Unhelpful Utterances: 6 Comments We Should No Longer Hear From Mental Health Professionals

Gary Sidley, PhD
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Professionals are paid to share their wisdom with those who are, typically, less informed. But, when dealing with mental health professionals in the psychiatric arena, it is wise to retain a degree of skepticism about the words spoken by the doctors and nurses commissioned to help reduce human misery and suffering.

During my 33 years of employment within the UK’s mental health services, I witnessed many colleagues, from a range of professions, who strove to alleviate the distress and suffering of the people who sought their help. Some offered humane, person-centred support, recognising that the patients’ emotional and behavioural problems were primarily the products of their life experiences and subsequent – often desperate – attempts to cope with these challenges. In contrast, many others had bought into the dominant bio-medical (‘illness like any other’) approach espoused by traditional psychiatry, thereby instilling an unhelpful and misleading slant to their interactions with service users.

Throughout my career as a clinical psychologist working in the National Health Service, I heard this latter group of psychiatric staff regularly say things, to their patients or to other professionals, which could be classified as invalid, hope-quashing, stigmatising or unethical. Given that the bio-medical approach to human suffering has now been broadly discredited – even many traditional psychiatrists acknowledge the folly of this paradigm – I would expect the frequency of these utterances to be reducing within modern mental health services.

I list below six statements that I heard on a regular basis during my time in the psychiatric system, followed by a brief commentary. Let me know in the comments section whether any of these continue to survive in the lexicons of psychiatric professionals.

  1. ‘Does the patient have a severe and enduring mental illness?’

As well as conveying undue pessimism about the likelihood of recovery, this question (a favourite of psychiatrists during the weekly multi-disciplinary meeting) assumes there is a clear demarcation between those with a ‘mental illness’ and other overwhelmed, highly distressed people. In addition, the query wrongly implies that psychiatric diagnoses are meaningful.

  1. ‘Is this illness or behaviour?’

This, rather bizarre, question was often posed when discussing a patient who is chaotic, agitated and challenging. As above, it unhelpfully implies that there is a clear dividing line between the ‘mentally ill’ and the rest of us. Worse still, there are pejorative undercurrents consistent with the idea that people expressing high levels of misery and distress fall into one of two categories, either mad or bad. Typically, what is really being asked is whether the patient’s symptoms fit the diagnostic criteria for schizophrenia, bipolar disorder, major depression (regarded as proper illnesses and the sufferers, therefore, deemed worthy of help and compassion) or that of a personality disorder (regarded as not a proper illness and the sufferer undeserving of help or compassion).

  1. ‘It would be unethical to withdraw his antipsychotic medication; he has a definite diagnosis of schizophrenia’

I’ve heard this kind of comment from psychiatrists when asked – either directly by the patient, or indirectly by a professional working closely with the patient – to consider the withdrawal of psychotropic medication. As well as, again, unduly assuming that psychiatric diagnoses are valid, it conveys the erroneous message that anyone experiencing voice-hearing or unusual beliefs can only be helped by medication, in the same way that someone with Type 1 diabetes can only benefit from daily injections of insulin. Also, the statement indicates no regard for the informed views of the service users.

  1. ‘I suspect there may be a lurking depression’

This one I always found rather comical, conjuring up images of some pathological intruder hiding in the folds of the brain, waiting to pounce and thereby incapacitate its host with depressive symptoms [come to think of it, I suspect Ruby Wax would concur!]. The comment – a favourite of biological psychiatrists – is another expression underpinned by the spurious assumption that mental health problems are primarily caused by biological defects.

  1. ‘If you don’t accept treatment you’ll give me no option other than to section you’

This stark example of misuse of power is commonly heard when a patient is expressing reluctance about taking the medication regime prescribed by the psychiatrist. Whether or not a person can be legitimately detained under a section of the Mental Health Act should be determined solely on the basis of the presentation – in the UK legal framework, the assessed level of risk and the presence of a ‘mental disorder’ – not whether the individual is willing to comply with the doctor’s treatment plan.

  1. ‘We’ll keep on tweaking the medication until we get it right’

What this usually means in practice is that the dose of the current drug will be increased in stages until it reaches the maximum permitted (sometimes well beyond this upper threshold). If the sought-after improvement is not realised, another drug will be introduced, either instead of or in addition to the original one, and the incremental increase in dose will start again. As with example 3, the false assumption underlying this practice is that some form of biological treatment is essential to achieve recovery. Furthermore, when this ‘tweaking’ continues over a long period of time, any noticeable improvement that does occur is immediately credited to the medication rather than any of the multitude of other factors – life events, relationships, community engagement, talking therapy – that could be influencing the person’s wellbeing.

 

I am keen to discover to what degree these utterances persist in day-to-day practice. Maybe those readers who are still involved in mainstream psychiatric services, either as a service user or a professional, could let me know via the comments section.

65 COMMENTS

  1. Yep, these ideas continue to have a strong hold in American psychiatry today. Just look at the latest claptrap from ignorant politicians like Tim Murphy, who keeps repeating that “those with serious mental illness” (as if there’s a clear dividing line) need a kind of treatment (i.e. involuntary drugging) different from the rest of us. I think the situation’s probably worse in America than any other country, as we were the country which shamefully invented the medicalized DSMs and propagated the myths about biological mental illnesses all over the world.

      • Yes oldhead agree. It is very harmful that our country is so focused on profit, achievement, controlling others, rugged individualism, etc. I can see that my young friends are really harmed emotionally by the desperate struggle to survive that our capitalistic financial system creates for young adults. It makes me be ruthless to profit from my own work enough that I will not be in danger of falling through the cracks. It’s a bad deal all around but hard to change… well, only a good deal if you have the advantages and connections needed to profit and survive in such a system. If you don’t you can be fucked.

        To the article author, I also like the title of the article, “Unhelpful Utterances”. That would be a succinct way to describe most of what biological psychiatrists say.

  2. Agreed, we should never hear any of those things, EVER. But I think it also comes down to refusing to hear any of those things and stay passive.

    If they were spoken to me, I would go into Marine Corps Drill Sargent mode and tell the guy off 25.4mm from his face.

    We need to start standing up for ourselves, teaching people to stand up for themselves, and teaching children to stand up for themselves.

    Though this is about corporal punishment, not mental health, it is still an outstanding example of children being taught to stand up for themselves.

    http://thesatanictemple.com/campaigns/the-protect-children-project/

    Nomadic

  3. I most definitely still hear the “behavior vs. mental health” dichotomy. I’ve never been able to figure out what the hell they are talking about, since every “mental health disorder” is essentially defined solely by behavior! It’s like “situational” vs. “clinical” depression. We are always told that there is this big difference and that those with “situational depression” need therapy and support but that this won’t help “clinical” depression, yet there are not even any ham-handed, subjective DSM criteria requirements that attempt to make this distinction. Depression’s severity is solely evidenced by the clinician’s subjective assessment of the severity and duration of the “symptoms” that define the “disorder.” The question of “situational” vs. “clinical” doesn’t even come up, yet we continue to be fed this BS, meanwhile, the DSM 5 committees decide that being immobilized by the loss of a loved one for more than two weeks now qualifies us for being diagnosed as MDD!

    And yes, the skew to the biological does appear to be worst here in the USA, where drug companies have a stranglehold on our government and can charge obscene prices for their questionable products.

    —- Steve

      • And that two-week line was, of course, chosen after years of precise scientific research into EXACTLY when “normal” people are supposed to start feeling better after the loss of a loved one, and EVERY person who doesn’t feel better at that time is PROVEN to have a “chemical imbalance” that prevents them from just freakin’ burying Mom and getting on with their lives.

        Grief is SO inefficient!

        —- Steve

  4. “the doctors and nurses commissioned to help reduce human misery and suffering.”

    Ya , the suffering of the people around the person with the mental so called illness by shutting them up like the suffering of the boring teachers with energetic students.

    But number 6 on the list is the real scary one,

    When this ‘tweaking’ continues over a long period of time, any noticeable improvement that does occur is immediately credited to the improvement when compared to the damage done by the previous drugs long after the patients original condition has been forgotten.

    I like to asking people I meet that have been looking for the ‘right meds’ what they were like BEFORE ever taking any psychiatric drugs.

    Yes, how did you feel and what was going on n your life 5 – 6 – 7 years ago before you started on psychiatric drugs ?

    The answers are always different but the reaction of “I never thought of that” is usually the same.

    I never thought that way myself, I just always needed a pill to fix the damage from the previous ones.

  5. Thanks for the useful Article!

    1. ‘Does the patient have a severe and enduring mental illness?’

    But there’s no difference between them and us.

    From wildmind.org

    Mindfulness:
    “…..without our making any conscious choice to shift our focus we slip into a dream-like state in which we’re rehashing a dispute, or fantasizing about something pleasant, or worrying about some situation in our lives…..

    …..These periods of distraction can be so intense that they are like hypnotic states. They’re like dreams. They’re like mental bubbles of an internal virtual reality drama …..
    ….When we’re inside these hypnotic, dream-like states, they entirely capture our attention. They hold us spellbound. They’re irresistibly compelling. And yet, when the bubble eventually bursts, I find them to be rather lame! Noticing this lameness helps me to stay more disengaged from them…..”

  6. Not If The ‘Patient’ Recovers Through ‘Psychotherapy’ ; And Can Explain How They Recovered:-

    HOW TO SORT OUT YOUR QoF MENTAL HEALTH
    REGISTER
    Dr Axxxc J xxxxxx FRCGP (2006)

    “…Once an approved code is added to the patient’s record, there is no easy way to
    remove the patient from the MH register.
    The rationale is that any patient with a severe illness, even if controlled or in
    remission, has a significant chance of relapse and hence should have an annual
    review, rather like patients with certain cancers should…”

  7. Yes, as a patient, I heard all of these.

    The one that my psychiatrist seemed to like most was :

    ‘Is this illness or behaviour?’…if I didn’t behave as he would prefer/like/dictate he would threaten me with a “borderline” diagnosis and say how good he was to work with me because most doctors wouldn’t take borderline cases and I certainly didn’t want that on my records. Whether he put it there or not I’ll never know, because when my next doctor wanted to see my records, the original shrink said I’d become dangerous if MY DOCTOR was to see my records.

    Another one I heard after release from my first hospital admission was that I was now on the revolving door of medications and hospital admissions for the rest on my life, but I guess that’s related to No. 1…enduring condition.

    Well, I did have another hospital admission after I attempted suicide following the first (apparently a common response to being locked up and drugged), but that was over a decade ago, and while I still have severe reactions to any stress at all…good or bad, and trauma from all I experienced, I have been clear of meds for over 5 years and will never go anywhere near the “mental health” industry again.

    It is an industry of insults, drugging, total hopelessness, death and destruction…and it nearly claimed me as another of its victims.

  8. ‘We’ll keep on tweaking the medication until we get it right’

    This is code for “we have no idea how these drugs work”

    My personal favourite is the the distinction between “reactive” and “endogenous” depression. I remember my father being told by his doctor that he had the latter soon after his retirement (?)

  9. 1. ‘Does the patient have a severe and enduring mental illness?’ My psychologist and psychiatrist brainwashed my husband, and tried to convince me I had a, “lifelong, incurable, genetic mental illness.” The only problem was, I had no genetic predisposition to such, so I never really fully bought in. But both utterances convey a staggering pessimism, unless in your gut you know it is a lie.

    2. ‘Is this illness or behavior?’ I was never “chaotic, agitated and challenging,” I was “smiling, and inappropriately laughing,” when repeatedly questioned about the odd sexual side effects of the Wellbutrin. Thus, I never heard this one. I will say now that I am embarrassed that I used to trust doctors, and thought they’d took the Hippocratic Oath. Now I understand to never trust them, since their sources of information are filled with fraudulent science. And the mainstream medical field has an appallingly unethical “dirty little secret of the two original educated professions.”

    3. ‘It would be unethical to withdraw his antipsychotic medication; he has a definite diagnosis of schizophrenia.’ A little background is needed to answer this one comprehensively, I believe. I had the ADRs of Ultram, Voltaren, and Wellbutrin misdiagnosed as “bipolar,” when the DSM-IV-TR strictly claimed this was a misdiagnosis. But my PCP’s husband had, unbeknownst to me at the time, been the “attending physician” at a “bad fix” on a broken bone of mine, and I did agree with her I should stop smoking. But combining and opioid and an antidepressant is known to be the second most deadly combination of drugs, so it’s now obvious my PCP’s paranoid delusions made it seem to her that that it would be clever, to proactively prevent a non-existent malpractice suit for her husband, by participating in “the dirty little secret of the two original educated professions.”

    And, unfortunately for me, despite the fact I was wise enough to pay outside my insurance for a second opinion regarding these ADRs. I ended up being recommended to a psychologist who also likes to profiteer of covering up sexual abuse of small children, for her pastor and friends, via the “dirty little secret of the two original educated professions.”

    What was good, however, is the psychiatrist was in the dark, as was I at the time, and once the psychologist stopped mandating I see her, since I was “hyper” about the etiology of my illness. My psychiatrist started blaming my psychologist for the “bipolar” misdiagnosis, in his medical records, since he did seem to know that opioids, and even NSAIs, were mind altering drugs, since almost all information regarding this was deleted from the medical records he handed over. No doubt at the request of the psychologist, however, since her corresponding medical records were also not handed over. Good thing I kept copious and impeccable calendar notes, and the psychiatrist’s drug notes do prove this. But keeping good calendar notes was the only way I could continue to function, given the egregious poisonings with which I was dealing at that time.

    Nonetheless, once my psychiatrist stopped being deluded by the psychologist’s lies, he did start to wean me off the drugs, since all three of his anticholinergic toxidrome inducing drug combos, of course, had made me “psychotic,” to the point he had delusions the central symptoms of anticholinergic toxidrome poisoning were “the classic symptoms of schizophrenia.” And I had been a “pleasant, slim, white female” on my first appointment with him. So I would say I was one of the few, who did not deal with a psychiatrist who thought I had a definite diagnosis of schizophrenia.

    4.‘I suspect there may be a lurking depression.’ I personally never complained of depression, quite the opposite. I was quite the optimist prior to leaving psychiatric treatment, researching medicine and learning about the almost unfathomable in scope crimes against humanity, by today’s entire psychiatric industry, particularly the US medical industry’s completely iatrogenic childhood bipolar epidemic. Digesting the magnitude of these societal crimes has left me heartbroken. Especially, given my medical research, which proves today’s “bipolar” drug cocktail recommendations, which include combining the antidepressants with the antipsychotics, is already medically known to create “psychosis,” via anticholinergic toxidrome poisoning. And today’s psychiatrists will not take this out of their “bipolar” recommendations.

    5.‘If you don’t accept treatment you’ll give me no option other than to section you’ This stark example of misuse of power is commonly heard …” After I was withdrawn from the drugs, I did suffer from a drug withdrawal induced manic “psychosis” / actually an awakening to my dreams. It was a spiritual journey, a learning about the collective unconscious, a born again type story, so not scary, instead helpful, and amazingly serendipitous actually.

    Nonetheless, since my husband had been brainwashed into believing I had a “lifelong, incurable, genetic mental illness,” and neither of us had been forewarned of the withdrawal effects of the “bipolar” drug cocktails. My husband called the paramedics when I suffered from a sleep walking / talking issue one night, which landed me in an actual illegal hospitalization. Not just illegal, since I did awake and agreed to go back to bed, and was “neither a danger to myself nor anyone else,” according to one of the paramedics, who’d objected to illegally dragging me out of my bed.

    But also illegal according to the court and medical documents. In the US, if one does not agree to be forcibly treated, rather than going through the required legal proceedings, the unethical doctors and hospitals, just forge the patient’s signature on the voluntary commitment papers, so they may defraud that person’s health insurance company out of $30,000, not to mention switch a $6000 antique gold bracelet that patient is wearing out for a cheap gold copy.

    And the doctor who had me medically unnecessarily shipped a long distance to himself, rather than to the closest hospital that took my new insurance, has even now been convicted of committing the same crimes against lots of Medicare and Medicaid patients, at a different hospital. Although he was not convicted for the worse crimes, including murder, he committed against others, according to my research. Apparently today’s American lawyers and judges and the US government are on the side of America’s doctors, who are killing millions.

    https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

    http://articles.mercola.com/sites/articles/archive/2000/07/30/doctors-death-part-one.aspx

    If you think the US psychiatric and the mainstream medical industries’ haven’t been absolutely corrupted, you’re mistaken. I’m not certain how bad it is in the UK, but it’s appalling in the US. We’re living through pre-WWII Nazi Germany with our psychiatrists out of control behavior, not to mention our Federal Reserve’s fiscally irresponsible and out of control behavior.

    6. ‘We’ll keep on tweaking the medication until we get it right.’ As mentioned previously, each of my “tweaking,” was a different combination of “bipolar” drugs, medically known to create “psychosis,” via anticholinergic toxidrome. I do so hope the psychiatric industry does learn some day that their drugs and drug cocktails are mind altering, toxic, “torture” drugs. And that their DSM is nothing more than a handbook describing the serious iatrogenic illnesses they can create with the psychiatric drugs.

    Oh, but my research indicates that the psychiatric industry has switched from claiming Jews are “mentally ill,” to claiming child abuse victims and their concerned mothers are “mentally ill.” I don’t think this makes them morally superior to the Nazi psychiatrists, however, I will say they are now more insideous than the Nazi psychiatrists.

    I personally believe today’s psychiatric industries’ crimes against, primarily abused children, should be stopped. And at some point, we all realize the importance of treating all others, as we would like to be treated. “Power tends to corrupt and absolute power corrupts absolutely.” Today’s US psychiatric industry is absolutely corrupt to the core.

  10. Regarding the 6
    1)‘Does the patient have a severe and enduring mental illness?’
    The illness is given by the doctors and medical workers, it endures from external stigma (family friends) and internal stigma-belief of being diseased because a doctor said you were sick. If the patients is not being MADE mentally ill (every day) from the psychiatric drugs. As long as you take drugs you have limited insight into your actions and behaviour. Cause and effect is limited . If you perform well that day do you feel it/if you perform badly that day do you feel it?

    2‘Is this illness or behaviour?’
    illness would be a chemical imbalance causing (for example) the face to contract (TD or neuroleptic malignant syndrome), versus choices a person makes from freewill.
    There is not just 2, there is the third one of unconscious behaviour, such as a accidentally being late ( always) or accidentally breaking something from unconscious(suppressed) anger.

    3‘It would be unethical to withdraw his antipsychotic medication; he has a definite diagnosis of schizophrenia’
    They would have to face the brain disease they have caused by giving drugs to an innocent person if they withdrew the drugs.“Neuroleptic-induced supersensitivity psychosis” written by Chouinard G, Jones BD, Annable L. : Am J Psychiatry. 1978 Nov;135(11):1409-10

    4‘I suspect there may be a lurking depression’
    Everyone who is no longer a child has something to grieve over, which if dwelled on , can be called depression.

    5 ‘If you don’t accept treatment you’ll give me no option other than to section you’
    Same a the drug dealer saying if you don’t use my drugs I ‘m gonna bust your head open.

    6‘We’ll keep on tweaking the medication until we get it right’
    The religion of drugs, that everyone says are medications. People can not see the difference between a drug and a medicine. How a drug becomes a medicine magically when it is prescribed by a doctor. Which all leads back to who defines what illness is. Can the disease be seen in a unbiased blood examination? Is it a disease?

  11. Gary,

    All of the quotations on your list, as you say, are extremely unhelpful and “hope quashing”. I think that in the USA use of this kind of language varies from institution to institution or practice to practice, depending on the leadership style and opinions voiced by members of the specific “mental health” organization. We see this type of language most commonly communicated (in epidemic proportions) in high volume inpatient institutions or organizations composed entirely by or under the direction of insecure psychiatrists. (Psychology practices that adhere dogmatically to psychoanalytic doctrine may be largely biopsych free, but can also enact a similar form of blind “hope quashing” nevertheless.)

    The organizational culture of a mental health institution, and how that culture is defended impacts the choices made by clinicians which can limit the potential for “recovery” (or whatever word you want to use for what I’m talking about) for the patient. In its worst form, the culture maintains itself as a group- think mentality that uncritically protects the unsubstantiated and dogmatic claims of biopsych and represses critical discourse.

    The critical analyses that you offered for each statement appear to be “common sense” and certainly can be understood by the vast majority of clinicians. I would suspect that clinicians who would not be open to such a discussion would be those caught in a repressive system where they experience their work situation as so fraught with physical, emotional, social, and financial danger that critical discussion is not a safe option. The danger I am talking about, as I’m sure we both know, is not only the danger of working with aggressive patients, but also the social, financial, and emotional danger threatened overtly or subtly by repressive “colleagues”.

    I think that continuing the anthropological approach to the study of psychiatric and psychotherapeutic culture(s) is one very effective way to bring these unhelpful patterns of communication, values, and symbols to light and to understand the social dynamics through which these perpetuate themselves. Such analyses can be used to develop better explanations for what is going on in practice to offer better outcomes (or lives, really) for everyone involved in the “therapeutic situation”.

    Thanks for your article!

  12. I’m glad there are still Mental Health, Inc. people willing to stand up and speak out. My own experience has been that they (Mental Health, Inc. employees I’ve encountered in the US) strive to make good patients, but do not want the people/patients to become good people, good citizens.

    Of course, that was my experience when I was younger and my people were considered “rinky dink middle class” (a former counselor’s exact words). Now, I’m a tad older and my people are well-established and more affluent, and I find that, suddenly, the Mental Health, Inc. employees at least go through the motions of showing compassion and listening to me. Not to get all Marxist on everybody, but my own life experiences have led me to believe that race, gender, and SOCIAL CLASS (screaming caps intentional..sorry) play a huge role in “Treatment.”

    Again, good article.

  13. The distinction between so called real mental illness and ‘BPD’ is commonly seen in the response of staff It seems any
    woman with a history of abuse + trauma has this label inflicted on them. Staff then see you as less deserving and morally defective. I have lost count of the completely retraumatisimg things that have been said to me because of this ‘diagnosis: All labels are just pseudo medical and pseudo scientific Yet I am treated as if my issues are character flaws and inherent deficit. A clear line is drawn between ‘PD’ and Bipolar etc.I think it works like this -Woman+abuse, Iabel disordered then punish them for it.I would suggest anyone in distress should keep away from Psychiatrists. And if given ‘PD’label, be aware that within NHS there is entrenched stigma and often hostility.You end up trying to survive the label. And I don:t understand why MHS feel such contempt and loathing for victims of child abuse. Because that is what lies behind many’ ‘Psychiatric Diagnosis. So maybe only need one label for all. Survivors of Trauma and Abuse? Sorry may have gone off topic!

  14. Yes I’m aware that Borderline Borderline was originally a a psychoanalytic concept. The problem is that the criteria within the DSM is simply a list of behaviours. Social and moral judgements. It has become a deeply stigmatising label in MHS. Where all your issues are seen as a result of a disordered personality!When in fact a ‘PD’ is nothing more than a social construct that Psychiatrists inflict ion trauma survivors, further damaging them. It is far removed from it’s psychoanalytic origins and is toxic to those seeking help.NHS MHS treat trauma reactions by pathologising and blaming the individual It makes no sense. And only causes more harm.

  15. Thank you for this. I have recently tried within a group of fairly well-enlightened people who are attempting to change the “mental health” system that even transpersonally-focused therapists are loathe to give up these concepts. Worse, I think, is condescension seems to be part of the curriculum, no matter what the spin on “treatment” and that becomes the underlying edge to communications.

    I would add one more utterance that should be unacceptable. “You’ll have to take these the rest of your life”. I might not have fallen for that one had my mother not committed suicide because the psychiatrist added, “or you’ll wind up in your mother’s condition and nothing will help.” Then he went on to describe the “kindling effect”.

    I was a person who got drug after drug added to the protocol, increased dosages and for 13 years, I struggled to care for myself under the influence of so many drugs. After 10 years of increasing anxiety, panic attacks, the addition of a trained service dog to help me in public and a whole host of noxious drugs including Klonopin, the psychiatrist saying, “Well, maybe if we took you off the Welbutrin, you wouldn’t have so much anxiety” gave me the hint. OMG, he is treating side effects of the drugs by prescribing more drugs! This is the get a bigger hammer approach and I had had enough battering.

    I’m celebrating four months psych drug free now. The combination of drug neurotoxicity (withdrawal syndrome) and the processing of deep grief and working through the trauma that got buried under the drug blanket is a 24/7 task. I’m grateful for MIA and my friends with lived experience for sneaking me in the key to my own personal cage so I could free myself.