    Among the key points the author glossed over is that even though people like Torrey and Insel may say things that acknowledge many of the flaws of Big Pharma and the medical model, that has no bearing on how psychiatry -particularly public psychiatry -is practiced. People are still put on an assembly line of poly-pharmacy, which DOES cause significant harm and disability to many people,even if the author does not wish to acknowledge this.

    The message I got from this post is that those of us who are concerned with the dangers of psychiatric medication and forced treatment should just shut up or it will be our fault if a right-wing congress passes n oppressive mental health bill. That is nonsense.

    • I really like Darby’s comment that the dominance of the medical model is what leads to the lack of attention to sociopolitical factors. The need for calling attention to issues that are easily ignored by the majority is an essential function of activists of all stripes. It may be the willingness of some people to present issues in “black and white” that creates motion, even if the proposed solutions don’t exactly line up to their criticisms.

      “Business as usual” in Congress, or other public decision-making bodies, is more attributable to the politically disengaged than those with “extreme” views who pay attention and speak up!

    • “And the unreflective rant about “rigid anti-psychiatry” views was not helpful in furthering the author’s arguments.”
      Especially that this portion of the article misrepresented the views of anti-psychiatry folks considerably. It’d be nicer if the author took the our opinions from our own mouths instead of the pharma’s propaganda machine.

  6. Timothy, thanks for this piece. It’s probably true people in this “Whitaker camp” are simplifying issues and so on, but then again they are often not PhD students specialising in this type of thinking, reading and discussing Foucault and academic papers, etc.

    In any case, I agree with you that there are many factors besides just drugs that drive this increase in disability. I’ll give as an example my own experience of the psychiatric system. First, I live in Finland which has a somewhat different culture and history than USA. It’s a small and culturally homogenous country, with a relatively “egalitarian” social system, similar to other nordic countries of Europe, such as Sweden. The public health care is free for every citizen and people get paid for disabilities, including mental illness, by the state. Being somewhat distant and small country, Finland was also slower to follow with trends such as the increase in SSRI prescriptions for depression.

    I had quite severe issues related to anxiety, stress, depression, social phobia and so on from at least 13 years of age. At the same time, I also managed to somehow do quite well in school. Let’s just say that my symptoms were quite severe. Around 1998-2000, when I was roughly 20 years of age, I went to a university doctor to ask for SSRI, to try if it would help my quite severe symptoms. He was very reluctant to prescribe it, but eventually complied and gave me a prescription. I took it for some time, for some reason stopped it for a while, then wanted to try it again. I went back to the doctor to ask for new prescription of SSRI. This time he would not write a prescription and said that in his opinion, SSRI is not the answer to my issues. I protested and was angry, and he said I need to seek to the psychiatric part of the university health care if I wanted medicine.

    So, I then sought help from the psychiatric side. I had meetings with a psychologist who tried to ask about my issues. I wanted to get those SSRIs. The papers suggest I was suggesting maybe I have a bipolar, but they didn’t find any signs that suggest it. Finally I got to the psychiatrist, an older woman who also had a strong background in psychotherapy. I got her to prescribe SSRIs, but she was constantly saying that maybe I should eventually stop the drug, we don’t know much about the long term effects of these drugs and so on. I resisted and wanted to keep eating that SSRI. Eventually when I went to work, I stopped going to the university health care and also stopped taking SSRI.

    Fast forward to 2010 or so, when I was 33 years of age. I wanted to try SSRI again, to see if it would then again help with some of my symptoms. I went to the public health care this time, in a more suburban place I live in. I could have gone to a private health care, since in Finland the employer often pays for private health care for employees, but I think my idea was that I didn’t want the work related people to know about these issues. In the public health care, I saw a general doctor who readily prescribed me SSRI, asked some questions, and then also sent me for an evaluation. Long story short, they immediately added neuroleptic drugs, which caused severe issues which were intepreted as schizopohrenia, bipolar and so on within months. I was told I had a “progressive brain disease” which would impair my brain if I did not eat the drugs. When I complained of the very severe effects neuroleptics had on me, they wrote in their papers “patient had paranoidic ideas concerning his medication”. I was off the work for a year and they tried to push me to some “day hospital” And so on. After about half a year I finally figured out what was really going on, and then managed to fight my way out of the place.

    So, what was the difference between those years 1998-2000 and 2010-2012? I was actually in a worse condition in 1998 than in 2010. I can think of at least two major factors. One is that the kind of pharmaceutical health care with SSRI and “atypical” neuroleptics really broke through in Finnish care through that decade. This is similar to what Whitaker seems to address in Anatomy of an Epidemic. Other factor perhaps is that I went to the low quality public health care instead of health care of university or that paid by my employer. A lot of the health care in the public section seemed to be often focused on social and behaviour control. They had issues with getting psychiatrist work there, one psychiatrist handled a huge number of patients, a lot of the work was related to behaviour control with neuroleptic drugs, writing applications for disability and so on.

    I don’t know what that university health care looks like today. Probably they’re now more open to write prescriptions for SSRI, modern neuroleptic drugs. So, I think in part things have moved towards this direction in last decades because of the focus on this kind of treatment. It’s also probably true that even in a relatively egalitarian country such as Finland, people in different “classes” of people get different types of treatment. And so on.

    • Hey Hermes, I think I can relate to your statement about how you were (naturally) worse in 1998 than in 2010, which makes sense, since you had learned a thing or two about how to cope. It looks like the nature of our run-ins with our respective psychiatric establishments has a number parallels. I am also doing lots better now, but since I question them more, my files say I’m worse. The only way I am worse than ten or twenty ot thirty years ago, and not the best since ever seeking help, is how the behavioral healthcare industry has misinformed, traumatized, and dehumanized me as just another case.

  7. Thank you Timothy. ,
    I too think many of these points are very important and welcome them into the discussion and also, like some of the folks above, it’s clear to me that psychiatric drugs are also highly problematic and do indeed cause severe and grave disability all on their own. I’ve worked with thousands of people coming off meds now and to be clear some folks are put on these disabling medications for issues that are not even remotely psychiatric in nature and they still end up like the lot of us….disabled and crippled for at least some time.

    Also, I think there are many other factors besides what Timothy Kelly brings up…as Jon Keyes mentions our food supply is one…

    I’ve always considered Robert Whitaker’s argument to be just part of the equation and have often talked about how “everything matters” because we are, indeed, profoundly holistic beings. We like to slice things up and point the finger at this or that but the broader the picture is always better and the kaleidoscope of what comes together for each individual too varies. It’s never going to be the same thing twice.

    Our over medicalized western lives in general also have a large impact. In my own research to uncover what happened to me when I was struck gravely ill in what is vaguely called psychiatric drug withdrawal syndrome, it’s also clear, that excessive early use of antibiotics added to my becoming additionally sensitive to the ways that psychiatric drugs harm us in particular.

    Autoimmune issues are rampant among the folks impacted by psychiatric drug withdrawal issues which has been completely neglected as well. The medical establishment doesn’t understand autoimmune issues in any case and psychiatry will be late to the game for sure as it always is.

    I think the work of Bessel van der Kolk — The Body Keeps the Score — is hugely important. Gabor Mate is doing incredibly good work too…they start touching on some additional important things to consider.

    Because these issues are so broad and huge we need to get our information from many different disciplines.

    • Just some “side effects” psych drugs had on me (and mark I never did take any for more than a month – I congratulate myself on this decision every day of my life):
      Diazepam – first made ma “high” then gave me an almost total anterograde amnesia for almost a week and considerable aggressiveness although the latter one may be die to forced treatment (I simply don’t remember)
      Zyprexa – binge eating and “narcolepsy” (I fell asleep while riding a bike in the middle of a busy street), cognitive “fogginess”, extreme tiredness, emotional instability in withdrawal (lasting over a week after single dose of 2.5mg or less), restless leg syndrome
      Seroquel – total “zombification”, aggression, suicidality, restless leg syndrome
      SSRI (several of them) – anxiousness, panic attacks, emotional instability, shaky hands
      Abilify – severe nausea and vomiting
      There were more but I don’t remember off the top of my head. Not to mention none of them cured a toxic relationship I was in or resolved my stressful professional situation. They made it considerably worse.
      Btw, if someone tells you RLS should stop immediately when you stop taking the drug – they either lie or have no clue. It took me several months to get rid of it.

  8. Thanks for the post. I keep wondering when someone will look at the impact of employment on rates of PTSD in returning vets. I’m also remember the recent 60 Minutes segment on the rapid rise in SSDI claimants after the local mill was closed. It’s good for us to remember that the major hammer blows for mental health are lack of fairness and inclusion in society.

  9. I have serious disagreements with your arguments on about all levels. Although I do think there are many socio-economic forces at work in the manufacture and maintenance of problem people, I don’t think socialism through SSI/SSDI payments the way to go. If you switch gears to the other side of this equation, you get “lifestyles of the rich and famous”, and they remain relatively untouched and intact.

    As for the juncture of the psychiatric with the medical, many psychiatric treatments, including psychiatric drug treatments, harm the body. Medical need increases with the amount of harm done to the brain and the body. Stop harming the body, and you have less need for medical attention to be given to it. The simple fact is that we are treating harmful chemicals as if they were candy. What we are dealing with are the consequences of doing so. I would prefer to see LESS need for medical intervention rather than MORE need for such intervention.

    What you ignore from the beginning is how so much of these complaints arise from the fact that you have this law, mental health law, to get around the law. We can lock up non-lawbreakers with this law under the pretext of medical treatment. It is the fact that we are labeling aberrant or annoying behaviors as “sick”, and then locking up people for breaking these unwritten rules. Get rid of the law, and you won’t have so very many “sick” people, especially when this “sickness” has absolutely nothing to do with medicine, and everything to do with how you live your life.

    Certainly drugging may look like a good solution to social problems, on the other hand, drugging people, as has been pointed out, time and time again, is a way of masking, and not dealing, with very real problems. I’m not, and I never will be, good with the idea of replacing the opium of the masses with, say, the prosac of the masses. Of course, we’re there, aren’t we? Nonetheless, I don’t buy the view that a drugged nation is a more healthy nation.

  10. I’m having a little trouble with my browser at the moment, so if my comments appear in the feed more than once, I apologize. Here are my comments:

    Thanks for taking the time to write your article and trying to expand the discussion.

    First of all, I’d like to say that I agree with some of your main points, at least at this point in my process of learning about the whole subject of “mental illness.” For instance, I also believe that there is a physiological process involved in every aspect of being human, whether it’s the way our minds work and our bodies function, and that the whole system is intertwined, and that we ignore it at our peril. Shifting the emphasis away from crude, blunt-force manipulation of the brain with chemicals or electroshock, with all their disastrous long-term effects, does not mean that we shouldn’t pay attention to and study the brain. A renewed emphasis on psychological processes as actually lived does not exclude understanding the biological processes that underlie them. If anything, understanding the important effects of nutrition and how that affects the body’s ability to handle stress or the brain’s ability to regulate itself is hugely important, as are the effects of exercise and meditation or a practice like yoga, etc., in giving us the tools to change how we use our minds and our bodies for the better. Supportive social environments and meaningful work also affect the whole system, and psychiatry, if it was truly concerned with the whole person — mind and body and environment — would look at all of it. So even if antipsychiatry makes some very important points, I am not opposed to the idea of psychiatry in principle — the study and practice of medicine as it relates to the mind — if it could be brought around to actual medicine that optimizes the functioning of the whole person, instead of the crude and shortsighted and often disastrous methods it uses now, which the forces of institutional complacency and conformity reinforce through a myopic focus on incremental and virtually meaningless changes to those methods while blinding them to their disastrous results and deflecting attention away from other solutions. Of course, I don’t know if you agree with all that, but it’s my take on the subject.

    I agree with you also that medication needs to be less the sole focus of our concern than it is now, but that’s also where we seem to part ways.

    First, I never got the impression that Robert Whitaker was trying to explain every change in disability (SSI/SSDI) as a consequence of psychotropic use. In fact, I’ve never gotten the impression that disability, per se, was even Mr. Whitaker’s larger concern. Mr. Whitaker is a medical journalist, and his focus is on medicine — specifically, on psychiatry, if I understand him correctly. While people tend to focus on his book Anatomy of an Epidemic, which talks about antidepressant use and the rise in disability, I see the focus on disability as a way of looking at the real-world effects of psychotropic use — in other words, psychiatric practice. The other book, which I’m sure you know but which people talk about less, is Mad In America, which focuses on the history of psychiatric treatment of “psychosis” and does not really focus on disability. Thus, the common theme of his work is psychiatry, and I see his discussion of disability as only one pathway — the one he has chosen to explore, possibly because it is a clear way to demonstrate what is really going on and what the long-term effects are of current psychiatric practice — to talk about psychiatric practice in general. So, to bring it back around to the unfortunate title of your piece — that Mr. Whitaker “missed the mark” in how he talks about the rise in disability due to the use of psychotropic meds, I think that it might actually be you who missed the point. He’s not talking about everything that’s happening with disability, because that’s not his main concern. He’s using disability to draw a larger picture of the effects of modern psychiatry. The name of this website, after all, is “Mad In America”, not “Disability In America”, and while your concern with the larger issues surrounding disability is laudable and important and it’s good for us to know about other issues, you may have mistaken what Mr. Whitaker’s larger focus is, if I understand it correctly myself.

    Second, I disagree with you completely that we need to “decenter” from the discussion of medication. While some people who are well acquainted with the subject may be familiar with its broad outlines and ready to expand their focus to other areas, there are lots of other people who are using this website to explore the subject for the first time, or to keep up on current information and perspectives. The movement to change psychiatric practice — which is the real focus of this website, not disability — is starting to gather some steam, but the broad societal change hasn’t happened yet, and to “decenter” from medication is the very last thing we need to do at this point. If anything, we need to center on it even more and with even greater purpose: tie the broad range of perspectives together into a cohesive and panoramic picture that the public and practitioners can understand so that enough people will grasp enough of the whole dynamic that we’ll create enough momentum for change. Right now, many pieces of the picture are out there — the emptiness and failures of the current chemical imbalance model, the long history of psychiatry’s failures and the dangers of its coercive power, the long-term consequences of psychotropic use, the dangerously corrupt practices of the pharmaceutical industry and how it is intertwined with the psychiatric establishment. The pieces are out there, and I would like to see someone come along and create a unified picture of how it all works. And, if I get my druthers, there will be someone like you who has a broad knowledge of how public policy and government programs actually work involved in putting that picture together, because without that knowledge of the system, any attempts to implement change will be hampered along the way by institutional interests, just as Big Tobacco did, in order to preserve their own interests and profits, often by seeming to concede to changes while ensuring they were implemented in ways that worked to their own advantage.

    To take just a moment to address your point about the potential usefulness of psychotropics, while I too have lived experience, as you do, and while I take listening to what people with lived experience have to say about their experience extremely seriously, as you also seem to do, I do not automatically think that makes every one of those people universally and unquestionably well-informed on every single issue that affects them — and I say that out of lived experience too. For many years I was the model psychiatric patient: always medication-compliant, never questioning the good judgment or enlightened care of my psychiatrist. I took the minimal and skewed information he gave me (“You might gain some weight, and we’ll need to monitor your blood sugar” — not that they would probably skyrocket, with all the bad effects that follow) as sufficient information to give my “informed consent”, never suspecting that the process had been reduced to a parody of what it was meant to be. I believed he was saving my life — even as my body ballooned up and I developed high blood sugar and high cholesterol and more and more medications of other kinds were pumped into my body as a result of the whole metabolic syndrome, and over the years of his treatment I gradually grew more and more physically and mentally incapacitated, until I reached a point where I stopped functioning in any meaningful way as a human being and spent what few hours of the day I wasn’t sleeping just staring off into space, with nothing at all going on in my head — no thought, no emotion — and made never a peep as all meaningful connection to other people and the quality of my own life disappeared. Yet I would have reported to anyone who asked, as they sometimes did, that I was doing the best that could be hoped for — or that’s what I believed, according to my assessment of the possibilities within the framework of limited expectations that I had been taught. And so, in my present life, when I listen to a couple people I know who claim that they couldn’t get through the day without their antidepressants, that it enables them to function, I don’t accept their statements without looking into it further. It’s possible they’re right. Maybe they couldn’t cope without psychotropics. I don’t fight with depression, and I can’t claim to be an expert on it. But if being “medicated” for depression resembles being “medicated” for psychosis in any way, then I suspect there is a lot more to the picture than they may even be aware of themselves. That antidepressants are almost exactly as effective as placebos leads me to suspect that that’s all these friends of mine are experiencing — the placebo effect — as difficult as that might be to see in oneself (although it’s a very interesting effect of how our thinking can determine our experience, and deserves more exploration). Or that, like me, they are coming from a place where they simply don’t realize that there are other ways to do this — that although they may think antidepressants are the best they can hope for, maybe they don’t know about exercise and good nutrition and meditation and getting into the effects of trauma and developing some insight into what’s going on for them and how to deal with it more effectively. That is, they might know the words for those things, but not the experience of those things from the inside. They may, as I did, be mistaking impairment for the best possible outcome out of a sheer lack of knowledge, and who knows what they might learn if they could get outside the information bubble and seemingly unavoidable alternative of modern psychiatry and its presentation of itself as the principal if not sole authority on the subject of “mental health,” which is how it presents itself in spite of its limited perspective and unacceptably poor outcomes, and which is so thoughtlessly accepted without question and then repeated in the media to the exclusion of what I and many others believe to be more effective solutions. So, yes, we should listen to people with lived experience, but we should also not forget that their experience is also — in a phrase you seem to favor — contextually dependent.

    The last main thing I’d like to mention also relates to the “decentering” of the discussion away from medication. As I said, I wouldn’t remove it from a central position at all. But I would like to expand the center to include a complementary focus on the alternatives — the effective alternatives. If one wants to replace something, one should do one’s best to show what it might be replaced with. There is a great deal of attention paid to psychiatry’s harms and its need to reform, but less attention paid to what will be done to reform it. I guess it’s natural that anger and outrage motivates people to protest, and that happiness and contentment draws less attention or the desire to make noise. The personal stories on this website often focus on the harms of psychotropics and coercion, while going less often into what the positive solutions are. That’s only natural, of course, since so many of us, either ourselves or our loved ones, have been subjected to those harms: that’s our common ground. And if less focus is put on exploring the solutions together, that might also be because a lot of us haven’t found them yet, or are only just learning about them. We see articles that talk about Soteria or Open Dialogue — but mostly as general outlines, lacking focus on the real mechanics of how they work. In some personal stories, we see references to nutrition and exercise and meditation and so forth — but all we get, for the most part, is the broad outlines, a passing reference. But these are complex and sometimes difficult topics, and what people need — or what I needed, and still sometimes need — is a place to start with it all. For instance, I meditate, but that came about because I had the intuitive sense that meditation was about self-understanding, which I sensed I needed, and since no one (and certainly not my psychiatrist) was going to come along and just give me that information, I had to explore the subject on my own. Fortunately I like reading, I’m not intimidated by new subjects, and I’m willing to read things over and over again until I connect with them. The books are out there if you go out and hunt them down and dig through enough of them until you find one you can understand. But without that determination, and the good fortune of being pretty well educated and a reader by nature, I would most likely have never gotten into it all. And I know from talking to other people that most people don’t meditate because they don’t know what meditation really is. They have this notion, probably picked up from popular representations of people who have meditated a long time and who are pretty happy as a result, that you just sit down one day and a little magical lightbulb of bliss goes off over your head right away, and if it doesn’t then you’re doing it wrong — that you’re supposed to just instantly arrive at enlightenment or something, or you “just can’t do it right” — and they quit trying. But meditation doesn’t work that way, and maybe no one has ever told them that. To understand your own mind, you have to actually watch it for a while, experience what it’s going through, and just live with it. The end of the suffering — at least as I’ve experienced it — isn’t because you don’t feel pain any more. If anything, you’ll feel the pain even more deeply for a while. But you have to open yourself to it, go through it, in order to see where it comes from and how to work with it and how it loses its power over you, the same way a con man or a liar loses their power over you once you catch on to what they’re doing. But I don’t see a lot of discussion of the actual mechanics of meditation or the other positive alternatives. I see lots of documentation of all the miseries of psychotropics and withdrawal from them, which are necessary, but only passing references to the details of the positives, and while it’s at least mentioned in passing, it doesn’t do much to share the experience and get some insight into how things might work. So, yes, there needs to be more of a focus on things besides medication. Not at the cost of focussing on psychotropics, because that’s a fight that needs to be fought until it is won. Only that besides focussing on the harms of psychiatry, there needs to be an additional focus on the positive alternatives — which may even have the added benefit of reforming psychiatry from the outside, since, like Western medicine in general, they tend to not pick up on (or even dismiss and undermine) the importance of issues outside their traditional focus until the public forces them to look at what everyone else already knows (at which point they look around, do some “validation studies,” write some popular books, set up an institute to appropriate control of the conversation, and then give each other awards and honorary degrees in order to publicly congratulate themselves once again on how they’re moving in ever more progressive directions . . . but I don’t really care who takes the credit in the end as long the change finally happens!).

    Thanks for your article. Even if I disagree on what I think you meant on some points, the discussion itself is important to have. I guess I went rather far afield in my comments, but I thought you deserved a thorough response. I suspect that some other responses will not be as civil, but I recognize the good intent behind your thinking. But, while I wholeheartedly endorse free discussion, I wouldn’t catechize Mr. Whitaker on the failures of his work with a sensationalist title when you don’t seem to have taken quite enough time to consider its purpose or — there’s that word again — the context it depends on.

  11. I am very glad to see this article posted here. Over the years of doing anti-oppression organizing and advocacy, I have seen many times the resistance that arises when a community is challenged to broaden and strengthen its analysis with a more complicated understanding of how power and identity impact peoples’ lives. I feel unsurprised, but maybe a little disheartened, to see many comments so far jumping to the defense of a drug-centered conversation while seeing few engage with the important thoughts raised here.

    The “too academic” critique is particularly sad for me to read. After all, this is a site that regularly publishes highly academic and well-cited articles on pharmacology and psychology without such a response. I wonder if the issue is more pointedly that this article makesa use of vocabulary and references less familiar to the audience here, because these critical perspectives have been under-explored in our community. I am not an academic person at all, but I do have a lay-organizer’s understanding of analyses of systems of power. I had no trouble parsing this article at all.

    While I have no doubt that the (often coercive) overuse of psychiatric drugs is a factor in many individual’s disability, I also appreciate that racism, sexism, ableism, transphobia, moral training, mass incarceration, and class exploitation are major forces of power and domination in our society. These forces, when mingeld with a flagging economy, influence many individual’s stories as much, or far more as, their particular psychiatric drug regimen.

    Why is it, after all, that certain groups of people I run into seem to do better on certain amounts of psychiatric drugs than others? Why are some groups so hungry for them, while others so wary? Why is the representation of the anti-psychiatry movement disproportionately white compared to society at large, and even compared to other movements struggling against institutional violence, such as those vying to end mass incarceration?

    This certainly is a strongly drug-centered conversation. When we do talk about poverty, about foster care, about jails, prisons, and schools, we mainly come back around to talking about the drugs over and over again. Without leaving behind our concern about the impact of drugs and diagnoses on peoples’ lives, I think that we are overdue for a more comprehensive conversation about all the factors that influence madness and psychosocial disability.

    • I hope my comments weren’t viewed as being too drug centered in your mind Matthew…I totally agree that socio-economic issues are critically important as well and that there isn’t enough commentary on them in general. All the trauma based information I post at Beyond Meds embraces this view completely.

      I agree with all your comment as well…our abusive society is rife with “racism, sexism, ableism, transphobia, moral training, mass incarceration, and class exploitation” and all of those things make for a generally abusive and traumatic culture for everyone…

      Anyway, I did want to underscore that I think that without identifying how these issues are fundamental in our society we won’t get out of the rut we’re in…medicating everyone with little discernment….and thus making problems even worse.

      • Hi Monica!

        I read your comment as mainly discussing non-drug issues, but not particularly the ones that Timothy brought up. Obviously, the great work you do exploring trauma, spirituality, and alternative treatments should also be a part of the conversation as well, and I think they are already a part of the conversation much more than the factors that Timothy is challenging us with.

        After all, one of the most subtle and most effective ways that racism perpetuates itself is that white people simply do not have honest dialogues about it. The same dynamic is true for ablism, sexism, and other structural ways of centering power. Those of us not directly affected either are not willing, don’t know how, are too scared, or for some other reason won’t talk about these socioeconomic factors in our own communities.

        I know that you are someone who is willing to engage with this issues. And, I’m just naming that the same dynamic is playing out in this group where Timothy brought up race, religion, poverty, and other vectors of power and identify formation that we appear to not be really grappling with as a community, yet.

        I appreciate him helping to open up those doors!

        • It should go without saying that much disablism comes from prescription drug (ab)use when it isn’t actually imposed on a person by the authorities. Certainly discussions regarding poverty, racism, sexism, classism, elitism, etc., belong at MIA. I don’t see those in this article. I do see a lot of academic sounding nonsense (i.e. jargon). Maybe Timothy Kelly could clarify his position a little. That’s just the way I see it.

          I’m not saying that a person can’t be damaged beyond repair. I’m saying that a muscle that isn’t exercised will atrophy, and atrophy, as an aim in life, has a lot to be desired.

          • Frank, You’re right on and clear… it’s the positive thinking patrol out to protect diversity, again. And let’s all never-mind about the behavioral healthcare system of entitlement, the powers to detain and discredit, the complete lack of intelligent conversation within hospital walls on what is medicine versus what is sociopolitical fate, and the passive aggression of the politically correct Left.

        • I don’t really know where the criticism comes from because in my reading of MIA topics of socioeconomics and systemic oppression of various groups of people comes up in almost every story and even if not in blog posts themselves, then surely in the comment section…
          In my view drugging is just a part of the oppression that locks up people inside their own minds and shows them their suffering as individual rather than collective, preventing any effective organizing.

        • Matthew,

          You wrote:

          “I also appreciate that racism, sexism, ableism, transphobia, moral training, mass incarceration, and class exploitation are major forces of power and domination in our society. These forces, when mingeld with a flagging economy, influence many individual’s stories as much, or far more as, their particular psychiatric drug regimen.”

          Response:

          Racism and sexism? Are we talking about institutionalized versions, or individuals hearts and minds? We’ve come a ways with the first, with a way to go with the latter.

          ‘Moral training’ gets put in the same problematic list as racism? What do you mean by ‘moral training’? Surely, parents have an obligation to teach their children right from wrong; how to learn be responsible adults. I’m lost.

          ‘Transphobia’? I’m not seeing a lot of this. Former Olympian, Bruce Jenner isn’t receiving a lot of backlash in the press, at least none that I’ve seen or heard; nor is there chatter in the street. I think many people prefer to mange their own lives.

          As far as the demographics of professionals in psychiatry (residents, APA, 2011), it’s not a good ole boys/ white man’s club:
          Gender: 55% female, 45% male;
          Race: 53% white, 7.8% black, 26% Asian, 8.6% latino…
          So, if there’s a trend, it’s not toward more white guys, it’s toward more Asian women.

          The APA, it could be argued is a pretty “diverse” group, at least in regard to gender, race… Diverse in ideas? Not so much.

          The larger point of addressing ‘oppression’…. yet not a word about ISIS, a group that beheaded 21 Christian Egyptians recently?

          Duane

    • I’m very much in agreement with this comment, Matthew. I would especially like to see more articles here attempt to grapple with the questions you raise here: “Why is it, after all, that certain groups of people I run into seem to do better on certain amounts of psychiatric drugs than others? Why are some groups so hungry for them, while others so wary? Why is the representation of the anti-psychiatry movement disproportionately white compared to society at large, and even compared to other movements struggling against institutional violence, such as those vying to end mass incarceration?”

      • Why is it, after all, that certain groups of people I run into seem to do better on certain amounts of psychiatric drugs than others?

        Maybe a better phrasing would be “Why is it that certain groups seem less damaged by psychiatric drugs than others?” (tho I’m not sure exactly what groups you mean)…?

    • I would even go so far as to argue that perhaps for some people in this movement, the reason they’re not able to join in, align with, or even care much about other social movements dedicated to dismantling oppression is that the only true oppression some people have faced has been at the hands of psychiatry. And if that is the case, then that says a lot concerning one’s social position, and relative ignorance of others.

    • “I feel unsurprised, but maybe a little disheartened, to see many comments so far jumping to the defense of a drug-centered conversation while seeing few engage with the important thoughts raised here.”

      I think of it as an oncoming tsunami. The drugs are destructive enough that an actualy atrocity is occurring because of all the disinformation that big pharma and psychiatry has been feeding to the public. Sure, socioeconomic factors, stigma, etc are all a problem… but they’re not ruining a million childrens lives with permaenent brain damage… they’re not killing tens of thousands of people a year… they’re not being forcibly injected into people whose problems may have been caused by those drugs in the first place.

      If presented with two problems, one being critical and a matter of life and death, the other being an issue of quality of life and tweaking a system for improvement… I’d like to think the priority goes to the former.

      • Racism is a grave matter of life and death! Racism kills tens of thousands of people a year and harmfully disrupts many lives both within psychiatry and in many other ways. Reducing the impact of racism and other forms of oppression to to “quality of life” has the unfortunate impact marginalizing the lived experience of people of color.

        And, after all, these are interlocking issues, not separate ones. The harms of psychiatry disproportionately impact poor people and people of color.

        • I understand that there are issues with racism and prejudice, but just imagine if the powers that be in psychiatry could no longer prescribe the drugs the way they do. Imagine if an angry young black male were being taken to the psych unit, angry because he’s oppressed, disturbed and disturbing, about to be swept under the rug by the powers that be. In our current system, he’ll be forcibly or coercively drugged into submission. Zonked out. Zombified. Then he’ll be offered services in exchange for signing a force-drug-me advanced directive and a conditional discharge.

          Now imagine that same scenario except with no drugs. Imagine that the legal perception of these drugs had changed to the point where malpractice suits against doctors were common, and there were very little support for these drugs by the public. The racism would still be there. People would still be trying to sweep the angry black man under the rug. But where would the serious harm come from, without the drugs?

    • Nah – it wasn’t the focus. David Healy’s posts are sometimes use metaphor a little too librally but I can understand what he is on about. However if I read an academic paper I struggle. This was pitched somewhere between the two.

      I’m steeped in social analysis, just like you Matthew. I too think the issues raised are important. I just think it just needed a bit of editing to render it in plainer English.

  12. It just occurred to me that what was lacking in this article, and in pretty much all articles in Mad In America these days, was any acknowledgement of human rights violations in psychiatry at all. Since the author attacks the “dogmatism” of anti-psychiatry, I think it’s valid to discuss this.

    I think psychiatry cannot be reformed any more than slavery. There were many people before the Civil War who advocated for the reform of slavery. Slavery benefited the slaves, they said, who were not capable of dealing with freedom or functioning as citizens. (Doesn’t this sound familiar?) So the reformers wanted such things as less beatings and kinder treatment.

    That’s what those who think psychiatry should be reformed are basically advocating for too. But reforming psychiatry and reforming slavery lead to the same thing: the perpetuation of a system whose basic purpose is to take away the human rights of the people who are subjected to it.

    I also think there is some confusion, which is encouraged by people like Dr. Torrey, about what it would mean not to have psychiatry as a system that people turn to when they are in distress. If psychiatry lost its power, its defenders say, then people would have nowhere to turn for help. This is really nonsense.

    Programs like Soteria House and peer-run respite centers help people, and they are not run by psychiatrists. In fact, the psychiatric profession fights them tooth and nail. Decent psychiatrists like the late Loren Mosher, who started the first Soteria House, are viciously attacked by their colleagues. In Dr. Mosher’s case, he was driven out of his position in the NIMH as a result of his advocacy of a more humane way of dealing with people in distress.

    I totally support the efforts to develop alternative ways of helping people with emotional problems. But while working on these alternatives , we must recognize that to put them into practice, it will be necessary to fight for them politically.

    I think working for alternatives and having an antipsychiatry position go hand in hand.

    Anyway, I am disappointed that MIA recently seems to be presenting only a reformist view. I don’t think analyses of the fine points of psychiatric treatment is going to advance anything important any more than talking about reforms to slavery was very helpful either.

    At bottom, the real problem with psychiatry (as with slavery) is its consistent and intense violation of the human rights of the people who come under its control. Talking about reform just helps to perpetuate these violations. We should be concentrating on ending them.

    • I think that besides the harm done to me by the Lithium, is the anger that sometimes flares up in me owing to the fact that an institution put one over me, and that I have no recourse. It is difficult sometimes to separate the evils of the institution from its practitioner, though I know that it is important to do so. With my son soon to go off to college, I feel that it will enable me to make bolder stands in the community, so as to not non-necessarily embroil him in my issues.

    • How is this article even remotely “reformist”? The lack of focus on the fact that this movement is overwhelmingly dominated by people with considerable privilege (often by virtue of race, gender, sexual orientation, socioeconomic status, educational access, etc.) is hugely problematic. It should be brought up more, and it should not be derailed. For a supposedly radical movement, the fact that even mild criticisms of this sort can bring about such strong negative reactions (and willful dismissal of the main points of the article) is a pretty strong indicator of how deep this problem goes.

      • Melodee, I simply think that the article is misrepresenting the views of most people who blog/comment on MIA and declare themselves anti-psychiatry. Also the accusation that we shy away from pointing to socioeconomics as a major problem and that it has to be resolved in order to have any meaningful change is simply untrue. The author is building a strawman. That’s our main problem with the article.
        As to most of the people here being ones with considerable privilege is just a matter of how life is right now – I guess many people who are disadvantaged don’t have an opportunity to engage in activism because they are too busy trying to survive (kind of a definition of disadvantaged…). It is a problem but it is not that they are not welcome here.

      • When I hear or read people lecturing me about how anyone who disagrees with them is racist, sexist, etc., it has almost always been my experience that they themselves are coming from a position of great privilege. Myself, my first political activity was in the civil rights movement of the Sixties. I got into it because of my own experience. I was torn from my foster parents at age six and experimented on with shock treatment, then sent to a state hospital (of the 1950’s) for the rest of my childhood. For this reason, I have identified with all people who have been put into a situation where their humanity is disregarded and their human rights taken away. So I think when people make accusations of this sort they are often wrapping themselves in the flag of someone else’s liberation. And I have to ask them: what have you experienced in your own life?

        • Human rights taken away
          humanity disregarded

          Folks like those you relate to? Seems to be the price for admission. Here, people identify with and accept and even support the psychically injured. A special niche where the damaged goods of a sick culture find refuge.

          Even for a drug pushing proponent and survivor of the fictitious ADHD hoax?

          Dylan sang just when you thought you couldn’t lose any more, you find you have even more to lose

  13. Matthew: I agree with your point about broadening the conversation. I have also noticed that the movement here on MIA is mostly white, however, the majority of the posts here put lie to the fact that broadly speaking, anti-psychiatry is the province of the wing-nut right. While I have my own concerns regarding what all the medical authorities related to my case agree on-lithium case my stage three kidney disease-I certainly make the effort here to steer the conversation into other fields of endeavor. Often, but not usually, someone will follow up with a response to my post and that is gratifying. I also assume that my post are read by other people, even if they do not write a response. I also have been posting on other sites, such as Electronic Intifada, Fairness and Accuracy in Reporting, Counterpunch, and Znet, but it is on MIA that I feel like I am most part of a community.

    • Hi Chris,

      I also was damaged by lithium. I also consider my children when “making waves.”

      I just wanted to say that I don’t reply to a huge percentage of comments that I read. What I do take from them, like you, is a sense of community. I read them every day.

      Thanks for posting.

    • I happened to be working in nuke weapons development when a psychiatrist put me on a high dose of LiCO (3000mg/day). An engineer saw me shaking and asked what was wrong. When I told him I was taking lithium
      ( a vital hydrogen bomb element) he advised me to stay away from it as any amount is toxic. Not about to take his word for it, I did my own research and learned this. Lithium is indeed toxic and is not an essential trace element, but it is chemically similar to potassium which is found in every cell of the body. The drug of choice for manic-depression was formerly potassium bromide. Like all bromine compounds, it caused bromine toxicity and was withdrawn use. Today, we have a chelated form of potassium supplementation which is non-toxic, but unfortunately for psychiatrists, non-prescription. My first tissue mineral analysis from the same lab used by the nuke weapons industry, Analytical Research Labs, revealed a severe potassium deficiency and I was designed an orthomolecular program which included chelated potassium.

      My research into lithium turned up some interesting trivia. In the days when Coca-Cola contained cocaine, 7-UP contained lithium. Lithium is atomic number 7. A check from the Lithium Corporation of America paid for the burglary of the Watergate Hotel.

  14. Thanks Timothy for this post. I too thought that Whitaker may overemphasize and oversimplify in his assertions that medications are the major driver fueling the rise in SSI/SSDI rates. Another Boston Globe journalist, Patricia Wen, wrote a piece a few years back about “SSI – the New Welfare”. In it, she described impoverished families seeking a stable income by taking their children to Psychiatrists to qualify for SSI. (ADHD was the most common diagnosis, if I recall correctly.) Some parents she interviewed commented that to qualify for SSI, the child must be on meds.
    The political push behind the Welfare to Work legislation aimed to reduce the Welfare rolls. This resulted in a cynical relabeling from being low income to being disabled. Entitlements based on low income seem far less damaging to these poor children than being psychiatrized.

    • Thanks for raising this point, Wayne. Psychiatry has been given almost sole rights to the poor, many of whom will take the medication to get financial help for their families, especially since the possibility of even getting out of the psychiatric networks is not high.

      I will not even touch upon people who get the money through psychiatrizing their children. Again, however, it is psychiatry that is the worst factor of the mix.

    • “Entitlements based on low income seem far less damaging to these poor children than being psychiatrized.”
      I’d suggest that they are at least as bad. Being psychiatrized means being stigmatized for life (deprived of opportunities in education, workplace and so on) as well as drugged with substances that destroy your ability to escape the system. There’s a reason why many of psych drugs were dubbed “chemical lobotomizers”. They keep people down very well in case they were to rebel against the system. It’s not either/or it’s both.

  15. All I know is psychiatric drugs disabled me and if I listened to them I would still be drugged into zombie anhedonia .

    Remember this https://www.madinamerica.com/2014/06/five-year-study-re-affirms-housing-stabilizes-people/

    I know many people whose family and insurance companies spent way more than the cost of a small house on hospitals and rehabs .
    Many prescriptions cost the same as a car payment.

    By skipping all the nonsense and nonsence programs and using money already spent on them we could actually help people.

  16. With all due respect for your survivorship status, you seem to be a person looking for a job in academia – not going too far for employment here, obfuscating there. This kind of behaviour will keep you your position, but, I believe, is costing academics their critical role in society. This is the route by which liberals have become largely ineffective in today’s world.

    Most people who have been involuntarily incarcerated and drugged (usually by concerned relatives) are not searching for a “big picture” discussion of utopia. Psychiatry is violating people’s civil liberties and poisoning millions daily. The situation with our children alone should make everyone fearful. The use of drugging as a means of controlling old people is beyond totalitarian. The only joke is that mainstream doctors are close behind psychiatrists, threatening everyone’s health with their arthritis killers and dangerous statins. They too are primarily interested in keeping their jobs. Doctors’ obeisance to Big Pharma and studious inclusion of all members of the “medical-industrial union” has destroyed doctors’ critical role of making medical, rather than political, decisions. A doctor’s primary role should include maintaining skepticism in prescribing medicines. Medicines are deadly. And again and again, Big Pharma is not required to answer for criminal activity. I think our focus on medication misuse is crucial, not just for MIA, but for the society at large.

    • It’s astounding to me that more people do not understand that the war against human rights is being conducted by AMA medicine, conventional ADA dentistry , and of course psychiatry . This Trojan Horse disguised within so called main stream health “management” professions is especially because it operates under most peoples radar the most dangerous direct and growing threat to human rights definitely in the USA and spreading elsewhere. Remember the poor cannot access the same necessities as the wealthy potentially can, and that the modern day robber barons are conducting a cull and enslave agenda coming at us from all directions. Thats what their round table discussions are about.

  17. Eric
    I want to thank you for your ever insightful and thorough responses.

    One thing I wanted to note about the title is that though I at first was also upset by it, I then later felt extremely grateful that such a title could appear on the Mad in America website! It reminded me that Whittaker has always requested that the psychiatric community present counter arguments to his claims if they have them. It is what makes him the truth seeker that he is and it is because no-one in the psychiatric community has provided serious counter claims to the longitudinal studies that his research is so powerful.

    One other note – I believe that the reason that medications remains (and should remain) a central theme, is more to do with the subject of coersion than treatment. To use perhaps a not very sophisticated comparison, there were so many issues of poverty, discrimination etc, facing ‘freed’ slaves, but discussing these issues must have seen `extravagant’ to the people who continued to be enslaved.

    I agree with Mathew that many discussions on this site come back to medication , and conversations seem to go round and round with no resolution. I believe we could move forward with other discussions on this site if there was something very definite in place on the MIA that was working against coersive treatment. Perhaps one of many talented legal writers on this site could blog about strategies for setting up some kind of working paper that could be used as an alternative `model ‘ to current legislation. Perhaps there could be a forum set up to deal with this issue so all the people with lived experience who suffered under coersion, families facing fears about coersion, and critical psychiatrists dealing with the day to day conundrum of having no viable alternatives to coersive treatment could provide input that covered all the relevant issues.

    • ” Perhaps one of many talented legal writers on this site could blog about strategies for setting up some kind of working paper that could be used as an alternative `model ‘ to current legislation.”
      Yes, that would be awesome. We need our own model legislation to counter all the Murphy’s bills and other hysteria driven discrimination acts.

  18. I think that, due to pure and dangerous stigma, there are so many assumptions about people on disability and how and why, that can so easily be, by and large, totally false and misleading. Personally, I think a person’s financial situation is their business, and their business alone. Our society makes it out to be a reflection of the value of a person, and nothing could be more harmfully stigmatizing and so completely false. We sure have bought into this, up until now, but I think the world is waking up to the implication of this socio-economic imbalance. And here, in the mental health world, it’s strikingly apparent, and we see the harm it has done, and the issues it has created and crimes it continues to perpetrate. My stance on psychiatry being a harmful and damaging institution is firm.

    There are tons of unjust and blatantly discrimination-based reasons that people wind up on disability and, literally, get stuck there, simply from negative expectations from their support, which is easy for people to internalize when one is bombarded with these messages, which is what occurs in the psychiatric system. This is a complex network of social ills and media and government based illusions, purely based on profit and desiring an imperialistic sphere of influence.

    I got stuck here for a while, and my solution was to perceive my freedom, and from that perception, came the reality of it, which I now live. The work force has become toxic. People with time on their hands have the opportunity to create a new world. Radical change occurs when people are backed to a wall. I believe this ‘disability’ status and the stigma and misconceptions that come with it, have backed people to the wall.

    “Freedom’s just another word for nothin’ left to lose…” Kris Kristofferson, Me & Bobby McGee.

  19. All too often, the mental health system prevents people from getting the help they need.
    Much research, including advancements in treating individuals with mental health problems comes from outside the pharmaceutical industry; however these advancements frequently are overshadowed by the loud voices and deep pockets of the drug companies. This has resulted in higher costs and less effective care for individuals with mental health issues. I go into this subject in much more depth in my newly released book, Liberty & Mental Health – You Can’t Have One Without the Other (www.libertymentalhealth.com) , but include here a few highlights.
    “Many mental health programs are not staffed with physicians practiced in medical diagnosis and thus are unprepared to detect a large proportion of physical diseases in their patients…California’s state mental health programs fail to detect many diseases that could be causing or exacerbating psychiatric disorders” (1)

    In 1995 a study found that from 5–40% of psychiatric patients have medical ailments that would adequately explain their symptoms. (2) The next year, in 1996, Sydney Walker III, M.D., a psychiatrist, in his book, A Dose of Sanity, claimed studies have shown that from 41% to 75% of individuals are initially misdiagnosed, often due to overlooked treatable conditions. (3) In 2009, it was found that up to 25% of mental health patients have medical conditions that exacerbate psychiatric symptoms. (4)
    There are 4 reasons in the medical model for brain dysfunction 1: Anatomical abnormalities or damage. 2: Lack of oxygen or glucose 3: Electrolyte imbalance 4: Neurotransmitter deregulation: the imbalance of brain chemistry. (Biology and Human Behavior: The Neurological Origins of Individuality, Professor Robert Sapolsky, Stanford University, The Great Courses, The Teaching Company © 1996)
    The use of the Koran Algorithm would significantly reduce the number of individuals misdiagnosed, however utilizing other research done since would also reduce the number of people diagnosed with various mental illness and steer them into appropriate treatments.
    Trauma can result in shrinkage of the hippocampus which is adjacent to the amygdala, and can be considered the emotional center of the brain. This shrinkage affects the communication between areas of the brain and is responsible for heightened fear and anger responses. (Does Stress Damage the Brain, by J. Douglas Bremmer MD, Biologivcal Psychiatry 1999; 45:797-805; Traumatic Amnesia, Repression, and Hippocampus Injury due to Emotional Stress, Cortisosteroids and Enkephalins by R. Joseph, Ph.D. Child Psychiatry Hum Dev. 1998 Winter;29(2):169-85) This means trauma would fit into category 1. Several proven non-drug methodologies are available to treat trauma, including Somatic Experiencing (www.traumahealing.com), Eye Movement Desensitization and Reprocessing (www.emdr.com), and Tension & Trauma Releasing Exercises (www.traumaprevention.com or the book The Revolutionary Trauma Release Process by David Berceli, Ph.D.)
    Then there is magnesium deficiency – which falls into category 3, magnesium being an electrolyte, as well as a key component of serotonin. “…Magnesium is essential in regulating central nervous system excitability thus magnesium deficiency may cause aggressive behavior, depression, or suicide. Magnesium calms the brain and people do not need to become severely deficient in magnesium for the brain to become hyperactive… a marginal magnesium intake overexcites the brain’s neurons and results in less coherence – creating cacophony rather than symphony – according to electroencephalogram (EEG) measurements.” (Transdermal Magnesium Therapy ©2007 by Mark Sircus, Ac., O.M.D pg.5)
    In order to reduce costs and improve treatments for those with a mental health diagnosis, we need to move away from a system dominated by the drug industry.
    “In the beginner’s mind there are many possibilities, but in the expert’s there are few.” (Suzuki Roshi)
    1. A Medical Algorithm for Detecting Physical Disease in Psychiatric Patients, Hospital and Community Psychiatry Vol. 40 No. 12 Dec 1989, Pg. 1270 by Harold C. Sox, Jr., M.D., Lorrin M. Koran, M.D., Carol H. Sox, M.S. , Keith I. Marton, M.D., Fred Dugger, P.A., Teruko Smith, R. N.
    2.Allen MH, Fauman MA, Morin SF. Emergency psychiatric evaluation of “organic” mental disorders. New Dir Mental Health Serv 1995;67:45-55.
    3. A Dose of Sanity by Sydney Walker III, M.D. 1996, pg 13/ Hoffman, Robert Science News, Vol. 122, September 11, 1982; Herringm M.M., Debate over ‘false positive schizophrenics’ Medicine Tribune, September 25, 1985. Pg 3; Koranyi, Erwin K., “Undiagnosed physical illness in psychiatric patients,” American Family Physician, Vol. 41, No. 4, April 1990
    4. Christensen RC, Grace GD, Byrd JC. Refer more patients for medical evaluation. Curr Psychiatr 2009;8:73-74.

  20. Thanks for reminding us that it’s not just psychiatric drugs that are the problem. In support of the 2013 This American Life piece, which states that the largest increase for disability is for conditions described as “back pain and other musculoskeletal problems” please note the 2012 article in the New York Times, “Painkillers Add Cost and Delay to Job Injuries” (see: http://www.nytimes.com/2012/06/03/health/painkillers-add-costs-and-delays-to-workplace-injuries.html?pagewanted=all&_r=0), we read that workers are suing insurance companies for non-drug treatments like physical therapy because of “the excessive use of drugs like OxyContin, Percocet and Duragesic”; “workplace injuries are drawing particular interest because the drugs are widely prescribed to treat common problems like back pain, even though there is little evidence that they provide long-term benefits. Along with causing drowsiness and lethargy, high doses of opioids can lead to addiction, and they can have other serious side effects, including fatal overdoses.” Not sure how to use “intersectionality” to forward this argument, but victims of psychiatry sure as hell have common cause and overlap with the workers of our world. Together we’re being drugged into disability by those with other interests.

  21. First, I think the author has misunderstood Robert’s article.
    Secondly:
    “Fundamentally, however, relationships between disability, medication use and welfare system dependence are driven by a far more complex set of socioeconomic forces.” – how about “the poor” have many more normal, legitimate reasons to feel distress and experience states of mind which get you a label of “mentally ill” which in turn get them on drugs which do nothing to help but turn the solvable problems into life-long illnesses in large part due to the “side effects”? And in the same time make sure that these same people will not have the cognitive abilities to understand how the system is screwing them and physical strength to do anything about it?
    Psychiatric drugs are part of the abusive socioeconomic system and psychiatry is a tool of social control.

  22. Timothy,
    I am so glad to have your contributions on MIA. I have come to deeply value your perspective.
    This is a rich essay and there is much to think about. I will focus on one interesting point – the notion of “moral negotiation”. It has struck me that often – when we talk about drugs or trauma or the “realness” of so-called psychiatric conditions – there is this subtext of morality: who or what to blame. Some may target the family or the person who is considered lazy or defective in some way or the psychiatrists who are uncaring or the toxic drugs. While I hope this is not seen as an attempt to avoid responsibility for my own actions, this search for someone to blame can divide us and distract us from finding common ground and solutions.

    • I don’t think it’s about ‘blame’ Sandy, which is a judgment, and which becomes a personal ego issue; but more about cause-and-effect, which is neutral, and necessary to know in order for things to shift, change, heal, and grow. I believe that is a distinct and vital differentiation. Ego takes us into denial. Truth is what sets us free, always.

        • Ok, that’s fine to agree to disagree. Still, given my experience from the inside of so called ‘mental illness’ onset, ‘mental illness disability,’ then healing from ‘mental illness’ and ‘disability,’ embarking successfully on two careers, one in healing and teaching, and on in performing arts, now fully back integrated into life, my community, and moving along great guns, in perfect health and and grounded, I feel I have a lot of clarity on this issue. I respect and honor, of course, that you follow your own path to truth.

          • I was just reading this comment:
            “On this website, I have found trying to discuss issues openly with psychiatrists to lead only to feeling shut down, subtly demeaned, dismissed, resisted, and somewhat manipulated.”
            Lest I repeat the errors I have apparently made in the past with you, I will exit this conversation.

          • And btw, my mother completely owned her issues when I spoke my truth about where I felt my ‘illness’ originated. Really, it was more of a perception than measurable objective reality, we all concluded, finally. She resisted and felt very guilty for a while, but we talked about it, and about forgiveness and self-forgiveness, and got all the clarity we needed. That’s how family healing works.

          • I read your last comment after I posted mine.

            I understand why you say this, but still, I’m always open to discussing this further. Not necessary, though, if you are not comfortable with it. Truth-speaking in a group setting is edgy, and merits appropriate neutrality, to my mind. I have good reason to express what I say.

          • Plus, I have to say, this is exactly what I’m talking about. I’ve been trying to give you a client perspective, from a former client who got a lot of clarity about this. Now, from your fear of ‘making mistakes’ you are shutting down the conversation. I’ve been direct with you about how your communication has made me feel. I would just like it to be acknowledged, for once. This is not personal, it’s totally professional. This is exactly what I’ve run into repeatedly, when trying to present a client perspective, for the purpose of change. This is why things are stuck, and why I feel there is an inherent barrier in communication that inhibits reform, and why we need radical change.. Why exit the conversation, why not go for clarity? Your choice, though. I’ll let this settle for a while, feels like a hot button to me.

            I’m always grateful for your courage, Sandy, I’ve said it many times. We all struggle with these ‘relationship issues,’ each and every one of us.

          • Alex,
            I have tried my best to address you here – and in our other communications – with openness and respect. You make it clear how inadequate that has been. It is disheartening to think that has left you feeling “demeaned, dismissed, resisted, and somewhat manipulated.” Maybe that is my own personal failure or maybe it is something related to my psychiatric perspective. I do know that was never my intent. But this is not the point of this current blog and that is in part why I am exiting this particular conversation.

          • Thank you, Sandy, I appreciate what you say here. I’m a bit saturated with this right now, because it’s been around an issue that’s quite important to me.

            My last post in this thread is below, and I really don’t know what to say to help neutralize this at this point. Please know that it is absolutely nothing personal, I have a lot of respect for you, like I do just about anyone, because we’re all part of this, somehow.

            My experience in all of this has been intense, as it has been for many. I am trying to release the energies that do me no good in my life, conflict being one of them. I just haven’t seen any way around it in this arena, and it wears me down to the point where I’m not enjoying myself.

            Sometimes, dialoguing and disagreeing, and getting to the heart of things for clarity is fun, and I enjoy it. But when it becomes so personal like this, which as I’ve said always, is NEVER my intention, but it always gets down to ‘I don’t know what else to say, I’ve tried to communicate with you.’

            Imagine if I were in your office and vulnerable! If that were the case, giving up on me would have devastated me. Now, however, this is just proving my point. I can’t see where I’ve been unreasonable, I’ve been transparent and what I consider to be direct and clear. Apparently, as client and clinicians, we’d never get to the bottom of anything, because even as peers on this website, we cannot.

            While I don’t see this as a reflection on either one of us in character or intention, I feel I can trace it to what I’ve said, that I can’t get clarity from you. That’s not a judgment, it just is. I still certainly like and respect you as a person, and think you’re doing an admirable job of soul-searching, but I can’t help but to notice a lot of resistance to taking in relevant information. I see you swatting it away, as if with a fly swatter. Maybe that’s my perception, I don’t know, but it sure has felt this way since we started dialoguing–exactly a year ago, I happen to remember it was Valentine’s Day when we had our first dialogue.

            Anyway, I appreciate, respect, and listen to whatever you have to say. I hope one day you can feel about and do the same, regarding what I have to say.

    • Sandra,

      I have always found your comments to people to be respectful so I am wondering if I am misinterpreting the comment you made above.

      Saying that people are ‘searching for [something] to blame ‘ such as toxic drugs, implies that toxic drugs are never harmful for some people. (otherwise we would of course blame the drugs in those specific situations, and do all we could to prevent those particular people from being forced to take them .)

      What people like me are only searching for is information and support that leads to solutions for recovery and safety of our loved ones. We naturally harp on about the things that seem to us to be the biggest threats to safety and recovery in our individual situations, particularly to any people within the system who we feel may have some power to influence change. My one regret is if any of my comments made the people who are trying to do their best in a bad system feel blamed.

      Timothy,
      I do not have a breadth of understanding about how many different people recover so I have no reason or authority to disagree with your article when you say “that medication is helpful for many people. The question is: for whom, for how long, and how best to weigh the benefits against the risks” I do, on the other hand, have an incredible depth of understanding about one particular situation, and I sadly know that if my loved one needed to be hospitalized for any reason, I am not likely to come across someone in the system who could answer the question you pose in regards to his personal situation. I am much more likely to come across someone who assumes medication is helpful for all. Yet despite this, and despite all my practical knowledge of his recovery on and off medications and despite my endless research, I might not have to give informed consent to a treatment in hospital even if I believe it will hinder or harm his recovery. Can you understand that fear which in turn does not allow me to “decenter medications in these discussions?” I do not want to interfere with the treatment of any other persons who are helped by medication. So I am not “taking a one-sided perspective on psych meds”. The current paradigm of care that allows forced medication when psychiatry does not know ” for whom, for how long, and how best to weigh the benefits against the risks” is the paradigm that is taking “too one sided a perspective on psych meds”.

      I am going to `try’ and stop commenting about this issue on future posts. I used to think that people who wrote articles that didn’t recognize that forced medications could be extremely harmful to some people, didn’t understand the circumstances of how some families live. I thought I was helping to provide another dimension to the problem which would hopefully lead to a better system in the future. Now however, I am starting to think that it is not that these people don’t understand the issue, it is that they don’t agree that is a huge danger to the well being of some people.

      • Hi Sa,
        I realize I did not elaborate much on my comments since I was just trying to reflect on one part of this post that I especially liked. What I am trying to say is that it is often just hard to understand why any of us get to be the way we are. I think in trying to find meaning, we may come upon an understanding that makes sense to us. That can often be helpful. But it does not necessarily mean it is “true” in some absolute sense and it does not mean that it will apply to others who appear to be struggling in similar ways. I think we all need to remain humble and recognize that there is going to be much uncertainty.
        Now, let me add that I know many people here are certain that they have been harmed by others including psychiatrists and I am in no way trying to undermine those voices. But I think it gets problematic when any of us make assumptions that apply to others. Let me be specific by focusing on psychiatry. Years ago, there were assumptions that if a person developed an extreme state (what I would call psychosis), this was due to a failure of parenting and bonding going back to the first months of life. Later on, there was an assumption that this was due to the failure of the development of certain regions of the brain. I do not think either of these positions are true in any absolute sense although parts of them may possible true for some. I also think that if one is convinced of either of these assumptions, one can do harm. The point is we do not know.
        Similarly with drugs. There are good and important reasons to be cautious about their use. But there may be people who find that the benefits outweigh the risks. These are difficult decisions for anyone to make and I agree with many here that people do not often get adequate information on which to base their decisions (and there is much we need to learn), but to blame everything on drugs seems to miss other things that might be at play and that is what I think Timothy was trying to articulate here. The problems were are describing seem highly heterogeneous so solutions will likely be as varied. I am not sure if that clarifies my comments.
        I am in a position where I agree with both Timothy Kelly and Robert Whitaker. I do not see their arguments as either or but both/and. I see Timothy’s blog as an important extension of Whitaker’s argument.

        • “I think we all need to remain humble and recognize that there is going to be much uncertainty.”

          If you’d been through what a lot of us have been through, I’d hope you’d see differently, here. Most of us have here taken a journey more humbling than one who has not taken it could ever imagine. And we survived, and are collectively growing in our self-respect and self-confidence, awakening to how this has all occurred, and it’s not a very nice story, because it involves what we feel is legalized crime.

          In this case, uncertainty breeds fear and neglect. Certainty, however, is a healing concept, sorely missing in mental health ‘care.’ And that has everything to do with rising disability rates.

          • I read an article in the news just a couple of weeks ago, about a child born in Australia with Down Syndrome and the mother abandoned him because of this ‘flaw,’ just left the hospital without him. Fortunately, the father didn’t feel the same way, so the kid does have a chance at life, here.

            There are millions of kids born with all sorts of issues like this, and the mothers don’t abandon them, but instead love them unconditionally and learn from them, honoring and respecting them for the gift they are. These spirits are often called ‘healers.’

            We never know when a remedy for anything will be found, so when and if it is, whom would you imagine, just off the cuff, has the best shot at a fruitful productive life, brain issues and all?

          • And, despite anything, which child is more likely to feel love in their hearts, which makes all the difference in our health and well-being, and which child would more than likely carry around a hole in their hearts, causing them perpetual grief, and, more than likely, suicide ideation?

            Regardless of any physical condition, how we respond to it, either acceptingly and with self-compassion or with resistance and self-hate–depending on the example of the adults around us–makes ALL the difference as far as our mental and emotional well-being.

        • While I do believe I was harmed, I honestly think we are more than just the totality of our trauma. I think we are also, in some respects, people who are either equipped with poor coping skills, or worse, what we have encountered was beyond any preparation that we could have been equipped for. When I am asked to give readings, I often hear question that amount to, “Well, do you think that was the best possible way to have handled that situation?” However, I still haven’t found anyone who could propose a better option. Alex, you seem to be searching for an absolute here, and I think, as all of our experiences are unique, that’s going to be hard to find.

          • Not an absolute, but definitely more of an acknowledgement with regards to how children are affected by the attitude, beliefs, and behaviors of adults. We’re all psychic, and kids pick it all up.

            And so do clients, even though many are told they are hallucinating or paranoid or whatever, whereas really, they’re picking up the truth. That’s called gas-lighting–making one believe they are crazy when they are so not. It’s done to kids and it’s done to clients.

            Were we to acknowledge this more acceptingly, without self-judgment–but simply to acknowledge that there may be something to learn here, from which we can all grow–then I think we would move forward quite a bit with these issues.

            I’m not a fan of the phrase, “It’s complicated,” because those that say it tend to be on some payroll, and what do they care if we get clarity. They just want to dialogue forever, until retirement.

            Yes, it’s complex, but that’s no reason to not dig for answer right then and there. Often, over-dialoguing and making it personal keeps us in perpetual ambiguity, when we need clarity, as people are falling through the cracks daily.

            I understand the resistance here, because it is profound self-reflection that can often lead to hard truths, but I feel it is well worth the effort to find our truth and then give it a chance to unfold. When we trust a process, we learn so much more than we can imagine. Trust is hard when reeling from betrayal, but it can be learned again, if given the chance. That’s up to each person to decide for themselves, however.

            I don’t at all think we’re the totality of our trauma, but I think we are the totality of all our experiences, good and bad, and then some. We all have a story we tell and live by, and we do have the will to shift these stories by seeking out different perspectives. How each of us do this is personal and unique, which is our diversity. But to me, this is pure healing and evolution.

            We all do the best we can with what we know how in the moment, but we also have daily opportunities to grown in our awareness, consider different perspectives, and discover how we are not nearly as limited as we once believed we were. I believe that is the ‘trauma’ talking, when we believe we are limited, or somehow, inferior to others. I think that’s a false belief, and what I would target for healing.

            But that’s just my viewpoint, and when I do healing work with others, you can bet that I will never, ever let anyone get away with believing they are less than. If they insist on fighting me on it, and wanting to stay in victim identification and dependent, then we are not a match.

          • “Gaslighting or gas-lighting is a form of mental abuse in which information is twisted/spun, selectively omitted to favor the abuser, or false information is presented with the intent of making victims doubt their own memory, perception and sanity. Instances may range simply from the denial by an abuser that previous abusive incidents ever occurred, up to the staging of bizarre events by the abuser with the intention of disorienting the victim.”

            http://en.wikipedia.org/wiki/Gaslighting

            It originates from a 1944 classic film, Gaslight, with Ingrid Bergman and Charles Boyer, where he, the husband, drives his new wife mad by making her believe all sorts of things about herself that we, the audience, know are not true. The film is wonderful, btw, I highly recommend it for those who enjoy classic film. Ingrid won an Oscar for her performance in this.

          • It is a process, but it’s different for everyone, and most people have to overcome their victimization on their own terms. We aren’t trying to glue the broken pieces of a life back together and claim it’s still the same. Most treatment programs sell a version of the fake it till you make it tagline, but it doesn’t actually work.

          • I’m also frighteningly familiar with gas lighting. In fact, it and I still have a rather personal and extensive relationship… but that’s a tangent for another day. I think you seem very motivated, but I think, like most people who have survived the system, you are looking for a reason this happened to you. You are looking for accountability… I’m going to tell you something I learned the hard way… even with a congressional hearing, I never found those. something about people like us, coping skills, connections with others, stress management… whatever. Something about people like us make us different. Psychiatry is generally uncomfortable with that differentness so they tried to stuff us back into a neatly labeled box and likely broke us more than we already were. However, I think we have to be like this… one absolute that I can give you is that above all else, the underlying programming of humanity is survival. Fight or flight will always your last breath trying to save you. I think that that’s what we are. I think mental illness was the option between destruction and saving ourselves.

          • “I’m also frighteningly familiar with gas lighting. In fact, it and I still have a rather personal and extensive relationship… but that’s a tangent for another day. ”

            I believe this is not a tangent, but a central feature of why prolonged disability exists in the mental health world. I posted this for others to consider it in their experience. It was an eye-opener to me, and when I processed this, it allowed me to see it and not take it on. I’ve experienced it a lot in advocacy, when their money was threatened by my truth. I’ve experienced it, here, too, on MIA. Insanity.

            “I think you seem very motivated, but I think, like most people who have survived the system, you are looking for a reason this happened to you. You are looking for accountability…”

            I know why this happened to me, and my family has taken responsibility, along with my own accountability. That story is under my belt and integrated. It’s a story of forgiveness, and having healing dialogues, and it worked, because my family is now whole again, and back on track, thanks to my truth-speaking, and not stopping until the truth was unearthed.

            Other than that, I’m very clear on the trajectory of my illness, disability, and healing. I’ve done that work, also integrated it, and have moved on.

            I’m here trying to communicate with others, and finding it often futile due to erroneous assumptions made, and insisted upon, a direct replication of the system, exactly. Crazy-making.

            “I’m going to tell you something I learned the hard way… even with a congressional hearing, I never found those. something about people like us, coping skills, connections with others, stress management… whatever. Something about people like us make us different.”

            I do not relate to this, so when you say “people like us,” I wouldn’t include myself in your ‘us.’

            “Psychiatry is generally uncomfortable with that differentness so they tried to stuff us back into a neatly labeled box and likely broke us more than we already were.”

            Yes, I know, I made a film all about this in 2011, updated in 2014, called Voices That Heal. It’s on YouTube if you want to check it out.

            “However, I think we have to be like this… one absolute that I can give you is that above all else, the underlying programming of humanity is survival. Fight or flight will always your last breath trying to save you. I think that that’s what we are.”

            I wholeheartedly disagree. We can be anything we want. We can shift and change programs. I learned how to do this in my training and healing, and I work with people on this all the time. Your perspective makes me feel boxed in and terribly limited, so I must reject it for myself.

            Life is about thriving, creating, loving, and feeling joy, not just simply ‘surviving.’ We can evolve from that fear-based consciousness, and for our health and well-being, it’s a step in the right direction.

            “I think mental illness was the option between destruction and saving ourselves.”

            Yes, I agree, and I was almost destroyed, about a minute away from death at one point, if that much. I had pretty much checked out but came back. Learned a lot in that time, btw.

            But I “saved myself” by persevering and retrieving my soul, heart, and spirit entirely, despite the nasty messages I kept getting from the mental health world, that I was basically doomed. Haha, proved them wrong. I found my way, and it’s all behind me.

            Perhaps it’s best if I stay out of the way, here, and let you all figure this out for yourselves. I’m done with my journey, so best that I move on.

            Honestly, I don’t know what the deal is here. I can’t tolerate messages of stuckness and duality any longer, I’ve had my fill of it. There’s a great big world out here, where fun, joy, and integrity go hand in hand. I wish everyone luck in finding their way to it.

            When you change your belief, you change your reality. Anyone can always create good health & well-being, if they just learn their inner guidance, and trust it.

            Blessings for good healing, whomever and wherever you are.

          • I apologize for my assumption. It was merely a common observation.
            When I say “people like us”, I am referring to anyone directly involved in the psychiatric system.
            What I don’t understand is, seeing as you are now completely healed, what are your questions so insistent?
            You are asking for what can’t be anything more than opinion, and I prefaced the statement to reflect that, but you reject, demean, and criticize any “answer” that is provided. This site is about healing, opinions, individuality, and each person is at a different place in their healing. It can’t be expected that any idea would be universal or absolute. However, I am glad that you have found security and healing in your own path towards coming to terms with what you have been through. I wish you the best.

          • Before I go (for the day, at least, ya never know)–one thing acidpop, to explain why I don’t relate to what you’re saying–

            After going through all this and coming off the drugs, etc., I went straight from the mental health and voc rehab system (which I took to legal mediation and won, I’ve talked about this), I became an actor, from having mustered up the courage to take a singing and performing class, via some volunteer work I did for a theater company in San Francisco. I felt fragile and sensitive, but also brave.

            This was 3 years after a suicide attempt, and at the start of my legal mediation. I just had to do something fun, so I went for it. I’d always enjoyed theater, but I’d never done anything like this before.

            Over a period of 7 years, I performed on stage and did play after play after play in San Francisco, including a Broadway operetta which I’d never feel was in my scope, and I got accolades for it, a lead part. I was already blown away that people liked my work on stage, I got great reviews and parts offered to me without audition. Directors really enjoyed working with me, and audiences came to see me.

            I never, ever would have imagined this, although I’ll confess, it was a secret dream of mine. I had gone to see Wicked a few years earlier, before all this had begun and while I was in my darkest hour, and I was crying throughout most of it because I though I’d lost this dream, and it looked so much fun. I was jealous and heartbroken. A psychiatrist had told me I had lost all my dreams, which is what precipitated my suicide attempt. These are the words that rang in my ears as I reached for the pills.

            I don’t think I’m anything at all special, I just believed in myself and focused. I think ANYONE can do this–not theater, necessarily, but whatever encourages one to really reach, in a way that is challenging in a fun and joyful way. I had an amazingly fun and healing journey doing this, sure beat sitting around and feeling that I was cooked in any way whatsoever.

            So this is why I feel the way I do. I’m a healer and teacher to encourage people do reach for the best, and to keep expanding this, to never give up until one is satisfied and fulfilled, and to enjoy the process, not to walk it with rage and fear, but with hope and optimism.

            I can’t help people, however, who feel they are limited by their own doubt. That’s an internal double bind to work out.

            I think any of us, if we just allow ourselves to stretch a bit, can find our way to our own brilliance. We all have it in there somewhere, and it’s just itching to fill your body and being. To some, I may sound crazy, and if that’s crazy, I’m totally good with it, whatever, eh?

          • To answer briefly your last post, which I saw after mine posted, I’m an activist, and I do it my way. For me, it works because my truth rings true to me, so I know I’m walking my talk. I feel there is a lot of activism to achieve within this community, itself. I find it filled with all sorts of stigma. I feel you characterize me incorrectly, and I’m sure we all do this with each other here. It’s kind of messy. If you check out my film, you might get to know me better. Or not.

          • I am glad that you have been both successful at fulfilling your dreams, and that you find some pleasure in helping others through your own experience. I’m sorry you view me as a person stuck in their situation. I have lost a lot to my diagnosis, but I do not feel stuck. Every day I am learning to live with who I am. This is the first time in 37 years that I have felt grateful and lucky in just being myself. I am learning to like myself regardless of all the breaks and damage. However, I don’t intend to defend where I am as far as recovery. My only intention when I responded was to try to give you an answer because it seemed important to you.

          • Well, I certainly appreciate the engagement, acidpop, and of course I totally respect your truth. I don’t see you as stuck, but I did think that you were seeing yourself as stuck, in a way, so I’m glad to hear that’s not the case. You’ve obviously done tons of very courageous healing work, and I imagine you’ve had a positive, healing impact on others as well. I always appreciate your truth, you speak it with passion.

            Thank you, this has been enlightening and encouraging to me.

        • Thanks Sandra for clarifying for me what you were saying.

          I think most people are not saying either ‘drugs are all bad’ nor are they `making assumptions that [their situation] applies to others’. They are saying that drugs harmed them, psychiatry cannot yet predict which people might get harmed or helped to a reliable degree and yet people (or families in the case of questions about capacity) do not have to give informed consent for questionable treatment, and that this is wrong (and doesn’t happen in other areas of medicine). When people make these points, many professionals write blogs that assume people are saying ‘drugs are all bad’ or ‘my situation applies to everyone’. They say ‘coersion is really only a paper tiger and is not a problem today’ or ‘alternatives should be provided to all except for the severely ill’ (even though medication hasn’t been shown to reliably improve the lot of many of the severely ill either.) And so the arguments and conversations go round and round and round.

          Timothy I think many of your points are very good and I too think that many of the issues you talk about could be a valuable extension to Whitaker;s work. However, ‘decentralizing the issue of forced medication’ seems far too contradictory to his basic premise to be considered an extension.

    • Sandy, I’m not sure what the current paradigm would do without the allied mental health industry’s bold tradition of declaring war on stigma, while guaranteeing that it takes effect, tying forced treatment protocols to labels, rubbing it in with the abrogation of civil rights. I can’t think how they would support their mission of getting people to stop blaming the victim when their focus is on escaping criticism for doing it themselves. But it is a nice fantasy that no one should get blame directed at them for the inconveniences associated with “needed care”.

  23. These arguments are specious one way or another. Socioeconomic factors absolutely would not matter if the drugs actually worked, because if “mentally ill” people were successfuly treated with them then nobody would even know they were mentally ill. There would be no socioeconomic factors to oppress them. Meanwhile, the “side effects” of the drugs themselves — particularly movement disorders, apathy and somnolence — would certainly put someone at a disadvantage in a competitive society. One way or another — if the drugs worked, we wouldn’t be having this discussion, regardless of other factors.

  24. And besides that, if you were to work on accomplishing anything in regards to social and economic justice within the current system, it would certainly guarantee that more people would be forced to take the drugs. As it is, any attempt to try to use services put in place to help “mentally ill” people to integrate will require, either by policy or coercion, a person to be on psych drugs.

    If you try to campaign to the public and our government that “mentally ill” people are disenfranchised and deserve better, then certainly with their current understanding of “mental illness” their first thought (and probably only though) is going to be “how then can we get them all into psychiatric treatment and improve medication compliance?”

    The drugs are the foundation of everything in our society regarding so called mental illnes, whatever it really is, even when it’s psychosocial and socioeconomic. So until you solve the drug issue, you really have no foundation to work from.

  25. Ok, I’ve been sitting with all of this extremely rich and powerful information, applying it to my own experience then and now–meaning, recalling how it felt to be in dialogue with mental health professionals when I was disabled, vulnerable, and filled with fear that I was permanently damaged by 1) horribly toxic medication, and 2) extremely stigmatizing and healing-inhibiting mind and control games played by a lot of members of this particular community. Seems to be standard operational procedure, from what I’ve gathered over a period of time, up to and including present time.

    Then, of course, it was infuriating, because it felt as though acid were being poured into my wounds, and it was disorienting and terribly painful and anxiety inducing to experience that level of stigma, disregard, and cultural control during a long and rugged withdrawal from a lot of medication. I was in chronic pain, trying to heal, and being demeaned and sabotaged in the process.

    And that’s no exaggeration, I ended up winning a legal mediation against a non-profit voc rehab agency for blatant discrimination, and that gave me complete credibility. I had been mistaken for someone complacent and compliant, because I did try to respect the rules of the culture, but when it interfered with my healing and professional development, I drew the line and spoke up, which of course did not go over well, until I found a really good, level-headed and neutral, employment attorney who worked for a non-profit OUTSIDE the mental health system.

    Up until then, of course, my truth was only disregarded as delusional or paranoiac, simply because there were certain people in charge trying to cover their asses, and they took advantage of the multiple stigma which my situation carried. We’re not dumb, you know.

    After winning the mediation, I felt free because my truth about being discriminated against had been unambiguously validated, once and for all. In the mental health system, where I was considered a ‘mentally ill disabled person’ who would not deserve more than a bag of old clothes as a settlement (oh yes, that is what they initially offered me, to settle this), outside of this world, I am considered and treated like a respectable, healthy, level headed, perfectly fine individual, and one who speaks his truth for the purpose of creating positive change in the world, nothing else. My website, film, work, and my life reflects this, all who know me know this.

    So now that I have a positive sense of self and identify as I do in the world, in the flow of society (although I live on the rural fringe, because I think society is toxic, after having lived in San Francisco for 17 years, dealing with all this, out here is just fine with us), I can stay pretty neutral with all this as I experience it yet again, and instead, get a lot of good insights for myself, here.

    Overall, it validates what I continue to think, that this is a losing battle, trying to reform psychiatry, and anything about the mental health world. I’m just grateful that I’m not part of it any longer. I’ve just been here to bring whatever it is I learned along the way, in order to help create change, so people can heal and be free of all this totally unnecessary and system-inflicted misery and suffering. I think that’s perhaps one thing we do have in common, each and every one who posts here, although I can’t be to sure. I’d hope so, in any event.

    And in this case, I’m going to allow myself to ‘blame,’ because, indeed, I blame the mental health system for our social ills, bar none. Mainly, because they WON’T ACCEPT FEEDBACK, and they’re hostile about it.

    That system has set the worst example imaginable, to my mind. I can hardly even fathom it at the moment, but I can feel how overwhelmingly this system has brought down western civilization.

    That is my conclusion at the end of it all–diagnosed and medicated for over 20 years, educated in the field and clinically trained, having had an exhaustive and very conscious journey as a hard core client as a disabled person, and then climbing out of all that, ditching all the meds, healing a new way, leaving all this behind, and oh yes, giving it the finger. How can I not flip it off! I entered the mental health system thoroughly, with trust, and it failed me miserably every step of the way, up to and including when I tried to reasonably protest practices that were obviously doing all harm, and no good.

    I know my story and so do my loved ones. We’re all pissed, but what can we do. It’s ALL protected by law–or at least by gatekeepers. I think there are a lot of people professing to do good while really only protecting the system. I think there’s a lot of that happening, come to think about it. I ran into it quite a bit among those whom I thought were supposed to be ‘advocates.’

    Thank GOD I’m healthy now, I found my way. But this is crap, I don’t see any hope for it. Sorry, that’s my totally truthful opinion, humble or not.

    And now, I’m going to enjoy the rest of my Sunday. This has been cleansing for me. Thank you for reading.

  26. Well done! I think this quote sums up the intent in this article.

    “One point that strikes me as particularly urgent is that
    “Mass incarceration has led to the systematic exclusion of crucial data on 8–10 million (mostly minority) men who have been imprisoned over the last 35 years, obscuring the true extent of this nation’s worsening health and social outcomes among the poor.” ”

    The rise in SSDI claims might have more to do with the fact that incarceration rates in many states have risen more than 5 fold over this time period. The war on illegal drugs has also branded many as felons unable to obtain work. I agree with this article that policy may actually be creating or driving these trends. The drug companies and psychiatry become the benefactors of this new populations attempt at survival.

    To be diagnosed with a mental illness and have a criminal record adds more road blocks to the recovery process. Recovery after you have fallen no mater how that happens seems to be made harder by those that want to pile on once you are down. Once someone is incarcerated and then treated as if they are mentally ill compounds these issues as well. Throw on top of this overzealous drug and psychiatry professions that also drive policy and we may never see people come off of SSDI in their lifetime.

    Whitaker’s work opened up this discussion. Like him I think the most important point is educating yourself so that we can add value to this life we live. I’m not sure the concern is what is driving SSDI as much as why aren’t we getting better results. Are there alternatives?

  27. Many Psychiatrists are handing out benzodiazepine scripts like there candy. And most do not have a clue of how to help them safely taper off them after the become severly sick and disabled with multiple symptoms. These Benzos stop your own GABA in your brain from working and the GABA takes a long time to heal. I for one was highly encouraged to take Klonopin when I had a period of anxiety after a total knee replacement. I felt concerned, but my doctor continued to reassure me I was on such a low dose, I was doing well, stay on it. He said I could taper off of it in the future easily and just do it slowly. his patients taper and continue working at the same time. Well 5 years later all hell broke loose for me with the severest anxiety symptoms, depression, a total nervous breakdown. I was fighting for my life for 20 months as my Psych doctor put me on Lexapro up to the max doses, then tried Effexor up to the max doses. My central nervous system got even worse from the Anti depressants. I was fighting for my life everyday. I searched for help online, found a support group, they spoke of the horrors of taking Benzo’s and what can happen when you become tolerant to them. And when you hit tolerance the best thing to do is very slowly taper off. My doctor and therapist that I have seen for 36 sessions kept telling me, don’t read about Benzos online, don’t read online. I was fighting for my life with no help, just spending thousands of dollars on the psych doctor and my therapist. I finally gave in and went back to the support group and it is the best thing I could have ever done. I’m getting help for myself when no one in the medical field told me it was the Klonopin and that I was in tolerance / withdrawl. I’ve never taken any other meds for illness before this and my labs are good every year. I’ve worked all my life. Taught special needs children for 19 years and loved them. When this serious Withdrawl happened my life was happy. My husband and I of 38 years became empty nesters, our kids were doing well and both homeowners. Daughter got married, love my son in law. I looked forward to going into work everyday. My life has been a shell for 20 months now as I try to liquid taper off this drug with horrific side effects, severe anxiety. It is an evil drug to me and shows no mercy. I have a new grand baby on the way and am concerned I won’t be able to be a good grandma. I need complete silence every morning. I don’t drive, can barely cook. My support group is all I have. They are the people that understand. It is very professionally run with great administrators that are so helpful getting us started on a safe slow taper plan, we communicate with fellow benzo suffers and support each other knowing many of us are going to taper for a long time so our brain can heal as we remove this aweful medicine from our bodies drop by drop everyday and have to hold because we feel sicker as it is removed from our daily dose.
    This was a complete shock to my husband and myself. He has been my rock along with the support group. It’s a horrible experience to live through day by day, year after year until you hope to be healed. Some don’t make it. I hate psychiatry now. For me any way. There is research that I’m seeing that taking Benzos longer term can increase your chances of getting Alzheimer’s disease.
    I just want to heal and live some life again with my husband and family. I am 58. I know I carried on with this and sound like I’m whining like a crybaby. But this has impacted my life tremendously and never should have happened. I really feel sorry for others that don’t know this may happen to them. Also the support group I belong to is adding several new members every day.
    I sincerely Thank you

  28. Hi Timothy,

    First let me thank you for your bravery in posting a blog that I think you knew would stir some anger and create a bit of controversy among the readers here. Personally, I appreciate your position as a person who is attempting a sort of middle-of-the-road approach and who challenges the point of view of many while also seeing some of the reason for such views to exist in the first place. Complacency and dogmatism, indeed, can be highly problematic. The number of comments and long discussion generated by this article, I think, is a good thing even if it is frustrating for some Although we have discussed before the fact that there are some pretty fundamental philosophical disagreements between us, I genuinely appreciate finding myself challenged and forcing myself to try to understand where you are coming from so that I might broaden my own perspectives.

    Having said that, I agree with some of the previous comments that it appears as though you are almost dismissing and minimizing the argument that so many “anti-psychiatry” advocates stand for. I have felt this before with you, and I think some of the comments here clarified this feeling for me. Just because a position is “extreme”, that does not mean that it lacks nuance or complexity. In fact, I think I am in full agreement with Ted that psychiatry cannot be reformed any more than slavery. This is not because I am thinking in black-and-white terms. Sometimes, an extreme position is entirely rational. The assertion by you, and some other commenters, that MIA, its authors and its readers, neglects sociopolitical and ethnic problems is, to me, an unsupported criticism. I know that every article I’ve written has largely included this and has never commented on medications at all. So, I can just take myself as a prime example that this criticism is not quite accurate.

    As for Whitaker’s arguments, I don’t know. Yes, socioeconomic factors play a large role, but then, the 80’s was one of the first times that our current disability program existed and that a huge recession hit…but we did not see the numbers that we see today, and the major spike did occur at the same time as the boom of SSRI’s. Of course, I think most people who read this website and certainly Whitaker understand that correlation cannot be equated with causation. But, the trend is certainly an interesting one that needs to be taken seriously.

    You mention the concurrent rise in disabilities due to back pain, etc. Someone mentioned the NY Times article…and I agree that the medical model in this sense is just as problematic as it is in psychiatry. I work as a personal trainer. I have gotten into full-blown arguments with some clients begging them to wait before taking a pill or having surgical interventions…and all but one time did this result in the disappearance of back pain. In fact, several clients were also able to get off other “medications” as well. I think we need to look at another factor that is often ignored in the argument about drugs on both sides….It’s not just the direct effects that drugs exert (though this is an undeniable problem…dementia, lethargy, etc.), but the context in which the distribution of drugs lives. If a person goes to any kind of doctor in this day and age, it is unlikely that he or she will take the time to get to know the person, understand the full context in which “symptoms” developed, work with the individual to change his or lifestyle (including decreasing stress, nutrition, exercise, finding meaning in life, working through past trauma, etc.) or take the time to withstand pain while more naturalistic measures are incorporated. Instead, a distant, detached, and expert stance is taken and a drug is prescribed. Even before the drug is taken, we have separate body and mind, we have taken out the factors of caring relationships, and we are jumping to a quick-fix to solve everything. This is a societal problem, not just one of psychiatry.

    Drugs have helped people cope with all kinds of issues since the beginning of time. Medications save lives, drugs help us live them a little easier. When discussing psychotropics, we need to discuss them in this context. Of course some people find them more helpful then others. I like to have a beer at night…I don’t know a lot of other people that enjoy a good beer like I do without needing to get drunk. But is that a medication? Does that mean that somebody else should be forced to drink alcohol because it helps me to de-stress at night?

    These issues cannot be minimized. But, I also agree with you that the larger context must also be of great importance. The society we live in today is sick. RD Laing, Foucault, and others have written in great detail about the relationship of so-called mental illness with society, yet they are on the fringes and also seen as extreme. The topic of mass incarceration also cannot be separated from discussions of mental health, in large part because of the problem of involuntary hospitalization. If we reformed our penal system, which would require reforming a society built on fear-mongering and vengeance seeking, and started understanding that people who commit crimes and act in anger are in just as much pain and in need of just as much love and “help” as those who get labeled as “psychotic”. People who advocate for involuntary treatment often are just as guilty of discrimination as the rest of us, because their fundamental argument is that some people “deserve” “treatment” and others are just somehow “bad”. Not to mention that the labeling of someone as criminal or mentally-ill serves the purpose first and foremost of marginalizing, blaming, and dismissing.

    I realize I have written way too long of a response. I love that you consistently have this affect on me. You are not easily dismissed…but you sure do push some buttons. That is a good thing.

  29. ” In fact, I think I am in full agreement with Ted that psychiatry cannot be reformed any more than slavery. ”

    I have to agree with this statement completely. Each day more revelations about the FDA”s, hiding of fraudulent drug data are revealed. This makes it clearer just how deep the issues regarding medication and psychiatric medications go.

    People simply do not get better on psychiatric medications, they do not get cured. All they get is their symptoms controlled. Symptoms that bother others. Unfortunately the use of medications to treat symptoms, for a significant percentage of people, in the long run make them worse. Unfortunately many of individuals may become disabled. Its also true that those that stop taking their medications, improve and become symptom free without any treatment at all.

    Primarily because there is absolutely no understanding of what causes the symptoms in the first place. Consequently any treatment with medications is just guess work.

    While there are probably individuals who do not fit into this scenario, that does not mean that what is happening to them can be accounted for by psychiatric interventions. Once again because there is no understanding of causative factors, its also true that positive outcomes are not understood either. In fact it makes them more problematic because they may result in justifying increased treatment approaches based on a misunderstanding.

    I thought that Robert Whitaker’s article on increased SSI assistance was great and to the point.

  30. This is a very important and intense discussion, and I thank the author for provoking it!

    I found myself both strongly agreeing and strongly resisting parts of this article. I do think there are many factors contributing to the increasing disability rates mentioned by Whitaker, and most are social and economic in nature. The collapse/undermining of community, the removal of other forms of economic support, the general move of dollars from the poor and middle class to the rich, all of these create a powerful push toward using disability as both an explanation for “failure” and a form of income.

    I also agree to an extent that focusing EXCLUSIVELY on medication misses the larger point of how and why this is happening. However, I can’t agree that medication should be relegated to some kind of a background issue, as it has been a huge tool in helping to encourage and enforce the distorted view of “deviance” that supports the current status quo.

    I believe that a critique of psychiatry needs to focus on the use of both DIAGNOSIS and “TREATMENT” as a means of blaming the victims of the very oppression you rightly identify as central to the disability trends we see. Framing any discomfort or upset with the current system as a “disease” avoids confronting the real social issues that face us. While I’m sure you agree with that last statement, what you don’t identify is that psychiatry has PROVIDED this “out” to both the victims and oppressors.

    Second, I think the data absolutely shows that psychiatric drugs do, in fact, increase the likelihood that a person will not recover from his/her “disability,” whatever the social and political reasons they may have been driven down that path. Whitaker provides a strong biological explanation for how this happens, and it is completely coherent with prior research into drug addiction and withdrawal. Interestingly, the exact same thing has been recently observed about pain medication, the other arm of increasing disability – short-term use of pain medication leads to relief, but long-term use leads to the drugs becoming ineffective and pain levels actually increasing. Managing long-term discomfort with drugs is simply not a viable plan, and that is absolutely true, over and above any of the socioeconomic issues you correctly raised.

    Additionally, I agree with Alex 100% – in the move to stop demonizing parents, we’ve supported the ridiculous idea that parents are never responsible for their children’s mental/emotional suffering. This is, of course, a ridiculous proposition for anyone who has worked with abused kids or adults. Parental mistreatment is a primary cause of “mental health” problems, and this is actually part and parcel of the very oppressive structures the author has described. The family is a unit of society and often has embedded the same authoritarian social structures, including power imbalances, punitive structures, and excuses for the powerful continuing to be abusive. Alice Miller has written eloquently about this phenomenon. We will never make any inroads into addressing inequality and oppression if we let parents off the hook for harming the most oppressed and least powerful social group, namely, our children.

    Finally, even if the huge rise in disability is not primarily driven by the drugs, it’s clear from the rising disability rates that we are seeing that the diagnosis/drug paradigm is not successful. The whole idea was that “medical” treatment of these “diseases” is going to lead to people who were previously unable to work and participate in society becoming productive citizens. It appears the opposite has occurred. Whether or not the drugs are directly to blame, this is a failed paradigm and it needs to be scrapped. And the main reason it has NOT been scrapped, and that “antipsychiatry” has gotten a bad name, is because psychiatry supports the oppressive social structures that continue to be viewed as the status quo.

    In essence, it’s only a failed paradigm from the point of view of helping “mentally ill” people get better. From the point of view of institutionalizing oppression toward anyone disturbing the status quo, I’d say it works like a charm. I think the analogy with slavery is quite apt.

    —– Steve

    • Thanks, Steve, and since you mentioned the family issues, I wanted to take this opportunity to clarify something about this, on a bit more subtle level.

      Of course, it’s clear when there is blatant family abuse, and many of us have talked about subtly insidious dynamics that can be literally ‘crazy-making,’ but I also wanted to bring in one component that I think is often missed, and important here–in that, as adults, how we respond to life and its events is what sets an example for kids.

      I know that my parents tended to make drama of everything, creating problems as they went, catastrophizing everything, taking everything personally, being defensive, etc. It wasn’t 100%, but that was their general character.

      There were other issues, too, but this was a big one that influenced how all of us–my 2 sibs and me–felt quite burdened and on guard, and of course we carried this into adulthood. We internalized a lot, and a big part of my healing was to reverse this, ground, and practice a new perception of life, that it does not have power over me, but me over it. Little by little, my family has been taking my cue, so it’s been textbook family healing. So interesting to have experienced this.

      But indeed, we impact our kids in so many ways. If we listen to them and take them seriously, they will teach us to grow. Most important thing I learned in this whole thing, and one way in which we sort of got it backwards.

      • I agree completely. My parents modeled kindness and tolerance, but they also modeled sweeping conflict under the rug and denying the presence of emotional suffering. They are good people and tried their best, but my mom was overwhelmed by 4 kids under the age of 5 in a day before support groups and indoor parks and the like. So we were neglected, emotions were stuffed, and we had scapegoats, none of which were able to be talked about. I managed to have some more healing conversations with my dad later in life, but going back over what had happened in the past continues to be taboo to this day, including among my brothers.

        I have no intent to be hostile or blameful toward parents, but it is important to recognize the damage that can be done, even from innocent behavior on the part of the parents. They were children once and were hurt as well, just as we were, but it is my belief that being able to consciously face those hurts allows us not to pass them on to our kids. It’s something we can actually do something about, rather than blaming our brains and waiting for magic pills to make it all better. It just bothers me that discussion of family dynamics, beyond overt abuse, just never seems to be allowed in many current therapeutic circles. Just like my family, come to think of it!

        —- Steve

        • This is why there are no golden rules. I know people who have major issues because of their parents, even if there was technically no abuse or neglect going on. Things like favouring one sibling over another or overprotection to the point where all the decisions are taken by the parent even for adult children. In the same time it’s a bit touchy subject for me because I had a misfortune to talk to a psychiatrist who wanted to “frame” my family (which may have its issues but who has not) and first tried hard to convince me I was abused and when I got somewhat angry at his ignoring of what I was telling him he switched gears and blamed my family for being to good for me (basically I am a spoiled brat). That is why I have little respect for psychological counseling either – it can be very harmful if one takes what the therapist says at face value and there is a lot of place for gaslighting and abuse (as exemplified in the satanic cult stories).

          • A really good therapist never tells you what the problem is. That’s perhaps my biggest of many beefs with psychiatry – they are so arrogant that they think they can tell a person what is wrong with them and what will help. A good therapist is humble – they know that the client is the one with the answers, and their job is to work to help the client get those answers to the surface, rather than telling them what to think or believe about themselves. But I’d say 80-90% of counselors don’t manage that adequately. It requires being willing to sit with the client in uncertainty and discomfort and not blurt out an answer that makes you feel more comfortable at their expense.

            —- Steve

          • Steve, I think there are different perspectives on ‘what a really good therapist’ is and does. What you’re talking is merely one approach. There are a variety of ways to provide good counseling and psychotherapy, and some are more directive than others. Nothing wrong with that, if handled with neutrality and respect for the clients’ process.

            I don’t even think there is any such thing as a ‘good’ vs. ‘bad’ therapist. It really depends on how well the personalities of the therapist and client match, and what kind of relationship dynamic is formed. Nothing wrong with diagnosing–and, in fact, it does bring focus and clarity to the issues at hand. But it certainly doesn’t have to be a DSM or even a western-based diagnosis.

            One can be diagnosed with an imbalance (either in themselves, or perhaps in their environment, which is a reasonable diagnosis) in a very neutral, simple terms–not with a label of a chronic condition, that’s what I think is bs and toxic) and then a treatment plan sketched out (client goal, topics on which to focus for dialogue, focus exercises, grounding exercises, etc.) and followed flexibly, of course leaving room for all sorts of discoveries based on, not only a client’s process, but also our own, the therapist/counselors. Psychotherapy and client counseling is a multi-dimensional process, not linear.

            But to withhold information can sometimes be cruel for a client, and trigger old wounds, that of withholding love. That’s often used as a weapon of abuse on kids–conditional love. “I will love you if you do this for me.”

            There are many ways to provide effective psychotherapy. What you describe is merely one approach.

        • Coming from a Latino Jewish family, my family modeled many things. In the end, it was up to me to pick and choose what I wanted to carry forward, and what I wanted to leave behind, as well as what I wanted to add on my own. That was the level of ownership I learned in my healing.

          For sure, they had chutzpah, which I greatly admire. My dad was a physician, extremely competent and respected, taught med school, as well, and worked for the county. He came from the Jewish ghetto of Argentina, humble beginnings, and he was quite forthright. He was a rager, but he was honest, I’ll say that for him. I learned a lot from his legacy.

          It’s the last part–the parts of my life with which my family cannot resonate–that challenges them, they’re just as stigmatizing as the system. But they’re learning!

          Middle class professional academic is their culture, not mine. I went working class, it felt more authentic to me, and relaxed. I loved working customer service retail, they were horrified, called me a ‘plebian.’ Endearingly, of course, all in jest, but that was their perspective.

          Now, I’m the one enjoying my freedom, so it’s all quite ironic.

          One of my favorite and truth-ringing quotes, from Kahlil Gibran’s The Prophet:

          “Your children are not your children.
          They are the sons and daughters of Life’s longing for itself.
          They come through you but not from you,
          And though they are with you yet they belong not to you.”

    • Very good point about the use of diagnosis and “treatment” as a means of blaming the victims of oppression, not to mention effectively compounding it by decreasing likelihood of recovery — which as B pointed out, can make it more difficult for people to fight against the oppression they face. This is a key intersection that people committed to anti-oppression work should be grappling with, not deflecting.

      I see it as one of the keys to rethinking psychiatry too. We need to focus on the harms and the alternatives but also the root causes of the experiences that get labeled and drugged. So in that sense I very much agree with the author’s call for a focus on structural violence, which obviously is a huge source of trauma, but disagree that the issue of psych drugs can or should be detached from this. Similarly, I agree with “loosening up polarizations” but disagree that “shifting attention from debates about [psych drugs]” is the way to go about it.

  31. Take the focus off of psychotropic drugs and coercive psychiatric “treatments”? Hogwash. Then this: “…including the putatively causal role of medication in increasing disability.” There is nothing “putative” about it (except for using the euphemistic term “medication” for psychotropic drugs). Psychotropic drugs cause irreparable harm. This is an indisputable fact. Thank goodness for people like Whitaker who have the courage to point out the obvious.

    • “Psychotropic drugs cause irreparable harm. This is an indisputable fact.”

      I am sorry, I am going to have to firmly dispute this fact. Yes, they cause harm in all sorts of ways, they are toxic. But the damage they do is NOT irreparable. I know this for a fact. It is a matter of discovering your healing path, and following it. Eventually, we get there, to complete healing, if we allow ourselves to by believing in it.

      I agree with all you say about slaying the dragon of psychiatry, it is, indeed, a dragon. But this message that the harm done by these toxic drugs is irreparable is, in and of itself, precarious in that it denies hope for people.

      My damage from 20 years of taking these drugs, culminating in a nasty mix of nine of them, and then from a painful and rugged withdrawal, healed completely 100%. Took a while, and I had to focus diligently on what my healers were telling me to do, but I did and it worked. I was quite bad off, so I never thought I’d heal, but thankfully, I was wrong. Please let’s never lose hope that full and complete healing from these drugs can occur.

  32. I have a unusual and completely overlooked option to suggest: Why don’t we award people with equal rights to the furthest extent of the law, stop labeling people under social constructs like disabled, unemployed, mentally ill, black, white… And we allow people to decide for themselves how they want to label themselves, and if people would rather live in prison than in an institution (which is really nothing more than the same concept with a different social structure), then let them. We have tons of prisoners who choose to spend most of their lives going back there. The ADA is nothing more than an obstacle Congress volunteered to put in place in order to avoid the mentally ill being labeled a suspect class which would have awarded them rights and protections… Protections from things like pharmaceuticals and coercive treatment…. Those should have been in place ages ago. The thing is… we are always in search of a new label that we can blame, fearmonger, and scapegoat in this country, and by keeping the rights and freedoms disproportionate in certain groups, we create groups that can’t fight back. Historically, we are that group. There are more than enough rights to go around and if that means people have the right to end their lives, the right to refuse treatment, the right to marry anyone they want (age restrictions and species still apply) It doesn’t really hurt the rest of us. In fact, it might make us more understanding and more human than what we have become. The problem with psychiatric drugs is simple… the cure is a lie. It’s not a cure…. it’s not even a treatment that can be proven… It is a way to subjugate and produce profit. My aunt recently died of cirosis of the liver… She was a wealthy, organized, functional alcoholic. If you had asked her what would cure her, she would have told you alcohol, and in the short term, she would have seemed right. No more withdrawals, social anxiety, panic, insomnia… all of those symptoms would have been gone, and she was “happy” being an alcoholic. In the end though, it was just as effective as most psychiatric drugs…. As long as you only looked at the right now, it seems like an effective answer. Treatment, or rather, effective treatment is about learning to live with things the way they are with the realization that they may never get better. You learn to live with yourself with all of your insecurities. You don’t look for a substance that might make you into someone else long enough to forget your insecurities.

    • Fortunately or unfortunately, depending on your point of view. I think that articles and points of view, that are academically based, and presented in the format of Academia… Have very little to do with the Mental Health business….

      Mental health treatment as it exists in the USA, is capitalism at its worst.

      Its really about maximizing profit, not helping people. Its structures and functions are designed to minimize cost, while maximizing profit. Ultimately People are viewed as someone to profit from. Those that care, those that want something different are systemically dehumanized and devalued. By the so called medical profession of psychiatry.

      And articles can be written from any point of view, but they will never understand that they are a moot point.

      As long as the meat grinding system remains, to harvest pain and make the most profit possible form it.

      I liked what you said AcidPop5

  33. Hi Timothy, Thank you for your excellent article. I also really appreciate the discussion. My take on this is that while everything you discuss here about analysis and psychosocial understandings is relevant and critical, there are larger forces at work, whose agenda is very different from yours’, mine, and ours’. To speak about the drugs as if we were really discussing inert chemicals is to obscure the reality that there is a powerful corporate agenda at work. A corporate agenda that laughs at these discussions because they provide distraction. Meanwhile, Thomas Insel makes clear to world leaders that “we” need to ferret out the brain diseased worldwide and subject one and all to our brand of “treatment”. This is not about concern for people, or questions about etiology, this is about market share and profit. I think it is profoundly naive to imagine that in this world of growing corporatocracy and oligarchy that the prevailing forces really are affected by anyone’s understanding or scholarship. They are not. It really does not concern the medical pharmaceutical insurance complex that more people are disabled. Captive audience. I have been covering medical kidnappings for three years now, as well as “child protective services” round ups of sick kids for pharmaceutical research, and they get bolder and more brutal daily. I support Ted C’s analysis that the focus on civil and human rights needs to take the forefront. Regarding the tone police, I hope you will ignore them as I do. The drive to tell other people how they should express themselves is not one that supports freedom of speech. Thanks again for your honest and thoughtful contribution.

  34. I appreciate the many sincere comments posted here, and I would like to focus on the main point of Timothy’s article: that there may be causes other than medication that keep people on disability. After walking away from the mental health system in the 1960s, I became a psychotherapist, and during my 35 year career as a psychotherapist, I worked for several years for a psychiatrist who provided treatment to injured workers. Most of our patients had physical disabilities: back injuries, head injuries, chemical poisoning, disfiguring industrial accidents, heart conditions brought on by stress, etc. The Workers Compensation system in the United States is completely adversarial and was created to protect employers from costly personal injury lawsuits, although insurers have created the myth that most claims are fraudulent. Injured workers have to prove that their injuries are work-related and insurance companies usually deny their claims, saying they are either not work-related or not serious injuries causing disability. In order to receive minimal temporary disability payments, workers usually have to hire lawyers who send them to physicians who write reports on their behalf while “defense” doctors write reports denying their claims, in effect protecting the employer and the insurer and keeping the worker in an adversarial, stressful situation. During this period, the worker often doesn’t receive needed treatment, and pain and illness as well as loss of income and assets can create severe emotional crises that are then treated by psychiatrists who provide medication for anxiety and depression, which are addictive, toxic and can cause other health problems. After a year in this frustrating and debilitating situation, injured workers who can’t return to work, like people whose illnesses are not work-related, can apply for Social Security Disability which is also usually denied in most cases and only awarded after a hearing before a judge which takes place after another year. My experience with the patients I worked with was that they were honest and genuine and their claims were righteous. Their lives were disrupted by pain, illness, and injury, which were worsened by the psychological stress of the system, by feelings of betrayal by their employers, by fear, loss, and insecurity, and the anguish of severe consequences to their families, including poverty and homelessness for some. If and when they received a settlement from the insurance company, it was usually minimal, as are Social Security benefits, and all they had to live on for the rest of their lives if they couldn’t return to work. I believe that most people on SSD have in fact dual diagnoses: physical injury/illness and psychiatric diagnoses so that even if they were able to go off their psych meds they might not be able to return to full-time work, and they were often discriminated against when they tried to find work because of their past injuries and psychiatric diagnoses. Some years ago, drug addiction was considered an illness and drug addicts were able to receive SSI or SSD but treatment programs were stopped and because they continued to use drugs and spent their disability money on them, the law was changed to require that they have a concomitant psych diagnosis in order to receive benefits, so this population was also sent to psychiatrists and prescribed psychiatric meds. I’m glad that Bob Whitaker has so clearly made the case against psychiatric medication and I would like to see the larger socio-economic issues continue to be addressed in a way that would disabuse the public about psychiatric diagnoses and intra-psychic causes of emotional distress and effect real change in public policy.

    • Thank you for this enlightening and insightful post. Your clarity around how the corruption works is refreshing, and it rings completely true to me.

      “….even if they were able to go off their psych meds they might not be able to return to full-time work, and they were often discriminated against when they tried to find work because of their past injuries and psychiatric diagnoses.”

      Indeed. Discrimination and stigma play the largest roles in prolonged disability, as far as I’m concerned. Even the meds issue is based on stigma and discrimination, so it all falls under this umbrella. Radical change would mean detaching from this and rewriting our stories, which is a process of healing. Change in society will occur when we shift our self-perception.

      Those who stigmatize and discriminate, especially when it is systemic and institutional, will not change, until they face they their own judgments, and who knows when that will be? That’s a rough road.

      Thank you so much for this. Clearest post I’ve read on the subject.

      • And btw, the issue of pure and extremely toxic stigma–that, personally, I feel is what is really and truly at the bottom of why solutions and clarity are so incredibly challenging to achieve, here, and why suffering and disability is so prolonged–is that I feel it is the hardest issue to detect. I don’t even think research can do it justice, it would all be so skewed by stigma, from conception to delivery. These things are felt on a gut level, it’s a prominent and deeply felt negative, constricting, powerless feeling when one is truly experiencing stigma, as many of us on here recognize.

        To me, stigma is born from fear and discrimination, and we are so in the habit of this duality and fear-based living, this toxic level of stigma abounds in ways that permeate our existence at this time. There is no clarity anywhere–other than the clarity we all have that something core and vital in our society, is, indeed, amiss– due to this illusory division in society, and that is the idea of corrupt power, right?
        To keep things confused, in conflict, and in chaos. That’s empowering to established mainstream power, when their communities are in conflict, because they can sit on the gold. That’s how it seems to work, from what I’ve been able to gather.

        Of course, that’s really a house of cards, but short term thinking seems to accompany greed, especially now that the money class has reason to be a bit desperate to cling to their riches. There is definitely an awakening going on in the world around all this, and the masses are so not pleased with what is being unearthed about people they have trusted, even if they are people they didn’t know, media heroes. But it’s happening in our lives, as well, as more and more comes to light about the world and society in which we’ve been living, and how illusory and programmed it’s been.

        We’ve bought it, though, for a long time, so this is a major process of transition, as the old systems lose their power, and new information and solutions come to light.

        To me, the issue of prolonged disability and corruption go hand in hand, and the most powerful weapons of corruption are stigma, because it produced fear and shame, and this disempowers people, really throws them off their game. That’s a natural reaction to stigma and discrimination.

        Were we to not take this on, they would not have the power, because we could get clarity on the issues. That’s my feeling about it, anyway, seems logical to me. That’s why I say the key to resolution, here, is based on our self-perception. When this is strengthened, stigma loses its emotional power, and corruption can be unearthed. That would free a lot of people I think.

        • Oh, and one other thing I discovered about this—people tend to conform to the establishment, even if they have a radical mindset, in order to avoid feeling their own self-stigma. That is, we don’t like to be perceived as ‘weird.’

          Personally, and this is just me, I think we need to be done with that, because we’re all weird in our own way. When we care too much about what other people think, we sacrifice our truth. Corruption will never come to light if we continue to enable it by fearing stigma, we have to face it in order to move past it. That’s very empowering.

          When we speak our truth among those that do not agree, we have courage, truth, and light on our side. Don’t give in to their desire to shame and disorient. It’s just a tool!

  35. Mr. Kelly, I feel confident that the title of your article will mostly help Robert Whitaker advance his views, since those who read between the lines will see that you misconstrue his purposes in keeping at his journalistic attack on dangerous prescription drug use and abuse. But you have heard enough on that from some good commenters already. You bring up all sorts of things that need remembered, but I wonder if you recall that we are waiting to see if Whitaker decides to proclaim that psychiatry is ideology. Since it looks like the abrogation of civil rights is a principle of their service model, and that they employ science to the ends that serve it, it seems like the fairer criticism is that he’s leaving us all with one foot on the platform and one foot on the train. I think that he gets the drug problem and the plight of sufferers just right, but that the people who want to feather their nests as types of authoritative commentators on how the issues should get discussed let you off to easy on the legal conundrum that psychiatry creates and maintains for us all–in its present form.

  36. Though this was not the focus of much of your article, I wanted to thank you for your mention of one of the axes you suggest for refocusing reform efforts : “The identification of areas where interests and perspectives align among advocacy groups that may otherwise strongly disagree about the role of psychiatric treatment in recovery.” As a mental health consumer and professional, I have long felt that we will be better served in reforming mental health care by meeting on common ground than by presenting a divided front. While I am not against the eventual dissolution of psychiatry, I think we have a long way to go. Regardless of my personal or others’ individual beliefs, I don’t see us making significant progress with black and white anti-medication and anti-psychiatry stances. I would love to see us be able to make more significant progress by uniting together with a common goal of advocating for change.

  37. I also appreciate this article and a lot of the points it made. Thank you, Mr Kelly. I don’t think I have anything to add that hasn’t already been said. This discussion is also interesting. It’s funny how some people don’t really care where you’re trying to go, they just get mad when you won’t get on their train and shovel coal. (On another note I was absolutely taken aback by your picture. The pain in your face is striking. Whoever took that picture did great work.)

  38. Timothy, you are as correct as members of the American Rifle Association who claim that guns don’t kill. Of course antipsychotics don’t cause mental illness (although they clearly cause akithisia, tardive dyskinisia, sleep disorders, suicidal ideation etc ad nauseum).

    People held in high esteem (physicians) who tell people experiencing extreme but oftentimes reasonable reactions to life events or experiencing physical illness or brain damage, who then inform their patients that they have a neurological condition (without even the scantest biomarker) which they will experience for the rest of their lives and for which they must take one and usually more antipsychotic medications which will in turn cause psycho-symptoms (whew) cause mental illness.

    You have kicked off what has been an illuminating and exhausting discussion for which you must be commended. But all the psychobabble and educanto in the world will alter this basic fact. That fact that it is so basic explains the anger and frustration of the army of nay-sayers who’ve taken part in it.

  39. Hi Timothy, I came back to share a recent discovery. In addition, I hadn’t read your biopic until now, and so hadn’t realized until now that it was your first post. A very ambitious one. I had intended to look at your previous efforts, too. I’m sure you’ve got folders of old stuff on hand, and that’s good. Best luck on whatever’s coming up, but I do hope you’ll enjoy something from these topically related pieces.

    http://philpapers.org/archive/ELPTSO.pdf

    http://static1.squarespace.com/static/53a79084e4b01786c921de45/t/53a854fae4b0cd712a481fb1/1403540730432/The+Phenomenon+of+Boredom+%28Martin%2C+Sadlo+%26+Stew%2C+2002%29.pdf

    The first can be thought of as appearing due to the recent rejuvenation of the Sartrean critique of psychology by Dr. Jonathon Webber, while the second represents the typical litany of behavioral healthcare specialists suggesting all the usual handwringing about what to actually endorse in people’s natural mode of acquaintance with reality, given their terribly unworkable views of self, and others and their almost peasant-y ideas of real free will. Also, that second article was the earlier published of the two and is sort of far on in a long line of what transpired after the academic and professional elite here rejected Sartre’s advice about advocating self-sufficiency and emotional self-control, kinds of which are well with anyone’s reach. That is, he argues that given the right conditions for cluing them in about how they effect their decisions and how their decisions shape their perceptions, people can be well served by common sense. Not just for staying adjusted, but for conditioning social relations positively as well. Not many workbooks, plenty of fessing up, you could say. Maybe you won’t want to go back to the other more common type of serious research much, and will get compelled to wonder “what if”–about the whole industry and its teaching arrangements.

    Good luck in things–

    • Timothy, I also just thought of cooling my jets to be more understandable in my aims. So take into account, that I realize that mistaken conceptions add up and the people at the end of the line of one or more of them often cant’ see things any other way. The social problem or problem with the culture of behavioral science might be exemplified in the continuing indelibility of Freud’s masterful investigations, for instance. To the neediest among us and not the most happily educated, the truth of Freud is his supression of data regarding abuse against girls, as it’s officially now briefly mentioned. Are we to think he didn’t suppress the facts because he hadn’t the foggiest about even little boys? Horrors, Sigmund: the truth. And our educators in the field: thanks for nothing much.

  40. It’s good to see social inequality being raised because the ‘drugs = all disability payments’ is not accurate or helpful and more so at a time of rising psychocompulsion which is leaving people sanctioned, using food banks, losing their homes, or worse: https://vimeo.com/157125824

    I’m not pro-drugs (but I respect anyone’s real choice to take them, I say ‘real’ because I acknowledge that it’s mostly not a choice). Employment is being touted in the UK as a ‘treatment’ and cure and recovery with a government ‘Behavioural Insights’ department which designs programmes pushing CBT and DBT to force people into workfare or work with the ‘correct’ attitude (think Ehrenreich ‘Smile or Die’). Bear in mind the UK has more vacancies than available jobs and mental health service users have the highest rates of unemployment and the reasons for that include meds but are not solely located in that. We have a million people in the worst and harmful employment – zero hrs and people in full-time minimal wage work or 2-3 jobs where they cannot make enough money to live. We have a housing crisis, the level of homelessness is palpable, and £9.3 billion in housing benefits is being handed directly to buy-to-let multiple homes landlords, this is corporate welfare, alongside corporations paying so little their employees need Working Tax Credits, this is yet more corporate welfare.
    The welfare system is causing systematic poverty, distress, READMISSIONS, and suicide on an unprecedented scale. The current system has dispensed with flexibility if a person can work one week then might not be able to for a while, or may only be able to do limited work, or is more stable with voluntary work as an outcome (which benefits charities, NHS Trusts and universities especially).
    There is in-work welfare conditionality and people attempting part-time work lose essential WTC’s the moment they lose a disability payment which can be received both in and out of work. Self-employed also lose working tax credits if they cannot secure a full-time minimum wage salary.
    Supports in education and to live have been withdrawn, mobility scooters/vehicles have been removed. The situation is very dire, there’s a lot more to the issues than psych drugs. Even if those drugs were removed all these problems would remain because they’re structural, this is what neoliberalism does, and it relies on there being unemployed/low paid people so that money can be siphoned upwards to the very wealthy and corporations – they are taking the most in corporate welfare.

  41. Thank you for writing this Timothy and for engaging with all comments.

    Open Dialogue are partly selling themselves on Whitakers argument on getting people off benefits (the much promoted 75% back into work/ed within 2 yrs which isn’t as straight forward as much that will politically appeal).
    OD is apolitical or at least apathetic when it comes to politics and the current landscape for people in receipt of in or out of employment disability benefits, because I never see any mention of it. I sincerely hope some people will raise these questions if the Whitaker and OD ticket rests on ‘drugs = disability claims’, you will find not all psych users/survivors will buy it.

  42. Hi, i’ve been reading MiA for some years, yet i think this is my first comment.
    Firstly, i think large part of this article is using a straw man arguments when presenting both whitaker’s work and “anti-psychiatry”.
    Secondly, while i agree that rising disability rates are probably partly caused by socioeconomic factors and, as author seems to suggest, some people are going for disiabilty payments as a mean of welfare/benefits, i think the author uses this argument in order to say that drugs are not to blame, they are not as bad as whitaker and others here describe it here and that we should focus more on a bigger picture. Yet, the problems described, such as stigma, the form the benefit program takes and others all arise because of the dominance of the biomedical model! And the main practical part of the model are the drugs used! The only way to move forward is to first undermine the biomedical model by showing that the treatment proposed by it does not work and even more is probably harmful. Focusing on socioeconomic factors won’t change anything now, as it may only be used in order to push more drugs and coercion on people. I don’t understand, how, in good faith, may the author cite lip-service of insel and torrey, while actual clinical practice has got nothing to do with those statements. Maybe some people go into social disiabilities programs because of socioeconomic factors, but that does not change the fact, that they are prescribed meds which at best do not help and at worst keep them in the disabled group and in a state in which they are unable to provide for themselves! PS Sorry, I’m not a native english speaker, as you probably figured out, but I felt i needed to add my opinion here.

    • “Focusing on socioeconomic factors won’t change anything now” – tell that to people working zero hours, full-time and still needing state top ups, people using food banks, people struggling to find cheap enough rent. It is socioeconomic factors which can help drive people into psychiatry, drive people back, or keep them there.
      You might as well say there is no point in ever addressing poverty

      • that’s not what i meant. perhaps i have/i had some problems with communicating what i mean. of course, socioeconomic factors can lead people into psychiatry. of course, fighting poverty, economic inequality, exclusion, racism, discrimination etc is important and all those factors can drive people into psychiatry. and i think all people involved here know that. but i don’t think it’s what this article says. i think what it says is: rising disability rates are not (only) because of drugs, but (also) because of other social problems. which is, of course, partially true. still, the problem is, as long as people are entering the mental health system, for whatever reason, and the biomedical and disease model dominate – no one will ever consider those socioeconomic factors, because part of the story behind biomedical model is that the most important factor is individual, personal, vulnerability or, if you will, biological defect that has to be fixed with drugs. if we don’t change the view that drugs don’t work – also by showing that there are other causes of mental distress, basically, that bad things happen to people and they screw them up, and not that they were born with faulty brains, people will be drugged and opressed by psychiatry. addresing the CAUSES of social problems suchs as poverty and fighting them is not a job for psychiatry, it is a question of the organisation of the whole society, economy, culture etc. as long as biomedical model dominates and people believe that drugs are safe and necessary all mental health programs focused on addresing social issues will end up as mass drugging programs. and this won’t solve the problems of the poor and excluded, it will only make them drugged and poor and excluded.