I’ve spent my adult life working in mental health services. I worked for 15 years in residential treatment with adolescents, and another 15 years in large outpatient programs with adults. I’ve been in clinical roles and leadership roles, primarily as a group therapist.
I am a strident cognitive behaviorist. I’ve been a passionate and sincere student of human behavior for as long as I can remember. I respect the scientific method, and try to maintain critical thinking.
Obviously I haven’t been a true believer in the psychiatric standard of care for a long time; at some point I became a skeptic. However, I never stopped to consider that my suspicions could be evidence of a “serious mental illness” until it was suggested by my supervisor in a “counseling” meeting.
Although it’s hard to specify when the seeds of my insanity took root, the documentation of it began shortly after I donated Robert Whitaker’s Anatomy of an Epidemic to our clinical library. I suggested that Whitaker’s statistics mimicked trends in our own clients.
Questions of my sanity first came up behind my back. I only know about it from a former co-worker, after she switched allegiance.
Months passed. Whitaker’s statistics clearly correlated with the day-to-day, person-to-person anecdotal evidence in our patients. I was especially interested in the people who returned to us, months or years after being discharged. What these people had in common was that they accepted their illness and complied with medications.
Obviously I shared my observations with my team. I was eventually able to form something of a predictive template for bad outcomes. I wasn’t surprised by the initial defensive reaction. It’s an understandable reaction to cognitive dissonance.
I was surprised that as evidence accumulated (and accumulate it did) the defensiveness only deepened.
The official pushback began gently. I was invited to counseling sessions, offered more trainings and greater supervision. I believe they genuinely wanted to bring me back into the fold.
It was no longer gentle after the fourth or fifth disciplinary counseling session. They had to come right out and tell me to “stop telling people they can get better.”
Ultimately they expressed their concerns for my own mental health which, they assure me, were shared by many members of my team. Although they declined to offer a specific diagnosis.
My boss asked me “how could you be the only person who sees this big conspiracy?
A valid question, it must be said. And I had no immediate response.
This, after all, actually is a definition of a delusion, especially now that the DSM 5 is the new standard.
Perhaps, all this time I have only been in denial?
I developed a list of all the crazy things I believed.
There are no lab tests of any kind for any DSM diagnosis. The diagnosis is subjective. The diagnosis can’t be tested for, measured for severity, or tested against. The current system lacks validity and reliability. Everyone inside the system seems to acknowledge this, but simultaneously insist on treating a diagnosis as sacred.
For example: It is rare that two psychiatrists in our network seeing the same patient will arrive at an identical diagnosis.
And, any legal case involving competing psychiatric testimony will demonstrate how two experts can examine the exact same evidence for as much time as they care to and arrive at completely contradictory conclusions.
Psychiatry is faith-based medicine. It discourages second opinions. Psychiatry places an institutional priority in convincing people to “accept their illness,” even at the expense of informed consent.
The chemical imbalance theory had been completely debunked even before Prozac came out. This is so well-known that psychiatric talking heads are even now trying to pretend they never believed it.
Psychiatrists who did promote the idea, or continued to present it, are simply misleading people for their own good. The “stigma of mental illness” justifies a little coercion. Since, obviously, the people who accept their illness and comply with medications will have the best outcomes.
Except that there is very little evidence that people who get treatment have better outcomes then people who don’t. In fact, the worst outcomes, (chronic illness, disability, shorter life span, suicide, violence) are associated with people who have been exposed to treatment, especially across time.
By “treatment” I am referring to medications, and/or psychotherapy. Although psychotherapy will not cause weight gain, diabetes, and shorter life span of medications, it is far from benign.
1 in 5 Americans are currently taking a psychiatric medication. Yet the conventional wisdom holds that not enough people are in treatment. The numbers are often repeated: “40% of mental illness is untreated.” Which led a recent APA president to declare “the greatest challenge facing psychiatry is untreated illness.”
Prescription drugs are now the leading cause of death in young adults. Opiates being the worst, but psych meds are frequently involved, particularly benzodiazepines.
A recent CDC report on suicide confirms one of my less documented long standing delusions: The suicide rate (for mental illness) has never been higher, and most people who kill themselves are in treatment when they die. Many people were not suicidal until after they got into treatment.
It surprises even the most experienced clinicians who fail to realize that there is no treatment proven to prevent suicide, simply because you can only accurately measure suicide in those who succeeding in killing themselves. In other words, those who failed in treatment.
Suicide prevention consists of a series of assumptions we make about why people kill themselves and what they need from us to not die. Mostly this amounts to drugs, talking at length about why life sucks and is futile, and being very subtly rewarded for making existential threats and gestures.
As far as I can tell, most of the mass/spree shootings in America involve people who have been exposed to treatment. And, as far as I can tell, mental health professionals are as good at predicting violence as the CIA was in predicting the fall of communism.
Because of the legal requirements for disability, 100% of the people permanently disabled by mental illness have participated in treatment, usually across time. No one has slipped through the cracks to disability, simply because it requires a doctor’s efforts to become successfully disabled.
And, the disability rates are staggering and unsustainable. I suspect they increase wherever psychiatric treatment is more widely available. It is not uncommon for a person to have maintained an occupation and social role without any treatment at all, only to become disabled after getting into treatment.
I suspect the same correlation can be found in the divorce rate and availability of marriage counselors. The incidence of unresolved grief and the availability of bereavement counselors, and the rate of PTSD and the availability of trauma counselors. As I said, therapy is not benign.
Obviously there is a very clear financial incentive to encourage chronicity, since we can’t charge someone who recovers. There is no profit in recovery for the treatment provider. Like any other business our best customers came back over and over again.
And, treatment is the only item on the menu. The only option for someone who clearly deteriorated after getting into treatment is more treatment.
The people who become chronically mentally ill are our best customers.
People who pursue disability are particularly profitable, because they will engage in treatment in order to secure documentation, and don’t complain when treatment fails. They may come back to inpatient several times in the two years of appeals in order to demonstrate and document their incompetence.
Like any other faith-based system, it is impossible to disprove a negative. I can’t disprove God any more then I can disprove restless leg syndrome. Or Asperger’s, or ADHD. Faith and denial are evidence resistant.
Certainly my sincerely held beliefs conflict with widely held conventional wisdom, which is the very definition of a delusion. And now I have been diagnosed by several skilled and experienced mental health experts who knew me well. Yet I don’t accept my illness, which constitutes anosognosia, more evidence that I am indeed insane.
The last year at the hospital was bad. I hired a lawyer. I went to work every day expecting security to come walk me out. I attended six therapy sessions through our EAP program.
The whole thing ended rather quietly. I was downsized and given a generous severance package. People cried when they announced I’d be leaving.
I can’t find anyone in the field to work for who has managed to avoid the corruption, and even if I could, who would want an old group therapist with a fixed delusion? The people with integrity went out of business a long time ago. These days I run a very selective online private practice and produce a podcast about the dark underbelly of the mental health system. The podcast is called anosognosiac, and you can find us on iTunes.
I did find an answer to my boss’ question that troubled me, “how could you be the only person who sees this?”
I am not the only one. Many other people have come to the same conclusions I have. Many are articulate and offer compelling evidence.
Also, since leaving the hospital I’ve been quietly approached by some of my former team members, including one who participated in my diagnosis, who admitted they actually saw the same problems I did, but worried over the consequences of speaking out.
I have mixed feelings about this. On the one hand it is vindication. On the other hand, some of those professionals looked me in the eye and made me question my own sanity.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.