Editor’s note: The following is prepared notes for testimony provided by Sandra Steingard, MD, to the Vermont State Senate on February 17, 2016. Dr Steingard’s testimony begins at 6 minutes, with questions and answers that are not in these notes, but well worth seeing.
Vermont is a wonderful state and I am privileged to call it my home. We are known for our progressive ways, and this extends to our mental health care system. However, there are intense disagreements here – as there are everywhere – and I have learned in recent years about how changes that seem positive can have unexpected consequences.
In 2011, our state hospital closed suddenly over the course of a 24 hour period when it was flooded during Hurricane Irene. A battle that had been raging for decades – do we need a state hospital? – required an immediate answer. The Governor and legislature agreed to build a new hospital but with a maximum of 25 beds as compared to the 54 beds contained in the old one. To replace this, we developed several innovative recovery programs. But we also started admitting people to our community hospitals who would have, once upon a time, only been accepted at our state hospital. The idea was that this would allow people to remain closer to their homes.
This is where is gets complicated. The laws and procedures for forcing people to take drugs against their will had been fairly stringent in Vermont. While there are many here on MIA who think that any law that allows this to happen sets the bar too low, it has been my experience that Vermont has much better protection of due process than other states where I have worked (Massachusetts and Pennsylvania). The legal process would typically take weeks to months. But when the community hospitals became involved, they brought their considerable power to the discussion. Many of the community hospital psychiatrists – including the majority of the faculty at the academic hospital in Vermont – objected strenuously to the many due process protections embedded in Vermont law.
Health care reform factors into this because with the many changes underway, the community hospitals and especially the academic medical center have enormous power and influence in the state. In 2013, the legislature reviewed the procedures for forced drugs and changed them by allowing for this process to accelerate in some circumstances.
But this was not good enough for some parties, and in an unusual move, Governor Shumlin added a change into his budget bill that would have sped the process up even more. He argued that this change would save the state $5,000,000 because people would get started on drugs faster and get discharged faster.
The House Human Services Committee was one of several committees who review the budget and they held hearings on this issue. I was asked to testify and what follows are my comments.
When I came to Vermont from Pennsylvania 23 years ago, I was shocked at the legal process. In Pennsylvania, it would take up to one week to give a person drugs against his will. This happened after a rather perfunctory hearing and a request to a colleague to render a second opinion approving the use of drugs. In Vermont it took months and involved long legal proceedings. I thought at the time that this was a waste of limited resources. I did not understand why Vermont was so suspicious of my good intentions and medical knowledge.
But over time, I have come to believe that caution is warranted.
I will try to make four main points today:
- Our diagnostic systems are not refined enough to allow us to know who will respond to which kind of treatment.
- It has been axiomatic in psychiatry that antipsychotic drugs are essential in the treatment of psychosis, and I believe there is adequate data to allow us to challenge that proposition.
- The antipsychotic drugs are not quite the miracle drugs they are often purported to be.
- There are increasing concerns about the effects of antipsychotic drugs over the long term, and this may be having more of an impact on who is spending long periods of time in our hospitals than the refusal to take these drugs.
- There are non-pharmacologic ways of helping people who are psychotic. Because we have had such a drug-centric approach to treatment, non-pharmacologic approaches are not adequately employed.
Our ability to arrive at a psychiatric diagnosis has not advanced much in the course of my career. Our understanding of the underlying nature of these problems has mostly resulted in deepening our appreciation of the complexity of neural function. A recent study that was heralded in the press as showing a big breakthrough in the understanding of schizophrenia found that multiple gene sites involved in what is called “pruning” increased one’s risk of being diagnosed with schizophrenia. While fascinating, what did not receive attention is that this new finding accounted for only a 4% increased risk of developing psychosis. These reports tend to suggest that it is best to understand schizophrenia solely as something that happens inside the brain, independent of life experiences. Perhaps this is true for some but we now have an increasing understanding of the ways in which traumatic life experiences – such as poverty, social isolation, bullying, violence, and other forms of abuse – can result in many of the neurological changes in the brain described as explaining psychosis.
We have tended to think of those conditions that are “brain problems” as most amendable – and maybe only amendable – to drug treatment. We tend to think of those problems that we consider as “psychological” or “environmental” as most amenable to non-pharmacologic treatments. But these are false distinctions. We are in constant interaction with our environment. It is almost impossible to tease this apart and get to root causes of the problems we encounter in clinical practice. The vulnerability to environmental stress makes us all vulnerable to the many problems that beset humans but it also brings us hope since the environment can change and the brain can recover.
What are antipsychotic drugs? When they were first introduced, they were called major tranquilizers. The French physician who introduced them to the psychiatric hospitals did so after he noticed that they caused indifference. As recently as 2009, a major US psychiatry textbook notes that normal volunteers who take these drugs experience “feelings of dysphoria, paralysis of volition, and fatigue.” (unhappiness, lack of drive) These drugs can cause tremors, muscle spasms, involuntary motor movements, weight gain, diabetes. There are good reasons why people would be reluctant to take them.
Yet, for most of my career, I thought that drugs were essential and delay in treatment was not at all helpful. This notion came from the following sources:
Efficacy of the drugs: When the antipsychotic drugs were first used, it seemed to be helpful for many people who took them. However, if you look at current meta-analysis on efficacy they still all favor antipsychotic drugs. However, the effect size of recent studies is much lower than is generally acknowledged.
Other recent studies show only modest reductions of symptoms in people who take the drug as compared to those who take placebo. One study of people over 40 who were followed for two years, found no effect of drugs on any outcome measure.
On a pragmatic level, I would argue that many people who are in hospitals for extended stays are there because the drugs are not effective in reducing symptoms. In some instances they once were, and the declining effect of the drugs over years – while not entirely relevant to this hearing – has been a strong focus of my interest over the past few years. I reviewed the 8 Howard Center clients who are currently in hospital on Emergency Exam (involuntary status) or court ordered observation. Two are refusing drugs that I believe were helpful in the past. Five, however, are on drugs and were on them at admission but experience limited benefit from them. (One was off drugs but started them after admission.)
Duration of untreated psychosis: There has been a hypothesis in the field for over 20 years that delaying the use of antipsychotic drugs results in worse outcome. Researchers had noted that in the early studies, the group that was put on placebo did not catch up to the group that had been given active drugs, even after the study ended. Richard Wyatt, an influential psychiatrist, wrote a paper on this in 1993 and looked at other studies that he thought suggested that delaying drug treatment was harmful. This idea – a hypothesis – quickly became part of the accepted wisdom of our field. I have reviewed this literature and taken into account more recent studies. I do not think this hypothesis has been supported by ongoing research. While early intervention seems to be helpful, this intervention does not need to include drugs.
I have come to have many concerns about the anti-psychotic drugs. There is growing evidence that taking them continuously over many years may not maximize recovery. There are many studies that support this conclusion. In one important and recent study published in JAMA Psychiatry in 2013, over 100 individuals with first episode psychosis, after 6 month stabilization period with drugs were randomized to either take the drugs continuously or only when symptoms were recurrent. At 7 years the group on intermittent drugs had a 40% recovery rate, as compared to a 17% recovery rate in those who were maintained on drugs continuously.
As I have had increasing concerns about our current drug-centered system of care, I have studied non-pharmacologic treatments.
The International Hearing Voices movement, in which voice hearers help each other to make sense of and live with their voices and to understand the ways in which the voices are an experience to be understood as opposed to eradicated, is just one piece of evidence that for some non-pharmacologic interventions are helpful. We have begun to implement this approach in some of the DA’s and we have an intensive training planned for next month.
Another approach is Open Dialogue from Northern Finland. This is a paradigm of care that involves the individual and his family. They do not consider drugs an essential element of care and they try to avoid using them. In other ways, however, they share many of the values we hold dear in VT and they embody many principles of recovery:
- Flexibility of services
- Families included in an open and respectful way.
- Peer involvement (now being piloted here and in the UK)
In 5-year outcome studies of people experiencing a first episode of psychosis, only about 20% of people are on drugs and only about 30% have even been exposed to drugs. Yet, only 19% of their group is on disability. This is dramatically different from even the best first-episode program in the US.
There is another reason to mention Open Dialogue. It appeals to people with lived experience in the mental health system, to family members, and to those clinicians who have had some exposure to this way of working. You have all had enough experience of the many battles in this field to know that a treatment approach with such wide appeal is uncommon.
I have personally witnessed dramatic improvement in people who have taken these drugs – even under force. I work with people where I have come to the conclusion after many years that I have no way to be of help other than to offer these drugs – even under force. However, I also witness less positive outcomes. This is such a serious and intrusive act on a person. When this topic comes up, brave people who have been on the sharp end of the needle come forward. They are angry. They are not so sanguine about leaving the decision up to the well-intentioned psychiatrists. I know folks like this, too. Some people come out of this experience angry, frightened, and alienated, and I have – in the past at least – taken some comfort in knowing that we had a vigorous legal process in place. Their stories are as true as the stories from psychiatrists who talk about people who ask – after the fact – “Why did you take so long?” People who are labeled with psychiatric conditions are often poor and less well-educated than the doctors, lawyers and judges who hold power in the system. One thing I did not appreciate when I was a young psychiatrist – who was baffled by VT’s legal system – is how much power, even with the best laws, is given to those with economic and educational privilege. Gov. Shumlin mentioned in an interview that it was cruel to withhold treatment. I think it is cruel to deprive people – who often have so little – of their rights to a fair hearing.
A final note: This plan is supposed to save us $5,000,000. If it goes forward, can we invest $1,000,000 in Open Dialogue? There is a group in VT who is already piloting this. We would like to go further. We believe VT could be on the forefront of implementing a progressive, humane, and respectful treatment for our citizens and we believe we might ultimately save the system money by diverting people from a life of long-term disability.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
I’d feel better if you discussed our biophysical environments as well as our psychosocial environments. I’d have more hope for the patients if their biophysical environments were examined as thoroughly as their psychosocial environments.
Actually I don’t think Open Dialogue would be interested in blood money.
Anyway, I thank Dr. Steingard for her testimony. It is important and strategic for persons such as herself to stress to those sincerely wanting to know that scary bogeyman “diagnoses” like “schizophrenia” often obscure the reality that someone has been repeatedly traumatized and is reacting in idiosyncratic expressions of desperation. And that the body and brain process information from the environment constantly and are not units unto themselves. And that psychiatric drugs are not “medications.”
For the rest of us, the enormity of the ignorance and official misinformation reflected in psychiatric mythology being into coercive laws continues to be staggering.
Being embedded in coercive laws.
Can we have that edit feature now?
Yes, how about a comment editing feature…
It would be excellent if Vermont can do trials for Open Dialogue on a larger scale. The case should be forcefully made based on the Seikkula cost/benefit analyses for their catchment area in Finland (detailed in three studies) that this is a program which could eventually save the Vermont government a great deal of money. More importantly, it might help more living, breathing, but very distressed psychotic human beings get well.
Let me comment on Sandra’s “Five Points”, with the harshness of these comments mainly being directed toward establishment psychiatists and not Sandra herself –
1.Our diagnostic systems are not refined enough to allow us to know who will respond to which kind of treatment.
— It’s not a question of not being refined enough; it’s that these diagnoses are fraudulent: as writers like Richard Bentall and Mary Boyle argue, they are fundamentally invalid. People’s emotional suffering cannot be carved at the joints into schizophrenia and bipolar. The situation is arguably even worse now with the advent of DSM 5, with its horrifically unreliable field trials which humiliated the field of psychiatry. Psychiatric diagnosis based on “observable symptoms” will never be valid, and rarely have high reliability in the real world. Its only purpose is for insurance and to create the illusion that psychiatrists are real doctors treating real diseases.
Before real change can begin, this woeful state of affairs – the lack of a truly scientific classification system in psychiatry – has to be admitted and faced… as John Read wrote in a recent essay, psychiatrists should face the grim possibility (for them, great for everyone else) that as a profession their services are hardly needed or not needed at all, to quote Read, “While psychiatrists everywhere are doing their best to help people, their profession is in crisis. Psychiatry is struggling to defend itself from multiple sources of critique, and to reassert its future role. One possibility that is taboo for any profession to consider, however, is that it has little or no useful role.”
2.It has been axiomatic in psychiatry that antipsychotic drugs are essential in the treatment of psychosis, and I believe there is adequate data to allow us to challenge that proposition.
— With the recent meta-analysis showing no solid evidence base for long-term use of antipsychotic drugs, this false notion – that antipsychotic drugs should be a front-line, lifelong treatment – should be challenged at every turn. The other studies like Wunderink (mentioned in this piece), Harrow (see MIA education series), Gottdiener (the meta-analysis showing that adding drugs to psychotherapy for “schizophrenia” made no difference to long-term outcomes in a sample of 2,600 clients), plus the results achieved largely without drugs by Open Dialogue approaches, Need Adapted Approaches, 388 Approach in Quebec, and many outpatient psychotherapists within ISPS… all of this is more grist for the mill pointing to the fact that promoting antipsychotics as an essential long-term treatment is unethical, unnecessary (except for the drug companies’ bottom lines) and harmful for many.
3.The antipsychotic drugs are not quite the miracle drugs they are often purported to be.
— This must be the understatement of the century. “Not quite the miracle drugs”… how about WAY less than miracle drugs. Nightmare drugs, for many… Get real.
4.There are increasing concerns about the effects of antipsychotic drugs over the long term, and this may be having more of an impact on who is spending long periods of time in our hospitals than the refusal to take these drugs.
— Also, hospitals are one of the worst places to go if one if psychotic… because one will face psychiatrists who are deluded into believing that one has a brain illness, will be pressured to take drugs, will be partially or wholly separated from one’s family and loved ones, etc. This is why programs like Open Dialogue that meet the person where they are in their home/family situation and try to minimize hospitalizations are so important.
5.There are non-pharmacologic ways of helping people who are psychotic. Because we have had such a drug-centric approach to treatment, non-pharmacologic approaches are not adequately employed.
— It’s funny that this has to be said, “There are non-pharmacologic ways of helping people who are psychotic”. I mean, really? Is grass also green and water wet? I get that Sanrda is partly writing this article for people in the “mainstream”… but the degree of ignorance among mainstream psychiatrists – people who are meant to be experts on helping people experiencing psychosis, but are in fact some of the most poorly trained and often dangerous people for psychotic people to see – it’s simply breathtaking.
Lastly, and ironically, Gov. Shumlin’s statement is almost completely false; but not an intentional lie… simply a falsehood from a deluded politician who has swallowed the Koolaid of the drug company/APA lobbyists. “It’s cruel to withhold treatment”… No… given that “treatment” means giving people ineffective and often harmful antipsychotics drugs, and lying to them that they have a brain disease, thus worsening their chances of recovery… given this “treatment”, the true mercy is in fact withholding or escaping treatment. This is a large reason why the poor people in India, Columbia, Nigeria, and other backward nations profiled in the World Health Organization studies of schizophrenia did so much better than those in “advanced countries” – the people in poor countries were “cruelly” spared treatment!
I want to put in a positive comment for Sandra Steingard, whose writing I often criticize when she comes out with essays here. Being “in the system” as a psychiatrist in America for decades like she has, and then coming to question one’s assumptions to the degree that she has, is very impressive. Although I do not agree with her on everything I respect her writing and wish that many more psychiatrists would follow her example and start to question the foundations of the disease model. Well done Sandra.
I agree, that is the one comment that really bothered me, though I want to thank Sandy for having the courage to speak up about this issue despite no doubt receiving a lot of flak about it. It is important to characterize these diagnoses as subjective and to a large extent arbitrary collections of people who for myriad reasons have some kind of similarity of “symptoms.” I even object to the word “symptom,” as it implies some kind of medical malfunction, while many who are diagnoses literally have nothing wrong with them at all and are simply displaying the emotional effects of abuse, stress, and an unsupportive cultural environment.
Of course, this idea doesn’t sell well, and maybe Sandy’s ability to get her message across would be limited if she started using words like “fraud” and “deception.” But I do think it’s important to get that on the table – these “diagnoses” aren’t lacking refinement, they’re lacking VALIDITY, and even Dr. Insel has admitted the same.
This is the same Governor Shumlin who penned a New York Times Op Ed arguing against FDA approval of Oxycontin for children, right? My sense from the kerfuffle that editorial sparked was that it’s…arguable…since there are some cases where it can actually be very helpful for children in intense pain. Really, I don’t know enough about it, but there’s something pretty interesting here about a physician-governor who wants to prohibit a drug that may be helpful in some circumstances while promoting the forceful administration of another drug against people’s wills. Is this what happens when you merge physician-authoritarianism with political power?
He is not a physician. His worry about opiates – which I happen to share – is that there is a lot of diversion which has fueled a serious opiate addiction epidemic.
See what iatrogenic neurolpesis, an iatrogenic pharmacological disorder, and suffering the pangs of abrupt, MD-forced drug withdrawal can do to a sensitive person? Anyway, this has been bugging me for 2 – 3 weeks, & I’m finally back for a more measured response, as regards the current, so-called “Opiate/heroin crisis” being caused by “over-prescribing” by Dr.s. As I said above, yes, *some* of it is caused by mis-, or over-prescribed pharmaceuticals. For example, in 2013, Walgreens paid an $80.MILLION fine for filling bogus Rx scripts, mostly in Florida pharmacies…. But, any serious researcher, even a private citizen with some computer & office skills, could EASILY begin to ask & answer that question. Between the Centers for Medicare&etc., the “propublica” “Dollars For Docs” database, and a few other publically accessible sources, the exact amounts of narcotics/opiates Rx scripts written COULD BE calculated. Correlate that with Pharma’s production figures from the Wall St. Journal, or some such industry intel source. Compile all this data with FBI drug arrest statistics. We could easily get a fairly accurate picture, *STATISTICALLY QUANTIFIED*, as to exactly how much/many prescription opiates have been produced and distributed in this country in the last 10 – 20 years. Then, we look at how many “addict-dose-days” that quantity would supply. (In other words, how much “stuff” does each addict, and added up, ALL addicts, need per day/week/month/year, etc…..) Following me, so far? Then, we can calculate how many addicts there actually ARE, based on similar statistical investigations. And, do you REALLY think that Pharma has NEVER done exactly what I’m describing here? That the DEA has NEVER done exactly what I’m describing here? That the Mexican Cartels have NEVER done the same? Really? The Mexican Cartels are making MANY BILLION$$$ per year! (Purdue Pharma, makers of >Oxycontin2013, including several $BILLION$ in some of those years. That means perhaps $500BILLION ->*$1TRILLION or more, in the last 10 – 20 years, on narcotics ALONE! IN SALES & PROFIT! Do YOU >get it, yet<SANDRA? We have the "drug problem" we do, BECAUSE of the War on Drugs, and yes, FORCED DRUGGING IS PART OF THAT…..
The most educated can be the dumbest & densest, because they think they know. They think they know…. May God have MERCY on us all/
OOps. There’s a line or two missing, somehow, after “Oxycontin2013…., a few lines from the end. Sorry. I think the point I’m making is clear, anyway….ANY major media outlet is ONLY conveying skewed “news”, and deliberately NOT reporting or publicizing MOST of the TRUTH…..
I think Dr Steingard has a narrow view of what she describes as vigorous legal process. Anyone who has some experience in court rooms quickly realizes the party with most money generally prevails in the civil/tort side, and the state prevails in criminal justice, in a country that holds the most people in prison.
Forced drugging similarly, is a rather vague concept. There are procedures in place to just drug people, essentially involuntarily, but voluntarily as far as the law is concerned. What the Dr has said, and this is where psychiatrists wield, in my opinion, way too much power in conjunction with courts, is that she has no problem drugging people that meet certain conditions. That’s still not precise enough, and anyone who is in vulnerable states is not going to have access to vigorous defense of their rights.
A couple years ago, I narrowly survived / escaped being dragged 60 miles in handcuffs and shackles, because some poorly supervised “police prosecutor” decided to go vendetta, and pad her numbers at my expense, with fabricated, trumped-up “criminal charges”. Thankfully, the crooked judge was smarter than she was, and he & I have known each other decades longer…. Forced treatment of ANY kind is a gross human rights violation. After all, why was it the SHERIFF’s who would have “transported” me, and not somebody from the local “community mental health center”? And, what kind of MEDICAL treatment is NOT available **here**?/
Anybody who would even consider “forced treatment” has some VERY tall hurdles to overcome, before they will have ANY real credibility in MY book….
FORCED TREATMENT IS TORTURE.
How is “depot injection under court order” really any different from *waterboarding*, in terms of being a HUMAN RIGHTS VIOLATION?…. Well?_______________?….
People are indeed very excited about Open Dialogue ™. It would seem because they have come across other people that were also excited about Open Dialogue ™,
Yet despite hunting high and low to try and find someone who can actually tell me what it is, I cannot determine what it is.
I know what it isn’t. It isn’t the same as having an “open discussion” or an “open debate”. Although, it would appear many people mistakenly think that it is. Others seem to think — wrongly — that Open Dialogue ™ is about opening up your heart, or being nice and smiley, or not pinning people down in a five-person hold and injecting their “ass-cheeks” with an antipsychotic.
Open Dialogue ™ is also not the opposite of a monologue, as Rufus May keeps suggesting. If it was, then it would simply be a dialogue.
One interesting feature about Open Dialogue I have learnt is that it is heavily influenced by the work of the Russian literary critic, Bakhtin. He proposed that there was absolutely no point at all trying to find answers in the individual Self, because essentially, there was no individual Self.
It’s worth bearing in mind that Bakhtin developed his ideas under Stalinism…
Personally, I welcome Open Dialogue ™ — as well as I am able to understand it — if indeed it aims to introduce a more socialised way of thinking into our individualised, decadent, Narcisstic, navel-gazing cultures.
Here are some formal research papers on Open Dialogue to give you some more to digest. There’s quite a bit of data here on both the results and the theory:
Thanks for the extensive list of URLs linking to further reading about Open Dialogue. I’ve read a number of them already and they do explain in convincing detail the structural changes necessary to implement the Open Dialogue approach, but do not actually explain what that approach is, beyond alluding to the works of Bakhtin and a few others.
It interests me how Bakhtin might be called upon to inform a social therapeutic approach to psychosis. I should probably have been clearer about that.
It strikes me repeatedly that the problems stemming from a monomanic medical model approach to distress are universal, and Sandra Steingard’s article is no exception.
Inievitably an ennui sets in when the medical model has whole systems under its spell.
Open Dialogue promises to break that spell, and that’s no bad thing.
But I do wonder what the dialogic method actually looks like, so to speak,
Open Dialogue viewpoint has a lot in common with some psychoanalytic viewpoints like Robert Stolorow’s Intersubjectivity – i.e. viewing problems through the eyes of both people experiencing it, and seeing how they are each influencing each other in ways that contribute to the problem. It is the complete opposite of the medical model of “mental illness”, which assumes that emotional problems exist in a closed world of the individual, with external social factors mattering little.
Other psychoanalytic writers in this vein include Donnel Stern and Lawrence Hedges.
Anything with a trademark is suspect to me actually. Unless I missed the irony or something.
Read it in depth. It’s good stuff. Not all “brand names” are bad.
If if works – it works.
If it works – it works.
Works to do what?
Works to help people who are terrified, delusional, and nonfunctional, and estranged from family, become able to return to school and work, have better relationships, and not be overwhelmed with fear and delusions, Oldhead… and do this much more frequently than simply giving a person drugs and telling them they have an incurable brain disease. The first paper I cited, Five Year Experience of Nonaffective First Episode Psychosis, gives the results most clearly.
The first paper I cited, Five Year Experience of Nonaffective First Episode Psychosis, gives the results most clearly.
More with the shrink speak. I should have guessed.
I hold to my original comment. Anything with a trademark is a scam. I think the Buddha would agree.
Oldhead, it’s not shrink speak. It’s a good paper. Read it. Seikkula is one of the least medical model people out there. He does really good work helping families and suffering individuals.
Can you provide a reference for the Buddha agreeing with you? If there’s no transcript of the Buddha saying this then I’m not going to believe it. I only believe things that are in published papers. 🙂
So glad you’re in MY SANGHA, “BPD”….. *grin*
The Buddha didn’t trademark and sell his wisdom. Disagree?
I participated in a model Open Dialog session. It appears to mostly involve gathering the people a client feels connected to in a room, and discussing the issues and possible solutions as a group. The most interesting part is that there are two therapists involved, and the two of them talk to each other about what they’re thinking and wondering right in front of the group! A major contrast to the obfuscating language and secret notes and meetings that characterize “treatment planning” in most mental health settings. There is a big emphasis on being comfortable with the unknown and letting each person have their own experience respected and validated. There is also an emphasis on reconnecting the support network emotionally and communicationally, and it is believed that this process if engaging in dialog with the supportive community around the person is key to reducing or even eliminating “psychosis” by creating a common, shared reality among the participants, including the idea that all participants, even the therapists, are learning as they go and are as vulnerable and as human as the identified “patient.”
I hope that helps a little. I’m no expert, but that was my experience of the process.
Thanks for this nutshell explanation, Steve, sounds very interesting. I like the idea of transparency among the therapists–that’s certainly novel and, I think, important in general.
And the idea of everyone vulnerable to the process of the “identified patient” really gets my attention, as it suggests that the IP is leading the healing, which makes sense to me. Given these are generally social issues, the one ‘carrying the ills of society,’ so to speak, has an opportunity to give them back as a way of healing and releasing, which seems just and appropriate to me.
That’s all well and good as far as it goes. But without people grasping the political context for their suffering, and having an understanding the material conditions which underlie it, and some hope of overcoming these, they will ultimately be grasping at straws in terms of a lasting solution outside that room of supportive “peers.” Not that there aren’t exceptions to almost anything.
No one else have issues with the trademark? (At first I thought it was a joke.)
The above was for Steve, not Alex. Hi Alex.
No matter how low key Dr Steingard is, compare the latest article by Dr Ronald Pies, apologist for psychiatry, via what seems like his own public forum, The Psychiatric Times. Dr Pies has been refuted on several occasions here in MIA by Robert Whitaker and Phil Hickey, but he keeps coming back. This time he has filled 4 pages with an ambiguous appraisal of anti-psychotics. On one hand he follows his line where he appears to be the voice of the reasonable `new’ psychiatry, but loses more and more of this as he goes along. Link- http://www.psychiatrictimes.com/blogs/couch-crisis/long-term-antipsychotic-treatment-effective-and-often-necessary-caveats?GUID=A12064EF-6DD0-43DB-B41B-8FE0B8042738&rememberme=1&ts=25022016#sthash.d4D3H6dv.dpuf. It seems that the major establishment is just not having it. It’s drugs now and will remain so. A lot of pseudoscience in here – Hostile to criticism; conspiracy arguments; motivated reasoning; cherry picked evidence; presenting low grade and dismissing more rigorous evidence; untested core principles; vague, imprecise, technical jargon; LOOKS like science but lacks the true methods of science; makes grandiose claims from flimsy evidence – all this is embraced by the rank and file, so the fact that Sandra is stepping out of the zone suggests tow things – her personal courage and the underlying effect of the crumbling of the sandcastle that is psychiatry. Ron Pies and sundry other like Daniel Carlat are trying to hold it together but the tide is coming in and they know it. I wonder how long it will take?
The arrogance, stupidity, and ignorance of someone like Dr. Pies is breathtaking. This is most evident when he assumes that “a lack of medical training” undermines the ability of critics to make valid criticisms of long-term antipsychotic use. This, despite the fact that “schizophrenia” has never been proven to be a valid medical illness.
Pies says, “schizophrenia is usually a very chronic illness” – It is incredible in this day and age that people like Pies still believe these lies. The World Health Organization and Vermont studies disproved this notion decades ago – most people fully recover or improve significantly.
I read the linked essay, and the bias in terms of Pies wanting to find or twist data to support the efficacy of antipsychotics is so blatant.
Meanwhile, the relative oblivion toward the great value of psychotherapy and family therapy for psychotic people continues, with antipsychotic drugs discussed in isolation as if they were the most important treatment under consideration.
Pies continually writes as if “schizophrenia” were a distinct disease with a clear cut-off point separable from other psychoses/emotional problems. The acceptance of this has to stop. A better model is available: of psychosis as a continuum with no clear cut-off point delineating “schizophrenic” or “non-schizophrenic.” Psychiatric research into “schizophrenia” should be abandoned. Abolishing schizophrenia and moving to a more uncertain continuum-based conceptualization of psychotic states is both realistic and more hopeful for suffering people and their families.
I got an advertisement sent by PT in its email list for brand-name abilify which it specifies should always be used over the generic.
The tide can’t come in soon enough. The big trend that I see taking place on the unit I work on in a state “hospital” is putting people on one of the long-lasting shots of the so-called “antipsychotics” so that people can’t stop taking the drugs. They say it will lower the number of people coming back through the revolving door but I suspect that the number will not change and may increase since many of the so-called “antipsychotics” end up causing many of the problems that they’re supposed to take care of. We shall see but I hate the fact that people have to go through this just to prove to the psychiatrists that these drugs are toxic.
Good for you for testifying!
Thank you for your efforts in reform. I do personally believe you left out some relevant information, however. I’ve picked out some points that I hope you might agree need further light shed upon them, especially when educating our government officials.
“we now have an increasing understanding of the ways in which traumatic life experiences – such as poverty, social isolation, bullying, violence, and other forms of abuse – can result in many of the neurological changes in the brain described as explaining psychosis.”
As one who dealt with “the dirty little secret of the two original educated professions,” as confessed to me by an ethical pastor. In other words, he confessed that historically, and obviously still today, the psychiatrists role in humanity is to cover up child abuse for the religions and easily recognized iatrogenesis for the incompetent doctors. I do so hope you will include the reality that 2/3’s of all so called “schizophrenics” today are, in fact, child abuse victims, as John Read’s research points out.
Especially, given the reality that the neuroleptic drugs themselves can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, and the central symptoms of neuroleptic induced anticholinergic intoxication syndrome. And since neither these antidepressant, neuroleptic, benzo, or “recommended bipolar cocktail” induced “psychoses” causes are listed in the DSM, as a possible billable cause for “psychosis,” they are likely almost alway misdiagnosed by psychiatrists.
“normal volunteers who take these drugs experience ‘feelings of dysphoria, paralysis of volition, and fatigue.’ (unhappiness, lack of drive) These drugs can cause tremors, muscle spasms, involuntary motor movements, weight gain, diabetes. There are good reasons why people would be reluctant to take them.” Again, especially in child abuse victims or their concerned parents, who are also “normal” people dealing with nothing more that an appalling crime. Since the antipsychotics can also cause “psychosis,” via anticholinergic toxidrome, in “normal” people, this should also be mentioned to the government. Not to mention, you completely forgot to mention the reality that withdrawal from these drugs is known to cause a drug withdrawal induced super sensitivity manic “psychosis.” Which I believe was relevant to your discussion.
“delaying drug treatment was harmful. This idea – a hypothesis – quickly became part of the accepted wisdom of our field. I have reviewed this literature and taken into account more recent studies. I do not think this hypothesis has been supported by ongoing research. While early intervention seems to be helpful, this intervention does not need to include drugs.” I do appreciate your pointing out that force medicating everyone for being disgusted, by disgusting real life atrocities, is not a wise move. My disgust at 9.11.2001, was apparently my psychologist and psychiatrists’ rationale for claiming I was “bipolar,” according to their medical records, despite the fact most people in our society do believe 9.11.2001 was a disgusting event.
“There is growing evidence that taking them continuously over many years may not maximize recovery.” And forcing antipsychotics onto people likely does not maximize recovery, since, in reality, the antipsychotics are “torture” drugs in the US, just like they were “torture” drugs in Russia decades ago, which the US psychiatric industry did confess to decades ago, if I recall correctly. And which the UN confessed to in 2013. I hope you rethink your belief in the need for forced treatment, other than perhaps immediate and a one time only need, to calm an irate and irrational person. Although, personally, I’m quite good at behaving calmly, and calming irate and irrational persons, which my experience has shown most doctors are not good at doing, albeit such rational behavior by doctors would also not be profitable for them either. Whereas in my former profession, it was the wise way to behave. And Peter Breggin also recommends such behavior.
“Flexibility of services
“Families included in an open and respectful way.
“Peer involvement (now being piloted here and in the UK)”
This is pretty much the opposite of psychiatry’s belief system today, given they’re lying to patients and their family’s claiming their made up, “lacking in validity” “mental illnesses” are proven “life long, incurable, genetic mental illnesses.” Such lies, and subsequent inappropriate druggings, rip happy marriages and families to shreds.
“I have no way to be of help other than to offer these drugs – even under force. However, I also witness less positive outcomes. This is such a serious and intrusive act on a person. When this topic comes up, brave people who have been on the sharp end of the needle come forward. They are angry. They are not so sanguine about leaving the decision up to the well-intentioned psychiatrists. I know folks like this, too. Some people come out of this experience angry, frightened, and alienated, and I have – in the past at least – taken some comfort in knowing that we had a vigorous legal process in place.” “[A] vigorous legal process in place, to protect the psychiatrists, rather than the harmed patients, is what you mean, I presume?
As to being one of those who was assumed to be “less well-educated than the doctors, lawyers and judges who hold power in the system,” because my fields of study initially were in business and art, not medicine or law. Although I was claimed to be “one in a million” by a new family physician, due to my ability to research medicine, and medically explain exactly how I was misdiagnosed, then tortured. I would like to point out that certain professions, who apparently historically paternalistically chose to create a system to cover up child abuse, are not necessarily more well educated, just differently educated. And the system of child abuse cover ups these “educated” professions have created is a very sick, unjust, and evil one, which should be ended by the women within these professions, rather than perpetrated by them.
I do appreciate your rethinking the lies you were taught, by our historically paternalistically controlled system. And do hope as a society we may continue to evolve past such a left brain only, myopic, iatrogenic illness to cover up child abuse, for profit, creation system.
Clearly, very different than in New England. Sounded like everyone agreed who spoke. Of course, finding ways in which people agree is always the best approach. The guy asking for the studies seemed like he could be between totally dismissing it, or completely converting. Although, the end more toward that latter.
If I’m correct it’s largely to prevent, an alternative to more forced drugging? The people being largely focussed on would be not helping, and the ones not deemed by Vermont to require, forced drugging? Would they also, use this before going to court? Of course, we all know how easier preventing change is from reversing it. Especially in people’s perceptions.
However, on a side note the people who are being deemed necessary for the drugs. A risk listed was, jail which, nobody would argue is not the goal. However, isn’t jail a risk in any situation? Although, not why I brought it up. I’m quite interested, and have used the LEAP system, to help with conflict . Heard of it? It was originally made for med compliance, but can’t even go there now. So, it’s expanded to general conflict, and works wonders. At least, this could bring it down to where it’s not so high tension, that it’s considered an emergency. While I have all sorts of ideas on untapped ways it could be implemented, it’s use for mental health’s main goal is pretty much med compliance.
Basically, though it works to reflectively( listen )without judgement. To use your CIA example. I’m hearing the CIA, is bugging your phone. check in, am I hearing you right? . Not agreeing, just showing you heard it, no judgment. Empathy, that sounds really scary, and violating. I know I’d feel that way if it were me. (Apologies), I’m sorry, that people don’t believe you, and are putting you in a hospital and if this upsets you, but I am unaware of that happening. The police aren’t either(Acknowledge) the police, and I don’t know everything, so I’m not saying it isn’t happening. (Agree) I don’t want you to end up in a hospital, or take medicine. (Partner) How can we work together to not have that happen? The police usually send you, so how can we find a way to stop calling them together?
It’s just an example, but hope it gets the gist.
Shortly before he blew his brains out, the American author Ernest Hemingway reported to his shrink that the F.B.I. was tapping his phone, and spying on him. His shrink labelled him “psychotic”, and “delusional”, and put him on drugs. Years after, with F.O.I.A. requests, we learned that the F.B.I. **WAS** tapping his phone and spying on him. And, given the state of telephone technology at the time, phone taps *COULD* sometimes be heard by sensitive ears…. Obviously, this is a VERY condensed version of a much longer story, but the point remains…. The shrink could not have independently confirmed the TRUTH of Hemingway’s complaint, and so jumped to a wrong conclusion, which did more harm than good to the patient…. Just sayin’…..
Yes, and wasn’t it shortly before he killed himself that he stated that the drugs they’d put him on destroyed his creative writing ability and that because of that life wasn’t worth living anymore? The system smacked Hemingway with a double whammy.
I’m not a Hemingway scholar, but it would be useful, and educational for us all, if *somebody* could look up exactly *which* drugs he was put on.
Bravo, Sandra! I’m commenting before looking over other comments, knowing there are certainly some if not many here who see you as too much of a “collaborator with the enemy”. I do not, even though I have a loved one who has many times been on the “sharp end of the needle” and was deeply wounded and damaged by “the system”. In fact, I am currently in the midst of a crisis involving yet another family member who is in the throes of a first episode psychosis. Fortunately, we got her out of the hospital fairly quickly and we are blessed to have a very thoughtful, careful, recovery-oriented psychiatrist (like you!) and many caring friends working with us. Once again, I applaud your courage, passion, honesty and candor. As I’ve said before, you have what I call “real world” credibility since you’re not just posturing but actually working to help people recover. Thank you for your advocacy and willingness to “go against the grain” of your profession.
Don’t know where you got that? Most seem very positive to me, and the only thing critical was on forced drugs. Don’t understand “collaborator with the enimy”. Think you need to explain that more. Also, I’ve been on a court ordered medicine. So I guess that makes me have “real world credibility”. Depressing, but true. Posturing around? Are you serious? How do you know who’s helped people? Certainly it sounds good, and I’m sure it’s difficult to question something so ingrained in what one was taught. However what do you want people to say? That forced drugging can be okay?
Mealt a lot of it sounds good, however forced drugging is still never going to be okay. Still, comment confused me.
Russeford may reply but I think this comment was based on history and the topic. Russerford had not read the comments yet. I agree with your assessment and I appreciate the thoughtful discussion.
Thanks, Sandra you can see it’s been mostly cleared up, although still a bit confused. I have always seen this site as not having a clear enimy. The opinions are just to wide. Although, interesting as it would come up, because I was actually worried would be one of the exceptions. Xavier Armador, is probably pretty contracersal here. Although, I still find he has some really good stuff. I’ve only read “I’m Right ,Your Wrong, Now What?” I’ve put off reading, “I’m Not Sick I Don’t Need Help” Won’t enjoy it at all, but perhaps will tell me if there’s any hope of seperating. You’re good at getting others to see past differences. Think, LEAP will ever become more than a tool, for med compliance?
Hello, Sandra! I’m kinda jumping in here, but I want to let you know that I watched the video where you, and Frances, and another gentleman were all on a panel, at a conference, or something, recently. Frances led off, and he spoke assuredly, and confidently, and what he said was mostly “yada, yada, yada”! Same ole’ same ole. You know, well-spoken LIES!. You did pretty good, but the notes you used detracted from the power of your words. The “other guy” wasn’t given as much time, or coverage.
Sorry this sounds so vague, but I do want you to know that I do like you personally, and it’s my critiques and attacks against the abuses of the pseudoscience of psychiatry, and the gross over-use of DRUGS, (they are NOT “meds”!….), which fuels my passion. We don’t have to agree, to get along. I’m really pretty laid-back, in person. But, yes, ANY forced treatment is torture, and a human rights violation…..
I hope you’re well-versed on exactly what “MK-ULTRA” was, and still IS….~B./
This is to Bradford.
Thanks for those comments. I appreciate it.
Kayla, my opening comment about Sandra being perceived as a “collaborator with the enemy” (i.e., mainstream psychiatry) was based on previous responses (by some) to articles she’s written here. I hadn’t read any of the comments here beforehand and agree with you that most of them have been positive. And in speaking of “real world credibility”, i was in no way trying to deny or denigrate the experiences of those, like you or my older daughter, who have been victimized by forced or strongly coerced psychiatric treatments that seemed to harm much more than help them. I am trying my best to advocate for such people, and I’m sure many others who comment here are doing the same! At the same time, my own experiences and those of a wide range of people I continue to hear from leads me to have an appreciation for just how knotty the dilemma(s) can be for anyone dealing with a severely psychotic state–the individuals themselves and those who love them and are trying to find the best way back to sanity. My sense is that some people (not you) find it easier to “posture” in a stance that something is always wrong or always right than to deal with the hard realities of situations in which each path is fraught with serious potential difficulties. Having said that, I am firmly in yours and Sandra’s camp in terms of strengthening the safeguards against forced drugging. Hope I’m not coming across as a politician here!
Russerford, I’m not familiar with “mainstream psychiatry”. You mean, more traditional practices? I get it, but still seems like it may just bring conflict from another artical, which is just a little confusing, since you don’t appear to be trying to. The posturing makes sense. However, I’ve talked with people who were labled being in a severely, psychotic state, and don’t think they were dangerous. I think a lot of that comes from people’s own insecurity as to what they were saying. I also say that, as a doctor who admitted, he only said I was psychotic, when he really thought it was a mood disorder, but I had a choice to take mood stabilizers, and stop the antipsychotic. Like, I’m supposed to trust him. It was very much literally like doing time. He didn’t care, that I was the same exact, after his set time of how I needed to take the medicine. Sure, I’ve had situations where people were labeled as psychotic, come up with some things about me, that were pretty bad. However, I know who I am. A doctor never has, but people have said I was paranoid. As a result of, life, such as my mom suffocating me out of frustration. Another reason the dangerous excuse bothers me, people not labled psychotic are often dangerous. Glad, you realize the dangers of forced drugging. No, not coming off as a politician, although we could seriously use a politician who talk about stuff like this, and not just repeat psychiatrists.
To clarify, I’ve often conciddered DSM, mental hospitals as mainstream psychology, simply because that is generally accepted. Not to say mainstream(in general) means it’s bad, but I would concidder, what Sandra to be reforming main stream psychology, and open dialogue is an alternative. It could be the new mainstream here, as it is elsewhere. Not, sure if it’s what you meant. Although, it sounds like she is calling for both alternative, and mainstream approach. At least what I consider mainstream. Some of here ideas about nutrients seem more, what I’d concidder alternative medicine.
Do you consider stuff like Nami, and APA mainstream, because I honestly see many people in the mental health community distancing themselves from that scene nowadays. Especially, APA. However, I mostly just hear about people talking about their families, which is kind of odd. I don’t know what is mainstream anymore, because the majority distances the self from what I previously conciddered “mainstream”
I always point out how forced drugging is a violation like rape. Rape is using force to put something in a persons body against their will. Bodily integrity is the inviolability of the physical body and emphasizes the importance of personal autonomy and the self-determination of human beings over their own bodies. Violation of bodily integrity is as bad as it gets.
I have personally witnessed dramatic improvement in people who have taken these drugs – even under force.
I was told I look better on Zyprexa, but anyone who has experienced the anhedonia from that crap can tell you there is nothing “better” about it. The most insidious thing about psychiatric drugging is that how outside observers will see “improvements” an then can’t figure out why the person quits treatment.
People who are labeled with psychiatric conditions are often poor and less well-educated than the doctors, lawyers and judges who hold power in the system.
They know 1000 times more about mental illness and the effects of those drugs cause they have lived it and taken them. Ask a well-educated person about anhedoinia and they will spit out a well worded and very correct answer but they really don’t know what anhedoinia is like cause they never lived it.
Most of this forced drugging has nothing to do with helping the person anyway, in reality the person is drugged for the benefit of the people around them. Who wants to see people walking down the sidewalk laughing and talking to themselves acting strangely when we can shut them up with a chemical lobotomy and make them look “better” and have them just shuffle along with an emotionless no one home blank stare ?
I agree the forced drugging aspect is really a problem. Even many “reform” psychiatrists support forced drugging. I think forced drugging should not be used under any circumstances; except perhaps limited use of brief-duration tranquilizers (or ideally just restraints) in cases where a person is about to kill or grievously harm themselves or others.
But the forced, month-after-month use of court-ordered antipsychotics is totally wrong. These drugs don’t treat any known illness and come with a host of horrific side effects. The process is totally unscientific, disrespectful, and dehumanizing. The psychiatrists who support this practice are not true doctors, and should be disbarred and in some cases thrown in jail.
Have to disagree with any forced drugging, or restraints. How, is someody who wants to kill the self going to be helped by that? More, like give them more reason to, and less likely to trust anybody. Drinking, poison to escape an abuseive home, combined, with not taking mood stabilizers, and criticizing the DSM, got me court ordered Antipsychotics. Doctor admitted he lied, about me being “psychotic”, because he can’t force mood stabilizers. He said he was pretty sure I was “bipolar”.
Just as arbitrary as anything else. Also, assault is never okay, hence why forced drugging isn’t either. However, forced drugging will not help.
I do not support forced drugging and certainly in an ideal world would like to see no forced drugging and far fewer drugs period. Nevertheless, if forced drugging were only used for at most a few days at a time, it would be a massive improvement over the current situation where many people are forced to take drugs for months or years under community orders.
Sometimes politically one has to make compromises to get to an eventual destination one wants to reach.
And as for restraints, I don’t think you can realistically ethically argue that restraints should never be used. If someone is trying to kill other people, they have to be stopped from doing this, at least until they calm down a little. It’s an unfortunate reality. Ideally talking to and comforting them would always work, but we both know that’s not always possible. However restraints and seclusion should be used far less and only for the most serious physical threats.
You might want to read a prior blog of mine dealing with the abolition of ‘force.’
This blog appeared before you stated being a regular commenter at MIA. Read the discussion as well, for it covers practically every aspect of this issue from all angles, including extreme/exceptional circumstances.
Restraints go on the outside of the body, the drugs go on the inside of the body and that’s a huge difference.
Of course to outside observers the restraints look much more barbaric on the outside of the person then the neuroleptic ‘nerve seizing’ drugs usually look on the inside of the person.
Restraints don’t cause neuroleptic malignant syndrome a potentially life-threatening reaction to the use of almost any of a group of antipsychotic drugs or major tranquilizers (neuroleptics) characterized by high fever, stiffness of the muscles, altered mental status (paranoid behavior), and autonomic dysfunction. Autonomic dysfunction alludes to defective operations of the components of the involuntary (autonomic) nervous system, leading to wide swings of blood pressure, excessive sweating and excessive secretion of saliva. No one gets that from being restrained if they are bent on attacking people.
Of course in reality if someone is really upset they usually get both restrained and stuck with the Haldol needle.
Psychiatry: We know that Haldol stuff is very dangerous and unpleasant but screw it there just mental patients and their lives and health have very little value to us.
Video: Haldol is evil why do we tolerate forced drugging
I read your article, and basically agree with it. I certainly agree that forced drugging or ECT should never be used.
As for forced restraint, despite reading the article, I was not convinced that it should NEVER be used. There are a very few instances that come to my mind – like a psychotic person coming at you with a knife or a baseball bat, believing you to be a person from their past that has to be killed – in which temporary physical restraint, while undesirable, may be necessary to prevent harm of others. I know that if a delusional person were coming at me murderously wielding a knife, I would not hesitate to use whatever force I could to stop them, and to restrain them afterwards. Of course the goal would be to try to calm the person down, get them into a state where they’re not trying to kill others, remove the physical restraint as quickly as possible, and do so without ever using any injectibles/drugs or other things put INTO their bodies.
I do not support forced drugging and certainly in an ideal world would like to see no forced drugging and far fewer drugs period. Nevertheless, if forced drugging were only used for at most a few days at a time, it would be a massive improvement over the current situation where many people are forced to take drugs for months or years under community orders.
Sometimes politically one has to make compromises to get to an eventual destination one wants to reach.
So, BPD is this the point where you trade in your anti-psychiatry credentials for “alternative shrink” ones?
This is scandalous talk and I am in fact surprised, though not shocked. Have you been talking w/Ms. Altman?
I don’t really think forced drugging should be comprimised. If somebody is a harm to someone else, I don’t see why they should not just be detained in someway. However restrainsts, just seems unnecessary, not to mention dangerous. I’ve heard of people, being injured, or even dying as a result. Besides how is a person supposed to calm down if being strapped down. It’s counterproductive. I get the need to confide them if they are really a threat to people, but not strap them down.
Forced psychiatry is always wrong. There is no room for compromise on that.
This comment amuses me… I don’t formally identify myself as an antipsychiatrist. I have my own views. But if you think about things in this rigid way, then I guess so, I am a traitor to your cause!
Maybe you think that if some deluded person comes at me wielding a knife, I (and by proxy, anyone trying to help a psychotic person) should just stand there and let them stab me through the heart. I don’t think so. I’d do everything I could to bludgeon them into submission, tie them up, and leave them restrained until they stopped trying to cause harm.
It’s easy to sit in front of your computer and write about how force is always wrong. But when someone’s trying to murder you, you’ll fight back. Force is sometimes necessary to survive. I’m a ruthless survivor who will do practically anything to survive… I’ve been involved in real fights for my life, both metaphorically and literally. I know that sometimes people won’t listen to reason and the only way to stop them from hurting you is to subdue them with force. That’s my harsh experience, and I’d do it again if I had to.
Ironically, Altman (who I haven’t heard from) used to write about how violence is always wrong. I also disagreed with her then. Sometimes the end justifies the means.
I wonder how many people who believed they would never use force against a psychotic client have done so when they get attacked by that person. It reminds me of Macchiavelli’s quote, “The promise given was a necessity of the past, the word broken is a necessity of the present.”
Kayla, the point is murderous people have to be stopped from killing. Restraints is one method. If there’s a less invasive way, I’m all for it. If putting them in a locked room, where they can at least walk around, for a period until they calm down works, maybe that is better. One might still have to briefly restrain or hold onto the person to get them in there. My point is that there has to be some method for stopping crazy people who are trying to cause physical harm to others.
BPD — Don’t change the subject, which is forced drugging. It has nothing to do with self-defense, unless you’re in the habit of carrying around a loaded syringe for protection.
My other question is, are you offering these “compromises” on behalf of yourself or all of us?
But if you think about things in this rigid way, then I guess so, I am a traitor to your cause!
“Rigid” meaning consistent? Guilty as charged.
And what do you see as “my” cause as differentiated from yours?
I appreciate you reading my blog on ‘force’ but you must have neglected to read the comprehensive discussion that followed. All of these questions were delved into in great detail. Everything you are speaking up about was addressed.
I am NOT a pacifist nor was I advocating that people sit back and accept being attacked or do nothing if others are being attacked. Yes, these are difficult questions, but you are traveling on a slippery slope when leaving the door open for ‘force’ in “special” circumstances.
Please read the entirety of discussion under that blog – no stone was left unturned.
“Maybe you think that if some deluded person comes at me wielding a knife, I (and by proxy, anyone trying to help a psychotic person) should just stand there and let them stab me through the heart. I don’t think so. I’d do everything I could to bludgeon them into submission, tie them up, and leave them restrained until they stopped trying to cause harm. ”
Hi BPD I had exactly that situation occur. I said I was leaving my wife and she tried to stab me in the heart with a large carving knife whilst I lay on a couch. I gently took the knife from her, returned it to the kitchen and tried to speak to her to get some help. The help she received from a psychologist? Drug Boans without his knowledge with benzos to knock him out, put a knife in the pocket of his pants, and call Mental Health and yell “Help, help…”. And a life was then systematically using criminal methods destroyed. So in some ways I did try and stop my wife from causing harm, but when you can have a gang of criminal thugs who will assist in causing harm (and calling it medicine) then I might have been better just letting her stab me on the couch.
And I’m sure there will be assumtions made about Boans behaviour before this attack, assumptions which would be wrong. It has been when anyone who I have tried to have examine these matters realises that I had done nothing wrong that I am given the cold shoulder. The reality has to be that I did something wrong, and then it justifies the Intoxication by deception, criminal conspire to conceal evidence of a criminal offense, kidnapping, false documents by a public officer, assault, ……. and then we step into the ‘cover up’. Much easier to destroy my life and see how much I can take before suicide.
I don’t support forced drugging ever; have not said so in any comment. I was saying hypothetically that if forced drugging were used much less frequently and for shorter duration, that would be way less harmful than the current nightmare where people are forced to stay on drugs for months or years. It would still be bad for those people who are drugged, and I would still be against that.
My opinions are my own. I am not speaking for you or anyone.
Due to the time it would take to read I’m going to skip the 200 comments right now, but if this issue comes up more substantially in a new article will certainly be interested to see the discussion. I am not in a position to influence policy, anyway… I’m just a person with a normal non-psychiatry job… so my position is not as important as those who are involved on a day to day basis. Sorry. I do support your work.
More nested comments needed…. and editing…
BPDT and Kayla
To clarify my position on the use of ‘force’ I have copied a response I made (Oct. 17 2014) in a discussion of my blog “May the ‘Force’ Never Ever Be With You.”
This was in response to Jonathan Keyes who at the time was supporting the use of ‘force’ in special circumstances
You said: “I think this comes down to my fundamental question. If you oppose force, why do you support police and the prison system for working with the “mentally ill”?”
I do NOT support the police or the jail system working with those labeled “mentally ill.” The prison system in this country is oppressive and the police have a role in society of maintaining order. If the status quo inordinately benefits the 1% at the top of the pyramid and is unjust to those in the middle and especially at the bottom, then therefore the maintenance of “order” by the police is mainly for the benefit of the 1% at the top.
I support people creating alternatives to keep people in distress away from the police and the jails and the psych wards. I have no illusions that this can be widely accomplished without major systemic changes broadly in society, as I referred to in my last response.
So what do we do until these bigger changes take place? Organize. Take a stand, and fight back! Refuse to go with the flow. Refuse to do the system’s dirty work. Let some one else do it, and then call them out on it and shame them (with science and survivor narratives) where ever they are and where ever they go.
You said: “If someone who is labeled “mentally ill” is attacking a vulnerable person, would you intervene…and how? ”
Here is the best I can offer in a very difficult dilemma for anyone working inside the system. They (the distressed person) should be told ahead of time what will happen if they are violent or threatening violence. They should be pulled away from harming some one else. They should be offered support, consolation and compassion. If they are so aroused that they cannot calm themselves (with this kind of support) then they should be offered short term use of sedative drugs (such as Benzos).
If none of this support or offer of drugs works then they should be told that if they cannot control themselves the police will be called to intervene. They should never be forcibly drugged or contained in a psych ward against their will; the short and long term harm FAR exceeds other alternatives.
I believe that if psychiatry was forced to turn over its control of labeled people to other forces in society (even jails), than societal outrage regarding their treatment of such individuals would force more benign approaches to emerge in these other institutions, even prisons and jails.
We need to shine a spotlight on the inordinate and oppressive power that psychiatry wields in this society. We cannot do this by accepting (or reconciling) their right to drug and detain people against their will in ANY circumstances, violent or not. Do you really trust Biological Psychiatry to safely detain some one in this level of distress?
Jonathan, do not under estimate the powerful effect you could have on other people around you by taking a strong stand against the use of forced drugging and forced hospitalization.
BPDT and Kayla
Here is a second response I made in the discussion of my previous blog mentioned above. I cannot stress enough the richness of the content of that discussion. Many people participated and made very valuable contributions to a most difficult issue.
You said: “I just can’t support the idea that we should criminalize everyone who is aggressive/violent and psychotic. I take exception to the idea that.”
You are twisting words and phrases and creating “straw man” arguments to justify your support of ‘force’ and forced drugging.
Where did I EVER say that, or where did anyone else opposing ‘force’ on this thread promote such a position.
We should ALWAYS avoid (wherever possible) involving the police, the courts, and the prison system when dealing with people in extreme psychological states. My trust in those institutions is on a par with psych wards which you SHOULD know from prior discussions is not very high.
You said: “… I think it is highly troubling to turn over every aggressive and psychotic person over to the justice system. The humane thing to do is to give them space until the psychosis passes. If you call that enabling…so be it.”
Jonathan, you are unfortunately now making things up about my position to prop up your increasingly indefensible position on ‘force.’
Where did I EVER say “to turn over every aggressive and psychotic person to the justice system.”
So let’s be clear on YOUR position as stated above:
“The HUMANE (emphasis added) thing to do is to give them “SPACE” (emphasis added) while the psychosis passes.”
Based on your past (admitted) practice in some emergency situations, the “HUMANE” thing to do is tying someone down to a gurney and giving them the “SPACE”; a forced neuroleptic injection.
How BENIGN you tried to make it sound above. But many here at MIA are very aware of the so-called “SPACE” you are carving out for them, and it ain’t so benign or pretty. For many it is extremely life damaging.
Jonathan, the “enabling” that is referred to above (by me) involves the frequent cycle of forced treatment that many people who are caught within the mental health system seem to repeat and are all too familiar with.
Many of these people know that if they defiantly remain acting out or violent that this will often force people like you to forcibly drug them and incarcerate them in a psych ward. They don’t really want it to happen, but they also do not want to calm down and obey you.
This is very much like a defiant son rebelling against an abusive father. He will sometimes push the situation to a point where he will force the father to play out his abusive role so the son can hold on to his anger and prove to himself that he is the ultimate victim (which he is).
This way (the son) does not have to look at or take responsibility for some of his own behavior. And of course the father feels justified (for his own violent actions) because the son may have been out of control. The cycle of violence and dysfunction continues, each “enabling” the other.
Sometimes parents are forced, as a last resort, (when a child is completely out of control) to take their child to a dept. of social services where ultimately a judge will often pose the question to the teenage child, “would you rather follow the rules of your parents or live in a foster home for a while.” Sometimes this coercive choice becomes enough to convince the child to behave better and/or perhaps the physical or emotional abuse by the parents will be revealed to authorities.
Jonathan, you are caught up in an analogous situation in the work you do. You are playing the role of the abusive father/mental health worker who justifies his abuse based on the out of control behavior of the unfortunate patient in the emergency room. The patient in this situation (because of dire life circumstances) is also not willing and/or able to take responsibility for their behavior at that moment. “Enabling” is not the solution to this dilemma.
Jonathan, my position is as follows; PLEASE PAY CAREFUL ATTENTION AND DO NOT DISTORT MY WORDS: in these extreme (hopefully rare) potentially out of control situations the person acting aggressive or violent needs to be given clear and consistent (over time) options by the caregivers.
” Nigel, you need to calm down now or things are going to happen here that neither of us want to happen. In the past you may have been forcibly restrained and then given a forced injection of powerful drugs and ended up on a locked unit of a psych ward. This was wrong and abusive treatment. I have participated in that abuse myself and very much regret my prior action actions, and I am very sorry that you may have endured that type of “treatment” in the past.”
“Now we do things differently. I promise you that someone will sit down and listen to your problems or grievances in your life and attempt to find answers and solutions. You will not be drugged against your will or locked up against your will. You may be given some prescribed drugs if you request them. If you are feeling out of control we have some short term sedative drugs to help you sleep or relax more.”
“Nigel, I am very worried about your situation. Because we don’t yet have safe alternative programs for people in your situation if you don’t calm down now and continue to act aggressive or violent, we will be forced to call the police. This will be our only available option.”
“Nigel, I would hate to have to do this because I do not trust the police to know how to handle you in a compassionate way, and you may end up being isolated and abused. We do not want this to happen, so PLEASE, Nigel, do not force us to make this call. Nigel do you clearly understand the situation and the options before you.”
Now, Nigel has been given clear options. If he makes the wrong choice here, it is terribly unfortunate, but it is a FAR better option (at this primitive place in our history) than the forced drugging and forced “treatment” that you, Jonathan have to offer. An option that you BTW also have the ability and the right to refuse to carry out.
And Jonathan, if Nigel ever comes back to your emergency room, because he was NOT “enabled” in the cycle of violence that you offer. I bet the odds are that he would choose to calm himself down the next time and possible accept your offer to talk about his problems, maybe self admit himself in a crisis stabilization unit (we have one in my city) and perhaps take some drugs to help him get a nights sleep. In this new scenario he would avoid being re-traumatized and his chances of getting better would be increased.
It was an extremely important discussion Richard and I’m glad you have reposted your comments again here.
And for me what stands out is that there has been a ‘clear warning’. I look back at me informing a Doctor that if he were to continue with his physical examination of me that it would constitute an assault. My clear warning which was ignored by a doctor attempting to deceive and exercise powers he did not have.
I don’t know that he fully understood the consequences of inserting objects into me when I had expressly denied consent, or why that may have been a ‘trigger’ for me. In fact, he didn’t really find out a lot about me from the 3 minute ‘assessment’ which found that I was a bunch of mental illnesses that required drugging really.
So the ‘clear warning’ was issued, but the good doctor also knew that he would be supported in his assault through a further victimisation should any complaint arise. He had good reason to feel this confident, they are damn good at doing peoples heads in.
I read your two comments and am supportive.
I am sure we agree on much more than disagree. You know that I comment a lot on MIA, donate money to MIA, have my own site, support other psychiatric survivors to avoid the system, etc. because I care about helping people and am heavily anti-diagnosis and drugging. So I think it is better to focus on what we have in common than to squabble over the few areas we might not agree totally. I can disagree with you on a few things and still support you overall, and vice versa, I hope.
I am sure we agree on much more than disagree… So I think it is better to focus on what we have in common than to squabble over the few areas we might not agree totally. I can disagree with you on a few things and still support you overall, and vice versa, I hope.
In general yes, but it’s still frustrating to see you taking an ideological step down the slippery slope.
Meant confine. It may be over said , but edit would be useful.
Here’s an idea, that’s somehow considered nuts, why don’t we change the legal system, so anyone who is a real danger to people, can only be detained in a humane way. They can choose to get help, not hurting others in anyway they choose, and make sure the people involved are willing to actually help them in the way they want. It’s better for everyone. They will likely feel better, and won’t be a threat. Then there will be no justified for force. No, harming others, and if they can do that, it’s all that matters.
It sound to me like you haven’t been on the inside of a psych hospital and seen delusional people trying to physically attack the nurses. Sometimes this is caused by drugs, but sometimes it’s not… sometimes the person is murderously angry and just wants to hurt somebody. People in these states can’t always make a free choice to get help… they are too angry and scared. In these cases action must be taken so people don’t get hurt. That’s why sometimes brief seclusion and/or restraints are used. Maybe restraints shouldn’t be… but if not, there needs to be another way of stopping them from hurting others.
I drank poison, so I’ve seen the inside of a hospital. Actually, I did see one guy get kind of violent, but luckily he just threw a chair, at a mirror, and no one was hurt, and smashed an apple. You forgot, constantly shining a light in someone’s face. This nurse was also antagonistic. Not, as a blanket statement, but a helping profession, was not for her. They almost put her on one to one, till I begged them to have someone else do it, because he was could’ve really hurt so one. It was teriying, and on the verge of tears until they agreed.
Replying here, because there isn’t a reply, to where I’m responding. Richard, after skimming the comments, I read through almost all your discussion with Jonathan, agreed there was a lot of comment, but just skimmed for something that stuck out. I only missed a couple, but read through the rest. Sorry, should’ve clarified that I was responding to them.
Anyways, my question wasn’t about forced drugging, as I know you against it. Although, this was specifically about what you thought as jails, or an entirely different system, because I agree, with most as far as attempting to help people, and not forcing. I also agree that detainment of some kind needs to take place. However, this was about making the leagal system safer for everyone. That was my question. I meant it for, when you’re at the point of having to call the cops, do you think that improving the leagal system would help? Meaning, they’re there to only contain violence, and offer help. Just detain, as long as they will harm people, and offer help, but not force it.
Putting someone’s hands on someone, to stop eminent danger is different than being strapped down. Puting somone in a room is different than strapping them down.
Well, sometimes you can even injure yourself in a padded cell if your hands & feet are free. Temporary restraint is still better, and more comprehensible to the person, than forced drugging.
Well, I was more referring to violent people. I guess they could hit themselves, but restraining them could cause injury, and even death. Although, I would deffinatley agree no on the forced drugging. I think, they make stuff to cushion people’s, hands. That would at least he better than forces restraints, but I’m still sticking, to that they should only stick to confinement. It also is only to prevent violent acts on others.
Richard, also think police should be required to treat people humanely anyways. The leagal system isn’t that great anyways, and think people would at least want to reduce harm if anything else. Meaning, if people weren’t mistreated in jail, they may not hurt people. Also, for arguments sake, let’s pretend the mental health system is a perfectly humane system that is designed to help people. Is it really fair to draw a line, and say these people are in distress, but these other people are bad, and we ought to teach them a lesson? Aside from not being affective, likely everyone who is acting violently is in distress of some kind. Similarly, people should only be confined to the point they won’t hurt somebody, and they should be put in a situation that’s good when it happens. Meaning they have a place to stay, and food garenteed, and they are offered help finding employment, instead of being turned away. It may also attract people who wish to become police officers who wish to protect, and serve. If anything I think people would agree, for more peaceful ways, if it keeps them, and the ones they care about safe.
Not to mention, all the stories on psychiatrists who need to protect people from the violently mentally ill, may reduce some of the polices fear of them. Also, it may make people not think of themselves as out of control and dangerous. Maybe also if a police killed someone, it would turn into more than a mental health ad. Most, people who are perceived as straight up criminals, have families/friends who wish to investigate. They don’t jump to saying how they should’ve been treated. Obviously there are accretions to both, but that’s at least the side most people see.
I sometimes wonder about what to do with the angry person. Call it psychotic if you will, whatever.
Sun Tzu says something like ‘the city destroyed can be rebuilt, and the angry man happy again. But the dead can not be brought back to life.’
Drugging anger with stupefying drugs is imo a silly thing to do. I would be much more likely to ‘lash out’ under the influence of a stupefying drug like benzos, than I ever would with my best available faculties.
Drug em if you must. But at least give the angry man a chance to once again be happy. And this isn’t done by increasing the ‘potential’ for violence under the influence of drugs.
, all clues and no solutions. That’s how things really are” Dennis Potter Singing Detective 🙂
I was referring to what the police are told. They are told, people with a diagnosis of psychosis are dangerous. They go in already expecting violence. I think they should always try, and desolate, any actual violence. However, them being told horror stories is not helpful, to a group, that isn’t even violent, and also, any incident is blamed on a so called illness. Then, psychiatrists wish to make a drug commercial. They don’t take any responsibility to there part, weather the direct, of drug, diagnosis, therapy, or indirect telling people that psychotics, are dangerous, and unpredictable, to get people to take drugs.
The line for forced drugging in my State
Nurse: take these pills
Boans:what are they?
Nurse: 4 benzos and an anti psychotic
Boans: No, I have a bad reaction to benzos and they will make me ill
Nurse: Code Black
surrounded by a dozen security and nursing staff I am informed that my right to consent has been removed and I will be subjected to restraint and forced drugging by a doctor who introduces himself as Dr “I’m the boss around here”.
Glad to hear that the line is a little more stringent elsewhere, because this type of behaviour in my State is called “accepted practice”.
Given that sort of ‘protection’ I hope that those in the US can see how ‘dribble therapy’ could be used by both corrupt public officers and organised criminals to ensure that any evidence of wrongdoing never sees the light of day. And if I had not witnessed it first hand, I would give myself a number of labels …..
Damaging people using this method of course is usually followed with calls for more resources (security and placements for those damaged). Sure looks like medicine if you do it in a hospital though lol
In Illinois the doctors who force medicate people do so prior to any legal system involvement, and just forge patients’ signatures on the voluntary commitment papers, to prevent the patients from having their day in court. According to my medical records, I was immediately force medicated with 9 drugs, on day one in the hospital. Then “snowed” with various different similar combinations of massive drug cocktails for ten more days. All to “cure” a non-existant “chronic airway obstruction,” in reality, a one time ever, “not a danger to self or others” sleep walking / talking problem. And also to cover up prior medical “bad fix” and “Foul up” confessions, and medical evidence of the abuse of my child.
Definitely, forced treatment is being done for the financial benefit of the doctors, not the well being of the patients. My force medicating doctors charged my insurance company $30,000 for their torture of me. And my force medicating physician was even arrested by the FBI years later for having lots and lots of patients medically unnecessarily shipped long distances to himself, “snowing” patients, then performing unneeded tracheotomies on patients for profit. But he was curiously not prosecuted.
I will admit, when I spoke with the DuPage county states attorneys about this, they did get really embarrassed and it struck me there may have been some financial kickbacks going from such criminal doctors to the states attorneys’ office.
I will also say the second time I was medically unnecessarily sent to a different county, one in which I did not live, to this same psychiatrist, after getting a “medically clear” diagnosis at a forced physical, with no HIPPA forms signed. Because a policeman took me into a hospital for quietly lying in a public park, minding my own business, looking up at the clouds. Not certain when such became illegal or a “mental illness” in the US.
I was again briefly force medicated, first with a neuroleptic, to which I have adverse reactions. Then I was force treated for a non-existent UTI by that psychiatrist, according to those medical records. I’m quite certain forced treatment for non-existent UTI’s should be illegal, but the drug forced upon me was one known to create “psychosis.” It also made my heart feel like it was going to stop, so I wasn’t forced to take it for too long.
Of course, that state facility refused to hand over those medical records until after the two year statute of limitations to sue for the malpractice was up. I didn’t have health insurance at that time, so I’m not certain how much the state of Illinois was charged for that week of unneeded medical incarceration.
Forced treatment should be illegal.
a doctor who introduces himself as Dr “I’m the boss around here”
I only got the assault and rape with needle threats from a guy like that and staff when I refused the prescribed drug overdose and made my own threat that someday I might see them outside the hospital alone and retaliate, if they violate my body or put their hands on me. Put your hands on me and see what happens when I see you outside this place, alone.
I mean what the hell I am sick and go into the ER looking for alcohol detox voluntarily ( I thought I would get a real hospital bed ) but instead get transported to this hellhole , strip searched and 36 hours later I am being threatened with assault with needles full of drugs.
I said no more drinking today , F this alcohol its killing me , I need help. I am going to get a nasty bill but I need detox, this has to stop. I never got any detox medication and like I already wrote they were just hell bent on forcing a HUGE dose of disabling drugs down my throat, a SCARY dose of disabling drugs down my throat.
If I ‘needed’ the drugging so badly that they threatened barbaric measures including rape like needle penetrations then why have I been sober ever since, for years now and not had ANY mental health problems ???
So many of these articles about forced drugging infer that these barbaric measures are only for really “sick” people. They pull this crap on everyone who refuses their pill lobotomy day one.
I swore during my inpatient nightmare when it was over I was going to speak out, that’s why I write on MIA almost every day.
Yes the_cat, he is an interesting character Dr psycho eyes I’m the boss around here. I’ve met others like him at football clubs who know the methods of obtaining consent using these methods.
There was a happy ending of sorts which didn’t require the use of the car park though. My wife and psychologist who came up with the plan to drug me with benzos and use a throw down to have me detained seem to have wanted me to attend this hospital emergency dept where the psychs husband worked as a Consultant Psychiatrist (I was ‘groomed’ into attending). This Head of the Emergency Dept it would seem was doing a favour for a friend. Bait him and then drop him.
Unfortunate that my wifes Doctor and another man came out from behind a curtain just as the needle was about to be injected and he was taken away. I was not injected.
Seems he used to be the Boss around there, but is now as a result of being snatched from the brink is in anothers pocket. He is no longer really the Boss anymore, but at the bidding of his new boss.
Boans was used as bait to catch a criminal ‘snower’. And he isn’t his own man anymore lol
Good for you the cat. I had a similar experience; after all the harms that happened to me at the hands of psychiatrists; I swore I would speak out too. Don’t stop, I enjoy hearing your voice. Even if you are a little crazy about guns.
Bravo Sandra! I continue to admire your personal courage and integrity in these matters.
In criminal law, Blackstone’s formulation (also known as Blackstone’s ratio or the Blackstone ratio) is the principle that: “It is better that ten guilty persons escape than that one innocent suffer”. Other commentators have echoed the principle; Benjamin Franklin stated it as, “it is better 100 guilty Persons should escape than that one innocent Person should suffer”.
How many people convicted of some DSM label in mental illness forced drugging court in would have got better if they escaped drugged ?
Psychiatry doesn’t think that way, some pharma funded study will say 51% percent of people benefit so 49% of people are condemned to suffer.
Even if the treatment is painful, even if it is life-long, even if it is fatal, that will be only a regrettable accident; the intention was purely therapeutic…
But because they are ‘treatment, not punishment, they can be criticized only by fellow-experts and on technical grounds, never by men as men and on grounds of justice…
C. S. Lewis, “The Humanitarian Theory of Punishment”
Escaped UNdrugged ! Spell check got me again.
“People who are labeled with psychiatric conditions are often poor and less well-educated than the doctors, lawyers and judges who hold power in the system.”
I was not aware of this. My impression was that going the psychiatric route for support is what made people become poor. I also knew a lot of people in the system who were extremely well-educated, as I was when I was going through all of this. And the ones without formal education were still well-informed, and in fact, quite brilliant.
You’re right, however, a power shift is sorely needed. I believe this is why we are telling our stories and finding our voices. Personal empowerment goes a long way in getting past the economic and other personal agendas of powers that be.
Do a search on Google for psychiatric diagnoses and economic status.
“Mental illnesses” do discriminate against the poor, contrary to the denials of deluded psychiatrists and ignorant politicians. Compare to the wealthy and middle class, there is more violence, stress, abuse, and neglect among poor people – and so within this group there is inevitably more emotional distress and inevitably more people labeled with pseudo-illnesses like schizophrenia.
This is also why black people get diagnosed with schizophrenia 2-3x more often than white people. It’s obviously not because having black skin makes people become psychotic. It’s because having black skin correlates with being poorer, getting abused and neglected more as a child, getting discriminated against and bullied more, getting poorer nutrition, and generally being treated like shit. Those are the real causal factors of severe distress.
Of course, a few sad-sack psychiatrists are saying that “schizophrenia” is “overdiagnosed” in blacks, as if schizophrenia were some thing that existed outside of the racial or social context. But nobody outside of psychiatry can believe their fairy tales…
I agree, BPD, that the system operates as one big sitgma machine. I believe that’s the problem, too many false and negative associations simply from our diverse nature. I also believe that class division is, in reality, a hologram. Indeed, the system operates via class division. What I’m saying is that many people lose everything after a diagnosis because they become disabled from the treatment. This would not be necessary, exepct that the system has become a corrupt circus and one deceit and betrayal after another. This is costly for everyone concerned.
After listening to your testimony before the committee including the question and answer periods, I was impressed with the way you presented the research on medication and long-term functional outcomes. Your deep involvement in the local mental health scene over many years gave a lot of credence to your perspective and it seemed to me that the committee members genuinely respected your contributions because of that, over and above your credentials as a physician.
Going forward when speaking to these budget-minded folks, I think you could make your case even stronger by articulating more clearly the cost implications of the evidence base that you presented. Of course the committee wants to hear “if you do X, you will save Y dollars over so many years”. But even if the answer is not this simple in your view, it can be just as important for you to explain why they need to reconsider their assumption that the forced medication approach will save the state money.
There’s clearly a belief on the part of the proponents of the forced treatment policy that it will both improve outcomes and save the state money. You did a good job of explaining how the research shows it probably won’t improve outcomes, but you could have drawn a clearer link to why it also is unlikely to reduce long-term costs. I think there were a number of committee members who would have liked you to go a step further in explaining that to them. People seemed to respond well to concrete illustrations, so for next time perhaps you could think through an example something along the lines of:
Suppose we in Vermont experience the same results as this Wunderink study, where about 20% of the patients on the medication minimization arm had a better functional outcome, and the other 80% had on average the same levels of symptom reduction, relapses, and functional outcomes as those who took medication consistently over time. If we institute a forced policy of long-term maintenance medication for everyone, we’d be spending all that extra money on meds for this population over 10 or 20 years without improving outcomes, and in fact we would cause worse outcomes for about a fifth of the population. Is that really a good value for our state?
And then on top of that, you can conclude by highlighting all of the evidence-based approaches you are working on to actually improve outcomes more dramatically.
Just want to let you know, Dr. Steingard, that I appreciate the point of view that you bring to this website and what I see as your desire to be fair and honest and true to science and reality and individual differences. Having first-hand experience with “schizophrenia” and using neuroleptics (it’s many diseases and everyone’s different, blah, blah, blah) I do share the concerns so frequently brought up on this site re. iatrogenic harm, but I also find the evidence lacking to support the point of view that “schizophrenia” is a “lifestyle” (as Loren Mosher put it) in all cases or most cases. I’m willing to accept that at least one aspect of it is that it involves an unfortunate/poor reaction to stress, perhaps with a strong biochemical basis in my case — actually I hope so as I’m embarking on some megavitamin therapy (under the direction of an “orthomolecular” physician) –anyone interested should look up “Schizophrenia: An Orthomolecular Approach to Re-Balancing Brain & Body Chemistry” on youtube or Abram Hoffer. Neurofeedback may also be useful to look into. I generally do think psychiatry must simply be “lost in the money” (based on my disappointing encounters with a few uninspiring psychiatrists), so it is encouraging that at least a few are willing to be the leaders that should be expected of someone with an MD, so thank you Dr. Steingard for that. Having said that, if we’re looking for solutions we shouldn’t be too narrow in our search (or cling to tightly to unproven ideas).
Thanks, chris12345 – and thanks to everyone for what appears to be a respectful discussion on an extremely contentious topic.
I think our opinions are in alignment and I am glad you have chosen to speak of your experience here. This is such a complex topic and there remains much we do not fully understand. There appears to be incredible variability – in outcome, optimal treatment, etc – among people who experience this broad entity we label as schizophrenia. I am mostly frustrated at colleagues who seem to reject that very simple premise. Some deal with this by saying “Well, they didn’t really have schizophrenia.” That is a meaningless statement when the way to prove it is for someone to reject the recommendations of the profession and go on to do quite well. But it happens the other way when someone says they find benefit from the drugs and are told they have just been co-opted by the system.
“Some deal with this by saying ‘Well, they didn’t really have schizophrenia.’ That is a meaningless statement when the way to prove it is for someone to reject the recommendations of the profession and go on to do quite well. But it happens the other way when someone says they find benefit from the drugs and are told they have just been co-opted by the system.”
This is a brilliant statement, Sandy. We do tend to rationalize a lot when looking for a specific outcome, rather than simply letting the outcome speak for itself.
I agree that when we find effective healing away from psychiatric protocol, which as we know has proven to be quite harmful for so many people, that is evidence of there being ‘something more’ out there, in terms of helping people to alleviate their suffering and become aligned with themselves in a more comfortable and grounded way, where they feel their own value and worth as a human being. From that, all things are possible I believe, but most of all, full on transformational healing.
I think it would be fascinating to study the healing processes of those that rejected psychiatry after becoming ill from it who then went on to other kinds of healing which worked. At least then, psychiatry could at least have the opportunity to expand its breadth of healing knowledge to include those that reject medication and even perhaps, psychotherapy.
There are many things that can replace, or at least complement, these practices, so that force is something that never, ever has to be considered. There are other options, from an expanded perspective, if we were to honor and integrate what we are calling ‘alternatives.’
Although I would suggest that the list of ‘alternatives’ is extremely vast and varied. It includes so much more than simply healing modalities. To me, ‘alternatives’ is really about seeing things differently, considering a bigger picture, for example.
There is a lot that can be created by considering how different tools and perspectives can work together in a way to broaden our perception of human processes.
Yes, Sandra, I really wanna see you address the issue – that at the University & PhD, & MD level, there’s a movement in Europe and elsewhere, to end the concept of “schizophrenia” as a distinct medical entity, legitimate diagnosis or not…. You must admit, Sandra, that the absence of evidence – the complete lack of so-called “biomarkers”: is a telling, and damning indictment. Where’s the MEDICAL EVIDENCE that so-called “schizophrenia” even exists at all, outside the minds of psychs and the moldy pages of the DSM-V?…. Will we see a DSM-V-R? A DSM-V-TR?….. Whether it’s “evidence of absence”, or NOT, you must admit there’s absence of evidence…. RSVP?________________????….
(Yes, that makes ALL forced drugging & treatment TORTURE, in MY book!)
Tell THAT to the MEDICAL MAFIA in Vermont…..
Can you get a jury of your peers before psychiatry is allowed to violate your body and alter your mind in Vermont ?
This whole idea of forced drugging is so vile and wrong.
Here is some interesting stuff I was reading working on this post, As psychotropic drugs are a powerful method of altering cognitive function, many advocates of cognitive liberty are also advocates of drug law reform; claiming that the “war on drugs” is in fact a “war on mental states”
Much more here https://en.wikipedia.org/wiki/Cognitive_liberty#Freedom_from_interference
Mental health court: You have been convicted of illegal thinking, like 1984 and the thought police.
I have a friend in AA who was convicted of mental illness and forced to take lithium and some of the other chemical nightmares psychiatry calls ‘medicine’. I am encouraging her to write her story and post it online because for one thing I am tired of these articles that infer that forced drugging is reserved for only those who are “severely mentally ill” otherwise known as bat shit crazy.
Lithium ! Effects → extreme thirst, urinating more or less than usual; weakness, fever, feeling restless or confused, eye pain and vision problems; restless muscle movements in your eyes, tongue, jaw, or neck; pain, cold feeling, or discoloration in your fingers or toes; feeling light-headed, fainting, slow heart rate; hallucinations, seizure (blackout or convulsions); fever with muscle stiffness, sweating, fast or uneven heartbeats; early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears. tremor of the hands; weakness, lack of coordination;mild nausea, vomiting, loss of appetite, stomach pain or upset;thinning or drying of the hair; and itching skin.
What right does any human being have to inflict any the above on another ? Its criminal.
So she is writing her story and we are going to http://www.ripoffreport.com that program that works with the courts and helps enforce this barbarism and just expose this crap the best we can.
I have another thought for you, regarding this:
“Efficacy of the drugs: When the antipsychotic drugs were first used, it seemed to be helpful for many people who took them. However, if you look at current meta-analysis on efficacy they still all favor antipsychotic drugs. However, the effect size of recent studies is much lower than is generally acknowledged.”
This has to be understood in terms of how efficacy is defined and measured. The “efficacy” being referred to is in reducing delusions and hallucinations over a period of a few weeks or months. When the long-term side effect profile is considered, the symptom reduction is hardly a net gain in the long term for most people, nor does it relate to functioning better nor usually to negative symptoms (more important to many clients). The perspective or desire of the client is never considered… “efficacy” is more about making them less of a disturbance to the family and treating clinician.
Outside of Open Dialogue, some of the best long-term outcomes with psychotic clients have been achieved by long-term psychotherapies under practitioners such as Gaetano Benedetti, Ira Steinman, Murray Jackson, Gary van den Bos, Bert Karon, the 388 project’s French therapists, David Garfield, Vamik Volkan, Bryce Boyer, Harold Searles, Daniel Dorman, and others. These therapists work either with no drugs at all, or with limited low-dose uses of drugs which are usually tapered down as quickly as is realistically possible. People can work on their fears and goals far better this way, when they have access to as much of their conflictual feelings as possible. This perspective is largely lost in mainstream psychiatric settings, in which there is so much overfocus on an intervention that often should not matter much at all in the long term (drugs). The only reason for this overfocus is the drug companies’ need to profit and psychiatrists’ need to be seen as real doctors treating actual illnesses. It has little or nothing to do with what is best for clients.
I would suggest you revisit the Gottdiener meta-analysis that I linked above, and note how adding antipsychotic drugs to long-term psychotherapy of schizophrenia did nothing whatsoever to improve outcomes, in a sample of 2,600 clients drawing from 37 different studies. In the long-term, the efficacy of antipsychotics, if any, is probably even worse and less meaningful for quality of life than in the short-term. Again, antipsychotics should not be the central issue in helping psychotic people – the relationship with the person and their family should be central, and their goals should be first, not the goals of the treating “doctors” to use drugs.
I thought Sandra already addressed a lot of those points. May, be a good idea, to listen and not just assume stuff. Especially when listing a lot of suggestions. Not, to say they may not be good, but it’s a lot, and sound like you don’t know where she is coming from, but I’m not her, so I don’t know. I know the comments to me seemed pretty assuming, and like you didn’t listen.
However, partially was also saying this in hopes I didn’t come off that way. I’d suggested something, that I personally find useful. I also made sure to understand her point of view, and not assume. Granted, I guessed she may not be familiar with it. I also asked. A big reason too, I thought she may not’ve, as I don’t think it’s commonly used. Is typically only associated with med, compliance so it may be all she heard. A big reason though, was I was suggesting it to be used for purposes that may not be thought of. I also explained my thoughts, a bit. I tried not to ramble, but also wanted to give somewhat of an idea, in could either ask questions, or look into it more.
“I have personally witnessed dramatic improvement in people who have taken these drugs – even under force.”
This will look like cherrypicking ssomething rotten and it is and it isn’t.
I find these kinds of claims problematic. Essentially when what is being claimed is that an infringement, violence, deprivation, torture upon a person in some instances can bring about worthy and laudable results.
It is at best a claim for the efficacy of a Stockholm Syndrome.
This is a questionable statement by Steingard. It is also elevating anecdotal evidence in a way that is not really reliable or evidence of anything.
Also, the statement does not clearly causally link “taking these drugs” to “dramatic improvement”, although it implies this link. The possibility remains that the drugs could be doing nothing or causing harm, and the dramatic improvement could result primarily or wholly from Steingard or other people’s attempts to help, or from the client’s attempt to help.
I can’t resist the opportunity to take cracks when people are covertly supporting the “drugs work” / biological model without good evidence…
Rasselas.redux I’m really not arguing against anti force by any means. You make very good points. While, I wouldn’t call it cherry picking, as force is in important thing to discourage whenever possible. I will say, that I’m not sure any of people listening were anti force. From my understanding they were talking about preventing more forced drugging. I wouldn’t settle for it, but perhaps even as a result, there won’t be forced drugging. I personally wouldn’t be satisfied with anything less than all forced drugging be illegal.
However, BPD, some of what you say seems very valuable, and don’t take this the wrong way, but a lot of what you say seems one sided. Not saying you shouldn’t have your own opinion, but I think if you don’t always see where someone already agrees, or is aware of something you’re saying.
I am not being cagey about this. I am doing more than implying a link. I am being explicit about the link. That is my observation. I understand that there might be factors operating other then the drugs but for some the change appears to be dramatic. For some, the change is experienced as a relief from what their mental state was before. For some the change seems positive to outsiders but negative to the one who is taking the drug. These are after all psychoactive substances. I adhere to Joanna Moncrieff’s drug centered model so I am not implying that they are correcting some underlying defect, just that they have an effect.
I feel pretty sure after years of experimentation that when I have a glass of wine at a cocktail party, I am more relaxed and less socially awkward than I would otherwise be. I think that is a drug effect but who can ever truly answer that question.
I do not intend to make light of forced drugging but I am speaking to my own limitations in not finding any way to keep some people out of jails or hospitals when they decline to take one of these drugs that appears to allow them to live more peaceably in our world. I truly wish I could figure out something else and I invite all of you to step forward to help your fellows in finding some alternative path.
Sandra, I appreciate your effort. However, if you casually draw an equivalence to booze at a cocktail party you sound much less convincing. I assume your readers are insightful enough to avoid being fooled when they read, but it’s ok to be pro-drug “with conditions.”
Careerists are actually the ones who keep prisons and hospitals full. It is very difficult to have psychiatrists understand larger problems, when their salary depends on ignoring them.
This is about power, we can safely stow empathy or self-aggrandizing commentary. All doctors want to be helpful as far as we know, even the psychiatrists who have less overtly killed people. There was no lunge with a knife, there was a prescription pad and a profession heavily vested in protecting itself.
You were pretty clear, but in case I prefer to try and avoid speaking for others. Althoug, it is pretty frustrating to see when somebody clearly did not listen, which brings me back to when people say suffering doesn ‘t prove mental illness, and then somebody else says, you’re not acknowledging the pain of people with mental illness are in pain.
Gene, I’m not sure I understand wheat you mean. I’m not sure that statement was meant to be convincing of anything. I think it’s understood many including myself will always be against force. I think it meant that a reaction to chemicals isn’t evidence for a disease.
Some doctors have inadvertently killed people. I think, your examples should give us more reason to fear, and not less. The first rule of medicine is do no harm, which makes them responsible for finding out dangers involved in a prescription. Yea, mistakes happen, but your mindset sounds like it could stunt accountability.
“I feel pretty sure after years of experimentation that when I have a glass of wine at a cocktail party, I am more relaxed and less socially awkward than I would otherwise be. I think that is a drug effect but who can ever truly answer that question.”
And this is a choice that you make to consume alcohol Sandra, and I would expect if you had two or three that you would not drive a motor vehicle. But what about me? The ‘fighting drunk’? Should I be forced to relax at this cocktail party by having alcohol administered against my will because from experience we know that it relaxes people? And when I become aggressive as a result, I am then held responsible for my actions? Despite my refusal to consume the alcohol?
And these drugs? Forced to take them and then harm others as a result? Though I’m certain that it would be attributed to some ‘illness’ rather than the drugs.
It’s a point worthy of deep consideration.
I was just trying to address the issue of the link between a drug and its effect. I believe I have observed times when the effect of the drug appears to be overall beneficial for that particular individual.
So with alcohol, it can be beneficial for some and terrible for others, This distinction has to do with a host of factors.
Thanks Dr Steingard,
I will say though that the point I was trying to make stands. That the observed effect may appear to be beneficial most of the time, and yet produce an increase in potential for violence.
For example, my experience with alcohol is that whilst after consumption I may appear jolly and relaxed, but am much more likely to pop someone on the nose should they provoke me in ways I would normally let slide.
Given that situation the ability to force me to consume alcohol against my will would to me mean that I should not be held responsible for my actions, and that the person who has the power to force me to consume has taken on that liability.
This is not what we see in cases for example where people under the influence of these drugs going on shooting sprees etc. And there is, from my personal experience a loophole that could be exploited by people with evil intent.
I’d also like to add that you have contributed so much to me being able to resolve the evil acts which have been perpetrated against me. Thank you for your help is solving this rather twisted puzzle which was created to conceal these acts.
Very well done! There is a need for uncertainty and you explain it well.
There is no magic bullet. It takes time in a time when we want a quick fix.
It’s mind, body, spirit. Time changes the mind, medicine changes the body, and the spirit needs support.
Thank you for sharing.
After sharing this in ISPS, I’m gonna put this on here as well: These interviews below represent the types of results and client-satisfaction we could be having if the focus for psychotic people were more on effective psychotherapy rather than “To Use Drugs, or Not to Use Drugs”…
In the last 2 weeks I got a chance to speak to a couple of skilled therapists of psychosis, Gary Van den Bos and Dorothee Bonigal-Katz. I wanted to report a little bit of what we discussed, because I know they want others, in particular young therapists, to hear about their work.
Gary Van den Bos is the co-author of Psychotherapy of Schizophrenia, which he wrote with Bert Karon. Gary and I live about only 10 minutes apart, in McLean, Virginia outside Washington DC. So we met in person at a coffee shop in McLean because I wanted to ask him some questions about his book and his life’s work, and after repeatedly nagging him I finally got him to meet me. He’s now retired after many years as head publisher of the APA… during which time he also worked in a private therapy practice with many severely psychotic people labeled “schizophrenic” and “bipolar”, often young people who had been hospitalized and started therapy with Gary upon getting out of the hospital.
Over more than 40 years as a therapist Gary told me he’s worked with over 100 psychotic men and women in serious attempts at psychotherapy, i.e. 1 year or more, usually meeting at least twice a week or more often. Most people he worked with for at least 2-3 years, often longer. He worked most often with no antipsychotic medication at all, or occasionally with low doses, tapering down as quickly as possible.
Gary said that about 80-85% of “initially schizophrenic” people that he worked with got much better, i.e. became non-psychotic, were able to work, have relationships, and not need drugs. Of these 80-85% , he said perhaps two-thirds were “essentially normal, and you would never know they had had serious emotional problems if you didn’t ask them”… and another third were “mildly disturbed, but feeling and functioning much better.”
Gary also told me that the majority of young psychotic people he worked with were able to have long-term intimate relationships and/or get married and have families (something which gives the lie to the notion that schizophrenia is a disease innately associated with low fertility… more like associated with rarely getting sufficient help to get well).
Gary said that he felt it often takes a year or a bit longer for a young psychotic person to begin to develop a trusting relationship in psychotherapy of the kind that can lay the ground for eventually resolving the psychosis. He felt that a large majority of therapists/psychiatrists – perhaps 80% or more, he told me – simply don’t work with “schizophrenia” from a perspective that will work to heal the person, believing mistakenly, rather, that they have a brain disease requiring drugs…. this of course makes the work much harder and often impossible.
It was great speaking to Gary.
Then yesterday I got to speak to Dorothee Bonigal-Katz, a psychoanalyst in London, UK… we spoke on the phone after I emailed her and set up a time to speak. I was interested because she runs a “Psychosis Therapy Project” sponsored by a nonprofit mental health charity called Islington Mind. On the charity’s website, not much detail on the project is available so I wanted to find out more.
Dorothee said that the idea of the Psychosis Therapy Project is to offer people with a label of schizoprhenia or bipolar long-term, open-ended psychotherapy for as long as they want at very affordable, low-cost sliding scale prices. Most or all of the cost is subsidized by the charity.
Currently, the project has about 14 therapists, including Dorothee, the lead therapists, working with about 45 different psychotic clients. Some of the 14 therapists are young therapists and some psychoanalytic candidates… Dorothee is the leader and tries to teach the younger therapists about effective psychotherapeutic approaches to psychosis. The clients are usually seen 1x or 2x a week, although sometimes 3-4x a week, depending on what the client wants.
Dorothee said that the setting of the Psychosis Therapy Project is a kind of clubhouse where clients can come for weekly meals outside of their therapy sessions, get peer support from other clients, create art in a drawing room… the idea is to develop a community around the therapy sessions.
The Psychosis Therapy Project hasn’t done formal outcome research, as its primary goal is to serve its clients, but Dorothee says that most clients are very happy with the therapy they get. Additionally, in the last 2 years, the 45 people in psychotherapy have a 0% rehospitalization rate, and this is in a population of people with a long history of hospitalizations and “sections.” Also, Dorothee noted to me how the majority of clients stay in therapy for the long-term; the drop-out rate is relatively low and Dorothee feels the unpressured environment and the clubhouse help clients stay in contact. Clients are also free to leave for a period and return later, and their therapy doesn’t have any set end date.
The approach Dorothee teaches (as the leader of the group of 14 therapists) is based on a Freudian, Lacanian, and Laingian understanding of regressed mental states which emphasizes relinquishing labels and assumptions (Dorothee was trained in Paris, France). The Psychosis Therapy Project focuses especially on “listening without trying to fix the psychotic person, without trying to solve their problems right away”. In this, their approach is the opposite of most English psychiatrists and mental health services, who are primarily concerned with “eliminating symptoms” and with controlling behavior.
Dorothee said that the people doing the best tend to be those who never took drugs or who come off them quickly after hospitalization… .I’ve heard this so many times now that it didn’t surprise me at all.
Lastly Dorothee talked about The Psychosis and Psychoanalysis conference in London that is going on in a few months… noting that they have 250 signups so far. She encourages others to come.
It was great talking to Dorothee too!
I share these accounts of my talks in the hope that you will find them useful, and because I want to generate more awareness that intensive psychotherapy of psychosis, usually with low-or-no drugs, can be very valuable and effective. From reading mainstream psychiatric accounts, one might never know that these kind of successes existed, relatively rare as they are in the sea of overdrugged failure that pervades American and global “treatment” of psychosis.
The tragic thing is that these positive outcomes could be so much more common, were we as a society to abandon the brain disease-life long drugging model and adopt a primarily person-centered, psychologically/socially oriented, hopeful conception of psychosis and recovery. That would, of course, require giving up most of an average of $18 billion in annual profits from sales of antipsychotic drugs… something psychiatrists and drug companies do not seem too keen on, even though the massive overdrugging contributes to preventing millions of psychotic young people from recovering to the point where they can become enduringly non-psychotic and live normal lives with jobs, friends, and families.
That does sound so very, very encouraging…. with only 15 – 20% failure rate, and the estimated ~3million schizos in America, we could do a near drug free cure with what, 2 – 3 “patients” per year per therapist, that’s what, a *MILLION* new “therapists” we’d need….????….at maybe 10 patients per therapist, per year, that’s 300,000 +/- new therapists we’d need…..????….. Please, tell me my math is wrong, based on the stats provided above. Let’s be scientific about this….
Dr. Steingard, your testimony was superb. Mad people can’t often count on being protected by their psychiatrists from abuses in the mental health care system. I was blown away by how you focused not only on the health-endangering aspects of forced-treatment, but also on the injustice of this form of medical abuse and the anger that Mad people feel over having to endure or risk enduring it. Thank you SO MUCH for having our backs!
Thanks, J, for your kind comments.
“Antipsychotic drugs are not the wonder drugs they are made out to be.” I’m pretty sure I’m not quoting this correctly, but one of the statements the doctor made was to that effect. I didn’t know what psychotic was till I was tricked into taking anafranil. After that demon drug was taken away from me and I went into severe withdrawals, they put me on mega-doses (“heroic”) of Haldol which only made my thoughts more confused and my evil thoughts impossible to control. They didn’t needle rape me–it was consensual, albeit I was lied to and seduced–I believed doctors had my best interests at heart and knew what they were doing. A few centuries ago, people probably had similar thoughts while they had knives and leeches applied to their veins to let the bad blood out.
Sandra, you have a conscience, and that’s good. But I wonder often how educated psychiatrists in general are in history, literature and philosophy–that is, the Humanities. They seem to have trouble understanding concepts like autonomy, personal integrity, ethics and freedom.
Psychiatry itself is a pseudo-science. A renowned kidney surgeon from UCLA told me that in his view Western medicine is a step above what it was in the Middle Ages. Psychiatry is not even that advanced–it is totally a construct of the human syndrome of power/control/narcissism (interesting that the last has been removed from DSM, isn’t it?) and the proof is that it is solely imposed on the poor and minorities. No upper class white person is coerced–only the bottom rungs of society feel psychiatry’s full force and impunity.
If psychiatrists had a grasp of history they’d know where they stand in its pageant–with the Inquisition, the witch-hunters, the voodoo doctors and the Stasi. Do any of those ring a bell? But, no, you don’t see the resemblance because psychiatrists are by and large the least unconventional and the least educated of any professionals I’ve ever encountered.
You will really follow your conscience when you renounce all the unjust power you’ve been granted and encourage the death of psychiatry. But, be careful. Look it up: the first judge in Germany who questioned the condemnation of witches was subsequently burned as a witch himself.