Evolution or Revolution? Why Western Psychiatry Won’t Change by Incremental Steps

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Five years ago, when I worked as a clinical psychologist within the UK’s psychiatric system, a senior colleague urged me to be patient. After hearing me — again — express my frustrations at the speed of change, and the stubborn endurance of bio-medical approaches to human suffering, he would urge me to aim for modest, incremental improvements in the existing system, to not expect too much too quickly, and to strive for ‘evolution not revolution.’

But how realistic is it to expect that the biological skew of Western psychiatry can be sustainably changed one small step at a time?

During the last decade of my career in psychiatric services I experienced mounting recognition that a paradigm shift — something akin to a revolution — would be necessary if, as a society, we were to meaningfully promote or restore positive mental health to our fellow citizens. Further reflection has highlighted four reasons for my pessimism about the potential for organic change to the existing system:

  1. The degree of change required

Despite the emphatic discrediting of the bio-medical, ‘illness like any other,’ approach to mental health problems, the routine discourse heard throughout mainstream psychiatric services continues to be dominated by assumptions of brain diseases and chemical cures. A fly on the wall of a typical inpatient unit or community mental health team anywhere across the Western world would witness professionals wrangling about correct diagnoses and corresponding medication combinations. Where pockets of more enlightened psycho-social practice exist, they are typically viewed as optional add-ons, supplementary to the core biological treatments.

The distance yet to travel to realise a more appropriate response to human misery and overwhelm is vast and daunting. Meanwhile, numerous people who seek help from psychiatry are experiencing interventions that are of limited benefit and often damaging. Given these circumstances, the adoption of an evolutionary approach to change is difficult to justify on both practical and moral grounds.

  1. Vested interests

Two powerful institutions benefit hugely from the current ‘diagnose and medicate’ approach to mental health problems and will use their considerable muscle to quash attempts to promote sustainable change.

The misdemeanours of the pharmaceutical industry have been well documented. The concept of brain disorders that demand indefinite medication is such a lucrative one that drug companies will stoop to any depths to maintain the biochemical imbalance myth: sponsoring bogus brain diseases (for example, suggesting that social phobia is synonymous with being ‘allergic to people’ [1]); bribing doctors to promote ineffective drugs for unapproved uses [2][3]; influencing the stance of service-user organisations through their funding [4]; and speaking directly to the general public through media advertising [5].

The psychiatric profession is the second major stakeholder who would be terminally damaged by a paradigm shift away from bio-medical approaches to mental health. The power, status, and remuneration of consultant psychiatrists are dependent upon the perception that their medical expertise is central to the treatment of mental health problems, in the same way, that other specialists (such as oncology, gynaecology, neurology) rely on the overarching skills of their medical practitioners.

Unsurprisingly, given what is at stake, the psychiatric profession’s substantial power continues to be deployed to counteract any effort to shift the tone of mental health services away from bio-medical dominance. One widely used strategy is to neutralise alternative approaches by removing their more radical elements so that what remains appears different from the dominant orthodoxy only in the degree of emphasis [6] — what might be referred to as the, ‘we’re already doing this’ approach. For example, some years ago I recall a psychiatrist claiming his was already a recovery-orientated service on the basis that it strove to cure people of their mental illnesses.

Given these vested interests, innovators espousing alternative approaches to mental health are likely to be ignored, discredited or neutralised.

  1. The general public’s liking of simplistic explanations

When faced with complexity, human beings are drawn to explanations that require minimal effort. Bio-medical accounts of mental health problems offer such a seductively simple message. If a person is acting bizarrely, hearing voices and overly suspicious, biological psychiatry can label him as suffering from ‘schizophrenia,’ suggesting the presence of an underlying brain abnormality. Similarly, withdrawal, despair and a lack of enjoyment of life can conveniently lead to a diagnosis of ‘depression’ and the implication that the person’s malfunctioning neurons are somehow causative of the presentation.

Over the last three decades, many of the so-called ‘public education’ initiatives around the issue of mental health have promoted these kinds of lazy — and spurious — explanations [7]. Similarly, current ‘mental health first aid’ courses adopt an illness approach to human suffering [8], while celebrities like Stephen Fry and Ruby Wax continue to espouse ‘broken brain’ explanations for their personal struggles [9].

Although, when left to their own devices, the general public lean towards psychosocial factors (bereavement, trauma, environmental stress) as the primary causes of mental health problems [7], the bio-medical, ‘illness-like-any-other’ accounts can be seductive. These simplistic explanations negate the need to further question our own roles and responsibilities for the prevalence of human suffering; labelling people as ‘mentally ill’ conveniently avoids reflection about the contributions of families, work colleagues, neighbours and fellow citizens via processes such as scapegoating, discrimination and victimisation. Consequently, piecemeal advocates of alternative approaches, scattered across the existing psychiatric system, are unlikely to harness the widespread support of the general public necessary to realise the desired radical change in the way we address mental health problems.

  1. The lack of political will

A fundamental and sustainable shift away from bio-medical approaches to human suffering will not be achieved solely by changes to psychiatric provision; whole-system transformation to the legal and political domains will also be required.

Mental health legislation across the Western world constitutes a form of legalised discrimination, denying people with mental health problems fundamental civil liberties afforded to all other citizens [10]. Yet, it is rare to hear high-profile politicians advocating for reform; their silence is in stark contrast to campaigns to change laws that perpetuate sexual and racial discrimination. It seems that these legal generators of misconceptions – portraying psychiatric service users as people with internal defects that render them inherently risky — will remain immune to change for decades to come unless there is an injection of revolutionary energy that allows the rejection of laws (such as the UK’s Mental Health Act) to be seen as part of the ‘last great civil rights movement’ [11].

Furthermore, the current ‘illness-like-any-other’ approach, in locating the cause of mental health problems in the brains of individual sufferers, gets our politicians off the hook. If it is assumed that diseased brains are primarily responsible for human misery and overwhelm the well-documented contributions of societal ills, then homelessness, poverty, intra-family violence, high-crime neighbourhoods, unemployment, and discrimination can all be conveniently ignored by the government of the day.

Taking all of the above into account, it seems unrealistic — even naïve — to expect that radical change away from bio-medical approaches to human suffering can be achieved organically, one step at a time, by innovative practitioners embedded within the existing psychiatric system. A hefty dose of revolutionary energy is needed to ignite the system from its current self-serving inertia. But how can such a catalyst be developed?

What follows are my reflections on the kind of forces that might be necessary to start, and maintain, a fundamental shift away from the current ‘illness like any other’ approach to mental health problems. Such a transformation will require multi-level changes to the Western world that stretch far beyond a redesign of existing psychiatric provision. Consistent with this premise, I will structure my proposed changes under two broad headings: legal and political.

 Legal: fundamental revision to mental health legislation

Mental health laws across the Western world represent legalised discrimination against people suffering with emotional distress and overwhelm (12)(13). By sanctioning incarceration of law-abiding citizens without trial and non-consensual drug administration, mental health legislation rides roughshod over two fundamental human rights afforded the rest of the population.

In the UK, the justification for coercion under the auspices of the Mental Health Act is based on two dubious assumptions: the presence of a ‘mental disorder’ and the conclusion that the individual presents a risk to self or others. A formal psychiatric diagnosis is typically seen as broadly indicative of a mental disorder, despite the construct being virtually meaningless, providing scant information about both the course of a mental health problem and the interventions likely to be beneficial (14). Likewise, even the most comprehensive of risk assessments (for suicide and homicide) are only marginally better than guesswork and are unlikely to reduce the number of high-profile incidents (15)(16)(17).

In addition to legitimising discrimination, the implicit assumption within the legislation that people with mental health challenges are risky perpetuates the ‘psycho-killer’ myth and the associated sensationalist media headlines. Furthermore, the fact that sectioning requires no formal assessment of decision-making capacity implies that all people with mental health problems are inherently defective, an assumption that leads to more stigma, less proactivity, more hopelessness and overuse of medication (18).

It is unrealistic to expect a radical change in the way we respond to human suffering while all professionals operate within the discriminatory infrastructure of mental health legislation. What we urgently require is a collective scream of disapproval from mainstream psychiatric personnel — social workers, psychiatric nurses, psychologists, and psychiatrists — comparable to the reaction we would expect if the legislative framework underpinning their day-to-day work was blatantly racist or sexist.

Furthermore, the organisations representing psychiatric professionals possess a moral and clinical responsibility to oppose discriminatory mental health laws. For example, the formal bodies and trade unions that advocate for mental health practitioners might usefully consider supporting a ‘conscientious objection’ clause whereby their members can legitimately — and without fear of censor — opt out of colluding with the fundamentally unfair ‘sectioning’ process. Collectives of social workers and psychiatric nurses could be particularly potent in this regard, given their relatively high numbers and central role in its day-to-day implementation.

Political: make the economic case for radical reform

Money is the primary driver underpinning Western societies, with income generation, the rate of taxation and level of government spending typically determining whether proposed changes are desirable and sustainable. As such, to be viable, a revolution in the way our nations respond to human suffering would need to make economic sense. The seductive financial implications of radical reform must be made explicit, without fear of disturbing the sensibilities of the vested interests — traditional psychiatry and the drug companies — that act to maintain the status quo.

Some commentators argue that rejection of the ubiquitous capitalist system is necessary to improve the mental health of our citizens meaningfully. Such arguments are not without merit. Consumerism and the pursuit of profit undoubtedly contribute to the power differentials and social inequalities that are to some extent responsible for the emergence of mental health problems [for example, (19)(20)]. It is, however, unrealistic to expect a wholesale rejection of capitalism by the Western world in the foreseeable future. Nor am I convinced that these generators of human suffering would not arise in other political systems.

The economic advantages of a paradigm shift away from bio-medical approaches to mental health must be spelled out and widely promoted if radical change is to be achieved. The main elements of such a proposal might include:

A) The phasing out of acute, hospital-based inpatient units

Re-locating safe spaces away from (hugely expensive) inpatient hospital units to community-based respite houses, where criteria guiding staff recruitment would focus mainly on personal qualities and lived experience of mental health problems rather than a designated professional qualification, would markedly reduce expenditure. There is already plenty of research evidence to support the argument that non-medical units can provide an effective service, at significantly less cost, for people overwhelmed by psychotic experiences — for example, the Soteria approach (21).

B) Shifting the lead role for mental health away from physical health providers

In the United Kingdom, this would involve the withdrawal of lead responsibility for mental health away from the cash-strapped National Health Service (allowing it to concentrate on physical health problems) and redirection of funding towards an expanded 3rd sector and charitable organisations. Not only would this transition save money, but the culture of the new environment would be more enabling, less stigmatising and free from the suffocating risk aversion so characteristic of traditional services.

C) Phasing out psychiatry posts

The considerable savings from a system that no longer requires the employment of psychiatrists should be highlighted. As of April 2016, there were almost 9,000 medical psychiatry posts in the UK, with about half of these at consultant level (22)(23). Realistically, attrition would be a gradual process but could start immediately by shedding the significant number of consultant psychiatry posts that are currently vacant and covered by — extremely expensive — locums. The compensatory requirement for an expansion of General Practitioners to attend to the physical health needs of those struggling with emotional problems would not hugely detract from these savings.

D) Drastic reduction in the drug budget

The grotesque overuse of psychotropic drugs by traditional psychiatry has been widely documented, reporting year-on-year increases in consumption. Community prescribing of antidepressants and antipsychotics in 2014 for England alone reached 57.1 million and 10.5 million respectively (and these figures exclude inpatient hospital settings) (24). In the USA, the amount spent annually on these drugs has recently been estimated to be $11 billion for antidepressants and a staggering $15 billion for antipsychotics (25). A much more cautious, and shorter-term, use of medication would save a vast amount of money that could be redeployed towards prevention and the promotion of mental wellbeing (for example, the funding of projects to support socially disadvantaged families).

 

If we are to achieve the desired paradigm shift away from the bio-medical approach, these economic arguments — delivered in a detailed and comprehensive way — should be at the forefront of the fight for more appropriate responses to human suffering. Professor Peter Kinderman has offered one recent, worthy attempt at such an analysis in his book, A Prescription for Psychiatry (26).

 

This article originally appeared on http://www.talesfromthemadhouse.com/blog/

References

(1) Moynihan, R., Heath, I. & Henry, D. (2002). Selling sickness: the pharmaceutical industry and disease mongering. British Medical Journal, 324 (7342), 886 – 91.

(2) Neville, S. (2012). GlaxoSmithKline fined $3 billion after bribing doctors to increase drug sales. The Guardian 3 July 2012. Retrieved 21 January 2014 from, http://www.theguardian.com/business/2012/jul/03/glaxosmithkline-fined-bribing-doctors-pharmaceuticals

(3) Harris, G. & Carey, B. (2008). Researchers fail to reveal full drug pay. New York Times 8 June. Retrieved 21 January 2014 from, http://www.nytimes.com/2008/06/08/us/08conflict.html?ref=josephbiederman&_r=0

(4) Goldacre, B. (2012). Bad Pharma: how drug companies mislead doctors and harm patients. Harper Collins: London. (pp 266-71).

(5) Gilbody, S., Wilson, P. & Watt, I. (2005). Benefits and harms of direct to consumer advertising: a systematic review. Quality and Safety in Health Care, 14(4), 246 – 50.

(6) Boyle, M. (2013). The Persistence of Medicalisation: Is the presentation of alternatives part of the problem? In S. Coles, S. Keenan & B. Diamond (Eds.), Madness Contested: Power and Practice (pp 4 – 22). PCCS Books.

(7) Read, J. and Haslam, N. (2004). Public opinion: bad things happen and can drive you crazy. In J. Read, L.R. Mosher & R.Bentall (eds.) Models of Madness: Psychological, Social, and Biological Approaches to Schizophrenia (pp 133 – 45). Routledge.

(8) Davidow, S. (2016). Mental health first aid: your friendly neighborhood mental illness maker. http://www.madinamerica.com/2016/04/mental-health-first-aid-your-friendly-neighborhood-mental-illness-maker/

(9) BBC ‘In the Mind’ programme. http://www.bbc.co.uk/inthemind

(10) Sidley, G. (2015). Tales from the Madhouse: An insider critique of psychiatric services. PCCS Books pp 62 – 67.

(11) Dillon, J. (2013). ‘The personal is the political?’ In M. Rapley, J. Moncrieff & J. Dillon (Eds.), De-Medicalizing Misery (pp. 141 – 57). Basingstoke: Palgrave Macmillan.

(12) Sidley, G. (2015). Tales from the Madhouse: An insider critique of psychiatric services. (p62-67) PCCS Books.

(13) https://criticalmhnursing.org/2015/05/29/the-mental-health-act-legalised-discrimination/

(14) Bentall, R.P. (2009). Doctoring the Mind: why psychiatric treatments fail, pp. 89 – 109. London, Penguin.

(15) Szmukler, G. (2000). Homicide inquiries: What sense do they make? Psychiatric Bulletin, 24, 6 – 10.

(16) Witterman, C. (2004). Violent figures; risky stories. Advances in Psychiatric Treatment, 10, 275 – 76.

(17) Morgan, J. (2007). ‘Giving Up the Culture of Blame’. Risk assessment and risk management in psychiatric practice. London: Royal College of Psychiatrists.

(18) Sidley, G. (2015). Tales from the Madhouse: an insider critique of psychiatric services. PCCS Books.

(19) Cole, S. (2013). ‘Meaning, Madness and Marginalisation’. In S. Coles, S. Keenan & B. Diamond (Eds.), Madness Contested: Power and practice (pp.42 – 55). Ross-on-Wye: PCCS Books.

(20) Holmes, G. (2013). ‘Toxic Mental Environments’. In S. Coles, S. Keenan & B. Diamond (Eds.), Madness Contested: Power and practice (pp.250 – 255). Ross-on-Wye: PCCS Books.

(21) http://hubpages.com/health/soteria-loren-moshers-soteria-approach-as-an-alternative-intervention-for-acute-psychosis

(22) http://www.gmc-uk.org/doctors/register/search_stats.asp

(23) www.cfwi.org.uk/publications/in-depth-review-of-the-psychiatrist…/attachment.pdf

(24) http://www.hscic.gov.uk/catalogue/PUB17644/pres-disp-com-eng-2004-14-rep.pdf

(25) https://www.imshealth.com/files/web/IMSH%20Institute/Reports/The_Global_Use_of_Medicines_2017/global%20use%20of%20meds%202017%20left4%20Spending_Therapy_Area_2017.pdf

(26) Kinderman, P. (2014). A Prescription for Psychiatry: Why we need a whole new approach to mental health and wellbeing. pp. 175 – 185. Palgrave – MacMillan

 

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72 COMMENTS

  1. Thanks for your thoughts!
    I have been thinking of an amnesty program along with a program sponsored by governments – I know – issues but if all psych docs were required by the FDa/CDC AMA to alert ther patients and former patients that there are legitimate concerns regarding the medications prescribed to them and if suffering from a set of prefectures symptoms from a committee of consumers and researchers and doc – they could be allowed Medicare and free supplemental insurance
    CEOs of zBig Pharma would forfeit any ongoing bonuses to a listed charity or survivor based program
    By signing up for amnesty that would be admitting guilt
    but free from litigation
    Side effects could be treated
    Not a perfect plan but something to think about
    The need for witnessing of the human rights violations that go on in inpatient settings must be a priority
    Unfortunately – it’s so bad because cell phones are not allowed or family or friend 24 hour visitation much less gifts of food or flowers
    This aspect needs to be seen by all players
    Until the abuses are brought to light even the most open to all connecting work cannot be accomplished
    Can anyone get a lawyer to go into a unit?

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  2. BBC Presenter Jeremy Paxman best describes CBT:-

    http://www.digitalspy.com/tv/news/a808986/jeremy-paxman-depression-doesnt-want-to-be-labelled-a-victim/

    “….It’s always worst in the middle of the night, and what seems insurmountable at 3am, at 8am looks completely different.

    “The critical thing they teach you doing CBT is there is another way of looking at things. I would really like to learn that skill…..”

    (CBT kept me sane when I stopped taking my “medication”).

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      • Exactly what I was told myself!

        I have a friend an ex psychiatric nurse who is also a counsellor and according to him CBT “can get you out of trouble” but for Recovery deeper (non drug) help would probably be needed.

        But he agreed that “getting out of trouble” with CBT was better than “getting out of trouble” with Largactil.

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  3. Thanks, for many decades I have been saying that we need quality “revolution” in mental health, and it fact the whole planet. For one thing, the mental health industry has grown via a cycle of having catastrophes and then reform. The mental health industry eats reform and grows and grows.

    Briefly, we must also consider the way our world is not responding adequately to emergencies such as climate change. It takes decades for excess carbon to impact our environment. And because of this delay the public needs to use our minds to understand the threat. Also, the butterfly effect means that once we enter chaos, there is a great deal of uncertainty about exact outcomes.

    Therefore, we certainly need quality revolution on a planetary scale. Unfortunately, centuries of mental health oppression has helped harm the human spirit into the death of conformity.

    Thanks again for calling revolution!

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    • David – thanks for reading and taking the time to comment.
      And I agree with your comment that the mental health industry is largely immune to ‘strategies’ and internally generated attempts at reform. Here in the UK, our National Health Service – the main provider of mental health services – is stubbornly resistant to any attempt to change the way it does things; hence the ‘illness like any other’ approach persists.

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      • There’s a lot of people working very hard and earning a living out of treating traditional long term “Mental Illness” + disability. So the suggestion that these sick people can become Recovered through not taking their “medication” with the help of “psychology” – is not going to be welcome.

        Basically speaking the traditional medical drug treatments are whats causing the Longterm Disability.

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        • “…the traditional medical drug treatments are whats causing the Longterm Disability.”

          So does the prejudice, marginalization, and social wounding from the system, etc. Long term disability doesn’t necessarily mean a person is “disabled.” It can also apply to people who are simply deemed undesirable in and of no value to a narrow, driven, fear-based, and uptight society. Disability can simply be founded on stigma–the illusion of “not fitting in.” That, alone, is traumatic for people, so it’s a socially-induced disability, by way of “othering.”

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  4. Thank you for this post. I agree wholeheartedly regarding the need for more than incremental change.

    I think there is a simple health case to be made for a radical paradigm shift, too. There are a great many people who have had their physical health destroyed through psychiatric drug use. There are, as studies show, many people dying much earlier than they would have died, if it hadn’t been for treatment, specifically, psychiatric drug treatment. There is also the matter of dementia arising from the excessive use of such essentially toxic substances.

    You mention psychiatry and drug companies as vested interests. I think those vested interests go way beyond the psychiatric profession and drug companies alone. There is a whole service industry built up around the maintaining of people who are “not working”. These people receive state salaries, and those salaries would be put at risk if enough people were “working”. I would add worker co-ops, and other innovative ways of paying people for labor, rather than”rehabilitation”, to the important measures you list for phasing out acute inpatient units.

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    • Frank – I appreciate your feedback and interest.
      And you’re right about the other vested interests. It’s just that I see the pharmaceutical industry and the psychiatry profession as being the two most powerful and they therefore comprise the most formidable obstacles to radical change.

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      • I’ve been reading about the Franco Basaglia and the anti-asylum movement in Italy, and the impression I’ve gotten, from that movement, is that it is also possible, given the right conditions, for psychiatrists to be catalysts for change rather than obstacles. I mean we could be “rounding up the usual suspects”, but I see the problem as being a broader matter than apparently you do. Psychiatry and the pharmaceutical industry, for example, have a lot of help from another institution, also subject to corruption and ‘conflict of interest’, and that institution is politics. There is commerce in licit drugs, too. It’s not like Pfizer, Eli Lily, Glaxo/Smith/Kline, et al. aren’t Wall Street investments. Money is invested in keeping certain people down and out. We’ve got those ‘brudder’ and scheming corporate exes to consider as well. These corporations also own the media, and they’re the sponsors of most shows after all, especially with ‘direct to consumer’ advertising. Yes, psychiatry and pharmaceutical companies wield too much power, however, I don’t think power disparities begin and end with the operations of those two professions.

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  5. Gary

    Thanks for raising the important questions and themes of this blog.

    You are so right to argue that “incremental” change is not only impossible when looking at the powerful economic and political entrenchment within and around the current “System,” and immoral when looking at the amount of harm being done by today’s “mental health” system.

    However, I believe you have fallen into the same “incremental” and unrealistic trap that your blog is attempting to criticize.

    As the commenter, Oldhead, has pointed out many times at MIA, the word “Revolution” gets thrown around many times today and it often bastardizes its meaning and strips it of its fundamental and necessary components in the current historical era.

    You said: “The misdemeanours of the pharmaceutical industry have been well documented.”

    The word “misdemeanors” minimizes the nature of the crimes being committed and the seriousness of the current situation for psychiatric victims. For some of the top leaders of Big Pharma and the APA, felony fraud, false imprisonment, felony murder and /or manslaughter, more accurately describes the true nature of the crimes committed.

    You said: “Some commentators argue that rejection of the ubiquitous capitalist system is necessary to improve the mental health of our citizens meaningfully…It is, however, unrealistic to expect a wholesale rejection of capitalism by the Western world in the foreseeable future. Nor am I convinced that these generators of human suffering would not arise in other political systems.

    It is here where you slip into defeatism and reformism when you state (without any legitimate arguments to back up the statement) that “Revolution” is not only impossible, but might also contain some of the same forms of oppression that exist today.

    I say, today’s “mental health” system has now evolved (over the past 4 decades) into an institutional entity that is now inseparable form the future rise and fall of the entire Capitalist/Imperialist system itself . When looking at both the central and vitally important features of the pharmaceutical industry in relation to the entire U.S. economy, and at the important role Psychiatry and their psychiatric drugs play in neutralizing (by rendering their brains and rebelliousness into mush) some of the sections of the American and British people, who in the past have brought forth significant numbers of political activists and creative agents of change.

    Here I am talking about social outcasts and delinquents, prisoners, minorities, women and other more rebellious sections of the people. These are the very people who today receive the most psychiatric labels and drugs. This has now become very useful to the future preservation of the entire political and economic system. The ruling class may not have been aware of the important role of Psychiatry and their drugs 30 years ago, but I believe “The Powers That Be” are now increasingly aware of the value of this institution in maintaining “law and order” and will not allow Psychiatry to die or lose significant power.

    The profit motive and the Capitalist System that spawns its role in all human affairs on the planet has clearly become a major impediment to all human progress. This is especially true when looking at science, medicine, support for people in psychological distress, war, and at the current human attempts to stop the wholesale destruction of our environment.

    I believe that yes, we should all fight for some of the reforms that you propose, but let’s not delude ourselves into thinking that your reform package is remotely possible within the current political and economic system.

    Revolution will not, and cannot be the product of the struggle for reform. On the contrary, reform may often be the byproduct of the struggle for Revolution. And actual reforms that do come into being in this struggle will not last without genuine revolutionary change taking place.

    All this means we must do the necessary and hard work of summing up both the positives (of which there are many) and negatives of past efforts at Socialist and Communist revolutions (which from an historical perspective are only 165 years young), and chart a new course for the future. Nothing short of this is going to get us where we need to go. And the human rights struggles related to psychiatric oppression could be a big part of any future Revolutionary efforts.

    Respectfully, Richard

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    • Very heady post Richard. A few short impressions:

      felony fraud, false imprisonment, felony murder and /or manslaughter, more accurately describes the true nature of the crimes committed.

      Dare I say “cultural genocide”?

      Some commentators argue that rejection of the ubiquitous capitalist system is necessary to improve the mental health of our citizens meaningfully…It is, however, unrealistic to expect a wholesale rejection of capitalism by the Western world in the foreseeable future.

      The end of capitalism is a prerequisite first step which would open up the possibility of a world without “mental health,” period, and the alienating framework which such concepts imply. It would not be a solution in itself, but would represent a loosening of the impediments which hold back the human spirit and reduce us to units of production.

      I’ve often considered the many fleeting successes and crashes of efforts to secure Socialism in an analogous way to the films you see of early efforts to fly — machines with flapping wings, etc. crashing & burning. But eventually they got it right.

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      • Oldhead – As I stated in an earlier response, I’m not convinced (but open to persuasion). Are there any examples of a different political/economic systems where human suffering is minimised?
        I’m not a political scientist and admit to ignorance in this domain. Are there any references you could recommend to me that illustrate how a radically different political system would markedly reduce the factors that we know contribute towards human suffering and overwhelm i.e. power differentials, victimisation, intra-family abuse; poverty, homelessness, discrimination etc.?

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        • I think it’s more important to be discussing Murphy right now but for the record —

          I can’t do your research for you, but the early stages of numerous revolutionary states during the last century showed great promise prior to capitalism being restored. Extreme poverty and homelessness were in some cases eliminated. But all this was being actively opposed and subverted by the capitalist countries the whole time, and still is, so socialism is yet to take root in any one place for the long haul. I think it should be obvious where the improvement of material conditions for the masses is concerned, that the elimination of capitalism (organized exploitation) is a prerequisite; also to eliminating the militarism, racism, patriarchy, and other oppressive institutions and attitudes which go with it.

          However I think while we still have a chance to stop the Murphy bills we should be more focused on that, and less on abstract speculation.

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    • Richard – Thank you for your interesting and detailed response.
      I accept your point about the term ‘misdemeanours’; it does indeed understate the seriousness of drug-company behaviours.

      I’m less convinced about idea that the total rejection of capitalism is the central and essential prerequisite for radical change in the way we respond to human suffering. I suspect competitiveness and significant power imbalances would emerge in any political system, but I’m open to being convinced otherwise.

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    • I agree about the term “Misdemeanors.” These are high crimes, the equivalent of medical “treason!” They completely violate the trust of the public that pharmaceuticals are intended to be safe and helpful. They are crimes of the highest order.

      — Steve

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  6. ” . . . . an expanded 3rd sector and charitable organisations” . . . . YES!! This really is the way forward – the ‘State’ needs to relinquish full ‘control’ of the mishmash of institutional treatment/professional biomedical pipelines to certification and then they need to get out of bed with big Pharma. In the US, presidential candidate Hillary Clinton is exploring this are in the democratic platform: “Integrate our nation’s mental and physical health care systems so that health care delivery focuses on the “whole person,” and significantly enhance community-based treatment” – see: https://www.hillaryclinton.com/briefing/factsheets/2016/08/29/hillary-clintons-comprehensive-agenda-on-mental-health/ . . . . Would Dr. Sidley be able to connect with those working with the future US President [if Clinton] to make this revolution become reality? We are going backward at a pace that is frightening — I have see it first-hand and it is criminal what is happening. Barbara Carder – Hilton NY.

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    • Barbara – Your interest in my article is appreciated. I’m glad you concur with the idea of investing much more in the 3rd sector/charitable sector. I do, however, harbour mixed feelings about the mental and physical health having integrated provision. In one way this idea makes sense (our psychological wellbeing impacts on physical health and vise versa). On the other hand I believe there are dangers in viewing our approach to each as similar – the ‘illness like any other’ approach to mental health problems is unhelpful in a range of ways (e.g. increasing stigma, encouraging the assumption that biological deficits are the primary causes, increasing passivity, reducing hope etc.)

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      • Well, one of the problems is that mental illnesses are actually syndromes, like any other- and the other syndromes all have multiple causes. Bio-medical psychiatry is no problem, should it consider its “diagnoses” to be syndromes that require fruther investigation, instead of independent “behavioral entities” to be treated by the usual prescription of trance medication.

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      • Dr. Sidley – I understand your reluctance to link mental-physical, but in the US due to health insurance issues, we’re only at ‘baby steps’ — first we [the United States] had to get universal health coverage. Then — open the door wider to ‘third sector’ [do you mean SANE in the UK and Center for Addiction and Mental Health in Toronto/Ontario?] — the vast level of humane [emotional, spiritual, social, therapeutic] responses HAS to come to bear on the suffering at whatever level [0-10 and prevention]. It’s not an ‘either/or’ situation but now, today, treatment is a stressful and punitive gauntlet that legally stigmatizes for life. There can be many different avenues a person can travel and accidentally come across — not just non-profits, but online and street people, wanderers, creatives. . . .. Yes, let’s not ‘default’ our thinking and our outreach to dead-end diagnoses – put the DSM on a back shelf -NOW- or you will continue to simply describe pathology. I find your language helpful to the endeavor . . . . let’s look at the United States as a ‘special case’ in the world and never give up on the baby steps. —– Barbara

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    • Hillary Clinton — are you serious??? She supports the concept of merging “mental health” with REAL health as put forth in the horrid Senate bill (S2680) described by Phil Hickey above. Soon you won’t be able to get a broken bone set without getting a “depression screening” and maybe a script for Paxil in the process.

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  7. I have proposed one revolutionary paradigm shift — rethinking the DSM/ICD “diagnostic system” that is based on the biomedical/disease model. My Self-Acceptance Psychology is based on actual research on the effect of childhood trauma and attachment trauma, along with well-accepted facts about the threat response (“fight-or-flight”), shame and fear of social exclusion. This model fully explains all “mental disorders” as normal, if maladaptive, responses to these factors and makes complete sense to those who read it. I address the power of shame as an emotional driver of most “mental disorders.” Emotions such as shame are the cause of emotional and behavioral distress, not imagined neurochemical imbalances.

    However, the likelihood that this or any other paradigm shift takes hold is nonexistent because of 1) the inertia of public opinion now that the “neurochemical” myth has taken hold 2) lack of financial backing at the level that Big Pharma is able to exert to fight against this accepted myth 3) clinicians who are afraid to stand up to the American Psychiatric Association and its assumed and presumed authority over the diagnostic system.

    I just handed out 500 business cards at a psychotherapy conference trying to generate support for Self-Acceptance Psychology and got essentially no response. The profession must open its eyes to the falsehoods of disease model. Every person who comes into my office harmed by false “diagnoses”, stigma, shame and medication breaks my heart.

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    • Harper – I share your views about the important role of trauma/life adversity in the emergence of mental health problems, and also the destructive effects of shame. Also – as described in my article – I recognise the challenge of overcoming obstacles like public inertia and vested interests, but I suppose I’m a tad more optimistic about the potential to overcome these formidable barriers.

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  8. Dear Gary,

    You’re certainly right about the opportunity to save the western world a fortune – most psychiatric disability comes from the psychiatric drug treatment.

    (I’ve winessed, non drug recovery work very effectively in real life)

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    • Fiachra – Thanks for your comment. I think the economic arguments could be distinctively potent in triggering radical change. And I’m already convinced that many people experiencing overwhelm and severe emotional distress can recover without resort to drugs.

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      • You are correct; many people experiencing overwhelm and severe emotional distress could recover with the drugs if the psychiatrists provided emotional support and physical protection instead of the drugs.

        There were studies done in the late 60’s and 70’s dealing with the recovery rate of people suffering from psychosis before the advent of the drugs. Prior to the late 50’s and 60’s people recovered at rates up to almost 60%. It took some time to accomplish, but many people moved through the psychological and emotional distress and pain and got on with their lives after one episode of being psychotic. This accounted for about 30% of people studied. Then, there were about 30% or so of people who experienced a couple of episodes but then went on with their lives never to return to the “hospital” ever again. Unfortunately, about 30% never seemed to recover.

        Of course these are rough percentages since they don’t add up to 100%. The point of the studies is that 60% is a pretty damned good recovery rate, all things considered, especially when the recovery rate today is no more than 16% and I think that that number has been fudged. What was once an episodic experience has been turned into a chronic experience. Shame on psychiatry and the drug companies.

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  9. Gary,
    This is an excellent, cogently-written article.

    The powers sustaining the present psychiatric system in terms of the massive profit motive, the allure of simplistic explanations of distress, the ability to deflect “blame” from people around suffering individuals, support of the illusion that psychiatrists are doctors treating brain diseases… are truly formidable.

    I like in particular the idea of creating incentives for change via cost savings compared to business as usual. I think this – i.e. money – is one of the most powerful weapons that can be wielded by would-be reformers. Saving money by using far less drugs, releasing unnecessary psychiatrists, closing enormously expensive and ineffective psychic prisons are all attractive ideas to cash-strapped governments who already want to cut mental health budgets. Meanwhile, promoting cost-effective options like peer support institutions and programs led by professionals without medical training seem like no-brainers.

    I would add that spreading the knowledge about how the psychiatric system does harm contained in this and many other articles to families of emotionally distressed people could be very important. Many family members of people caught in the system are themselves functional and not ensnared in it personally; thus they are more able to immediately demand change.

    Lastly, two criticisms: 1) I agree with an earlier commented who noted that “misdemeanors” is a euphemism, and a bad one. As Peter Gotzsche said, the behavior of drugs companies and their agents has much in common with organized crime. And organized crime takes things a little bit, and sometimes a lot, beyond misdemeanors.

    Secondly, you used the term “medications.” In my recent article, “Rejecting the Medications for Schizophrenia Narrative”, I explained why this is a misnomer as no physical disease process is being treated by such chemical compounds. Thus “medication”, a word generally understood to mean a substance treating a disease caused by biological or genetic malfunction, is an inappropriate word to describe generally psychoactive substances that do not treat valid medical diagnoses…. and such terminology supports the status quo. If you want to do something easy to bolster your current advocacy efforts, consider substituting the word “drug” or “neuroleptic” (for antipsychotics) for the term “meidcation.”

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  10. I don’t really get the point of this blog. I mean, yes, yes and yes as far as the contradictions and oppressions enumerated, but this stuff has all been known for years. What to do about it should be the issue.

    I particularly don’t get why anyone would expect the psychiatric industry to adopt changes which would disempower it and make itself less of a dominant force. This all seems to be based on a belief that a tyrant can be talked out of being a tyrant, or that an industry can expected to voluntarily go out of existence based on well-reasoned humanitarian concerns.

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  11. VESTED INTERESTS :-

    Below is a copy of a complaint I sent to a UK Eye Doctor regarding suppression of drug eye damage (and Recovery):-

    “………
    Dear Ms XXX (Patient Liaison),
    Thank you for taking the time to talk to me on Thursday. My complaint is about the reluctance to record psychotropic eye effects, and discrediting a person for reporting them. Please take a summary from my email (below).

    Your Sincerely

    (Me)

    Sent from Yahoo Mail on Android

    On Mon, 11 Jul, 2016 at 5:14 pm

    Dear Dr XXX (Consultant)

    I have an appointment on this week at XX (Hospital)

    I applied for my notes earlier in the year.

    MY PROBLEMS
    I see in these notes that following the interview of March 15, 2012 you sent out a letter in which you said that I was taking Seroquel for “Psychiatric Problems”. I wrote to you at the time explaining my situation – but I DON’T see my explanation in the notes I received.

    DRUG INFORMATION
    Would you please look up the prescription of Seroquel 25mg per day in your manual – (as far as I know Seroquel at this level is not suitable for any Psychiatric Problem).

    MISREPRESENTATION
    MH Misrepresentation is something I’m coming across again and again at XXX (Hospital). If you look at nearly any MH drug information sheet you can see reference to MH medication and eye damage. When I state my personal experience of this damage to doctors at XXX (Hospital) I notice negative MH comments going onto my notes. Please STOP doing this.

    (I notice Dr XXX of the XXX Hospital, has also misrepresented in the notes).

    OTHER MISSING INFORMATION
    I had an interview with XXX (nurse) prior to going to XXX (Operating Hospital) where I mentioned drug induced heart rythm. At XXX (Operating Hospital) I had an interview with a younger nurse where I explained my historical drug reactions. And I showed a letter from a (previous) Irish doctor now an Experienced Psychiatrist, acknowledging suicidal drug reaction and Misdiagnosis. I can’t find either of these interviews in the notes.

    MY HISTORICAL SITUATION
    1980 – 1984 I was exposed to psychotropic medications for several years. These medications were causing suicidal reaction and disabling side effects (extrapyramidal).

    1984 – 2016 I made longterm recovery as a result of stopping medications (carefully) and moving to Psychotherapy.

    YOU YOURSELF
    As a doctor you might not approve of Recovery through the Talking Treatments, as it shows up the expense and failure of the medical approach – but this is the way things have been for me.

    I don’t know why XXX (Hospital) objects strongly to hearing about Psychotropic eye damage – it is acknowledged by drug manufacturers.

    Yours Sincerely

    (ME) ……. “

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  12. “It is unrealistic to expect a radical change in the way we respond to human suffering while all professionals operate within the discriminatory infrastructure of mental health legislation.”

    Perhaps it is how we *perceive* suffering that will require a radical shift that would bring revolutionary change. There is a spiritual element to these issues that most often goes missing. That opens a whole new door to how these issues are addressed–mostly in the fact that from this perspective, they can actually be resolved, so that evolution can actually occur, as per our nature.

    Academic and political perspectives have failed us miserably, and only have served to cause suffering, as well as mass confusion. To inject an authentically spiritual point of view would rock the mainstream boat, appropriately. It would also create a new reality.

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    • Alex – Greater emphasis on the spiritual dimension might be one way forward. I do, however, believe that the mental health legislation acts as a generator of much that is wrong in the current system, essentially by the inherent assumptions that all people with ‘mental disorder’ are risky and have internal defects.

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      • Right, and that’s what I mean by shifting perspective as a gateway to forward movement. From a spiritual perspective, by which I mean from a broad energetic point of view–the spirit of the situation–no one is “broken” and the only thing which causes us risk is our own fears and distorted, limited perspective, a mere and infinitesimal fraction of what is really true, from that broad spiritual level. The spiritual perspective is that we are learning, growing, evolving, and awakening as we go along, if we allow ourselves to. Keyword: allow.

        From this perspective, all are of One consciousness, each of us representing a different and unique aspect of that One–“all that is” (what some call Source, God, Universe, etc., that which is greater than our physical selves).

        That is unity consciousness, as opposed to the duality which inherently incurs conflict, stigma, and judgments (shame, guilt, etc.), leading to trauma, violence, and general chaos, because we are not recognizing our continuum of humanity, which is what connects us all.

        No one is immune to life’s trials and tribulations, we all must face them. How we perceive that which causes us stress is pivotal to how we will respond to it. If we see it as a threat, something to fear, then we will more than likely spiral down in some way, because we will perceive the cause of that fear as something outside of us.

        Whereas from a spiritual perspective of energy, where we acknowledge being the creators of our own reality, we perceive our trials as guidance, that which moves us forward, because it is generated by our own spirit as the means to personal growth and evolution. To me, were we all to adopt this, then we’d all be taking responsibility for our own life experience and seeing the value of each and every challenge. I believe this would great reduce stress and violence on the planet, leading to peace in the world. Inner peace = outer peace.

        It is a radical shift in perspective in some communities, however (not all, this is standard in some communities), and not necessarily an easy one to make. Although I highly recommend it, as it is a life-changer. That is the journey of radical change, the inner journey of healing and awakening. It’s how we go from being a victim of life to actually partnering with it in order to create our desired life experience. A spiritual perspective puts us in charge of our lives, by teaching us where we are at the controls.

        Life is an education, not a prison. However, it will be what we perceive it to be, because our perception is what moves energy and creates what we recognize as our physical reality. That’s my way of thinking, in any event. Not everyone will take to this, but for me, it WAS the way out, and it continues to be the perspective by which I live my life.

        That was the “alternative” that finally worked for me–applying the spiritual aspect of reality. That is what opened the door to healing and personal growth, after having gotten painfully stuck, thanks to what the system dishes out–the drugs, the stigma, the gross incompetence and lack of soul education. Took a radical shift in perspective to create transformative change in my physical life, and it was well worth the effort, leading to emotional freedom and limitless creativity. No more boxes, none.

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          • It’s vital in these spiritually bankrupt and emotionally regressed times. And once you get it, there’s no going back. This is where growth, awakening, change, and evolution is headed, I’ve no doubt. Best wishes.

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        • Alex I love that you wrote this, I am a psychotherapist in private practice that feels very strongly called to be involved in somehow revolutionizing the roles/meanings of “spirituality” and mental health as we know them..spirituality is just as stigmatized as Mental Health in many ways, so I’m way beyond thinking that it’s enough to be another practitioner incorporating “spirituality” into my practice…we really need a paradigm shift that takes the essence of what the truth is of both and alchemizes that into, well, the next level of consciousness of course..since we are experiencing that anyway on the planet as we speak!

          So for me it feels like beyond paradigm shifting even, it’s more like a completely new reality of how we experience those elements in mainstream life as it is known now. As you kind of indicated, there aren’t even any Mental Health issues in actuality, nothing is broken, except our belief in the illusion that the world is broken. I specialize in trying to completely de-pathologize the ppl I see (if they allow it!)..literally nothing needs to be an issue ever if we are living in a highly conscious reality. It’s not even that things aren’t issues, they just wouldn’t exist at all (the things we know to be issues now that are pathologized in and abt ppl, including their own pathologizing of themselves of course).

          It’s also true (in my understanding anyway) that we’ve been purposefully unconscious up until now bc that has been a desired and valuable expression of The Absolute in and of itself (just as is everything)..but as we know there is this grand awakening happening now and that’s changing..but I agree with the author of this blog that it is time for radical, radical change. Beyond even what most ppl know revolution to look like throughout human history. Life as we know it is going to be over! So I feel like in some ways this radical shifting will just happen more organically through us becoming more skillful in balancing allowance and manifesting..

          But, I know that part of my highest joy involves helping to lead this somehow. It is a strange limbo to be in, not fitting in nor wanting to be in the field of Mental Health, but continuing to use it as a platform still to do what I do (which is basically just use the theory and practice of higher consciousness as a therapeutic modality), bc I’m on my own journey of pretty rapid and kind of spontaneous awakening..I have a vision of allowing some radical circumstances in my life to come to fruition and then sharing it all w the world and letting the act of doing that do at least some of the work for me, but in the meantime, I am hanging out in this limbo trying to at least bridge the gap between spirituality and mental health but essentially really wanting to merge the two to create a reality where “spirituality” is just synonymous w the common sense of life, and where bc of that, there is eventually no such thing as Mental Health of course but perhaps in the interim we have a system that de-pathologizes..like “Unshrinking” (I use that term to describe what I do actually)…a system that works in the reverse that it does now.

          It is the most joyful thing to have ppl come into my office and to tell them that their only problem is that they are not being who they really are and that that is what is causing their “symptoms”..but also that their symptoms ARE actually parts of who they really are that have become distorted, and/or really, really loud bc they aren’t being listened to and essentially loved. And then integrated. And then they have no necessary purpose anymore, and they can fall away. Or, they are realized for what they really are and they become alchemized into strengths. Like elements of mania and psychosis and “personality disorders”…or any diagnosis. And truly the only barrier to this method is ppl’s own fears/illusions, of course. I’ve been “fired” occasionally bc ppl won’t allow themselves to be de-pathologized. They are more comfortable w the judgement..it gets them off the hook from having to know and love themselves!

          But, anyway, I’m glad that you were able to make the shift in consciousness that you did 🙂 There really isn’t even the language to describe what a profound difference it will make when it is chosen..allowed. This comment has gotten quite long so I will stop rambling now but I think my basic point is that I’d love to see an interim “reverse Mental Health system” ..de-pathologizing, de-conditioning, de-programming, learning how to experience and use the energy of unconditional love which is our essence. Learning to live within the new non-co-dependent relationship paradigm that is being templated now (a whole other thing!). But a system specifically for ppl who have chosen identities that involve mental/emotional/behavioral pathology. To un-do the damage as a way to help accelerate the higher consciousness shift for the collective…

          PS I had to laugh when I saw that one of your posts was @11:11..and on my birthday!!

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          • Juleen, awesome post (and powerful numerical synchronicity!)–and yes, exactly what I’m talking about, allowing a new reality to unfold, which is what happens as we allow our perspectives to shift. Releasing the old and allowing the new (aka healing and change) is a radical shift, the challenge of which is that all our resistance is going to come to light for us to face and sort through somehow.

            As we shift dimensions, we face our shadows and must somehow integrate ourselves with full on self-acceptance and true self-compassion. It’s a hefty clearing, very profound.

            That’s how this core shift is healing—at least, we are given those opportunities. As you rightly note, not everyone is into taking that particular healing journey, as it does shed light on all of our programming, about which we are faced with some challenging choices here.

            Are you familiar with the terms “ascension,” and 3D vs. 5D consciousness? From all you say above, I’m thinking you know what I’m talking about, you are describing it perfectly–how we are shifting from operating in a linear reality to a multi-dimensional focus, where present time is all that is, each moment a convergence of multiple realities and energies.

            According to the universal laws of energy, where we choose to focus is what determines the reality we are creating for ourselves. And we have a lot of choices with each and every experience, moment to moment, on where to focus and what story we create for ourselves as we go along in life. We can always shift focus when we are ready for change. That’s our creative process in full power.

            To my mind, this determines everything about ourselves and our lives, and we have all the control we need in terms of where and how we choose to focus our attention, and which perspective navigates our present time consciousness. We have so many choices here. So much follows from this choice, like a chain of energy reactions which leads to 1) how we feel in our bodies and 2) what we manifest for ourselves.

            Indeed, spirituality gets just as stigmatized as anything, it is so often confused with religion, which is more like a cult to me. I think of spirituality more directly as “pertaining to the spirit,” which to me, is what is way more vast than our physical selves, yet on the continuum of it. I see this as universal.

            When we expand consciousness, we perceive more of who we are, and some of that is physical and some of that is on a spiritual (energetic) level. I believe our emotions are the doorway to how we can be aware of this connection between body and spirit. This is where I did a lot of neural pathway re-routing, with very focused meditation and awareness work. It was tedious at first, and still fascinating. But given how we can program our neural pathways, it eventually becomes second nature to expand our thinking, it is more ease than effort.

            My brain and nervous system changed a great deal just from practicing this, really calmed the “fight or flight” issue, while shifting my entire self-perception, and therefore, my experience of life. This is where I feel my power to make change, beginning internally. I believe we change on a daily basis, that is our nature. Really, it’s a matter of awareness. When we connect with our ever-changing natures, we experience more ease in life, because we are allowing our higher consciousness to guide us, and that is who we are! No more “social approval,” we become our authentic selves, regardless of anything. That is how we discover our true path and life purpose, because we are listening to ourselves, not the judgments or expectations of others. And in the process of being true to ourselves, we create that which pleases us most, because we are honoring and expressing who we really are, no pretense (like, for political purposes, for example).

            To make it practical, I see spirituality in terms of energy. My healing was centered around the principles of energy and vibrational frequency of our thoughts and emotions, and how this drives the feelings in our bodies as well as what we manifest outside of ourselves. To me, it follows a very common sense connect-the-dots logic and is the most practical thing I’ve ever learned in my life. It is all experiential learning. Reading about it is one thing, applying it and living it is what counts. That’s where our energy and perspective shift.

            I had been a psychotherapist before going into the system for support as I withdrew from all psych drugs, and that’s where I discovered the extreme limitations of “mental health services.” I was ostracized from my own field because I came out as a psychiatric client, and plus, my personality did not fit the culture. I’m actually an artist (actor, filmmaker, music director and performer) so I was way beyond the scope of this narrow perspective. I have a wide range of emotions which I like to own, feel, and express, I think that’s normal for artists, and my entire life now is about creating art via one medium or another. I always know my center, no matter how far to the edge I go.

            I think that’s the key to maintaining clarity, a sense of control, and also general well-being and enjoyment of life–to know our center, and to know how to get back to it when we are triggered. Everyone gets triggered, daily, that’s a fact of life. But not everyone knows how to come back to center before spiraling downward, that’s the problem. This spiritual energy work is what connected me with this awareness of coming back to center. That made life livable again for me.

            However, a wide emotional range of expression does not go over well in the “mental health” world, as we all know. Without awareness of spiritual energy–to which we shut the door completely when we invalidate, shun, marginalize, and drug strong emotions–there is nowhere to grow, we hit a ceiling! Things get very frustrating here, and our clarity, grounding, and overall well-being become highly compromised–not to mention, our sense of empowerment. At this ceiling is where feelings of powerless creep in, and that can be extremely uncomfortable and produce all sorts of debilitating anxiety, depression, and rage.

            It was when I turned to a chakra and energy healing program that I learned how we operate as energy, and that is what opened the door for me to transformative healing. I healed by leaps and bounds in the couple of years I attended this program to both heal and train. This is how I expanded my healing practice, once I became grounded and clear enough to get back in the saddle. This also took me from mental patient to theater and stage performer (which I’d never done before, this all started with volunteer work), which changed my health and my life indescribably. I attribute this to knowing how to follow my spiritual path.

            Then, I studied Law of Attraction in depth, as a healing tool, followed by Kabbalah studies, where I learned about “co-creating with the light.” All of this added up to be the most practical and common sense healing and personal growth path I could imagine.

            I’ve been in practice for 12 years now, teaching what I’ve learned along the way and helping others to apply it, and am currently co-creating with a couple of partners what we’re calling “Healing Academy for the Performing Arts,” where I’m combining everything across the boards—meditation, energy work, spiritual growth and awareness, music, and the arts. We’re just finishing up our second quarter of meetings, and are rehearsing for our next series of shows, as a band which performs for senior residents of assisted living centers. We cater to them musically with songs from the 20’s-50’s. They love it so much, it is really fun and gratifying.

            To me, this is extremely spiritual, in every way—connecting to each other as spirits in this energy field of music. It is healing for everyone concerned, individually and socially.

            AND, no one gets categorized here in any way. I come from the system, but my partners do not. We have diverse backgrounds and growth processes. There is no discrimination in energy healing. We are all energy of varying frequencies, ever-expanding as per our nature; and somehow, we all fit together harmonically. That’s it–unity consciousness.

            So all of our healing and consciousness work is getting cycled into community service now. We’re having a fantastic time with this, all based on feeling and sharing joy. To us, that is the healing elixir.

            I’m curious how this all speaks to you. Seems we are similarly trying to integrate all of this healing information. It is sooo not easy! Lots of resistances to truth and light in our world. It is hard to receive love when one has been deprived of it for too long. I think that’s a core trauma, lack of love. We have to start with loving ourselves if we want to experience this shift.

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          • Oh, and I really love this, emphatic yes from me–

            “… I’d love to see an interim “reverse Mental Health system” ..de-pathologizing, de-conditioning, de-programming, learning how to experience and use the energy of unconditional love which is our essence. Learning to live within the new non-co-dependent relationship paradigm that is being templated now (a whole other thing!). But a system specifically for ppl who have chosen identities that involve mental/emotional/behavioral pathology. To un-do the damage as a way to help accelerate the higher consciousness shift for the collective…”

            That’s what I call creative thinking. Juleen, we are speaking the same language here! This is exactly what we do in our groups, we are deprogramming in order to know our true selves. We’re just a little country operation, though, I live in a small rural town. I’d love to expand, but at this point, I’m waiting for the light to show the way, that’s all we can do at present, as we do what we can with what we have. I’m always on the lookout for that opening, somewhere, somehow. Up to me to manifest this, right? Hmmm…

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          • Yes Alex I was referring exactly to “ascension” from 3D to 4D and beyond. It’s a very exciting time to be on the planet. I believe there is a collective of us that are meant to be doing this first to be able to integrate and “ground” it here in this “3D” physical reality as part of helping everyone else make the transition. Which is unprecedented for us as a species. It is abt de-segregating spirituality, politics/social reform and science and realizing more consciously that we have to merge them all in order to experience the reality we want to experience (and that really it’s all ultimately different aspects of the same “thing” anyway). Basically mainstreaming what has previously been considered the realm of “spirituality”. Bc there is definitely a stigma to spirituality yes. It is considered pretty “other” in discussions like this one bc the thinking is that that’s all well and good, but how do you take this spiritual wisdom and make it practical in order to be effective within the agreed-upon social constructs we have of government and economics and other regulatory systems. Well there are definitely ways, that isn’t the issue..the issue really is making them palatable to the mainstream who is asking this question! That I believe is the charge of a lot of us at this current time. Many of us have not necessarily been “spiritual” ever before but have been forced there through trauma and/or spontaneous awakening experiences that you cannot ignore or deny..this has all been by plan though, for those individuals to have lived life up to a certain point very grounded here in physical reality, scientifically-minded, often deeply entrenched in the various regulatory and other systems we have here and also in the fear-based programming of humanity. This is to help with the integration, teaching and mainstreaming of all of this so we can make the shift from there being these often relatively fringe social reform/revolutionary movements (which have all still served crucial purposes) that are coming from this energy of conflict and lack beliefs regarding mainstream society, to movements that are actually effective in actualizing unity consciousness. Which will eventually alchemize the even bigger conflict and oppression energies of war and violence (which have all served as perfect expressions of Creation, it’s just time to ascend higher to our natural state of being bc we’ve extracted most of the meaning from them).

            In my practice and when I communicate abt this stuff w those are are not more conscious, I do it in a way that sets it apart from “spirituality” . I feel like we need a completely new “category” of thought and form that merges spirituality with the categories that the mainstream considers empirically sound, for teaching, integration and mainstreaming purposes. Basically something completely new altogether. Bc even this higher consciousness movement mostly, or often, feels like it comes from the energy of conflict and lack, a victim mentality. As well as, generally speaking, all of the years of other reform/revolutionary movements and activity. It has all still been born from the premise that governments and systems are these constructs outside of our separate selves that we are the receivers as opposed to the creators of. All governments and systems are, are projections of our beliefs and energetic states individually and as a collective (as is the rest of our physical reality). This is why we have the collective experience of being the victims of governments and corporate world (and of reality in general), and why coming from this belief system and energy only keeps perpetuating this reality for us. This is why things appear so impossibly entrenched, bc we have created them to be this way. Paradoxically, the bigger energies that we perceive as controlling the planet have always known this, consciously or unconsciously, that’s how they effectively manifest themselves as being in these positions!

            This is why I feel unsatisfied with our existing paradigm of reform and change of any kind, bc it was not ever meant to effect drastic reality shifts to begin with. It was meant to begin to raise consciousness gradually. Even what we consider to have been big reality shifts in the evolution of our species really weren’t, bc they were contained within what we had agreed upon as reality. Now we are literally shifting upward in consciousness density as we speak and we need to take it to the next level as well in terms of how to embody, integrate, teach and mainstream this. It’s literally abt being on the cutting-edge of reforming the idea of what cutting-edge is and how it is in form. My understanding is that we in our lifetimes will begin to see the actual physical manifestation of the beginning of unity consciousness. Which will be a completely new reality. And not a new reality as in modern day vs ancient civilizations and earlier, it means a new reality in terms of shifting our idea as being separate beings to being one being, not in an abstract way but in ways such as merging to more of a telepathic consciousness (the Internet will one day be considered an ancient precursor of this!)..you can already notice this though w the huge increase in ppl’s intuitive capacities (esp in those of us who have been slapped awake having been formerly “I-won’t-believe-it-until-I-see-it-or-until-science-proves-it-” ppl)..again this is part of the plan to ensure more access/influence/relatability/credibility within certain parts of the collective for the purpose of grounding and mainstreaming, to facilitate a fresh vision that isn’t necessarily already connected to this in more formal “spiritual” terms.

            Alex I love that you were a psychotherapist too and that you were able to do the arduous work to begin to connect w who you really are (certain of us suffer through that first so that as “time” goes on others will begin to embody it more and more effortlessly..you are on the cutting-edge of this though!) I think you’ve barely just scratched the surface though! Remember to remember that you ARE the light and to be conscious of remaining in an energy of empowerment as opposed to waiting or feeling small or lackful in any way. That’s what caps and plateaus us often. Try envisioning the way first, to whatever feels like the next level of joyful expansion for you..instead of waiting for the way to be shown to you..focus on visualizing it more pointedly, even if it’s just feeling the essence of how it feels and what it represents. Your vibration is already so high that I bet if you do that in a more focused way than you have, you’ll start to feel the flow toward it being unblocked.

            Often what happens is that ppl set their sights way, way too low, just bc of our lack beliefs that we are the receivers and not the creators of our outside circumstances. Your physical circumstances only reflect your current state of being essentially, they are just a mirror of you. So look for the ways that you might not be taking action bc of beliefs that your circumstances aren’t abundant enough to provide the means for the action..or bc of any beliefs that might come from a place of forgetting that you are completely free and that any limitations are just illusory. In my experience sometimes you need to take some sort of “drastic” action to take it up to the next level if you feel like you’ve already done what I’ve described and you still feel “stuck” . This is when it benefits you to learn how to connect w your intuitive guidance system which uses emotions to help you navigate by telling you how close or far from the truth of your true being you are (the worse it feels, the further from the truth it is!). It sounds like you are probably pretty astute re: this concept already in general, which can be tricky sometimes to discern your true intuition from what I call emotional reactivity/fear..esp w this idea of taking drastic intuitive action, obviously. It’s like an advanced level of using LOA!

            But the thing abt this stuff is that in my experience it is actually 100% empirically reliable as a therapeutic modality..and outside of therapy. It’s one of the ideas I’ve tossed around, being involved in mainstreaming these ancient spiritual truths and laws of energy and reality through building a more empirical research base in and through clinical Mental Health practice and application. Which is a completely different approach than my idea of an “unshrinking” system! It hasn’t been until really recently that I started to be guided to different communities and means to further explore how to actualize all of this at the next level..I’m really not concerned abt the seeming obstacles at all bc I know that’s all just illusory..the only obstacle I even consider an obstacle is whatever might be left of own lack belief/fear conditioning, bc that’s literally the only thing that stands in the way of allowing the flow of ideas and answers and opportunities that match the level I am envisioning at. And whatever other spiritual lessons are left. I just don’t have a sense of outside limitations anymore outside of what I’ve created. So the work for me is how to navigate my own stuff in order to allow any of my ideas or desires to be realized step-by-step (the work for everyone actually, the ONLY work).

            Recently I was “guided” to the teachings and community of Bentinho Massaro who is a new whippersnapper in the spiritual community that has a pretty cutting-edge vision and is really action-oriented, so I’m curious abt sharing my ideas there also, etc. In fact that’s how I found this blog in the first place was bc I was doing some “intuitive Googling” to inspire some creative focus/clarity around developing my own vision/theme/purpose to prepare for taking it to the next level. So I was very happy to find someone like you posting abt using spirituality as a conduit for systemic reform on a non-spiritual blog! 🙂

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          • Wow, Juleen, perfect synch in our thinking, without a doubt. I’ve met a few other lightworkers on here who no longer post here. The focus is just so different, and yes, there is a lot of demeaning and patronizing “othering” associated with having a spiritual perspective. I believe this is academically based. I’ve been distancing myself. I hadn’t even checked this site in over a week, and had a whim last night, and happened to see your comment, which I otherwise wouldn’t have seen because this is an old blog, and I’d have had no reason to check it out. All sorts of synchronicity around here!

            There is so much here on which to chew and comment, I appreciate the rich depth of your wisdom. Indeed, like you, I believe it is the task of the day to create bridges of ascension. I think when we authentically and fearlessly live our truth, we attract a lot of help, starting with from the universe. Then guides show up, and on and on. I love that process, it is fascinating as it unfolds.

            This thread has gotten rather long, so I’m going to keep it relatively short this time, simply mirroring your truth as my own. We have so much in front of us to explore, discover, and learn. It is an exciting time, indeed. Our DNA is even changing and expanding. We can be transmuters of energy and ascension way-showers as a healing presence, and we are on our path.

            Victim/conflict/lack energy can always be transmuted into creatorship, inner peace, and abundance, working with polarities. I believe one informs the other, that’s the transformation. I work with the energy of abundance, that has served me miraculously. From that, all I need springs, like fishes and loaves.

            A couple of quick add-ons here. First, I just wanted to acknowledge this beautiful guidance—

            “Try envisioning the way first, to whatever feels like the next level of joyful expansion for you..instead of waiting for the way to be shown to you..focus on visualizing it more pointedly, even if it’s just feeling the essence of how it feels and what it represents. Your vibration is already so high that I bet if you do that in a more focused way than you have, you’ll start to feel the flow toward it being unblocked.”

            Thank you, Juleen, total light speak. I can feel it strongly because I’ve been working on just that, so you got me, here. I’m impressed, seriously! I’m taking this to heart, thank you.

            “…your intuitive guidance system which uses emotions to help you navigate by telling you how close or far from the truth of your true being you are (the worse it feels, the further from the truth it is!)”

            Esther Hicks/Abraham fan, by chance? Sounds exactly like her teachings, which I love, and indeed, I agree. Being out of alignment with our true being is what causes us discomfort, and which, in turn, guides us to our alignment, indicated by how we feel. It’s beautiful ease, I think.

            Thank you for this exquisite dialogue, it has been refreshing. Any chance you have a way to contact you via email? I’d be very interested to continue this discussion in private, but I don’t have a public address to offer any longer. This timing is actually rather uncanny to me, so I’m wondering if LOA is hard at work here, on my/our behalf!

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          • Hysterical that you just happened to check this blog last night!!? I had assumed you had just remained subscribed to it..the synchronicity in my life never gets old ever!! Yes you can contact me at [email protected]..and yes the AH teachings have definitely been a staple along the way for me!

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  13. Fiachra
    Thanks for bringing up the vision issue
    This gets lost in the discussion so many times
    and not the issue you remember to complain about
    There are so many when taking these drugs or whatever you want to call them
    Lamitical caused nighttime driving hell for me and at times Ibeould be in tears since I was driving kids all over
    Not one doc or therapist ever discussed driving and or visual issues with me or my husband
    This was tantamount to severe medical malpractice because
    I was driving not only my children but others
    I tried to avoid but had such a hard time formatting and putting the problem out since there is almost complete sulence in this matter for various complex reasons
    Lack of color vision yes in a trip I was unable to really see things being pointed out by guides
    Another no brainier but then I had no idea this could or would be an issue
    Talk about lack of informed consent and my guess the only folks that knew where big pharma!!

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  14. The problem is that if you allow the eye doc to know your meds
    Then you are stigmitized
    and your complaints are utterly disallowed
    So much for help – if and this is a big the eye docs would really be informed of visual side effects of neuroleptic a
    Knowing some eye docs and some who went into the field specifically because they did not like sick people – my guess is that ignorance around this issue is huge
    One needs to read Merton in his much regettable last years and his defamation against those who are unable to honor the other in the world
    Stunningly prophetic to this very minute

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    • CatNight,

      When I told the doctors how the drugs had affected my eyesight they completely avoided discussion on this – and focused instead on mental health diagnosis.

      When I avoided diagnosis and returned to the historical eyesight damage, the doctors automatically entered negative and inaccurate mental health comments.

      It’s a bent system and it’s bent because of the pharmaceutical money coming into the overall medical system.

      Ultimately, if the drug eye damage effects are airbrushed out of patients Records then the Eye Research becomes distorted and cannot be trusted.

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  15. There’s a third powerful institution that benefits hugely from the current ‘diagnose and medicate’ approach to mental health problems – governments. Although they are pressured to spend billions of dollars on mental health services, it suits governments to have distress labelled as mental disorders – pathologies located within unfortunate individuals – rather than result of pathogenic government policies that foster inequality. And governments can pretend to be really caring by funding anti-stigma campaigns too!

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    • I see it as a type of Official Money Laundering Scheme, with a smaller group of people benifitting from the pharmaceutical profits (and influence).

      Notice most political parties are more or less middle of the road and supportive of Globalisation. A system like this facilitates larger wealth pools for smaller groups of people.

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    • Raven — Exactly the point, you cracked the code! This is the essential function of the “mh” system, to keep the populace believing it’s a personal problem, not a system problem. The various “treatments” and Catch-22 terminological double-talk are simply tactical means towards that end.

      Please keep posting — we need more people pointing out the obvious.

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      • When the government transforms social problems into personal problems (pathology), because doing so relieves it of the need to do something real about them, and offers the mh system as it’s way of dealing with them, you get an idea of what must be going on here. The mh system becomes just another means of keeping people down. The established authorities are all the more secure in their authority if that authority isn’t questioned and, thus, threatened. Convince a person he or she is “incapable” and you’ve won the ballgame as far as that one person is concerned. Convinced many people, and you’ve got your own oppressed group of subservient “underlings”. Such convincing isn’t exactly conducive to change, even when there is a great need for it.

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      • In a stressful society I think as human beings without a MH system most of us would level off any way ; but a small minority of people might not.

        With MH treatments a lot more people have become desperate (I know I was). So I don’t think the safety valve is working at all.

        Maybe the Revolution is coming regardless.

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  16. While you are correct to point out the large barriers to incremental change, the problem I see is that the barriers to revolutionary change are even bigger! So it’s easy to call for revolution, but not so easy to make it happen.

    There could though be incremental changes that then set us up for bigger, revolutionary changes. So instead of seeing it as either/or, it would be more of a both/and strategy.

    For example, we need to have smaller “alternative” programs get started within the current system, just to create the awareness of what is possible and to test out how to really make it work. And then we need to build support for such things, so people actually see the need for the revolutionary changes you talk about.

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    • The current system has no function, and no purpose, other than to achieve the collective self-blame and internalized repression among the population we just discussed. Why try to “change” it? Into what? Did the Jews escape the camps by forming “alternative” camps within the larger ones?

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      • Oldhead, your comment only makes sense if you ignore the fact that people have lots of problems with things that might be called mental health difficulties, even before they ever encounter any “treatment” or “mistreatment” by the mental health system. Lots of people seek help, and they aren’t crazy for looking for help, because they really are having trouble. Further, they do sometimes currently even get help, for example by good counselors, or doctors that might help them with a physical health condition related to their problem, or whatever.

        We wouldn’t be talking about alternatives like Soteria and Open Dialogue if people hadn’t experimented with various kinds of incremental change. Soteria for example evolved out of alternatives that were first tried within mental hospital wards, and Open Dialogue evolved out of family therapy and psychodynamic approaches.

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        • They are improvements over gross dehumanization but I wouldn’t worship at the altar of either.

          At any rate, talking about “incremental change” vis. a vis. psychiatry is putting the cart way ahead of the horse. Where does anyone get the notion that “change” of any sort is on the agenda of Psychiatry Inc., other than in “think tank” discussions about how to avoid or suppress it? Do you think they’re standing by waiting for our helpful suggestions about how they could reduce the need for their “services” and all the drugs and other expenditures which come with them?

          To review — people are freaking out, psychiatry or not, they need help, and occasionally they stumble upon it (by someone’s definition) in the “mental health system,” in spite of itself. What is that supposed to demonstrate?

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  17. I’ve noticed myself because I’ve made official complaints that the medical model is defended to the hilt even when (in my opinion) it is in the wrong so Officially there must be some reason. I presumed it to be because of a type of pharmaceutical medical financial reason. But I did notice great defensiveness.

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    • Fiachra – The status quo is defended to the hilt. Another tactic used by supporters of traditional psychiatry – one that I’ve recently experienced on Twitter in response to this article – is to accuse me of ‘doctor bashing’ and/or of being involved in a ‘turf war’ between professionals. (Such responses enable them to avoid having to address the valid criticism).

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  18. Great article! And I agree. I hope change comes sooner rather than later. Until then, people will often have to take control of their mental health themselves. I struggled with chronic depression and anxiety for years, got fed up, and abandoned the conventional medical system completely in order to heal myself. Taking care of my thyroid was a big part of my recovery: http://www.optimallivingdynamics.com/blog/13-ways-to-support-your-thyroid-for-better-mental-health-brain-increase-improve-boost-hormone-t3-t4-hashimotos-autoimmune-depression-anxiety-hypothyroidism-hyperthyroidism-underactive-low-naturally-supplements-mood-disorders-schizophrenia-psychosis

    Anyway, thank you for writing this. I’ll share it on my Facebook page.

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  19. Allopathic medicine is eugenics. IG Farben and the History of the Business with Disease www4.dr-rath-foundation.org ‘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 transmitted through one’s family effected by a corporately controlled culture ( 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. So What? ! To continue to call that person ‘ mentally ill ‘ is to be obtuse, be ignorant of the facts, the reality, the truth of that person’s lived stressful experiential life. Hocus Pocus Diagnosis where the focus is on the label, and Not on the facts of the individual’s experiential stressful 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, with No Cumlative Healing Effect, making them instruments, tools of torture, used by pontificating psychiatrists provided by pilfering pharmaceutical companies for the MONEY at the expense of suffering individuals. Allopathic medicine is eugenics. Pharmacy < Pharmakeia < Sorcery, Drugs, Enchantment Psychiatry? Modern day black magic We, those erroneously labeled ' mentally ill ' survive, thrive, We Have Earned and Only Accept Respect. 🙂 Kurt Wilkens LCSW

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  20. Hi.

    It’s not clear what reform of mental health legislation you are supporting. Since you mention lack of capacity assessments, I guess that you support the kind of reform that is designed to subsume commitment and forced treatment in mental health under the framework of legal incapacity.

    Are you aware that legal incapacity laws are also discriminatory? The Committee on the Rights of Persons with Disabilities, monitoring body of the Convention on the Rights of Persons with Disabilities to which UK is a party, has elaborated on this in a General Comment, http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD/C/GC/1&Lang=en.

    Among their points:

    13. Legal capacity and mental capacity are distinct concepts. Legal capacity is the ability to hold rights and duties (legal standing) and to exercise those rights and duties (legal agency). It is the key to accessing meaningful participation in society. Mental capacity refers to the decision-making skills of a person, which naturally vary from one person to another and may be different for a given person depending on many factors, including environmental and social factors. Legal instruments such as the Universal Declaration of Human Rights (art. 6), the International Covenant on Civil and Political Rights (art. 16) and the Convention on the Elimination of All Forms of Discrimination Against Women (art. 15) do not specify the distinction between mental and legal capacity. Article 12 of the Convention on the Rights of Persons with Disabilities, however, makes it clear that “unsoundedness of mind” and other discriminatory labels are not legitimate reasons for the denial of legal capacity (both legal standing and legal agency). Under article 12 of the Convention, perceived or actual deficits in mental capacity must not be used as justification for denying legal capacity.
    14. Legal capacity is an inherent right accorded to all people, including persons with disabilities. As noted above, it consists of two strands. The first is legal standing to hold rights and to be recognized as a legal person before the law. This may include, for example, having a birth certificate, seeking medical assistance, registering to be on the electoral role or applying for a passport. The second is legal agency to act on those rights and to have those actions recognized by the law. It is this component that is frequently denied or diminished for persons with disabilities. For example, laws may allow persons with disabilities to own property, but may not always respect the actions taken by them in terms of buying and selling property. Legal capacity means that all people, including persons with disabilities, have legal standing and legal agency simply by virtue of being human. Therefore, both strands of legal capacity must be recognized for the right to legal capacity to be fulfilled; they cannot be separated. The concept of mental capacity is highly controversial in and of itself. Mental capacity is not, as is commonly presented, an objective, scientific and naturally occurring phenomenon. Mental capacity is contingent on social and political contexts, as are the disciplines, professions and practices which play a dominant role in assessing mental capacity.
    15. In most of the State party reports that the Committee has examined so far, the concepts of mental and legal capacity have been conflated so that where a person is considered to have impaired decision-making skills, often because of a cognitive or psychosocial disability, his or her legal capacity to make a particular decision is consequently removed. This is decided simply on the basis of the diagnosis of an impairment (status approach), or where a person makes a decision that is considered to have negative consequences (outcome approach), or where a person’s decision-making skills are considered to be deficient (functional approach). The functional approach attempts to assess mental capacity and deny legal capacity accordingly. It is often based on whether a person can understand the nature and consequences of a decision and/or whether he or she can use or weigh the relevant information. This approach is flawed for two key reasons: (a) it is discriminatorily applied to people with disabilities; and (b) it presumes to be able to accurately assess the inner-workings of the human mind and, when the person does not pass the assessment, it then denies him or her a core human right — the right to equal recognition before the law. In all of those approaches, a person’s disability and/or decision- making skills are taken as legitimate grounds for denying his or her legal capacity and lowering his or her status as a person before the law. Article 12 does not permit such discriminatory denial of legal capacity, but, rather, requires that support be provided in the exercise of legal capacity.

    I have copy/pasted this long quote rather than pulling out only one or two sentences so you can see the Committee’s reasoning in context. They also later in the document specify that “the provision of support to exercise legal capacity should not hinge on mental capacity assessments; new, non-discriminatory indicators of support needs are required in the provision of support to exercise legal capacity.” (para 29(i)).

    A wide range of support is contemplated:

    17. Support in the exercise of legal capacity must respect the rights, will and preferences of persons with disabilities and should never amount to substitute decision-making. Article 12, paragraph 3, does not specify what form the support should take. “Support” is a broad term that encompasses both informal and formal support arrangements, of varying types and intensity. For example, persons with disabilities may choose one or more trusted support persons to assist them in exercising their legal capacity for certain types of decisions, or may call on other forms of support, such as peer support, advocacy (including self-advocacy support), or assistance with communication. Support to persons with disabilities in the exercise of their legal capacity might include measures relating to universal design and accessibility — for example, requiring private and public actors, such as banks and financial institutions, to provide information in an understandable format or to provide professional sign language interpretation — in order to enable persons with disabilities to perform the legal acts required to open a bank account, conclude contracts or conduct other social transactions. Support can also constitute the development and recognition of diverse, non-conventional methods of communication, especially for those who use non-verbal forms of communication to express their will and preferences. For many persons with disabilities, the ability to plan in advance is an important form of support, whereby they can state their will and preferences which should be followed at a time when they may not be in a position to communicate their wishes to others. All persons with disabilities have the right to engage in advance planning and should be given the opportunity to do so on an equal basis with others. States parties can provide various forms of advance planning mechanisms to accommodate various preferences, but all the options should be non-discriminatory. Support should be provided to a person, where desired, to complete an advance planning process. The point at which an advance directive enters into force (and ceases to have effect) should be decided by the person and included in the text of the directive; it should not be based on an assessment that the person lacks mental capacity.

    You will see that they include advance directives, but as some of us have pointed out, advance directives are problematic if they are meant to bind the person’s will at the time an event occurs; since the person retains legal capacity at all times, it’s not clear that having provided at an earlier time for something to be done towards them would legitimize for instance the use of force to accomplish it at a later time when they refuse the intervention.

    These two paragraphs reinforce the right to legal capacity as persisting at all times and being unqualified; support is not a control mechanism but a means of exercising a will that the person has formed at some level; the person can always override a misinterpretation of his/her will by the supporter, and no person can be obligated to use support.

    18. The type and intensity of support to be provided will vary significantly from one person to another owing to the diversity of persons with disabilities. This is in accordance with article 3 (d), which sets out “respect for difference and acceptance of persons with disabilities as part of human diversity and humanity” as a general principle of the Convention. At all times, including in crisis situations, the individual autonomy and capacity of persons with disabilities to make decisions must be respected.
    19. Some persons with disabilities only seek recognition of their right to legal capacity on an equal basis with others, as provided for in article 12, paragraph 2, of the Convention, and may not wish to exercise their right to support, as provided for in article 12, paragraph 3.

    Here is what the General Comment says specifically about abolishing forced psychiatric interventions and the need for independent support and non-medical alternatives in mental health context.

    42. As has been stated by the Committee in several concluding observations, forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention. States parties must, instead, respect the legal capacity of persons with disabilities to make decisions at all times, including in crisis situations; must ensure that accurate and accessible information is provided about service options and that non-medical approaches are made available; and must provide access to independent support. States parties have an obligation to provide access to support for decisions regarding psychiatric and other medical treatment. Forced treatment is a particular problem for persons with psychosocial, intellectual and other cognitive disabilities. States parties must abolish policies and legislative provisions that allow or perpetrate forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using mental health systems who have experienced deep pain and trauma as a result of forced treatment. The Committee recommends that States parties ensure that decisions relating to a person’s physical or mental integrity can only be taken with the free and informed consent of the person concerned.

    There is more that is worthwhile to point out, but I will invite you to contact me through MIA if interested in exploring how this framework answers particular questions. I will also point you to a follow up document, the CRPD Committee’s Guidelines on Article 14 (liberty and security of the person) which links up the question of non-discrimination in relation to liberty and security (which you are addressing in this article re mental health legislation) and legal capacity: http://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc.

    All the best,

    Tina Minkowitz

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