Tip of the Iceberg: How Professionals Cling to the Disease Model

Matt Stevenson
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I am a layperson member of ISPS (International Society for Psychological and Social Approaches to Psychosis) who has written previously about how rejecting the “medications for schizophrenia” narrative helped me to recover from severe distress.

In this piece, I wish to critique a recent journal article that illustrates how supposedly “progressive” mental health professionals covertly cling to psychiatry’s disease model.

The article in question is “Antipsychotic treatment: experiences of fully recovered service users,” published in the Journal of Mental Health in March of 2017. The multiple authors of this piece include researchers from Norwegian psychiatric hospitals, Larry Davidson of Yale, and the current Chair of the ISPS Executive Committee, psychiatrist Jan Olav Johannessen. The article purports to be a qualitative investigation of the effects of antipsychotic treatment, one which highlights the perspectives of service users.

While it appears informative and useful, I contend that this article illustrates a far too common reality in psychiatric publishing: a superficial veneer or “iceberg tip” of progressive-appearing research suggesting generalizable new knowledge, covering an “iceberg base” foundation of fallacious illness-model assumptions, pessimistic framings of “mental illness outcome,” and obfuscation of the fact that historical research in psychiatry does not generalize to future settings.

First, there are several genuinely positive aspects to this piece. The authors seriously consider that long term use of antipsychotics may be detrimental, a major step within a profession that has traditionally focused on drug prescribing. They further recommend “presenting antipsychotic treatment as one of many tools supporting the person’s active recovery processes, rather than as the main passive, if not exclusive, way to recovery.” This is an equally progressive view, especially compared to psychiatrists who write about drugging as the primary (and often only) treatment for “schizophrenia.”

Additionally, and in accord with the general public, the article considers psychosocial factors as central to recovery, stating, “Functional recovery beyond the acute phase was, however, primarily attributed to individual efforts and social influences, and less to medication.” And lastly, the authors quote several recovered formerly psychotic people at length — an amazing thing to read, given that most psychiatric articles leave the subjects of treatment voiceless.

This is the tip of the iceberg.

What lies beneath? First, throughout the article, and only briefly interrupted by quotes from service users, the terminology of psychiatry’s disease model permeates what are actually severe problems in living.

Being terrified, nonfunctional, or paranoid is described as “illness” (seven times in the article). How someone feels and functions over time is reduced to “course” (of illness). Giving someone numbing drugs to limit their ability to feel whatever is causing their distress is described as “treatment” (24 times). And general tranquilizers such as Seroquel and Zyprexa are cloaked in the misleading medicalized term “medication” (39 times). The authors could have chosen to use terms like “distress,” “experience,” “neuroleptics,” “administration of oral tranquilizers,” but they do not. Partly as a function of the medicalized language, the distance between the professionals writing the article and the “patients” receiving “treatment” becomes almost palpable.

It seems the authors are unaware that biogenetic language leads to harsher judgments, more prognostic pessimism, increased stigma, less motivation, greater fear, and worse outcomes. Or perhaps they simply do not know another way of writing about their fellow human beings more “humanly.”

I say this seriously: as an outsider, I’ve come to wonder whether medical training and working in hospitals for decades reduces the ability to see one’s suffering fellow human beings as just that. Can a psychiatrist authoring such an article consider that they themselves might become psychotic and have to take tranquilizers if they had been abused or neglected in the way that many of their clients have? Then there is the pressure from journals and one’s fellow professionals to use the ascetic, impersonal, meaningless language of “disease” to describe fear, paranoia, and hallucinations.

While the constant and unevidenced medicalized jargon is problematic, the most damaging quote of the entire piece comes in the introduction:

“Between 9 and 21% of service users with FEP achieve clinical recovery (Jääskeläinen et al., 2013), making this a highly relevant sub-group.”

It is to this faulty assumption that I want to primarily devote this critique. The reader should see that despite positive efforts, the authors mechanistically state — at the very outset of their article — that only 10-20% of the people they, the professionals, label as having “first episode psychosis” (FEP) will recover. This statement is made with very little context regarding FEP — nothing about which service users, receiving which services, for how long, being treated by which professionals, and so on. As is far too often the case with psychiatric journal articles, it is stated as if it is universally true merely because the professionals say it is. As we will see, nothing could be further from the truth.

To make such a pessimistic statement as if it were absolute truth is alarming, resting as it does upon a single meta-analytic study that is severely flawed. One can imagine that other professionals or family members might see such an assertion and decide to stop reading or not seek treatment — after all, why bother trying to understand a problem if the affected person may have only a 10 or 15% chance of getting well?

For those labeled and seeing such a prognostication, the consequences might be even more severe, including an increase of hopelessness and fear and possible suicidal ideation or attempts. Can you imagine how a person feels who is already terrified and isolated, and who after receiving such a diagnosis finds out that professionals think they only have a 10% chance to recover? They may look online — articles such as Johannessen’s are widely available on the internet — and find that authoritative-sounding PhD and MD professionals are extremely doubtful about their prospects, resulting in increased fear and lessening ability to confront the actual sources of their distress.

If these potential harms to service users are real, one has to wonder what goes through the mind of these authors to allow such a statement (an unevidenced one, as I will describe below) to be uncritically published. The statement is so problematic that it deserves a thorough investigation.

The central problem is that the FEP-outcome statement relied on a meta-analysis that contained multiple serious problems.

First, the Jääskeläinen meta-analysis relied on fundamentally flawed assumptions. This study took data from people labeled with “schizophrenia”-spectrum diagnoses (disjunctive labels which are commonly acknowledged to be invalid because people can “have them” while having no symptoms in common), and who were treated primarily at psychiatric hospitals, and frequently given psychiatric drugs. It then suggested that the historical outcomes of this arbitrarily-selected group are what should be expected for future groups of people — under any or no treatment — given such labels by a professional.

The illogicality of these assumptions might not be immediately apparent. But consider the following viewpoint about the generalizability of historical findings in psychiatry by Jan Smedslund in “Why Psychology Cannot Be An Empirical Science”:

“Empirical research in psychology can only be seen as mapping temporarily stable statistical tendencies at the aggregate level. These mappings must be evaluated on pragmatic grounds, i.e. as yielding possibly useful knowledge in limited domains for a limited time… The regularity that is nevertheless observed cannot be taken to reflect permanent laws, but only temporarily stable feedback-loops. These are like whirls in a stream which are stable only as long as the total flow of water does not vary and the stones on the bottom maintain their positions… The findings in psychological journals may superficially appear to be of the same order as those reported in physics or chemistry and, hence, psychology may superficially look like an empirical and accumulative science. The conditional and transient nature of psychological findings is rarely acknowledged, perhaps because the publication and preservation of empirical findings will then appear unjustified since they cannot be taken to be useful in the future. The scarcity of attempted replications also allows psychologists to avoid thinking about this problem.” (emphases mine)

Jääskeläinen therefore took outcomes primarily from psychiatric hospitals employing antipsychotic treatment, occurring under a unique set of past conditions, and assumed that the average of these outcomes represented a universal — rather than conditional — truth about the “course” of the already-invalid label “schizophrenia” (in other words, a mind-twister within a mind-twister, something all too common in psychiatric articles). In using these terms and assumptions, she not only veered far away from describing her fellow human beings in human terms, but also ignored the possibility of much better outcomes achieved in non-psychiatric settings.

Space does not allow me to elaborate here, but please see part two of my article “Rejecting the Medications for Schizophrenia Narrative,” which mentions interventions such as Open Dialogue, 388 program, Soteria, Diabasis, and other forms of intensive psychotherapy that can lead to much higher rates of recovery than 10 or 20 percent.

So what exactly was wrong with the Jääskeläinen study, considered as a support for Johannessen et al’s statement about FEP’s 9-21% recovery rate? In their article, “The Empirical Evidence about Mental Health and Recovery,” Mike Slade and Eleanor Longden thoroughly deconstructed the Jääskeläinen meta-analysis, and I will draw heavily on their critique in analyzing both.

First, it is instructive to consider the seven conclusions that Slade and Longden attributed to professional-leaning, mechanistic approaches to mental distress:

1. Recovery is best judged by experts.
2. Few people with mental health problems recover.
3. If a person no longer meets criteria for a mental illness, they are in remission.
4. Diagnosis is a robust basis for characterizing groups and predicting need.
5. Treatment is needed to improve outcome — and should be widely available.
6. The barriers to receiving effective treatment are availability, financing and client awareness.
7. The impact of mental illness, in particular schizophrenia, is entirely negative.

The authors then contrast these assumptions above (which appear disturbingly close to the assumptions permeating Johannessen et al’s article) with the following seven:

1. Recovery is best judged by the person living with the experience.
2. Many people with mental health problems recover.
3. If a person no longer meets criteria for a mental illness, they are not ill.
4. Diagnosis is not a robust foundation.
5. Treatment is one route among many to recovery.
6. Some people choose not to use mental health services.
7. The impact of mental health problems is mixed.

Slade and Longden then identified three primary problems with the Jääskeläinen article’s pessimistic finding about “schizophrenia” recovery:

1) Sampling strategy, a.k.a. exposure bias — Jääskeläinen primarily took her sample of “schizophrenics” from studies of people entering hospital settings or in regular contact with services. As Slade states, “many people live with psychosis-like experiences outside of mental health services. Their ability to self-manage without attracting the attention of services indicates a lower level of severity and a higher rate of recovery. This means that people with less severe difficulties are systematically less likely to be present in the samples included in the Jääskeläinen review.”

2) Follow-up period, a.k.a. assumption of linearity — Jääskeläinen assumed that the recovery rate of people in the sample was linear, progressing at a fixed rate per year. Slade comments, “No justification is given for this (unstated) assumption, which is undermined by the review finding that duration of followup did not predict recovery estimate.” He continues: “Recovery is not linear. The available empirical evidence indicates that recovery is heavily influenced by context, both social (e.g. social and professional relationships), and psychological (e.g. locus of control, wellbeing)… pooling studies of very different duration into one aggregated analysis is not justified.”

3) Outcome evaluation — The “recovery rates” for people labeled with “schizophrenia” varied massively across the 50 studies comprising Jääskeläinen’s meta-analysis. Slade states: “What recovery rates were found? They ranged across the 50 included studies from 0% to 58%. Even to the casual observer, this might raise some concerns about simply pooling the data to produce a single overall estimate of recovery rate. This problem of combining apples and oranges is known in the systematic review trade as heterogeneity, defined as the extent to which there are genuine differences underlying the results of included studies. Dealing with heterogeneity is a standard challenge in systematic reviews. Are the included studies sufficiently similar to be pooled (or ‘meta-analysed’) to produce an overall estimate of recovery rate?”

Slade and Longden continue by asserting that every key decision Jääskeläinen made leads to more pessimism about outcome — from limiting the study group to those with the most severe problems, to treating studies of markedly different follow-up period as artificial equals, to pooling vastly different studies to produce one global recovery proportion.

Since Slade and Longden wouldn’t say it straight out, I will: the Jääskeläinen study of “schizophrenia outcome” was bullshit. Jääskeläinen’s faulty assumptions about “schizophrenia recovery” parallel the pessimism and equally faulty assumptions that have underlain the fictitious “schizophrenia” diagnosis for decades.

And since Johannessen et al took their numbers about First Episode Psychosis’ recovery rate from such a flawed study, their assertions should also be dismissed. To take such massaged data based on invalid diagnoses as “truth” without acknowledging the severe problems with Jääskeläinen’s meta-analysis, and in equal denial of the far greater recovery rates achieved in multiple alternative approaches such as Open Dialogue, is extremely problematic. It relates to what I will describe below about psychiatry’s generally poor image as an unscientific profession which cannot relate to its “patients” as human beings in their lived contexts.

Ironically, in the “limitations” section of their article, Johannessen et al admit that “Findings are context dependent to the participants and setting in which the study was conducted.” Nevertheless, they seem unaware of the profound contradiction between making this admission and quoting Jääskeläinen’s context-dependent piece, with all its assumptions, as evidence of a supposedly general truth that only 9-21% of people labeled by professionals with First-Episode Psychosis recover.

Considering that one of ISPS’s objectives is:

“Advance education, training and knowledge of mental health professionals in the psychological therapies and psychosocial interventions in the treatment and prevention of psychotic mental disorders for the public benefit regardless of race, religion, gender or socio-economic status.”

One must wonder why one of the leaders of ISPS’s Executive Committee is involved both in uncritically communicating faulty information about this low FEP recovery rate being a general truth, and in using disease-model terminology despite the growing awareness about the harms of using words such as “illness,” “schizophrenia,” “prognosis,” “medication,” “disease,” etc. to describe human suffering.

As a psychiatric survivor my take-home messages, and I direct these squarely at professionals, are the following:

  • Stop presuming that severe distress is “an illness.”
  • Stop euphemistically referring to general tranquilizers like Zyprexa and Seroquel as “medications.”
  • Stop assuming that your definition of recovery is the generally valid one.
  • Stop assuming that the rate of supposed “recovery” seen in one quasi-experimental setting under “treatment as usual” is the rate of recovery to be expected for anyone anywhere given the same invalid label. It isn’t.
  • And kindly stop labeling us, period.

I am dismayed that in the year 2017, supposedly “progressive” mental health professionals are still writing using the language and assumptions that Johannessen et al employed in their journal article.

As another ISPS member, John Read, wrote in an essay last year:

“A dilemma for all of us who are struggling to broaden our understanding of human distress beyond simplistic, pessimistic, bio-genetic ideology, and to improve our mental health services accordingly, is whether or not to soften our criticisms of psychiatry in the hope of reaching those psychiatrists whose minds are not totally closed. But doing so rests on the assumption that change can come from within the profession. For the last few decades examples of that are few and far between.”

Following from Read, I am somewhat pessimistic that any serious response will be coming from Johannessen et al in response to this critique, even though Jan Olav and I are members of the same group.

But I hope this type of public critique encourages other dissident professionals, along with survivors and family members, to keep speaking up. We should demand immediate changes to the harmful ways professionals label and make pessimistic assumptions around human distress, and we must do so loudly and unapologetically.

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105 COMMENTS

  1. One thing Mr. Stevenson and big-time psychiatry seem to have in common is ignorance how malfunctions in regions in the body at large can effect mental functioning, such as fluctuations in blood sugar, food sensitivities or under- or overactive thyroids (among many others). Many of these respond effectively to medical treatments NOT centered around psych drugs or prolonged psychotherapeutic investigations of early life traumas.

  2. I looked up ISPS – the International Society for Psychologial and Social approaches to Psychosis.

    There websites states, “ISPS is an international organization promoting psychotherapy and psychological treatments for persons with psychosis (a term which includes persons diagnosed with “schizophrenia”).”

    Having found out what the organisation is I am left wondering what this crock of drug poisoning shit that the article you review was published in thier journal? It sounds more like drug company marketing blurb than anything to do with psychological or social approachs to helping people in distress.

  3. Matt

    Great blog. Very insightful critique of some of the serious weaknesses remaining in the so-called “Critical Psychiatry” movement.

    Your emphasis taking on “System language” is an important lesson for many writers here at MIA who have not yet taken their own critique of what’s wrong with the “mental health” System far enough, or to the next level.

    And that next level will ultimately (in the final analysis) lead to an “anti-Psychiatry” position, that is, seeking to abolish Psychiatry as a legitimate medical specialty AND stripping them of any, and all, legal rights in society to take away a person’s human rights with disease labeling, forced drugging and incarceration in Psych hospitals.

    Matt, about your quote from John Read: “A dilemma for all of us … is whether or not to soften our criticisms of psychiatry in the hope of reaching those psychiatrists whose minds are not totally closed. But doing so rests on the assumption that change can come from within the profession.”

    I would add that it also comes from an incorrect outlook that says “gentle” and “unoffensive” criticism and/or political critique is the only type of feedback that leads to people actually changing their minds. This is simply NOT TRUE in the real world.

    In my own experience (as well as my knowledge of many other people I know), quite often, it is very sharp and uncompromising criticism that ends up forcing people to deeply examine their own belief system, thereby leading to a more radical transformation of one’s political outlook.

    I am not suggesting that personal attacks or cheap sarcasm and snide remarks are the way to go here. But let’s face facts here, there is a serious clash of world outlooks (based in a class society) that have devastating consequences on the daily lives of millions of human beings. This could very well lead to some type of Civil War. We don’t have time to be all “sweet” and “sensitive” about these life and death questions.

    Every one is usually somewhat defensive when they first encounter criticism of their views, but it is the reflective period that follows that can provide the basis for change. Soft peddling our views or fearing that we might offend someone’s feeling will only SLOW DOWN our Long March to true liberation from this madness.

    Richard

  4. “Fully recovered” doesn’t “use services”. “Fully recovered” does not describe any “service user”.

    The way to ” full recovery” is through cessation, and ultimate termination, of “service use”.

    With a reported 9 – 21 % “recovery rate”, you can see why I don’t think it is a good idea for anybody to pay much attention to the stated opinions of so-called “mental health experts”. There must be few “symptoms” of a so-called “mental illness” less pronounced than standing in attendance upon such an “expert”.

  5. This statement is completely true: “The terminology of psychiatry’s disease model permeates what are actually severe problems in living.” In contrast, I consider the ISPS use of the term “psychotic mental disorder” to describe mental distress in terminology of psychiatry. ISPS implies that “mental disorders” are medical problems that are better addressed through non-medical therapies (social welfare therapies). Consistently, John Read advocates this position when considering whether to work with psychiatry.

    It is harmful to the “mental health” of the community to treat “problems with living” as medical problems; consistently, it is wrong to give psychiatry (a medical profession) any credibility in addressing “psychosis.”

  6. Damn! Matt sounds a hell of a lot smarter than the quacks he’s critiqued! Of course, as a member of ISPS, he’s in a great place for insider information about psychiatry. But, he’s still put a smackdown on the cherry-picking antics of “researchers” in the industry of mainstream psychiatry. The fact that psychiatry DOES NOT WANT ANYONE TO RECOVER is one which ought to become widely publicized in lay health forums. Good on you, Matt!

  7. Great article, Matt, thank you. I have to agree with you the problem is the DSM disease model itself. The DSM needs to be gotten rid of, if for no other reason than the head of the NIMH confessed the DSM is scientifically invalid in 2013. It’s 2017 now, why is the DSM still in use? Especially, given the fact that misinformation and complete omissions in the DSM are resulting in blatant misdiagnoses, thus maltreatment.

    Take the “schizophrenia” treatments, for example. For decades, “presenting antipsychotic treatment as … the primary (and often only) treatment for ‘schizophrenia'” has been the norm. Yet in all these decades, none of the psychiatrists except one group of Japanese psychiatrists that I’ve found, has ever noticed that the antipsychotics/neuroleptics can create the negative symptoms of “schizophrenia,” via NIDS:

    https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome

    And none of the psychiatrists have yet to admit that the antipsychotics can also create symptoms that are indistinguishable to the doctors from the positive symptoms of “schizophrenia,” via the central symptoms of anticholinergic intoxication syndrome, aka anticholinergic toxidrome.

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

    And since both NIDS and anticholinergic toxidrome are omitted from the DSM, these neuroleptic induced illnesses are almost always misdiagnosed as one of the billable DSM disorders, since this is the only way the psychiatrists can get paid … and out of the DSM, out of the minds of the “mental health professionals.”

    Realistically speaking, what are the chances that “schizophrenia” is a real disease entity when it’s historic, “mandatory” treatment, is know to create both the positive and negative symptoms of “schizophrenia”? Next to none? When the treatment is known to create the symptoms a disease, that theorized disease needs to be seen as having an iatrogenic etiology, not a genetic one too.

    Today’s “mental health” industry needs to dump the DSM. Or at a minimum add NIDS and anticholinergic toxidrome into the DSM, so the “mental health professionals” are not being intentionally blinded by this DSM omission. And they should also dump the antipsychotics, just think we could likely rid the world of almost all the “bipolar” and “schizophrenia” if we did this, wouldn’t that be wonderful?

  8. Matt: you wrote: “And general tranquilizers such as Seroquel and Zyprexa are cloaked in the misleading medicalized term “medication” (39 times). The authors could have chosen to use terms like “distress,” “experience,” *“neuroleptics,” “administration of oral tranquilizers,”*.

    I have something to say about the words I put in *’s: Mainly I think the best way
    to refer to psychiatric meds is [emotional] pain-killers, of course with the caveat that in
    rare cases, any type of pain can be life-threatening. To me *neuroleptics* and *oral tranquilizers*
    sounds likes medicine too (although not as much).

  9. Thanks for talking out, Matt. I think the real experts are people who have recovered, or people that have helped people to recover.

    I don’t like the term “antipsychotic” because these drugs might be as effective as paint fumes; theres also a slimy suggestion attached to “antipsychotic”. I think the term “neuroleptic” would be more appropriate.

    I don’t like the term “psychosis”, because it’s very extreme, and its open to misuse. For example a person in a road rage incident could be classed as “psychotic”. Or a person thinking they might have “cancer” could be classed as having a “psychotic” symptom.

    I don’t agree with “illness” either, because I think the use of this term also involves a type of slimy undermining.

    (Thanks again for the great Article Matt).

    • Antipsychotic is a misnomer, for these drugs have been known to cause psychosis in people who took them. I suffered greatly from paranoia and nightmarish hallucinations when on 10 mg of Haldo or Stelazine per day.

      As far as “psychotic” or “psychosis” goes, I’m not sure what other words to use. Headache is not a specific medical diagnosis and can have many potential causes, yet it accurately describes a pain in the skull. We could say Person-Whose-Perception-of-External-World-Differs-from-that-of-Mainstream-Consensus but that’s rather awkward. Or we could refer to the kind of reality break the person experiences–hallucinations or delusions–perhaps.

      Needless to say, delusions are highly subjective. One MI worker asked to be my job coach. I overheard her telling someone over the phone that I was delusional for wanting to be a reporter or journalist for the city newspaper eventually.

      I have a bachelor’s in English and good writing skills, but because I was “mentally ill” I was delusional and uppity to aspire so high. She never knew I heard that conversation, but I disliked and mistrusted her afterward.

      • I can relate to this…while forcibly detained and drugged in “hospital” I made notes on what was happening on the ward.

        When I got copies of my hospital records (by navigating the complex legal processes myself) there were comments by nurses about my writing and how I “had delusions I was a writer”. Writing had actually been my profession for some 20 years before I switched into the senior management role I had when admitted.

        The staff simply couldn’t or didn’t want to comprehend that I was a well educated professional….every positive part of my personal and professional history ceased to be of any relevance as soon as I became “mentally ill”.

        I became purely my (fraudulent) “illness” in their eyes, and that’s how I was supposed to remain for the rest of my life….and they let me know it and forced on me drugs designed to ensure that outcome.

        Keep your aspirations!…and your absolute distrust for anyone who professes to want to help you with your “mental illness”.

        • They pahtologize every little thing that you say or do and make it part of your “illness”. I bet that they never once asked you what you were writing about or why writing might be important for you. They never check anything out because they know that they’re the “experts” on your life, no matter what.

          • Stephen G, That was precisely what they said to me in various nuthouses. I used to ask for pencil and paper as pens were usually not allowed. I remember they told me that writing was “useless” and that I was “incapable” because I was “writing instead of going to group.” What did they do in group? They played bingo! I remember I told a PhD psychologist that I had an MFA in Creative Writing and his response was to say that I had a “useless master’s degree” and that I should “get a day job.” He suggested bagging groceries. I left his office not knowing whether to laugh or cry. I remember right after ECT my doctor was surprised and said to me, “You mean you REALLY used to have a PART TIME job?” I then told him I used to be a music major and I was a composer. His eyes opened wide…like kinda surprised to hear that this very spaced out patient used to be a college student..I think maybe they realized they should not have done those shock treatments…..You really wonder about “them.”………..

      • FeelingDiscouraged,

        I certainly appeared mad when I was in the Unit – but qualified staff would have recognised the difference:- extra pyramidal side effects are stereotypical.

        Years later it took another client to point it out to me. He advised me to return to the doctor and get it straightened. I eventually did this by cutting medication (and making recovery).

        At the time (1985) my irish consultant psychiatrist was on the examining board of the Royal British College of Psychiatrists.

  10. I wonder why no one seems to realize the “mental” system has a vested interest in preventing our recovery. Do they think it would be good for the psychiatric establishment if say 70% of the “mad” made full recovery in less than five years and never came back for services? I don’t think all those elitists posing as scientists/doctors at the APA would be jumping for joy if most of us got well. Big Pharma would not be pleased at the drop in drug sales either.

    Creepy Pete probably lacks the insight to realize why he wants his son Kevin permanently crazy and disabled. Yet we know if Kevin Earley ever recovered that would seriously hurt his father’s speaking career.

    • Feelin

      I’ve started thinking the same thing as I contemplate the revolving door that we have in the Administration Dept. in the state “hospital” where I work. We set people up for failure when we discharge them with their big bag of drugs and absolutely no support where people are going back out to live. We have no programs for preparing people to be more successful for when they’re discharged back into society. We just throw them out the back door and say: “Good by and good luck, see ya.”

      • Stephen, I remember seeing others discharged, watching the whole thing happen to fellow inmate, watching the reaction of staff as the prisoner walked out the door. Big to-do. Then, just as the door was closing behind the person now freed, the staff, rather audibly, said,

        “He’ll be back.”

        This had an impression on us. It was so grossly disrespectful. They’d even shake their heads so dismissively. Sometimes not even caring, or use these gestures of disrespect. Yeah it did rub off on us. The level of hopelessness was high. And upon return of us criminals, we were told,

        “Back already?”

  11. Excellent piece, Matt…thanks.

    …and, of course, these studies that say 9-21% recovery rate only include those who stay in “treatment”. They actually prove how damaging and destructive “medical treatment” is for so-called “mental illness”. Around 80% of their “patients” will be disabled for life. Makes one wonder why they are allowed to persist.

    Those of us who don’t like those odds (and the forced drugging and extreme abuse that kept us entrapped and terrified) find ways to exit the system completely and disappear back into society as soon as possible. We of course were lost to them and couldn’t be counted.

    I had one very severe “psychosis” (aged 49 FEP) and was forcibly drugged and incarcerated in a hospital back in 2004. It took me ages to get off Olanzapine and Mertazapine…it has now been 7 years since my final neuroleptic drug-taking, and apart from reacting with fear to doctors and any mention of “mental illness”, I function just fine and am continuing to improve (memory, emotional regulation, physical balance, bloods etc). I didn’t function at all while I was in “treatment” for an “illness”, because that abusive and destructive drugging kept me “ill” and in the system.

    I don’t doubt I’d still be in and out of forced “care” had I accepted their model of “mental illness”.

  12. I gave psychiatry a try. 25 years of trying. Finally I read a book by that rogue psychiatrist William Glassner and realized it wasn’t my fault the “meds” weren’t working, that psychiatric “treatments” keep people crazy and disabled. It was quite a relief!

    I kept wondering why all these “effective treatments” weren’t working. I couldn’t work–even part-time. I couldn’t keep my apartment clean; for some reason I couldn’t perceive all the dirt and disorder. I gained nearly 200 pounds, made poor decisions, all my relationships were bad, had bizarre emotional outbursts and mood swings, and kept wanting to die.

    Must be my fault, right? MI staff kept telling me the meds could only do so much–I had to make good lifestyle choices too.

    It’s very hard to make the right choices as a drug addict. Now that I’m less drugged good choices come easier.

    Insanity is doing the same thing over and over and expecting different results.

  13. I WAS a member of ISEPP. WAS. I quit. I was a very enthusiastic member of ISEPP and then, quit in disgust. I know in my heart that “professionals,” including “psychotherapists,” are not the people who will knock the system down.No, to end any oppressive system, this system must be taken down by those who are oppressed themselves. US. Patients. Ex-patients.

    In fact, ISEPP represents those who want to continue their legitimacy as professionals and oppressors, and continue the duality of professionals who “treat” the sick. This is bogus and I decided, when I quit, that to remain a member was only validating the duality. i couldn’t keep doing this. I couldn’t say, “These therapists are different” when I knew in my heart they were not. They see us as sick and people who need to be healed. Same ole. I personally have nothing to recover from but the trauma of abuse done to me in the hospital, and all that was done to me after age 50. I also had abusive therapists, the worst of this also happened when I was an older person. I choose not to go to a trauma therapist, as this would be defeating the purpose, but to find others who were abused and just talking about it. I saw the ISEPP group as mostly complete hypocrites. Although, having met a few in the group, many were very nice people and interesting to talk to, and also, more intelligent that the average psychologist I had encountered over the decades that I was a psych slave. Other than that, no difference. Some in the group claimed they had been patients, but still, validated their status as oppressors/healers/so-called experts, which frankly, I saw as hugely contradictory (feet in both camps). The RADICAL changes and demands we are asking for is a grassroots effort here. (Still hoping to actually talk about it.)

    And I was also called “severely mentally ill” by so-called “experts” who claimed I could never live independently outside of an institution.

    • No, to end any oppressive system, this system must be taken down by those who are oppressed themselves. US. Patients. Ex-patients.

      Good to see you spell that out Julie.

      If you check old issues of Madness Network News from the 70’s — the original authentic anti-psychiatry movement — you’ll see slogans like “the liberation of mental patients is the duty of the patients themselves.” Later we started using the term psychiatric inmates.

      • I often use the term incarceration. I have started saying “mental system” instead of “mental health system.”

        Another thing I have noticed is that many do now recognize the harms of pharmaceuticals but fail to realize that labeling is harmful. In fact, many who understand that these drugs do much harm also in the exact same breath validate the disease “fix me” model. So here, we have the statement, “There are very sick people in society who need fixing but not by drugs.” This is seriously warped, allowing for psychiatry to slip right back in and continue the practice of eugenics and segregation. The disease idea still validates that “there are some among us who are inferior” and that is the problem with it.

        We can indeed validate that many struggle without calling it “disease,” especially not permanent disease requiring lengthy or ongoing or lifelong treatment such as therapy. Sadly I know very few who enter therapy (or, as they call it, the therapeutic process) and then, end therapy. They may stop with one therapist, but they never truly manage to stop seeing therapists. They can’t! They’re hooked, because therapy creates dependency, dependent mentality, and the idea that one is deficient.

          • It is so funny, i hear people telling me how great their therapists are, how they have “even increased the frequency of sessions to twice a week” and will praise this therapist and say how helpful he/she has been and add, “She/he is a lifesaver, I would be dead without her…” As soon as I hear that, I know it is a red flag. I start to wonder about therapy abuse. It might be ten years later, the person will tell me about abuse, how hard it was to get away and break the dependency, but more often, the patient dies. These dependencies rarely get caught, and the therapists keep doing this, always under the radar of the law. I have known a few.

        • Another stupidity of the mental illness system. All your symptoms and diagnoses are permanent even if you show marked improvement. They never remove the BPD label no matter how well-behaved you are or non-manipulative. After 50 years you’ll still bear the Stigmata of craziness inflicted by the high priests of Shrinkage.
          If I have a bad case of the flu I can have a fever of 104 one day and five days later it could easily be back to 98.6 degrees. Would a REAL doctor of a LEGITIMATE branch of medicine continue treating me for the highest fever I ever had long-term and put it in my medical records so others could do so? I don’t think so.

  14. Dear Matt
    brilliant piece, i was a member of ISP”s ( I’m a nurse general trained not Mh thank God and family member who has survived a lot of pressure personal and professional to keep my family afloat and to fight the system) unbelievable stuff vicious and cruel fascist in the extreme. you note i say “was” member of ISPs I got really tired of their turgid journal with its we aren’t like those psychiatrists stuff in fact they are exactly the same just less well paid.. just as keen on drugs and imprisonment really studies dressed up with numbers to make them look like professionals.. little vignettes about some “patient” interspersed best to unsubscribe ….!
    keep the good blogs coming matt!