The Medicalization of Conversation

Tom Strong, R. Psych.
30
2081

Talking to a counsellor about upsets, relationship difficulties, or just feeling stuck seemed a lot simpler before these normal life challenges came to be seen as signs of possible mental disorders needing treatment. I am referring to a medicalizing trend that seems to be taking at least two directions. Seen one way, medicalizing our concerns legitimizes them; seen another way, this medicalizing renders normal life challenges into the stuff that others diagnose and treat for us. Unsurprisingly, this has been a boon for big pharma as is well known at this website. But I want to speak to what this has meant for counselling — that modest way of conversationally helping people overcome life concerns that haven’t always been seen as medical in origin or nature.

Alongside concerns one might have about madness are the everyday moods and forms of stuckness that ebb and flow. The diagnostic dividing line on what is or is not a psychiatric concern changes in small and big ways. Only some fears will morph into anxiety, while few sadnesses or stucknesses will stabilize into depressions, and I will be restricting my comments here to those concerns undiagnosable as a severe mental disorder. Mostly, such emotions relate to people, developments, and circumstances in our lives — and only secondarily, relate to the functioning of our organs or intellect. Sharing and reflecting upon our stuckness and emotional ebbs and flows with others often helps us move on. Sometimes such sharing and reflecting isn’t enough and so we might remain stuck or moody enough to want to talk to someone else who is not close to us, burned out by us, or entangled in relations with us — like a counsellor, perhaps.

A counsellor and counsellor educator myself, I joined my profession back when people presenting such forms of moodiness or stuckness seemed able to talk their way through many concerns with a counsellor’s assistance. And they didn’t need to think of themselves as needing a diagnosis to see me. I’m a psychologist, too, and will sometimes refer to myself as a family therapist, yet things get blurry as to who does what these days, as a “mental health professional.” I still like considering myself as a counsellor first, though; someone who works to help others through good conversation.

Emotionally speaking, ours has become an era focused on wellbeing, with the quality of our mental health at its center. A particular kind of logic increasingly informs public and professional approaches to wellbeing, a medicalizing ‘diagnose and treat’ logic according to sociologist Peter Conrad.1 Diagnostic boundaries around what passes for normal seem redrawn culturally and professionally as more human woes evolve into new or expanded mental disorders requiring treatment. There is a complex backstory here to this medicalizing in counselling. Some of it relates to counsellors’ professional legitimacy in the public’s eye, but another aspect is about their economic viability within our mental health services.

Mad in America has been a cyber (and occasionally virtual) forum for many readers, in large part thanks to Bob Whitaker’s and others’ critiques of the psycho-pharmaceutical industry’s excesses and abuses. But the medicalizing logic of psycho-pharmacology hasn’t stopped there; a version of it found its way into the mental health industry which rations counsellors’ services. Primarily enabling this rationing is use of DSM5 (Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition) diagnoses, and evidence-based interventions for treating each diagnosed disorder. As far back as the mid-1980s, software algorithms based on this ‘diagnose and treat’ logic and language supported rationing mental health service delivery.2 Unsurprisingly on first evaluation, pharmaceutical interventions were identified as most cost-effective for relieving the symptoms of DSM diagnosable disorders. Lagging behind, it seemed, were the conversationally oriented ‘treatments’ of mental health professionals, like counsellors. Such treatment evidence is more equivocal nowadays, particularly for addressing the moods and stucknesses raised above. Still, a medicalizing logic persists in spheres like counsellors’ work, counsellor education, mental health administration, and for a public who understandably wants to understand their moods and stucknesses — as mental health professionals do.

Cultural critic Eva Illouz3 claimed that the default language of self-understanding is increasingly based on DSM diagnoses. Psychologist Svend Brinkmann4 suggested that we have been losing our languages of suffering as mental health discourse overtakes other ways people understand and discuss their concerns. A recent pair of edited books advocates, “De-medicalizing misery.”56 Even Allen Frances, who oversaw the DSM-IV’s development, entitled his recent book on the DSM5 process “Saving normal,” to warn of the DSM5’s excessive medicalizing.7

For counsellors, such medicalization enables some parts of their work while constraining other parts. My concerns began out of my own conversational work as a counsellor. Generally speaking, counsellors learn several approaches to helping, diagnostic and intervention aspects of psychiatry included. In learning these approaches, they acquire different languages for making sense of and addressing the concerns clients bring to them. In my own case, I practiced in the language of couple and family therapy where concerns are seen to occur between people, not inside them. However, in practicing within a provincial mental health system, my language for understanding and addressing client concerns fit poorly with the diagnostic and treatment language used to manage services within that system. The issues are even more commonplace today. This lack of fit wasn’t only because of my using the language of couple and family therapists either. Try counselling to empower clients in abusive or discriminatory relationships, or exploring existential meanings around personal loss, or building on personal strengths. Such conversations, to me, typically do not involve treating symptoms inside people.

Counselling has always dealt with client and professional meaning in some form; the languages used, and how they’re used, are central to its meaning-making. It matters that we can share and transform our meaning with each other in understandable ways, which makes language, and how we use it, important to counselling’s conversational work. By social constructionist thinking (e.g., Burr, 20158), any language is always partial and can’t get at an experience’s full meaning or significance. Take one of Allen Frances’ concerns for example: grief after someone we love passes. What does a symptom-based language of grief leave out, that other spiritual, financial, or relational languages of understanding and talking might supplement? What might each language cue up for the conversational work of counselling?

Answering my last question: if medicalizing discourse is expected, one will evaluate the client’s physical and emotional symptoms (e.g., sleep disturbance, despondency) for severity and possible diagnosis. Treatment of those symptoms, in some form or another, would follow. This clearly involves a different conversation than one focused on the importance of the deceased person in the clients’ life, or the spiritual meaning of a close one’s passing. My point is not to pit one language against the other; medication can temporarily relieve a spiraling-out-of-control sleep disorder, enabling later conversations with clients that couldn’t otherwise happen. Medicalization’s ‘diagnose and treat’ logic and discourse isn’t one size fits all, however, when it comes to the conversations of counselling.

Medicalization has had an effect not only on such conversations but on everyday thinking as well. As the palette of language for bringing colour and meaning to our emotional experiences and life predicaments gets displaced by a more official-sounding psychiatric language, insidious things can happen. We might take on psychiatric understandings as exclusive self-understandings to live by. An upside of doing so is that a kind of medical legitimacy is conferred. A stable sense of community among those sharing a diagnosed condition can also develop as Svend Brinkmann (2016) showed through his research into “diagnostic cultures.”9 From a Masters student, Stephany Huynh, here at my university, I learned of the diagnostic legitimacy and community issues somewhat in reverse. Stephany spoke to members of the “Aspie” community after Asperger’s Syndrome was dropped as its own DSM disorder in the then new DSM5, being later placed under a broader category: Autism Spectrum Disorder. Gone, for the aspies she talked to, was the kind of medical legitimacy mentioned above. That former diagnosis, for some, enabled particular funded services, but more importantly, many had seen their diagnosis as a kind of identifying badge of honour, a diagnosis conferring legitimacy on behaviour previously seen as eccentric (at best) by others. These aspies became diagnostic ‘outlaws’ or outliers of a sort.

There can of course be potential downsides to living by medicalizing language. I recall some years ago, in my training, hearing someone saying that behind every important self-description used in counselling lies a story. Moods and stucknesses clients bring to counselling find their storied coherence, in part through how they are talked about. DSM diagnoses originally offered a diagnostic shorthand, enabling researchers and mental health professionals to readily communicate about the symptomatic meaning and severity of concerns that clients (or patients — consider the differences in terminology) present. However, a diagnostic term does not a full story make; the media can also play a role in furnishing the meanings and storylines publicly associated with any psychiatric diagnosis. The self-help media are thriving in ways that help one officially (i.e., medically) learn about their concerns and what to do about them, as any quick search of Google or YouTube reveals. One’s moods and stucknesses can be diagnosed (by self, professionals, or others), but they also arguably (to me at least) remain fair grist as conversational material in search of further actionable understandings.

Even for diagnosed concerns of lesser severity (e.g., depression or anxiety), diagnoses may still be usefully supplemented with other languages of suffering, or of unused meanings and resourcefulness. It is whether (or how) clients live according to the languages they are exposed to (or that are proposed to them) that matters most. Linguistic downsides can arise if one feels limited by a diagnosis’ media-furnished storylines, particularly if such storylines implicate one’s sense of identity and possibility. At worst, diagnoses offer a totalizing or exclusive language that furnishes convincing storylines to clients and counsellors of progressive enfeeblement, demoralization, and failure.10

The ‘diagnose and treat’ medicalizing logic and discourse I have been describing has seen its share of resistance from counsellors, including from me. Among scholars of counselling, debates have raged over what counsellors should listen for and respond with as they converse with clients. Considerable research has been informing the debates, without any clear winner over what should be said and done — other than research consistently identifying the quality of the conversational relationship as paramount, and with client feedback on the process and outcomes helping to keep the relationship that way.11 For me, this is not another way of saying that the (mental) health professional needs a good “bedside manner.” It is about counsellors engaging clients on what they want to see different in their lives, conversed with in respectful and resourceful ways about which clients have considerable say. Medical language and logic is but one language and way for engaging in these conversations.

A concern that brought me to academic life as a counsellor educator came from recognizing the effects that medicalizing logic and language were having on my own practice as a counsellor. Sometimes the effects crystallized in bureaucratic expectations that I stick to a medicalizing discourse, despite it being antithetical to my preferred approaches to practice. How, for example, should one square a relational understanding of parent-child conflict with an agency or insurer’s need for a diagnosis like “oppositional disorder” (i.e., in the child) so that the parent and child can legitimately be seen together in counselling? More importantly, I have been concerned with the increasing incursion of ‘diagnose and treat’ understandings into normal aspects of the human condition: the moods, stucknesses, and relational conflicts that can seem unadressable in clients’ lives without some kind of professional assistance. When, or how often, do such concerns foretell acute or chronic mental disorders, and when might they otherwise relate to parts of the warp and weft of everyday life?

My hope is that students of counselling engage in conversational work that clients deem collaborative, reflective, resourceful, and above all useful in addressing what concerns them. As all of this relates to the medicalizing logic and language that I have been critiquing; my concern is not that counsellors need to know and be able to use this logic and language (they do, to talk to other health professionals and to sometimes make referrals when warranted). Counsellors are professionally obliged to engage in ethical conversational work not tethered solely to a medicalized language and logic. However, for economic, professional, and cultural reasons, this language and logic seems to have become primary. For the public, this primacy brings constraints on what users of counselling might be able to discuss, should their concerns be non-diagnosable within increasingly rationed counselling services paid for by public funds or private insurers. The moods and stucknesses once seen as legitimate reasons to talk to a counsellor arguably may be diminishing in cultural significance given how our formerly responsive social safety net is defunded. As what is left of that safety net becomes more prescriptive in line with a medicalizing logic, I am concerned for what this means for the conversations of clients and counsellors.

Show 11 footnotes

  1. Conrad, P. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore, MD: The Johns Hopkins University Press.
  2. Sharfstein, S.S. (1987). Third-party payments, cost containment, and DSM-III. In G.L.Tischler (Ed.), Diagnosis and classification in psychiatry. A critical appraisal of DSM-III . (pp. 530-538). New York: Cambridge University Press.
  3. Illouz, E. (2008). Saving the modern soul: Therapy, Emotions, and the Culture of Self-Help. Berkeley, CA: The University of California Press.
  4. Brinkmann, S. (2014). Languages of suffering. Theory & Psychology, 24, 630 – 648
  5. Rapley, M., Moncrieff, J. & Dillon, J. (Eds.) (2011). De-medicalizing misery: Psychiatry, psychology and the human condition. London: Palgrave Macmillan.
  6. Speed, E., Moncrieff, J. & Rapley, M. (Eds.) (2014). De-medicalizing misery II: Society, politics and the mental health industry. New York: Springer
  7. Frances, A. (2013). Saving normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. New York: William Morrow.
  8. Burr, V. (2015) Social constructionism (3rd ed.). New York, NY: Routledge
  9. Brinkmann, S. (2016). Diagnostic cultures. London: Routledge.
  10. Gergen, K. J. (1990). Therapeutic professions and the diffusion of deficit. Journal of Mind and Behavior, 11, 353-368.
  11. Wampold,B. E., & Imel, Z. (2015). The Great Psychotherapy Debate: The evidence for what makes psychotherapy work (2nd ed.). New York, NY: Routledge.

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30 COMMENTS

  1. As long as the myth of “mental illness” and the corresponding myth of “mental health” predominates, innocent people, including children and the elderly, will be dragged into the psycho-pharmaceutical industrial complex through any means possible, including the nefarious webs of so-called “psychotherapy.” This notion of medicalization of every day life, or the manufacture of madness is not a new development. Thomas Szasz wrote clearly and eloquently on these topics many decades ago. Those who understand the history of psychiatry, as well as the history of psychotherapy or psychoanalysis stay as far away from both as humanly possible. Third world countries often have an advantage over industrialized nations like the United States because those who suffer are cared for by their families and their communities instead of being relegated to secondary institutions, which, whatever their good intentions, often produce more harm in the lives of the suffering individuals. Once psychiatry is seen for what it is, namely, an institution of coercion and slavery, the only moral and reasonable action to take is to work to abolish it. The abolition of psychiatry will prevent more future suffering than all the counseling in the world could ever provide.

      • I’m glad to see your comment here, “littleturtle”! I missed this article last month, and so I didn’t see your comment. I believe you when you say you were helped by a psychiatrist. Not all psychs are bad people, and they don’t always hurt people. I think that “Slaying_the_Dragon”, above, was speaking about psychiatry as a whole. That shouldn’t take away from your personal experience. You really are one of the lucky ones, especially in the long-term. Too many of us here at MiA, myself included, were very badly hurt by psychiatry. So we condemn the WHOLE of psychiatry. But even a very bad person can do a good thing, at least once in a while. I like reading your short comments. They always make me think. Thank-you, “little turtle”!

    • There ARE alternatives to the psycho-pharmaceutical industrial complex, all linked to huge changes in lifestyle. But sadly, there are few places left in the world where these alternatives exist…and where one can prevent or avoid the “complexities of the complex”. It’s like going to the shopping mall…which I hate to do. At some point, when the hole in the bottom of my shoe started to make a blister on the bottom of my foot, I had to enter the “gates of shopping hell” to buy a new pair of shoes. Now I can just enter the “virtual gates of shopping hell” on my computer…and hope the shoes I buy, fit…but ANYTHING to stay out of the mall! If we could just find those alternatives to the lives we are leading…maybe some nice way of life where we don’t have to “wear shoes” at all…those psycho-pharmaceutical “complexities” will disappear for lack of need. Or maybe we’ll just lose interest. In the meantime, most of us have to “wear shoes”…find ways to protect ourselves from today’s friction of living. And when those protections wear thin…we may have to get a little help. r.reeves 1/12/2018

      • There ARE alternatives to the psycho-pharmaceutical industrial complex

        In the interest of not appropriating language, especially that of Black-led struggles such as the prison abolition movement, I consider the literally politically correct term here to Prison/Psychiatric Industrial Complex.

        Btw, there is a legitimate use of the term “politically correct” which does not require air quotes, and goes beyond the common understanding of the term as inordinately focusing on semantics, or promoting absurd convolutions of language to fit liberal ideology. (The latter IMO is rarely correct, politically or otherwise.)

        • Hi Oldhead..a little hard to understand but I wanted to say, prison is certainly no alternative to therapy. It is the place we are “storing” human beings with mental health conditions and not offering any treatment. I’m guessing you know that, and were trying to say that. There are groups working on ending this abomination in our country. We need to support them, at the same time, moving toward better mental health treatment for the relatively few, truly unwell people. rr

    • Hi Slaying,
      After a short conversation here, trying to restore some confidence in the choices that people have within the mental health “industry”, I went back and did some review of Whitaker’s book and some others – Shrinks, American Psychosis, ADHD Nation. Until I read some of this history, I didn’t realize how bad “psychiatry’s self-concept” really is. It’s evolving and trying to incorporate advances in neuroscience. It’s not driving the advances, in my opinion, but the driver is technology which has enabled new ways of studying the brain. New breakthroughs have “forced” the psychiatric industry to adapt (or they have taken advantage of advances; or the consumer has asked them to make changes to incorporate advances…our economy is dynamic, there are lots of players but clearly its all “mental health economics”.). As this has played out, ALTERNATIVES TO PSYCHIATRY/MENTAL HEALTH THERAPIES, have faded…religious practice, availability of exposure to nature, availability of healthy foods and exercise (I’m speaking of MOST people; keep in mind the rise of processed foods, media entertainment that have led to the obesity problem), schools and religious establishments as centers of community life, decline in marriage (keep in mind divorce rates over the last 40 years), rise of the dysfunctional family and so many other things. PSYCHIATRY IS FILLING IN THE GAP, unfortunately. My hope is that with continued advances in neuroscience, we will explain away the conditions for which we have labels (thanks to psychiatry, the DSM, etc.). For example, recent research shows bipolar is clearly not caused by a gene or even cluster of genes. It is caused by the physiological mechanism involved in dendrite growth (I should attach the reference, here. Will do that if you are interested.) IN TIME…we may actually get bored with some of these conditions as therapies become more multi-dimensional, recognizing and attempting to “fix” all external causes as well as improve overall internal health. All mental illness will NOT be removed and the industry will not completely go away, but the artificial epidemics should disappear if we lose interest and NORMAL CURVES IN MENTAL HEALTH will come back, with “illness” being found relatively in the 1 or 2 standard deviations from the mean, where they belong. R.Reeves, PhD. (not a neuroscientist, I read.)

  2. But this problem is also built into the core of Psychotherapy. The therapist has an agenda, otherwise they could not possibly be a therapist unless they went along with it. The client must submit to the world the way it is, and renounce any possibility of striking back against violators in any way. The client must accept that their problems are primarily the result of their own errors in living, Original Sin.

    A Work In Progress
    https://sites.google.com/site/stompingthecockroach/

    • You keep saying that, but it’s not necessarily the case. I provided therapy from the point of view that the person came in needing/wanting some change in his/her life, and that my job was to catalyze whatever change that was, as they conceived of it. Part of the job was to help them figure out what it was, but that’s not the same as me having an agenda. I agree that most therapists these days lack the skill to do that, but that doesn’t mean EVERY therapist has an agenda for the client. I had a therapist who was very helpful to me in accomplishing MY goals, and actually refused to tell me what she thought about anything I said or did, instead insisting that what I thought of it was what mattered. I can’t see that she had an agenda, other than to help me make sense of my world and decide what I wanted to do differently.

      • Oh, and I CERTAINLY didn’t discourage any impulse to strike back at the perpetrators of harm – to the contrary, I always felt that anger and intent to act against oppression was a sign of progress, as the person was moving AWAY from being a victim and toward taking ACTION, which seemed in most cases to be the best antidote to feeling bad about him/herself.

      • But Steve that is of course the lie. For one thing it is very unlikely that the therapist has any real solidarity with the client. Most of the time the therapist is quite well off, as well as educated and articulate. A highly marginalized client will usually have none of this.

        And then for people who are highly marginalized the answer should be becoming a revolutionary. Being an outside they have no stake in the present order. Very different if they should have the misfortune of discussing their affairs with a therapist. Said therapist is only going to teach them how to become an Uncle Tom. And the end result is that the client is the one who is wrong, because of their refusal to submit and refusal to live the lies.

        Here is a fictionalized account of revolutionary consciousness raising:
        https://www.youtube.com/watch?v=b1PmnZ9hejw&feature=youtu.be&t=24m42s

        A Psychotherapist is never going to do this, promote conflict and actions to restore one’s social and civil standing by vanquishing foes. No, the therapist collaborates with abusers and supports them, because he is one of them.

        We need to start teaching people to defend themselves against therapists, and especially children.

        Most of the time the marginalization starts in the middle-class family, because it exists only to abuse and exploit children, and this is because the middle-class lives in Bad Faith:
        http://www.iep.utm.edu/sartre-ex/#SH4b

        People need to learn and change things about their lives by working with comrades, shoulder to shoulder, and by achieving victories, because this is the only way one restores their social and civil standing, their honor.

        I did much to restore my honor by helping to get a Pentecostal daughter molester convicted and sentenced. But now I need to do more, work with comrades, instead of the DA.

          • Not so, psychotherapy is by definition something based on changing the client, instead of fighting to redress injustice.

            So it is always true that the practice of psychotherapy is wrong.

            The minimum response to a psychotherapist should be the middle finger.

    • The Original Sin, is denying God…not therapists. I’d never “submit” to a therapist. If a therapist requires “submission”…a client should leave that person’s care, immediately. If a therapist requires “trust me”…a client should leave that person’s care, also. If the therapist requires “here’s what I do here, please let me take you through this program”, a client has a choice to stay or not stay. Yes, I agree that most therapists are trained in one type of “therapy” or another. That places the responsibility on the client to know what approach is used in that office, which I find extremely risky and difficult, especially when the client is suffering and may not be able to clearly decide. That is why I believe all “listening and caring” professionals or volunteers, need to find out as quickly as possible, what the CLIENT BELIEVES the approach will be, what their fears and anxieties are about entering the therapeutic relationship, what the “AGENDA OF THE CLIENT”, is, so to speak. The therapist does have an AGENDA, as you say, and both individuals need to be “on each others agenda”, so to speak. Many things will impinge on establishing a TRUE, “we respect your spiritual beliefs”, helping relationship…timing, money, family influences, emotional state of the client, logistics, the weather, what other things God has in store for you the day you seek help…etc. Watch out for bad therapists, and seek good ones…the same way you would watch out for bad preaching and seek good preaching. And if you are one of the lucky ones, who can pray…just let God lead you to the help you need…whether it’s therapy or not. You’ll get what you need and so will others…especially those who need to learn about “ORIGINAL SIN”…hopefully they can learn about it without having a panic attack, extreme anxiety over the issue or other emotional or mind-related injury. But it happens to people, sometimes. r.reeves 1/12/2018

  3. Being able to converse in a variety of styles seems right to me. Clients come in with pre-conceived notions about what the counsellor is able to do for them. The first task is often to “talk them down” from whatever expectation they have of YOU (the listener)…chit chat, vamp-until-ready sort of conversation. Could take minutes…could take months. Eventually, they will hopefully, see you as you are…ready to listen and help them identify and work on their “problem”. If meds are needed to slow the process down…then hopefully…you are working in a collaborative group, can make referrals, can get them the medical support they need as they work with you (avoiding “over-medicalizing” as you say). I don’t think counselling is being threatened by the medical model. I think the general population is getting wise to the fact that the DSM5 is a problem (the NIH isn’t using it for bipolar diagnosis, for example)…that one shouldn’t dive into medicines for mental health issues. But because of stigma, the general population isn’t diving into “counselling” either. They are still avoiding treatments of any type. THIS IS A HUGE OPPORTUNITY TIME FOR TALKING THERAPIES OF ALL STRIPES TO GET TO WORK AND LET THE GENERAL PUBLIC KNOW WHAT PSYCO-SOCIAL SUPPORT IS and that talking to your “Aunt Haddie” is not the best they can do. Beef up your academic program, training people to speak all the languages they can…analytic, non-directive, cognitive behavioral, medical…whatever it takes to help them LOSE INTEREST in the approach they think they are taking with YOU…and simply have that helpful conversation…r.reeves PhD.

      • I agree with you. There are experienced “caring and listening” volunteers available to you that do not charge for their services. You can find them online…there are many places to “chat” or if you’re really in crisis, get immediate help (Crisis Text Line for example). There are some therapists who post free videos and talk about all kinds of helpful subjects. Or if you need a flesh and blood person…many free clinics are out there, or if you are medicaid eligible, almost any clinic will take you. Religious organizations are often great places to find “caring and listening” volunteers – find the “no judgement” places…progressive churches, multi-faith or inter-faith organizations often train and supervise their volunteers (one well known program is Stephen Ministers, in many Christian organizations…free, trained, supervised…so you can get dependable help.) Also, National Organization for Mental Illness has FREE programs, support helplines and other services. They basically have a “don’t over medicalize” point of view, at the same time, letting people know what meds are out there and the pitfalls to look out for. They are very “peer to peer” oriented, so the people who you would learn from, have been where you are. There are 900 NAMI chapters across the country. Get out (or online) and explore what is available near you. Look up!!! r.reeves 1/12/2018

    • Judy, what you say makes tremendous sense, but unfortunately because the therapist is asking you to make personal disclosures when they have done nothing to prove that they are really on your side, it is even worse than what you describe.

      “The Original Sin, is denying God…not therapists. I’d never “submit” to a therapist. If a therapist requires “submission”…a client should leave that person’s care, immediately.”

      The therapist is in fact insisting that you submit. For one thing, anything you say to the therapist could be repeated directly to law enforcement. For another thing, the therapist is a therapist because they are committed to the proposition that the solution to problems lies within you.

      Imagine this, a victim goes to a police station to report that they were just raped. What she hears is, “You came to the right place. We have therapists on duty around the clock to help people just like yourself learn that the remedy is inside of yourself and that you don’t need to go through life being angry and a trouble maker, and that you just need to be more careful about how you dress and about situations. We don’t want you to be angry.”

      That is in fact how it used to be done. Well in the Psychotherapist’s Office it is still being done that way. Though many will be more careful about how they phrase it.

      “The practice of Psychotherapy is wrong because it is profiting off of other people’s misery.”
      https://www.amazon.com/Against-Therapy-J-Moussaieff-Masson/dp/1567510221/ref=sr_1_1?s=books&ie=UTF8&qid=1515629126&sr=1-1&keywords=jeffrey+masson+against+therapy

      A Work In Progress
      https://sites.google.com/site/stompingthecockroach/

      • Hi Tireless. Thanks. So, here is where I think “therapy is going” and why “it’s all in you” approaches will continue to fail, as they may have failed you in the past. Dualistic beliefs about mental illness leading to “thumbs up or down diagnoses” are out; spectral thinking in psychiatry has at least given us (clients) the possibility of being “not so bipolar” or “not so autistic”, for example. Diagnosticians have to look for and acknowledge LOW levels of anxiety, depression, mania, suicidal ideation, autism…whatever the issue the client (we) seem to be presenting. They also have to acknowledge the possibility for CHANGE in the client’s (our) state…with or without therapy, drug or otherwise. WHERE SUCCESSFUL MENTAL HEALTH CARE IS HEADED…is toward even more complex “diagnoses” that acknowledge the multidimensions of lives that have produced the state the client is in…EXTERNAL and a few INTERNAL (genetic predispositions, physical health including brain (physiology) health, and psychological states the person brings with them into therapy). (Trauma, btw, is only one external circumstance, but people talk a lot about that today, as a source of “the problem”. It may be. The notion of ACEs, Adverse Childhood Experiences, is a little broader and more useful to explain specific events. But looking for specific events in someone’s life can often result in a big nothing. Humans often feel unwell, simply by growing up in and where and how they grew up. No therapy will ever be better than preventing pain and suffering, ending social inequities, values and beliefs that marginalize and keep people from knowing they are valued as much as the next guy…the basic human belief that promotes positive mental health.) Clinics and individual therapists will promote COMPLETE REMISSION, RECOVERY or HEALTHY LIVING WITH A DIAGNOSIS… to the extent that they can view the individual in a multidimensional (holistic) way and be able to provide support for external as well as internal factors. This approach is consistent with “clinics”, “community level mental health centers/services”, hospital settings that have social workers available, any collaborative approach that includes non-medical (schools, police, other social services) that are setup to work alongside medical personnel. Getting this to happen takes politics, advocacy, money – maybe from unexpected sources trying to do good or deal with corporate guilt, leadership, good medical professionals, good non-medical professionals…it takes voters who get it and it takes grass roots efforts. r.reeves

        • I forgot to mention…people who have healthier ways to approach feeling, being socially and psychologically healthy should absolutely stay away from psychiatry or mental health workers. Religions, for example, have served the purpose of promoting positive mental health – always and way before drug companies were invented. People should be encouraged to develop a health spiritual life or belief system that serves them in times of fear, confusion, pain, grief, other human states that sometimes lead to mental illnesses. Our religious institutions have taken a hit in recent decades and we need to bring them either back…or let new ones enter the mainstream. Average (meaning everyone) people will benefit from average spirituality…let’s at least acknowledge that. We really should put psychiatry out of business, but until that happens…we can at least regulate it, FEED IT SOME REAL NEUROSCIENCE THAT INFORMS RATHER THAN PROMOTES FALSE NEEDS (the result of out of control business practices, which everyone is susceptible to). rr

      • Tireless

        The one therapist that I’ve ever dealt with and whom I found to be very helpful during a very difficult time in my life when everything was out of balance did not do one of the things that you mentioned above. I did not have to share one thing that I didn’t want to share. He never had any expectations of me and said that what was important were the expectations that I had for myself, much as Steve stated to you in an earlier post.

        It seems to me that you paint all therapists with a very broad brush and I don’t think that this works very well. Granted, there are a lot of very bad therapists out there who obviously work from a position of power, but not every therapist approaches people in this manner. You seem to attribute lots of motives to therapists that I never once experienced from my therapist. Call me lucky but my therapist let me work on what I wanted at the speed that I wanted.

  4. Psychobabble, gobbledygook, ridiculous nonsense. Sure, I read the article. It’s written in Modern American/Canadian English. And it’s still psychobabble and gobbledygook. Let’s place blame where it’s due: The pseudoscience LIES of the drug racket and means of social control known as “psychiatry”. The DSM-5, and all previous DSMs, are nothing more than catalogs of billing codes, pretending to be “scientific”. Why call it a “Statistical Manual”, when there’s NO statistics in it? And Tom Strong lays out in brief how ALL of medicine has been polluted and corrupted by these psychiatric terms. These invented words, – these neologisms. Use of neologisms was once declared to be a “symptom” of “mental illness”. Who knows if there will be a “DSM-6”? If there is, it will only need ONE entry: Psychiatry. Psychiatry has done, and continues to do, far more harm than good. What is MOST needed, in counseling/therapy in particular, and medicine in general, is TRUTH, and HONESTY. Truth and honesty are rare commodities in psychiatry, and THAT is the root of the troubles Tom Strong describes here. Why do we need anything more than “justified need for services” to bill for payment? Rather than bemoan the latest labels, let’s all work to SIMPLIFY medical language, especially in the so-called “helping professions”.

  5. I am a Canadian woman disabled in the crime of domestic battery, systemically discriminated by police who all too often obstruct justice against vulnerable persons, later sent by my brain injury team to a shrink with no informed consent who repeatedly drugged me causing 4 back to back near-death adverse drug events, using toxins I didn’t want or need, for an imaginary disease I don’t have, that are contraindicated and unapproved for use in vulnerable brain injury survivors because they have been known for over 40 years to cause brain injury – to say nothing of the suicide, early death, disability and addiction caused by the ‘sick care” industry. Despite this, they are happy to kill us with their sick lying diagnosis and their dirty Allopathic drugs anyway, because no one holds them accountable for the crimes they commit against us.

    Enter the elephant in the room. the legal system discrimination and abuse that most victims of sick care never get close enough to (by design) to begin to address the fraud and abuse of the former. The government, sick care and the legal system work in concert to silence and block the legal rights of victims iatrogenically re-injured by the vile medicalization of social problems that this author fails to address. His bias, via the Aspie story, is plain and obvious.

    There is much more to this currently unfolding nightmare of serious dangers and risk of death lurking in so called “care” that is rooted in the medicalization language that is obscured here. And it is destroying the fabric of society. As we die and our lives continue to be ruined, people such as this author get to keep their pathetic jobs.

    Social inequality is rooted in the justifications for continuing to harm innocent victims while people who profit off regurgitating it, continue to make lame justifications that maintain their dirty business as usual practices. No wonder there is so much hate against the 1%. This diatribe makes me physically sick to my stomach.

    Here is a brief glimpse into the realities lurking behind some of what was not said herein.
    Physician and Patient Safety, Hospital Governance, Nurse Collective Bargaining
    https://www.youtube.com/watch?v=UqPr_cy02PA

  6. judybier, first of all, do not say therapy failed me. This did not happen, and I would never put myself into a position where one could say that that had happened. I am not a confessional pity seeker. I am a fighter, and just like in any other guerilla war, I protect and defend the privacy of my affairs.

    Psychotherapy is wrong because it is profiting off of the misery of others.

    And again, who is ‘not so bipolar’ or ‘not so autistic’ is not important, as not one should be taking advantage of people by asking then to disclose personal affairs.

    And again, depression, mania, autism, what ever, the answer is always the same, give that therapist the middle finger.

    And talking about the ‘clients state’ is just a way of putting the responsibility for the fact that they live in an unfair and abusive world back onto them. Again, the perfect remedy is the middle finger.

    We don’t need community psychotherapy centers, what we need is political organizing to punish abusers and obtain reparations for survivors, and to restore people’s social and civil standing, their honor.

    Psychotherapy and healing are just completely wrong headed approaches and should not be tolerated.

    It takes activism, a grassroots effort to refuse all psychotherapy, psychiatry, and recovery in all of their forms, and instead insist on and obtain penalties for perpetrators, reparations for survivors, and restoring of the social and civil standing of survivors.

    Steve Gilbert, I am glad that that time with that therapist went well for you, and based on what you say I can see why you value it.

    But there is a problem in that most people do not know that they should be extremely careful in what they disclose to a therapist, because that is how they transfer responsibility back onto the client.

    You may indeed have gained much from that therapist, but the reason for this is that they were not doing the things a psychotherapist does. This therapist had no need for a psychotherapy license, or for a shingle which said ‘psychotherapy’.

    We already have ‘Philosophical Councilors’, and that is completely open ended as to what it can be.

    But consider also, why do you need to go to someone’s office and pay them and confess to them. It is so very much like what religion does. If Western Religion were not such an abject failure, Freud would never have been able to get started.

    Political consciousness and political activism have to be the way. Work with groups of like minded and like interested persons, learn as you man the barricades and fight shoulder to shoulder. What gets people out of their heads is when they are taking risks to defend themselves and others.

    What terminates Uncle Tomism is simply the demonstrated ability to politically organize, and the willingness to take risks in defending ones self and others. This is what restores the public honor which the Mental Health System, the Recovery Movement, and Evangelical Religion are designed to take away.

    Bradford, rather than debating with White Coats, we need to have our own forum where we can plan and take actions, things which take down the mental health system, instead of giving it a forum by which to try and repackage itself.

    Judi from Canada, I am saddened to hear about what you have been through. Domestic violence and abuses are one of the most crippling things around. And then to hear that you have been disabled, greatly bothers me. And I can understand because I know of cases of domestic abuse where the legal system is not sufficiently protective and turns against the one demanding redress. Seems that judges and prosecutors also persecute those who appear to be out of compliance with the Self-Reliance Ethic. They are advancing Capitalism, Social Darwinims, and the Middle-Class Family. So the legal system turns into another round of violation and abuse.

    We need to make corrections to our legal system, and we need to make sure that our medical system does not itself turn into another round of abuse of survivors.

    I hope you have terminated all contact with the mental health system, with its drugs and with street drugs, and with any talk therapists, because such therapists will never really be on your side.

    • TF3: I don’t disagree with your sentiment. But I don’t agree that fighting for “privacy” is going to win the battle for people abused by the system, in the long haul. The big fight will be won, when the millions of little battles are won. For example, the label I wore for 30+ years, was “bipolar”, though I never believed the diagnosis. I was marginalized before I felt ill and after, though I was never fully aware of stigma, for years. (Most of us aren’t born WOKE, so to speak. Some of us find out later in life.) Once I had some facts, which I learned from a research group in Wisconsin, some peer support which I received from an advocacy group in California and with the help of my primary care physician who suggested I stop my meds… I was able to “fight” to shed the label, the diagnosis, the treatment and years of living under stigma. Of course it would be best to have never suffered at all. To quote myself a few days ago: “No therapy will ever be better than preventing pain and suffering, ending social inequities, values and beliefs that marginalize and keep people from knowing they are valued as much as the next guy…the basic human belief that promotes positive mental health.)” My “misery” was from no single source, but the lifestyle of stress I’d chosen. (Yes, some degree of agency, taking responsibility, finding the “stuff” with ourselves, promotes “winning”. My “misery” was certainly not from a single gene or even a single individual. There are millions of stories describing “abuse” by the “system” – to use your terms – but approaches that push back on the “oppressor” without taking care of the “oppressed” can be stifling – having a chilling effect on the individual battles, which others are attempting to win. It will be the accumulation of many little fights being won, which will bring success…in my humble opinion. Tell your story. rr

  7. Regarding the labelling that is currently going on – these labels not only disempower the patients but also lead to increased stigma (i.e., referring to someone as ‘bipolar’ or that someone is a schizo, as well as other DSM labels that often end with “disorder”). Additionally, receiving a label and being told that these are ‘long-term conditions’ (which is what is happening now) could lead to further progression of these conditions through nocebo effects (i.e., negative expectations leading to negative outcomes: opposite of placebo effects).

    Research has also found that ALL symptoms listed in DSM (used in the labeling process) are normally distributed in the population – that is, they happen as a continuum in the population [reference: Understanding Psychosis and Schizophrenia (2017) by the British Psychological Society Division of Clinical Psychology]. It is just that as a result of specific life experiences, some people sometimes have extreme readings in some of the symptoms. At the same time, we cannot deny that people need help to cope with whatever they are experiencing.

    As I see it, instead of assigning labels to people, why not use some type of a coding system that can be used by doctors only to record an individual’s level of stress, the level anxiety, etc., so that the progress of the patient can be monitored. A code may look like A3S5W8 – meaning anxiety rating of 3, stress rating of 5 and ‘worrisome thoughts’ rating of 8. Then, once these numbers return to normal levels, the person can be considered as not needing further help.
    I think such a system should perhaps replace the current DSM labeling.

    • Are you an attorney or at least familiar with any, TF?

      If so, I have an idea for a class action suit against psychiatry or Big Pharma–not sure which.

      A lot of those diagnosed with “Bipolar” wound up with the label due to a very bad reaction to an SSRI triggering what some call “psychotic mania.” The point of the lawsuit would be to draw public attention to 1. how easy it is to get labeled as SMI. 2. How these drugs hurt people. 3. How harmful the labels themselves are.

  8. In defense of Tom Strong:
    I think you’re basically a “good guy”, who means well, and wants to help people. But that’s not enough, Tom. Especially not if you’re gonna write here at MiA. As good a person as you are, I think you’re also self-deluded as to the “Nature of the Beast” within which you work. There *WERE*, after all, Nazi concentration camp guards who had wives, children, and pets. I’m sure there were at least a few guards who enjoyed petting the family cat, playing with the family dog, and watching the children laugh and play. Of course, all that good stuff happened when they were off-duty from guarding Jews in the death camps. So when you come here to MiA, you’re not talking about *US*. You’re talking about YOU. Sure, you love your patient “pets”, and client “children”, but you’re part of an EVIL, FASCIST system that has done, and continues to do, far more harm than good. Yes, I’ll say it as explicitly as I can.
    “Psychiatry and the mental health system are as evil as Nazis and Fascists.”
    If it were possible to *FORCE* psychiatry to answer the question below, what do you suppose they’d say?
    “If what the psychs say is true, that psychs & psych drugs “help” people, then how does psychiatry explain the fact that the more psychiatry we have, the more so-called “mental illness” we have?”
    I know I’m really not so clever by asking these questions.
    Psychiatry will answer the way they ALWAYS do. they will simply **LIE**.
    But still, I wonder what *YOU* have to say, Mr. Tom Strong? RSVP?__________________?………….?…