Bridging the Benzo Divide: Iatrogenic Dependence and/or Addiction?

Richard D. Lewis
180
1022

As the benzodiazepine crisis spreads throughout the United States and other parts of the world, so does the debate within the benzo victim/survivor community about important definitions of key medical terms and about safe and successful paths to healing and recovery. Do “iatrogenic benzo dependence” and “addiction” represent completely separate medical and social phenomena? If they are to have distinctly different scientific definitions, can they also (at the same time) intersect in multiple ways in people’s actual real life experience? And what is the medical and social significance of exploring these concepts and seeking unity of understanding and purpose? Before delving into the content of this debate, let’s briefly review the social context from which this “Benzo Divide” has emerged.

With almost 100 million benzodiazepine prescriptions written per year in the U.S., combined with the fact that there is a total absence of proper regulations and safety standards for this category of drug, high levels of suffering have been caused by a disabling form of iatrogenic dependence affecting an untold number of unsuspecting victims. Victims whose only “mistake” was trusting in the recommendations of Big Pharma, Psychiatry, and medical doctors who erroneously believe that tranquilizing pills are the quickest and best solution for patients seeking better ways to cope with life’s stressors. Most often neither the doctor nor the unsuspecting patient in these situations has the remotest idea what long term misery lies ahead for those following this all too common medical advice.

The number of benzo victims, which is likely in the millions, most certainly involves a large segment of people (perhaps, even the majority) who have no life experience or connection to anything involving substance abuse or addiction. When patients in this group are viewed as if they are common “drug addicts,” cultural prejudices combined with bad medicine adds “insult to injury” by often dictating more harmful forms of treatment.

At the same time we also know that there are a significant number of people damaged by the proliferation of benzo prescriptions whose behavior patterns have involved some prior (or current) misuse or abuse of various mind altering substances. We know that for this segment of the population, iatrogenic benzo dependence will frequently compound and accelerate their addiction, and in some cases even be a causative factor in the etiology of their addiction. Additionally, with newer studies indicating that at least 30% of all fatal opiate overdoses in this country involve benzos being present in the drug cocktail, this scary statistic only adds to our current knowledge of the amount of overall harm being done and the often deadly nature of the growing benzodiazepine crisis.

It is both mind-boggling and infuriating to contemplate the fact that most of these 100 million prescriptions for benzodiazepines are being handed out for long-term use, when knowledgeable medical experts have given major warnings for many years that benzos should only be prescribed for 2-4 weeks, including the time required for a safe taper. Irrespective of any one person’s prior history (involving addiction or not), prolonged use of this category of drug on a regular basis will lead to a state of iatrogenic (that is, medically-induced and harmful) dependence. This all too common form of medical malpractice can result in a myriad of negative physical and psychological effects that can be disabling for months, years, and even decades, especially if a person fails to receive a proper diagnosis and a safely designed protocol of medical care. This much-needed type of medical care often requires special forms of micro-tapering regimens that few people in organized medicine understand or know how to implement for their patients. In addition to issues of dependency, addiction, and involvement in drug overdoses, benzos also have documented connections to Alzheimers’ disease, dementia, greater number of fractures and falls, and higher overall mortality rates. Outside of a hospital setting, this makes benzodiazepines one of the most dangerous categories of drugs on the planet.

In many ways, “citizen scientists,” using their own painful life experience as a guide (along with a powerful survival incentive), are writing of their experiences on many nonprofessional internet websites such as Benzo Buddies.org, Beyond Meds.com, Benzo Beware on Facebook, Benzo Support.org, and Benzo.org.UK. As a result they have provided important emotional support for people affected, as well as helped develop some of the more cutting-edge approaches to finding more successful tapering and withdrawal protocols. It is here in the trenches of these internet forums where very important discussions and sometimes contentious debates take place regarding the road forward for all the victims of dangerous benzodiazepine prescribing patterns.

We cannot understand the true nature of today’s benzodiazepine crisis without examining key events that go back several decades in the historical development of modern Psychiatry. Space and time limitations preclude my going deeply into this history. It is accurate to say that it was collusion at the highest levels between the leaders of the pharmaceutical industry and the American Psychiatric Association in 1980 that led to the development of the DSM lll (the diagnostic Bible of “psychiatric disorders”) and the classifications for a particular set of anxiety and sleep disorders. This ongoing collusion between these two powerful institutions culminated in an arguably fraudulent campaign that created favorable conditions for FDA approval of Xanax (and other benzos) as a so-called “safe  treatment” for panic attacks and insomnia. The rest is (today’s) history, as the expression goes.

Readers are urged to read Dr. Peter Breggin’s book, Toxic Psychiatry (1991) and Robert Whitaker and Lisa Cosgrove’s Psychiatry Under the Influence (2015) for a comprehensive history of these events. In addition, it is helpful to explore the more recent history of how the explosion of prescribed benzodiazepines has paralleled the development of a similar epidemic of opiate pain drug prescriptions, and how this has impacted the rising death rate of prescription drug and heroin overdoses. Readers are also urged to review a prior blog written by this author titled, “Benzodiazepines: Psychiatry’s Weakest Link,” that further explores in a deeper way the social and political implications of these developments.

Given the dangerous levels of benzodiazepine drugs circulating within our society and the fact that they affect such a large and diverse sector of our population, how has it come to be that definitions of the terms “iatrogenic dependence” and “addiction” can carry so much meaning and at the same time be so contentious? And why is unity of understanding and purpose on this issue so important to achieve as we attempt to build a movement trying to end the harm done by the benzo crisis?

Activism in Support of Recognizing the “Ashton Syndrome”

Over the past several years there has been a growing and increasingly more vocal segment of the benzo victim/survivor community who are leading the charge in educating and challenging their community, as well as the entire medical establishment, about the fundamental difference between “iatrogenic benzo dependence” and “addiction.” They have made a strong case for why these definitions can be critically important, and why they could actually make the difference between failure and success for some patient’s recovery from benzo dependence. In fact, in November of 2015 a very scientific and scholarly presentation of these differences was authored by J. Doe and published online at the Mad in America blog in a two part series entitled “Don’t Harm Them Twice.”  For anyone seriously interested in this topic, either due to their own personal experience with these drugs or because they are devoted caregivers and/or activists for people negatively affected by them, this new document is a must read.

J. Doe, along with others with similar ideas, are following in the path of benzo crusader Dr. Heather Ashton who worked for many years (1982-1994) in England in a clinic that championed the cause of hundreds of victims of benzodiazepine dependence. It was out of this work that she developed the highly respected Ashton Manual, which designed a new path-breaking tapering protocol that provides one important option for people trying to safely withdraw from this category of drug. As someone who has been a longtime critic of the Disease-based medical model, and involved in addiction support work for over twenty years, I found J. Doe’s new document both illuminating and challenging. This work is definitely a “game changer” and will forever change the way myself and others use the language related to issues of drug dependency and addiction.

Everyone owes a great debt to the important contributions that J. Doe and others have made in carrying forward the torch of pioneers like Dr. Heather Ashton. Today, J. Doe and others are calling for the recognition of a newly identified medical condition related to iatrogenic benzodiazepine dependence, called “The Ashton Syndrome.” Their long term goal is  “…to educate medical providers about the complexities of iatrogenic benzodiazepine dependence and how it differs from addiction, abuse, or substance abuse disorders (SUD) so that it is treated as a legitimate medical problem as opposed to a behavioral issue.” We all must learn from, respect, and support J. Doe and other’s efforts to change both the language and the harmful treatment “That Harms Them Twice,” as well as, support their advocacy for recognition of the Ashton Syndrome.

Exploring the Interconnection Between Iatrogenic Dependence and Addiction

While we must overall give high praise to the work done by J. Doe and others, there is an unfortunate secondary countercurrent to their arguments that weakens their scholarship and threatens to possibly widen an already existing divide within the benzo victim/survivor community. While there needs to be a black and white distinction made between the scientific definitions of “iatrogenic benzo dependence” and “addiction,” there is a lot of grey area between these concepts when examining the real life experiences of all those people being harmed by benzodiazepine drugs. J. Doe’s theoretical shortcomings tend to downplay, or even deny, the reality that there are many people who have BOTH iatrogenic benzo dependence AND addiction issues present in their current or past life experience. In their advocacy for establishing distinctly different definitions for these two phenomena, they have chosen to promote both a theory and practice that encourages distancing themselves from anything addiction related. This includes distancing themselves from those people in the benzo victim/survivor community who also suffer from addiction related problems in their life. If J. Doe and others fail to reconsider this approach it could place unnecessary limits on the potential to build broad support among activists for their advocacy work, as well as interfere with future efforts to build unity among all those damaged by benzos.

Ironically, Dr. Heather Ashton (after whom J. Doe and others have patterned their advocacy work) clearly acknowledged in her writings the common intersection of “iatrogenic benzo dependence” and “addiction” in the lives of a number of her patients. In Dr. Ashton’s dedicated work she embraced the addiction community while questioning some aspects of the Disease-based 12-Step approach to recovery. Some related quotes by her on this topic are as follows: “A large portion (30-90 percent) of polydrug abusers world-wide also use benzodiazepines”  (Ashton Manual, 2002) and “Initially prescribed benzodiazepines, if not carefully supervised, can lead to escalation of dosage and entry into illicit drug scene in vulnerable individuals” (Drugs and Dependence, 2002).  And finally, what follows is a quote from some important questions and answers on the Ashton-inspired website Benzo.org.UK – FAQ File #38, that speaks directly to these very issues being discussed and debated today:

“It is important to note that a sizeable percentage of benzodiazepine dependents do exhibit patterns of abuse. The clearest signs are taking doses far in excess of what your doctor has prescribed, and/or having a history of abusing other drugs in the past or simultaneously with your benzodiazepine.”

In an effort to pursue these questions in a deeper way I am proposing one possible way to break down the different segments of people who are harmed by iatrogenic benzodiazepine dependence:

  1. People who have had no history or connection to substance abuse or addiction
  2. People who have had a prior history of substance abuse and are in a current state of abstinence
  3. People currently abusing or misusing other mind altering or addictive substances, including opiates
  4. People whose iatrogenic dependence on benzos was a contributing factor to them evolving into abuse patterns with other substances such as alcohol, or a relapse back into addiction with a past “drug of choice,” and lastly
  5. People whose prescriptive use of benzos evolved into some type of abusive or addictive pattern with benzos, singularly, or with other categories of drugs.

As one can see from this breakdown, all those people included in groupings 2) thru 5) may have elements of both “iatrogenic benzo dependence” AND “addiction” in their life experience. This makes it obvious that there is NOT an impenetrable wall between these two concepts, nor could there be in a world where more and more people are polysubstance users and quite often, polysubstance abusers where the reality of “addiction” comes into play. Due to their powerful synergistic effects with other substances, benzos are an extremely popular option for many poly-drug users and many people acquire them through legal prescriptions. When looking at all opiate drug users (prescribed or not) at least 60% also use benzos, either daily or on a regular basis. Unfortunately it is very common for people receiving synthetic opiates, such as methadone and suboxone, to also have concurrent prescriptions for benzodiazepines.

While I have not attempted to actually define “addiction” in this context, let’s just say that leaving aside the common characteristics of physical dependence and tolerance, most people who identify as “addicts” will highlight all the “mind games” connected to the description of their addictive behaviors. They will often describe in great detail the duality of feeling like they are of “two minds”; one that wants to stop the use of a substance due to an excessive amount of negative consequences, and the other that wants to keep the substance in their life despite all the identified problems. Here we are talking about behaviors and thoughts that go well beyond simply following a doctor’s prescribing recommendations. Benzos are just one of several categories of drugs where people end up engaged in a serious form of cognitive dissonance about their choice to use certain mind altering substances given all the risks and benefits associated with their use.

This reality leads us to conclude that there are TWO main reasons why people include the use of addiction language to describe their relationship with benzodiazepine drugs. One reason would be the influence of certain cultural prejudices and the related long history of medical confusion and ignorance about terms such as “physical dependence” and “addiction.” J. Doe and others have correctly focused on this problem and brought greater clarity and understanding, attempting to overcome these medical disparities and set forth a new scientific standard.

The OTHER important reason for people using addiction language to describe their connection to benzodiazepine drugs is the fact that these drugs CAN BE, AND ARE, in some people’s real world experience, ADDICTIVE. This is why people on internet benzo forums feel compelled to discuss issues of addiction and recovery connected to benzos, even when they might sometimes misuse certain word terminology out of the confusion referred to above. For those people who ONLY want to focus on the issue of iatrogenic benzo dependence, this truth about benzos’ connection to addiction may be uncomfortable and inconvenient. However, it is critically important to acknowledge this truth and accommodate and support this other sector of the community harmed by benzos, and attempt to find ways to build unity of understanding and purpose while engaging in principled dialogue.

Yes, we know that it can be terribly invalidating to label and treat a person as a “drug addict” that is only physically dependent on benzos and taking these drugs exactly as prescribed by a doctor. And yes, this frequently leads doctors to force rapid tapering protocols on vulnerable patients with no addiction history. However, it can be equally as invalidating to deny that “iatrogenic benzo dependence” intersects in multiple ways within the lives of many people struggling with “addiction;” people who will ALSO SUFFER when yanked off of their benzos or forced into similar rapid tapers when a doctor becomes aware of their addiction history. Is there not an aspect of adding “insult to injury” to promote a view that people with addiction problems should be subjected to “distancing” or somehow be separated off from other benzo victim/survivors because they may have made past unhealthy choices in their lives?

To further illustrate specific examples of some disappointing secondary arguments presented by J. Doe in “Don’t Harm Us Twice, Part 2, we need to critically examine the following quotes:

J. Doe stated: “People taking benzodiazepines as directed by their providers do not identify with being addicts.”

Counterpoint: This statement ignores the fact that some people who suffer from iatrogenic benzo dependence ALSO identify with being “addicts” because of current or past problems with addiction. These people may have taken their benzodiazepines exactly as prescribed by a doctor, but also have a history (or current pattern) of addiction with other substances. They may have, at times, also used benzos as a separate (or additional) drug in addictive or abusive ways.

J. Doe stated: “How do we stop using the word “addiction” in relation to cases of iatrogenic benzodiazepine dependence?

Counterpoint: We do not have to stop using the word “addiction” in every situation, nor should we.

Yes, we need to identify those people who only have iatrogenic benzo dependence and NOT call them (or treat them) as “addicts” for all the reasons J. Doe has posited. However, the word “addiction” DOES apply to many people who also suffer from iatrogenic benzo dependence and they must be understood and supported as well. In fact, their particular medical cases are often far more complicated because of their addiction history, and they are much more likely to suffer from too rapid tapering protocols (or a total cut off) once a doctor becomes aware that some type of addiction has been involved in their lives with either benzos or some other drug. For these patients this will also cause great harm by worsening withdrawal syndromes and creating conditions for possible dangerous patterns of addiction relapse. While there are many services offered in our society for people with addiction problems, due to the dominance of Disease-based theory and practice that guides most treatment in detoxes and rehab centers, these programs are sorely lacking in quality, and their success rate mirrors these shortcomings.

In order to stop any group of patients from being incorrectly labeled an “addict” due to physical dependency on benzos, we need to challenge the hegemony of the Disease-based theories of addiction and the related dominance of 12-Step Philosophy that controls (90%) of all addiction treatment in this country and pervades the outlook of the medical establishment. We need to sharply pose the following question to those people caught up in Disease-based thinking: Name another “disease” in which a “decision” can lead to the end of all the related “symptoms.” We cannot “decide” to end cancer or diabetes, but we can decide to end an addictive behavior, even if these decisions are, by nature, very difficult and complex.

We need to respect the fact that 12-Step Programs DO work for some people, though for nowhere near as many as touted (see discussion at The Fix, regarding Dr. Lance Dodes’ new book, The Sober Truth (2014)). However, at the same it may be necessary to criticize 12-Step Program zealots (or doctors) who repeat ad nauseam “a drug is a drug is a drug…” and promote the view that everyone, addiction history or not, may be “a single drink or drug away from an addiction or relapse,” or that physical dependence equals addiction.

People who participate in 12-Step Programs are not an impervious monolith. There are widely divergent views within these recovery groups, and this includes some people who openly criticize aspects of the Disease Concept of Addiction and the more rigid “single blueprint” approaches to recovery. For these more open minded AA/NA attendees, their lives more closely embody the philosophy in the oft-repeated cliché that makes perfect sense in these situations, “take what you need and leave the rest.” The growth over the past few decades of important alternatives to 12-Step Programs, such as Rational Recovery, Women for Sobriety, and Smart Recovery etc, reveals a very unsettling reality facing people with addiction problems in our society; that is, the current Medical Model has no viable or highly successful solutions for their life’s dilemma.

Yes, it is understandable that some people in the benzo community might want to subjectively distance themselves from 12-Step Program rigidity and dogmatism that often promotes ignorance and attempts to paint everyone into an addiction box. The worst of the commonly repeated clichés such as “shut up and get stupid” or “your best thinking got you here” or “Addiction is the disease and AA/NA is the medicine; if you don’t take your medicine you are destined to relapse” are indeed difficult to hear repeated over and over again. This is especially true if you have no addiction issues present in your life.

Not all people with addiction problems are hopelessly under the sway of these forms of rigid 12-Step thinking. We must somehow resist any tendency to deny reality or invalidate other people’s addiction experience with benzos in order to justify a subjective need for distance from that which makes us uncomfortable. To bring clarity and scholarship to all the scientific issues related to “iatrogenic dependence” and “addiction” we (out of necessity) must dissect and deconstruct the Medical Model and the Disease-based thinking that permeates the entire addiction and “mental health” industry. When we do this in a comprehensive and challenging way we can raise principled struggle with those people negatively influenced by the Medical Model while still EMBRACING ALL people harmed by iatrogenic benzo dependence, INCLUDING those with addiction problems. 

J. Doe stated: “My argument has always been that anyone speaking out about benzo dependence and withdrawal carries a responsibility to honor and appropriately represent the people affected.”

Counterpoint: Yes, yes, yes, I would hope that everyone would follow the “High Road” implied by this statement. This must include understanding and honoring the experiences of people who suffer from iatrogenic benzo dependence AND have additional issues of addictive type behaviors and/or thoughts interwoven within the fabric of their lives.

J. Doe stated: “Just as it is intolerable to turn rape victims into the accused, it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it on themselves.”

Counterpoint: While I believe J. Doe and the others advocating for their position have no intentions to demean or stigmatize the addiction community (and they have even stated this desire), this was a poor choice of analogy in multiple ways, and it unfortunately ends up contradicting their good intentions.

Nobody in the benzo victim/survivor community (including those with addiction issues) “deserves their suffering.” nor does the statement “brought it on themselves” accurately describe people’s common path to addiction. Nobody really chooses to become an “addict.” Addiction is usually a process that creeps up on a person slowly until one day they realize the drug (or behavior) “controls them more than they control it.” Now they may find themselves stuck in a pattern of self-destructive or self-defeating behaviors that “cause more harm than good.” Perhaps, formerly successful coping mechanisms have now evolved into a pattern of behavior that has become so habitual that it is very difficult to stop despite the awareness that the negative consequences outweigh the benefits. Once a person becomes more aware of this reality, “recovery” then becomes an optional “choice” in their life, and may soon evolve into an actual “event.”

“Bridging the Benzo Divide,” and the Road Forward

On one level, when considering all the cultural prejudices against people with addictions, it is understandable how some strictly benzo dependent people might arrive at some of their conclusions about the need for distance from all things addiction-related. This is especially true when these prejudices influence the actions of doctors who often treat them with disdain or force all too rapid tapering protocols on them. However, given the powerful forces in society who benefit from using psychiatric labels and also from the sale of massive amounts of psychiatric drugs, it is highly unlikely that a more narrow strategy of “going it alone” will be listened to or achieve the desired goals for those duly harmed. This is aside from the fact that this path can have the unfortunate effect of marginalizing or perhaps even invalidating the life experiences of another sector of the benzo victim/survivor community who face additional addiction problems.

Seeking another path towards “Bridging the Benzo Divide” has the potential of uniting all sectors of the people and their families harmed by benzodiazepine drugs. We must face the reality that we live in a very powerful and entrenched profit-based system that has given rise to the current Medical Model. This model includes Biological Psychiatry’s Disease-based dominance and control over an omnipotent “mental health” system and almost all forms of addiction “treatment.” It is in this context that the current benzo crisis has arisen and caused so much damage. When looking at class, race, or gender divisions within our society, this profit-based system and the powerful institutions that control it have a thousand and one ways of creating divisions among the oppressed and exploiting those differences. When looking at the benzo victim/survivor community we must find ways to avoid allowing ANY unnecessary divisions or separations to take place among the ranks of those harmed by these drugs.

Given that the benzodiazepine crisis emerged from within Big Pharma, Psychiatry, and organized medicine, it is important that many doctors step forward and acknowledge the enormity of this problem and become active in being part of the solution. There is a desperate need for doctors who have the compassion and courage to take the necessary risks involved with helping patients deal with protracted withdrawal and the tapering complexities connected with benzos. This includes being willing to work with those patients whose cases are more complicated by having additional addiction related issues in their life.

Taking on all aspects of the benzodiazepine crisis, from its broadest and most inclusive perspective, will have the greatest potential to advance the cause of this very important human rights struggle. An overall strategic approach that recognizes the commonalities of life experience and attempts to “unite all who can be united” has a far better chance of achieving our goals related to obtaining safer medical care and ultimately ending all the ways benzodiazepines harm people, in this country and around the world.

* * * * *

References:

American Academy of Pain Medicine press release March 6, 2014, Stanford University researchers (Ming-Chi Kao) warn: Prescriptions for Benzodiazepines Rising and Risky When Combined with Opioid

Ashton, Dr. Heather; Ashton Manual (Benzodiazepines: How They Work And How To Withdraw, 2002) and Drugs and Dependence (2002), available at Benzo.org.UK

Benzo.org.UK; Benzodiazepine Dependence and Withdrawal; Frequently Asked Questions (FAQ file #38)

Breggin, Dr. Peter; Toxic Psychiatry: Why therapy, empathy, and love must replace drugs, electroshock, and biochemical theories of the “new psychiatry”, 1991

Dodes, Dr. Lance; The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, 2014

Doe, J; Don’t Harm Them Twice: When Language Surrounding Benzodiazepines Adds Insult to Injury, Part 1; and Don’t Harm Them Twice: What Can Be Done, Part 2, Mad in America blog, 2015

Fiore, Kristina; Killing Pain: Xanax Tops the Charts; MedPage Today; Feb. 25, 2014.

Hickey PhD, Philip; Benzodiazepines: Miracle Drugs; at Behaviorism and Mental Health.com

Jann, M; Kennedy, WK; Lopez, G; Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics; J Pharm Pract.; Feb. 27, 2014.

Jones, Jermaine D.; Mogali, Shanthi; and Cormier; Sandra D.; Polydrug abuse: a review of opioid and benzodiazepine combination use; Drug Alcohol Depend.; 2012, Sept. 1; 125(1-2); 8-16.

Jones et al; Pharmaceutical Overdose Deaths, United States, 2010; Journal of the American Medical Association (JAMA)2013; 309:657-9.

Ornstein, Charles; Jones, Ryann Grochowski; One Nation Under Sedation: Medicare Paid for 40 Million Tranquilizer Prescriptions in 2013; Propublica.org; June 10, 2015

Skepticalscapel blogspot.com, Pain is Not the 5th Vital Sign; Aug 29, 2014

Whitaker, Robert; Cosgrove, Lisa; Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform; 2015

180 COMMENTS

  1. Hmm, this is an interesting article Richard.

    I confess I have long thought of many, not all, long-term benzo users as being addictive in their use of the drug. It is obvious that benzos can be used by (again many, not all people) as a way to distract oneself from and numb difficult thoughts and feelings… in a similar manner to illegal drugs like opiates. I took benzos myself (Valium)… and could sense right away that the calming/emotionally relaxing sensations one gets from benzos could be profoundly addictive. I sensed the danger and stopped using them after less than 3 months, before I could get profoundly attached to them. It was difficult even then to stop, but I realized it would get worse later.

    As Peter Gotzsche says, it would probably be better if all these drugs were removed from the market. Benzos are mainly a way to dull down feelings of distress when better options of facing reality – talking to friends/family about your life problems, psychotherapy, exercise, having enough money and a job, etc. – are not available or are not easy. Their main function is to profit psychiatrists and drug companies, and perhaps secondarily to help people self-medicate and avoid facing their issues, as I was starting to do with them at one time.

    • Appreciate the article, but not sure why this relentless demonization of big pharma and benzos…..similar trope over current “opiod” hysteria…blaming “opiod addiction” on Big Pharma and “oxycontin, etc. Big Pharma should be celebrated for providing us these ameliorative drugs. Psychiatry should be abolished, but this scapegoating of drugs is misplaced. Benzos are an excellent anixolitic for episodic anxiety or to just chill out–you clearly don’t want to take over long-term–pretty simple. If you can’t restrain yourself, then get help doing so, but just because you can’t, don’t retch-up the restrictions for the vast majority of users who can use prudently.. People have unhealthy “addictions” or “dependency” on thousands of different things/activities unrelated to drug use–no reason to single out benzos as the bane of society….

  2. I think this was well-argued. I disagree with many of your premises. My damaged CNS doesn’t allow me enough cognitive ability to argue my points as effectively as I would like to–but here’s my best shot.

    First. Asking for individual recognition for iatrogenic dependency (I.D.) is not the same thing as distancing or perpetuating current stigma toward addicts. I am comfortable saying that that modern stigma toward addiction alone pails in comparison to stigma toward ID (or addicts who experience intersection with I.D)– (which includes the misdirected and unacceptable stigma that addicts receive) AS WELL as stigma around not fitting into a well-defined, well understood category of illness. Let me be clear, addiction stigma pails in comparison because I.D. stigma included addiction stigma AS WELL other kinds of stigma.

    I can’t begin to explain how traumatizing it can be when you are no longer taking a drug, or you are actively tapering off of a drug with no other goal than to be off–and your family member, partner, friend, or acquaintance calls you an addict and precedes to bully your taper by using addiction language and addiction protocol.

    Not to mention the protocol that comes hand in hand with addiction protocol DOESN’T benefit Iatrogenic dependency or those who feel they have addiction to benzos. Stigma is one thing, but protocol can kill you instantly. And language informs both.

    Second, intersection is not the same thing as inter-changeable.

    I have friends in the Benzo community who have legitimate addiction to Opiates (as you mentioned). I would never distance myself from these individuals, and I actively and compassionately acknowledged their experience with drug abuse and the psychological/pathological drive to keep using. Is it too much to ask for the same for my unique experience (which yes intersects with theirs)? I know some people who have Lyme disease who were inappropriately placed on a benzo and now suffer from I.D. Should I group their Lyme disease in with my I.D.? If the protocol for I.D. might negatively affect their Lyme disease. Absolutely not.

    Third. it’s not “inconvenient” or “uncomfortable.” That’s reductive. It can be deadly and cause I.D.’s to feel so misunderstood that we often: rush off our drug, flee or are actively kicked out of our homes, and commit suicide. If you are going present an argument about how I.D.’s are recognized you might want to begin be recognizing our authentic experience as one of being in a state of constant survival. We aren’t really afforded the tolerable sensatio of feeling “uncomfortable” about this.

    “It is important to note that a sizeable percentage of benzodiazepine dependents do exhibit patterns of abuse. The clearest signs are taking doses far in excess of what your doctor has prescribed, and/or having a history of abusing other drugs in the past or simultaneously with your benzodiazepine.”

    Fifth. This statement may still be describing someone whose I.D. has gotten out of control and does not equate to addiction to benzodiazepines. And I think this really demonstrates the problem. I believe people who take their benzo as prescribed AND those who might take more than was prescribed STILL might not have embody the pathology of addiction. I.D. can compel some seriously desperate behavior particular in inter-dose withdrawal.

    Fourth. Unity isn’t the main motivation of people who are in survival mode–a nd shouldn’t be when it’s to our detriment. Pointing out intersection is totally fine, and no one is arguing a lack of intersection. But it’s not okay to turn intersection into an equation. Authentic recognition and support are the only things we can and should care about. Unity if is for healthy people who don’t have to struggle for authentic diagnosis and help.

    • Mind the many typos. I get very revved and weak when my misunderstood illness continues to be arbitrarily corralled into an adjacent experience. This practice has history on its side and yet people actually suffering from I.D. (And the lived consequences of addiction conflation) are breaking our backs for some specialized recognition, and we have to argue online with presumably relatively functional people who can work. It’s pretty breaking.

    • If you are going present an argument about how I.D.’s are recognized you might want to begin be recognizing our authentic experience as one of being in a state of constant survival. We aren’t really afforded the tolerable sensatio of feeling “uncomfortable” about this.

      This.

  3. However, the word “addiction” DOES apply to many people who also suffer from iatrogenic benzo dependence and they must be understood and supported as well. In fact, their particular medical cases are often far more complicated because of their addiction history, and they are much more likely to suffer from too rapid tapering protocols (or a total cut off) once a doctor becomes aware that some type of addiction has been involved in their lives with either benzos or some other drug. For these patients this will also cause great harm by worsening withdrawal syndromes and creating conditions for possible dangerous patterns of addiction relapse.

    I think this is a really important addition to the conversation about benzos. However, while I concede that J Doe’s article probably should have acknowledged the existence of these grey areas between cut-and-dried iatrogenic benzo dependence and addiction, I don’t think that J Doe intended to “distance” people with addictions in any moral sense, and I am not aware of any evidence of their having “denied” the reality that these grey areas exist. The whole point of J Doe’s article, from my perspective, was to promote the proper recognition and treatment of *non-addiction-related* iatrogenic benzo dependence.

    • Your conclusion is correct, uprising. Thank you. I didn’t cover the “grey areas” b/c the article was meant to be strictly about iatrogenic benzo dependence and it’s overall lack of recognition and it being completely misunderstood/mismanaged/misdiagnosed. And no, I never denied their existence nor did I intend to “distance” in the moral sense- only in the terminology sense which causes confusion and perpetuates further harms for the truly iatrogenically dependent population.

  4. “people who will ALSO SUFFER when yanked off of their benzos or forced into similar rapid tapers when a doctor becomes aware of their addiction history.”

    And then can go to any corner store, grocery store or department store in the country and buy as much alcohol as they can afford, which is many, many times worse. Doctors who act like gatekeepers to drugs need to get their heads checked and/or come off their high horse.

    • I used to stop at the liqueur store on the way to the hospital if I was suffering withdrawals and have a several drinks to survive going in the front door feeling like that. Benzos may work well on alcohol withdrawal but alcohol doesn’t help much the other way around for long for some reason.

      Another time the doctor increased my prescription and CVS said “insurance say its to early” OK I will pay cash. I will have to call the doctor … They never answer.

      Long story short I went back with my video camera stuck it in that *****es face and said you tell the doctor why I can’t have my pills. She made a stupid face , handed over the Rx and took my money .

      Glad that whole benzo nightmare is over.

  5. Having been to and then worked in drug and alcohol treatment centers I have seen dozens of people taken off benzodiazepines much to fast and have wicked panic attacks.

    I can’t figure out why when they call 911 for an ambulance do they also send a ladder truck cause I have never seen a person having a panic attack climb a tree.

    My second question is why do they insist on keeping all the flashing strobe lights going on the excessive number of vehicles when that only draws a crowd and gives everyone anxiety ?

  6. Richard,

    You think my argument falls short- I feel that you are naive in your desires to “bridge the divide”, and are missing the point. Perhaps this is because, quite luckily, you’ve never had to experience what myself and so many other iatrogenic benzo victims have had to endure- and so maybe it’s not that you don’t get it, but rather that you just are unable to b/c you haven’t personally lived or experienced it.

    I will try to explain (keep in mind- on a very uneven playing field- you with full use of your cognitive abilities, and me extremely cognitively impaired w neurotoxicity, which has made this dialogue so difficult all along, despite the desire. It is extremely frustrating to want to debate or to have so much back and forth when you can barely use your brain effectively) where I think you miss the point.

    1. Everyone already (for the most part- and incorrectly) equates benzodiazepine use with addiction. So, that problem is already recognized. What we’re trying to do here is not deny the experiences of people who fall into that category (or even the iatrogenic and then subsequently addicted category) or discriminate or stigmatize, but instead we are attempting to make a case and develop a platform for a very unique and barely recognized group of benzo users- the solely iatrogenically dependent. I resent what feels like you’re attempting to twist my words and trying to imply that I was somehow stating that they don’t need understanding or support- or that by not mentioning the “grey areas” that I was denying they exist or rejecting them outright, which is not the case.

    2. Because everyone already equates benzo use with addiction, there are unfair and misdirected consequences (some of them quite severe) for people who are just iatrogenically dependent and we feel this iatrogenic dependence alone (separate from addiction/the “grey areas”) needs recognized so that the people who fall ONLY in the iatrogenically dependent category aren’t harmed twice. There are REAL harms from getting this wrong (it’s not just semantics) and legitimate reasons why there is a desire to distance the iatrogenic dependence cause from addiction to avoid the harms from persisting.

    For example, consider you’re an attorney (or any other professional holding a license) and your doctor prescribes you Xanax for “stress at work”. You take it as directed, you become dependent unknowingly thinking you’re just taking “medicine” and being a “complaint patient” and then when you try to stop, you get severe withdrawal. This impacts your ability to function and work, your doctor equates benzos/withdrawal with addiction, you’re reported to your licensing board and they take away your license to practice, pinning you an “addict” and ordering you to AA/NA meetings/rehab and/or whatever other addiction interventions they see necessary (like 5 years of monitoring or drug tests). All of this because you took a drug your doctor prescribed, told you to take, and because the world at large misunderstands (including the medical profession) the differences b/w addiction and iatrogenic dependence.

    Another example, you’re a single mother recently divorced. You haven’t been sleeping well, so your doctor puts you on a benzo at bedtime. When you decide to stop taking it, you get sick and start to struggle to care for your kids, or you develop psychiatric symptoms which your ex-husband becomes aware of. He then takes you to court for custody and argues you’re an “addict” and wins custody over your children as you’re deemed an “addict” and unsafe to be a parent. Your doctor cuts you off b/c your ex-husband calls him and informs him that you’re abusing the drugs (you didn’t, but he assumed you did, b/c everyone thinks when you get withdrawal and try to go back in to get reinstated to make the suffering stop and to taper appropriately- you’re suddenly “drug seeking”). Now to get your kids back you have to prove that you’re “clean and sober”, but you needs to keep taking the benzo in order to stop the severe withdrawal and in order to taper. Now you’re also stuck trying to find a benzo-cooperative MD (there aren’t many) who understands the differences b/w iatrogenic dependence and addiction who will prescribe and allow you to taper slowly. Until you’ve personally had to scramble (in severe withdrawal, I might add, suicidal, desperate, and debilitated, getting worse and worse) all over your state- and for some people across states- looking for an MD to prescribe for you who “gets it”, and are rejected over and over again b/c iatrogenically dependent people are constantly lumped in with the people who abuse these drugs, I’m not sure you can understand.

    A third example – you are looking for an attorney to represent you in litigation case against your doctor who harmed you iatrogenically with benzos without informed consent. In this case, you MUST make a separate and distinct case for IATROGENIC DEPENDENCE ALONE because any misunderstanding or misdiagnosis of abuse/addiction relieves the doctor you’re suing of responsibility and places the blame on the patient. It is impossible to get compensation for the neurotoxicity and damage without being separately defined as the unique phenomenon that it is.

    How can you not see that there’s a NEED for a unique and distinct platform for iatrogenically dependent people b/c it is it’s own problem, and that by talking about it as it’s own problem doesn’t require me (or anyone else) to have to address ALL the problems that may result from benzos at the same time? And that by advocating for that distinct platform that we don’t have to somehow be discriminating against or rejecting addicts or the “grey areas” that may exist?

    This has gone on now for 50+ years without recognition or change and perhaps it’s because the iatrogenic problem has been lumped in for all this time with addiction and that terminology has been used incorrectly to describe this problem, so instead of the blame being placed on the prescribers/drug cos and the dangerous drug itself, it’s misdirected at the patients who can just be accused of abusing the drugs, so the problem lies with them (the users) and not the drugs at all…and the problem persists. By trying to continually “bridge the divide”, I feel your efforts feel more invalidating to the iatrogenically dependent group, as opposed to recognizing the addicts and the people in the “grey areas”. In other words, by trying to continually lump us all together (when we’re actively trying to distance ourselves for good reason), it doesn’t feel anything like unity, but instead feels more like erasure – erasure of the experience of the distinct phenomenon that many have lived solely as iatrogenic dependence and without addiction or the “grey area” as part of their experience.

    At the end of the day, iatrogenically dependent people aren’t dismissing that addiction to/abuse of benzos exists or that it can be deadly when they’re abused (esp in combination w opiates), nor are we dismissing that people can start out iatrogenically dependent and become addicts- of course those are true. Although, I think MANY cases that fall in this “grey area” might just be “pseudoaddiction” (which is still just iatrogenic dependence) misdiagnosed as addiction b/c the tolerance and interdose withdrawal to benzos is so debilitating and painful that many people are driven by the suffering to updose some (take a bit more than directed) in order to function and relieve the intolerable suffering due to being underdosed (again, something you have to experience to truly appreciate the severity and why/how that happens). However, if the tolerance/dependence/interdose withdrawal (all phenomenons of iatrogenic physical dependence that we are attempting to expose and hoping to bring education around) were recognized as such by medical professionals, these patients would stop taking more than directed if they were simply updosed to an adequate amount of drug to stop the tolerance withdrawal and would then not qualify as “addicts” at all.

    With all of that recognized, some of the advocacy of the iatrogenic benzo community would simultaneously nd secondarily benefit the addiction problem – as I believe most of us desire stricter regulations of the prescribing of these drugs (or at the least adherence to the 2-4 week prescribing protocol) so that there aren’t anymore innocent iatrogenic victims in the future. In a perfect world, they’d be removed from use totally except in the hospital setting for things like seizures (and other than measures for them to still be prescribed to people who are already dependent iatrogenically and need the drug access to taper). If the stricter regulations came to pass or they were removed from the market (save the reasons for use mentioned above), it would probably then, too, have a direct impact on the addiction problem that currently exists.

    Also, as I stated in my article- if you don’t expose the iatrogenic dependence problem as distinct and separate, many people aren’t going to know they’re at risk. People will hear addiction and (wrongly) think they’re “safe” b/c they were prescribed by their doctor and that so long as they don’t abuse them, they will be OK. And nothing could be further from the truth.

    I also don’t think that I should be required or it be demanded of me (or anyone else in a highly compromised state b/c of neurotoxicity to these drugs, who is just fighting for recognition and change around what happened to them) to advocate for and discuss every single outcome that can happen with benzo use. My personal passion is solely for the iatrogenic dependence problem b/c that is my story. I am not an addict and never have been and don’t think I can (or should be asked to) accurately speak for or about an issue or problem that I’ve never had and that I don’t relate to b/c it is not my experience. Why should we be expected to lump ourselves in with it or do advocacy for it when our efforts are better directed at what we did experience and what we feel is completely misunderstood (still) because it hasn’t been recognized as the distinct phenomenon that it is?

    Lastly, I’ll re-post an example I put elsewhere on the same topic, in the event you missed it, that I believe drives my point home:

    I have tried to think of a scenario or analogy that would be clearer or better explain the point. This is what I came up with: Say there was a household cleaning product that was approved as “safe” for humans to use by the EPA (or whoever approves these products). People began using the product in accordance with the instructions for use listed on the product and became gravely ill. Another group of people were inhaling the product in an attempt to get high from it.

    All of the families and individuals who were just cleaning their house with it (as it was intended to be used) came forward attempting to highlight for the public that this product had made them sick just from normal household use. The public then responded (b/c of all of the news around the abuse of it and no understanding publically that it is dangerous, too, when used as directed) accusing them of only getting sick because they were inhaling it like the other group. Or someone then asked them why in their advocacy around household use they aren’t also advocating for help for the people who are inhaling it? In their efforts, all they want is to have a platform to warn and educate others about the dangers of this product when used as directed in the home so that innocent people know they are at risk.

    When they’re (falsely) grouped in with the people inhaling it or the waters are muddied and the clear distinction between the two groups not made, the general public writes them off and doesn’t think they’re at risk using the product themselves b/c the public perception is that it’s only a problem b/c people were inhaling/abusing it. The activism failed. The as-directed household users can still have compassion for the addicts who need help with their addiction to and behavior of misusing the product (and recognize that behavior exists) without taking that on as their activism work, as it is a completely different issue and one which they most likely don’t relate to, as they weren’t inhaling the product themselves. They want the world informed to the dangers of using it as most people do, as it was intended for use, and to know it’s NOT even safe to use that way.

    Also, because the people (who are attempting to expose approved use of the household cleaner as dangerous) are misunderstood and falsely grouped with those who abused the cleaner, they can’t obtain appropriate medical help from their doctors/the medical community in being treated for the illness it caused. How frustrating and scary that is to be dismissed at every turn when you’re gravely ill- that is what we as iatrogenic benzo victims have experienced similarly and want to elicit change around with our distinct platform- and we feel we can’t do it if we don’t separate ourselves from attempts at “bridging the benzo divide” and being further and continually misdiagnosed and misunderstood as being addicts.

    • On a similar note, should all the advocates who are coming forward and telling their iatrogenic dependence/withdrawal/neurotoxicity stories about prescribed “anti”depressant use gone bad (in order to warn other unsuspecting victims about these overly prescribed drugs) be expected to highlight and advocate for the fact that some people are now choosing to inject Wellbutrin as “the poor man’s cocaine”? http://globalnews.ca/news/846576/antidepressant-wellbutrin-becomes-poor-mans-cocaine-on-toronto-streets/

      Or can we see and recognize that expectation would be silly and that while it’s the same drug- the circumstances are completely different and the iatrogenically dependent platform is unique and separate in it’s efforts and cause?

    • Your analogy regarding the household cleaner is pretty good and helps clarify your focus on making certain distinctions. The thing is, I don’t think anyone here would argue the outrageousness and even criminality of the situations people are led into vis. a vis. benzo dependence, or the legitimacy of the struggle to overcome it on all levels. On the other hand it might be useful to explore the distinction between the medical/pharmacological and physiological factors which constitute the original problem vs. the social, economic and political factors which exacerbate it.

  7. Going to add one more point and then I’m done on this topic.

    In your numbered list, numbers 1-4:
    “1.People who have had no history or connection to substance abuse or addiction
    2. People who have had a prior history of substance abuse and are in a current state of abstinence
    3. People currently abusing or misusing other mind altering or addictive substances, including opiates
    4. People whose iatrogenic dependence on benzos was a contributing factor to them evolving into abuse patterns with other substances such as alcohol, or a relapse back into addiction with a past “drug of choice,”

    All of the above, in my opinion, can still constitute iatrogenic dependence. It’s irrelevant if people have a past/current history of addiction/abuse of drugs if they are not abusing their benzo currently and they took them as directed by their doctor. It would be the same – iatrogenic dependence- if they were alcoholics (past or active) but were taking an SSRI/antipsychotic daily as directed that caused dependence and withdrawal syndrome which was completely independent of their addiction to/abuse of alcohol.

    I belong to a psychiatric drug dependence/withdrawal support group for ALL psych meds (not just benzos) with a diverse group of people w/ many different histories and experiences. There is one member who comes to mind who has a self-professed very long history of addiction with anything he could get his hands on. He has since been sober for many years. Once sober, he was prescribed and took SSRIs, under his doctor’s direction that it would “help” him with maintaining sobriety, which caused iatrogenic physical dependence. And now, since tapering for many years, he suffers from a severe withdrawal syndrome from the SSRI which he describes as being far worse, totally different, and persisting for much longer than his drugs of abuse.

    When discussing his issues, his being an addict is always referred to by him as a completely different problem than his prescribed SSRI dependence and withdrawal.

    Just the other day in my support group, this very topic arose surrounding an article about Luke Montagu’s wife. For history, Luke Montagu recently won a lawsuit against his prescribing doctor (for what was clearly iatrogenic dependence/medically mismanaged withdrawal) for millions of dollars. The article was titled “Julie Montagu on her husband’s addiction to prescription drugs”. ( http://www.dailymail.co.uk/home/you/article-3470982/Julie-Montagu-talks-husband-Luke-s-addiction-prescription-drugs.html )

    My recovering addict friend (who is also an iatrogenically dependent SSRI victim), who I discussed above, (who has always thought it was perhaps a bit ‘petty’ to ‘knit pick’ the language) in response to the article’s title stated, “Ok. I’ve never chimed in on the whole addiction word as before I thought everyone was making a big deal out of just language but in this headline it sounds really bad and just poor context”.

    Someone else then responded to him, saying: “Separate struggle. Separate language. Absolutely ridiculous and dangerous”.

    My recovering addict friend closed with saying: “I’m beginning to understand”.

    Another example of a similar situation would be Stevie Nicks and her iatrogenic Klonopin dependence. She was a cocaine addict in recovery when she was prescribed Klonopin to supposedly “help” her remain sober. She took the Klonopin as directed by her psychiatrist for many years which made her very ill. The two (her addiction and her iatrogenic dependence) were separate and distinct issues.

    She, too, would, despite her prior history of addiction, fall into the iatrogenic dependence category. And yet they still use the word “addiction” in this article (http://www.benzo.org.uk/nicks.htm) to explain her experience in spite of her very clearly describing iatrogenic dependence: “Basically, I went to see a doctor just to check in with somebody and let everybody know that I was OK. I guess when most people go off Klonopin they have a very hard time. I wasn’t one of those people, but he didn’t know that. So he suggested that I go on this drug for my nerves, and I just said OK to get everybody to leave me alone. Well, what a big mistake. I really wonder where I would be now, what I would have done if those eight years were full of creativity and love, and good things instead of full of nothing.”

    She also very clearly describes that she never went back on cocaine- and so it IS possible for people to be iatrogenically dependent on benzos/psych meds, and not get thrown back into active addiction w their prior “drug of choice”.

    I think when myself and other people advocating for the iatrogenically dependent benzo platform are saying it’s important to “distance from addiction” – we don’t mean not speaking to, shunning, denying their experience, or disallowing addicts/people w/ histories of addiction to other substances and/or benzos in our groups. Instead what we’re meaning is when referring to cases that are specifically iatrogenic dependence cases, distancing from (and really altogether avoiding using) the incorrect use of addiction terminology/the addiction narrative to describe a completely different and distinct phenomenon that is iatrogenic physical dependence (as was done in the articles previously listed- Luke’s wife/Stevie Nicks – which both incorrectly used addiction language to describe what was, in both cases, iatrogenic dependence).

    Thank you for this discussion Richard. Best to you and all. – J.Doe

    • @J.Doe, I completely agree with your reasoning here, and very much appreciate the efforts you have employed to delineate the I.D v. “addiction” struggle, which is so much more than the inherently daunting challenge to discontinue benzo use, though that ordeal in itself, is already too much–and then there is:

      The struggle to be respected and treated like a *patient* suffering from adverse effects of careless drug prescribing practices. This challenge is an unnecessary, cruel burden — adding insult to injury . As a nurse, I advocated for the I.D approach , in terms of supportive care for benzo withdrawal–with the same rationale that supports *universal precautions*( protocols that were started during the AIDs epidemic–) treating every patient as *harmed by the prescribing habits* of doctors, Regardless of whether the doctor relied on pharma infomercials — or his own biased view of himself as knowledgeable, skilled MD. — People are harmed across the board– and NONE should be labeled or viewed as *addicts* , considering the stigma attached to this label, DSM disease label notwithstanding…

      I wish I could share the most compelling cases that would further support your position — but because they involve *patients* I met while employed as a psych RN, I will just generalize from personal/professional experience , where I was frequently called an *enabler* and *naive* by clinicians because I advocated for patients to be treated as I.D. My colleagues adopted the popular blanket response doctors give for any complaint referencing their practice- in relation to a drug. It is always some aspect of the person who presents with complaints of I.D. that absolves the doctor of responsibility– and the most common response in cases of benzo I.D. is ” this person has an addictive personality–” “we are dealing with an addict.”

      Maybe the MIA audience is not aware of how much confirmation bias plays into this issue– meaning that it is almost impossible to be recognized as I.D once a psych admission has occurred– . This is why I would advocate for universal I.D. protocols– sans references to any past drug history–(illegal or prescription)– Safely monitoring the tapering while supporting the person suffering the *treatment* makes the most sense to me– It is not helpful to attempt to sort out other issues, and definitely bad timing for adding more stress — .

      I have been around the psych field long enough to suspect that the *addicition* focus is strictly about expediency for reimbursement– and good PR for substance abuse programs.

      Yes– more public education is needed. But, advocacy for I.D issues is crucial for appropriate patient care, AND to further the cause for whatever it takes to change the prescribing practices of self protection- focused doctors– either by shaming them or suing them. We have long passed the time limit to discuss and revise a very harmful practice, or rather our expectations of the medical community and other prescribers have been dismally dashed.

      My perspective is informed by my nursing philosophy and 40 years of experience working in both medical and psychiatric settings (includes *addiction tx.* ) I believe in honoring the patient’s voice, respecting their inner wisdom and providing safe, supportive CARE– with attention to his/her unique needs for physical and emotional comfort. This is commonly called, a person -centered, humanistic approach– superior -by far to any other I have seen.

      Thanks again, J. Doe for bringing in the perspective that I would argue is the best place to start meaningful dialogue and realistic problem solving for this very important issue.

      Best!
      Katie

      • Thank you so much, Katie, for your comment. All I can say is thank goodness that nurses like you exist and how lucky for any patients who received your care from such a well-informed place and perspective.

        I have pondered for quite some time a way for what you describe in your comment to come to fruition- treating the benzo ID patient like an actual patient with a legit medical problem- it is just physiological dependence (an expected outcome) and neurotoxicity after all. I have tossed around the idea in my head of perhaps some kind of a “network” of sorts or an advocacy effort strictly for medical professionals (nurses, doctors, PAs, NPs, etc) to join as members to show support for and do advocacy around (i.e. with the DEA or the state Boards of medicine) the mission of exposing and making universal humane protocols around benzo ID. Some of them, like yourself, know the truth about what’s really going on. It’s just sadly not enough. (I think at one point there was a group like this in Maine, I’m not sure whatever happened to them or if they closed down. And in the UK, after reading Barry Haslam’s comments it seems like the BMA *might* be coming around in the UK…we’ll see)

        Thank you again! In solidarity, J. Doe

      • Since there is almost always a factor of corporate control (in its many forms) when you scratch the surface of any discussion at MIA, I think what really underlies the issues being dealt with in this one is the fact that there is a corporate/pharmaceutical agenda at work here to deny that physical dependency, however defined, is a basic characteristic of the drugs they need to sell in mass quantities if the profit margin is to be upheld, and that rather than acknowledge this by offering reliable protocols for going off the drugs, they want to blame the problem on the already victimized consumers, and if possible keep them on the drugs indefinitely. This, of course, is a crime.

        Doesn’t this largely sum up the essence of what we should be uniting around?

          • No, just pointing out that the reason that it is not already recognized and treated as such is that there’s a profit motive underlying the “confusion.” You can’t eliminate the profit motive in a capitalist system but when you recognize what’s at work it’s easier to attack the problem at its source. The general populace also needs to understand the difference between opiate addiction and benzo dependence, iatrogenic or not, and especially between the detox protocols. But the current lack of education about this is hardly an accident.

  8. I used to be an addict, dependent on alcohol and other things and once upon a time, benzos. They were prescribed by my psychiatrist at the time and I was given directions as to how to take them. I did not take them as prescribed because I did not want to. Not every victim of a lie is a victim once the prescription is filled, at least in a voluntary outpatient setting. That said, before I start on a self righteous, unhelpful rant, it’s possible I received more of a warning about the habit forming nature and more education on this possibility because I had extensive addiction treatment, and it’s hardly news in D/A circled that benzos are tantamount to solid alcohol….I was detoxed off a fifth of vodka a day with Librium and Xanax.. My own gut said anything that felt that good would probably be something I would go to too easily.

    It’s worth noting they were not forced on me as part of an inpatient hospitalization, nor as part of AOD and I don’t think I was misled as to their habituating potential. My two cents.

      • This is not a judgment call. I apologize if it came off as such. Just offering my perspective that in some circles (D/A), there may be more access to the needed information that these drugs are habit forming and if a person is on them (whether by choice, by abuse or because they were lead to believe it was of no consequence to be on them for a long period) there are long term consequences when coming off them. My circumstance was that I knew they were habit forming, and not a real solution to my problems, but they worked in 30 minutes or so. I drew a quick line between emotional distress and quick, temporary relief and went for it. Despite access to information that it could be/was causing brain damage, I continued to use them because it was convenient. I wonder if others, maybe even those who were not “addicts” have had similar experiences.

  9. If doctors prescribed alcohol the way they prescribed benzos (and other drugs) there would be a great many more alcoholics in this world. This is the issue, and why there needs to be a paradigm change in the mental health field as a whole, not it’s relation to so-called substance abuse. The difference between “iatrogenic” substance “dependence” and “addiction” is that in one instance the substance was provided by a medical professional, and in the other instance, it wasn’t, and that in the context of “standard practice”. I don’t want to harass anybody with the intricacies involved in this sort of distinction. I do think it indicates the sort of change that the mental health field needs away from an over-reliance on chemical agents rather than strengthening the coping mechanisms that exist within an individual. Prescribing benzos long term, as so often happens, in any case is going to mean a dependency issue, and the kind of dependency issue that shouldn’t be occurring. Doctors would, in fact, in so far as it goes, know better if it weren’t for their cozy relationship with Big Pharma. Given this relationship, blocking a certain reflective regulatory and ethical capacity, history is doomed to repeat itself.

  10. Richard

    I think J. Doe’s analogies are right on.

    My whole experience with the iatrogenic damage I have been dealing with (and *will* be dealing with for ???? how long????) would have been so much more tolerable if this ‘syndrome’ was recognized by ‘the health care’ edifice, and the proper supports offered.

    My family perhaps wouldn’t have abandoned me when I couldn’t work and risked homelessness/hunger due to lack of funds.

    And to seltz above;

    My psychiatrist/’health’care provider assured me that I was taking ‘such a small amount’…and that I ‘didn’t have an addictive personality’, that my concerns about ‘addiction’ were not applicable (stupid me). And I never *ever* increased my dosage when the inevitable interdose withdrawal started happening (no ‘provider’ knew WTH was going on, only ‘care’ I received was more/different drugs.)

    There’s something about the tone of this blog post that makes me feel invalidated, just as J. Doe points out.

    This is a nightmare experience. How many die from suicide after discontinuing benzos, *even* after a ‘slow’ taper?? Why is NO ONE addressing the devastation incurred by individuals who FOLLOWED their doctor’s orders? Why did my doctor(s) not know there were severe risks involved taking these drugs? If I hadn’t had a friend with an internet connection, I would have never found BenzoBuddies and figured out what was going on with me, and would have ended up in a psych ward….When this is all conflated with ‘addiction’ it BLAMES the VICTIMS.

    I am truly sorry for those who get caught up in pursuing street drugs/pharmaceuticals as a way to decrease the pain in their lives, hell, I’m addicted to *sugar*! (mostly free since the ID set in, since it jacks my nervous system up along with many many other things I can no longer tolerate) I get it!, but putting us all under your “big tent” is not helpful to our personal and professional lives.

    Again, the examples J. Doe offers are totally applicable to our *unique* situation.

  11. Hi, Richard!

    Thanks for taking on a difficult topic directly! I have to agree that there is a spectrum of behavior and dependency and that it is not possible to categorize folks into “addicts only” and “iatrogenic dependency”, even though there are some who would fit rather clearly into one category or another.

    Perhaps the meta-message of this entire discussion is that the act of labeling, and especially labeling in a pejorative way, is at the core of the problem. It’s clear that our view of “addicts” is very judgmental and negative as a society, and that this view has been reinforced and exacerbated by the medicalization of addiction treatment and intervention by requiring those who want to get paid to adhere to the DSM criteria. It is important to remember that psychiatry coopted addiction intervention after the DSM-III came out (part of the plan), and that of course, like any other psychiatric label, the result is that the people so labeled would be stigmatized. And it seems more than understandable that someone who became dependent on benzos through following their doctors’ advice would resist being so labeled.

    I think the larger problem is that “addict” is just as vague and subjective a label as most any other in the DSM, and I’d like to make a pitch for not applying such a stigmatizing label to anyone. Instead, we need to look at each case and talk about b0th what behavior is happening and what is driving it, just like we would with any other of the spurious “mental illnesses” in the psychiatric Bible.

    I also appreciate the call for others to be sensitive to the needs of this unique group of folks who have been victimized by their own physicians, and would advocate for very specific kinds of support for people who identify in that way. But the identification should be left up to the individual, not appended from the outside by some well-meaning professional. It seems to me that this is the core issue that affects both “addicts” and “Iatrogenically dependent” people adversely, and should be tackled head on.

    There is a physiological withdrawal process from benzos that can be deadly if not handled properly, and appears by all reports to be very tricky and require careful management. That is a medical issue. But beyond this point, addiction and addiction “treatment” are no more medical than the “treatment” of “bipolar disorder” or “major depressive disorder.” The labels are invented and voted on by DSM committees in just the same way, and are just as political and just as fraught with social biases and judgments. For some reason, we as a reform movement seem to have shied away from saying this quite so bluntly about addiction issues, and I think the lack of clarity about that adds a great deal more discomfort to this discussion than needs to be there.

    Anyway, thanks for the thoughtful and thought-provoking article. I feel much more educated about the distinctions between what is called “addiction” and the unintentional dependency on benzos (or opiates) caused by following doctors’ orders, an issue that wasn’t until recently on my radar. I also appreciate the commenters who have most definitely enriched the conversation and educated me even more!

    —- Steve

    • it is not possible to categorize folks into “addicts only” and “iatrogenic dependency”, even though there are some who would fit rather clearly into one category or another.

      Why not? I think that in terms of treatment it is crucial – for both of those populations – to do just that where appropriate.

    • I think the larger problem is that “addict” is just as vague and subjective a label as most any other in the DSM, and I’d like to make a pitch for not applying such a stigmatizing label to anyone.

      That’s a big part of this too, the whole taking one aspect of someone’s personality or personal history and creating a noun out of it (murderer, thief, hero, racist, addict etc.) to hang on them as their identity.

  12. “This period spanned several years, all the drugs included. I was never warned or adequately informed of all the risks. At the time I was very naïve and ignorant about psych drugs. Many people simply do not know any better, like the younger me, and the myth of doctors as honest, unbiased, authoritative figures makes us even more vulnerable to the harm of their “treatment.” ” BTPDBA

    So why the guilt trip?

    What people need to be able to stay out of the clutches of psychiatry/medications is SUPPORT from family/community/social structures.

    But we have been atomized (very deliberately) and fed a story of ‘personal’ responsibility and nonsense about mythical *bootstraps*.

    When there are no tools available, and the milieu has nothing to offer a distressed or diseased (medical) individual, the institutions built to support the status quo are one’s only alternative.

    Let’s build some alternatives, hey?

    • There is no guilt trip humanbeing. I rarely feel guilt and don’t think others should feel excessively guilty either. Life is too short.

      In the comments above I’m saying that playing the role of the victim, blaming doctors, lamenting over how bad the system is… that ain’t gonna do shit. It’s only by becoming informed, taking action, facing difficult feelings, and improving the real issues that are making your life difficult… that is how you make things better, gradually, with slow frustrating hard work. That is what I did. And as you said getting emotional support from family and friends is absolutely essential, and when internalized can be much more powerful than the medical model.

      With this being said, don’t take our disagreements too seriously! They are just people’s opinions on a web board. Relax…

        • If you have a real argument to make, make it; if not… then I won’t worry about this projection from you onto me.

          I think the argument is that telling someone to “relax” is condescending. I thought so, at any rate. Stop psychoanalyzing people and stop telling them how they should feel or react.

          • Same to you… and yes of course I know you are being sarcastic, but I really don’t give a damn.

            Rather than worry about my comments, maybe spend a little more time addressing the issues at hand and remember that we agree on much more than disagree. You are far too easily upset by what I say, maybe you have Internet Comment Easily Upset Disorder. I’m just joking man 🙂 . You have a good mind and we could use more comments from you on the actual issues not only on this but many other conversations. Yes, I’m being serious this time, this is not sarcasm…

          • Thanks, but I don’t need a pat on the head, either. I didn’t intend my earlier comment as an order, but I forgot to say please, so it’s fair enough that you took it that way. (I sure hope nobody is foolish enough to ever take take orders from me.) But surely you can understand why it’s not cool to psychoanalyze other psychiatric survivors or invalidate them by telling them how to feel and/or implying that they are over-reacting somehow. Your initial comments (after the first one) were callous at best, so OF COURSE people would be upset by them.

  13. Richard,
    J.Doe is absolutely correct, in that iatrogenic benzodiazepine drug dependency needs to be universally recognised in it’s own right.
    After more than 50 years of over and miss- prescribing of the these highly dependent and dangerous drugs, the British Medical Association are finally waking up to their responsibilities on this issue and are desperately trying to seek a solution with interested Stakeholders. I have been publicly criticised by the BMA for calling this intervention ” Far too little and far too late “. I am however grateful that the BMA have finally stepped up to the plate and for that I am thankful but I stand by my criticism.

    This lack of ‘official’ recognition for a public scandal that has been going on now for decades, ( a deliberately policy ) has meant that very few dedicated withdrawal services and after care facilities, with the necessary expertise, are currently available to effectively tackle this world pandemic of benzodiazepine drug dependency. This is a crime against humanity.
    We have been and still are, being denied our human rights by Governments.

    This quite deliberate policy of muddying the waters of using the words ‘addict, misusers and abusers’ by British Health Agencies going back many years has not only allowed them to fully avoid their responsibility and accountability but has led to prolonged dependency, physical and mental health problems, permanent damage and deaths. To a set of drugs which where only trialled for weeks by the manufacturers but have made many, many $billions for the pharmaceutical industry.

    With clinical trials and assessments showing that long term usage of prescribed benzodiazepine drugs leads to an increased risk of developing brain damage, Alzheimer’s disease and certain cancers. Then effective world government intervention is urgently needed, to protect innocent world citizens who took their medication purely on the advice and instructions of their doctors.

    On the 19th of March 2016 I ‘celebrated’ 30 years of being benzo free but I am still suffering with their terrible legacy.

    Barry Haslam.

    The 1988 Committee on Safety of Medicines Guidelines on benzodiazepine drugs which recommended they be prescribed for 2 to 4 weeks only has been breached with impunity by the medical profession.

  14. Thank you for writing this article. The author makes some valid points, in particular, the need for recognition of the group of people prescribed benzodiazepines who are dealing with addiction related issues. What bothers me is that what he seems to be also saying is that Jane Doe and anyone advocating for recognition of “Ashton Syndrome” have no right to do so. That by asking for the needs of this specific group (people iatrogenically dependent without addiction issues or whatever term anyone chooses to use) to be met, implies a lack of consideration for those iatrogenically dependent with addiction issues.

    It is surprising to hear you challenge the voice of an unsupported and misunderstood group of people, on such an urgent matter that will positively impact their lives. This article perpetuates the very problem created by proponents of the Disease-based medical model who have used said arguments to avoid accountability and provision of services.

    This attitude has created devastating problems for people with no history of addiction – a significant number of whom, like myself, were prescribed benzodiazepines for medical conditions such as chronic pain, neurological movement disorders, menopausal symptoms, migraine headaches, etc. people with no psychological issues or addiction issues, who have not been able to get appropriate care.

    This article gives the impression those who are both iatrogenically dependent AND addicted are not acknowledged and at the same time is asking for those who ARE iatrogenically dependent to be disregarded.
    I wholeheartedly concur that someone who is both iatrogenically dependent and addicted is entitled to the same level and quality of care given to those with no addiction issues. The reality is that there are far more services available for people with BOTH issues but little to none for those without addiction issues. As you must be aware, there are differences in treatment approaches to both groups (although safe tapers and appropriate and adequate aftercare apply to both). In addition, many within the withdrawal community have reported not being able to access services unless there was an illicit drug use or other addiction problem. This is the reason Jane Doe’s article is so important and invaluable to us.

    You refer to a “gap” within the benzodiazepine community. The online groups are very supportive of every one affected by withdrawal, regardless of motivation or reason for taking the drug. Support groups and organizations do not turn away someone discontinuing a benzo because of a history of addiction and they do not identify members in terms of having addiction issues or not. I don’t know how this concept evolved but it may have to do with the misinterpretation of the requests of the “iatrogenic without addiction issues” group.

    It is common knowledge that there are many people prescribed benzodiazepines who are affected by withdrawal and are also addicted to illicit drugs, alcohol, gambling, etc. Many of them are actually quite open about their drug-taking history and they can afford to be this way because the withdrawal community accepts and supports them. I don’t know how the notion of this “gap” came about but as someone who has worked in this community for more than a decade, I have yet to see the divide you refer to or any stigmatization of people who have a history of addiction. Both groups are stigmatized and I speak from experience. Asking for recognition of “Ashton Syndrome” does not indicate division. It does not mean that one group perceives itself to be “better” or more mentally balanced than the other. It simply means that there is an urgent need for acknowledgement of this syndrome in order for there to be accountability and provision of best care.

    It should not be a problem that people in prescribed withdrawal without a history of addiction are asking that “Ashton Syndrome” be acknowledged.

    It should not be an issue that someone who has anxiety or a medical issue, when given a drug taken as prescribed, who broaches and initiates tapering off the drug with his or her doctor, chooses not to be labelled an addict or substance misuser.

    The difference being able to get a disability benefit due to “Ashton Syndrome” will make to someone who has lost a home, who has become bankrupt due to an inability to work as a result of severe physical and psychological symptoms will be monumental.

    You wrote: “On one level, when considering all the cultural prejudices against people with addictions, it is understandable how some strictly benzo dependent people might arrive at some of their conclusions about the need for distance from all things addiction-related.”

    I think the point has been missed here: There is no need for distance from all things addiction-related, except in avoiding inappropriate care. Addiction related issues such as relapsing, cravings, etc. are irrelevant. No, people in the withdrawal community without addiction issues do not want to be distanced. There is no “us” and “them” ethos. They simply want to be acknowledged and cared for adequately and appropriately. And their wanting this does not mean they think people with addictions issues are not entitled to the same.

    How can we justify concluding that one group’s pleas for recognition implies a lack of acknowledgement of the existence and needs of another group? This article could have simply advocated for the needs of those iatrogenically dependent on prescribed benzodiazepines WITH addiction issues, without implying that those without should be silenced. Thank you.

    • What bothers me is that what he seems to be also saying is that Jane Doe and anyone advocating for recognition of “Ashton Syndrome” have no right to do so.

      That’s almost the exact opposite of what Richard actually said, I don’t know why people have to put words in his mouth.

      It is surprising to hear you challenge the voice of an unsupported and misunderstood group of people

      To challenge and question is not to negate or dismiss, it is essential to developing a clear analysis.

      This article…is asking for those who ARE iatrogenically dependent to be disregarded.

      Could you quote that part?

      This article could have simply advocated for the needs of those iatrogenically dependent on prescribed benzodiazepines WITH addiction issues, without implying that those without should be silenced.

      One person’s implication is another’s inference. That’s a pretty strong accusation though, and if you believe Richard is trying to “silence” you I think you should at least provide a quote to illustrate your contention.

      • To anyone reading this article who may be involved in policy and procedure decisions that could affect people iatrogenically dependent on benzodiazepines, please, please, read the comments – specifically those from Barry Haslam and Jane Doe. They are relevant and extremely important. I have nothing more to say.

  15. Thank you for taking the time to respond. I actually read every word of your article, but with discernment… the overt and the covert. All I can say is: To anyone reading this article who may be involved in policy and procedure decisions that could affect people iatrogenically dependent on benzodiazepines, please, please, read the comments – specifically those from Barry Haslam and Jane Doe. They are relevant and extremely important. I have nothing more to say.

  16. I still regard the *survivor* voice as the most credible– . Knee jerk assessments and criticisms of both the *scholarly efforts* and the *intentions* of J.Doe and Dr. Ashton were made here by Richard– here is- just one example:

    >>J. Doe stated: “Just as it is intolerable to turn rape victims into the accused, it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it on themselves.”

    Counterpoint: While I believe J. Doe and the others advocating for their position have no intentions to demean or stigmatize the addiction community (and they have even stated this desire), this was a poor choice of analogy in multiple ways, and it unfortunately ends up contradicting their good intentions.<<

    Referencing Laurie Oakley's six part series on "Pharmaceutical Rape" which appeared on David Healy's blog recently, where you will find a very important opportunity to connect with the experiences and the struggles of people who are harmed by prescription only drugs.

    Perhaps Richard can change his perspective on the *language and analogies* used by the survivors of *pharmaceutical rape*– realize that the analogy J.Doe employed is not an insult to those claiming addiction issues with benzo withdrawal…? I think that this can only happen when he stops trying to defend remarks that were offensive to members of this group, and to me, too, as I find authoritative statements made that discredit the authentic voice of a" survivor" — unacceptable.

    By all means question and try to get a better or deeper understanding– BUT, do not presume to know what is known by and what motivates a *survivor* TO speak out and advocate for appropriate– long overdue CARE.

    Please. Is this really so hard to see??

  17. Here is the link to Laurie’s series on pharmaceutical rape–

    http://2spl8q29vbqd3lm23j2qv8ck.wpengine.netdna-cdn.com/wp-content/uploads/2016/02/RxISK-PR-Final.pdf

    here is a question for all who are jumping on Richard’s bandwagon:

    What term best describes the desire for a desired effect of an action to continue to be predictably pleasurable ?

    Relief of *medical* symptoms v. *mood manipulation *– what does it matter WHY you continue to take benzps– the result is the same– drug tolerance develops, physical addiction is noted upon discontinuing the drug-; CONTINUING to take benzos, and especially increasing the dose for either medical or mood effect is DANGEROUS.

    I see this as a critical MEDICAL issue– . The priority should be to focus on the physiological problems and risks for long term use and discontinuation of THIS drug.

    I.D advocacy does NOT harm those Richard is labeling as primarily *addiction*– but focusing on *addiction* certainly does harm to the I.D. victims– . Though, again, as a nurse, I do not delineate this way because, once again– the main issues are physiological, as in, life threatening.

    There are times when spitting hairs and disparaging the language or use of metaphors, in other words, semantics– used in an attempt to educate the public, is just plain ridiculous.

    Listen, listen, and listen some more….

  18. I have spent the past 5 years recovering from the effects of these awful drugs and most of that time I have been involved in the online support community. I have met a few people who abused benzos and some who had been addicted to other drugs in the past but the thing that strikes me about this whole discussion is that I can’t think of one person who would have been truly “harmed” by any kind of attempt to clearly differentiate between addiction and dependence.

    On the other hand, I have talked to hundreds if not thousands of people, including those who have or do have addiction issues, who have been gravely harmed by the medical community (and to a lesser extent family and friends), and much of this can be attributed to the iatrogenically dependent people being mislabeled as addicts.

    There is no “gap” that needs to be bridged. As it stands it one big tangled mess of misinformation, ignorance and confusion that has destroyed thousands of lives.

  19. “If this is true, based on your comment above you believe we both have no right to EVER question or expound upon the ideas put forth by survivors. ”

    So you are admitting that IS what you’re doing, Richard?

    How can you not see the similarities of your ‘ideas’ for benzo survivors and what psychiatry does to patient’s experiences?

    Admittedly, I am not the sharpest knife in the drawer, and my brain damage prevents me from processing information as I would like, but this whole discussion leaves me feeling helpless and misunderstood, and despairing of there ever being any recognition of this experience as a distinct entity with specific protocols?

    How is this helpful to the thousands of us who unwittingly followed our doctor’s orders?

    Cui bono?

    • It’s very disappointing to see people piling on Richard as though it’s a crime to attempt any sort of critical dialogue, whether they agree with him or not.

      This has nothing to do with being or not being a “survivor.” I am a “survivor” (who is more familiar with this subject than some may presume) and will always object to comrades being treated in such an unnecessarily ad hominem way. Most of what Richard is being accused of he never said; moreover the comments section is for respectful comments. I don’t remember any previous situations where people have been hounded simply for daring to participate or express a challenging remark. Especially when their motivation is clearly to struggle for maximum unity and clarity.

      Speaking of clarity, this is what I believe has been clarified by J. Doe and friends in these discussions:

      a. People can become dependent on benzos prescribed by physicians, independently
      of substance abuse reasons;

      b. Withdrawal protocol is different than that for withdrawing from opiates and should not be confused with such; and

      c. People who have become dependent shouldn’t be shamed or presumed to be substance abusers.

      These themes resound throughout these threads. I don’t know why at this point so many people think so many others don’t “get it.” Did I miss something basic? Because no one is unclear about or arguing with these points from what I can see. Certainly not Richard. Though it may be time to move on for now…

      • I think that if there is confusion (and I’ve sure been confused reading a lot of this), it might be due to the fact that Richard chose to use J Doe as a foil to make his argument about the intersection between ID and addiction. In addressing the “unfortunate secondary countercurrent to [J Doe’s] arguments,” he created a straw man as his article’s point of departure. That’s my best guess at the moment.

        I feel that this is far from resolved.

        • A “foil” or a point of reference? People who are trying to advance an analysis or hypothesis often refer to an existing piece of writing as a means of sparking further discussion; I don’t see why Richard is suddenly the bad guy for doing so. Don’t J Doe and most other MIA bloggers expect and desire their writing to stimulate discussion and even debate? If it were myself I would consider this a good thing. But suddenly somehow offering a counterpoint is seen as an attempt to deny the validity of others’ experience.

          • At this point I’d be interested in knowing what is considered to be the main bone of contention here, just to see if there is indeed a conflict or merely the perception of one.

          • I don’t think Richard is “the bad guy,” and I didn’t say anything like that.

            Wikipedia:

            A straw man is a common form of argument […] based on giving the impression of refuting an opponent’s argument, while actually refuting an argument that was not advanced by that opponent.

            Straw man arguments are not always intentionally made. I happen to think that this one was the result of an honest misunderstanding. That’s just my view as an outsider, and it’s not a vilification of Richard.

          • I don’t think Richard is “the bad guy,” and I didn’t say anything like that.

            Sorry UR, didn’t mean you personally, but t think it’s been an obvious vibe in others’ posts, though as there seems to be a little actual dialogue going on at the moment I don’t want to resurrect the negativity by dragging up quotes and examples.

      • @oldhead, I think there has been an attempt to engage in a critical dialogue as a response to Richard’s critical post. I appreciate sustained engagement by Richard and J.Doe as comments we all can read and ponder. Whether there are new understandings reached or any significant mind changing resulting from– at times, heated debate, remains to be seen.

        I can’t fully disclose the horrific consequences that I have witnessed with regard to iatrogenic dependence on prescription drugs, but I fully subscribe to recognizing the criminal element that conceived and perpetuated the practice of *blaming the victim* by assigning stigmatizing labels. The way this plays out on locked wards is dehumanizing — to the tenth power, causing harm rather than treating the condition that resulted from harm …. it is barbaric, criminal.

        I have no issue with anyone who self identifies with a label that secures him/her a treatment option that he/she is comfortable with. I oppose the sorting via evaluations/screening– from some presumed expertise that may discount the voice of the *patient* or simply disrespect his/her subjective experience and expressed needs.

        Richard, I presume, has written this blog in expectation of responses from the MIA audience, readers in general. I would not expect anything less than diversity here, and would be disappointed if there weren’t at least a bit of intensity.

        This is a complex, controversial topic– I think there are some nuances shared in the arguments — even mine. But, I have nothing new to say, so no more excuses for not completing a blog post of my own today :-/

        Cheers!

        • Richard’s blog is part of a continuing discussion (I don’t see it as a debate although some insist on looking at it this way).that goes back some months now. While it is accurate to characterize his concerns as largely focusing on the issues faced by those whose circumstances involve multi-drug dependency/addiction, I challenge anyone to show me a quote where he invalidates the call of “ID only” people for recognition of and support in their unique struggles.

          • I think part of the problem is that I feel that Richard mistook my Part 2 as a call to action for people who truly ID as addicts to stop calling themselves addicts, but what’s important to clear up is that the entire article was focused on ID only and coming from the perspective of a truly ID only person (me) and the “call to action” was to the ID-only community. In other words, it was asking that we, the ID community, start using the right language to describe what really happened to us and stop perpetuating the problem by using the same addiction language that has been used for years to blame the ID patient. Lots of people say “I was addicted” when the true story is one of ID only. I was in no way telling people who identify as addicts or who have an addiction-history to stop calling themselves that.

            I also don’t agree with the definition of the term addiction (and don’t agree either with the AA dogma, the “your disease is out in the parking lot doing pushups” stuff, or that addiction is a “disease” whatsoever), but I had to use it because it was a quote for how the medical community defines that term, and so as to differentiate between the two (ID and addiction). So, I was simply using it to make a distinction that it’s NOT the same as ID- and that in fact ID exists as a separate phenomenon seen and defined in other parts of medicine with other drugs that don’t typically have any “addiction” behaviors associated with them- i.e. beta-blockers.

            As for the quote about “as if they brought it on themselves,” I explained prior that I didn’t mean to perpetuate stigma (and even clearly stated in my article that nothing in the article was meant to be an attack, “put down,” or moral judgment to addicts at all). What I meant – and feel was misinterpreted – was that people do treat addicts that way and so, ID people don’t want to be subjected to that same stigma when our situation is very different from addiction, which is what has happened to many of us, simply because of the misdiagnosis and confusion around this topic.

            As for the great “benzo divide”, I’ve been in the community for over 5 years and like Yvonne and FG and others commented, I’ve yet to see or experience this “divide”.

            Lastly, as for the tone to the comments section that Richard keeps bringing up – I think it’s an impassioned discussion. Those of us in the ID community have been intermixed with or misdiagnosed with having addiction for so long that when someone comes along and does it again (injects addiction the discussion) to us when we’re (through horrific suffering) trying to forge a platform for ourselves just as ID alone for advocacy and education, it sucks – and sort of re-opens that wound of trauma that most/many in the ID community have all experienced.

            As I said before, i don’t deny the grey areas (although, I think some are just pseudoaddiction misdiagnosed as addiction- which I actually had a part about in the unedited version of my article, but my editor thought it should be removed due to length and the fact that I hadn’t brought that term up anywhere else in the article prior) exist – I just wrote the article solely about ID (and used addiction as the definition for what ID is NOT) and from that perspective and didn’t delve into the “grey areas”- not to deny or reject them- I just didn’t see them relevant to the ID only advocacy and platform.

            Also, this is type conversation- there is no inflection in text. I also, personally, just learned how to use the italics and other features- so before when I wanted to lay emphasis on words they were caps locked- which I know some interpret as shouting.

            I am still, also, very unwell and cognitively impaired and experience a lot of frustration in these types of interactions. Sometimes I see very long responses or complicated, very complex points being discussed and I have a hard time engaging and defending my points b/c my brain and nervous system are still very much damaged by the neurotoxicity. So, that’s something to keep in mind as well – that you’re dialoguing with very sick people. That’s not your fault – and was part of the reason I even considered not posting the articles until I was better so that I could better engage – but ultimately I felt the topic too important (and I, myself, too passionate about change around it) not to bring it to completion and put it out there.

            Best to all who have participated here.

          • @oldhead,

            The discussion has taken on a personal tone as opposed to fleshing out ALL of the points made by J.Doe, Barry Haslam, Yvonne Paige , @humanbeing, @uprising and me.

            Where you stand depends on where you sit. So it goes…

            In Richard’s last response to me above he says:

            >>”So on April 5th in Boston there is a big conference titled “The Opioid Crisis: Thinking Outside the Box.” All the state leaders from the governor to DPH officials and probably several people from the media. I have statistics to prove that in some areas where there are hotspots of opiate overdoses there is also an extremely high number of benzo prescriptions.

            “Does this involve the issues of benzos and addiction. Yes, it certainly does. This is a tremendous opportunity to do exposure about everything that is wrong with this System. Given my experience with addiction work, the statistical information I have at my disposal, and the fact that the state refused to investigate my complaint (see my blog “Deafening Silence”) it would be morally irresponsible if I DIDNOT attend this conference and speak out on this issue. I should not be the ONLY ONE making noise at this conference. <<"

            I appreciate Richard's dedication and respect his unique perspective based on his courageous first hand experience with
            challenging his colleagues and then making appropriate complaints. Although I am no less repulsed by the "Deafening silence" than Richard surely is, I do realize that the culturally tainted labels actually explain the silence.

            "Addicts" and the "Severely Mentally Ill" are classifications designated by the *ultimate authority* in our society, whom none of our specialized public servants dare confront. I have been to higher places in the chain of command than Richard has to date, and am only stating this to make a crucial point, that the "Deafening Silence" reflects deference to psychiatry on matters involving those whom psychiatry has stigmatized with labels commonly understood as *profoundly flawed*. We speak here about crimes against humanity based upon this overwhelming prejudice that has not yielded a bit to the outspoken outrage of professionals in the field.

            My radical suggestion, restated to reflect my appreciation for Richard's stated intentions at this conference, is this:

            Upgrade the status of those for whom you feel most passionate to advocate for. Apply the term, Iatrogenic Dependence across the spectrum– then, state your well thought out charges against the perpetrators. No Benzo victim left behind…

            My assertion is based on the one underlying truth about these drugs– and the that the proper *medical* attention is a foregone conclusion. Sharing the wisdom of years of experience with *addiction* issues will be lost on an audience that will stop thinking critically when the term *addiction* or *addict* is spoken.

          • Richard,

            RE: how to bold and italics in comments:

            Basic html is accepted by the comment form. Use for italics and for bold.

            So, drop the word you want in italics or bold in between either of the above listed codes.

            For example, if you want the word “benzo” bolded in your comments, you’d do:

            benzo

            ^^But, with NO SPACES (I just put spaces in the example above so you can see how to type it out. Had I left out the spaces in the above example, it would’ve just bolded it when I posted the comment and you could then no longer see the format on how to do it).

            It would be the same concept for italics, just with “i’s” instead of “b’s”.

          • When you’re going to leave a comment- look in the text below the white box for comments and it shows you the html code to use and just put the word you want in between either of the codes provided. (when I tried to post the codes alone in my prior response to you, they weren’t included).

          • The discussion has taken on a personal tone as opposed to fleshing out ALL of the points made by J.Doe, Barry Haslam, Yvonne Paige , @humanbeing, @uprising and me.

            It had taken on such a tone some time before you joined the thread, which is my point. Whatever valuable communication may be going on in spite of this is inevitably skewed by the unnecessary interjection of personal attacks and projections — to the degree that I think it would be futile to attempt to further discuss this or that intellectual “point.” I ask again, is there something specific about the subject matter that currently constitutes a point of serious contention? If not we should move on for now.

          • @ J Doe,

            Your last post was both clarifying (I know I’m using that word a lot) and reassuring that we can find our way collectively out of this seeming (and unnecessary) morass. You articulated both your original intentions and your reaction to the impassioned confusion which ensued in a way that makes a lot of sense, to me at least.

            I wouldn’t want you to not post something important to you just because you don’t feel that you’ve tied every little loose end together. All of our stories are works in progress, and I have been told by Buddhists that there’s so such thing as closure anyway. So I hope not having the “perfect” articulation of your thoughts at any given time doesn’t hold you back from jumping into future conversations.

  20. I have been watching the comments with interest and thank everyone for taking part.

    When I finally withdrew myself from benzodiazepines on 19th of March 1986 after 15 months of hell on earth, I did not think that 30 years down the line, this issue of iatrogenic drug dependence would still be in it’s infancy in providing dedicated withdrawal services, and after care facilities with the necessary expertise for the many millions world wide.

    We need to educate the uneducated, certainly the doctor’s and psychiatrists .

    We need to stop the flow of new patients becoming benzodiazepine drug dependent patients by making
    Guidelines mandatory and enforceable . With certain exceptions, such as end of life situations or emergencies. Certainly we need to stop long term prescribing of these highly addictive set of drugs.

    We need 24 hour help lines, which have been agreed upon by the British Medical Association, subject to the necessary funding.

    We need a network of local Peer Support Groups to be organised and set up by primary care facilities, with the direct involvement of ex drug dependent patients, in order that their acquired expertise can be fully utilized and also the assistance of compassionate nursing / therapists staff. Similar to Tranx Oldham.

    We need more individual States to replicate the initiative of Mass. in putting forward a Bill to acknowledge the need for action and recognition of this public health scandal and to make government officials fully aware of the clear and present dangers that benzodiazepine drugs present to the USA, both in financial, health and humanitarian terms.

    We need more world citizens to lobby their government representatives, to explain their stories and how these drugs have impacted upon them and their families and ask ” What can the government do for them ? ” We need to have our voices heard.

    We need more world citizens to communicate with local radio networks and newspapers and to tell it ‘ as it is ‘. By doing just that, I embarrassed our local health authority in Oldham, England to provide a dedicated withdrawal service for Prescribed Drug Dependence including benzodiazepines. This service was started in 2005 and it is still current in 2016.
    Individuals with passion can make a difference….. WE ALL CAN.

    Thank you for caring.

    Barry Haslam.

  21. I was on Ativan and Xanax for over 15 years, and Klonopin for about 10 years, all 3 for several years. This was in addition to 6 other drugs. It was a hellish withdrawal as most people describe.

    When I came off all prescribed drugs in 2002, I had never heard of any of this about iatrogenic or dependence vs. addiction, etc. I did not know that I was on my way to becoming a ‘psychiatric survivor.’ I had yet to wake up on an intellectual level about what had occurred with me, here, but I knew intuitively that something was a amiss regarding the way I had been treated medically.

    I was still on the verge of waking up to the fact that I had been horrendously abused and drained to high heaven, from the very people to whom I’d turned in trust for healing. I suddenly felt as though I had been in a vampire den, feasted upon, unknowingly, for years and years.

    Mostly, I knew that I was getting sicker and sicker on these pills and no one in the mental health system felt I was worth a listen, that I could not know what I was talking about regarding my own self or my health. Imagine what it’s like to be on the receiving end of that kind of personal and spiritual invalidation, when already feeling chaotic, ungrounded, excruciating anxiety and worries about surviving in such a cold, heartless, and utterly bigoted and stigmatizing environment.

    I knew of no one who had come off psych drugs. I only knew they were hurting me and doing great harm, and I could not function on these. I went for what soothed and when nothing did, I’d cry, scream, and complain, overall doing the best I could to get though these extremely rough times and moments, trusting my process of healing. During this time, I learned tons and tons about energy and natural self-healing. I no longer feel the effects of any of this, as far as I can tell. It is all behind me.

    It wasn’t until I started arguing with people on here who challenged my truth as a survivor, that I’d began to feel off balance again. I thought perhaps something was wrong with me, that I could not keep a cool head when my truth was being challenged. I realized it was because I am continually reminded on here of my experience in the mental health system. There has been on difference in the dynamic, I have felt it here through and through, which has been terribly disillusioning to me, as far as any kind of ‘survivor’ movement or community goes.

    I continue to share because I feel it’s important, but it does not feel safe to do so. When a survivor’s truth is challenged or questioned on MIA, I feel very discouraged about this cause, because that is the #1 affront in the system which is what leads to confusion and instability. There is no fighting it, that is how energy works. As far as I know, healing requires peace, followed by peace of mind.

    I commend everyone’s courage for participating in these very challenging and thought-provoking discussions. However, I found it eye-opening to pay attention to how it was affecting my health to be so constantly invalidated and questioned on these very personal issues, which I think here of all places, is exactly the opposite of what I’d consider to be sound and appropriate.

  22. I don’t think it is a bad thing to want to acknowledge the part that addiction can play when it comes to benzos but the dependency issue dwarfs any kind of addiction issues, and as such I simply do not see the need for some kind of movement to acknowledge the people who are “in between”. I don’t see it as a big problem and it only serves to undermine the push to get everyone on the same page as to the need for differentiating between two separate and distinct issues.

    Also, as J. Doe pointed out, it is likely that a lot of this gray area between addiction and dependence is not really gray at all. Before I touched a benzo or AD I was always a one or two beer a day kind of guy. Never had much of a taste for hard liquor and although I drank often I very rarely drank to excess. But that all changed when I got tangled up with psych drugs. One or two beers a day became six or eight stiff vodka and grapefruits.

    Was I displaying “addictive” behaviors with my increased alcohol use, or was my body subconsciously compensating for benzo tolerance (because I was dependent) by craving alcohol?

    I continued to drink after coming off the benzo, but as of about 18 months off I started noticing that my tolerance for alcohol and my desire to drink were starting to wane and by 20 or 22 months off I wouldn’t have been able to drink more than a couple of alcoholic beverages if I wanted to, and by about 24 months off alcohol was flat out making me sick. I am starting to tolerate alcohol better now that I am just over 5 years off, but I have no cravings and probably only average about 1 drink per month, if that.

    Did I need treatment for addiction? No, I needed to get off of those awful synthetic pharmaceutical drugs and allow my body to revert back to its natural state.

    It seems like there are a fair number of benzo survivors who ended up in a similar situation and because of the ignorance surrounding dependence they “default” to using addiction language and even label themselves as addicts when it is wholly inappropriate, and this only serves to create more confusion for everyone.

    What we need is a clear and concise delineation between addiction and dependence before we can even begin to discuss the nuances of any sort of gray areas. At this point any kind of push to “bridge the gap” is only going to create more confusion and that will stand in the way of the ultimate goal of ensuring that folks who are dependent receive humane treatment, which we all seem to agree on.

  23. @oldhead,

    As a Buddhist, I appreciate your promoting sustained and value creating engagement– It is challenging to articulate a separation between one’s beliefs and one’s emotional responses –in writing alone. (I read this in your very thoughtful response to J. Doe)

    I have a response to your comment to me re: the personal tone of this discussion:

    “It had taken on such a tone some time before you joined the thread, which is my point. Whatever valuable communication may be going on in spite of this is inevitably skewed by the unnecessary interjection of personal attacks and projections — to the degree that I think it would be futile to attempt to further discuss this or that intellectual “point.” I ask again, is there something specific about the subject matter that currently constitutes a point of serious contention? If not we should move on for now.”

    Specific to the subject matter–

    The responses to J.Doe’s expressing what she felt was *unfair* about Richard’s references to her previously published blog(s), are interesting. Rather than respecting her clearly stated objections , Richard and BPD defended their positions, insisting they were NOT disrespecting her very personal viewpoint. I felt queasy reading their comments…. which I found to be disrespecting her very personal and well articulated grievance.

    I liked J.Doe’s analogy about black women having a unique -to- themselves, set of issues that non-black women simply do not have. She also employed a very good analogy about a cleaning product that was both noxious in practical use and an agent that produced a *high* if huffed– or misused. I cringed reading the dismissal of her message via refuting the validity of the analogy to the subject at hand.

    The answer to your question, “the subject matter in contention”:
    I consider the defensive posturing described above to be “negating another’s validity, credibility– even disqualifying one’s to state what he/she is offended or upset about.”

    Example/analogy :”I am sorry if you FEEL I made an error.”

    What does that ACTUALLY mean?

    “Your FEELINGS are off…?”
    “I am SORRY your FEELING are off?”
    “YOUR off the mark feelings lead you to believe I made an error?”
    “Your FEELINGS will definitely change when I explain how wrong you are?”

    Anyway– there were many valid points raised here regarding I.D. as a very misunderstood, mislabeled and mis-treated malady– that yes, “Harms, them twice!”

    I think that there is room for us all to learn, when there is space provided for every perspective and it every perspective is respected as a unique and important contribution-.

    The tone is personal to the extent that specific people are sharing their own thoughts, but the contention I was trying to voice was based on principles that have been described and promoted here.

    It is an ideal we share, I think, that keeps us commenting despite feeling personally invalidated at times. I think we all know that it is silence that threatens our advancement more than the airing of any contentious or personally driven criticism of each other or by any one of us.

    Thanks so much, Alex– for your very timely inspirational comment– 🙂

    If we want to make an omelette, we better get used to breaking some eggs….

    • I have yet to see a quotable example of invalidation, at least by Richard. A person’s subjective feeling of being invalidated may or may not be the result of other people’s statements or actions depending on the specific circumstances. I hesitate to jump back into this as the principles involved seem to be engaged in a process of “reconciliation” and don’t need others stirring the pot.

      However, just so I know in the future — as a “survivor” of many things including forced incarceration and Thorazine at a clip of 1600 mg. daily, should I have the right to flash my credentials any time you disagree with me and demand you apologize?

      • @oldhead,

        I accept that you aren’t convinced by what I have recounted as my perception of invalidation is credible. I respect your perspective. But, then you note that the “principles involved seem to be engaged in a process of reconciliation”. I wonder why that would be noted in your criticism of my take on this, or rather, if one of the principles did not feel invalidated– what was there to reconcile?

        Is this a criticism of my interjecting my own lived experience as the reason I felt like addressing what I sensed was disrespecting the lived experience of a “survivor”?

        Maybe you think I cannot use the term “survivor” with regard to my credentials, or rather the position I was in, working in the trenches so many here survived?

        I accept that you may see this as inappropriate, or maybe even arrogantly presumptive on my part. Maybe it is, but I have always experienced visceral reactions to the dynamics described here by those of you who have experienced what I have witnessed.

        My gut feelings fueled my advocacy for victims of psychiatric abuse before I had the knowledge base to do more than paint a target on my own back. I guess, I should have learned to remain silent?

        Since you are defending Richard against what you seem to be presenting as your perception of my being unqualified or incapable of doing; that is, –challenging his position and his responses to others challenging his position, I think you are very clearly saying you don’t think I have the right to disagree, and that I should defer to yours and Richard’s credentials and apologize. I disagree with the premise, so cannot sincerely apologize.

        But, since you asked a question, I will answer honestly. No, I don’t think anyone has the right to force anyone to do anything against their will. Credentials do not negate the inherent value and basic human rights of others. Period.

        Fiery debate and passionate expression of one’s convictions may give the impression that a battleground has been created, but it is a battle of ideas, waged with words. This is the spirit I am bringing to writing the manifesto you have requested. I hope the first installment will be published here by the end of the week.

        Thanks for the *fuel*!!

        Best,
        Katie

        • Not really sure what this has to do with anything.

          I think you are very clearly saying you don’t think I have the right to disagree, and that I should defer to yours and Richard’s credentials and apologize

          Ever hear of irony? The “credentials” I refer to are those of “psychiatric survivor,” which you seem to assume automatically trump the logical content of any discussion/debate. Richard does not have such “credentials” so I guess I must assume that you missed my point. You do seem intent on perpetuating divisions that the principles here have made at least some baby steps towards attempting to resolve.

          PS “Survivor” in my book means those who have been psychiatrized; if that applies to you my apologies; if not, bearing witness to the oppression of “survivors” does not make you one yourself.

          • Whatever…regarding points missed– just trying to respond to a palpable hostile tone you have directed at me– or figure out where your hostility is coming from. And on that note, what’s up with “the principles”–? Another group that I can’t join?

            Sorry? You are using another label here, the *principles*?
            And come to think of it,that division you are creating without naming names, definitely excludes me–according to you. Oops!

            Divisiveness is fueled by label making, categorizing–splitting groups into smaller groups. Monty Python’s “Life of Brian” is my favorite example of the fate of many groups who can’t agree on a basic purpose or goal for themselves. Maybe you missed my point, or the ideas I shared for unifying the platform to address the most dangerous, debilitating effects of long term benzo use ?
            Unifying is the opposite of perpetuating divisions.

            I guess if psychiatric survivors was the name of a club, and you were the president, I would be denied membership? Well, another lost opportunity for a new label for me, that doesn’t alter, in the least, the value of my lived experience. Nor does your excluding me from rightful claim to the title, “psychiatric survivor” invalidate my feeling of connection to this “group”.

            Shared humanity trumps all the labels…

          • You are indeed perplexing Katie.

            My comments about “survivor”-ship were in response to your original attack on Richard on behalf of “survivors,” a group of which I am a part. I’m not thrilled with the term personally; it was easier when we used the term “psychiatric inmates.” That got more complicated when the shift to outmate drugging took hold.

            And on that note, what’s up with “the principles”–? Another group that I can’t join?

            Say what? I meant the principle participants in this discussion, i.e. J Doe, Richard, et al.

            I guess if psychiatric survivors was the name of a club, and you were the president, I would be denied membership?

            Nothing like personalizing an objective truth. Am I accurate in inferring that you are claiming “survivorhood” based on your experience as a psychiatric nurse, or are you also a former psychiatric “patient”? Otherwise it would seem that your are trying to insinuate yourself into a classification which you don’t fit (which you should be glad about). Unless people are going to suddenly start playing with words, there are survivors and there are allies of survivors. And the bottom line is that survivors decide who our allies are and who speaks for us. If you find that threatening there’s something wrong; it’s simply a matter of definition. Not that this is particularly relevant to the subject matter.

  24. Richard, thanks as always for the courage to write this article. This discussion has generated a lot of truth in the dynamics of this discussion that I feel are core to breaking up the toxic alliances that create oppression in the mental health system. I really appreciate how everyone comes to the table so authentically with their feelings and perspectives. One thing I do appreciate about this website is the transparency it generates, I think that’s vital to social healing.

    Katie, from someone who went through this with extreme consciousness (for better or worse), from various angles professionally and as a client-turned-advocate, it seems to me that you deeply understand the nuance which creates the division and separations which undermine, both, healing and justice.

    I’m also a proponent of unity consciousness because I feel that, whether we realize it or not and whether like it or not, we are all connected and we affect each other in profound ways. As I see it, our choice lies in awakening to that or staying in denial of it. The former brings clarity with ease, while denial tends to be a bit rough after a while. That’s one of the most critical things I learned as I healed from psych drugs toxicity, and all else that came with this particularly complex and educational journey.

  25. @oldhead,

    Maybe I would be less perplexing if you stopped categorizing me according to your own personal , subjective truths?

    For instance, you say:
    “My comments about “survivor”-ship were in response to your original attack on Richard on behalf of “survivors,” a group of which I am a part.”

    You say, I *attacked* Richard.
    I say, I confronted him with my perception, that he invalidated those who disagreed with him from their *lived experience*. I very specifically addressed what came across in his written responses–that is NOT a personal attack on Richard, by definition.

    You say, I attacked Richard on “behalf” of a *group*.
    I say, I confronted him based on my personal *lived experience* with a *group* –
    Let me be more clear and say the experience I have as a nurse over the course of the past 40 years
    influences my relationship to the basic underlying cause of the benzo scourge. I worked within the profession that developed reckless irresponsible prescribing practices and then absolved themselves of responsibility for the harm they caused. The *group* I defer to is comprised of every individual who is a victim of what Laurie Oakley has so aptly called, Pharmaceutical Rape. My professional responsibility to victims of pharmaceutical rape in the case of benzos, a by -prescription -only, pharmaceutical, was impeded by attitudes shared by my colleagues that the victim was presenting *them* with another layer of pathology, as opposed to what I consider to be an objective truth, that is; the victim was suffering the harm caused by the ineptitude of the prescribers of these dangerous drugs. This is the context within which the *harm them twice* approach to “treatment” was designed.

    If you have not suffered the effects of benzos, then you aren’t in the *group* I was deferring to when I confronted Richard’s responses to those who are in that *group*.

    You say:
    ” I meant the principle participants in this discussion, i.e. J Doe, Richard, et al.”

    I say: You very clearly indicate that I am not a* principle participant* in the discussion. Am I wrong in assuming that this deprives me of some rights or privileges regarding comments I add to the discussion thread –as a NON-principle participant? My subjective take based on your manner of addressing me, is that it does.

    Following your assessments of my comments based on the various categories you have assigned me to, i.e.; *attacker on behalf of the group you self identify with* – you then claim your analysis is an *objective truth* by saying:

    “Nothing like personalizing an objective truth.”

    Actually, oldhead, I have personalized your subjective misperception of my participation here, which I find personally offensive. And I cannot seem to convince you that I am not insinuating myself into anyone’s exclusionary *group*. The term*survivors* is usually linked to a specific group of victims. I am part of a group of professionals who have been both victimized and exploited by the same corrupt institutions and industries that have assailed you and other psychiatric survivors– not all of the members of my group have survived, as in literally lost their lives, not just their careers.

    What do all survivors share in common, besides good fortune? Survivors usually have a strong sense of commitment to help others who are still suffering and a desire to share their wisdom. The larger, inclusive group of *survivors* of the medical/psychiatric/mental health institutional empire, could share their personal lived experiences, their individually acquired knowledge and wisdom — and embrace each others’ diversity. Yes, this is possible, and it is probably the best shot we have to achieve a goal I believe we all share– preventing the mass production of more innocent victims.

    MIA is where the counter narrative began to evolve into a vision for a social justice movement. I think the success or failure of this vision depends on how we transcend differences. The motivation might be linked to recognizing the power of our connection.

    On another comment thread, a few months ago, you said that someone should write a manifesto. Perhaps you meant someone in the psychiatric survivors movement, though at the time I read that discussion, that I did not participate in, I began to think about the research and writing I have been working on for the past 6 months, reshaping my work into a basic and total affront to psychiatry. Historical evidence provides the best reasons to extricate it from our culture and then, logically from our courts, schools, political system…

    By definition, I can only truly be an ally, in the true sense of the word, for those I am personally acquainted with. I suggest everyone employ the greatest care in choosing allies– should be someone who stands to lose as much as you do IF things go wrong.

    Best,
    Katie

  26. Well I don’t see how much of anything can be too “personal” considering we know nothing about one another other than what gets written here, and have never interacted in any other way. So to go on like this is frankly getting tedious, I feel like you’re projecting things onto me for whatever reason. But whatever — maybe it shouldn’t matter so much to you what I think. I hold no animosity, whether that disappoints you or not. In fact from your writing I have always considered you an “ally.”

    Actually, oldhead, I have personalized your subjective misperception of my participation here, which I find personally offensive.

    Again, I don’t know you well enough for you to be “personally offended.” Getting into “personal” quarrels is not my agenda here. But maybe some of my “subjective misperception” could be the result of you not making yourself clear.

    you then claim your analysis is an *objective truth* by saying: “Nothing like personalizing an objective truth”

    My analysis? That “survivors” are those who have experienced psychiatric “treatment”? Isn’t that like saying it’s “my” analysis that “mental illness” is a metaphor?

    Anyway, the need for a survivor-led project to draft an anti-psychiatry manifesto is a collectively acknowledged need and I’m glad that you take it seriously. We need a solid core group of people to accomplish this collectively, not just one or two people with overwhelming energy and commitment. In terms of “power politics” I think “survivors” should comprise at least a simple majority of participants, but we can cross that bridge when we get there I would absolutely like to see more people taking this seriously, as it is necessary to formalize, coordinate and ground the movement so that we can actually accomplish something.

  27. No animosity from me either–:-)

    The personal offensive stuff is about proceeding from not clear where I am coming from to telling me what I am doing. The step in between is where you ask me what I mean, or why I am saying–whatever I am actually sating– that step was/is missing. I am not angry about it– anymore.

    Also, there are many people who have been victims of crime(s) and abuse, who identify themselves as *survivors*. Psychiatric abuse is a crime that is perpetrated in varying degrees of severity and claims a wide variety of victims. The term, psychiatric inmate is the only appropriate description of locked ward “treatment”. I think there was a huge misunderstanding regarding my use of terms and my relationship to the terms I use.

    I want to be clear about my respect for the voices of people with lived experience , who have survived medical/psychiatric harm/abuse. I don’t discriminate based on any aspect of difference between them, meaning that strictly because I am a nurse, who has always considered those in my care my priority; their subjective experience and expressed concerns, needs, wishes, are what I have to know in order to provide care, comfort, safety for them. Listening , imo, is the most important nursing skill – though now it is considered *old school* hype.

    Even a quick glance through the comment threads on this site is worth more than any continuing medical/psych-related education course, conference seminar, in terms of knowledge gained. This is directly related to the participation of psych survivors– . That’s why this site is so threatening to mainstream psychiatry. Any professional, even an investigative journalist is subject to attack for prioritizing the info that supports their position around *your* testimonies.

    I sincerely apologize for allowing my frustration and all of my other equally distracting emotions, that are evoked here sometimes, to influence my tone or the content of my comments. In all honesty, I get riled up, *triggered* here whenever my voice itself is invalidated — and what I am saying is completely ignored.

    I kept a journal during my last year on Bader 5 at Boston Childrens Hospital. I have documented hundreds of responses from colleagues and upper level administrators to hundreds of my professionally stated concerns and complaints. None of the responses addressed what I was saying. They were all “reasons” for discounting my credibility. The most common “reason” was that I over -identified with patients and parents, then I was criticized for being hung up in the details and missing the big picture– or referencing non-Harvard affiliated experts, or worse–* invalidating * the expertise of clinicians who held positions of authority on the unit. Setting aside the implications and consequences of my voice being disregarded there, the common thread running through all of these responses is that the best way to avoid dealing with an inconvenient or uncomfortable truth is to negate the validity of it based upon negating the source. It is the very same tactic used against patients everywhere in the health care system today. I’d probably be a better communicator and more formidable ally IF I did not —over-identify with victims, inmates and survivors in general . 🙂 because of “what has happened to me”.

    This is not to say I believe I meet strict criteria to be included or rather accepted in your group, oldhead, but I am definitely in solidarity with your goals.

    I suggest collecting individual *manifestos*, and compiling the jewels from each of them–into one big bad a*s manifesto, then employing the “Demand Progress” website tactics and create a media/political storm– before the end of this year.

    P.S.: My research into the connection between child psychiatry and juvenile court was motivated solely by my involvement with Justina Pelletier’s family over 10 months and then finally meeting Justina. What I discovered is better than Hillary Clinton facing Donald Trump —(speaking in terms of Hillary’s desire to be POTUS).

  28. There can be no timetables for creating a position paper. This is a process which will depend on the ability and willingness of people to participate and will not be successful until a critical mass of participants, especially survivors, is achieved. But I do hope more people take this seriously, rather than waiting for others to lead.

  29. Hi Richard,

    I want to respond o the common you addressed to me above– where there are no more reply button :-/ and even though I think you wanted the last word re: negative energy infusing this blog post discussion thread. I really want to highlight miscommunication– and remove any doubt as to ill intentions causing the derailment you described.

    First of all, I addressed my first comment o J.Doe– in support of her well articulated position that refuted. imo. your references to her previous 2 posts. I will repost the paragraph in your post here that led me to agree with her.

    >>”While we must overall give high praise to the work done by J. Doe and others, there is an unfortunate secondary countercurrent to their arguments that weakens their scholarship and threatens to possibly widen an already existing divide within the benzo victim/survivor community. While there needs to be a black and white distinction made between the scientific definitions of “iatrogenic benzo dependence” and “addiction,” there is a lot of grey area between these concepts when examining the real life experiences of all those people being harmed by benzodiazepine drugs. J. Doe’s theoretical shortcomings tend to downplay, or even deny, the reality that there are many people who have BOTH iatrogenic benzo dependence AND addiction issues present in their current or past life experience. In their advocacy for establishing distinctly different definitions for these two phenomena, they have chosen to promote both a theory and practice that encourages distancing themselves from anything addiction related. This includes distancing themselves from those people in the benzo victim/survivor community who also suffer from addiction related problems in their life. If J. Doe and others fail to reconsider this approach it could place unnecessary limits on the potential to build broad support among activists for their advocacy work, as well as interfere with future efforts to build unity among all those damaged by bentos.”<>”humanbeing on March 24, 2016 at 7:48 pm said:
    In my opinion, I think this is a bit of what’s going on here and why so many of us are uncomfortable with this article.

    https://www.madinamerica.com/2015/11/dear-man-sexism-misogyny-our-movement/

    And neither did you– address this directly.

    I posted an apology to @oldhead, who defended you from what he perceived were my unjust attacks.

    >>”I sincerely apologize for allowing my frustration and all of my other equally distracting emotions, that are evoked here sometimes, to influence my tone or the content of my comments. In all honesty, I get riled up, *triggered* here whenever my voice itself is invalidated — and what I am saying is completely ignored.<<"

    And finally engaged with Alex as a means for bringing some closure to the angst
    I was still feeling…

    I definitely do not and never have harbored any ill feelings toward you– I absolutely disagree with points you made in your argument, but that is not to say I cannot appreciate where you are coming from. The problem I encountered when both disagreeing with your points and the way in which you addressed others, who were *survivors* of the Benzo scourge , is the precursor of negative energy, and though I do see how my fledgling attempts to participate in the process of reconciling the miscommunication and the misperception of ill intentions, I don't quite understand you posting both a judgment of my participation, suggesting a justification for my being attacked, and basically blaming me for the negative energy. That is below the belt, imo.

    Yes, we have exchanged emails– and I wonder why you didn't address me personally with the perceptions you posted here? It is only because you wrote here, that I am responding here.

    Best,
    Katie

  30. “However, given the powerful forces in society who benefit from using psychiatric labels and also from the sale of massive amounts of psychiatric drugs, it is highly unlikely that a more narrow strategy of “going it alone” will be listened to or achieve the desired goals for those duly harmed.”

    And from a comment above:

    “I believe that if people are EVER going to understand (through education and political activism over a considerable period of time) the difference between “iatrogenic dependence” and “addiction” then they can ALSO understand that when it comes to benzos these issues are complicated and do intersect in many people’s lives. I don’t believe that totally separating them off advances your/our cause in the way you project it will.”

    I respectfully disagree.

    Currently, what little awareness there is of prescription drug harm is almost entirely seen through the lens of addiction. This is no accident. This story plays well in the media for a reason: it shifts the blame away from the structural conditions (many of which are perpetuated by the pharmaceutical industry) and onto the individual. The addiction narrative turns what is a social-structural problem of a profit-driven healthcare industry into something that appears instead to be a personal failing of “addicts and abusers.” It says to the casual media consumer, “prescription drugs and healthcare are fine, it’s the personal failures and problems of addicts that are to blame.”

    This pattern of shifting the blame away from structures and onto individuals is very common, from the welfare mom (who is poor because of her moral failings, not because of economic injustice) to the kid with ADD (who is medicated because something is wrong with his brain, and not because something is wrong with his hyper-competitive and standardized schooling). The iatrogenic narrative does the opposite of this, and shifts the blame and spotlight onto the structural issues themselves. Instead of blaming the victim, it blames the actual perpetrator. The iatrogenic narrative terrifies mainstream healthcare and the pharmaceutical industry, because it says that this can happen to anyone. This is the narrative that is so conspicuously lacking, and so desperately needed. Once this new story is finally recognized and acknowledged, the emperor will have lost his clothes. This will benefit us all – including addicts.

    Make no mistake, a unified front is the ultimate goal in facing these massively entrenched systems. The strongest forms of unity arise when those with very real differences come together in a common cause without negating their distinct narratives and perspectives. Both addicts and iatrogenically harmed individuals face a common structural failure and source of injustice, which impacts different groups differently, but all groups tragically. And precisely because it impacts so many different people in so many different ways, it serves to weave a radically diverse constituency together into an emergent (but not homogenized) unity. But this goal will take time to achieve.

    I believe we need to first be heard separately before we can be heard together, as little to no awareness or validation currently exists for iatrogenic benzodiazepine harm and dependence as separate from addiction. Without acknowledging our unique experience of iatrogenic dependency and bringing awareness (and a new language) of that experience to the public, medical professionals, and the media, I do not believe we will advance our cause at all. The fact of the matter is that abuse and addiction has been the sole narrative of benzodiazepine harm for decades, and very little has changed in public or professional perception and policy. Those who have been iatrogenically harmed by benzodiazepines have yet to be seen, heard, supported, or validated at all, and yet are being told that we must also continue to advocate for those who have very visibly dominated the public platform for the past 50 years. As someone who has been iatrogenically harmed from benzodiazepines and incorrectly treated as an addict, it’s incredibly frustrating to read this, however noble the intentions might be. At this point in time, we need a different story to emerge, and for different voices to be heard independent of those with addiction issues. Without this, I fear nothing will change for anyone.

    • Thank you thank you meghan and *Katie*!

      I tried to stay away from this as I found myself reliving traumas from the past and becoming someone I thought I had left behind in the past.

      As other “benzo survivors’ have pointed out, it is difficult to debate all this and defend ourselves optimally when our brains are still dealing with the damages. It may not be personal, but it has been very difficult for me not to take it that way and to wonder, again; who does this article really serve?

      Katie; I admire your tenaciousness and am grateful for your advocacy. This has been keeping me up at nights and has literally giving me nightmares. Thank goodness for those who, like yourself, are able to parse words more skillfully than I would ever be able to do.

    • This is no accident. This story plays well in the media for a reason: it shifts the blame away from the structural conditions (many of which are perpetuated by the pharmaceutical industry) and onto the individual.

      Exactly. One of my only substantive contributions to this thread has been to point out that the “confusion” is the result of successful corporate strategy (which is a common thread running through most forms of psychiatric oppression). This is a main reason why these issues need to be struggled through.

      As far as narratives, we should never base our strategies or analyses on how something plays in the media. What’s important is to be correct, as truth has a power greater than any “spin.” The function of the media is to obfuscate and delegitimize people’s aspirations.

      The addiction narrative turns what is a social-structural problem of a profit-driven healthcare industry into something that appears instead to be a personal failing of “addicts and abusers.” It says to the casual media consumer, “prescription drugs and healthcare are fine, it’s the personal failures and problems of addicts that are to blame.”

      Again, how things “appear” is essentially irrelevant unless you’re selling something or running for office. Those addicted to opiates, etc. need to develop a group political analysis as well, though likely such already exists. (None of this is my “specialty” btw.)

      However, people who have chosen to make it their focus to advocate for the special needs of people identifying as “ID”-only” should not be automatically expected to expand their focus to related or semi-related concerns of other groups (or sub-groups) unless they choose to do so. Nor should they be expected as a group to have an analysis of opiate addiction or multi-drug dependence, or be expected to automatically address these any time they host a forum or write an article about ID. (Although there’s nothing wrong with being versed in many subjects.) There’s no reason for advocates in these areas to be in constant conflict as long as they are given the mutual respect for creating their own “narrative.” Though we should always be open to benevolent criticism and challenge.

  31. I wonder why it was so easy to launch campaigns that focused on potential for harm and the requisite criminal prosecution for distribution of *illicit* drugs? A very streamlined process, with no negative attribute of pushers and users left unspoken.

    Consider for a moment why it is only the *users* of pharmaceuticals, who for whatever reason, ingest these manufactured “medications*, who are scrutinized, categorized and regarded with suspicion?

    Where does the responsibility lie for marketing dangerous *poisons* to people who are not predisposed to mistrust prescribers ?

    If the root of the problem is concisely stated, the action required to rectify it addresses all aspects of dangerous prescribing, but it also calls for a more comprehensive approach to providing care for everyone who has been harmed by a drug that has yet to be described accurately.

    Lorazepam is commonly prescribed to adolescents. It is routinely prescribed for teens diagnosed with an eating disorder . IT, better known as Ativan, is promoted for treating anxiety in adolescents whose symptoms always worsen on a locked ward. Ativan is always added to the chemical restraint order, to reduce the side effects of a neuroleptic or atypical ” antipsychotic “drug. Never is heard a discouraging word— safe, effective– when taken as directed by a doctor.

    Is there a safe way to prescribe benzos? Not likely to happen until Benzos are better known than doctors would have you believe.

  32. A note to J Doe:

    I have to wonder why this keeps happening (in reference to the media coverage of the hearing)

    You may be overthinking your analysis of the media portrayal of the hearing. It is in the nature of corporate media to reduce complex matters to sound-bites and buzzwords (“addiction”); partially to appeal to the 15-second attention span of the average viewer so they don’t change the channel before the next commercial, and also (in this case) to prevent people from learning enough to risk them drawing the conclusion that they should stop buying pharmaceuticals. They will do this no matter how brilliant your presentation is if it is in their corporate sponsors’ interest.to do so. So people shouldn’t necessarily blame this on a flaw in their approach.