Tearing Apart the DSM-5 in Social Work Class

Sascha Altman DuBrul
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I’m currently a student at the Silberman School of Social Work. This was the final paper for “Human Behavior 3.” HB3 is a required class which is basically a crash course in understanding and using the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders). In Human Behavior 1 and 2 they cover all kinds of ideas from psychodynamics to systems theory, and have the students practice writing biopsychosocial evaluations. I’m not sure what it looked like in the past but in recent years HB3 has become a DSM memorization class, so much so that we did most of the 5 week class online with modules that looked like the image I’m posting below. I don’t know what other people’s papers looked like, but here is what I turned in to my professor last week. Thanks so much to all the friends and people in this community who helped me out when I was losing it reading that Abnormal Psychology textbook last month!

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Practice Case Study: “David”
Human Behavior 3
Sascha Altman DuBrul
Silberman School of Social Work

Case Study: “David”

David is a 21 year-old white male who presented at the local mental health clinic with his mother. She initially brought David to see the family’s primary care physician (PCP) with concerns about his increasingly odd behavior, and what she described as changes in his eating and sleeping patterns, hygiene habits, and overall daily routine. She was highly concerned was that David would not eat any food that was prepared by her in the home over the past several days.

David’s mother reported that he is an only child. His parents separated shortly after his birth, and he has always lived with his mother. She reported that he left high school in the 11th grade, following poor academic achievement and poor attendance. He had already been held back one grade but it was increasingly difficult for him to attend school, particularly since he endured teasing by other students. She reported that David had not pursued his GED or vocational training, but enjoyed creative writing. She enrolled him in writing classes at the local community college last year, but David left after he felt that the other students were attempting to sabotage his work by controlling him, his thoughts and his ideas. David has never worked nor does he have any friends. His mother recounted that David always presented differently from his peers but did not elaborate further.

Upon further assessment with David, he reported that he was angry with his mother for brining him to the clinic. He added that his mother has recently tried to harm him and stand in his way. He stated that she is attempting to poison him through the food she prepares. He also believes that she is monitoring his activities and preventing him from writing because she is attempting to interfere with his plan. When asked to elaborate on this plan, David reported that he has been directed by voices to share a message, through his writing, about the presence of outside forces, which are attempting to take over the world. He believes that he has been chosen to spread this message but that there are also voices of “non-supporters” who represent these outside forces. The “non-supporters” are attempting to alter his thoughts and influence his writing, so their threats to the world will not be revealed. David has recently stopped watching television because he believes that the outside forces are able to see him through the television, and also monitor his activities. David did not express fear or worry, and his affect remained flat throughout the session.

Presenting Problems

It is clear from David’s mother’s description that he has been struggling for a number of years with fitting into society (being teased, dropping out of school, never having a job) and that recently his behavior has shifted (unspecified eating and sleeping patterns, hygiene habits, overall daily routine.) By reading David’s narrative it seems obvious that he is experiencing delusions (outside forces attempting to take over the world), hallucinations (multiple conflicting voices he feels are coming from outside of him), and feelings of persecution (feeling his mother is trying to poison him.) We are told he has a “flat affect” when discussing these subjects and is angry about being brought to the clinic.

Case Summary

Common sense would suggest that David is experiencing a “psychotic disorder.” Psychotic disorders involve a loss of being in touch with reality and are characterized by abnormal thinking and sensory processes (Ray, 2015). I am drawn to the “Schizophrenia Spectrum,” section to learn more about the broad category of disorders referred to as psychotic disorders in the DSM-5 and try and diagnose David because of what appear to be the delusions and hallucinations he is describing. According to the DSM-5:

Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms….(APA, 2013, P.87)

I am drawn specifically to the official descriptions of delusions and hallucinations:

Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose). Persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group) are most common… Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, wealth, or fame)…are also seen.” (APA, 2013, P.87)

David appears to be exhibiting “grandiose, persecutory delusions” that his mother is trying to poison him, that he has a mission to save the world, and that the outside forces are able to see him through the television and monitor his activities. Our initial assessment seems to fit with this first criteria. Furthermore, according to the DSM-5:

Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts. (APA, 2013, P.87)

David reports that he has been directed by voices to share a message, through his writing, about the presence of outside forces, which are attempting to take over the world. He also describes a rich inner world of conflicting voices (“supporters” and “non-supporters”) that appear in the form of voices inside his head. This is a potential second criteria for a schizophrenia diagnosis. There are a few options for diagnosis that the DSM-5 provides including schizotypal personality disorder, schizoaffective disorder, schizophrenia, and brief psychotic disorder. David appears to potentially fit the description for someone with schizotypal personality disorder:

“The diagnosis schizotypal personality disorder captures a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships; cognitive or perceptual distortions; and eccentricities of behavior, usually beginning by early adulthood but in some cases first becoming apparent in childhood and adolescence.” (APA, 2013, P.90)

On the other hand, since we have only encountered him for a short period, brief psychotic disorder might be an appropriate diagnosis as it lasts more than 1 day and remits by 1 month (APA, 2013, P.94)

Some other potential options are schizophreniform disorder, which is characterized by a symptomatic presentation equivalent to that of schizophrenia except for its duration (less than 6 months) and the absence of a requirement for a decline in functioning. Or schizoaffective disorder, in which a mood episode and the active-phase symptoms of schizophrenia occur together and were preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms. In this initial assessment we do not see evidence of a mood disorder. Actual Schizophrenia lasts for at least 6 months and includes at least 1 month of active-phase symptoms, therefore it would take half a year before we would be able to give a conclusive diagnosis. (APA, 2013, P.96)

Other Puzzle Pieces and Questions to Ask

In order to understand the deeper layers of this story, it is significant that David is an only child, that his parents separated shortly after his birth, and that he has always lived with his mother. It would be very important to understand what kind of relationship he has, if any, with his father. It is obviously important that David endured teasing by other students. It is significant that he left high school in the 11th grade, following poor academic achievement and poor attendance. It is important to note that this reporting comes from his mother, we don’t known any back story from David’s perspective.

Some immediate questions I would ask David: how long has it been since he’s eaten? Since he’s slept? I would assess if there were any chance he’s been using street drugs. If I were talking to David directly I would want to assess his ability to focus on the present moment, ordinary topics, humor, his willingness to explore how others might perceive his ideas. More than anything, I would want to be clear that he was safe: is he thinking of hurting himself or others?

 

Psychosis as Teacher

All of that said, from the perspective of clinicians such as John Weir Perry, Michael Cornwall, and Arnold Mindell, any DSM diagnosis in the schizophrenia category is at best meaningless, and at worst, harmful, in being of service to people who struggle with what is considered psychosis.

According to psychotherapists like Perry and Cornwall, the key to working with David would be to begin by establishing a trusting connection with him so that “the painful emotion that is being metaphorically expressed via attributions of persecution, that have their genesis in early trauma, can start to emerge, be named by him, expressed directly, and integrated.” (Cornwall, M., personal communication. June 20, 2015.) It would involve way more than a few sessions with someone looking at a diagnostic manual for guidance. In fact, I believe this type of therapy, to be done well, must be practiced by someone who has a lot of life experience and a lot of compassion and desire to “travel” into the world of someone else’s shadows (Perry, 1974). There is so much rich material to explore from a metaphorical perspective, from David’s fears of being poisoned by his mother to his feelings that he has an important mission to save the world. David clearly needs allies and others to talk to who have been through similar situations and can relate to the complexities of his experience.

From this perspective, what we are calling psychosis is basically the psyche’s natural attempt to experience and express emotion that the person isn’t yet prepared to experience, identify and express. It is a calling from deep within a person for change and growth. This is a powerful reformulation of the disease model into something that looks more like a wounded healer model (Mitchell-Brody, 2007).

Arnold’s Mindell’s (1988) Process Oriented Psychology also sees psychosis as a potentially healing force. Mindell has developed a complex methodology for revealing the deeper meaning of bodily processes: feelings, pains, habitual gestures, even chronic illnesses. Whereas some therapies attempt to eliminate these processes, especially the ones considered negative or undesirable, Mindell’s approach is to amplify and follow them until they reveal what he sees as their hidden messages. Process Oriented Psychology uses the language of “extreme states” rather than “psychosis” (Williams, 2014). In Mindell’s view, psychosis is a term based upon the paradigm of pathology. “Extreme state” on the other hand is relativistic; it is neither good nor bad but simply says that someone’s experience is unusual relative to his world.

Working with David as a client would involve developing a relationship over time, paying very close attention to his speech patterns looking for “primary and secondary processes” (Mindell, 1992), and helping him feel understood and seen. I would be very interested in his writing and want to encourage him to express himself, get in touch with his dreams, all of his different inner voices, and give him inspiration and space to be creative with his thoughts and ideas. Using the Internal Family Systems model (Schwartz, 1997) I would attempt to teach him a meditation practice to get in touch with his inner Self, learn to see his voices as Exiles, Managers, and Firefighters and initiate a process of inner growth and development where his voices might become his teachers and guides.

Peer Support

While he spoke of outside forces being able to monitor him through the television and fear that his mother was trying to poison him, I was way more concerned to learn that David doesn’t feel like he has any friends. There are many people in our society who don’t have a peer support network, and the ability to connect to others is a key piece of healing and growth. Having others to share what are considered by society to be unusual and “psychotic” experiences can help enormously with feelings of isolation and stigma.

Two recommendations I would offer to David would be the peer-support community on The Icarus Project (DuBrul, 2014) website and its associated Facebook group. The Icarus Project offers a non-pathologizing frame for conditions that are often considered “mental illness”, specifically psychotic conditions. There are forums with names like “Experiencing “Madness” and “Extreme States”” or “Alternate Dimensions or Psychotic Delusions?” where many people like David have written extensively about their experiences and beliefs and can give feedback to one another. http://theicarusproject.net/ Online communication has many advantages for people who have issues with being social, and is a good first step in breaking out of the isolation that comes from struggling with what is often considered to be mental illness (Naslund, 2014).

Another option for David would be to attend a Healing Voices Support Group. The Hearing Voices Network, which began in Europe in the 1980s (Romme, 1992) is a collaboration “between professionals, people with lived experience, and their families to develop an alternative approach to coping with emotional distress that is empowering and useful to people, and does not start from the assumption that they have a chronic illness.”

At a Hearing Voices Support Group David would find others who also have experiences of voice hearing and it might help to normalize his experience and find enough common ground to make friends. http://www.hearingvoicesusa.org/

CBT For Psychosis

I’ve recently learned about the ways some of my colleagues are using a technique known as CBT For Psychosis to help people like David. The following text is taken from an introductory sheet about the process by Ron Unger LCSW (2014) and the points seem very relevant to our situation with David:

Normalizing: rather than identifying psychotic experiences as categorically different from “sane” experiences, focus on the continuum of human experiences, and notice the connections between psychotic experiences and more conventional ones. Explain to clients that in distressing or overwhelming situations, it is normal for unusual experiences to occur.

Therapist self disclosure is an important part of this type of therapy. Disclosing your own less normal experiences helps your client see the continuity between their own experience and yours. You are not saying that your own experience is the same as theirs, only that there are understandable connections and similarities.

A formulation is a way of understanding how the psychosis came about and what maintains it. In developing a formulation, you collaborate with the client in assembling a story that shows how the client’s psychotic experiences naturally came about as a result of the client’s history, which includes events intertwined with coping attempts and interpretations of experiences. The formulation should be condensed, such as one diagram or a written paragraph. But it can also be very inclusive, including predisposing, precipitating, perpetuating, and also protective factors, allowing for a clear understanding of what happened and of what is happening. It may change with time as you learn more.

http://recoveryfromschizophrenia.org/cbt-for-psychosis-trauma-psychosis-handouts/

Conclusion: Narrative Humility and the “Ethical Demand For Competence”

Given the little information we have, it is not clear to me that it is useful to try and draw any diagnostic conclusions about David’s behavior from this initial case study. According to Sayantani DasGupta (2004) from the Narrative Medicine program at Columbia University:

Narrative humility acknowledges that our patients’ stories are not objects that we can comprehend or master, but rather dynamic entities that we can approach and engage with, while simultaneously remaining open to their ambiguity and contradiction, and engaging in constant self-evaluation and self-critique about issues such as our own role in the story, our expectations of the story, our responsibilities to the story, and our identifications with the story—how the story attracts or repels us because it reminds us of any number of personal stories.

It feels very important in cases like that of David that we do not see him as an object, but as a subject, and that two interacting subjects (the client and the clinician) cannot act together unless some kind of mutuality between them has been established. This becomes very challenging when the clinician relates to the client as someone with a biological brain disease (Read, 2006).

There are questions from many very intelligent people (Lewis, 2006) (Whitaker, 2011) (Cooke, 2014) about the entire concept of “schizophrenia” and whether the current diagnosis actually has anything useful to add to clinical practice concerned with what is now considered severe mental illness. According to Polland & Caplan (2004):

The building of a narrow, pathology-oriented database poorly equips the clinician to understand what is wrong and what sorts of causal processes are in play in the person’s world or the clinical setting. In addition, an impoverished, pathology-oriented body of information fails to provide the basis for an adequate understanding of the person, their life, their goals, and their values.

I strongly agree with this statement, and as someone who has my own experiences being “treated” in the mental health system I feel that it is our duty as social workers to train and be trained as best as we possibly can to treat our clients not only with the personal respect that they deserve, but with an over arching world view that doesn’t begin by pathologizing their behavior as potential diseases and disorders. Part of my required reading for Human Behavior 3 was an essay by Lyter & Lyter (2012) entitled Diagnostic and Statistical Manual For Mental Disorders: Making it Work For Social Work, which spoke about the “ethical demands for competence” necessary for social workers. From the authors’ perspective, this meant using the DSM with “care and accuracy” (P.54), but from my perspective as a young clinician, competence means paying close attention to my own feelings, paying close attention to the internal world of my client, understanding the relationship between us, paying very close attention to as many factors as possible, and holding a space of love and understanding as much as possible. The DSM-5 cannot teach that. My Abnormal Psychology textbook cannot teach that. I think we do an incredibly disservice to the entire field of social work by placing so much emphasis on diagnosis.

References:

Adame, A. L. (2013). “There Needs to be a Place in Society for Madness”: The Psychiatric Survivor Movement and New Directions in Mental Health Care. Journal of Humanistic Psychology, 0022167813510207.

American Psychiatric Association (2014). Desk Reference Guide to the Diagnostic Criteria from DSM 5 (paperback) Washington, D.C.: APA.

DasGupta, S., & Charon, R. (2004). Personal illness narratives: using reflective writing to teach empathy. Academic Medicine79(4), 351-356.

DuBrul, S. A. (2014). The Icarus Project: A Counter Narrative for Psychic Diversity. Journal of Medical Humanities35(3), 257-271.

Network, H. V. (2010). Hearing voices network.

Lewis, B. (2006). Moving beyond Prozac, DSM, and the new psychiatry: The birth of postpsychiatry. University of Michigan Press.

Lyter, S. C., Lyter, L.L., (2012). Diagnostic and Statistical Manual of mental disorders: Making it work for social work. The International Journal of Interdisciplinary Social Sciences 6(6), 53-6.

Mindell, A. (1988). City shadows: psychological interventions in psychiatry. Taylor & Francis.

Mindell, A., & Mindell, A. (1992). Riding the horse backwards: Process work in theory and practice. Arkana.

Mitchell-Brody, M. (2007). The Icarus Project: Dangerous gifts, iridescent visions and mad community. Alternatives beyond psychiatry, 137-145.

Naslund, J. A., Grande, S. W., Aschbrenner, K. A., & Elwyn, G. (2014). Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube.

Perry, J. W. (1974). The far side of madness. Spring Publications.

Poland, J., & Caplan, P. J. (2004). The deep structure of bias in psychiatric diagnosis. Bias in psychiatric diagnosis, 9-23.

Ray, W. J. (2015). Abnormal psychology. New York: Sage Publications.

Read, J., Haslam, N., Sayce, L., & Davies, E. (2006). Prejudice and schizophrenia: a review of the ‘mental illness is an illness like any other’approach. Acta Psychiatrica Scandinavica114(5), 303-318.

Romme, M. A., Honig, A., Noorthoorn, E. O., & Escher, A. D. (1992). Coping with hearing voices: an emancipatory approach. The British Journal of Psychiatry161(1), 99-103.

Schwartz, R. C. (1997). Internal family systems therapy. Guilford Press.

Unger, Ron. CBT for Psychosis Handouts. Retrieved from:

http://recoveryfromschizophrenia.org/cbt-for-psychosis-trauma-psychosis-handouts/

Whitaker, R. (2011). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. Broadway.

Williams, P. (2014). Rethinking madness: Towards a paradigm shift in our understanding and treatment of psychosis. Sky’s Edge Publishing.

29 COMMENTS

  1. I look at it from another viewpoint.

    If you were David and you read your medical files and saw this written about you, would you feel threatened, would you trust your parent, would you trust the person who wrote it to care for you? Or, would you walk away devastated and betrayed never to try again.

    The analytical approach loses the humanity that those in emotional distress need so very much.

  2. You’re so right about concretized diagnoses doing a disservice to most people. I think your instincts are well taken and encourage you to keep thinking along the lines you already are regarding the DSM..

    It’s shocking how arbitrary and silly the DSM criteria are. Why should 2 weeks, or 1 month, or 6 months, mark the division between “Brief Psychotic Episode” or “Schoaffective” or “Schizophrenic”? Why can 2 people be “schizophrenic” yet have no symptoms in common? (2 out of 5 DSM symptoms) Does anyone think people’s emotional distress really operates like this? It’s just bulls–t.

    Emotional distress occurs along a continuum, is individualized to the person’s unique history of relationships and subjective emotional experience from the day they were born, varies from day to day and minute to minute, and cannot be meaningfully captured by these concretized schizo-fictions.

    Probably the best thing that could happen to this “David” would be if were never diagnosed, never medicated, and never came into contact with a psychiatrist at all. This would be most likely in a poor country. As soon as he gets into our “advanced” psychiatric system, his chances of feeling better are likely to go down, while the profits of Big Pharma and the psychiatrist go up.

  3. Bravo. Thank you for for going against the grain of modern social work. Most social workers knuckle under to biological psychiatry’s orthodoxy. Social work is supposedly distinguished by its “person in environment” approach to emotional and mental issues; its embrace of DSM is a massive betrayal of that crucial perspective. You have done a wonderful job of exposing that betrayal.

  4. My only experience with social workers (and I have zero recollection of such, since I’d been put on a hypnotic drug prior to meeting the social worker), other than one school social worker later wanting to stigmatize and medicate my child because he overcame child abuse that occurred at a young age. And surprised his school system by getting in the top 1% on his state standardized tests by eighth grade.

    Is social workers are expected to be in the business of covering up easily recognized iatrogenesis by doctors by medically unnecessarily shipping innocent people who’d dealt with prior iatrogenesis to evil doctors like V R Kuchipudi. Here’s his arrest warrant for having lots of patients medically unnecessarily shipped to him, “snowing” patients,” then performing unneeded surgeries on patients for profit.

    http://www.justice.gov/usao/iln/pr/chicago/2013/pr0416_01a.pdf

    The illogical, unchecked by our current society ‘delusions of grandeur’ based, caste system currently working within our medical community is absolutely turning the social workers into patsies for the incompetent doctors. The US was founded upon the belief that ‘all are created as equal.’ The US medical community, and their medical caste system, has seemingly forgotten this reality.

    And, today’s medical community in the US was seemingly educated by the Nazi eugenicists from Germany, which most humans know was an inappropriate belief system, except apparently the medical community did not choose to acknowledge this reality.

    I hope the social workers wake up and realize today’s fraudulent eugenics based DSM “mental illnesses” are nothing more than insidious iatrogenic illness creation, via misdiagnoses of ADRs and withdrawal symptoms of psychiatry’s supposed cures.

      • And the bipolar? Yeah only took 8 weeks on medication, to go manic, and of course, then told(No its not the medication, hohoh, it doesn’t do that), you are now bipolar (Yeah I was 35, suddenly bipolar?)……. Yes, the truth, I had serotonin syndrome….. all clear in hindsight. I now think psychiatrists are true witch doctors, now imagine if I told them that!

    • The illogical, unchecked by our current society ‘delusions of grandeur’ based, caste system. This system only seems to exist when doctors put themselves on a pedestal. The psychiatrists I have met? Even damn worse, and for people who have been abused, ie the gentlest ones in our society, become victims of this horrific system…… Yes the delusions of grandeur of Psychiatrists, is disgusting. The DSM V, shows this ………. no physical way of diagnosis, so they are so grandiose, they can make up their own diagnosis, label us, medicated us, and send us crazy (thus proving their diagnosis???).
      Yes, the first question should be to ask the patient, “what are you on, what have you been on previously” In my case one damn valium, let to 8 years of Effexor, ( oh valium doesn’t cause that! hohoh!) YES IT DOESN, IN ME! Hoping one day to get back to how my mind was, that day, before taking that one damn valium. My loss of everything in 8 years, I will never get back.

  5. Please see the article on the DSM-V written by myself and Jeff Lacasse published in Families in Society. It’s available for download from scholarworks. Google “Littrell and Scholarworks” and it will come right up. I wonder why given that the federal government has abandoned the DSM, schools of social work continue to pay homage. Also, check out my website “littrellsneuroscienceofwellbeing.org”

  6. regarding the Case Study: “David”
    Yes his mother is attempting to control him, that is what mothers/fathers do.

    The adult child named David needs to be separated from their parent before violence ( stemming from “who is in power?”) occurs.

    David apparently does not know the world runs on money and he is expected to earn it when he reaches an adult age.”directed by voices to share a message”

    From the description it seems Davids mother has made him crazy over the years. “David has recently stopped watching television because he believes that the outside forces are able to see him through the television, and also monitor his activities.”

    It took many years to make David crazy, it will take years to make him un-crazy.

    The pharmaceutical companies will profit for many years from selling drugs to control Davids behaviour.

    David , having limited social skills, will have to have people paid (social worker) to converse with him (for David to stay somewhat sane).

    What does David want? “Working with David as a client” Bullshit. “At a Hearing Voices Support Group” Bullshit.I doubt he wants that.
    Encouraging “voices” to be external is some crazy advice.

    Someone has to be direct with David and tell him what is going on in plain language. Tell him the truth.

    If you put thieves together in jail, you get thieves that teach each other to become better thieves.

    If you put crazy people together, sharing crazy ideas, you get them off the street, which is what everyone (making money) wants.

  7. Can I ask Sascha, why did the possibility that the ‘symptoms’ of Davids illness may be being caused by the poison being administered without his knowledge by his mother not enter the equation?

    I know that my wife administering benzos without my knowledge was seen as being psychosis and bi polar disorder, that required further drugging with benzos.

    Would we see the same symptoms if he was being poisoned without his knowledge?

    Regards
    Boans

    • The difference between me being delusional about being drugged, and not being mentally ill is a simple matter of a fact. The documents demonstrate that I was ‘spiked’ with benzos. Hide that evidence, and I am seen as delusional.

      David gets gals lighted at school by bullies, mum sees the resulting problems and hears from the ladies at the bridge club that XXX drug works well, slip a few into his dinner and watch for the results. Embarrassed by the failure and increasingly bizarre behaviours, David is taken to a clinic, where Docs are not informed of the poisoning, and diagnose ??? that requires which drugs?

      Have him blood tested.

    • Good point Xspecialed (I just love crank yankers lol).

      My thinking on the possibility of David being drugged without his knowledge is this. David, despite suspicions about his state of mind, knows his body. If his mother were ‘medicating’ without his knowledge, he would notice things that may not be verbalised during assessment. For example, 1 hour after dinner he usually sits down to watch television. As the drugging kicks in, he starts experiencing strange thoughts, on being messages from the tv.

      It may be that among those supposed ‘symptoms’ there is a truth, which if overlooked, could be disastrous for his health and future path.

      Love the t shirt too Sascha. I went to school not far from where they started their career. M4o motorway, near the Portobello Rd.

  8. Sascha – I sincerely hope things are working out ok for you at school, because the field of mental health desperately needs people like you to get professional degrees and work on changing the current generally deplorable scene, instead of just sitting back and complaining about it. And I do admire you for jumping right in and advancing your ideas from the get-go.

    However (and I speak from experience here) if you find yourself in danger of being expelled by the august body you have gone to for instruction and enlightenment, I hope you have the guts and intelligence to moderate your feelings and ideas enough to get to your goal of an advanced degree, otherwise known as a job ticket. If it comes down to the wire and you have to choose between integrity and lying (or at least refraining from speaking truth to power), then please for the sake of us all, lie without compunction. You MUST have the degree/degrees to be taken seriously and effect change in the future. And your success in graduate school will make you a shining example to others following you. All this before you even get started on a professional career, where I and many others expect great things of you. Don’t disappoint us!

    I sincerely hope I’m exaggerating the possible problems awaiting you. If so, then professional education has come a long long way.

    With much respect and affection,
    Mary S Newton, PhD

    • I second what you say. Sascha needs to lie like a rug and seem to conform if they come after him for not being compliant enough in his studies. We need good people like him with advanced degrees because no one pays any attention to the average Joe on the street when Joe speaks out against something. Letters behind one’s name mean everything these days.

      • You know I used to think that an education was something that no matter what, no one could take away from me. The I came across a “mental health intervention”. Drugged without my knowledge, snatched from my bed by police, and locked in a mental institution for no other reason that being the victim of domestic abuse, they were going to inject me with brain damaging chemicals within the hour.

        Not even my education is safe.

    • I beg to disagree. The mental illness industry is a growth industry that is growing by leaps and bounds. Mental health professionals are as much in need of treatment for this bogus disease industry as are their clients. One very effective form of treatment is the pink slip.

      When much of the problem with this industry today concerns the drugs which this industry dishes out with such abandon, we hardly need to get more people involved in this pill pushing business. Getting them off drugs, well, that’s something else.

      • Yes, but who pays social workers? Public health and welfare systems do. He who pays the piper calls the tune. Okay, it was forty years ago, but my friend was asked to leave her Master’s of Social Work Program at a prestigious university just weeks before graduating because it was said that she “identified too much with her clients.”

    • Yes, Mary, I see your thinking here. Sascha, an example came to my mind. A man by the name of Mark Epstein, MD may be one to read. He is a psychiatrist, however, the struggle to “hide” his views for many years is paying off. In the social work area you actually have more leeway, but peer pressure to not rock the boat is still there.

      Personally, I have been told repeatedly by the therapist that her only job was to remind & convince me the only help for me was medication. In addition, I have had therapist deny working with me as soon as they heard the “Schizo-Affective” diagnosis. Now, I see the same closed minded stamp of “your life is over” being put on my now 21 year old. (Even my therapist was shocked they wrote him off as schizophrenic at age of 16. Neither the parents, nor health professionals knew of family history.) I felt pressured to give him up for adoption when he was 8, thus I am limited as to what I can do.

      You inspire and motivate me to do my part in bringing light to a dark, ignorant people. It takes both the victim and perpetrator seeking a better way to make a change. As MLK, jr said “The community must heal.”

      t

  9. I believe the biopsychiatrists would assure us that “David” in the case study is suffering from defective genes, a chemical imbalance, and/or brain disease for which there is no precise cure. Fortunately, they would further have us believe, there are dozens of marvelous drugs, ECT, and other effective treatments that will “stabilize” this unfortunate young man. David would then be subjected to all sorts of brain-numbing chemicals and procedures for the remainder of his life.

    However, just from my readings of MIA and a psychology 101 course I took 35 years ago, I would suggest that David was in severe emotional crisis because many of his most basic needs were not being met.

    A 21-year-old young man who has no friends, no social life, no job, dropped out of school, a history of being teased, etc., would likely feel miserable, hopeless, marginalized, defeated, irate, anxious, etc. How could he live like that? What purpose would he have to even get up in the mornings?

    As David’s abysmal situation continued, he would become more and more physically, psychologically, and emotionally exhausted and ill. The delusions, hallucinations, paranoia, and other symptoms he’s manifesting are last-ditch coping mechanisms for him to try to tolerate his wretched life.

    I think for David’s mental health to improve, his present life circumstances and future prospects need much changing for the better, starting with the alternative treatments the author suggests in the article. I believe David would stay stuck where he is or decline even further if he goes down the biopsychiatric path of lifelong drugging and other toxic treatments.

  10. Over all, I like the direction you are heading. The holistic (whole person) approach is one I am seeing must be explored in all health professions. Yes, it takes more time, money, and other resources. Isn’t it just as simple as what Weight Watchers has been trying to teach, though. “You didn’t get over-weight over night, it’s not going to come off over night.”

    It certainly does take two to tango, though. Many patients, the mad included, desire a quick fix. I feel that the professionals must do as a loving parent does, say “No”. Naturally, when a child is hungry and tired she wants candy to quickly squelch those painful feelings. It takes tremendous effort for the parent to prepare a meal and “force” the child to go to sleep.

    • “Force” isn’t exactly a word that is person driven. Medication doesn’t have to be involved for a professional to attempt to manipulate an individual. It may be less physically damaging to approach it without medication, but no less disempowering to insist that the individual “should” look at aspects of their life that may be less than relevent. (I know when I was getting well if I had one more discussion about mindfulness I was going to take a bridge. It’s a powerful tool, but I was more suited to action and so many people were on the non-traditional bandwagon that it was all I heard about in this false either/or. Either valium or meditation. No other option.)

  11. Actually, I believe that is is problem with social workers who work with clients. No where in this material did I see anything positive about this person, in terms of his strengths.

    My own experience with social workers is that they should not do therapy or counseling with anyone Because they lack an understanding of suffering, because they they themselves have never usually been the recipient of treatment.

    The principal reason the DSM was reformed was to make it easier for the insurance companies to process billings, and to dispense with clinical information that is considered unnecessary by them, since people only need to be put on drugs.

    I dislike educational settings, because there is a fundamental shift from feelings to head orientation, and this inevitably leads to devaluing the patients experiences, and a focusing instead on head oriented valuations, at the expense of people.

    They don’t write books about what makes people healthy and well, so people always come up short in this kind of situation.