Important New Book— “Outside Mental Health: Voices and Visions of Madness”

Bruce Levine, PhD
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It has become increasingly mainstream to criticize psychiatry for its corruption by drug companies, invalid diagnoses, lack of long-term treatment effectiveness, and other scientific failings. The recently published book Outside Mental Health: Voices and Visions of Madness reminds us that perhaps the most pathetic aspect “inside mainstream mental health” is how simplistic, boring, and reductionist it is—when our natures are so very complex, fascinating, and non-reductionist. Outside Mental Health restores the full range of color to our humanity.

Outside Mental Health is authored by radio host and therapist Will Hall, who as a young man had been diagnosed with schizophrenia. The central question Hall asks is: What does it mean to be called crazy in a crazy world?

This central question leads to specific questions that include: What does an “altered state” mean, and can it be terrifying but also exhilarating and illuminating? Is “hearing voices” really a symptom of illness or simply another dimension of our humanity? How much does context affect the experience of illicit and psychiatric psychotropic drugs? What is the relationship between modern art and what is commonly called “psychosis”? How can jazz, punk, and political activism help people who have been diagnosed with schizophrenia and bipolar disorder? And what egalitarian alternatives outside of mainstream mental health have been found to be far more helpful for people experiencing altered states?

The answers Hall receives to these and other questions in more than 60 interviews and essays from ex-psychiatric patients, as well as scientists, journalists, artists, and dissident psychiatrists and psychologists create a new conversation that can help transform society into a truly more inclusive one that values the talents of those who are now alienated, stigmatized, and marginalized.

What I observed in my professional training is that the earnest desire of most psychiatry residents, clinical psychology and social work graduate students, and others training to become mental health professionals is to learn how to help people who are struggling with severe emotional difficulties. The tragedy is that the educational component that would be most helpful for them is routinely missing from training.

This missing component consists of listening to—and ideally becoming friends with—people who once were diagnosed with bipolar disorder, schizophrenia, and other psychoses but who are now fully functional and can articulately describe how they experienced their altered states and what was helpful. Outside Mental Health goes a long way to filling that void.

Outside Mental Health,” Hall tells us, “is a call to rethink madness and our responses to it, not to neglect those in pain. Human suffering and madness are real. People do lose touch. During my time of deepest torment, I was so incapacitated and impaired that a disability check and housing subsidy were lifelines to survival. As much as I want to change the mental health system, I am grateful for the support it did give me.”

Hall has not been in a mental health facility during the past fifteen years, and he no longer receives disability checks or uses psychiatric medication. But don’t stereotype Hall as an anti-drug zealot, as he states: “Nor do I demonize medications, as harmful as they can be. I have seen meds help a wide diversity of people, and I embrace a harm reduction view, advocating for each person to find their own way.”

Not stereotyping is a lesson repeatedly taught by Outside Mental Health, as each person’s experience of their altered state can be quite different, their understanding of its meaning quite different, and their approaches quite different.

Outside Mental Health’s collection of interviews and essays include scientists, journalists, and doctors who, like myself, came to rethink a good part of what we had been taught in our professional training. Similar to most mental health professionals, my encounters in training with people diagnosed with serious mental illness were in psychiatric hospitals (and, in my case, for two years working as a therapist in a psychiatric emergency room); and such clinical experiences confirmed the bleak picture conveyed in psychopathology textbooks. Most mental health professionals in training see patients diagnosed with psychosis who regularly relapse into dysfunctional states that create chaos and anxiety for themselves and their families.

So, it does not surprise me that one of Hall’s interviewees, ex-patient Eleanor Longden (author of Learning from the Voices in my Head and currently a doctoral researcher) reports to Hall that she was told in her psychiatric hospitalization, “You would be better off with cancer, because cancer is easier to cure than schizophrenia.”

What most mental health professionals in training don’t see are people who had been diagnosed with severe mental illness but who ultimately reject their diagnostic labels and standard treatments and go on to have satisfying lives. Outside of my mental health professional training, I discovered this group of people, some of whom are interviewed in Outside Mental Health; and it is from them that I have learned how harmful autonomy-depriving treatments can be and how mutual aid, collaboration, and autonomy-encouraging approaches can be positively powerful.

More mental health professionals should also be asking Hall’s question: What does it mean to be called crazy in a crazy world?

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14 COMMENTS

  1. Hi Bruce, lovely Article. Will Hall is a brilliant representative.

    I think if people can accommodate their situations then diagnosis has to be irrelevant. I support Buddhist type solutions myself.

    I was originally “in” the Maudsley Hospital London; and at the time, I thought the diagnosis approach was ridiculous.

    Eleanor Longdens ‘cancer comparison experience’ is very interesting because all young people have life situations that they overcome – and this is nothing like cancer.

    FACT
    Every recovered “schizophrenic” could save the UK taxpayer about £60,000 per year (Professor Knapp, of LSE and Kings College).

  2. Seems like a book well worth reading, more so for those who are still under the spell of psychiatric mythology.

    Sounds like Will is still teetering on the edge of the anti-psychiatry movement, though not openly identifying with it. But it also sounds like the connections others may make due to his insights may lead them to more basic and radical conclusions than those of the author himself.

    I do wish Mr. Hall would stop euphemizing CNS altering drugs as “medications.” Also:

    I was so incapacitated and impaired that a disability check and housing subsidy were lifelines to survival. As much as I want to change the mental health system, I am grateful for the support it did give me.”

    A guaranteed basic income and housing are basic human rights in some countries, this has NOTHING to do with “mental health.”

  3. What does it mean to be called crazy in a crazy world ? For me it meant being flushed down the toilet of torture psychiatry . To come out after repeated flushing finally from the other end after literally first escaping 5- 6 times and finally as a psych-survivor , like finally coming out of a black hole loop with a story to tell that might really help other’s , and being told to limit it to a thousand words and basically told I’m glad that worked for youuu, but we are all so greatly different that an individual’s experience is more or less antidotal , and we have the highly educated that in an evidence based way will sort through the sands of pseudo -science with their limited lived experience and divine the truths we can use to help ourselves reinvent the wheel as the search itself is commodified further while we the 10 to 15 percent of the 200,000,000 people in just the USA have added on A-N-X-I-E-T-Y !!! in us, just from the mercury in our dental work without really understanding what that means . I do . Ask Christopher Shade PHD (Videos on YouTube)
    Thank You Bruce , I will eventually read Will’s book .

  4. Excellent article Bruce.

    I think calling people crazy is just something that most people learn to do. Mostly all it means is that they don’t like what the other person is saying or doing. But it also gets to something deeper, this concept of the misfit, the one who doesn’t measure up to societal standards.

    Not too long ago people would be called gay. Now they are called crazy. Amounts to the same thing. It comes down to capitalism and the authority vested in the middle-class family.

    And so then when doctors, therapists, and the government get involved, saying that someone is crazy, and offering a more formal diagnosis, it simply means that that person is not in compliance with the expectations of capitalism and the middle-class family.

    Like Peter Breggin writes, drawing in part from Foucault, Psychiatry was invented to justify incarcerating homeless men who were not breaking any law.

    It still is used that way today. Someone who is not really doing anything wrong, but is for whatever reason not complying with the expectations of capitalism and the family, is deemed crazy. Doctors are brought in to determine the exact nature of the craziness, as defined by DSM.

    So this starts with the family. This does not mean that it is my family or your family, though it usually is. But always it is The Family, that which is held up as the ideal.

    And the government goes along with this because it depends on capitalism and The Family in order to maintain order and stay in power.

    And in the life of an individual it usually starts with in their family, with them being made into the scapegoat. And often therapists and other types of doctors are brought in to make the parents right. And sometimes the child is put on drugs.

    So we need to fight this at multiple levels.

    1. Holding Parents Accountable. Scapegoat a child, you lose everything you could ever have and are branded a criminal.

    2. Make our society more fair and just. Stop using the Self-Reliance Ethic, as it is just an adaptation on Original Sin. Everyone wants to do good things, and we need the talents and abilities of everyone.

    3. We the survivors of the middle-class family must set up our own alternative ways of living, and we need to start taking in the other survivors and scapegoats. We must make our own foster care group homes, otherwise protecting children remains impossible.

    4. Discredit psychotherapy, as all it does is blame the victim. Round up the therapists who do this to children and lock them in a prison cell and throw away the key.

    Nomadic

    http://freedomtoexpress.freeforums.org/complicity-with-parents-in-drugging-t260.html

    Andrew Vachss
    https://www.youtube.com/watch?v=96sRDV4fNmI

    https://www.youtube.com/watch?v=Wh9CpxDsc_o

  5. I am aware, and have been aware for some time, that it is possible to “recover” and that people have successfully “recovered.” But why is there still no choice except medication, hospitalization, and involuntary “treatment?” Why are Soteria Houses almost nonexistent when there should be many? Why is there no easily accessible Open Dialogue? And why is the Murphy Bill sailing along unimpeded? Books like this give the impression that progress is being, or has been, made, but I haven’t seen it in “real life”– at all.

    • None of the things that you mentioned are going to be funded because they work and anything that works is against the drug companies and the power of psychiatry. The funding for Soteria House was jerked once the results were in from a couple years of existence. Mosher was fired from his position as head of the Schizophrenia Department at NIMH. Anything that works is going to be suppressed. the money lies in making people ill and making people think that they are ill. After all, psychiatry is the only “medical specialty” that works to keep it’s patients “ill”. The recovery rates in the years before the advent of the major tranquilizers in the late 1950’s were from 60-80%. Now the rate, in this time of “evidence based practice” and “best treatment” is at most, 16%. I think that a lot of this simply boils down to money and egos.

      • Stephen and all,
        I always read your insightful comments when they appear in a comment section and I agree with everything you say in the above comment , but for me the one sentence (“After all, psychiatry is the only “medical specialty” that works to keep it’s patients “ill”.”) reminds me that although psychiatry is the most glaring example of over reaching applied pseudo science to the point of crimes against humanity . Certainly the AMA with its bogus chemo -radiation industry , vaccination industry , ( there are more examples) the suppression , criminalizing and under cutting of the validity of Traditional Naturopathy and evolution of other ancient natural modalities from around the world also constitute crimes against humanity as well as ADA dentistry with their continued use of 53% mercury in so called silver amalgams and root canals (there is more) also constitute crimes against humanity .The government and for the most part the general population’s acceptance of these AMA and ADA practices (and there is an unacceptable level of coercion in them also ). I’m trying to say that this precedent which has been “established”of government sanctioned applied pseudo -science in these areas and others , practiced by the AMA and ADA makes it that much harder to strip psychiatry of the unlimited power it wields against the population .
        I guess it’s called the Therapeutic State cause there isn’t any real effective oversight over any of it making it the powerful’s stealth torture weapon –pseudo science applied with the facade of health care or other benefit for the people — same old same old eugenics in new bottles “kinder and gentler”. I guess this subject could easily fill a book. I believe that the powerful’s multi- faceted assault on the people with applied pseudo science in so many varied areas pertaining to life itself is the greatest threat to all life forms on the planet . Thank’s, Fred
        If possible check out the documentaries “I AM” and also ” 1971″ on Netflix .

    • dkjamil, you say that it is possible to “recover”.

      Then you decry medication, hospitalization, involuntary treatment, and the lack of Soteria Houses.

      Why do you go along with this, the “recovery” approach at all? It is predicated on the idea that you suffer from some sort of defect or deficiency, and at bottom this comes down to a moral issue. While people may not call this a mental illness, that is still what it means, mental illness or moral illness.

      People show the behaviors which we associate with mental illness when they are under stress, when their socio-public identity is destroyed, or when the are delegitimated. This is how our world is set up, this happens. Most of the time what you find behind it is The Family. It is not always my family or your family. But usually it is. Always it is The Family, that which is held up as an ideal.

      So parents and school teachers, and school counselors, and clergy, and psychotherapists tell people that they have something wrong with them, and that their problems exist inside of their own head.

      And this is very similar to what the Christian evangelicals put out via their outreach ministries. People are considered “rebellious” if they don’t accept the unjust life they’ve been handed and if they don’t solve problems by “forgiveness”.

      It is all an adaptation on the concept of Original Sin.

      So people who believe in Recovery are at great risk for ending up confessing on the psychotherapist’s couch, in the psychiatric hospital and drugged, in the evangelical church seeking salvation, and unemployed, underemployed, and homeless.

      Recovery stinks. I don’t ever endorse that concept.

      I promote Restorative Justice. It is not a second chance, it is a first chance. Really, it is the place in the world which well all deserve. And the way we are going to get it is not by seeking pity or by letting therapists play with our heads. It is by organizing and seizing it.

      http://freedomtoexpress.freeforums.org/index.php

      Nomadic

      • I don’t go along with the term “recovery.” I believe it reinforces the idea of “mental illness,” which is why I put it in quotes, but the people who wrote the post and the book seem to agree with it, as well as many others I am currently talking to. It is an issue I am working on, but a difficult one.

        • dkjamil,

          Thank you for clarifying you position. I’m glad you don’t agree with the concept of recovery.

          I think it extremely important that none of us say things which even give the impression that we might agree with it, even in limited situations.

          I don’t support Mind Freedom in any way shape or form because they are not committed to redress. While they may not use the word “recovery”, their entire position is built around the concept of asking for pity to facilitate recovery.

          I have not read David Smail’s stuff yet, but I will.

          http://davidsmail.info/introfra.htm

          Hardly any of the ‘symptoms’ of psychological distress may correctly be seen as medical matters. The so-called psychiatric ‘disorders’ are nothing to do with faulty biology, nor indeed are they the outcome of individual moral weakness or other personal failing. They are the creation of the social world in which we live, and that world is structured by power.
          Social power may be defined as the means of obtaining security or advantage, and it will be exercised within any given society in a variety of forms: coercive (force), economic (money power) and ideological (the control of meaning). Power is the dynamic which keeps the social world in motion. It may be used for good or for ill.
          One cannot hope to understand the phenomena of psychological distress, nor begin to think what can be done about them, without an analysis of how power is distributed and exercised within society. Such an understanding is the focus of this web-site.

          As I see it, the psychotherapist tries to convince you that you are the cause of all your own problems, as they only exist in your own head and they all pertain to matters of the past.

          Whereas in fact, the issue is that you are living in a deligitimated state. This is so because the survivors of middle-class family child abuse refuse to organize and fight for concrete gains. Instead we prefer to lie on our therapists’ couches, or to punch their pillows and scream at them. So we only hurt ourselves more by magnifying our own impotence. Psychotherapy has always been designed to make us distrust our own impulses, especially in the areas of aggression, conflict, and sex. And then sometimes they are even able to convince people to take drugs that push it even further.

          And so recovery groups, like Mind Freedom reinforce this.

          So it comes down to a contest between those who lie about, cover-up for, and perpetrate middle-class family styled child abuse, and use this to socially advance themselves, versus that small number of use who resist and try to do something about it.

          Psychotherapists are not supposed to add to the abuse, and now they are required to report suspected cases of child abuse. But as they always have done, they still usually disregard this and add to the abuse. This is how they make their money.

          So right now, we who do not accept the abuses of the middle-class family are usually standing alone and in isolation, while people try to use concepts from therapy and religion to make us wrong. And this will continue to be so until we an enlighten our brethren and then organize and start acting. We have to obtain some concrete gains, otherwise it is all just recovery and therapy.

          http://children-laws.laws.com/child-abuse/child-abuse-forums

          http://freedomtoexpress.freeforums.org/index.php

          Nomadic

  6. Bruce,

    I agree, getting to know people who formerly identified with labels like “borderline” or “schizophrenic”, and who suffered severely but got better, is a crucial experience that can make mental health workers much more optimistic, encouraged and better informed about how to help those currently suffering.

    I try to be one of these people myself, through my blog here:

    https://bpdtransformation.wordpress.com/

    I also have a chapter just published in this new book:

    https://www.amazon.com/This-Not-End-Conversations-Personality/dp/1623157064

    Other chapters in the book get a bit overfocused on labels, but my chapter is straight from the heart and is about refuting labels like BPD and moving beyond the illness identity.

    I now have a really good life, working full-time, owning my own place, being financially secure, having friends etc… whereas once upon a time I was involuntarily hospitalized more than once, took more than 10 different drugs, and was nonfunctional, hopeless and in terror most of the time, being labeled both “borderline” and various schizo-diagnoses by different psychiatrists. I know this type of hard work/recovery can be achieved, and so have a lot of confidence when I speak to other people currently suffering or to mental health workers.

    Will Hall is a great guy, but I agree with oldhead he should not call psychiatric drugs “medications”, as this is an inaccurate designation for compounds that do not treat specific illnesses.

  7. Being considered ‘ crazy ‘ by those who are victims of cultural conditioning is Actually a compliment. Jason Hairston ‘ Mental illness ‘ is simply a denigrating description, a maddening metaphor, a pejorative psychiatric label for the stresses and strains of a person’s life beginning at conception such as the different timing of environmental risk factors like toxins, infectious diseases during mom’s pregnancy and / or trauma; physical, mental, emotional, sexual ( allostatic overload, Bruce McEwen, neuroscientist ) that a person Unconsciously Reacts To and is simply given a description of that person’s lived stressful experiential life, a ‘ diagnosis ‘ by an unaware, often compassionless pro. Allostatic overload effects epigenesis. Hocus Pocus Diagnosis where the focus is on the label, and Not on the facts of the individual’s experiential life, the hypnotizing, mesmerizing effect, objectifying the person to be controlled and managed by harmful synthetic chemicals, pharmaceuticals and ECT, electric current through the brain, for the MONEY. Harmful synthetic chemicals, pharmaceuticals and ECT, electric current through the brain, with No Cumlative Healing Effect, are instruments, tools of torture, used by pontificating pros for their pockets at the expense of suffering individuals. Then, medical records are documentation for the day of reckoning when correctly understood. Allopathic medicine is eugenics.

  8. What does it mean to be called crazy in a crazy world? The book possibly make a good answer to it, as my first thought is that it mean what people make it mean.

    My best period of life has been after I made it mean nothing. When I took the step to never rely on medical science for interpretations of my experiences any more. This conclusion did I make on the background of my own education, that gave me another science (continental educational science) fit for interpretations of my experiences. And that also made me aware of Jacques Rancière’s work on the politics of aesthetics:

    “The police, to begin with, is defined as an organizational system of coordinates that establishes a distribution of the sensible or a law that divides the community into groups, social positions, and functions. This law implicitly separates those who take part from those who are excluded, and it therefore presupposes a prior aesthetic division between the visible and the invisible, the audible and the inaudible, the sayable and the unsayable. The essence of politics consists in interrupting the distribution of the sensible by supplementing it with those who have no part in the perceptual coordinates of the community, thereby modifying the very aesthetico-political field of possibility” (Rockhill, 2013, Kindle Locations 158-162).

    In connection to my own discovery, of different kind of science working with the interpretation of the same kind of experiences, it made me understand science in itself as such an ‘organizational system’ that ‘establishes a distribution of the sensible’, making it weak for the possibilities of ‘politics’. In other words, where in medical science a distribution of the sensible may be classified as ADHD, in another organizational system the same distribution of the sensible may be classified as the natural state of human beings. So to be crazy in a crazy world is to me to interpret a distribution of the sensible according to a given organizational system, and the solution to break free from it is through a personal useful political action that modifies the very aesthetico-political field of possibility.

    Bibliography:
    Rockhill, G. (2013). Editor’s Introduction: Jacques Rancière’s Politics of Perception. In J. Rancière, The Politics of Aesthetics. (Kindle Edition). New York: Bloomsbury Publishing Plc.