INTAR 2016: A Global Call for a New Paradigm In Psychiatry

Robert Whitaker
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2418

The most striking part of INTAR’s 2016 conference, which was held in Lavasa, India from November 26 -28, with a fourth day given over to a roundtable strategy session, was that it brought together people from 40 countries, including representatives from the World Health Organization, the United Nations, and the International Disability Alliance, and by conference end this gathering had embraced a common thought: a new global health narrative was needed, one that could replace the failed “medical model” that dominates mental health today.

“We need a new paradigm,” said Alberto Vasquez, research coordinator of the office of the special rapporteur to the United Nations on the Rights of Persons with Disabilities. “People are clamoring for change. We want to see something else.”

The American Psychiatric Association (APA) created its disease model when it published the third edition of its Diagnostic and Statistical Manual in 1980, and over the past 35 years, this American-born model has been exported to much of the world (and hence, the globalization of mental health). However, what became clear at the INTAR meeting is that as a country adopts the disease model, it will eventually prompt at least a few brave souls to stand up and try to fight it. For instance, there were people from Nepal, China, Indonesia, and the Philippines at INTAR (to name just a few of the countries that were represented), and they all told of a desire to join a larger international effort to combat the disease-model practices.

“There is a globalized community that is coming together for resistance,” said Bhargavi Davar, who heads the Bapu Trust, which hosted the INTAR conference.

The Bapu Trust 

In many ways, the conference represented the fulfillment of a vision that the founders of the International Network for Treatment Alternatives and Recovery had when they began the organization in 2004. INTAR was started by dissident psychiatrist Peter Stastny and a small group of mental health activists, mostly from New York, and as the organizational name indicates, their goal was to create an international network of professionals and people with lived experience who would promote alternatives to the traditional mental health system and the regular use of psychiatric drugs. The organization has had its struggles, as it has operated without any real funds, with the scheduling of a conference dependent on finding a host who can put on the event, but it has plugged along, and the Bapu Trust proved to be a perfect partner for INTAR. Together they created a conference that Stastny called a “high-water” mark for the organization.

Bhargavi Davar founded the Bapu Trust for Research on Mind and Discourse in Pune, India in 1999. She came from a family of users of psychiatric services, with her mother Bapu having suffered horribly within the system. Bhargavi, having earned a Ph.D. in the philosophy of psychiatry, founded the Bapu Trust to support survivor-directed research and advocacy, and to promote non-drug alternatives. Her own research has focused on such topics as traditional healing practices in India and gender issues in psychiatry. In this way, she turned the Bapu Trust into a user-led initiative that has academic credentials and the influence that comes with such research. Today, it serves as an organizing hub for mental health advocacy groups seeking to promote alternatives throughout India and Asia.

There were many memorable aspects of the conference, starting with the joyful experience of being among such a culturally diverse group. That was a feeling, it seemed, common to everyone there.

It was also notable that many of those with lived experience who were speakers or workshop presenters also had connections to an international mental health agency or advocacy group, or had served as members of the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD). This was evidence, at least for me, of how a user movement that resists the current model of care is increasing its influence, in ways small and large.

Highlights

Everyone who goes to a conference may remember different talks and workshops as having a particularly deep resonance. This one had an abundance to choose from, but there were two presentations that struck me the most.

The first was on the importance of the CRPD. Even though Tina Minkowitz, who was a member of the committee that produced the treaty, has written eloquently about it for MIA, I am afraid that I thought it was a “pie in the sky” document, given that it requires countries to recognize the right of individuals with disabilities, including “psychiatric” disabilities, to make their own “informed” choices regarding health care services. This stands in direct contrast to our expanding system of state authority in the United States over the lives of people with psychiatric diagnoses, both in the hospital and as “outpatients,” which is built on the assertion that people with schizophrenia and other “psychotic” illnesses lack insight into their illness, and thus the state may exercise guardianship over them. But at the conference, Diane Kingston, who is a vice-chair of the UN Committee that monitors compliance with the treaty, made a good case for how the CRPD could be used to “hold countries accountable.” The committee’s reviews produce findings of non-compliance, which can then be used to push countries to enact legislation consistent with the CRPD, she said.

There are 160 countries that have ratified the treaty (although the United States has not). Kingston said that Costa Rica is the one country that has been certified as fully compliant with the CRPD. This shows that it is possible for a society to develop alternatives to forced treatment. “Coercion,” said Chris Hansen, who was a delegate to the UN convention, “is a systems failure that leads to a violation of human rights.”

The second was by Kwame McKenzie, a professor of psychiatry at the University of Toronto, whose research has focused on the intersection between societal factors and psychiatric disorders. Specifically, he told of a guaranteed-income experiment that ran in the province of Manitoba, Canada in the 1970s, which was designed to assess whether the guarantee of a livable income, without any conditions, would lead to a disincentive for low-income people to work. What the researchers found was that, in fact, it provided many people with the opportunity to return to school and get better jobs. It also led to a reduction in psychiatric hospitalizations and visits to mental health professionals.

His talk served as a powerful reminder to think of social initiatives that can serve as “therapeutic alternatives” in this world of mental health. We all know this–create a more just society, and psychiatric distress will abate–and yet we still tend to focus more on therapeutic interventions, such as Open Dialogue Therapy, when we talk about “solutions.”

Imagining the Future

I was asked to be one of the speakers for a final plenary on “Where do we go from here.” And, in retrospect, I think I stumbled in trying to respond to that question.

In the process of co-writing Psychiatry Under the Influence, I became convinced that the best way to understand the problem with our current system of care is that it arises from a “false narrative,” which comes wrapped in the gauze of science. Societies have organized their thinking around that false narrative, and that is producing social injury on a vast scale. And so I spoke briefly about how the disease-model narrative arose, and all the ways it is belied by scientific findings.

Thus, if we are to go in a different direction, we first need to see the current narrative in this light. But how to describe a new narrative that would replace the disease model? At this conference, speakers had given voice to many strands of what would add up to a new narrative, and such strands of thinking are familiar to readers of MIA. Different conceptualizations of psychiatric distress, different therapeutic approaches, respect the rights of individuals with psychosocial problems, create a more just society, and so forth. But how can you weave those strands into a succinct narrative, supported by “evidence,” that can successfully be pitched to the public?

In other words, how can you reshape the public mind, and have it organize its care around a different, humanistic narrative?

I didn’t ably sum up the challenge in that way at the plenary. I spent so much of my 20 minutes on summing up the evidence for the false narrative that governs us today that I didn’t organize my own thoughts on “moving forward,” other than to say that it was surely a collective task.

However, the following day, at the strategy roundtable led by Alberto Vasquez and Alexandre Cote from the International Disability Alliance, this was the task that was taken up. The participants included the two representatives from the World Health Organization, many people who had been members of the UN Convention on the Rights of Persons with Disabilities, and leaders of psychiatric survivor/user organizations, and the group spent the day discussing and thinking about a new “narrative” that could both replace the disease model and be succinctly “marketed” to the public.

It was a big-picture way of thinking of “solutions.” At the close of session, Vasquez and Cote promised to draft a five-page paper on a new narrative, and I have to say, I am eager to see what they write.

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32 COMMENTS

  1. There’s nothing wrong with the medical model of diseases; the problem is that psychiatry’s a caricature of medicine. It shows first in the non-recognition of organic conditions that affect mental functions and secondly, in “behavioral diagnoses”, like all the “personality disorders”, which are simply descriptions of clusters of maladaptive activities and not independent disease entities, allowing the psychiatric “medical model” to become muddled with moral influences about what’s pathological and what isn’t.

    • I see, and share a lot of your same concerns. However, if force could be eliminated, that would be great. Even if they acknowledge no proof of a chemical imbalance, but still claim to have the ultimate truth. Especially if force is still involved. How can we go from there? If it’s already accepted there is no proof, but still allow them to have authority. Although, less overt forms of oppression still scare me, like people who feel hopeless, and like it’s there only option. Still I fear the force part will still be there. Still a big what if. Seems like people aren’t even ready to buy the facts. Think that largely surrounds wanting to believe force is right. Fear to take responsibility for decisions.

      • You might need force, but in only a small percentage of situations, not as a routine, where your wards are bulging with involuntary patients, locked up because they don’t want to be stupefied by neuroleptics. Of course, I’m not a believer in standard chemotherapy. You don’t want to be forceful because you’re too inept to properly treat your patients. Present-day bulging involuntary wards are a sign of psychiatric ineptitude.

        • What kind of force, and in what situation? I personally believe the only time any force, should be handled by law, and only be containing violent people. Unless it’s something in the moment where they can’t be there. Also think the legal system should revolve around helping people. That would bennifit everyone, as apposed to punishment.

    • “…”False narrative” wrapped in the gauze of science…” – I believe Dr Terry Lynch describes Depression as a type of unhappiness. That’s what it was prior to “Prozac” coming on the scene.

      I think “Traditional Methods” work most of the time for the “Severe Mental Illnesses”. Cognitive Behaviour Therapy is a traditional method. And talking and sharing are traditional methods.

      (I suffered from terrible Anxiety when I discontinued a “long acting injection”. I found what was needed in the normal community – and this has worked for 30 years).

  2. “In other words, how can you reshape the public mind, and have it organize its care around a different, humanistic narrative?”

    They say some people are sick cause they cant function in society, maybe society is sick cause so many people can’t function in it ?

    Guaranteed-income experiment …
    “Abilify” 2mg 30 tablets $717.30 10m 30 tablets $717.30 20mg 30 tablets $1,011.76 from the website “True Med Cost”

    I guess the pharmaceutical companies have their own Guaranteed-income experiment going on but I see it all the time, people go through treatment that costs the same as a down payment on a home and the zip lock bag full of prescriptions they leave with costs the same as an average mortgage payment, but the original problem they had of homelessness and joblessness remains.

    Now imagine if the doctor had the ability to write an Rx for an apartment or a house when the person leaves treatment instead of “Abilify”. I think far fewer of them would stress out, relapse and return.

    • Well stated.

      I will never forget when I was discharged from the “hospital” with a brown paper bag of drugs and a reference to a homeless shelter. My bill for my little “hospital” stay was $62,400; but of course, if I was living in a homeless shelter there was no way I was going to pay that bill. The drugs that I was supposed to take cost three or four hundred dollars a month and again there was no way I was going to be able to pay for such things. Of course I never planned to take the damned drugs anyway so the brown paper bag went into the trash and I went merrily on my way.

  3. From the start , you have patients who are willing to be treated for their illness, and then you have prisoners(patients) who do not want the “medicinal” treatment of brain damage of electroshock or chemical lobotomy. Two vastly different peoples.

    People have the problems and doctors are supposed to treat them. Doctors can not say “NO, I can’t treat that complaint.”
    Demand and Supply.
    What do people want? Music.
    Technology solves the demand. First we had the Walkman for people who wanted music on the go, then the portable CD player. Now both are obsolete. Today we have various tiny devices to play music.

    Demand and Supply for Psychiatry.
    IMO the number one reason for psychiatry is a legal way to obtain drugs. Imagine a voluntary patient, how are they going to get their drugs? They need a psychiatrist to legitimize their use of drugs. The psychiatrist cleans the nastiness up. They are not taking drugs, they are taking medicine.

    Number two is Pre-Crime: People feel fear or pity for the “insane”, what might they ( the mad) do?
    The psychiatrist controls the mad with the fear of incarceration and with drugs ( addiction).
    ____________
    The world is insane now, with the U.S. surgeon general Dr. Vivek Murthy, saying
    “Science tells us clearly that addiction is a disease of the brain,” Murthy said. “It affects the circuitry of our brain that controls decision-making, impulse control and our stress and reward systems.”

    The problem of freewill to choose badly or choose wisely, is not and never shall be a medical problem.
    The circuitry of the brain the surgeon general writes of, is after addition has occurred for a time. Psychiatrists in the early days complained people return to their addiction after being cured, cured by being locked up.

  4. I think Szasz is/was right…its time to abolish psychiatry. You can’t exactly blame voluntary people/patients when the culture as a whole is feeding us the lies of psychiatry from a young age. Besides, lots of voluntary patients end up disabled and dependent upon the tax payers because of a mix of the drugs and other “treatments” and stigma (which the psychiatrists can and will gleefully use to their advantage, especially against “trouble makers”).

    Psychiatry is draining the coffers and damaging society, and has been for some time. The rational solution would be to get rid of it and use the $$$ for something, anything, more productive and useful. If there are people whose problems–whatever the nature of the problems, whatever the root cause–are made more bearable by the use of psychiatric drugs, then let general practitioners handle those cases. At least the costs will be lower and the people/patients will get proper health care along with the psych drugs.

  5. EMAIL FROM ME TO MY PUBLIC REPRESENTATIVE IN THE UK CONCERNING “SEVERE MENTAL ILLNESS” + THE OPTION OF WELLNESS

    On Tue, 22 Nov, 2016 at 9:25,

    Dear “Detail Removed”

    Mental Health often sounds hopeless.

    https://www.google.co.uk/amp/www.bbc.co.uk/news/amp/38025401

    RECOVERY DEFINITION
    I see Recovery as when someone is NO longer disabled, and NO longer costs anything.

    MENTAL HEALTH COST TO THE UK
    The UK spends about £100 million per year on Mental Health Research – with nothing to show for it. Mental Health Disability rates are rising and Mental Health life expectancy is falling. Each Severely Mentally Ill person costs the UK taxpayer on average £60,000 peor year.

    RECOVERY
    I made my Recovery in Ireland in 1984 as a result of (carefully) coming off strong medication with the help of Psychotherapy.

    I can substantiate more than 30 years of solid Recovery. And I can explain how it came about.

    RECORDING RECOVERY
    I would like to record a Professional account of my Recovery because I genuinely need to – to protect myself against misrepresentation*. I would also like to Record my Recovery to contribute towards improvement in the Mental Health situation in the UK.

    FUNDING REQUEST
    I have previously asked my GP and the NHS for Funding for this, but have been avoided. The money might be taken out of this type of budget. Please read why below :-

    http://www.bbc.co.uk/news/uk-england-norfolk-25915457

    EXPLAINED FURTHER
    *I discovered in 2012 that my GP Surgery had put my name on a Severe Mental Illness (SMI) Register in 2002/03 and were gaslighting my records in proportion. At this time in 2002/03 I was working as a subcontractor at “Detail Removed” (House of Parliament Bldngs) “Detail Removed”.

    *I have a (very fraudulent) SMI 10 year Record Qualification + As a Building Subcontractor I’m sure I’m Qualified to look after myself.

    I AM SERIOUS
    I am serious about my Funding Request, and hopefully making a contribution to UK Mental Health Recovery.

    Thank you for reading this.

    Yours Sincerely

    “Detail Removed”

  6. Thank you Robert
    I truly wish I could have been there
    I was in graduate school in D C during the time between DSMII and III
    It was the time right before Reagan became president and when the concept of Family Therapy was in full bloom
    It was a time when Social Work professionals had a long time history from 1905 that was more instead of less
    Good folks where on the front lines and even management had some heart in the Mental Health field
    Not all by a long shot but there had been the sixties and deinstituluzation and the war and that had allowed an influx of more open folks
    The DSMIII was not taught prior or right before that it was a disease model approach at best it was categories in line with GSW and SOB with medical labeling shorthand
    At worse it would be convent for insurance
    They were not meant to be seen as diseases but somehow they were co-opted as such during and after the Reagan era
    If one remembers that time there was a massive and extremely determental review of SSI/SSD
    I saw people die because of those reviews
    The DSM III also dropped which I now consider as us survivor myself label
    Ambulatory Skizophrenic sorry folks I have to do the TWAIN Huckleberry Finn thing here
    It was for those folks who had different or crazy thoughts but could function fine in society
    By taking this label off the powers that be in the APA effectively threw many of us underneath a semi
    I think one could say that was the watermark of today
    Back then med students interns of all ilks could come to open or were invited to closed reading of old literature- case histories- and academic journals
    Learning was made available and many of the time constraints were not in place
    It was all symptoms not disease processes
    When I was dx as borderline and psychotic that never ever would have been the dx before
    Reagan years medical processes
    The use of categories for biological processes is nothing short of medical malpractice except there are few docs who are still around which would could compare and it would still be not enough to constitute medical practice as defined by law as an incident outside community practice
    This gives me hope that someday the confederacy of dunces can be taken down

  7. Good to see that the CRPD was so well represented at this conference as it is probably our best bet when it comes to ending coercive treatment. I’m glad you were able to see the importance of it. I hope other people are able to do the same. Realpolitick tells me that if there is any way we are going to make progress on the matter, this is it, by getting countries to ratify. Eventually, the message offered by international law should wear down even the resistance of exceptionalism in super power holdouts.

    It is also good to know that efforts are at work to organize internationally for a paradigm change. I’d have to say that we have our work cut out for us in that department, but maybe we will be able to, through it, counteract some of the most disastrous effects of westernizing medicine in the developing world.

    • Australia ratified it and we have one of the highest rates of compulsory hospitalisations in the world. We also already have your Murphy Bill in compulsory `community care’ where one can be indefinitely on `parole’ for years, with forced hospitalisation for not taking `meds’ a looming threat all the time. We have a 30-60% forced ECT rate as well. (the US is 3%?) Our private hospitals have no government supervision and the Tribunal safeguard system is de facto, a total farce. We also recently had a Senate Enquiry into Abuse, Violence and Neglect of the handicapped including `mental illness’, that, to date, has led nowhere. All the while our Human Rights organisations and government pay lip service, spouting motherhood platitudes to `respect, include and empower’ the handicapped, the mentally ill, all those LESSER people. Patronised in discussions, forums etc, brutalised, incarcerated and injured in fact. We are surrounded by toothless tigers, looking beautiful but achieving NOTHING.

  8. I do not believe that it is accurate to state that the APA developed the medical model in 1980 when they actually expanded it to cover all mental distress (“neuroses” as well as “psychoses”). The APA is a medical organization of medical doctors; expanding the disease model provided them with much needed legitimacy. It was previously illogical for a medical profession to dominate care for social welfare problems.

    A social welfare narrative explains mental distress; I hope to propose a social welfare model of mental distress at this website.

  9. Nice work. Psychiatry needs to take a big step back to me in this new narrative. Too much damage that the MDs have caused with their narrative. Insurance companies back off. Professionals in general need to be less aggressive in forming a vision. Let survivors, those who are paying for their own healthcare and children and adolescents and families lead the discussion for once. My opinion is to get rid of DSM V. Insurance should allow for consumers to pay for whatever they need which now needs to include detox from psychiatric medications. Let’s get back to healing people!

  10. Thanks Bob, it sounds like a great conference. You are no doubt too hard on yourself.

    I wonder if the message that the selective use of psych drugs approach can achieve an 80% recovery rate, while the current medical model achieves a 5% recovery rate might resonate with the general population and policy makers. I pulled 97 seconds on this out of a talk I gave in October and posted it on YouTube at https://youtu.be/Ts17LI77BUo

    • Jim,

      The main problem is that most people don’t know that 80 percent of people can fully recover.

      If the average American parent was aware their child had an 80 per cent chance of full longterm Recovery through the Psychological Approach then they would organise this recovery (if for no other reason than to recoup their original investment in their child).

      • Jim,

        Also, I believe Public Funding Providers have a duty to provide the best value result for taxpayers money:- And this would be A Full Recovery Option.

        When I attended my Psychotherapy in London in the 1980s provided by genuine psychotherapy trainees they didn’t see me as a great problem – and our psychotherapy relationship worked.

        (I spread out into other areas as well)

        It’s only when I look at the medical records that I see the Severe Mental Illness and the Doom and Gloom.

        I reckon at least 50 per cent of the UK Mental Health budget spend is generated by White Collar Professional Fraud.

        (…And it doesn’t stop with Psychiatry).

    • I agree, it sounds like a rational and hopeful conference. I’m glad the rest of the world just wants to say no to the current fatally flawed, made up, scientifically ‘invalid’ psychiatric disease model, and it’s violent forced drugging system. I agree with Jim, more honest assessments of recovery rates should to be part of the narrative.

      But I also agree, the problems in this world are much larger than just the psychiatric system, and the solutions are greater economic equality and more mutual respect amongst humanity in general. Our current society is based upon false scarcity, competition, and terror, which is a dumb way for our world to be ruled.

      We could eliminate likely most “mental illness” if we moved towards a world that was based upon cooperation, instead of competition. Or at least go back to having a society based upon actual fair competition, rather than a world controlled by psychopathic monopolies and oligopolies, who don’t know how to do anything more than worship the short run profits they make in a now nearly defunct, and fraud based, monetary system. It’s the way society is currently structured, in general, that is the problem.

  11. Bob, After presenting the painstakingly collected evidence for the false narrative that governs us, I’ve heard you ask audiences, “What happened to a more Shakespearean view about what it means to be human?” This question is such an encouraging and important one in attempting to recognise what can lead us to creating a humanistic narrative we are seeking here. This narrative is more about our society and bigger than the humanely designed and effective responses to each other’s differences and distress (responses that are not psychopharma’s forced treatment). Thanks for sharing the joy to be had at discovering there is so much global and culturally diverse support for change. And bravo to Peter Stastny and others who have recognized the rights and violation of rights of people with psy diagnoses for decades. Diana

  12. Important baby steps being taken in the direction of a psychiatry free world.

    U.S. refusal to sign this document is pretty typical; it similarly refuses to be subject to authority of the International Criminal Court when its own its own soldiers and rulers commit war crimes.

    However, never underestimate the power of international pressure (if not opinion) to influence domestic policy in the U.S. This is something I learned while working on behalf of U.S. political prisoners. Mumia Abu-Jamal — internationally recognized as America’s Mandela — would be dead by now had not world governments from the European Parliament to the Japanese Diet, along with the masses in Africa, South America and elsewhere, stood up to save his life. (Though now that he’s off death row they’re still trying to kill him by refusing to treat the hepatitis C they gave him.) No one reads about this here but in France children learn about it in school. Likewise with psychiatric oppression. It may take the international community to first establish the moral principle that psychiatric torture is not something civilized societies condone, much as it did with the death penalty.

    Though it sounds academic, the movement away from the medical model actually portends the end of psychiatry itself. Once the public reaches critical mass in terms of its ability to see through the myths and half-truths psychiatry exploits (which Bob W is in the process of methodically deconstructing), nothing will remain to prop up psychiatric oppression but guns, i.e. government. And we’ll see how long that lasts. 🙂

    I do wish RW would be more consistent with the use of quotation marks around “schizophrenia,” etc., as this helps keep people from falling back into the mindset that we’re really talking about medicine and not social control. Also, while the “biomedical model” may have formally been birthed in 1980, the “disease model” has been around since the inception of terms such as “mental illness,” “manic depression,” etc. in the 1800’s and earlier.

    (My 1st draft of this went poof when I tried to send it; hopefully you’re seeing this.)

    • “Schizophrenia” in inverted commas is good; and I don’t like the term “antipsychotic”, I think neuroleptic would be the suitable term.

      I don’t like “psychotic” either because most people even before “medication” arrived were not “psychotic”. Most would have been anxious or distressed.

  13. Psychiatry and Psychotherapy exist to oppress. And it is not just the government doing it. It is a cluster, The Middle-Class Family, The Commercial Sector, and Religion. And the government than uses all of these in order to maintain power.

    But there one unique thing about the government, it is the only part of this which we can potentially alter by the ballot box and by court actions.

    Nomadic

  14. If you or I have been marginalized, we do not restore our social and civil standing through Psychotherapy, Recovery, and Healing. No, we restore our social and civil standing by fighting shoulder to shoulder with comrades, fighting for social justice.

    And every day that we delay, we are only helping those who want to use eugenics and social Darwinism against us.

    Nomadic