House on Fire: A ‘Mental Health Literacy’ Parable

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Below, I present a fictitious conversation between a client and therapist. This dialogue is inspired by discussions with my clients about their experiences in the mental health system. It highlights a number of problems that are described at the end of this post.

* * * * *

Therapist: How are you?
 
Client: My house is on fire!
 
Therapist: I’m sorry to hear that. How are you feeling?
 
Client: I’m terrified! My dog is trapped inside! All my possessions are burning! What am I going to do?
 
Therapist: I understand that you’re upset. What’s going through your mind?
 
Client: I can’t believe this is happening! It doesn’t seem real. It’s like I’m dreaming or something.
 
Therapist: Do you also feel detached from yourself or your surroundings?
 
Client: Yeah, I feel like I’m in a daze. You hear about this happening to people but never think it can happen to you.
 
Therapist: I understand. These are common symptoms of Acute Stress Disorder. It’s a mental illness some people experience in response to a traumatic event.
 
Client: What do you mean mental illness? My house is on fire! My dog is trapped inside!
 
Therapist: I’m not saying you have a mental illness, only that you might have one. We’ll have to wait two more days and see if your symptoms continue before we know for certain.
 
Client: What symptoms?
 
Therapist: Symptoms like feeling unreal and being in a daze, and other symptoms like having upsetting memories and nightmares about the fire.
 
Client: Aren’t those to be expected?
 
Therapist: It’s normal to feel upset when something bad happens. But if you have a variety of symptoms that last for at least three days, and they bother you, then you may be suffering from a mental illness.
 
Client: Uh, okay. But what am I supposed to do? My house is on fire! My dog is trapped inside!
 
Therapist: Let me teach you some skills for coping with your negative thoughts and feelings. If you are feeling upset, breathe slowly and count to ten while thinking “relax.” You can also tense and relax your muscles. Negative thoughts can be replaced by positive thoughts, like memories of funny movies or times when you were happy. You can also imagine your negative thoughts floating past you like clouds in a sky. 

Client: Okay. But what am I supposed to DO?
 
Therapist: Practice your coping skills like we discussed. And come back and see me for another session as soon as possible. 

* * * * *

Two weeks later…

Therapist: How are you?
 
Client: I’m devastated. My house burned to the ground. My dog died. I lost everything.
 
Therapist: Have you been feeling depressed?
 
Client: Of course.
 
Therapist: Have you felt depressed most of the day, nearly every day for the past two weeks?
 
Client: Since the fire, yes.
 
Therapist: Have you lost interest in things you used to enjoy?

Client: I guess so. I used to enjoy hanging out with my dog, watching movies, and surfing the internet. But my dog died and all my stuff was destroyed in the fire.
 
Therapist: How have you been sleeping?
 
Client: Terrible. I’m staying at a friend’s house on the sofa and their baby cries all night long.
 
Therapist: Have you felt fatigued or had low energy?
 
Client: Yeah, I’m tired all the time.
 
Therapist: Have you been thinking about death a lot?
 
Client: I can’t stop thinking about my dog. It must have been horrible for him to die in the fire. I miss him so much and can’t believe he is gone. He was my best friend.
 
Therapist: Have these symptoms been bothering you a lot?
 
Client: What symptoms?
 
Therapist: Feeling depressed, losing interest in things you usually enjoy, not sleeping well, loss of energy, and recurrent thoughts of death.
 
Client: I guess. I’m just really upset and don’t know what to do. I lost my whole life in the fire.
 
Therapist: I think I understand the problem.
 
Client: What do you mean?
 
Therapist: You’re suffering from a mental illness called Major Depressive Disorder, also known as clinical depression. You reported having five symptoms that have persisted for two weeks, and the symptoms are producing significant distress.
 
Client: Wait a minute. I’m feeling depressed because of the fire. I’ve lost interest in doing things I used to enjoy because I can’t do them anymore because of the fire. I can’t sleep because the baby screams all night long. I feel fatigued because I’m not sleeping. I’m thinking about death a lot because I just lost my best friend.
 
Therapist: It’s normal to feel sad when something bad happens, like a fire or the death of a loved one. But when symptoms of depression persist and become distressing or interfere with your life, that’s when we know a mental illness is to blame. But don’t worry, you’re not alone. Depression is the most common mental illness. It afflicts millions of people every year. And it’s not your fault: it’s not a sign of weakness or poor character. Depression is a brain-based illness caused by a chemical imbalance. It’s a real medical condition, no different than diabetes or cancer.
 
Client: I’m confused. Isn’t it normal to feel depressed after what happened? Why are you saying I’m mentally ill?
 
Therapist: Because your symptoms meet diagnostic criteria for Major Depressive Disorder in the DSM-5, our diagnostic manual. Good mental health literacy involves recognizing the symptoms of mental illness. In your case, that means understanding that things like depressed mood, difficulty sleeping, and recurrent thoughts about death are symptoms of clinical depression.
 
Client: So, you’re saying that thinking I am depressed because of the fire instead of a chemical imbalance in my brain means I have low mental health literacy?
 
Therapist: That’s right. It’s important to understand that mental illness is real, serious, and treatable. Understanding the facts about mental illness reduces stigma.
 
Client: It reduces stigma to say I’m mentally ill with a chemical imbalance in my brain?
 
Therapist: Yes. The best way to combat stigma is by having good mental health literacy. Understanding that depression is a real, treatable illness caused by a broken brain reduces stigma.
 
Client: But it makes me feel worse about myself to think my brain is defective.
 
Therapist: Would you look down on someone for having cancer? Would you blame them for being sick?
 
Client: No, I guess not.
 
Therapist: When people understand that you’re sick with a real medical condition, and that it can be treated, they will have less stigma toward you.
 
Client: Wouldn’t it be less stigmatizing to say I feel depressed because my house burned down and my dog died?
 
Therapist: But that shows low mental health literacy. Remember, depression is a biologically-based mental illness. And the good news is that we have effective treatments for it.

Client: What kind of treatments?
 
Therapist: Both medication and therapy can help. Antidepressant medications help correct the chemical imbalance that causes depression. Therapy provides emotional support and helps you learn coping skills for managing depressive symptoms.
 
Client: How do you know I have a chemical imbalance in my brain? Don’t I need to take a test or something?
 
Therapist: No, that’s not necessary. We can tell your brain has a chemical imbalance because your symptoms meet DSM-5 diagnostic criteria for Major Depressive Disorder. Although antidepressant medications are effective, they are only part of the picture. Many people respond best to a combination of medication and therapy.
 
Client: What does therapy involve?
 
Therapist: Therapy provides a safe space for you to talk about what’s on your mind each week. I will listen with empathy and no judgment and provide emotional support. I can also teach you skills for coping with your depressive symptoms. These include skills for reducing negative feelings, like slow breathing and muscle relaxation. You can also learn skills for reducing negative thoughts, like replacing negative thoughts with positive thoughts and watching your thoughts pass through your mind like clouds in the sky. Having a good relationship with a trusted therapist is the key to success.
 
Client: What do you mean by success?
 
Therapist: Having fewer symptoms of depression.
 
Client: How am I supposed to have fewer negative thoughts and feelings? My house just burned down and my dog died!
 
Therapist: That’s where the coping skills come in.
 
Client: But I lost everything. I don’t know where to go from here. What am I supposed to DO?
 
Therapist: I will refer you to a psychiatrist for a medication consultation. Let’s meet again next week for another treatment session. You can book it with the receptionist when you pay for today’s session.

* * * * *

The dialogue above highlights a number of problematic views and practices commonly encountered by clients in the mental health system:

1. Understandable psychological reactions to stressful events, even catastrophic traumas, are viewed as “symptoms.” In other words, they are seen as indications of disease. If enough “symptoms” are present for a sufficient period of time, which can be as brief as a few days or weeks, and they are distressing to a person, that person is pronounced “mentally ill.” Although some psychological distress in response to stressful life events is allowed, it becomes “mental illness” at the point where it meets DSM diagnostic criteria for a “mental disorder.”

2. Once a DSM-defined “mental illness” has been diagnosed, the cause of the problem is located inside the client, more specifically in the client’s brain. An obvious environmental cause, like the fire described above, becomes largely if not entirely irrelevant. The problem is seen as a brain disease caused by a chemical imbalance. Notably, this chemical imbalance is not actually tested, nor does a valid test for it even exist. Indeed, the chemical imbalance theory is a scientific myth. But brain pathology is simply assumed to exist when a client’s “symptoms” meet DSM criteria for a psychiatric diagnosis. This is achieved by the reductionist argument that because the mind is what the brain does, a psychological problem is by definition a brain problem. This argument allows psychological “illnesses” to be diagnosed through the use of logic rather than objective tests as with medical illnesses.

3. Clients and their family members are encouraged to have good “mental health literacy.” This means adopting a biomedical model view of psychological experience. To have good “mental health literacy,” the following beliefs are encouraged (among others):

  • Psychological experiences that appear on DSM diagnostic checklists, like feeling depressed or having difficulty sleeping, are “symptoms” of “mental illness” regardless of what is causing them.
  • “Mental illness” is caused by a malfunctioning brain regardless of what is happening in a person’s life.
  • “Treatment” works by normalizing a malfunctioning brain.

Individuals are encouraged to incorporate their “mental illness” into their identity and view their experiences through this biomedical lens. This same lens is used by many mental health professionals, scientists, and “mental health literacy” and “anti-stigma” organizations. Notably, clinicians who adopt this perspective have less empathy for their clients, which raises concerns about stigma (see below).

4. High “mental health literacy” is promoted to reduce stigma. The goal is to reduce blame by reframing psychological problems as brain illnesses over which the sufferer has no control. Unfortunately, blaming the brain to reduce one type of stigma worsens other kinds of stigma. Consistent research findings show that blaming psychological problems on brain disease, faulty genes, or a chemical imbalance makes people more pessimistic about overcoming the problem, makes others less inclined to socialize with the “mentally ill” person, increases concerns that the person is unpredictable and dangerous, and fosters the view that the “mentally ill” person is fundamentally different from “normal” people. Strangely, mental health literacy advocates and organizations seem not to know, or care, about this research.

5. Psychotherapy that offers no structure or focus, that teaches clients that negative thoughts and feelings are “symptoms” which need to be controlled with superficial “coping skills,” that equates success with “symptom reduction,” fails to directly address pressing issues in a client’s life, ignores behavior, and is founded on the notion that a good relationship between therapist and client is all that is necessary for an optimal outcome, is routinely offered to clients and presented as “evidence-based.”

* * * * *

I frequently encounter clients whose journey through the mental health system involved exposure to all five of these troubling views and practices. Indeed, problems 1-4 reflect current best practice according to many professionals and organizations who promote “mental health literacy” and the DSM-focused biomedical approach to mental health “treatment.” 

At the heart of this approach is the belief that DSM diagnoses are valid biological diseases. Although this belief is not scientifically supported, and is acknowledged as such at the highest levels of the scientific community (e.g., by the psychiatrist in charge of DSM-5), it nonetheless governs the mental health system and makes ridiculous client-therapist conversations like the one presented above possible. I deliberately chose a “house on fire” to underscore the absurdity of the dialogue. But I contend that a conversation like this is no less absurd if one replaces a fire with an acrimonious divorce, the death of a loved one, sexual abuse, combat trauma, financial ruin, unemployment, a serious medical problem, or other stressors and life circumstances that prompt many clients to seek mental health services.

Problem 5 speaks to a pervasive quality control problem in psychotherapy. Many therapists are trained in a model of care that views unstructured, supportive talk therapy as “evidence-based” for most any psychological problem. Although many science-based therapies have been developed and rigorously tested for specific psychological problems, and are considered best practice for the delivery of psychological services, most therapists do not provide them and most clients do not receive them.

Although they may not “blame the brain” as often as psychiatrists, many psychologists and other therapists have also adopted the DSM-based biomedical framework in their work. They discuss their clients’ experiences as “symptoms,” attribute them to diagnoses that are implicitly or explicitly understood to be valid “disorders” that clients “have,” frame the goal of therapy as “symptom reduction,” and to the extent their work has a particular focus, emphasize the use of “coping skills” to control or eliminate negative thoughts and feelings.

The underlying philosophy of this framework is healthy normality, which says that humans are by nature happy and content, and that psychological suffering is therefore abnormal and indicative of an underlying illness. Psychological “symptoms” (e.g., negative thoughts and feelings) are treated like physical symptoms (e.g., fever, sore throat): both indicate that the sufferer is sick, and both are meant to be eliminated. Therapists teach their clients “coping skills” for reducing “symptoms” with the goal of achieving good “mental health.” Within this approach, the paragon of psychological health is a person with no negative internal experiences. Personally, I find it difficult to imagine that such a person could exist. If such a person did exist, I imagine that he or she would be extraordinarily sheltered, naive, and boring. 

I hope this post raises awareness about problems in the mental health system and encourages efforts to fix them. Any such efforts must begin with critical analysis of the widely accepted but scientifically unsubstantiated notion that DSM diagnoses are brain diseases. Our society and mental health system desperately need an alternative approach to understanding human psychology and addressing psychological problems that is founded on rigorous science rather than the potentially harmful pseudoscientific ideas and practices described above. The reason why is simple: mental health outcomes have dramatically worsened as the DSM-based biomedical paradigm has come to dominate how we approach psychological problems, and compelling scientific evidence suggests that the paradigm itself is worsening our psychological well-being.

***

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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29 COMMENTS

  1. Thank you for pointing out the harmful behavior of today’s DSM deluded psychologists. My psychologist thought my concerns that my child had been raped were “depression caused by self” and “bipolar.”

    An ethical pastor did finally confess to me that psychological and psychiatric profiteering off of covering up rape of children is the “dirty little secret of the two original educated professions.”

    And medical evidence is in proving that profiteering off of covering up the abuse of children is, in fact, the number one actual function of today’s psychological and psychiatric industries 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).”

    I do so hope the psychological and psychiatric industries do some day get out of the business of profiteering off of turning child abuse victims, and their concerned parents, into the “mentally ill” with the psychiatric drugs, especially since such behavior is illegal. But I guess you won’t have much business if your industries get out of the child abuse covering up business, according to your own medical literature.

    • Liar, Liar, Your Pants Are on Fire would be the title of one book I would purchase from an Alternatives Conference. Sixty years (?) later, Fire, the word, even in starting my Fire Tablet, triggers recalls of a parent with a huge hand, slamming me up the side of the head, with the Words, “I’m going to pop the fire out of you”, etched into my psyche. Oddly, this moment would hold the trauma throughout the body for years. The punishment was delivered just before a routine Sunday afternoon drive with siblings and parents. But oh, no-o-o-o-o-o, the peaceful Sunday afternoon, drive was not to happen. Time stopped that day.

      A few years later, in being fired from a banking job, the first career job, rather than resign quietly and realize employment elsewhere, one could not quit the fire. So, efforts were made to create a new bank that would serve the credit needs of Blacks and Women. Efforts were made to try to communicate with me, but now in an elevated mood (danger to self ?), the pressure to perform would alter a safe way of knowing reality. Surviving a flipped jeep and nearly freezing to death in the snowfall along the interstate was a threat to the new fallen snowflakes. Some snowflakes actually perished due to my bodily warmth being radiated into the new fallen snow. Had I been out there much longer, the soul would have made its way back into the heavens (assuming I have one worthy of value and values for the career trajectory).

      Sixty years later after those remarkable words of being fired in from the first career job, in Louisville, Ky I would be once again fired from a job in the probation period. But by the 9th month of that calendar year, the Courier-Journal would experience a massive killing by a man on Prozac.
      The whole mind of the community would be disturbed and I, now on the elevator in the county government building, would hear, “We ought to kill all of those crazy people”. The invisible nature of hatred spoke loud and clear to me.

      In returning home I would begin to craft art expressions and build a fire in the fire place to fire the pottery if not the Bible. In addition, the sinks and tub would be filled with water, in an effort to control the thermodynamics within the house and the internal way of my thought process. (To think later about the bi-polarity in ways of knowing how to moderate the “social-technical thermodynamics of that moment” seemingly is on par with the forensic digs of antiquity.
      (With the candles burning, was their a threat to self or others? The actual legal language of warning, warning being considered from my perspective at this time?) On these pages, there seems to be much post-discussion being able to post write. But is there a way to describe the whole scene being made from those periods that shows the whole perspectives accurately?

      For the next frame, in the story would have my wife coming to our home that was not operating within the norms engineered for family living.

      So, with some discussion, we would travel to my doctor’s office, where the consultation was made and the recommendation to “Just go home and try to rest”….. Was there a threat to self or others being made? …..

      Hopefully, my story or better, our stories will emerge to provide the requisite information to change the systems. While helping create an economy where people are not fired at will, where inclusion is not a word one counts the labels in attendance. Rather, perhaps a different way to assemble can emerge that communicates the unconditional, the ineffable nature of love will happen.

      This afternoon, I ask, “Where were my kindred spirits at these times?” For the story to unfold much is needed, from the voices of the past to speak. Many have been silenced (in response to the thinking of (being a threat to self or danger to self and others) as well as to to an issue greater than self.

  2. Hi Brett,

    sadly, even with something like my wife’s d.i.d. in which the DSM got the trauma basis right and all of ISSTD has been formed to figure out the ‘best practice’, you are correct that it doesn’t seem to inform the psychiatrists or psychologists much better other than if one happens to be personally more intuitive and insightful. It’s a sad fact that using attachment theory and the concepts of neural plasticity (both actually science based) as my basis for much of what I do to help her heal requires me to do nearly the opposite of the ISSTD guidelines they put out.

    Of course, it’s kind of clear to me that ISSTD really doesn’t understand d.i.d. How can they when they have such a truncated view of it as their therapists only see it in action in the office AND it’s highly unusual for someone, especially therapists, to have 100% access to everyone in the system like I do…and trust me the 3 littlest girls who NEVER talk to my wife’s counselor had the worst trauma and taught me all kinds of things I didn’t have to deal with in the first 4 girls who will talk to the counselor.

  3. The most frustrating aspect is, if you explain these ideas to people in “mental health” departments, they feel accused, flustered and view you as an oddball. The more resilience you show to them and their stupid notions, the more rebellious the mental health workers also become.

    These ideas etc., they exist only on our little websites that we have made for refuge. To make any practical change, we would need a hell a lot of money and man power.

    While people like Mr. Bill Gates etc. will make billions of dollars of charitable donations to vaccine research, you will find no such donations to this cause. Part of the reason is, psychiatry and it’s associated “skeptic” movements (of which, like a fool, I considered myself to be a part of in my younger days), have done a very good job of portraying people like us as cranks.

    Like many authors, you have brought forward the disease-mongering nature of psychiatry and psychology as it exists today. But is the alternative, “psychotherapy” all that great?

    “Psychotherapy” is just as bad. It teaches people in the worst of situations that the problem and solution lie within the person themselves. When true social justice issues appear at the individual level, neither the psychiatrist nor psychologist are anywhere to be found, except in large scale issues like gay rights. When was the last time you saw a psychotherapist donating money to a man who is suicidal due to economic hardships? When was the last time we ever saw a mental health worker barging into someone’s house to stop abuse of children and getting them justice from the perpetrators? Never. They will offer them useless psychotherapy though, wasting their own time and that of other people. There are a few situations where some guidance may be helpful for a short period of time. Not more than that.

    And perhaps, the rest of us are also to blame, because the professionals who do make these sacrifices, may not even be rewarded for them. In fact, it may end up screwing them. And this is something, we all need to do something about.

    Sam Timimi for instance, does not label kids with ADHD. When you go on his articles on psychology today, you will find parents writing “I hate professionals who write these things, if only they had kids with ‘ADHD’ they would understand”. They miss the whole point. As if to give your children drugs and “therapy”, you need to label them with life long stigmatising, truth obfuscating, tautological labels which potentially could ruin them.

    Psychotherapy, especially for kids, makes them so dependent, and their families so trusting of, the words of the enlightened “psychotherapist”, that the kid will end up in an endless loop of listening and talking, lose his instincts, his self-confidence, his capacity to make independent decisions and face the consequences himself, good or bad. It will become a much longer road for them to reach their full potential in life. Frankly, I prefer the personal, responsible, voluntary and non-forced use of drugs with minimal side effects compared to that. The only thing is, one should not have to go through the mental health system to procure them. Because once you do that, all the garbage, the disease-mongering, the constant noting down of “observations” like a lab rat, the labelling, all come into play. One has to rely on the charity of the benefactor (the psychiatrist/mental health worker), to get them or even to stop them if one does not wish to take them anymore.

    Ultimately, I have learned (the hard way), that a degree is not a mere certification of specific knowledge, but a means to get into a role of power, and a role of trust that people so easily give to the mental health worker, even though he/she may be as ignorant as a sack of potatoes.

    In many cases, it’s so surprising (but not at the same time), that ordinary people, can understand issues of people so easily, that all these highly qualified, disease mongering, so called “scientifically minded” “therapists” fail to comprehend.

    If one wants to make true positive changes to the life on an individual, one has to spend time taking personal risks with no expectation of reward, except perhaps some internal satisfaction. This is simply not possible for the professional. And when a professional offers a half-baked, pseudo-solution to a problem (like those fancy terms “CBT” and crap), he simply runs the risk of making the individual even worse. It is upto people, especially those who have been through this garbage, to offer help to the coming generations, completely independent of the mental health system and any worker that is associated with it. Naturally, this will have risks to be taken into account too.

    “Therapists teach their clients “coping skills” for reducing “symptoms” with the goal of achieving good “mental health.” Within this approach, the paragon of psychological health is a person with no negative internal experiences. Personally, I find it difficult to imagine that such a person could exist. If such a person did exist, I imagine that he or she would be extraordinarily sheltered, naive, and boring.”

    Which is obviously absolute crap as I have already written. Some people have lives so bad, they would be crazy to not be depressed.

    I will say one thing though. To date, I have not met a mental health worker that is “bad”, in the sense that they enjoy the suffering of their clients. Sure there are a few douches, but not generally. I have met some incredibly mentally dull ones (who you can make out, got into med school because of discipline and work ethic and not due as much intellect as others), and some really smart ones. But what I have noticed among many is, they don’t realise the full consequences of what they are doing. I am yet to meet a non-labelling, “antipsychiatry” psychiatrist in my country.

    But that does not matter in the least. The entire mental health community, is in a way, psychotic. Much like some of the people that come to them, they lack insight. Insight into the fact that they are, as a whole, a sickness to society despite their most positive and best intentions. And this psychosis is something that they have spread to the public at large like a contagious infection.

    But this is also a double-edged sword. The rebellious mental health workers who realise all this, probably find it hard to break through the professional barriers imposed on them by their colleagues, the law, and a totally psychiatrically indoctrinated and brain-washed society, who will defend conventional psychiatry to their own peril.

    If a “therapist” does not provide, “evidence-based standard of care”, and turns his client away by saying “your problems cannot be helped in the least by the mental health profession”, and that individual commits suicide, the mental health worker will be sued. He will face professional and public disgrace. This is also a problem.

    Unless, a suicide is caused by prescription drugs, the risks of which were not made aware of by the prescriber, if you kill yourself, the responsibility lies with you (unless the suicide was caused due to someone else’s actions). There are so many kids that commit suicide in my country, because they do not get into their favourite college, don’t get 90% marks in their exams, or are dumped by their lover. Stupid people. Perhaps they are better off removed from the gene pool.

  4. Just to echo some of the other comments – to identify correctly the harmful nonsense of biological based labels within psychiatry is great – however to assert there are scientific talk therapies is to psychologise social/cultural distress and falsely represent the talk therapy industry.

    We’ve had around 100 years of clinical psychology and its spawned hundreds of talk therapies many now make claims of being science based or evidence based with the RCT often held up as the gold standard – yet the RCT has been shown to be useless for talk therapies for many reasons like mind small sample sizes and the myriad confounding variables you simply cannot control for and that an effective placebo is impossible to find – then there is the massive issue of reproducibility https://www.nature.com/news/over-half-of-psychology-studies-fail-reproducibility-test-1.18248 Bruce Wampold in the great psychotherapy debate basically states that there is little difference between the ‘therapies’ and what is useful are three marginally helpful aspects namely the alliance, some structure and getting the person to do something between sessions.

    Again after 100 years of this you’d think perhaps we might be seeing human beings getting better, wellbeing increasing etc but the opposite is true very soon the WHO predicts that the cultural disorder of depression currently re-framed as personal pathology will be the biggest cause of suffering on earth.

    Self interest is really harming us all on a massive sale – this is a great book to summarize the issues with psychotherapy https://www.amazon.co.uk/Therapy-Industry-Irresistible-Talking-Doesnt/dp/0745329861

    This fellas work is also great – this could heve been written last week http://www.davidsmail.info/talk96a.htm
    https://www.amazon.co.uk/Power-Interest-Psychology-Materialist-Understanding/dp/1898059713

    We need to come together as human beings point to what is wrong and seek collective action to change it – we’ve been surrounded by ‘experts’ for so long we have almost lost the ability to feel and think with clarity. One thing that might help is to drastically reduce the time most of us spend at repetitive boring, stressful jobs that bend people out of shape and make community and caring almost impossible http://neweconomics.org/2010/02/21-hours/

    be well people

    • i wish there was someone who remembers who i used to be. i can barely remember myself. my original self is gone. destroyed. no recovery. i’m transmogrified, unrecognizable to myself. feeling the constant, chronic, ever-present need to rescue myself when i know it can’t be done. always feeling all wrong, not okay. 100% of the time. never gonna change. a done deed is a done deed. there’s no undo.

      people have this almost magical belief that total recovery and healing are possible. omg, it’s not. it’s not universal. sometimes, a person is harmed and damaged to a state of permanent disrepair.

      humanity doesn’t want to acknowledge or admit it.

      there ARE things we do NOT heal or recover from.
      there are things we can not ever change.

    • Thank goodness for articles like this…absolutely perfectly describes the binds clients are tangled up in so often. The abhorrent diagnostic manual has now been aped by a self selected group of ‘experts’ who promote psychodynamic therapy – The Psychoanalytic Diagnostic Manual Ed2…Worrying there does not seem to be any necessity for gaining approval for it’s use. The title makes it seem ‘official’ – any group of people could publish such a book especially when self funded, including by an undisclosed mysterious ‘5 others’ in addition to the ones who have been named. The checklists are numerous – the diagnoses and sub categories of each are numerous – there is huge potential for mis use. Real individuals living complex lives cannot be broken down in this dehumanising way in order to make the project of therapy seem more scientific and attractive to funders and policy makers -but no doubt it will be promoted.

  6. I agree with all this. Also, if someone wants to call them “biological conditions” then one has to understand that it is HUMAN EXPERIENCE (i.e., psychological causes such as severe psychological stresses) that brings about changes in biochemicals and the brain. Many of studies have shown this. Mice subjected to various psychological stresses (e.g. being restrained) clearly show dendritic atrophy and loss of dendritic spines [see for example: Popoli M, et al. (2012), The stressed synapse: the impact of stress and glucocorticoids on glutamate transmission, Nature reviews Neuroscience. 2011;13(1):22-37.] – these changes are reversible through psychological means (e.g. when stressed, restrained animals are released as described in the same article). Studies have shown that as taxi drivers do their jobs (psychological causes), the brain changes. Jugglers gain more grey matter in certain areas as a result of engaging in juggling. Various psychological habits, choices, etc., can also change the brain. For example, research has also shown that impulsivity trait results in reductions in gray matter. On the other hand, mindfulness practices (that result in reductions in impulsivity) are known to change the structure and function of the brain in positive ways (e.g. increases in gray matter and cortical thickness). So, it is important to get the direction of causation right when interpreting these types of studies.
    Psychiatrists get this CAUSATION TOTALLY WRONG – they think the causation happens the other way around.

  7. Brett, the power and clarity of this ‘clinical interaction” is immense.

    It should be used to protect our patients, our families and ourselves from the brutal labels for life, social isolation with irremovable iatrogenic stigma, and the grievous brain and bodily harms caused by fraudulently trialled and ruthlessly marketed psychotropic drugs.

    It has sufficient rational impact to begin to prevent what often leads to enforced misuse of some of the most toxic “medications” prescribed in alleged “medical practice”.

    The ADRs of these drugs then are interpreted by psychiatrists as emergent serious medical illnesses or cleverly diagnosed co-morbidities which were conveniently lying dormant before the fire, the death of the dog and soul-mate, and the loss of a whole, cherished way of life illustrated in this cameo.

    It would surely be an invaluable learning exercise for clinical medical students and for GP/Primary Care Physicians in training and especially for Psychiatry trainees to role play this exchange and debate the dangerous and destructive outcomes of the failed paradigm of psychiatric “care”.

    Thank you.

    TRM 123. Retired Consultant Physician.

  8. Brett

    A great blog that should be required reading for EVERYONE who wishes to pursue working in today’s “mental health” system.

    Your fictionalized dialogue has brilliantly exposed the essence of everything that is wrong with the current paradigm of the so-called “treatment of people experiencing normal human distress to an abnormal set of highly stressful environmental circumstances.

    We have a long and difficult road ahead to dismantle the System that encapsulates everything that you have so eloquently exposed in the above blog. Biological Psychiatry, in collusion with Big Pharma, has literally spent several hundred billion dollars in one of the world’s largest PR campaigns (ever in human history) that now pervades the thinking of vast sections of the population across the entire planet.

    Nothing short of major Revolutionary changes in the world can reverse the damage and harm that will continue if Biological Psychiatry is allowed to continue its means of social control in our society.

    Richard

  9. To all who have commented, thank you very much for your thoughtful remarks and kind words. Among the many issues critiqued in my post is the modern-day practice of “mental health literacy” education, which I suspect does not mean what most people think it means. Of particular concern to me are initiatives to “educate” children to have high “mental health literacy” in the name of reducing stigma and increasing help-seeking. Such initiatives are becoming popular and are heartily endorsed by the mental health establishment. We seem headed toward the day where a generation of young people will learn to construe their psychological experience through a biomedical lens. In a future blog post, I will deconstruct and critically analyze a “mental health literacy” program being rolled out in Canada (and other countries) that is now part of teacher training at some Canadian universities. Similar “mental health literacy” initiatives can be found around the world. In my hometown, mental health professionals have partnered with high schools to identify signs of “emerging borderline personality disorder” in students. At-risk students are encouraged to receive therapy that asks them to accept this highly stigmatising “personality disorder,” which is presented as a valid “mental illness,” into their long-term identity. I’d like to see more public critical discussion of the “mental health literacy” enterprise and its biomedical philosophy and hope that blog posts like this one will be disseminated far and wide and stimulate such discussion. Thanks for your support and stay tuned for a future post on this topic.

    • Dear Dr Deacon – you have exquistely portrayed the absurdities I felt as a training psychiatry resident and the conflicting interests of the patients (do no harm) vs the mythic religious dogma pseudo-science of psychiatry (doing definite harm) as I have come to see it by the pharmaceutically monetized propaganda of the APA and its tentacled training programs. Thank you sincerely!

  10. “‘mental health literacy’ program being rolled out in Canada (and other countries) that is now part of teacher training at some Canadian universities. Similar “mental health literacy” initiatives can be found around the world”

    You’re right. This is a common occurrence in my country (India) too. The poor souls who will enter into psychiatry have no idea what they’re getting themselves into. They will be enamored by the legitimacy of “medical doctors” to their own peril.

    “Similar “mental health literacy” initiatives can be found around the world. In my hometown, mental health professionals have partnered with high schools to identify signs of “emerging borderline personality disorder” in students. At-risk students are encouraged to receive therapy that asks them to accept this highly stigmatising “personality disorder,” which is presented as a valid “mental illness,” into their long-term identity. “

    Sickening. The entire field functions on truth obfuscating tautological labels. I tried explaining to a psychiatrist that half the stigma comes from their ghastly labels. They seem to be in denial of this fact. They are the ones causing a lot of the stigma and spreading false notions about these things.

    These kids will internalise these labels and it will lead to mental destruction without them even knowing it.

    Not to mention, they even engage in “family education”, successfully indoctrinating the families of the people whom they label.

    People need to have the option to not be labeled, and if still done so, they should be able to file a defamation suit.

    The enterprise of psychiatric “therapy” is to a large degree, a societal cancer on the global level.

    My question to you Mr.Deacon is, apart from writing blog posts, how are you practically fighting your brethren and providing tangible alternatives to clients?

    Have you ever reversed someone’s diagnosis? Fought with a colleague about how it has adversely impacted someone’s life? Of what use is “critical analysis” without these practical actions? Ultimately, as a Ph.D, you have power and you are in a role where you can use that power to truly save someone’s life.

    For example, IIRC, Szasz would engage in court cases to get people out of nut houses. Have any of you done that?

    And this is not a question I pose to you, but to all writers on MIA.

    When you say “At-risk students are encouraged to receive therapy that asks them to accept this highly stigmatising “personality disorder,” which is presented as a valid “mental illness,” into their long-term identity. , have you written a letter to the people creating and executing these programs that what they are doing will harm these kids? How does one explain to these kids or their parents the long term dangers of these programs? What about speeches uploaded to YouTube? All the writers here, can get into a large conference and upload these ideas in speech format online. There is power in numbers.

    • Registeredforthissite, thank you for your thoughtful comments. Your question – what have I done – is more than fair. My full answer would take a long time to write, and I’m proud of that fact because there is a lot I could write about (http://www.illawarraanxietyclinic.com.au)/. Many of my efforts have been devoted toward fellow professionals, as well as students and supervisees, and my efforts continue now in my capacity as a private practice clinical psychologist. I have a great deal more to understand about the relevant issues and to figure out how to address them. For now, I note that one important thing I have done is to have written this blog post, and to have done the research and acquired the knowledge necessary to have written it, and to have the courage to publish it here when doing so threatens the status quo in my profession. I hope to be able to make meaningful contributions to my profession and society and am continually working on how to do so.

    • As you say the label ‘Personality Disorder’ is one of the many loathsome stigmatising labels attached by one group of the more powerful on others. It has been recognised as such for decades by those who impose it yet is still used – the label itself causes harm and distress – isn’t there a duty ‘to do no harm’….see ‘Personality Disorder – Still the Patients Psychiatrists Dislike?’ in BJPsych Bulletin February 2017. There is actually another of the beloved check lists used to assess the ‘dislike’ ‘Attitudes to Personality Disorder Questionaire’ (APDQ ) synonyms are must haves of course. – just grotesque.

  11. Very interesting way to illustrate the pitfalls of DSM-mongering. My only reserve is that you illustrate “poor judgment”, more than misleading diagnosis. But then, DSM-4 expunged the axis system and so, “stress” became irrelevant. That was a big booboo ! It tends to pathologise everything that breathes or moves. Very sad thing in fact.

    DSM-4 gives mental health workers too much power. They (oh my God, I should write WE, since I am a clinical psychologist after all !), have legitimacy to transform normal experiences into mental disorders, based on their “best judgement” but the licence to practice doesn’t require a test for the quality of the mental workers judgement.

    I got a very good (or, bad in fact) taste of psychiatry’s way of treating people 18 months ago. Practicing since 1984, my family conflicts echoed in my workplace and I was mandated for a psychiatric evaluation. That was the beginning point in a spiral of professional catastrophes. I was then strongly urged to take either lithium or antipsychotics, menaced to be hospitalized, psychologically brutalized and robbed of my integrity. Now apt and fit to exercise again (since 3 months officially, but since at least 9 months in my mind …), I am reluctant to go back on my seat. I feel stigmatized, very badly. I sence I was broken somehow and I can’t say that to the different psychiatrists I met with because I know they will consider me as in MDD.

    The irony of my story is that I was traumatized. Not before, but after the diagnosis ! To make a long story short, I learnt, 4 months after the beginning of my sick leave – and at least 6 psychiatric assessments, that initially they suspected I was suicidal. Nobody had told me that to beginning with and I, innocently, was just complying with the pressure around me to reassure everyone. I felt a moral obligation to submit to all the hassle, thinking that if many people where concerned for my mental health, I couldn’t just keep on working and ignore their apparent empathy. In fact, I was never suicidal at all and I could of went to any judge to cancel the mental health obligatory assessment.

    Now, it has been over 18 months since my career has been interrupted, abruptly and, can I say cruelly. All this because the original psychiatrist, in my case, as in many too many, was biologically biased and determined to “unstigmatized” me. In so doing, he sanitized me, turning me into a bleached out, washed up ex-psychologist. At a time in my carrer, that I felt at last competent and in my best ! Life can be so full of scrap sometimes, sight …

    Signed : Mad in Canada !

    • “DSM-4 gives mental health workers too much power. They (oh my God, I should write WE, since I am a clinical psychologist after all !), have legitimacy to transform normal experiences into mental disorders, based on their “best judgement” but the licence to practice doesn’t require a test for the quality of the mental workers judgement.”

      i’m just curious. why don’t you, and others just like you, quit.

      if more people would abandon psychiatry and the mental system it might be heroic. maybe.

  12. Thanks for this GREAT blog post Brett, and for all that you do. For those unfamiliar with the excellent work Brett has put in to this area, i strongly recommend you check in this previous MIA post https://www.madinamerica.com/2015/10/psychologists-critique-the-biomedical-model-of-psychological-problems , and in particular thoroughly read the superb special edition of The Behaviour Therapist which Brett, edited focusing on “critical analysis of the biomedical paradigm. The purpose of this special issue of the Behavior Therapist is to contribute to this analysis. This special issue features 11 articles that present critical analyses of different aspects of the biomedical model. Contributors to this special issue include award-winning scientists and journalists, three ABCT presidents, the president-elect of the British Psychological Society, and individuals from clinical psychology, counseling psychology, journalism, neuroscience, psychiatry, and social work. These authors share a commitment to scholarly rigor and scientific evidence as the foundation for critical analysis of the biomedical approach. The exceptional articles featured in this special issue deserve a careful reading, and their provocative conclusions warrant serious consideration and ongoing professional dialogue.” Full edition is here https://www.madinamerica.com/wp-content/uploads/2015/11/Behavior-Therapist-Oct-2015.pdf

  14. listen,

    isn’t it true that SOME people really are all sorts of screwballs in the mind / personality / behaviors / emotions and it isn’t also true that the psychiatric DSM web has been over-cast, entrapping far too many people who never, ever needed any psychiatric diagnosis or “treatment”?

    to me, that’s one of the biggest problems. i say this because it’s not that human beings don’t suffer. we DO. the problem is that psychiatry does not discern and it’s harmed more people than it’s helped.

    don’t you think a sicko like israel keyes IS a severely mentally disturbed individual? he’s dead now but while he was alive he was a master manipulator who abducted, bound and raped, strangled and stabbed and shot, and dismembered his victims. nobody on this planet will ever convince me that he wasn’t one hell of a revolting, maddening sicko.

    oh, and dahmer too. he’s another vomit bucket.

    there’s a HUGE difference between malignant types: those naturally pre-disposed and those who become malign after major traumas. in other words, the predators and the victims.

    psychiatry just does not know how to weed a garden or discern spirits.

    • probably goes without saying but i’m the sort of person who will state the obvious because it’s always good to do so, as far as i’m concerned.

      whether knowingly or not, with intent or not, psychiatry is no victim. psychiatry is a predatory system.

      but maybe that’s to be expected, to some degree, when you deal with the very worst of what humanity has to offer.

      things like, horrific abuse and heinous murders. and worse.

      all the bad stuff.

      stuff that has me scarred for eternity – mind, body, spirit, soul and especially my heart.