It’s Not Easy Being “Clean”

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I think I have underestimated just how hard it can be for people to approach mental health problems from a psychological and social perspective. The longer I work with people who are experiencing severe psychological distress, the more they teach me about the difficulties involved in breaking away from an “illness” mindset. Medications, by and large, are still the mainstay of helping people with psychological troubles despite an increasingly widespread acceptance that psychological problems are not medical problems. Mental illness is an “illness” only in the same way that love-sickness is an illness.

Yet, medication does seem to help some people some of the time. Despite the benefits of psychotropic medication being exaggerated and the harms being minimised, it is the treatment of choice for some. Perhaps the main problem with medication for psychological torment is one of misinformation. Both the people prescribing the medication and the people taking the medication are often misinformed about the benefits of the medication and the range of effects it can have. And, as so often happens in clinical practice, when different combinations of medications at different dosage levels are prescribed, it is probably impossible to know how this particular medication medley will affect the individual who is consuming it.

Medication is often the first treatment option offered to people who access health services for help with psychological problems. People may take the medication that is offered to them because they believe what they are told about the nature of their problem and the potential benefits of medication. It might be a long time before the person questions whether medication is the most appropriate course of action. Some never question that at all. I imagine it is extremely difficult to question the “help” the treatment provider is offering you even if it doesn’t seem to be so helpful.

Healthcare professionals can communicate both overtly and covertly that they are the expert and that their advice and recommendations should be followed. People who want to explore options other than the ones being recommended may feel guilty about suggesting something different, and may be concerned that they will disappoint or offend their treatment provider.

The dynamics of the relationship between the “patient” and the “doctor” can make it very difficult for people to come off medication even when they want to. The people seeking help for their psychological unrest might be working with physicians who believe in the benefits of medication and communicate their faith in pharmacology in subtle and not so subtle ways. These physicians may overtly give support to a person’s desire to come off medication but they might also spend time reminding the person about how long they have had the problem, as well as what happened the last time they tried to come off medication.

When people are on different combinations of medications in different doses it can be very difficult to know what to reduce first and by how much. It is now recognised that dependence can occur quite quickly when people start taking psychotropic medication, and there seems to be a great deal of individual variability in how tolerable medication reduction is for different people. Often, the withdrawal effects of reducing medication can mimic the symptoms of the problem the person was medicated for in the first place (Gotzsche, 2013). This can be interpreted both by the person and the physician as a sign that their illness is worsening, with the solution being to reinstate the medication or perhaps to introduce another medication. An exacerbation of the problem following a reduction in or withdrawal from medication can also erroneously reinforce the idea that the person taking the medication has a medical problem.

It can take a lot of determination, therefore, to persist with non-pharmacological options for the resolution of psychological distress. Psychologically troubled people often have a really tough time just getting through the day. It is a lot to expect them to also be able to doggedly pursue their treatment of choice in the face of professional opposition and resistance. Remarkably, despite all these difficulties, that’s exactly what some people do.

Even if people are able to negotiate the provision of psycho-social treatment, however, they still face further predicaments. Working through problems psychologically can be arduous. It can be really hard-going to explore those things that you have been trying to avoid for so long. Looking at and investigating the distressing aspects of voices and images can be frightening and intimidating. Sometimes things can even seem worse – more confusing or scary – than they did before, while your mind struggles to make sense of its own objectionable activity. Looking at and listening to things that you’ve been trying to ignore, or push away, or keep a lid on for a long time takes courage, hope, and optimism. The benefits are great but it can take sailing a turbulent sea to get there.

The implications of thinking about distress from a psychological point of view in terms of personal responsibility and self-determination can also be confronting for some people. At different times and in different situations it can be comforting to think that this is happening to me, it is not anything I am doing to myself. Yet, the idea of “doing it to myself” is exactly the kind of attitude that a psychological approach promotes. Not in a blaming, critical way but in a “master of my own destiny, captain of my own ship” kind of a way. How could it be anything else? Even though the voices seem like they’re outside my head and even though they don’t sound anything like my voice, they’re still voices that I am generating. In fact, getting to know and understand more clearly the part of myself that is behaving so obnoxiously to other parts of myself is often, either directly or indirectly, a core part of effective treatment.

Grappling with the warring states of one’s own mind can be a tumultuous and baffling experience but one that ultimately leads to certainty, contentment, and wellbeing. Some people might find it easier to keep taking medication and not investigate the meanings and messages they are constantly communicating to themselves. In fact, the very act of labelling these experiences as “meanings” and “messages” conveys a particular perspective. It can be difficult to even accept there is a meaning or a message in the feelings, thoughts, voices, images, and other experiences that seem to be battering a person on all fronts.

A preference between medical and nonmedical approaches to psychological anguish may reflect a balance between short-term and long-term gains. Pharmacological treatments for misery and madness can produce relief in the short-term for the suffering the person is experiencing, yet the long-term benefits are much less clear. Psychological and social approaches, however, do not always have such an immediate calming effect. The full benefits of psychosocial methods are often realised over a longer time frame.

We are steeped in a social climate that promotes a constrained and steady life as the aspirational norm. Any deviation from this is treated as an aberration for which a remedy, often in the form of a pill, should be taken. Experiences that are not happy or upbeat are seen as problems to be eliminated. The manifestation of anger or sadness or dread or zealousness or uncertainty or disorderliness or excitability or moodiness is something to be “cured”. We seem to be living in a strange, “Goldilocks world” where people experiencing “too much” or “too little” of any emotional state are treated with suspicion and are implored to return to a “just right” state. In this world people can even be too happy or too upbeat. Of course what is “just right” is rarely determined by the individual but is prescribed by others.

More and more the health and lifestyle message informs us of a parade of different methods, medicines, and machines for achieving amazing results with minimal effort in almost no time at all. The idea that life can be tough is barely a whisper above the beguiling roar of life as a never ending party where people who are normal are relentlessly chirpy, agreeable, and successful.

The experience of living can certainly provide happiness and success but it can also provide misery, mundanity, mayhem, and madness. Life can be tedious, trivial, and tiresome. All of these things are part of the adventure of living. Questions such as “Who am I?” and “What am I here for?” can often underpin much psychological unrest. These questions, however, do not have quick and easy solutions. Drugs, either prescribed or self-sourced, will not provide the answers. The answers can only come from the individual who is contemplating the questions and, often, the places from which the answers will sprout are those places where the person is most reluctant to look.

Sometimes life can be a toilet. There is no doubt about that. It is not always easy being “clean” in the sense of working through problems and living life with a mind unpolluted by medication. Getting back to “clean” once someone has been taught to cope with problems by creating a medicinal mind-fog can be extraordinarily difficult. It is an inspirational comment on the human spirit that so many people manage to achieve this. The indomitable capacity of the human constitution to reorganize problems and restore balance must surely be one of nature’s most magnificent achievements. It will be a great day when our helping services truly assist this capacity to do what is in its nature to do instead of retarding or obstructing its efforts.

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Reference:

Gotzsche, P. C. (2013). Deadly Medicines and Organise Crime: How big pharma has corrupted healthcare. London: Radcliffe Publishing.

64 COMMENTS

  1. Yes I think it can be deeply challenging for people to avoid medications for psychological distress in this society. Insurance willingly pays for it. Doctors recommend it and it promises an easy solution. Therapy tends to have large copays and deductibles that act as a firewall for most low and moderate income people.

    But underlying that, there is a general desire to simply feel better, or at least- not be tortured by the…depression, anxiety, panic, mean voices, fill in the blank. In some ways psych drugs fill that role- they sedate and stimulate in a measurable way and change biochemistry. Instead of wading through the miasma of complex narratives, previous trauma and current stressors, psych drugs promise immediate (or very quick) relief of pain. Evidence based too!

    I sometimes think therapists who tend to critically appraise psychiatry underestimate this desire to simply “feel better”, to feel more pleasure and relaxation, to reduce the horrible symptoms please.

    If one thinks in simple forms of pleasure and pain, people see psych drugs as increasing pleasure and reducing pain. However, over time, it is often clear that they often cause more pain- in the form of deteriorating health, reduced cognitive function, metabolic issues, apathy, and lowered libido. Essentially, like most drugs- the beginning is great and down the road can often be bad.

    As a therapist and an herbalist, I am often struck by people’s desires to…simply feel better…to feel physically, somatically, cellularly better. Folks in distress truly do feel ill…mentally, emotionally and physically. We would do well to honor that physical feeling of illness and address it. Yes there is importance in honoring pain, exploring the root of issues, developing insight- but there is also importance in alleviating suffering- offering tools and techniques to reduce the pain, to offer alternatives to medications which promise immediate pain relief, immediate tranquility.

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    • Hi Jonathon,
      Yes, I agree. Feeling better is often the key. And the paradox of that is that medication can help people feel better initially (well, after the two to three weeks that they start to have some effect) whereas psychological therapies can be unsettling initially. People I see can have quite a torrid time in sessions but end up feeling better afterwards. That’s where I think the trade-off between long term and short term feeling better can be important.
      Tim

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  2. ‘ The indomitable capacity of the human constitution to reorganize problems and restore balance must surely be one of nature’s most magnificent achievements.’

    I believe in the above statement wholeheartedly.

    It is unbelievably challenging even to be a family member supporting a loved one in their struggle; particularly when `helping services’ play a role in ‘retarding or obstructing efforts’. I often think to myself ..if it is this hard for me…what about for my loved one,…and what about for others who may be on their own trying to struggle through. How can anyone find that much strength… but amazingly one does start to see the strength of the person push through.

    Thank you for such an important article that also highlights the importance of alleviating suffering -in ways that don’t create more suffering in the long term.

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  3. “Mental illness is an ‘illness’ only in the same way that love-sickness is an illness.”

    Ok. Now we’re getting closer to the truth. You have a Ph.D. (even though it is in a pseudo-scientific field), so I expect more out of you. Let’s analyze this statement a bit, shall we? What is “mental illness”? If it is an “illness” “only in the same way that love-sickness is an illness,” then what are we talking about?

    There is an important distinction to be made, one that people with or without Ph.D.s should be able to grasp. “Love-sickness” is a positive experience brought about by positive emotions that can be channeled toward a positive end. These emotions originate with the person who is experiencing “love.” In contrast, “mental illness” is a deceptive notion thrust upon those who experience negative emotions and symptoms, which often leads to further stigmatization, drugging, suffering, violence and suicide. This is an important distinction to make.

    Most people who believe that they are “mentally ill” did not come up with the idea themselves. In fact, 100% of the so-called “mentally ill” have inherited the stigmatizing label from a process that dates back at least to Freud and Charcot. Whatever afflictions a modern “mentally ill” person experiences, he or she did not invent the term “mental illness,” nor did he or she come up with the label from the DSM (Diagnostic and Statistical Manual of Mental Disorders). These are false categories, most often connected to a completely erroneous hypothesis of brain dysfunction or a “chemical imbalance,” that are marketed by pharmaceutical companies and perpetuated by an ignorant medical community, or a mendacious one (psychiatry, most notably). Most “mentally ill” people gladly accept the diagnoses they receive and the drugs they are offered as a way of attempting to look at their problems objectively. The only problem is that “mental illness” is a myth, the diagnostic labels are fictitious diseases, and the drugs are not medicines at all, but dangerous psychoactive, psychotropic chemicals. The people administering the labels and drugs are not doctors, except in name only. They are magicians of sorts. They are actors in a type of psychiatric theater.

    Except in a few rare cases (Romeo and Juliet), love-sickness doesn’t harm anyone. “Mentall illness,” on the other hand, has led to the suffering and death of untold millions of people. It is one of the biggest hoaxes ever to deceive the human race.

    “Pharmacological treatments for misery and madness can produce relief in the short-term for the suffering the person is experiencing, yet the long-term benefits are much less clear.”

    This “relief” of which you write would be better termed “spell-binding.” (See Peter Breggin, http://breggin.com/index.php?option=com_content&task=view&id=243) It is the kind of relief that one might experience from consuming an abundance of alcohol or illicit drugs. It is not only temporary, but harmful. These are not “medications” or “treatments.” They are drugs for Pete’s sake. Naturally, someone who is suffering with symptoms arising from an unknown cause will seek an easy solution, especially if ignorant (or deceptive) “doctors” prescribe them the easy solution as a form of “medication.” The psychopharmaceutical industrial complex has perfected the art of destroying human agency, first by diminishing the need for people to take personal responsibility for their own health and behavior, and second by exercising coercive measures in the name of fictitious diseases. It is bondage and slavery in the name of “medicine.” “Doctors” become the dominators and “patients” the dominated. Only the truth will set the “patients” free. Only the truth will hold the “doctors” accountable.

    Yes, human beings are resilient and amazing… but does that mean that psychiatric torture and abuse should continue? I think not.

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    • Hi Slaying,
      Wow! Out of my whole article you chose to focus on the love sickness metaphor. That must have really meant alot to you. I used the word “relief” rather than “spell binding” because that’s how some of the people I work with describe it. I’m sure people experiencing psychological distress didn’t come up with the “mental illness” term themselves but I’ve never heard them come up with the “spell binding” term either!
      I really didn’t mean love-sickness to be a central part of the article but I do think the agency that you mention is fundamental to living lives of value (valued from an individual perspective that is!).
      Tim

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      • Of course “patients” never come up with the term “spell binding,” because people who are spell bound don’t know it. A lot of doctors don’t know it either. Psychiatry has spell bound almost an entire civilization.

        The love sickness metaphor is central because it comes closer to explaining the truth that “mental illness” is also a metaphor, or a myth (albeit a much more dangerous metaphor).

        Anyhow, thanks for responding. I recognize that much work in this field is inspired by a sincere desire to help those who are suffering. The problem is that too often the “help” is what causes or exacerbates the suffering.

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        • Hi Slaying,
          The love sickness metaphor isn’t central for me but it is a good way of emphasising the idea that psychological distress is fundamentally different to a physical illness. Sometimes the two can co-occur but they don’t have to. People can be physical unwell and not psychologically distressed and it can happen the other way around too.
          I definitely take your point that what is offered as help is not always experienced that way by the “helpee”. One of my fundamental principles is that help can only be defined by the helpee and not the helper. If what I’m offering isn’t experienced as help by you then it isn’t help regardless of how good my intentions are. It’s not a very common idea but one that I think is hugely important. I’m glad you raised it.
          Tim

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  4. Just to be clear, I mean no offense by calling Clinical Psychology a pseudo-scientific field. I am just pointing out facts. Nor do I mean to insult the intelligence of the author, because obtaining a Ph.D. requires discipline and hard work. I believe that in spite of much evidence to the contrary, psychiatrists, clinicians, and mental health workers are capable of reasoning and discovering truth.

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    • Actually, I agree wholeheartedly with what you said, Slaying_the_Dragon, but I also agree with almost, if not all, Dr. Carey said. I think we, as humans, need to realize the corporations, especially the pharmaceutical ones, and the psychiatric industry, have intentionally defrauded humanity for profit only, and thus have behaved deplorably. Problems in life are, of course, not actually “life long incurable genetic mental illnesses” caused by “chemical imbalances” that can be cured with drugs. And how God damned dare people within these industries fraudulently claim such, psychiatry and psychology?

      But how absurd, insane, and disgusting the mainstream medical community has become, since they’re now advocating belief in the deluded, unproven eugenics inspired psychiatric stupidity, merely for profit. I do understand the mainstream medical community is doing this because the psychiatric industry has historically covered up their easily recognized medical mistakes, with psychiatric defamation and tranquilization, and have proof of this in my medical records. But I was told this was the “dirty little secret of the two original educated professions” by an ethical pastor.

      Perhaps it’s time for this “dirty little secret” of the medical profession to end, now that we all live in the information age? Especially since, in reality, all within the medical profession supposedly did take the Hippocratic Oath.

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    • Hey Slaying, the line that set you off actually is directly stated in the same terms that Dr. Evans uses by the author of The Myth of Mental Illness himself. I think it might be in The Meaning of Mind that Szasz says when someone tries to accuse a person of mental illness, then that psychiatrist is onto nothing more than a problem equivalent to lovesickness or some such “malady”. Maybe it’s because Tim’s first language is Australian that he sticks so close to the words of Szasz in his paraphrase here…. (Or maybe he doesn’t know that Szasz makes the statement, and he just comes up with one lucky correspondence to the whole of the right idea that mental illness is a myth.) Anyway, I think he meant to show patience for people who want some Valium instead of Risperdal and can’t get any (like me), something to take the edge off, or something like a mood stabilizer if they fear going berzerk for their own good reasons (which used to be me). Tim doesn’t seem to intend tolerance for labelling and deceiving persons about the efficacy of meds, at least not as I understand his terms. The one thing he missed clarifiying here was something he all but said outright: that it’s once you take the drugs as prescribed that you begin to risk having some very real medical problem. That’s our mutual concern about this issue, right?

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      • Good to know that there are reasonable, broad minded people out there. Psychiatry is perhaps the most heinous branch of modern pseudo-science, or as Szasz called it, the “Science of Lies.” Clinical psychology, with its psychotherapy, is much more benign than psychiatry (at least until it starts to go after a piece of the “mental illness” diagnostic pie.)

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        • Hi Slaying,
          There’s good and bad in every profession I guess. I’m fortunate to have known and worked with some really great psychiatrists and some of the biggest critics of biomedical psychiatry are, in fact, psychiatrists. There’s a lot clinical psychology could do to tidy up its own backyard but, as you say, psychology is more benign than psychiatry so, even when we get it wrong, it probably doesn’t have the devastating consequences that it can have when psychiatry gets it wrong.
          Tim

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    • That was my experience. I remember asking my last psychiatrist if he took the Hippocratic Oath, he got all confused. And he was all confused about the actual effects of his neuroleptics, as well:

      “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      He apparently wasn’t intelligent enough to understand some people are allergic to the neuroleptics, and that they can cause the schizophrenia symptoms. Thankfully, quoting my oral surgeon who said, “Antipsychotics don’t cure concerns of child abuse,” did finally embarrass this psychiatrist enough that he finally took me off the psychosis causing antipsychotics.

      I met a lot of complete hypocrites working within the psychiatric and mainstream medical community, but I’m certain it’s quite profitable for the medical community to cover up child abuse by turning the victims into schizophrenics with the neuroleptics. One has to wonder, given John Read’s research, if this isn’t the number one cause of schizophrenia.

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      • Hi Someone Else,
        Just picking up on your last point … I’m not sure “schizophrenia” is a “thing” that is caused by child abuse or any other event or happening. Once we start moving beyond the label of “schizophrenia” we might get close to understanding how people arrive in the severely distressed states they end up in .
        Tim

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        • Good point. Each individual circumstance is unique, and what people need is love, understanding, and a listening ear… not a diagnostic label that categorizes the sufferer in a certain way.

          Often people arrive at severely distressed states directly through the medium of psychiatry. In other words, psychiatry produces massive amounts of distress, whether by drugging, incarceration, psychiatric labels, electroshock, etc. Psychiatry produces “mental illness” which it then diagnoses and pretends to remedy. This is not to say that there are not other causes of distress, but that whatever the other causes are, psychiatry is not the remedy.

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          • Hi Slaying,
            Yep, I agree. Individual situations and circumstances related to psychological distress are unique and they need to be explored and examined not categorised according to a diagnostic system. There’s a great paper by E. I. Fried and R. M. Nesse (2015) called “Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study” published in the Journal of Affective Disorders. They analysed the symptom profiles of 3703 people who met the diagnostic criteria for Major Depressive Disorder. Overall, they identified 1030 unique symptom profiles so even with something as well known as depression we can’t assume what we know is going on for someone.
            I think you’re right too in that sometimes people can become more distressed as a result of treatment. It’s one of the reasons I think it’s important to let the person receiving the treatment be the best judge of how much treatment they need and how often they need it.
            Tim

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  5. You say the medication helps some people sometimes. How do we really know that though ? How intertwined is the whole thing.

    Like we have placebo right ? But what about… “reverse placebo” as it were. Someone gets told they have a problem, fully backed by the authority of government, peers etc. It’s not easy to just turn the back to that.

    Looking at the drugs, there seems to be no point in taking any antidepressant, there doesn’t seem to be much of anything behind taking a “mood stabilizer”, I can’t really see the point in taking lithium to the point where it’s classed as a drug instead of a mineral, and all the other drugs are for epilepsy which is an actual neurological disorder.

    So that leaves “antipsychotics”, as far as I can tell the main thing these drugs do is knock people out when they’re very distressed. So in effect, they’re a hardcore sleeping pill. I’ve never heard voices myself so, maybe they do stop voices for some people. For me, hearing voices seems like the only legitimate differing from the average experience that a person might have.

    Not going to mention sleeping tablets and benzos because as far as I know even psychiatrist worth their salt don’t want patients being dependant on them.

    Anyway I pretty much agree with the rest, i’ll just add that it does get a lot easier… and really who knows like other people say it used to be called a nervous breakdown and you just got back on with life.

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    • Hi barrab,
      How do I “really” know that medication helps some people some of the time. I guess I don’t “really” know that. I only know what the people with whom I work tell me and some of those people tell me that the medication has helped them. You can’t see any point in taking an antidepressant and, from my perspective, I feel the same way. Some people, however, do see a point and some people say that it helps them. It’s not the course of action I would choose but I think I need to respect that as a therapist. That’s all I was trying to communicate.
      Tim

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      • This is one of the reasons why the psychopharmaceutical industrial complex is so powerful: it convinces people that they are sick and that the drugs are “medicines”. Of course people think that they feel better when their symptoms are suppressed by drugs. People who go to a bar think that they feel better too after a few drinks. People who do illicit drugs think that they feel better for a while too. With psychotropic drugs, there is temporary comfort in supposing that the drugs are “medicine” and that the “medicine” is remedying some kind of “mental illness.” Unfortunately, most “patients” and “doctors” are completely unaware that psychotropic drugs are not really “medicines,” but powerful chemical compounds capable of inducing psychosis. Therapy might include an honest discussion about what Peter Breggin has written about in his books “Toxic Psychiatry” or “Medication Madness.”

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        • Hi Slaying,
          Psychotropic medications can be dangerous and toxic and their harms have been explained by some brilliant authors. Robert Whitaker’s book is sensational. Some of my other favourite authors are David Healy, Joanna Moncrieff, Ben Goldacre, Peter Gotzsche, and, of course, Peter Breggin.
          In my reply to Barrab I was picking up on the use of the word “really”. How do we “really” know? I’m not sure we do but I don’t think that means we can dismiss it either. I don’t really know that people are being helped by the conversations I have with them but I’m prepared to believe them when they tell me that they find them helpful or when they complete a questionnaire a particular way or when they tell me they’re socialising more or they’ve cut down on their cigarettes or they’re not as angry as they used to be.
          Perhaps I’m naive but, by and large, I tend to believe what people tell me. I may be misreading things but from the words that you’ve typed it seems as though you’re implying that people can think they feel better but they’re not really feeling better. I’m not sure I understand that distinction. Sometimes, after a hectic day at work, I have a glass or two of wine at night at home and I feel a whole lot better. Now do I just think I feel better or do I actually feel better. I don’t know and I don’t really care! When I get a headache and I take a headache tablet I think I feel better and that’s good enough for me.
          I guess the point of my article was just to say that it can be really tough to sort through problems psychologically and some people choose other ways of dealing with things. I think it’s their right to do so. People have to find their own way through the troubles that plague them. Sometimes I can help with that and sometimes other things are what they need at that time.
          Tim

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  6. Thanks Tim! It’s good to see you writing in this forum. I especially liked your paragraph:

    “More and more the health and lifestyle message informs us of a parade of different methods, medicines, and machines for achieving amazing results with minimal effort in almost no time at all. The idea that life can be tough is barely a whisper above the beguiling roar of life as a never ending party where people who are normal are relentlessly chirpy, agreeable, and successful.”

    I’m sure the problem you appear to have with all those chirpy people can be resolved with some kind of pill or other. Please contact your doctor……

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  7. “The implications of thinking about distress from a psychological point of view in terms of personal responsibility and self-determination can also be confronting for some people. At different times and in different situations it can be comforting to think that this is happening to me, it is not anything I am doing to myself. Yet, the idea of ‘doing it to myself’ is exactly the kind of attitude that a psychological approach promotes. Not in a blaming, critical way but in a “master of my own destiny, captain of my own ship” kind of a way. How could it be anything else?”

    I agree wholeheartedly with this. The more we can allow ourselves to take full responsibility for our life experience as that which is our path from which to learn and grow, the more free we become from victimization in any sense of the word. This creates an entirely different perspective and feeling to our experience, a different interpretation of reality, and therefore, a new reality. That’s the kind of internal change that will create external changes.

    This is also the spiritual perspective, referring to healing through spiritual awareness, how our energy works integrally to define and honor our own personal creative process.

    If I am master of my own destiny, then I am master over my entire reality–past, present, and future. We do have that power, but believing it can be so challenging for some. I respect that, although I will admit that being around radically self-responsible people is safer, easier, and more productive, as that is a mind-set of no blame, but entirely of self-empowerment through humility, which in turn, brings peace of mind. There is no sabotage or competition when everyone is totally self-responsible, only unity and co-operation. That’s what I’d like to see, true integration of humanity. We are connected, after all, even to those for whom we don’t particularly care, so we affect each other no matter what.

    Good time to remember the laws of cause-and-effect. In Kabbalah, they say, be the cause, not the effect. That’s awakening to our creativity and control over our life experience.

    “Even though the voices seem like they’re outside my head and even though they don’t sound anything like my voice, they’re still voices that I am generating.”

    Thank you, yes. Whatever we experience in life is the experience we are generating by what focus and perspective we choose to take. There are always options, here, to consider.

    Thanks for this very thought-provoking piece!

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    • Hi Alex,
      I’m really glad the article resonated with you. I love the term “radically self-responsible”. How amazing would the world be if radical self-responsibility was the norm?! I think the ideas of cause and effect are important to keep in mind. The particular story of behavior that I like (Perceptual Control Theory; http://www.pctweb.org) talks about the concept of circular causality rather than linear causality being more appropriate for living things. It’s a very cool idea.
      Tim

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      • Amazing website, Tim, thanks for sharing it. Personally, I think this is key, to own our perception as malleable, and to work with it not only as a healing and personal growth tool, but as a way of defining ourselves intrinsically on a day-to-day basis. After all, change is constant, and if there is one thing we can control at all times, it is where and how we choose to focus, which is what influences our reality more than anything. We are so incredibly creative, more than we give ourselves credit for, I’m sure.

        I say this from my own experience of healing–radical self-responsibility leads to radical healing. It was not until I owned that, on a meta-level, I created all the trauma, abuse, and disability that I had experienced in my life (not at all to self-blame, but as a design to awaken to who I am and what my life and purpose is about), which is what led to my journey through the system, that I was able to harness the power to shift these patterns and define myself as a creator (cause) rather than victim (effect). The result of taking this approach is that not only did my brain heal from the effects of the trauma, but also my entire world changed to one where I feel completely empowered and in control of it, once and for all. As a result, I have peace in my mind and heart, and create life freely as I wish. It was hard work to get there, but worth every awareness and focus exercise I did to uncover my deepest truth.

        I don’t expect others to take this same approach to healing, I know the challenges of this, and many people disagree that we create our own reality. Many think it is thrust upon us, which for me, leads to feelings of powerlessness and frustration, which is why I talk about this other perspective. I think it is way empowering. Personally, I was not going to stop looking for complete and full healing until I found it, and this is where it was, in the house of full ownership.

        Sitting in blame is painful and draining, and causes us only harm. Owning our lives and experiences gives us power over them, and therefore heals feelings of resentment and powerlessness, which only turn on us when we allow them to fester. Hard, hard lessons, but of utmost value, I feel, which is why I share them.

        Thanks again for your inspired perspective. I think you’re on it.

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        • Thanks heaps Alex. The healing journey you describe is very much what MOL tries to help people create. Getting to those meta levels seems to be a key in reorganizing all those problems that are being experienced. As you say, it’s hard work to get there but the benefits are worth the effort. Thanks for sharing your experience.
          Tim

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  8. Re: “Mental illness is an “illness” only in the same way that love-sickness is an illness.”

    Google:

    ‘Thyroid and Mood Disorders’… ‘Diabetes and Depression’… ‘Sleep Apnea and Mental Illness”…just for starters.

    Talk therapy cures none of these.

    I appreciate *some* of what you say, but I caution your profession in its efforts to bite off far more than it can chew. I would say it is wise not to assume anything when working with someone; including ruling out ‘illness’ before somatic symptoms are considered as possibly having ‘real’ meaning – namely, an underlying physical (dare I say) ‘illness’.

    Be well,

    Duane

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  9. From a recent blog post by Bruce Levine, PhD (MIA Author):

    “When Atkins was 21 years old, she developed serious motor skill problems and at times couldn’t walk. Doctors could not figure out what was physically wrong with her, and so they declared that it was “all in her head,” and she was given psychiatric diagnoses such as conversion hysteria. For the next 20 years, her physical symptoms were not taken seriously. Finally, Atkins found a physician who did take her physical symptoms seriously and diagnosed her with a form of Myasthenia Gravis for which she was successfully treated.”

    “But Atkins remains afraid that, given the psychiatric labels that remain in her medical records, she is still vulnerable to once again being stigmatized as a “head case.” Such fear makes Atkins appear mentally ill to those authorities who equate a fear of doctors with paranoia.”

    “Atkins is not alone. I recently consulted with a woman who, after years of misdiagnosis, figured out on her own that her physical and psychological symptoms were caused by pernicious anemia, a physical condition that can be treated with B12 injections, a simple and relatively inexpensive treatment which continues to be successful for her. But her medical records include diagnoses such as “somatic pain” and “somatoform” (which means that symptoms cannot be traced to any physical cause), as well as multiple other psychiatric diagnoses. These psychiatric diagnoses create a great deal of anxiety and anger for her because for any physical problem she may have, many doctors will not attempt to get to the root physiological cause; instead, based on the psychiatric diagnoses in her medical records (that she has so far been unable to have expunged), her physical complaints are dismissed as psychiatric issues. Her fear and anger seem quite reasonable to other people in her situation, but for doctors and even for some of her family members, she appears paranoid.”

    More here:

    http://www.madinamerica.com/2015/04/medical-nemesis-revisited-physician-caused-anger-despair-death/

    And sometimes very *real* neurological issues are present. Finding suppressed trauma is *not* always the answer. More from Bridget Mildon:

    “After trying to uncover hidden or suppressed trauma to no avail and after years of illness, why wouldn’t I question this veneer of authority? Yet, patients like me are routinely told it is they themselves who cannot be trusted. Like me, they are said to be caught up in an illusion of fabricated symptoms crafted from unconscious trauma and their own pretense. They have built their illness out of myths, on a foundation of emotional escape or make believe.”

    More here:

    http://www.madinamerica.com/2015/04/turning-patients-numbers/

    Be well,

    Duane

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    • In fairness, Cognitive Behavioral Therapy has a 13% success rate for Functional Neurological Disorder (aka, Conversion Disorder). Good news for 13%. Not-so-good news for the remaining 87%.

      The *majority* of people diagnosed with FND say they do not experience “conversion – from psychological (trauma) to somatic symptoms.

      Maybe, doctors are simply unable, at this point in time, to determine what is taking place with some of these folks… Maybe psychotherapists ought *not* to assume psychological trauma, any more than psychiatrists.

      Duane

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        • Ah, OK. Got it. Thanks! Yep, I agree – assuming we know what someone is experiencing or what’s wrong with them is a sure-fire way of shutting down the exploration of how they’re travelling. Of course, it’s fine to assume when you get it right but many times we don’t get it right and the people you describe are good examples of that.
          This is yet another problem with the area of psychiatric labels. As you point out, once someone has one of those labels, a lot of their experiences are interpreted from that perspective. I don’t subscribe to the DSM way of thinking about people’s problems so my approach is to listen and question without assuming. As people explain their situation in detail to me they’re explaining it to themselves as well and something very useful seems to happen when people say out loud the things that are bothering them and listen to what they’re describing.
          Thanks for commenting and highlighting the point about the problems with assuming – it’s one of the big barriers to effective (and therapeutic) communication I think.
          Tim

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  10. Tim, I really think you killed it with righteous effect here, and too bad you haven’t got an English-speaking world syndicated self-help column. When you previously talked of the great difference between yourself and other therapists regarding letting the client assume control over the frequency of sessions, presumably in tying this to your view of the importance for your clients of the deepest sense of responsibility for themselves that they can know, I admit that it worried me that you had decided to invite a face off with the worst of bad enemies to have: your colleagues. No worry, now, though. Just one thing of a colloquial nature: I am sure you recognize it as provisional and shorthand to speak of “parts of selves”, since there is no obvious way, strictly speaking, that we could have parts of ourselves. It’s innocuous until it’s taken literally: the most apt “parts” would seem to be your past, present, and future incarnations, while the subpersonal “parts” are surely you through and through: giving you voices, hysteria, tics and jumpiness, and so on. The only reason for stipulating the fact, however, is that your language is very meticulous and not at all distracting in its incredible correctness. Thank you–

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    • Hi again Travailler-vous,
      The reason I mention “parts” is because that is how many people I work with describe their experiences … “one part of me wants to move on but another part of me wants to sort it out with him” … one part of me has a thirst for life but another part of me has a desire for oblivion … and so on.
      Tim

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      • But obviously, Dr. Carey, no problem in that light at all. For all I know, however, you can catch people out confusing themselves sometimes about that. Like for instance, I know it goes nowhere with Freudian theory telling me I come in psychic parts…. So maybe, as with mental illness not existing as such, it’s another winnow for the chaff, as you filter out all the little misnomers and contradictions in talking about problems in living. I wouldn’t question anything about how you handle cases, and think you are truly one of the handful of people who might have had animated (as opposed to somnambulant) responses to me and my problem with the inapplicable label and the disparate and hard to describe abnormal experiencing that indicated traumatization. What I notice in full view in this article are the particulars of how you state your views, for what that implies about the rigor to which you submit your analyses of what problems in living and psychological dysfunctionality are and can be, versus what they can’t. Your method of description and explanation may all be second nature for you, but we do see very little exact appreciation overall of what we are calling the whole range of personal problems that you help people learn to help themselves with. For myself, I would say it was and is obvious that there have to be some brain deficits and brain dsyfunctions to account for in my particular case, for instance, but they just are only as medically serious as lovesickness or terrible yearnings, and so on, and are amenable to achieving better adjustment, per se. Yet, in fact, in this country I was able to work with no one who could so much as intelligently bracket such an observation and carry on to learn something further about me that wasn’t fileable or filed already in pure medspeak. I don’t mean to overstate my appreciation of what you put into the short, basic articles you publish here. They just really could use some company when it comes to the objective attitude about drugs and civic responsibility and questions of mental competence. No matter that the focus is alternative, we see lots of hedging and denial of injustices done…. (Strictness is worth it.) Looking forward to seeing the material you linked. Thank you–

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        • Hi Travailler-vous,
          Yes, people do often confuse themselves in the conversations we have and the confusion can lead to new and helpful insights and perspectives.
          I certainly take your point about how far we have yet to go on a societal level regarding our understanding of drugs and how the brain works. I get the sense that the tide is turning – and websites like Mad in America are a big part of that – but it’s a slow process at the moment and many people still experience the full brunt of a medical approach to psychological distress.
          Tim

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  11. Thanks, Tim, for an inspiring read. I agree with Duane’s proviso that we should be looking for and eliminating real physiological diseases before assuming psychological causes, but that being said, your analysis of the reasons for client resistance are quite on target. One of the great evils of the “medical model” is that it provides what seems like an easy way to avoid looking at what is behind our distress, which seems good in the short run but ends up preventing a more basic solution to our woes. Of course, there are also plenty of non-psychiatric ways to address immediate pain/distress reduction, the most obvious being meditation/mindfulness breathing, but to discover these options requires a much more honest and humble discussion with the client than many professionals are willing to engage in.

    The other barrier you don’t mention, and I really think you ought to, is that many therapists/counselors are extremely limited in their scope of practice. Many these days are trained not to even consider the review of historical trauma as relevant, but to focus entirely on present-time “new thoughts” (CBT) to replace the old “bad thoughts” without any consideration of what service those supposedly “bad thoughts” may have provided in the past. There is also often little discussion of unconscious or subconscious motivation or the effects of present-day harm a person may be experiencing at the hands of an individual or social forces much larger than him/herself. In short, many therapists today have adopted the psychiatric view that the problem/illness lies in the client him/herself, and that the solution is to help the client “adjust” to current reality. This approach has severe limitations, especially when dealing with trauma victims or others experiencing high levels of emotional distress. Naturally, when these therapists fail to have the desired effect, they are encouraged by our system to pass these people on to psychiatrists, because their problems “must have an organic component,” to use one of the common phrases.

    Bottom line, getting quality therapy is about more than just getting it funded, though that is a big barrier. It’s about knowing what quality therapy even is, what it intends to accomplish, and finding someone really capable of delivering it. I was very fortunate to find one on the first try, but that was back in 1982, when psychotherapy was in the ascendency. I think it’s a lot harder today, not only because of social mythology speaking against it, but because many therapists aren’t actually trained to get to the root of a person’s struggles effectively, and clients try it and find it doesn’t really get them what they need.

    —- Steve

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    • I can’t believe I used the term “resistance!” What I mean is a client’s unwillingness to engage in what the therapist thinks will be helpful to them. The term “resistance” kind of blames this on the client, whereas I think it is a sign that the therapist may be barking up the wrong tree and needs to stop deciding what the client needs and instead listen to what it is they are saying they need themselves.

      —- Steve

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      • Ok, so this is where communication gets so tricky here. To me, “resistance” is a totally neutral term–we either resist or we allow. I think it’s important to discern for ourselves when we are in resistance vs when we are open and allowing. I don’t put any judgment at all on these, they just are, and we all experience both states of being.

        These are two distinct states of being which matter when doing healing work. I think resistance is part of any process, and good to tag. I wouldn’t put any more weight on it than this. I often find myself in resistance, and I like to notice it, so that I can explore the resistance if I feel compelled, so that I could be more open. There’s usually an issue, thought, or belief there that is asking for attention, or it just might be a personal choice at that moment, and utilized as inner guidance. That’s the essence of spiritual healing.

        So it occurs to me that when I use this in a sentence, which I often have here as it is a relevant term in healing and dialogue, it would seem that there is a very good chance that you are going to interpret this as blame and judgment. And if that’s the case, then this is a perfect example of speaking two different languages (even though it’s all in English), because your read on what I say would be completely different than what I’m communicating, based on our different interpretations of the word “resistance.”

        I’m highlighting this because when I read what you said about resistance, I realized how differently we interpret this one word, that would make all the difference when attempting to dialogue. Perhaps it would be a resistance-filled dialogue!

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        • Hi Alex,
          You raise a really important point. Words can be used very differently depending on the intent of the person using the word. I agree, “resistance” could be used neutrally, however, I have often seen it used in a pejorative sense in that the client was somehow rejecting the help that was offered. For me, it all gets back to considering the perspective of the person we’re working with.
          Tim

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    • Hi Steve,
      Thanks for your comments. Yes, I definitely agree that physiological problems should be ruled out first. I’m not medically trained though so I rely on my medical colleagues to do that and I assume that if they’re referring a person to me it’s because the physiological aspects have been sorted. Definitely scope of practice can be a real barrier to progress for both the practitioner (from an ethical point of view) and the person accessing the service.
      Tim

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      • Tim,

        Actually as Stephen Gilbert pointed out regarding the young patient who had a hip tumor? which was overlooked by several doctors and got him a referral to a psychiatrist who made things worse, you can’t assume anything about referrals being adequately screened by doctors. Obviously, you are not trained to diagnose hip issues but it seems with careful questioning, you might be able to realize if a patient has been badly treated or not by doctors and perhaps refer them to someone who could help.

        Additionally, screening for sleep disorders is definitely not out of your territory as you can ask questions that may suggest someone should see a sleep specialist. Look at the Epworth screening tool for more information.

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        • Hi AA,
          Where I work in remote Australia we are very limited in being able to refer on to specialists.
          I guess we just have different perspectives on how to work with people experiencing psychological distress. The people I see are all accessing the public mental health service. When they come to see me I ask them questions about the things that are bothering them. Invariably, there are things that are bothering them of a psychological nature: they don’t know who they are; they were abused in their childhood; they can’t decide where their relationship is going; and so on. These are the things we focus on.
          I guess if someone came in and wasn’t bothered or distressed about any psychological conflict or dilemma but had some unexplained pain or sleep problem we might explore options for how that could be investigated but, in my experience, people are pretty good at deciding for themselves what they need and who the best person is to see if they’re given the opportunity to express that. Where I am mental health problems still carry a lot of stigma so coming to see a psychologist isn’t something someone does lightly. I’m sure some people would much rather go to a sleep specialist and have their sleep sorted out than come to a psychologist to sort out their mind.
          This is an important conversation and probably a good indication that we still have a long way to go before we can accurately pin down the nature of someone’s difficulties.
          Tim

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  12. AA,

    Thank you for mentioning sleep disorders. MIA has put up many articles on the connection to sleep disorders and “mental illness”; and IMO, this needs to be at the top of the list.

    I underwent a sleep study recently, where it was determined that I was having several airway obstructions per hour, and was fitted for a dental device, to keep the airway open.
    I have been wearing the device at night for about a month. It has helped greatly with memory, concentration and mood. It has been very helpful, especially with work, where there is often stress, and the need to be at the top of my game.
    Best,
    Duane

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  13. From my experience, pointing out that patients don’t often question the medication prescribed for them is spot on. Over the course of 4 years on a certain antidepressant, I struggled with several suicidal ideations & attempts. No one (not Drs, friends, family, or myself) ever questioned the side effects of what I was taking, even as I made my way into the ER & psychiatric facilities during that time. Instead, I was shamed, belittled, prescribed additional medication, yelled at, ignored, and even had objects thrown at me by medical professionals. By friends & family I was forced to move twice, “out of sight-out of mind”. My “courage, hope, and optimism” turning to ash after decades of psychological treatment failed to reveal some mystical, unconscious source of my symptoms.
    I finally connected the dots with my foggy brain after my last attempt. Knowing this was unlike me, I requested a change in medication on my own. Hopefully, my decision was the right one, as I desperately know I can’t survive much longer on that path. Only time will tell if this fork in the road will lead me to find the balance of living with chronic illness. Clean living isn’t an option for some of us, but knowing when medication is doing more harm than good is imperative for the lives of many patients.

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    • Hi Rhonda_B17,
      Thanks for taking the time to comment. Experiences like the ones you describe are just the kinds of things I had in mind while I was writing the article.
      I’m not sure whether there are some people who aren’t able to take the ‘clean’ option but, for me, the more important issue is how people come to be living the life they’re living. I think why people are taking drugs is perhaps more important than what they’re taking. If they’re informed and are voluntarily using some form of medication because they find it helpful then that seems pretty ideal. It’s a different scenario though when people are not fully informed and have inaccurate and incorrect information about the drugs and their effects or when they’re coerced into taking the medication.
      Unfortunately there are still too many situations like the ones you’ve described.
      Tim

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