A New Paradigm for Psychiatry: Answering the Call from the UN

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In Robert Whitaker’s article from last December, “INTAR 2016: A Global Call for a New Paradigm” he wrote that by the end of the conference, this gathering of representatives from the World Health Organization, the United Nations, and the International Disability Alliance 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.”

This call for a new paradigm reflects the awareness that the paradigm of pharmaceutical psychiatry, brought to you by the APA and the pharmaceutical companies, has failed. I have blogged extensively that these beliefs are not only ineffective and wrong, they are harmful, corrupt, and scientifically bankrupt. They will go the way of all false promises. Once biochemical psychiatry is discarded, which will inevitably happen, and is happening now, what will we be left with? What will replace it?

Pharmaceutical psychiatry replaced the older, psychoanalytic model. There have been many gifted analytic therapists – illuminating writers like Fairbairn, Winnicott, and Harry Stack Sullivan – as well as important understandings about attachment. And there have been many excellent teachers. Nonetheless, psychoanalytic theories are off-base, Byzantine, incomprehensible, and significantly wrong (I have also written extensively about these problems). Psychoanalytic theories had become dehumanizing and reductionistic, perpetuating a ‘we-they’ dynamic that violated the essential respect and care for our patients.

I have been a practicing psychiatrist for forty-three years. During this time I have dedicated myself to my craft: intensive psychotherapy. I am not a recovering pharmacological psychiatrist. I have been opposed to psychiatric drugs my entire career. Over time, a new paradigm for psychiatry has coalesced.

Such a paradigm needs to explain human struggle and how and why suffering occurs. It requires an appropriate treatment approach that heals pain and shows why and how it works. It needs to be consonant with contemporary neuroscience, and to be comprehensive regarding human behavior. The approach I will describe is consistent with the nature of consciousness itself, with the neuroscience of the brain, with child development, human relatedness, and attachment.

The theory is ‘The play of consciousness in the theater of the brain.’ The treatment is ‘The psychotherapy of character.’ Consciousness is organized as a living drama in the theater of the brain. This ‘play’ is a representational world that consists of a cast of characters, who relate together by feeling, as well as scenarios, plots, set designs and landscape. It is how the brain represents reality and how consciousness is organized in the brain.

All psychiatric symptoms come from plays that are written as a result of deprivation and abuse, i.e., trauma. They are not biochemical. Trauma can be generated by abusive or depriving parents, sexual abuse, physical abuse, bullies, loss, deaths, separations, divorce, war experience, etc. Through later trauma, we write new plays which can override the original one, and generate a darker play. This then becomes our new prism through which we experience the world.

Psychotherapy is the process by which one mourns the pain of trauma, allowing for a new play to be written that is grounded in authenticity and love. Psychotherapy must honor the inviolable boundaries of respect in order for it to be safe for the necessary explorations of pain, abuse, deprivation, and love. Within the safe emotional holding of the therapeutic relationship, the patient is able to mourn his problematic play. Symptoms and suffering reflect an adaptation to a toxic emotional environment. Psychotherapy generates a literal rewriting of the play in the brain. This is the process by which real brain change actually takes place.

Of course, everything is processed biochemically in the brain. But this is just mechanistic. A problematic emotional adaptation gets altered by the processes of psychotherapy which is then reflected in the brain. Psychiatric symptoms are not brain diseases. Depression is not a chemical imbalance generated in the synapses between neurons. Chemicals do not cause depression.

We need to give special attention to the psychotic worlds: paranoid schizophrenia, catatonia, hebephrenia, schizo-affective schizophrenia, manic-depression and paranoid state. I will quote from my book:

“In the psychotic worlds, there is an additional disruptive dimension to deprivation, abuse. In the context of major emotional deprivation, the damage to these plays derives from an unmanageable limbic nuclear rage. The cortex cannot encompass this powerful rage in a cohesive way. It fragments the cohesion of the intactness of the play itself and the intactness of the self persona. When the self and its primal play flies apart, it generates a state of terror, the dimensions of which are far more powerful than regular anxiety. This terror/rage is the central characteristic of all of the psychotic character worlds. It is the worst and most unbearably frightening state of all potential human experience.

Although the self and the plays are fragmented, consciousness continues its ongoing process of neuronal mapping, reflecting this new experience. Consequently, the cortical imagination now writes new plays that are anchored in this limbic rage/terror experience. Disrupted plays of a fragmented self and terror-filled feeling and other-worldly plots are written and inhabited. The feeling of these other-worldly plays are captured by words like awe, dread, or horror. There is an another tragic feature of schizophrenia—the Humpty-Dumpty factor.”

Often, once the plays and the self are fractured, they cannot fully be put back together again. This can lead to chronic states with some disability.

As a result of the fragmentation, what would be regular thoughts in an intact play are experienced as literal, heard voices in the plays of paranoid schizophrenia. These auditory hallucinations are given form by the cortical imagination, as voices of other-worldly figures who generate terror and awe, or command voices.

In manic depression, the central feature is that limbic feeling cannot be contained by the ruptured play. It spins out of control without limits. Manic flights of feeling should not to be romanticized. A patient in a manic psychosis can be quite humorous in his early mood-elevated phases. It feels ebullient. Like all mood states, it is contagious, and manic people make us laugh. It, however, always escalates out of control, and, in its final and inevitable form, shows itself to be a terror/rage state.

Manic-depression is now called bipolar, which I consider to be dehumanizing and mechanistic, like two poles of a battery. Mania is a very serious and debilitating psychotic character world, which always generates some disintegration of the personality and results in repeated hospitalizations throughout life.

Not medicating a patient with schizophrenia in today’s world sounds like a novel event, a new movement. But it is not. There has only been drugging since the 1950’s. Schizophrenia has been with us always. There has been a great deal of experience with the psychotherapy of schizophrenia. One of the best approaches came from Harry Stack Sullivan at Chestnut Lodge. He took the treatment outside of the medical model and created a respectful and safe environment, where people could have psychotherapy in a caring manner. I have written about Geel, a town in Belgium where for centuries the townsfolk adopted individuals with schizophrenia to live out their lives as respected members of their families. Also keep in mind that there is an acceptance that there is often some disability present.

Another important piece of knowledge that has been lost due to drug psychiatry is that when a patient presents with an extremely acute and flagrant psychosis, this ordinarily predicts a good recovery. It is counterintuitive that a longer term, quieter, chronic psychosis is actually more problematic. It used to be old news that people can recover from a first break and do very well. Old knowledge has been lost.

Psychotherapy of the psychotic worlds is no different from psychotherapy with anybody else. There are times where a judicious use of drugs may help people in a state of terror and fragmentation. But even with a potential use of drugs, drugs are never the treatment. Psychotherapy is the treatment. The writing of the play is trauma-based, and the trauma needs to be mourned. I do not pretend to have the final answer as to why the play gets fragmented. There may or may not be some kind of genetic susceptibility. To be clear, I am absolutely saying that schizophrenia is not a brain disease. It is a human process. I have been through this journey with people many times. We need to respect and reach, care and engage in a purely human way.

The play of consciousness is a unified field theory which not only includes psychiatry, it is consistent with neuroscience (as it must be), dreams, myths, religion, and art. The ‘play’ encompasses the ineffable human mysteries – birth, death, and the disparity between our ordinary sense of self and our intimation of a deeper authenticity. It includes, as well, the dark side of our nature. Human consciousness and human nature are one and the same. The creation of our inner play by the brain is the consummation of our Darwinian human evolution. This universal paradigm reflects a consonance of science and art.

I suggest that this paradigm needs to be the foundation of all the helping professions: psychiatry, psychology, social work and others. We should dedicate our resources to this enterprise. What is important is the quality of the practitioner, not his degree. The medical model is not germane. The education of therapists should be done on a mass scale to meet the needs of our society. From beginning to end, all of psychiatry is a human process, nothing more and nothing less.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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62 COMMENTS

  1. Robert

    Your call for “A New Paradigm for Psychiatry” provides absolutely NO justification for the continuation of Psychiatry as a medical specialty in today’s world.

    Your theory of “the play of consciousness in the theater of the brain” has great merit as one way to explain severe psychological distress. I have no doubt you are a very good therapist who has helped many people overcome enormous problems coping with a very unjust world.

    But where is your scientific rationale for keeping Psychiatry as a medical specialty when the essence of what you do in the real word is “therapy,” and also the construction of well thought out therapeutic theories for how best to work with people in distress?

    Since you agree that there are no brain “diseases” and the Medical Model is absolutely wrong when looking at ways of analyzing and providing support for people in distress, why hold on to the credential of Psychiatry/MD? Doesn’t the very existence of the MD moniker mislead people as to what you do and perpetuate the belief that these are “medical” problems that you are addressing in therapy?

    Yes, while Biological Psychiatry is the worst of Psychiatry on steroids, our Grandmother’s Psychiatry several decades ago was also quite oppressive when we look at the existence of lobotomies, Electro-shock, and other oppressive forms of “treatment” that people were subjected to. You even agree that psychoanalysis, which was more prevalent among psychiatrists in this period, also had its serious problems.

    One of best ways to proceed in a current movement to end ALL forms of psychiatric abuse is for activist doctors to declare Psychiatry THE SCIENTIFIC AND MEDICAL FRAUD that it TRULY IS in the real world.

    Robert, you could play a much more powerful role in this movement if you, as a psychiatrist with the MD moniker, would renounce the complete legitimacy of your profession as a medical specialty and sacrifice all the power and financial benefits that go with it.

    This would make a very important statement to the world that could potentially change many people’s thinking on the true nature and oppressive role of Psychiatry. And actually, this act of courage and defiance would provide a much STRONGER AND POWERFUL BASIS to promote your highly creative and useful theories of providing supportive therapy for those experiencing extremes forms of psychological distress.

    Respectfully, Richard

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    • Wow. Thanks Richard, you saved me a lot of writing. There is no need for a “new paradigm” for a field with no justification for its very existence. Also glad to see that you concur that so-called “biological psychiatry” is just a matter of degree; ECT (and beatings as a cure for “drapetomania”) are pretty “biological” too if you’re on the receiving end.

      Dr. Berezin’s conceptualizations may be useful and valuable for some; they would be more useful if they were divorced from the psychiatric mindset and all pretensions to “medicine.” And the psychiatric terms need to go too.

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    • I think the real problems psychiatrists have to solve are these two fictions, that their power to imprison patients is benign, and the fiction that they can simultaneously provide effective treatment.
      Unless the treating psychiatrist is the one advocating for the outcome their patient wants, and not the one signing the incarceration papers, I agree – there is little hope that psychiatry can survive. And in any case, to survive it will need to redirect the clinical gaze both vertically and horizontally. But I do see this happening more frequently in many trainees.

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  2. “Chemicals do not cause depression.” What about the instances when they do? As in taking accutane causing severe depression or antidepressants causing severe anxiety and depression? Peter Gotszche has stated these drugs create dangerous imbalances in the brain that were non-existent before their ingestion. Then what? This “depression” is then biologically or chemically created and may have triggered permanent changes in the brain. It may be drug trauma but how would it respond to psychotherapy?

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    • Of course the consequences of drugs creating brain problems is huge. That does not relate to psychotherapy. There needs to be a cessation, or a careful taper. Then there is grappling with the long term consequences of physical effects on the brain from the drugs. There is no doubt that a supportive relationship while going through this is important. There may well be underlying issues that would be useful to deal with in therapy, the reason why one was inappropriately given drugs in the first place.

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      • “There is no doubt that a supportive relationship while going through this is important.” But since all “mental health professionals” in our current society were taught “a ‘we-they’ dynamic that violated the essential respect and care for our patients,” the majority of today’s “mental health professionals” are incapable of such a “supportive relationship.”

        I somewhat agree with your theories of a “play of consciousness.” I do not agree that “All psychiatric symptoms come from plays that are written as a result of deprivation and abuse, i.e., trauma. They are not biochemical.” This is sometimes untrue, because combining the antidepressants and/or antipsychotics can actually make a person psychotic, via anticholinergic toxidrome poisoning.

        https://en.wikipedia.org/wiki/Toxidrome

        I also do not agree that “Mania is a very serious and debilitating psychotic character world, which always generates some disintegration of the personality and results in repeated hospitalizations throughout life,” because my experience was the opposite. I suffered from a drug withdrawal induced manic psychosis which functioned as an awakening to my dreams, thus an integration of my conscious and subconscious personalities.

        As to, “Psychotherapy is the process by which one mourns the pain of trauma, allowing for a new play to be written that is grounded in authenticity and love.” I agree, this is what psychotherapy should be, but until the psychological and psychiatric industries throw out the scientifically invalid DSM, and overcome their ‘we-they’ delusions of grandeur, this is not yet what psychotherapy is. I do agree relationships need to be based upon authenticity and love, instead of scientific fraud, greed, miseducation induced disrespect of fellow human beings, and delusions of grandeur that forced, or coerced with lies, poisonings of fellow human beings is one’s right, however.

        I would also like to see both the psychological and psychiatric industries get out of the business of silencing child abuse victims and their concerned parents, and covering up child abuse, en mass. Which does appear to be the primary actual function of those industries today given, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

        “Psychiatric drugs do not cure concerns of child abuse” – an ethical oral surgeon.

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  3. NO, ALL psychiatric symptoms DO NOT come from deprivation/abuse/trauma. That is simply a sweeping, overreaching, dangerous generalization.

    Also, Integrative nutrition and neurology show that that many ‘moods’, behaviours, and states of mind are indeed based in body biochemistry. There are issues that we have previously called ‘psychiatric’ that can be helped or remedied through diet, herbal/vitamin ‘therapy’, exercise, mind/body work (eg. yoga, qigong), a change in gut and intestinal flora, ‘energy medicine’, and even sometimes antibiotics.

    Talk therapy is great in theory, but in my experience – and regrettably – it’s too expensive for most, and not effectively delivered by most practitioners.

    Liz Sydney

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    • Liz. He isn’t familiar with biological therapies that are actually based on biological reality, such as the various orthomolecular treatments that his profession has kept secret from him in its effort to suppress heretical thought. The old megavitamin therapy’s been around for about 65 years, as has fasting therapy for cerebral allergies. Thyroid for recurring catatonic episodes got its start around 60 years ago. I should be worried about telling you this, as I’ll be executed for witchcraft or sorcery in the Brave New Psychiatric World. Or maybe just scheduled for an infinite daily series of bilateral ECT.

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    • Liz, Please try to understand that it is not what you (or society) gives that identifies the trauma – it is what the individual themselves takes. My mother was not aware that doing what society expected of her as a mother caused serious harm to her children. The abuse was completely hidden behind the societal norms of the time. That was the infant raising paradigm that the child, from birth was not to be played with for more than 10 minutes a day, that it was to be left alone to cry for hours at a time and only fed every four hours, among other strict restrictions. Mothers who violated these rules were severely castigated and shamed by infant welfare nurses. The outcome of such treatment led to entire generations of emotionally crippled people who have no idea why because it happened before language was available to identify their intense feelings of loss, vulnerability and emotional inadequacy. When such early emotional deprivation was later accompanied by other, more obvious abuse, loss and trauma, serious mental disturbance finds fertile soil. Your own statement is actually another `sweeping, overreaching, dangerous generalization’. Anything with physiological causes actually belongs in general medicine, or alternative medicine/healing, not psychiatry.

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  4. I’m confused by much of Dr. Berezin’s post. We are expected to believe his blanket statements that all psychiatric ailments spring from trauma because he describes how the brain responds to trauma. One doesn’t follow from the other, even if a psychiatrist says so. We are in the realm of speculative thinking, not science. I share his appreciation for psychotherapy, but then what are we supposed to make of his view of Geel, a place where ‘schizophrenics’ appear to be warehoused to live out their lives “as respected members of their families. Also keep in mind that there is an acceptance that there is often some disability present.” What does that mean? The presence of a disabilty sounds biologically linked. What role does psychotherapy play in the lives of these ‘disabled respected members of the Geel family’? Dr. Berezin appears to believe that people don’t recover from schizophrenia if they don’t recover immediately. Who are his patients? The worried well? Long term schizophrenic people with no hope of recovery? It seems that to many if not all psychiatrists, care of the patient is best outsourced to a professional or professional townsfolk, but I’m getting the the sinking feeling that for those with schizophrenia, there is no hope beyond the first episode. If I have totally misreprented what Dr. Berezin is saying, I’d love to be set straight.

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    • Rossa,
      Let me try to clarify a few points. The issue as to how trauma is digested by our temperament is the essence of how the play of consciousness is written. In my understanding this is how consciousness is organized in the brain. It attends to how psychotherapy itself works by healing the trauma.
      I don’t understand your problem with Geel. It has been an environment where individuals with schizophrenia have been accepted and treated with respect and love and appreciated for who they are. It is simply historically accurate to recognize that many people with schizophrenia suffer some degrees of disability. This has been true throughout history. The situation in Geel does not have any relationship to psychotherapy which is a very recent practice.
      I am suggesting that people can recover very well from schizophrenia. And psychotherapy can be such an important help. Not everyone is the same. Some people end up with some disability and others do not. I have treated many people with schizophrenia. The comment about a first psychotic break was a reference to the fact that schizophrenia is not hopeless, as it is often assumed to be by todays incorrect standards. I certainly did not imply that there is no hope beyond the first episode.

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      • Dr. Berezin,
        Thanks for your clarification, although I have to say I didn’t take away the same amount of hope from your article as you wished to convey. (I may be a poor reader.) My problem with Geel is the impression that is left with people like me who haven’t travelled there and don’t know its intimate workings. We rely on how others portray it and the message that I often take away is that ‘schizophrenics’ are people who are disabled for life, because they have to live apart in a sort of idealized Disney village where townsfolk take them in ’cause no one else is up to the job. They are mentally slow and can’t work and they’ll stay in Geel for life (probably not growing old. Lol.) Many of us are trying to get our relatives to lead full lives outside of the home and maybe the community center, and people who don’t know that there may be a different story to are getting their news from Geel: Schizophrenia means institutionalization, just in a town setting, not a hospital. But, I’m glad to hear you are hopeful, in any case.

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        • I’ve been giving more thought to your wondering why I have a problem with Geel. I’m looking at Geel from the perspective of a parent, not a clinician, and I think that’s where the viewpoint differs. Parents like me want something to aspire to, we’re looking for recovery stories. Clinicians don’t seem to mind the idea of populations of people who can be studied over the long term, and who are managed without necessarily recovering. Geel looks like long term care to me, which doesn’t sound very appealing because I want my own relative to finish his education, get a job, move out of the house, eventually to do all the things that ‘normal’ people do. When my son was experiencing psychosis a few years ago, I would have loved to know of a place where I could send him for a week-end or a week or two, to give me a needed break, before returning to the onward and (hopefully) upward struggle. If Geel provides that kind of help, well that’s a story I would love to hear. What mostly comes out of Geel, for those not intimately acquainted with it because we don’t live in Belgium, is the impression of the long term chronic state of schizophrenia. Clinicians probably wouldn’t even notice that this may be a problem for people like me who need a good deal of hope to keep going.

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          • Found it! Geel is for long term care. This is not appealing to me because without further qualification, the following extract from NPR assumes that schizophrenia per se is severe and chronic, therefore the assumption is long term care. This is how the public generally regards schizophrenia. There are no nuances in collective thought. “There are a few important criteria for acceptance into the Geel program. The program typically selects patients with severe mental illness or cognitive disabilities who have difficulty living independently. In 2003, almost half of the town’s 516 boarders had a cognitive disability, and over 20 percent carry a diagnosis of schizophrenia or other psychotic disorder, according to research by Jackie Goldstein, a professor emeritus of psychology at Samford University. Some boarders have traditionally had other conditions such as learning disabilities or autism…..Boarders tend to stay in family care for years. In some cases, when boarders’ caretakers grow too old or die, they continue to live with their caretakers’ children. In 2005, nearly a third of boarders lived in a foster home for more than 50 years.”

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          • Rossa.
            What’s more important than anything else is your situation with your son. The last thing in the world I would want is to affect your relationship with hope. Other discussions are secondary.
            My reference to Geel, is a historical one. It was a unique situation in Europe where people with schizophrenia were respected and valued. This is in contrast to otherwise vicious and horrendous attitudes. This was an enlightened exception to what was going on. Current day Geel is not the issue at all. When drugs came into Europe in the fifties, that infected Geel too. Todays Geel bears little resemblance to historical Geel. I was just referencing it as something humane. There was a humane period in the United States in the early nineteen hundreds, here in Massachusetts, when the state hospital system began. Back then the idea was for a pastoral cure where beautiful acres of land was used for individuals to be in nature, and away from industrial life. It was only later that it got perverted into warehousing and ended up as snake pits. Wars, and lack of money destroyed a good idea.
            In my knowledge, throughout history there were many theories about schizophrenia, most of them were horrendous and wrong. Many originated in religious persecutions. There are lots of ideas around today, some may be right, and others may be wrong. Schizophrenia has been plagued by false ideas. I’m in favor of whatever is useful. Historically, outcomes from schizophrenia have brought a great deal of heartbreak to families. That does not mean it will in your case. In my experience I have had gratifying outcomes through the hard work of psychotherapy. If other approaches prove to be useful, then that would be great.
            I wish you the best.

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      • Dr. Berezin,
        Thank you for your explanation of the historical reasons you used Geel as an example. You reminded us of the essential caring nature of its work. There would be fewer homeless people in countries that have towns like Geel. And, I agree that psychotherapy is hard work, but ultimately rewarding.
        I wish you the best, too.

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    • The Mental Health Service in Geel runs a normal acute inpatient ward on the main hospital campus, and more than 200 hundred families in the region are still fostering people form the hospital when needed, and this has been going on since the 15th Century! The original 4 bed hospital with its chapel from then is now a fascinating museum.

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  5. I have long thought that acting classes might do a world of wonder for some of those who ‘don’t know how to act’, or as one could put it, for those who “act out”, however acting also flies in the face of the idea of authenticity, a concept I think perhaps over-rated in the first place. What better reason for learning to act a little than being stuck in the muck of an impoverished authenticity? Outside of his or her element, if somebody else has determined what that is, a person might be much better off.

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    • I think I remember Judi Chamberlin defining “acting out” as shrink talk for “acting up.” This was before the AIDS group ACT UP was formed. MPLF in Boston briefly had a publication called “Acting Out.” It could be said that the ranks of the psychiatrized are full of untalented actors who couldn’t perform their assigned roles.

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      • It’s demeaning to call people untalented, and that without training and a trial run. I just don’t believe that it is true. Part of the problem is that the entertainment industry is a matter of corporate enterprises that would hold a monopoly on talent. Talent is so much about the marketing of talent that if you’re an artist, and you don’t pick up on that one thing, you’re totally off the grid. Untalented is a lack of marketing ability really. How did Vincent van Gogh, for instance, get to Sotheby’s? One can only make a long story short of that one. I’m not of the opinion that he got there because of the large number of untalented Vincents there are in the world, but that is, in a sense, the view put forward to the rest of us by the corporate owned mass media. A corporate owned mass media peddling to the populace’s infatuation with the idea of ‘celebrity’.

        I find a lot of appeal to your last sentence above. I think it could also be said that perhaps we have a great many actors who have an unrecognized talent in not performing their assigned roles. What to do with them? Whoosh! Out of sight/out of mind, or ‘institutionalized’. Certainly, there are better things we could be doing with these, albeit unrecognized, talented people.

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          • Okay. We see things differently, you and me, OldHead. I’m not discouraging anybody from pursuing that talent that cuts against the grain. Who acts the way society expects/demands? A conformist. (If not a dullard/simpleton.) I’m not peddling blind conformity and obedience. Troubling can be a complement.

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          • I can’t tell if we disagree on something or not as I can’t figure out what you’re trying to say. Offhand I don’t see anything you just posted that I would disagree with, or anything I said that you would disagree with.

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  6. Dr. Berezin:

    Thank for you this article, which is more concise than your previous articles and a good introduction for someone who is unfamiliar with your approach. It may offer some sanctuary for individuals who are fleeing from the medical model but I suspect most of your clients are privileged and it is too academic to be of use to families like ours. Still, your outspokenness may be able to encourage some younger psychiatrists to practice differently. Most clients in the community mental health system are like my daughter: stuck in the default, one-size-fits-all public system because of their lack of privilege or because their behavior or adverse drug reactions were criminalized, in which case, no private psychiatrist will take their case. A slow trickle down method of reforming psychiatry ‘from within’ is not enough to turn the tide for the unfortunate tsunami of people who are at risk of being tortured and killed in today’s system. We need a full fledged revolution.

    I am happy to report that my adult daughter, home at last after seven years of institutionalization, read your article in entirety and had a favorable response. She said that your ideas represent “a truth that would like to be recognized” She also noted that it is not as “anti psychiatry” as some of the other articles on this site. Presumably this makes it safer for her.

    My daughter is very much on the radar of the community mental health workers and because of this, she is particularly at risk of having her freedom taken away. For her, cooperating with her psychiatrist is not so much of a choice as a survival tactic. In the public system there is a dearth of providers who believe in alternatives; the medical model reigns supreme, N.A.M.I. reinforces the status quo, and human rights abuses are rampant. In my daughter’s world, my daughter has to cow-tow to ‘professionals’ who would laugh at this article.

    Even closed-door allies, administrators and providers who secretly laud your approach plod to work everyday and have no desire to upset the apple cart; they allay their guilt by saying “Once I am retired, I will speak out. For now, this approach is too ‘impractical’. A psychotherapeutic approach in which a highly educated professional is tasked with developing a relationship with someone at the rate of $300/hour will never find a home in the system under which I work. I have to move massive amounts of people through this pipeline”.

    My daughter ironically lost herself in the wilderness of our mental health system as a young adult; she may have remained unscathed had she received appropriate talk therapy or other helpful support in her adolescence. Unfortunately, once she was labeled and involuntarily committed, her spirited resistance led to psychiatric abuse and cover-up. Psychiatric abuse is a unique form of trauma that you do not list on your list of trauma, unless you consider psychiatric abuse to be non-existent or to fall under the broad umbrella of ‘loss’. One cannot underestimate the harm caused by loss of human liberty, loss of agency, loss of control, etc. Imagine my daughter’s trauma of being forced to ingest high doses of a medication that causes her to become incontinent, then while she sit through a commitment hearing when she is talked about by a judge, public defense attorney and psychiatrist who are all chummy, describing their mutual fly fishing trips, make indirect references to the urine on my daughter’s hospital gown as ‘evidence’ of her grave illness for they happily recommit her to involuntary care where she will continue to be forcibly medicated in perpetuity.

    For years, my daughter was a lone voice in the wilderness, crying futilely for her right to live a “drug free lifestyle” without any help or support from an army of mental health care workers, psychologists, nurses, social workers, and psychiatrists. She would have loved an approach like yours but no such alternative was made available to her.

    Like many psychiatric survivors, she experienced multiple, consecutive involuntary (long-term) psychiatric incarcerations as a result of her ‘non-compliance’ and because her adverse drug reactions were criminalized, trauma was heaped onto trauma via the corrections/justice systems which in collusion with psychiatry in an appalling manner that I thought would only be possible in a totalitarian society.

    During her many long-term hospitalizations, very little if any effort was made by a dizzying parade of doctors and other prescribers to distinguish between symptoms caused by her original trauma (the circumstances that led me to seek support from the mental health system in the first place), the symptoms caused by the compounding of her trauma through such conveyances as restraint, isolation and forced drugging, the psychiatric symptoms caused by adverse drug reactions (high dose polypharmacy) which we hope have not permanently damaged her dopinergic/serotinergic systems, and the symptoms of discontinuation syndrome, from those holidays in which she was able to elope, and in failed attempts to come off the drugs without any support, ended back in the system on even more drugs than ever.

    Anyway, things are getting much better. She is on a fraction of the medication she was forced to take for years and is doing a lot better for it. Despite the modicum of help she got from a psychiatrist to wean off several medications including Thorazine and Haldol, her progress is a testament to her resiliency against torture and abuse, not a testament to psychiatrists ability to change. When asked about her survival she pragmatically claims “My plan is to simply outlive the mental health system”. The level of corruption is so deep, and the outcomes are so bad, the current system of care is unsustainable so in a way, she may have a very viable emanacipation strategy—-just outlive the bastards.

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    • I’ve read most of what you’ve posted here on MIA since the day you first showed up. It gladdens me to know that your daughter is out of the “hospital” and is doing better. Perhaps the system will fall sooner than we think and she will be totally free finally.

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    • She also noted that it is not as “anti psychiatry” as some of the other articles on this site. Presumably this makes it safer for her.

      I’m guessing that she has been taught that some thoughts and opinions are not “safe,” such as being “anti-psychiatry.” This is understandable, particularly if she currently depends on a psychiatrist for her freedom and physical safety; she has likely been warned — either directly or by implication — that being anti-psychiatry is “extreme,” or “throwing the baby out with the bath water,” or unsafe in other ways. It’s important for her to understand that being anti-psychiatry does not mean having antipathy for every individual psychiatrist on a personal level, but rejecting the fraudulent basis on which psychiatry is based. I’m sure you’ll help her with this in due time. For now I’m glad to hear she’s out, which is worth celebrating.

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  7. Robert, your prediction depends upon the Survivors of Mental Health, Recovery, and the Middle-Class Family not wising up and learning how to protect themselves:

    1. One psychotherapist, One lawsuit.

    2. Total Non-Compliance under any and all circumstances.

    3. Zero tolerance for pity seeking or Uncle Tomism.

    4. Any Means Necessary, to protect the children of today.

    5. Vigorous Crimes Against Humanity prosecution in the International Courts. Charges can be brought by NGO’s. And local actions to put the mental health system out of business.

    And right now, lets discuss when, where, and how to set up our own forum and then take our first actions.
    http://freedomtoexpress.freeforums.org/reply-to-robert-berezin-md-t437.html

    Nomadic

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    • Her plight is not uncommon and I have lots of hope for my daughter to live a full and rewarding life rich with meaning and purpose. Psychiatric survivors who lead meaningful lives, especially those who became emancipated from the mental health system because they had access to alternative models are fountains of wisdom. I remember when my oldest sister spent a year in a psychotic state traveling around Europe in her thirties, her landing was to live with my parents for several years, then move to San Francisco where she had access to years of jungian and Gestalt therapy. she became a teacher and had a long, rewarding teaching career in the California public school system as a special education instructor. she became the go-to person to whom teachers referred their ‘worst of the worst’ students: children with severe behavioral issues. She became literally, a ‘children whisperer’ Adults referred themselves to her and she was too kind to turn people away. Her circle of friends was indistinguishable from the individuals who came to her for constant consolation and support

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  8. Psychotherapy is *a* treatment. It is not *the* treatment.

    And in any case drawing so close to another human being — especially during psychosis — only really ever amounts to this other resisting or succumbing in various ways themselves to psychosis.

    All human agency is performative. As our lives becomes ever-more theatricised, so too the performance will be graded in modernist terms, typically from 1-10. Henceforward, there will be a massive increase in so-called DID, ranging from the somewhat appalling (1-3) performances leaving a sickening or at least unsatisfactory impression (40something women mimicking gross apparitions of tiny bewildered children, for example) — as the watching eye becomes ever more prevalent, so too the urge to perform will grow.

    There is always– without exception — something sinister going on with psychotherapists. Given the right conditions that sinisterliness manifests.

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  9. Thank you for your community service in challenging mainstream “mental health care.”

    “Such a paradigm needs to explain human struggle and how and why suffering occurs. It requires an appropriate treatment approach that heals pain and shows why and how it works;” I propose a “Social Welfare Model” to replace the “Medical Model.” The “Social Welfare Model” describes mental distress as natural emotional suffering from distressful experiences and from physical ailments, rather than a medical problem of a biological dysfunction. This model describes emotions as understandable physically rather than intellectually. Extreme emotional suffering (from extremely distressful experiences) is perceived by the brain similar to extreme physical pain.

    The theory of a “The play of consciousness in the theater of the brain” describes an intellectual understanding of emotions. Instead, we physically feel the joy of a happy surprise and physically feel the pain of extremely distressful experiences.

    Emotional suffering is the natural, painful reaction to distressful experiences; it is natural, “normal” psychology- natural neurobiology. Most “psychiatric symptoms” misinterpret natural expressions of emotional suffering as a medical problem; psychiatry is a medical science addressing social welfare problems. This misinterpretation of natural psychology causes great social harm.

    There is no treatment for natural emotional suffering beyond time and positive experiences of emotional well-being. In contrast, there is a great deal we can do to prevent trauma in the community by promoting more social justice.

    Best wishes, Steve

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  10. I think psychotherapy can be sound and supportive to gain clarity, resolve inner conflicts, and achieve personal growth and evolution. My concern, however, is that it can be so risky for clients. Aside from way better training with a few more perspectives to consider than what is currently offered by the mainstream–which is especially narrow and myopic, imo–there needs to be some kind of checks & balances system to protect the client, who is in the vulnerable position of needing to trust, from mental abuse. Unfortunately, it is common.

    In addition, it is not a stretch to imagine that if one is seeking healing from childhood trauma and wounding, it can easily be repeated in a clinical relationship. It isn’t always transference; sometimes it is for real. And that can easily lead to way more trouble for the client, rather than healing. I believe it’s a common problem, and people suffer because of this–sometimes without even realizing they’re being gaslighted. I feel so strongly that something needs to be checked, here.

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    • As usual, I don’t disagree. Psychotherapy requires that the therapist be in fact trustworthy. The therapist can’t be in it for his own ego, or power, or control, never mind sadism. It really is a calling that proceeds from respect and love. Each therapist must find his own way sufficiently to not impose, but to listen. The art of therapy proceeds through responsiveness and intuition. Therapy is ultimately moral, (not moralistic) and the recovery of innocence and authenticity, the real source of strength to make it in this world. There are always dangers of misuse and as you say gaslighting, but we must do the best we can in this imperfect world.

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      • I do love your vision, Dr. B, always rings true to me and speaks to my heart.

        “…a calling that proceeds from respect and love,” indeed. I also see it as an art of “responsiveness and intuition,” what I’d call being fully in present time, awake to our own inner voice in the process of listening actively to and being present with others. Also, “recovering innocence and authenticity” as source of strength. I love how you put that. I would also add inner power to that, including the power to manifest what we most desire.

        With respect to gaslighting, it is a term and practice of abuse which I’ve brought to the forefront repeatedly because I believe it is underrated in terms of its prevalence and psychological danger. It is subtle and insidious, and very hard to catch. It causes terrible post traumatic stress symptoms which can be very challenging to heal, because, in essence, we wind up mind-fucking ourselves as per learned habit, leading to chronic self-sabotage from having internalized such false negative messages, causing perpetual internal struggling.

        Imperfection is part of life and the creative process. The idea is to learn, grow, and refine as we go. It is inevitable that we reach a point of passage where we are called to transform our perspective, in order to allow change to occur outside of us.

        I’m very much aligned with the catch phrase “There is no excuse for abuse.” Especially in the healing world. That is more than abuse–it is betrayal and fraud, not to mention sinister. Sadistic personalities seek to have power and control over others. If this is the best we can do, then I’m not sure how to reconcile this, because it seems far and away from acceptable.

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      • I always ask a psychotherapist if they like cats. I believe that people who like cats respect the animal for what it is, not what they want it to be. They can help give the cat the best life they believe it can have, but in the end it is the cat that must decide what it will take.

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    • Richard,
      I certainly have addressed the scientific legitimacy of contemporary psychiatry many times. “Contemporary Psychiatric Diagnosis is a Fraud. The destructive and damaging fiction of biological ‘diseases’.” and many other blogs. I do my best to address the truth as I see it.
      When I started out there wasn’t any pharmaceutical psychiatry. My quest at that time was to promote good psychotherapy, which is still my quest. Although one does not need to be an MD to do therapy, I believe there continues to be a place for the doctorly practice of good psychotherapy. Not only that there is a huge need to be a doctor of the mind, as well as the body. The mind and the body are actually one thing. I feel its important to have that current vacuum filled with intelligence, care, and compassion.
      I do my best to speak out. I’m clear about the state of psychiatry in today’s world. My identity is not political. I am a practitioner and this is what I value. I have spent many years as a kind of street priest psychiatrist, working in housing projects and committed to the community. We all try to do good in our own way. Your fight with psychiatry as a medical specialty is not mine.

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      • The mind and the body are actually one thing.

        That’s a philosophical assertion, similar to a spiritual understanding that “we are all One.” But when it’s misused it creates great confusion, such as the belief that the brain is responsible for mental phenomena. A phrase such as “doctor of the mind” is only valid in quotes, and when psychiatry is involved the entire analogy should be avoided. When one uses a medical degree to imply expertise in counseling, the fallacies of “mental health” and “mental illness” are perpetuated, whether intentionally or not.

        As for “psychotherapy,” it’s a word like “psychosis”; it means something different for every practitioner. And while there may be bigger fish to fry, the “therapy” analogy needs to go too.

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      • Robert

        Thank you for responding to this difficult issue.

        I am an admirer and supporter of the work you do. I also admire the fact that you speak out about what is wrong with Psychiatry and with today’s “mental health” system. You sound like a very caring and compassionate therapist. If I needed such help I might be very inclined to seek you out.

        You wrote the following:
        “I do my best to speak out. I’m clear about the state of psychiatry in today’s world. My identity is not political. I am a practitioner and this is what I value.”

        I believe you greatly underestimate the power of your words and actions when it comes to defending the future existence of Psychiatry as a medical specialty.

        Whether or not you like to identify as “political” your implicit defense of Psychiatry as a medical entity is most certainly a clear political statement (especially to those open minded people questioning the status quo) that has broad implications and specific EFFECTS in the real world. It might even preclude some people from believing it is necessary to look much deeper into the serous problems facing us in regards to the current crisis in “mental health” throughout the world. Knowing the true nature of Psychiatry in today’s world is a big part of knowing what must be changed etc.

        I believe it is our moral responsibility, in the face of the horrors that are spewed out daily with massive psych drugging, Electro-shock, forced hospitalizations etc., to do as much as we can to stop it all from happening and create more favorable conditions for future systemic changes in the world.

        If politically aware and conscious psychiatrists are not resigning from their profession as a more advanced MORAL and POLITICAL stance, then there could be some other justifiable reasons to hold on to the MD moniker/credential while still exposing the faulty science that props up its existence.

        For example, 1) radical doctors could be very helpful in providing medically necessary backup support for newly developed alternative respite programs for people experiencing psychosis etc. 2) Or use their medical credentials to provide (and scientifically study) much needed safe withdrawal programs and/or protocols for the millions of people trying get off these toxic psych drugs. 3) And lastly (but not less important) some doctors might keep their credentials to gain access to all the organizations and medical forums and meetings where they could continuously raise hell and disrupt “business as usual” by condemning all forms of psychiatric abuse and those people, especially the top leaders of Biological Psychiatry and Big Pharma, who are responsible for all the high crimes of medical negligence.

        Other than what I just stated, I can’t conceive of any justification for defending and holding on to a psychiatrist/MD credential given what it represents in today’s world. And to do so helps perpetuate (in certain ways) the myth of “mental illness” and all the horrible forms of “treatment” that go with it.

        Of course there are PhD doctors of psychology who provide therapy of various quality levels, and this represents a completely different category for which I am not presently raising any major critical questions at the same level.

        Robert, it sounds like you are very satisfied and proud of the work you do as a therapist; I get that. But please don’t underestimate the effect of your LACK of decisive action when it comes to challenging the very essence of the psychiatric profession when it comes to the legitimacy of calling it “medicine” or a legitimate medical specialty.

        Respectfully, Richard

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      • Much harm has come out of the imposter, psychiatry, as a medical specialty. Once you have removed the biological, you have also removed, strictly speaking, the medical. Talk anybody through anything, and the talker hardly needs a degree in medicine to do so. Merely having attained such a degree is no kind of proof that such a degree does anybody any good whatsoever. We have, on the other hand, much proof, and concrete proof at that, that it has done people bad.

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      • My identity is not political… Your fight with psychiatry as a medical specialty is not mine.

        Without challenging anything else, I do find this problematic. Everything about psychiatry and defending its existence is political; to say one is “apolitical” is really to say that one holds a political position supporting the status quo.

        The purpose of requiring an M.D. to practice psychiatry is to double down on the idea that an abstraction (mind) can have a literal disease. This fallacy is used to lead people in distress to internalize its causes and blame themselves, rather than recognizing (and especially confronting) the underlying socio-political contradictions which foster the material conditions for their unhappiness.

        Thus I think it is a bit disingenuous to dismiss Richard’s comments by simply saying “it isn’t my fight”; the question is, why not?

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  11. This reliance on psychotherapy, and favouring it to drugs is funny to me. To me, it’s even worse than drugs. I would rather take side effectless drugs independent of the psychiatric system, than either go to them for drugs or therapy.

    Truly helping people requires putting your hand in the shit and cleaning it.

    If a man beats the living crap out of his son, or gaslights him, or isolates him or anything else, how will therapy help the kid.

    If you truly wanted to help the kid, you would get out of your office (if you were a mental health worker) and bring the man to justice.

    But nope, instead the when the kid gets into psychiatry, he will get labels, providing only more fodder for the man to gaslight his kid.

    It happens all the time….

    The world needs a Batman like figure. You may find it funny or facetious to read that statement. But to me, it’s true.

    The law doesn’t always bring justice. Sometimes, it imprisons people who were already screwed over to begin with.

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    • Labeling an abused and traumatized person, rather than validating their story and reality and understanding that, regardless of anything, it has a root, is gaslighting, and downright cruel. Constant “you” statements (I notice you are this, I notice you do that, I’m aware you said this) is, both, self-conscious making and crazy-making, I consider at least a derivative of gaslighting.

      And yes, it happens all the time, it is sop, and not just by the therapist, but by clients, as well. I’ve known people who have been long term psychotherapy clients, and this is all they do, point at others the way are pointed at in therapy, ready to point out something wrong with a person, or some contradiction. People take the example from their own therapy, and pay it forward. I don’t find this a very comfortable in a relationship, to be so heavily projected onto, called this and that, being constantly told what is “wrong” with you.

      From Wikipedia—

      “Gaslighting is a form of manipulation that seeks to sow seeds of doubt in a targeted individual or members of a group, hoping to make targets question their own memory, perception, and sanity. Using persistent denial, misdirection, contradiction, and lying, it attempts to destabilize the target and delegitimize the target’s belief.”

      https://en.wikipedia.org/wiki/Gaslighting

      This article elaborates–

      http://narcissisticbehavior.net/the-effects-of-gaslighting-in-narcissistic-victim-syndrome/

      This passage got my attention:

      “The intention is to, in a systematic way, target the victim’s mental equilibrium, self confidence, and self esteem so that they are no longer able to function in an independent way. Gaslighting involves the abuser to frequently and systematically withhold factual information from the victim, and replacing it with false information. Because of it’s subtly, this cunning Machiavellian behaviour is a deeply insidious set of manipulations that is difficult for anybody to work out, and with time it finally undermines the mental stability of the victim. That is why it is such a dangerous form of abuse.”

      While it may really not be intentional, as expressed in this definition, and I imagine in the majority of therapy practices it is not, still, when it comes to compromising “the victim’s [patient’s] mental equilibrium, self confidence, and self esteem so that they are no longer able to function in an independent way,” sounds like the effect of psych drugs to me. This is a double whammy for clients, physical abuse from the neurotoxins and mental/emotional abuse—albeit unintentional—from the standard practice of projecting so heavily onto another person. That’s a lot of multiple trauma, caused by standard treatment, perspective, and paradigm. It’s why people can go downhill fast while in “treatment.”

      And yes, it’s totally advantageous to the abusers and oppressors to have this system in place, so that the “identified patient” is unmistakable. Takes the spotlight, and the responsibility, off of them. It’s a brilliant plan, totally double-binding, and extremely costly for people and society in so many ways.

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    • We need programmes that educate potential parents, and allow them to learn to manage their possibly distorted and destructive ideas about who they are in relation to their children. Grades 4-8 would be the best time to get to the kids. Those who have difficulties adopting non-violent ideas could be offered support within their families so it becomes safe to adopt non-violent approaches.
      Regarding legal action against abusers, not everyone wants/needs that type outcome, for some it would be a public humiliation. My experience is that people who have suffered must be the ones who make the decision about what action to take – and that any pressure from a ‘therapist’ risks being abusive

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      • Somewhere a decent parent is reading this and cringing, and thinking “I have never abused my kid, why is it always abuse?”. We aren’t talking about you, decent parent. Just thought I’d throw that out there.

        “We need programmes that educate potential parents, and allow them to learn to manage their possibly distorted and destructive ideas about who they are in relation to their children.”

        I think there are a few categories categories of parents who will go to those programmes.

        a.) Good parents that don’t need those programs, and would be good irrespective of the existence of such programmes.

        b.) Those who will not have the mental maturity to grasp anything from these programmes.

        c.) Psychopaths who will get through those programs with flying colours and still end up hurting their children, and then blame and gaslight the children themselves.

        I used to have these ideas too….”we need programmes” and all that. I fear those programmes will do nothing but waste tax-payer money.

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        • I think the only people who can have a positive impact on the life of future kids who will end up in such situations is the intervention of those of us who have been through it in the first place.

          We need to help each other. No one, no government or institution is going to do that. This will happen only at the level of individuals. For that, some of us need to be wealthy and powerful enough to fight the good fight.

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  12. Suicide is a big problem in this world. It is something around which the entire psychiatric industry is based. People feel puzzled over why someone would choose to kill themselves. Of course, there are suicide helplines. People aren’t helped. They are stopped from dying. That’s something that benefits social order more than just the person trying to kill themselves.

    Human beings created a role for people, people who are actually just like you and me, and christened them as psychiatrists/psychologists and mental health workers. People assume that these individuals have some sort of a secret ingredient that can fix lives, and the problems people have had since there have been people.

    It’s something that keeps the myths of therapy alive.

    And yes, I can’t generalise this to all cases.

    But when people in the public at large say things like “Oh, you have daddy issues, spousal issues, children issues…then you should consult a mental health worker”, they are simply perpetuating the myth of the “professional who fixes lives”.

    There are specific instances where I think certain information and drugs which aren’t worse than what they’re treating can be beneficial.

    But the myth of the “doctor of society” is just that. A myth. And it’s a myth that has had such terrible consequences.

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  13. Supporting ANY facet of the Mental Health Recovery System, supports all of it, because it promotes the lie that someone gets benefit from it, and then that some people then must need its more extreme forms.

    ZERO SUPPORT FOR ANY ASPECT OF IT!

    Nomadic

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  14. Good place to relate a story:

    Neighborhood young man acts real goofy. People call him crazy, say he has mental problems. Most people avoid talking too him. Probably about 20yo. Most would take him as probably homeless and drug addict.

    Yesterday, someone called police. They had a long talk with him. Woman asked me if they arrested him. I told her that they did not. She explained that she is his mother.

    She explained that he has ‘mental problems’, she seemed to have wanted the police to arrest him, and she refused to tell me if he is on drugs or alcohol. Sounds like he lives with her.

    She talks about getting him to court, meaning that when he has been arrested, she has used the court appearances to get involved in his affairs. Sounds like she wants him in jail. Talks about that as the only remedy.

    Now, my standing doctrine on these types of cases is, punish the parent, severely and publicly. These cases are the results of child abuse, and the most important thing is to let the child see that the parent is wrong and that our society punishes them.

    But this case is different from most of those I have seen. With most the parents are filled with Born Again and Middle-Class righteousness, and it is clear that they have used the child. Most of the time it is to make their marriage work.

    But this woman works in a fast food restaurant, and to me she comes across as a single mother who has nothing.

    So would taking what little she might have help?

    And of the son, of course I oppose therapy and Recovery Programs. Is this son someone who would be good to fight in a political movement? Hardly.

    So what to do, where to look?

    Well, if I encounter her again I will politely ask more. She knows I don’t agree with the concept of mental illness. But she is committed to this. It makes her right and her son wrong.

    So I will ask about the history, what age did his ‘affliction’ start, and how many doctors have seen him, and since when.

    Of course I am looking to establish this as child abuse. But also, the guys who should be punished are the doctors who did not report to the family court. A high level of conflict with a parent is child abuse. No matter if it is a single parent, married parents, or if they are rich or poor. The idea of mental illness was given to her by these doctors, and as they did not report, they are accomplice child abusers. So they are where the hammer should fall.

    And of course the son has to see that the reason for this is that his mother is wrong.

    Nomadic

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    • And, it is not just the mother who is wrong. It is our entire society. We do not protect children from familial child abuse. We use things like psychiatry, psychiatric medications, psychotherapy, and the recovery movement to cover up for child abuse, and for the fact that many go thru adolescence in entirely unworkable situations, and then enter adult hood with zero chance at adult life. And this will never change until people are able to see this.

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