Dear Colin Powell,
You don’t know me. I was the one bolting for the microphones when you gave your talk at the National Council for Behavioral Health conference (affectionately referred to as ‘NatCon15’ by its organizers), after you offered to take a few questions. Unfortunately, I didn’t locate the mics until – sensing the drifting energy of the overall crowd – you instead sent everyone off on their coffee break. I don’t imagine you could have seen me in such a sea of faces, in spite of my somewhat frenzied effort to make my way forward.
I want to start out by saying that you’re a very good speaker. It wasn’t clear to me if you were using a teleprompter (I know they’re available at the conference as I’ve heard others talk about using them), or if you’re just that good. Either way, suffice to say I was impressed with your polished ease on that big stage in front of (quite literally) thousands of people.
That said, I want to share some concerns with you about your talk, and particularly in consideration of the presence of those aforementioned thousands.
You have a powerful voice, and not just because of your skillful presentation. No, it is also because of your political and military career, the number of times most of us have heard your name on the news, and the highly influential roles you’ve held. This is why I was most concerned when you chose to promote forced treatment, employment discrimination and the chemical imbalance theory all within your less-than-one-hour talk.
Please allow me to expound. You told a story of a man who was saying frightening things about not ‘wanting to go on’ to his employees. He had purchased guns, and was saying and doing other things that his friends and co-workers couldn’t understand. You then explained how you ordered him into treatment at a location you self-professed to have chosen and paid for in the complete absence of his consultation.
When you told this story, I could appreciate your intent. It’s true that sometimes people reach out for help in ways that others find frightening or inexplicable. I’m not suggesting he should have been ignored. And, if I trust the implied outcomes of the version you shared (accepting that it was only you sharing and not the individual who had been so forced), it sounds like your efforts worked out okay.
I can’t take that story away from you, but I do wonder if you are aware that risk of actual suicide is highest directly after someone leaves the hospital. I also wonder if you’re aware of the hundreds of thousands of people who have been hurt or felt traumatized by forced hospitalization. (I, for the record, am one.) Have you ever sat and spoken with someone who has been so harmed?
So many people play the game of hiding any signs of their internal suffering for fear someone will come at them once again with force. What if this person had been one? What if, after your efforts, he simply learned to stop sending out those signs and instead took even more care to keep his plans to end his life a secret? What if you’d just talked to him and offered some understanding and show of concern instead?
Forgive me if I’m missing something, but your story left me with the impression that you didn’t even ask him a direct question before informing him he was to be hospitalized “for a few days, maybe longer.” In truth, your response was quite a normal one so I really don’t care to vilify you for it.
Yet, the fact that you offered this example of forced treatment as a triumph to the thousands in this audience is a problem. While people back on my own homefront are tirelessly working to demonstrate to the world that there are alternatives (such as the Alternatives to Suicide support groups we offer in our area), your much louder voice with its much farther reach is saying just the opposite. While those of us who have ‘been there’ advocate against force and speak to its myriad harms, you made light of it and even solicited laughter from the audience.
I realize you’ve had to be in charge of a lot over the years. Responsibility has been heaped on you in ways I can’t even begin to imagine. That was likely inescapable through much of your professional life. However, I can’t help but point out that it’s that ‘sense of responsibility’ for (aka., ‘over’) people that has driven much of the worst, most harmful aspects of the mental health system.
That brings me to my second point of contention: Employment discrimination. No, you didn’t say those words, but you did tell stories about two men who had killed themselves after promotions in the military. You followed that by lamenting that you and others hadn’t been able to “sense” something about them or their “makeup” that would have led you to realize those promotions were “too much for them to handle.”
Perhaps you don’t fully comprehend the implications of what you suggested in those few moments. I’m not sure all your listeners did either, so I’m going to spell it out here more fully. Your stories suggested you should have had the responsibility of identifying individuals who had something ‘wrong’ with their ‘makeup,’ and thusly weeded them out of the potential promotion pool.
That is terrifying to me. If we were to play this idea out, we would have to constantly be assessing and guessing our way through who deserves what job. People’s entire careers would be in the hands of our own biases, perceptions and imaginations. I recall a certain ‘risk expert’ who proudly purported to be able to assess who was at real risk for committing violence with an accuracy rate of 50%. Yes, he had the same apparent skill as a flipped quarter. Would our accuracy rate be so good? What are the consequences if not (or if so)?
Life is hard and messy, and these are complex and multilayered issues. I’m sure, if we had time to sit down and talk, we’d both find that there are no simple answers to any of this. However, that brings me to my final point: The chemical imbalance myth.
You shared that your wife was diagnosed by a psychiatrist as having a ‘chemical imbalance.’ You said she was, as a result, put on psychotropics and found success after doing so. I’m not going to attempt to take that away from her, but whereas so many issues encompass shades of gray, the chemical imbalance theory does not.
The chemical imbalance theory is not just unproven; It is debunked. But you need not take my word for it. Ronald Pies is a psychiatrist author, professor, and Editor in Chief Emeritus of Psychiatric Times. Though Pies and I have debated about other issues in the past, it seems most important and relevant to offer you the following quote from his 2011 article, “Psychiatry’s New Brain-Mind and the Legend of the ‘Chemical Imbalance.”:
“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”
Pies is not alone. In fact, many psychiatrists have stepped up and acknowledged that there is no identifiable chemical imbalance to which they can point, and researchers have concurred. On the other hand, many doctors (and pharmaceutical companies) still refer to the chemical imbalance theory as truth. Why? Because it helps convince the people to whom they are prescribing pills to be compliant. (Yes, psychiatrists have actually said this on the record, too.)
So, when you also referred to the chemical imbalance theory as truth to the thousands who were so eagerly listening to your every word, you became complicit in perpetuating a myth. And make no mistake: This is a myth that has harmed thousands, because for every person who feels that these drugs have helped them, there are at least as many who say they and others have been harmed in serious ways including early death.
Now, I’m not trying to tell you or your wife that she is wrong for believing the pills she takes so faithfully have helped her. I couldn’t possibly presume to know that. However, it simply does not follow that someone is treating a targeted chemical deficiency solely because they like the effects of ingesting a particular chemical. For example, just because a person appreciates the effects of caffeine, it hardly means that they have discovered within themselves a coffee deficiency.
Yet, if we perpetuate this idea, we are not just furthering a myth, but taking away choice. After all, if you believe you have an indisputable chemical imbalance, then how can you not find yourself trapped in the assumption that you must ingest chemicals to correct it?
If I’m honest, I’m feeling a little overwhelmed by all this. It feels fairly impossible to keep up. We’re trying to undo and undo and undo the ideas that you and others are able to put out much faster and wider than us. Today, you got a standing ovation from thousands. Tomorrow, I can only hope that a couple dozen will choose to take the time to come and hear me out at my workshop, in spite of having so many other options pulling at their time.
I suppose I can only hope you’ll reconsider your message (especially given the privilege of your reach), or that someday, as a part of such a process, you might give us the same time you gave that ‘NatCon’ audience. We won’t be able to offer rock star concert openers with light shows and drones flying about as the National Council managed, but we’ve got a ton to offer in experience and heart. We hope you’ll take the time to hear our voice.
CC: The World
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.