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

Gary Sidley, PhD
72
1857

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. https://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

 

Support MIA

Enjoyed what you just read? Consider a donation to help us continue to produce content, provide up-to-date research news, offer continuing education courses, and continue building a community for exploring alternatives to the current paradigm of mental health. All donations are tax deductible.

$
Select Payment Method
Loading...
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Donation Total: $20.00

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?

  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”).

  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!

  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.

  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

    • 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.

  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.

    • 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.

  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.

  8. 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.”

  9. 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.

  10. It is time for psychiatry to reconcile to its eugenic and custodial past and learn that dialogue – dialogical psychiatry – is a real option for transforming the experience of service users in ways that are being demanded in this century.

  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) ……. “

  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.

  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!!

  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

    • 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.

  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!

    • 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.

    • 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.

      • 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.

      • 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.

  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.

    • 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?

      • 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.

        • 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?

  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.

  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.

  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

  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