I was recently surfing the internet and came across an Etsy ad selling a lobotomy tool set – hammer and orbitoclast. I was tempted to make the purchase and indulge my penchant for this historical “apparatus” especially given its rise as heroic1 therapeutic intervention for three decades. It was a mere $168.00. Let me refresh your memory – lobotomies emerged as a treatment from 1936 until 1967. It was a psychiatric procedure that involved rendering a patient unconscious usually via electroshock then strategically drilling holes into the patient’s skull to access and cut nerves of the brain thought to be the areas that would cure the symptoms of psychiatric disorder.
Although I didn’t buy the historical torture device, that ad left me with one penetrating realization: psychiatry is here to stay. While psychiatry no longer performs lobotomies, and psychiatric practices have changed, the actual profession and discipline forges on despite its troubled past and my hunch is that it will continue to do so. In close constellation with other affiliated professions, (for example, social workers, occupational therapists, dieticians, psychologists, nurses, pharmacists, lawyers and now peer support workers) the field is not at all phased by the current onslaught of modern critique. The New York Times recently published an essay entitled, “Psychiatry’s Identity Crisis,”2 and in April of this year, the current editor-in-chief of the Lancet (one of the most well respected peer-reviewed medical journals), Richard Horton, proclaimed that a lot of published research is unreliable if not completely false.3
There are continued disputes about industry bias over clinical trials and the print media is often writing about problems of over prescribing medications for “people whose problems are close to normal.”4 Nevertheless, I suspect that the next ten years new PR efforts will be launched in order to socially market mental health treatments to citizens and continued attempts to encourage medical students into a psychiatric career will grow. Psychiatry will not be slowed down by all the sordid scandal. Western psychiatry is expanding into the global south, into the military, schools and rural communities. Technological interventions such as e-health only to serve to facilitate more access to mental health discourse, monitoring and treatments. Recently, Thomas Insel stepped down from his role as Director of the U.S. National Institute of Mental Health to join Google Life Sciences (one of the subsidiaries of the big conglomerate Alphabet Inc.) In his blog of August 2015, Insel wrote:
“As genomics, imaging, and large health care studies generate terabytes of data daily, companies that know how to extract knowledge from data have become essential partners for progress towards new diagnostics and therapeutics.”5
Today you can now download a variety of mental health apps onto your smart phone. More than that, biology is a much less isolated, siloed and is increasingly merged with disciplines such as sociology and law, for example, via new discussions about the role and the importance of social interaction in brain development and further in the study of epigenetics or with law in the development of “neurolaw” aiming to makes sense of the brain’s role in crime and delinquency. Biology is social.6
So, given psychiatry is here to stay, I beckon the question: Should consumer/survivors assist psychiatrists become better psychiatrists? What of the potential implications and pitfalls of such dangerous engagements? What dangers exist in not stepping in to participate in discussions and policy change? Given that the entire history of inpatient treatment has precisely changed because survivors spoke up to reform the practices, it makes it difficult to argue for abolition particularly since there is very little in terms of an implementable “Plan B” ready to be executed that speaks to the very complex issues in the lives of extremely marginalised people.
Presently, in Toronto (Canada) there are approximately 37 new students each year entering the residency program (called psychiatric residents)7 at the University of Toronto which takes us to about 190 new psychiatrists after five years and upon graduation. According to the Canadian Psychiatric Association, there are a total of 4770 psychiatrists in Canada.8 Given that consumers/survivors have historically argued and fought for inclusion, participation and a desired “seat at the table” in order to influence and inform processes, I offer below an example of one such attempt in Toronto, Ontario, Canada to modify the current practice of psychiatry. While attempts at psychiatric reform are nothing new, I want to query how peers/consumers/psychiatric survivors etc. in this latest exercise understand or imagine such change might be defined, let alone envisioned and rolled out.
“Patients as Teachers”
In the province of Ontario, Canada, a fairly recent initiative where consumer/psychiatric survivors are “advisors” to psychiatry residents in their fourth year of study is getting a lot of praise and attention both by psychiatric institutions and a bit of media. The program entitled, “From Surviving to Advising” or more delightfully, “Patients as Teachers” is meant to provide opportunities for residents to interact “intentionally” with “people who have recovered and, are recovering successfully from mental health and addiction issues.”9 It’s also meant to foster opportunities for residents to learn about “lived experience” in an atmosphere that is “free from the constraints imposed by the doctor-patient relationship.”10 In this initiative residents are permitted to bring forward clinical dilemmas they are experiencing with hospital in-patients (anonymously to protect privacy). These dilemmas and other topics can be discussed one on one with patient teachers in order to get feedback or advice. This initiative which began as a research project is currently evolving towards potentially becoming an embedded piece of training for all residents. The “how” and “what” of this inclusion is still embryonic.
Through this project, the residents work with former service users who are in “advanced stages of recovery” (a requirement for participating as an advisor or teacher). I am perplexed about the meaning and assumptions laden in that statement. Does it mean that only service users who are “well” and no longer experiencing struggles or distress can teach, speak or be taken seriously? How recovered must you be? What if you are too “recovered” and asking questions that move well beyond the recovery paradigm and begin to poke around into the colossal structural challenges for mental health clients both in and outside of psychiatry? What is the nature and boundary of this “voice” of an advanced stage of recovery? Is “recovery” being used as a term to replace conversations about “skills”? If one only singularly speaks about “improving on one’s recovery” as opposed to “improving skills,” then how does a patient ever hope to move away from the tautology that is the recovery self-narrative?
There are of course other questions and challenges such as how payment for this labour should be privileged and for whom. Since the focus is on the recovered self, the piece about skill set is not articulated and why would it be – the discussion could inevitably open a can of worms about employment equity and standards. In the long term, how should these patient teachers be situated – are they part of faculty? Do they have to go to school to become “patient teachers” or, are they patient teachers by virtue of having had mental health issues? What kind of mental health issues qualify? Are we to assume that just because someone has “lived experience” they are a good “teacher?” What values and principles and teaching styles will be moved forward and which ones will be left behind in the name of creating “safe comfortable spaces” for resident learning?
Mad in America blogger Sera Davidow and others have begun to pose important questions about the tensions and quandaries that arise from essentialist assumptions about service users or “peers” in the system.11 I have at various points also flagged the ethical snags with not only the depoliticised peer model as it is evolving, but also the way patients are leveraged through the use of their personal mental health narratives as a device for eliciting interest, attention and empathy from professionals.12 When I have tried to offer critiques about peer co-optation I am often relegated into a trepanation hole of no return. My criticisms are not at all targeted towards any specific “patient teacher” but instead at the underlying assumptions built into this initiative and ones like it that continue to obfuscate the overall larger challenges and meta narratives operating within psychiatry.
First, the assumption that power is somehow equalized in these exchanges that are deemed to be outside of the more formalized clinical spaces is, in my view, delusional. Yes, when not at the mercy of the rules, texts, policies, and the rigid regulations of a psychiatric unit, there is less pressure to fall into the “patient-doctor” role as we have historically understood it. However, this project is still driven and controlled primarily by (well meaning) psychiatrists and not any consumer/survivor organisation with an accountability structure and identity. Thus far, it does not seem to address the status or standpoint each individual brings to the table (such as privilege, race, disability etc.) and whether this project caters to anything outside of individualized dialogical exchange as opposed to a collective politicised one. There is perhaps not enough attention paid to the new kind of dynamic reproduced in this work: one of the residents compelled to interact with a patient teacher, and try as they might, consumer/survivors in this context can never disentangle themselves from identity inferences of former patienthood. Thus, the old binary of doctor and patient is not gone – it’s been merely turned into doctor and “recovered patient”. Which leads me to my final point.
My primary reservation has to do with the ways in which these individualized encounters prevent collective organizing and political solidarity between the consumer/survivors and ultimately, including the residents themselves. When I hear about efforts to make system change via that swag-less cliché, “hearts and minds” – skepticism creeps up into my frontal lobe. You see, it’s all a bit too…. convivial. Friendly attachments, minimal discomforts and what Sarah Ahmed has called the development of “happy objects”13 whereby all altruistic feelings can be driven into the assumption that everyone is aligned and equal. Past wrongs can be overlooked amongst these new “friends.” When and where there is in-depth acknowledgement of the serious problems within the field is a mystery and I would reckon it’s an important point given this initiative is essentially meant to be a remedy for the failures of the current mental health system despite self-promoting campaigns claiming the inverse. So failures, disappointments, current indignities of psychiatry remain all but sequestered; there appears to be no evidence or frame for how to teach residents to “unlearn” their power and privilege. And there most definitely appears to be no commitment to build capacity and independence for consumer/survivor organisations to build a business or a facility of their own.
For those few psychiatrists I have met and who constantly reflect on these tensions, I am grateful and for those consumer/survivors trying to earn a living – yes of course, I get it. I do not mean to diminish the complexity of system change or, of madness itself and recognise that solutions must mean more than platitudinous attacks. But, if there is one thing we have all learned from the past and from the wild optimism that can be conjured for new interventions, whether lobotomies or, “patient as teachers”… is that sometimes what appears revolutionary is not so much.
* * * * *
Endnotes:
- Pressman, J. (2002). Last Resort: psychosurgery and the limits of medicine. Cambridge: Cambridge University Press.
- Friedman, R. (July 17, 2015) Psychiatry’s Identity Crisis. The New York Times.
- Horton, R. (2015). Offline: What is medicine’s 5 sigma? Lancet Vol. 385, No. 9976, p1380.
- Kirkey, S, (May 13 2015). Antidepressants and other mood-altering drugs dangerous with very little benefit, expert argues. National Post.
- T. Insel. (August 31, 2015). Director’s Blog: Look who is getting into mental health research (Blog).
- Rose N. & Joelle M. Abi-Rached (2013). Neuro: The New Brain Sciences and the Management of the Mind. New Jersey: Princeton University Press.
- For more information on the psychiatric residency program please visit http://www.psychiatry.utoronto.ca/education/postgraduate-program/prospective-residents
- Canadian Psychiatric Association: http://www.cpa-apc.org/browse/documents/19
- For more info please see: From Surviving to Advising. Centre for Addiction and Mental Health.
- For more info please see: From Surviving to Advising. Centre for Addiction and Mental Health.
- Davidow, S. (July 4, 2013) Cheers for Peers (blog) in Mad in America. Retrieved from:
- Costa, L., et al. (2012). Recovering our stories: A small act of resistance. Studies in Social Justice, 6(1), 85-101.
- Ahmed, S. (2010) The Promise of Happiness . Durham: Duke University Press
Although one ever tagged me as an optimist, I don’t agree that psychiatry is here to stay. While the PR machine of both the profession and the drug companies (is there really any difference?) keeps grinding away, more and more people are damaged by psychiatry, and no matter how many self-serving lies are told, more and more people have become aware through their own experience that psychiatry is not a constructive force.
As for alternatives, there are many different programs that are frequently talked about on the pages of MIA, and although they have great difficulty getting funding, I think people who want to “reform” (whatever that means) the “mental health” system ought to be working toward the time when places like Soteria Houses and similar places are recognized and funded.
Meanwhile, the human rights abuses run rampant, but at the same time many more people are hurt by them, and they are more and more angry. This is just like what happens to many other groups in our society who have gone on to create mass movements that can change things.
We certainly don’t have such a movement right now, though at one point we had the beginnings of one. But I think that’s what we should be working for. And I think it can be done.
Yes, there are people who work within the system who truly believe they are accomplishing something but at best they are making life slightly better for psychiatry’s victims. And frequently people who do this are pulled into the system and strengthen it.
Again, I just don’t see that ultimately, the present system is going to last forever. But saying that over and over becomes a self-fulfilling prophecy. You can’t win anything if you give up before you start.
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Dear Ted,
Thank you for taking time to read my blog. I am interested in anything that helps implement something useful but my experience is that there is still a lot to learn about what people need from their various standpoints. Soteria (initiated by a psychiatrist, albeit a lovely one whom I had the honour of meeting years ago.) is one model but, it would not work for everyone.
All the best !
LC
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If survivors are going to teach psychiatrists, two questions come immediately to mind: 1) why isn’t psychiatric training and education covering what they should know in order to effectively help people? and 2) would the teaching survivor/client be paid what a med school professor would be paid?
How about the survivor apply their wisdom into their own personal and/or professional development. I’m tired of seeing our wisdom exploited and our stories used as evidence of someone else’s theory. That’s dehumanizing and is energy draining to people, to use their very personal and intimate information that way. Our stories are sacred. Healing is hard, rigorous work, and is extremely valuable to ourselves and our environment. Yet, we don’t get paid for doing it.
“And there most definitely appears no to be no commitment to build capacity and independence for consumer/survivor organisations to build a business or a facility of their own.”
Very, very true.
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The doctors are clueless, they don’t know how it feels to have anxiety attacks or ‘mania’ or ‘psychosis’ or any of it AND they don’t know what it feels like to take the drugs that they use to treat these conditions.
Its especially bad in the case of anti psychotics because often to outside observers the person looks “better” on the drugs. But how can an outside observer tell if a person is “calm” or suffering horrible anhedoina ?
The doctors are outside observers and Consumer/Survivors were inside observers, we know a heck of alot more than they do about all this stuff.
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“…we know a heck of alot more than they do about all this stuff.”
Seriously, truer words were never spoken. That’s the irony in all of this.
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Oops I left out the ADHD example,
Oh sure if I am high on Adderal or methylphenidate to an outside observer it looks like the drug works great, focused and attentive but then when the anxiety ridden crash comes along that feels awful outside observers and stuff I have read calls this “returning symptoms”.
Also anyone reading about Vyvance, that crap they cooked up to get a new patent and the billions that come with it will read how it is “effective” for like 12 hours. No its not. The peak is too high and sure blood tests show the level may stay up for 12 hours but most people know the only thing long acting about Vyvance is the crash, that can’t eat jittery anxiety that just won’t quit and the good focus part is no longer than the old stuff.
All the increased prescribing of Vyvance is a great example of how people who have never taken psychiatric drugs are basically clueless. There is NOTHING new and improved about that drug. Its a totally inferior product with MORE side effects.
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One more,
I also don’t think anyone who has ever felt the effects of ADHD stimulants on themselves would ever prescribe these drugs to children. Its just like cocaine whether you “have” ADHD or not. I know I have done both and “have” ADHD.
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Institutional forced psychiatry hasn’t been around that long. By my estimation it hasn’t been around 350 years. Saying so doesn’t make a good argument for its continuation, especially since that continuation involves serious human rights violations and much physical injury on top of deprivation of liberty.
Personally I’m not in favor of “consuming” that which does me damage. I don’t advocate “consuming” mental health services. I advocate instead liberation from the mental patient role. Cease consuming mental health services, and playing the mental patient role, and you would be boycotting psychiatry. I’m all in favor of boycotting psychiatry. We have another expression for boycotting psychiatry, and that expression is “well”.
One problem we have with psychiatry is that the corruption of psychiatry extends to user/consumers of psychiatry. When one doesn’t see the possibility of surviving mental health (mal)treatment, the career of mental patient looms large. There are better things anybody might be doing with their life and times. The same principal applies to so-called “care” providers.
There was a time when there were much fewer psychiatrists in the world than there are today. The organization that evolved into the American Psychiatric Association began in 1844 with 13 members as the Association of Medical Superintendents of American Institutions for the Insane. Now that 1 in 4 people in the USA are said to need the services of a psychiatrist in any given year. I say bunk. At present there are complaints in the news that there aren’t enough psychiatrists in the world to serve every rural backwater. We don’t need more and more psychiatrists any more than we need more and more mental patients by any other name.
The thrust of your post would support endless expansion of the mental health system, in other words, more and more mental patients, and with them, more and more mental health workers. I don’t see a whole lot of benefit coming out of the present epidemic spreading and gaining even more ground than it has already taken. Say if 1 in 3 people were said to need the services of a psychiatrist during the course of any given year. I think, at one point or another, it’s time to think of downsizing.
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Psychiatry, to my way of thinking, far from being among the eternal verities, is the oddest of luxuries. Freud’s couch is something of an odd luxury, certainly no necessity. Pills, and the addictions that go with them, given our current prescription drug culture, the panacea of psychiatry, aren’t any sort of necessity at all. Food, clothing, and shelter are necessities. If fellowship and medicine might be considered necessary, psychiatry isn’t even real medicine. Try as hard as you might with the concept, “mental illness” still doesn’t inhabit a body, it only exists as an abstraction. Psychiatrists, you will note, don’t have the cause for their mysterious maladies. No, that’s supposed to come with continuing research, the kind of research they’ve been conducting for the last 200 years. What you’ve got is a large and growing welfare system supporting a population of permanently dsyfunctional (i.e. underemployed) people. You end this sort of “dsyfunction” by putting people to work. Psychiatry is a ticking time bomb. Sooner or later, the system, our system of government actually, is going to be under threat from economic collapse. In the long haul, I figure it, psychiatry, has to prove unsustainable. Prop it up if you will. I prefer to knock it down.
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Oops, that should be “dysfunctional” and “dysfunction” not “dsyfunctional” and “dsyfunction”.
Also, regarding fellowship and necessity. The fellowship of the psychiatrist with the patient is kind of fake, to say the least. Psychiatry is more akin to prostitution. Real friends are there for you, not for a fee.
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Perhaps the question should be,
Are psychiatrists willing to listen to “patients” as equals whom they may be less knowledgeable than in certain ways?
If the answer to this question is no – which it likely is for most psychiatrists – then the answer is that “survivors” should avoid psychiatrists and continue to advocate outside of the existing system. For those few psychiatrists who are able to learn, the answer is yes, they might learn some useful things.
In my efforts to advocate for a non-lifelong-illness model of severe trauma (mislabeled “Borderline Personality Disorder”) I’ve made it clear to several mental health “experts” that I am speaking to them on a level. Usually I make the point that DSM labels are lacking in validity and reliability, that assumptions about a lifelong “BPD illness” with a genetic/biological basis is harmful and false, and that medications are minimally effective.
To their credit a couple of professionals have been receptive, but the majority have these messages pass in one ear and out the other, or they actively avoid and deny my points. When I bluntly tell them that their allegiance to the disease model is required to preserve their status and income, that tends to be the end of the conversation.
Psychiatrists peddling the “diagnoses are valid and necessary” and “medications are an ubiquitous front-line treatment” mantras don’t like it when someone can see straight through them. If enough distressed people were able to see through their distortions, it would become an existential threat to psychiatry as a profession. Since psychiatry appears to requires these misrepresentations for its survival, it follows that a majority of psychiatrists will be unreceptive to learning from former patients who have largely recovered using non-psychiatric supports and who could ultimately threaten their livelihood and identity.
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I have found that the culture of the mental health industry is simply not attuned to the truth, they simply don’t want to hear it.
I once gave a presentation to a group of clinicians and when I began talking about how the system is trapping people into a lifetime of dependence and ‘chronic illness’ based on stigmatizing beliefs projected onto them, a senior staff therapist became defensive, rolled her eyes, and walked out of the presentation in a huff. When I asked one of her colleagues what that was about, he said to me, “You hurt her feelings.” Apparently, she was not hearing that there is much more at stake here, in society at large, than her ‘feelings,’ but it just didn’t seem to matter to her.
In my experience, this is pretty typical. I have found that most mental health professionals are not neutral listeners; they have a personal agenda and take things too personally. I have found it very challenging to have a satisfying dialogue with most mental health professionals, and usually find it to have been a complete waste of my time. There are exceptions, but I think defensiveness and demeaning projection are the rules in that culture–aka brick wall.
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Otherwise, this conversation would have ended long ago because all the truthful information is already out there and being applied most effectively. Given their resistance to own their stuff, I’d say it’s more about leaving them in the dust, if they don’t want to listen. Humanity will evolve without the dualistic and utterly stigmatizing and discriminating psychiatric school of thought.
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“So failures, disappointments, current indignities of psychiatry remain all but sequestered; there appears to be no evidence or frame for how to teach residents to “unlearn” their power and privilege. ”
Start here: http://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-voices-of-people-harmed-by-diagnosis-and-refuses-and-refuses-and-refuses/
She says the APA refuses to listen.
Hey, APA. Is Paula scientifically correct? Is she telling the truth? Can you understand what she’s saying?
Do you see how I mocked you (while being serious at the same time)? Do you understand why I mocked you?
Paula said you refuse to listen. Is she correct?
It isn’t a matter of evidence-based science, right? It’s a matter of honesty and truth, right?
The goal should be understanding.
No understanding, No Peace. No Peace, No Justice.
Know Understanding, Know Peace. Know Peace, Know Justice.
For somebody to listen to an other, you have to think the other person is worth listening to (it’s called respect: the idea that we’re all equal, despite our obvious inequalities).
But if you judge, or prejudge, the person (or people) as being not worth listening to, and not worth understanding, you’re likely to secure that powerful, privileged position (arrogant superiority).
I see a road block, though.
“I write today’s essay as part of a larger, ongoing set of actions for public education, because the people need to know how utterly unresponsive and cold-blooded this unregulated lobby group is.”
While she’s telling the truth, sometimes people go deaf when they’re being charged. The wronged, injured, harmed ones should not have to relent. They’re (we’re) righteous in making their (our) charges. But I understand how human it is to fall deaf to heated charges.
Look at her next message,
“The APA’s fortress protects 36,000 psychiatrists, and although some I know personally and consider great human beings and helpers, the organization’s power and the cover of its so-called ethics rules provide protection for those who break the “Do no harm rule.” In fact, the APA’s motto might well be, “We will allow no harm to be done to our members who do harm to those who come seeking help.””
She’s REALLY saying something there. It needs to be understood but greater than that, there needs to be a proper response.
I think most people do not know how to do that (respond).
They need to be willing to hear, listen, understand and face the facts. They need to be willing to be responsible and accountable, to confess and admit, and repent.
Humility.
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If psychiatry is a profession based on illogical and fraudulent principles, wouldn’t helping to make people “better” psychiatrists be akin to helping people become better swindlers or crack dealers?
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I was going to say something like this too, comparing “helping psychiatrists become better psychiatrists” to “making con men better criminals” or “helping scorpions increase the lethality of their stings.”
It felt too cynical and absolutist to say that, but there is a grain of truth in this thinking. Most psychiatrists today believe in two massive foundational lies:
1) Human life problems are reducible to lifelong illness diagnoses which have a biological / genetic basis.
2) These problems require medication/neuroleptics.
It’s hard to really open someone’s eyes until they give up these beliefs. Some psychiatrists can learn to think different, or they already don’t practice that way. But many are into the (unconscious) lies so deep, and their identity and income so dependent on maintaining them, that they’re a lost cause.
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I would say the #1 lie (or grave error) is the notion that a mind can have a disease, any more than it can have a color, texture or odor (although such metaphors may have value when writing poetry). Not that #2 & #3 should be ignored by any means.
Also let me put in a good word for the scorpion, who only stings in self-defense.
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The mind sure can be harmed.
How can we say that some professionals in the industry are psychopaths or sociopaths, and expect that such a thing is true for them but is not true for those of us who have been accused (err, convicted)?
The mind can be darkened, distorted. We can lose elevation, inner light. We can be degraded in every way: body, spirit, heart, mind and soul (and even nations on the whole).
The trouble is thinking that it’s caused by an actual disease in the brain, or that a drug or pill is a proper solution.
The brain can be impacted and effected but that would be brain INJURY, not brain disease.
I don’t think psychiatry and its industry have a goal of social justice. I think their unrelenting goal is dominion, domination, control, authority.
That’s a rather disharmonious clash.
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Sure, some people given “mental illness” labels are sociopathic to some degree… in non-labeled terms, that means they’re lacking in conscience/morality, don’t feel guilt, do whatever it takes to survive regardless of who is harmed, etc. Many people who’ve been severely abused or neglected have to survive in this way at least for a period.
One difference is psychiatric survivors don’t have an income and professional identity that depends on misleading/harming others. I should note that the misleading by psychiatrists is usually completely unintentional – most psychiatrists have been educated only in and are true believers in the disease model.
I was struck when I spoke to the psychiatrists myself by how much they seemed to believe in the disease model. They didn’t seem like “bad” people – in the sense of intending to harm or be malevolent – not at all. I wouldn’t even necessarily say their goal is social control or domination. Their minds have simply been taken over by the poisonous weeds of the lies saying that people’s problems are illnesses and medication has to be a treatment. Once entwined, it seems like there’s no easy weed killer to “cure” them and bring their mental garden into alignment with what we consider “reality.”
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I find that psychiatrists are controllers, simply by personality. When a client gets powerful in their own skin–which should be what happens, that is healing–even the most focused, compassionate, and competent clinicians most often FREAK OUT and start pulling their power and control games. I agree, it may not be a conscious intention to dominate, but I think it’s inherent in these personalities. I wonder what their families and partners would have to say about that?
It’s another reason I can’t sit at the same table as psychiatrists. They are not humble to the process, and will always want to control everything. I’ve never seen so many mind manipulating maneuvers when they get triggered by clients and survivors. That’s been my experience 100%.
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Hi Alex. It sounds like you ran into some of the infected rotten psychiatrists.
I saw three different psychiatrists between about 7-11 years ago. Two of them were in outpatient settings. I have to say that those two were pretty nice, decent people who didn’t focus on labels and who tried to engage me in psychotherapy. So there are good ones out there. A lot of the focus tends to be on the worse ones – the ones who tell people what illness they have, who overmedicate, who do 15 minute med checks if that, etc. It is understandable but not every psychiatrist is so bad.
I do agree that very loosely or generally, psychiatry is a profession that would attract people who enjoy having power and control over others. It could also attract people who want to help, though, but then their desire to do that might become twisted by the disease model.
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Indeed, which is why I’m always careful to say ‘in my experience.’ And my experience is vast. I saw my first psychiatrist at age 21 and my last one when I was 44. That was 10 years ago, and I haven’t looked back (other than to relate my story).
I went through several psychiatrists in the latter years, all in San Francisco, where the state of the ‘mental health field’ is truly beyond abysmal, just terrible, really failing everyone, including the city at large. The psychiatrists were HORRIBLE, one worse than the other, truly clueless, guessing, utter lack of empathy and even understanding of interpersonal issues, and not owning a damn thing.
Plus, 3 of them were seriously abusive, gaslighting, sarcastic, and blatantly stigmatizing. If I wanted to not only heal but also to gain back my self-respect, it was imperative I take an entirely different route to healing.
During my years working with professional ‘advocacy’ (I learned this was only a term with no substance), I did sit at the same table as psychiatrists, and as usual, they were maddening, dismissive of anything they didn’t like or which reflected that perhaps a shift be made in our approach to ‘mental health issues,’ without any further inquiry. They shut down dialogue quicker than anyone, all resistance. Talk with no substance, and no desire to listen to anyone else, they just get too triggered. Completely and totally UNSAFE.
A few years ago, I spoke to a class of attorneys-to-be at Berkeley Law School, and when I talked about how the medication was so harmful to me, one of the students got really emotional and started reproaching me with this really defensive attitude, she even started crying from her anger and seemed quite overwhelmed and distraught. It was rather stressful for all concerned, and she didn’t even make an attempt at dialogue, she was just kind of hysterical about what I was putting forth, based on my experience of healing.
Turns out she was a psychiatrist who was also studying to become an attorney. I went back for a follow up with that class a few months later, and she was not there. Go figure.
In addition, I trained as a psychotherapist and in that process, I discovered not only how misguided this education was, but also how ‘controlling the client when they were exhibiting too much power’ was something my fellow interns enjoyed learning, and “practiced” on each other.
While I enjoyed working with clients and was a well-regarded clinician, I defected from the field in order to discover what would really help people. I knew this because while the mental health field was tanking me, while the energy and spiritual work, largely through the philosophy and practices of Chinese Medicine (acupuncture, herbs, Qi Gong), my energy balanced out, my mind cleared, and I healed.
So that’s where I’m coming from, here.
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Oh, and this includes both private and public sector. I’ve had both experiences.
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Nonviolent protest is the way
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Let’s marshal our resources as a movement. Let it be known that there are certain behaviors we don’t tolerate in our communities. What biederman and wilens did is unacceptable. Nonviolent protest. Media attention.
Gynecomastia. Suicide. Mania. A lifetime of drugging.
How long must we tolerate this?
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Hi Lucy,
You point out many aspects that seem troubling about this program. Certainly it seems oriented towards having primarily people who the system feels it has helped being the ones who speak to psychiatric residents. One can see that the major aspect of dialogue could be comments about some services problems or lack of empathy, but collusion with poor treatment modalities. As placebo responses in psychiatry are always high, one can always find people who feel they have been helped to recover.
A significant problem with psychiatric training these days is a strong orientation towards hospital based “mental illness” with not enough focus on the poor treatment received by the average person who ends up being medicated by their family doctor or a psychiatrist. It doesn’t seem like this patient/resident dialogue will change that.
Another important question is why residents are not being trained to listen to and learn from every patient throughout their residency? To give residents this experience in their last year seems to be too little, too late. The implication appears to be that during their residency, they won’t have the opportunity to actually see “recovered” patients so that they need this experience at the end. It is true, and a problem, that as most rotations in residency are for six months, that residents don’t tend to see the longer term evolution of patient care. This consumer feedback program may be partially aimed at this problem, but is unlikely to actually indicate the true problems in psychiatric care.
Like so much of what we see these days, institutions tend to come up with programs that make for good marketing but actually accomplish little.
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As the one peer worker in a state hospital where residents rotate through one of the units I can tell you that the residents avoid me as if I had the plague. I’ve tried initiating conversations with them with little result. It’s as if they can’t get away from me fast enough. I thought that maybe I was overreacting and imagining all this but asked other staff and they said the same thing. We have third year medical students too and they’re much more receptive to talking with me.
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Dear Norman,
Thank you for taking time to read my blog. I am still learning about education provided to residents in their rotations. This is especially pertinent as the Royal College of Physicians and Surgeons in Canada is moving towards “competency based” education . So education will be in flux for the next few years. It is taking me awhile to understand the way in which the education unfolds and its relationship to other areas of medicine. There is also quite divisive politics between the, ‘teach more pharma’ and ‘teach more therapy’ psychiatrists. It is all very complex and like many professional designations there are many things ‘at play’ that influences what these students become – much is driven by their privilege which is something that is relevant way before they even enter med school.
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Many consumer/survivors who provide peer support recovery services have wondered about engaging a volunteer psychiatrist/psychologist or other clinical personnel as “supervisors” to help with boundary, ethical or skill-based issues. What qualities would psychiatrists serving in this position need. Generating a list might help peer specialists improve their ability to select the appropriate person to help them in their quest to help their peers.
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As peer specialists we are trained in ethics and boundary issues and we have skills that are appropriate for the work that we do. We do not need psychiatrists or psychologists giving us advice on these issues. We are a service offered to people in the system that is on the same level as clinical staff, we work in tandem with clinical staff and we don’t work under clinical staff. Supervisors for peer staff must be peers themselves, we do not need clinical staff supervising us.
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Peer specialists have been co-opted enough by the system so why would we want clinical staff telling us how to do our jobs when they know little or nothing about what we’re supposed to go about our work? This smacks of peer specialists turning to psychiatrists and saying, “Please, oh please; show us how to do our work because you’re the only experts in town on emotional and psychological distress! We’re not smart enough to do it on our own!””
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Peer support has been thoroughly co-opted through the specialist certificate type qualification business. What do you qualify for now that you’ve got your certificate? Low man on the same totem pole that has the psychiatrist as top dog. You aren’t good for much beyond transportation and making sure inmates get their psych-poisons if you don’t want to be fired.
As I see it, this peer specialist business, intimately tied to psychiatric corruption as it is, most closely resembles the prison trusty system.
If you want to help the director of the state hospital, maybe, however, if you want to help and support victims of the injustice inherent in mental health law and the psychiatric system, you might consider doing something worthwhile and truly beneficial instead.
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I think that, by and large, your statement about peer work being co-opted is fairly accurate. Anytime you have peers charting on people so that Medicare will pay the institution you’ve got a huge problem. I won’t single any one particular state program out here in public as an example of a program that I feel is totally co-opted but is popular due to the fact that it made it possible for Medicare to be billed for the time spent with “patients”. You can’t do peer work in 15 minute billable increments! This particular state program is the template that many other states have used to create their peer programs. I believe that there are huge problems with this. When you create peer worker programs in order to bring more money in for the system I think you know absolutely nothing about peer work. Of course, I don’t think the people doing this really give a big damn anyway, they just see the possibility of more dollars for the system and a bigger way of trapping more people in the system.
That said however, I do believe that there are peer organizations that do the work that we are supposed to do. As long as they exist on their own, separated from traditional institutions such as state “hospitals” and psych units in medical hospitals they have the freedom to function as they should function.
In traditional settings it becomes almost impossible to keep from being co-opted. It’s all in how cps’s are introduced into the system in the first place. It takes a long period of time to educate the staff and change the culture of the institution, and then you’re not guaranteed that you won’t be co-opted in the end. Peers should be “in the system but not of the system” but this is very difficult to achieve. I believe that one of the best peer run organizations in the nation happens to be the Western Massachusetts Recovery Learning Centers which Sera Davidow is affiliated with. We are familiar with Sera here on MIA.
I know that many survivors of the system feel that peers have gone over to the Dark Side and in many cases I believe that they are correct. But I’m not so willing to say that all peer workers allow themselves to be co-opted and some do some really useful work with people as they walk with them in their journey of healing and finding health once more for themselves. They are probably far and few between though.
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Personally, career mental patient is not a position that suits me. The obverse of mental patient, when it isn’t psychiatrist, is mental health worker. Mental patients (consumer/”survivors”, whatever) are being trained as paraprofessional mental health workers. This is not the end of “sickness” the career option, it goes on and on. I’ve got a better idea. Cure the mental health workers of mental health work, and you’ve cleaned up the entire apparently catagious mess.
The mental health system is expanding by leaps and bounds Hiring mental health paraprofessionals from among the consumer/”survivor” population is one of the many ways in which the mental health system expands. I’m of the opinion that if you are going call people who are not “sick” “sick”, and treat them as if they were “sick”. Maybe you are the person who actually needs “help”, or whatever the on going excuse is. Cure the mental health worker of mental health work. I think it would make a great slogan
Given jobs in the mental health system, “Medicare” is hardly the only excuse people have for not leaving the mental health system, it pays. I’m of the opinion that it would be preferable to see people in real jobs rather than in what I’m tempted to call “turn-coat” jobs. Given real jobs, we wouldn’t need a mental health system, would we? Well, that what these peer support specialists aren’t doing so much, seeing that people have meaningful non-mental-health work.
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“Many consumer/survivors who provide peer support recovery services have wondered about engaging a volunteer psychiatrist/psychologist or other clinical personnel as ‘supervisors’ to help with boundary, ethical or skill-based issues.”
But their boundaries are rigid and unreasonable, which doesn’t allow for healing; their ethics are highly questionable because it is an unethical profession in practice; and from what I’ve seen by and large, their interpersonal skills are sorely lacking, which is how they drive people crazy. Quite the conundrum.
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This was what I was trying to express in my statement but you nailed it on the head. It totally surprised me that anyone would even suggest this in the first place.
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Any belief system requires believers, whether that belief system is based on verifiable observation or pure fantasy.
But without belief, its difficult for a belief system to attract adherents. Belief, or in the case of psychiatry the suspension of disbelief is the problem.
Its one thing to entice people with rational sounding discussions, framed in scientific jargon, especially when people are trained to worship science, and few have formal training or experience in scientific process.
Since most people don’t understand what’s being said to them about their medication, or their diagnosis, they must accept it on faith alone. But when the medications, and the belief system no longer works, it becomes more difficult to accept it.
Psychiatry typically reacts either to blame the patient or change the medications, and when medication changes don’t work they go back to blaming the patient.
At this point, the belief system is failing, it can no longer convince a significant number of professionals that it has anything at all to offer, some, also a significant number have noted that it is dangerous, and life threatening.
Quite simply, the world is full of people who are strung out on psychiatric medications, and are not helped at all by them, naturally they want get better, because they are tired of suffering.
Psychiatry has been identified as the perpetrator.
Once it has completely lost the publics trust, it will be gone. Sure there may be a few, dangerous psychiatrists who will hold onto the notions of the past, because their incomes depend on them.
People will simply stop believing in it. I myself have worked in the field full time since the 80’s, not as a psychiatrist, but as another professional. I have seen or evaluated, 10’s of thousands of patients, and I have never seen anyone helped by any thing psychiatry has to offer. They are so far away from what’s real that is shocking.
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You know… I’m just really curious… Who was staring out the window with their morning coffee, and suddenly, EurekA! They think. I know exactly how to fix this. I’ll just jab a ice pick into their orbital cavity and stir things around really good. That’s definitely the answer…. Or I’ll just run electricity through their skull… I bring this up because I’m supposed to be the one who’s unhinged and dangerous here, and I have never once thought of either of those things as an answer… To anything.
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Thanks for the laugh! When one really tries to understand the logic, or to follow the rationalizations that underlie “evidence -based treatment” it is truly mind boggling. I often feel like I have fallen head first into a Monty Python show and find myself searching for JohnCleese in a psychiatrist costume !
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I had my eyes tested because I thought the emblem was a stick and a snake lol. Then someone pointed out it was an ice pick and an electric chord wrapped around it.
Feedback for a psychiatrist??? They get whatever answers they want the way this system is set up. So we find out what answers they want, and then provide them 🙂
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Here’s a quote from a recent article about ECT in Visions magazine (http://www.heretohelp.bc.ca/visions/treatments-what-works-vol11/electroconvulsive-therapy):
“Electroconvulsive therapy (ECT) has been, and continues to be, among the most effective treatments in psychiatry. Over 80% of those patients receiving ECT can expect significant improvement or recovery from their depressive symptoms.1 In comparison, improvement rate with either antidepressant medication or a course of cognitive psychotherapy is 55% to 60%.”
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