Busting 7 Myths About the Practice of Psychotherapy

Enrico Gnaulati, PhD
196
2962

Confessing to a friend or family member that you were entering therapy used to mean something. It was akin to divulging that you were embarking on a quasi-spiritual endeavor to take an honest inventory of your past, to forge a truer self, to develop a greater capacity to love, to learn to live more intentionally. It also meant to better understand and productively express your emotions, and so alleviate anxiety and depression stemming from the suppression of self.

But we live not in the age of therapy, but of “mental health interventions.” The prevailing wisdom is that people are better off managing their mental health symptoms by turning to medications and availing themselves of short-term therapy aimed at speedily correcting thinking errors and changing unwanted behaviors. This is due to several pernicious myths about what treatment is effective and what kind of psychotherapy coverage is actually available under most health plans.

Myth 1: Psychotherapy is Mainly an Over-Utilized Service by the Worried Well

From a public policy standpoint, the major concern should not be that too many Americans are indulging in psychotherapy with doubtful progress. It should be that too many of our citizens receive an inadequate amount of psychotherapy despite its proven beneficiality.

High psychotherapy drop-out rates are one of the best kept secrets in the mental health field. Data from the Medical Expenditure Panel Surveys reveal that only about 9% of Americans who enter therapy continue for twenty or more sessions. This is alarming given that the most conservative estimate of the number of therapy sessions required for 50% of clients to show short-term improvement is 21, according to Brigham Young University professor Michael Lambert.

Myth 2: Short-Term Cognitive Behavioral Therapy (CBT) is Sufficient for Most People

While short-term CBT — changing exaggerated thought patterns and harmful habits — may have its appeal to the average overscheduled and efficiency-conscious American, its benefits don’t always last. A recent study out of the University of York, spearheaded by Shehzad Ali, found that 53% of depressed clients who underwent short-term CBT relapsed within a year.

And that figure may actually inflate the number who are adequately served by this form of care. A 2013 American Journal of Psychiatry study of 341 clients who were given sixteen sessions of CBT discovered that a mere 23% exhibited sustained recovery from depression.

Myth 3: Long-Term, In-Depth Psychotherapy is an Outdated Indulgence of Questionable Benefit

Long-term, in-depth psychotherapy is making a comeback. The latest findings of the Tavistock Adult Depression Study (TADS) show that 44% of depressed clients who were provided 18 months of weekly psychoanalytic psychotherapy (i.e., dealing with difficult past/present relationships and repressed emotions) no longer presented with clinical depression two years after treatment ended, compared to 10% of those receiving standard short-term CBT, or medications.

Myth 4: People Prefer to Take Meds than Talk to a Professional

Researchers at McLean Hospital in Massachusetts analyzed 34 studies involving over 90,000 people who were asked to select a straight preference between psychotherapy or psychiatric meds to address their psychological needs. Seventy-five percent of participants expressed a preference for psychotherapy over meds.

Myth 5: Psychotherapy Coverage Just Makes Health Care More Costly

It is commonly accepted that upwards of half of the patients on a physician’s caseload have medical problems that entail a strong psychological component. And, based on a landmark study by psychologist David Lechnyr, persons not in therapy are roughly twice as likely as those who are to visit a physician for no clear-cut medical reason. Psychotherapy is simply much cheaper than avoidable time spent in a physician’s office, a hospital ER, or an MRI chamber. Analysis by Nicholas Cummings, a pioneer in the field, points to a reduction in health care costs of 20 to 30 percent above the tab of the therapy treatment itself.

Myth 6: Rising Insurance Premiums are Due to Pricey Payments to Providers

Despite spiraling health insurance premiums over the past few decades, little to none of the added revenue has been allocated to reimbursing providers of mental health care at reasonable rates for psychotherapy visits. Blue Shield of California currently reimburses a client of mine $40 for a sixty-minute session, which is about half what a midlevel psychotherapist charged in the 1980s. The Practice Organization of the American Psychological Association estimates that since 2001 there’s been a 35% drop in the amount Medicare pays for a psychotherapy visit. Private health insurers typically adopt Medicare benchmark fees and pay for psychotherapy accordingly.

Myth 7: Mental Health Parity Laws Mean that Your Insurance Will Cover Your Psychotherapy Costs

A recent report by the risk management and health care consulting firm, Milliman, discovered that mental health services are four to six times more likely to be provided out-of-network than general medical or surgical services. In Washington, D.C. alone, about 63% of mental health related office visits were out of network in 2015. Here’s what’s behind those statistics: droves of psychotherapists are unwilling to contract with insurers because of low reimbursement rates, leading to costs being shifted from insurers to clients who end up paying out-of-pocket for needed care. This means that only those who can afford it get the help they need.

All in all, it is not enough that public policy pundits push for greater access to mental health services. Alongside improving access, there needs to be renewed focus on the quantity and quality of psychotherapy the average American currently receives. Health insurers will need to reexamine their false assumptions about the effectiveness of short-term, quick-fix therapies. They will need to abide by the parity laws in ways where reimbursement rates to providers are raised to levels that keep them commensurate with those of other health care providers, so that consumers are able to locate well-trained, seasoned mental health professionals available to provide in-depth, time-intensive psychotherapy of the sort that consumers really need to achieve meaningful and lasting change.

196 COMMENTS

  1. As a therapist in a community mental health setting, I completely agree. While CBT is an excellent treatment choice for certain issues, like panic disorder and generalized anxiety disorder, for it to be most effective, it has to be provided in a very structured, consistent manner, and frankly many therapists are unable to provide enough access to ensure that the full protocol is completed. I, for instance, do provide CBT to some of my clients, but at best I can usually only see them twice a month. For many client problems, intensive, consistent treatment provides the best opportunity for healing. Our mental health system is inadequate in terms of access, and because of this we see higher than necessary drop out rates and slower progress than is actually possible if providers did not have such high caseload sizes (I am expected to do two groups a week, two intakes, attend meetings/supervisions/trainings, and see 80 clients every two weeks or so). Unfortunately, insurance/payers dictate how most people receive therapy and mental health and substance abuse treatment, except for those who can afford to pay out of pocket, which is not the majority. Healthcare should be provided in a timely, affordable, and accessible manner, plain and simple.

    • When I came off a Long Acting Neuroleptic injection 35 years ago my recovery was of a self learnt “CBT” nature. My main problem at the time was “anxiety” and “CBT” worked completely, but it took time.

      People might have the problem of accessing any useful Psychotherapy on the NHS, this is why I think there’s a need for people to set up their own Mutually Supportive Groups independent of the NHS.

    • With 73% of adults opting for meds over CBT, it’s a discouraging stat that shows a pattern of dis-communication IMO. No one teaches the kids how to communicate when it counts (elementary school, middle school, etc). With many very young parents not knowing how to parent and opting out of church; that leaves the child to the mercy of the streets.
      Had to mention the church; even though I don’t believe in God. As a child I was sent to church every Sunday. It was in church that I learned manners and how to treat others.

    • Your link doesn’t work, streetphotobeing.

      I agree, “there needs to be renewed focus on the quantity and quality of psychotherapy the average American currently receives.” Right now most psychologists and therapists believe in the DSM disorders, despite the fact the DSM disorders were confessed to be invalid in 2013.

      https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

      And, of course, spending time talking to a person who is only interested in picking out a DSM billing code, is of less than zero value to the clients.

      And the truth of the matter is, according to the “mental health” industry’s own medical literature, the number one cause of distress, by far, is child abuse or ACEs. But NO “mental health professional” may EVER bill ANY insurance company for helping ANY child abuse victim EVER. Because child abuse is classified as a “V Code” in the DSM, and the “V Codes” are NOT insurance company reimbursable disorders.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      And since today’s “mental health professionals” may not bill insurance companies for discussing child abuse, they tend to deny it, and misdiagnose their clients with the billable DSM disorders. This has resulted in huge percentages of child abuse victims being misdiagnosed with the billable DSM disorders. Today over 80% of those labeled as “depressed,” “anxious,” bipolar,” or “schizophrenic,” are actually misdiagnosed child abuse victims. Over 90% of those labeled as “borderline” are misdiagnosed child abuse victims.

      https://www.madinamerica.com/2016/04/heal-for-life/

      Perhaps the therapists should consider giving up their belief in the “invalid” DSM, and consider actually trying to help their clients with their real life concerns?

          • Thanks, Fiachra. I saw someone else recommend that book the other day, I may pick it up. Is it in bookstores, do you know?

            Hey, I noticed yesterday that when a person now searches the internet for ‘can antipsychotics cause psychosis,’ the truth is finally the number one answer.

            “The antipsychotics / neuroleptics are anticholingeric drugs. And it is possible for these drugs to cause psychosis, hallucinations, and all the symptoms of schizophrenia via something called the central symptoms of neuroleptic induced anticholingeric intoxication syndrome.”

            Apparently that’s just on the bing search engine, not google. But progress is starting to be made at least.

  2. Joanna Moncrieff fails to recognise the horrific Akathisia epidemic induced suicide ideation and completed suicide. I’m sure Pariante was waiting for this. You see no MH professional who prescribes these drugs will admit this. Let’s move on from MH prescribing professionals.

  3. Akathasia must be horrible. I have seen friends with it. Not surprising it leads to suicide. Nasty stuff!

    For me, the main thing that led to my suicidal desires was the diagnosis itself. It alienated me from humanity even as the mind altering drugs alienated me from my own psyche. It made everyone regard me with fear and loathing–which made me want to die.

      • “it isn’t treatable with drugs but likely with manganese salts”

        Can you explain how re manganese salts? As far as I’m aware there is no easy way out of Akathisia, especially if a person has been on a drug long term and has the dose changed or changed to another drug with little taper and gone into akathisia. The correct course of action is to taper off all the drugs with the possibility of withdrawal akathisia and many other withdrawal issues. But what actually happens is the ‘doctors’ see it as a deepening of the illness, yes they (GP’s) might do physical tests which may-well come up negative which will reinforce the deepening MH diagnosis. But if there is a problem – say thyroid, it’s just more drugs and a spiral into horrific hell.

      • Bcharris, I’m in terrible physical pain since tapering off my Effexor and Abilify. I’m allergic to a lot of stuff and itch from head to toe. Plus my whole body cramps continuously so I ache and tire very quickly from light housework and short walks.

        What would you recommend?

    • This book was written 30 years ago when psychotherapy looked much different in America than it does today. Therapy is much more client-centered now than in the 80s. Psychiatrists rarely provided therapy today, whereas earlier on they were the primary therapist and prescriber for their clients. Today I view psychotherapy’s main problem being a lack of access to people who need it the most. We do have some excellent therapies for folks, such as EMDR, CBT, TREM, and ACT, but people who want an alternative to pills may have to wait too long and often cannot come to weekly individual therapy appointments without paying out of pocket.

      • Unfortunately, my experience is that the majority of psychotherapists these days adhere closely to the “medical model,” including applying DSM diagnoses uncritically and referring clients for drugs when they fit certain diagnostic categories. In particular, people who don’t have great insurance (which includes probably the majority of Americans) don’t have much choice and are not informed of options that are or should be available, nor are they informed of the potential damage these drugs can do.

        I recall talking to a woman on a crisis line who was frantic after a year plus of trying different antidepressants without results. She was feeling completely hopeless until I asked her, “Has anyone ever told you that there are other things you can do for depression besides drugs?” She stopped for a second, and said, “No…” When I told her that there were, she was SO relieved! Imagine, a whole year plus interacting with mental health professionals, and not one had told her there was another alternative?

        The idea that therapy is better today than in 1970 doesn’t seem right to me. At least back then, they had the idea that talking and listening was part of the process. Today, it’s much more about categorizing and changing “symptoms” rather than exploring meaning and options. At least that’s my experience.

        • Hi Steve,

          I would argue that most of us professional therapists don’t adhere to the medical model much, as we aren’t trained to think in terms of disease. But the reality is most of us work within the medical model, which requires us to follow certain guidelines in order for our agencies to get paid so that we can provide therapy. Actually, I hear that psychiatry and our pharmacy in my clinic is losing money, so maybe there is hope that one day we would only focus on therapy that didn’t require us to label everyone we see. I cannot admit a client into our program without a DSM diagnosis; the only other option for folks is to see private therapists who don’t diagnose and charge $100 or more a session, which is unaffordable to most. I will say that even our doctors at my clinic will talk with clients about behavioral strategies to manage or cope with various symptoms, so I know most of them try to provide some form of counseling. However, when they only see their clients on average of once every 3 months for 30 minutes, this is difficult on everyone. It’s inadequate. I think you should come visit my clinic, which is the largest in the state, because here we do focus most of our work on talking and listening. Many of us more or less ignore the diagnostic label and focus on the individual’s concerns and needs. If they don’t want pills here, they don’t have to take them. I’ve encouraged more of my clients to consider other options besides pills, but for some of them, they see no other choice. The other reality of your example of the individual with depression is that when someone is very depressed, the very idea of doing things actively can seem pretty overwhelming and difficult due to lethargy, anhedonia, poor sleep, etc. Even though it isn’t popular on this site, I do believe that some people make real positive strides on antidepressants to help energize them into being more active in their lives. The other issue is that primary care docs, who often are inadequately trained in mental health treatment, are the docs prescribing mental health pills. They don’t have much time with their patients, and thus people don’t receive adequate follow up and informed consent.

          • I agree with most of what you said, though I see your clinic as being an anomaly compared to the low-income clinics I am aware of.

            Also, the woman I was talking about wasn’t too depressed to consider taking action (and honestly, I don’t buy that such a condition is anything but exceedingly rare – people CAN take action, but they have to find a REASON to take action and have HOPE that it will make a difference!) She was EXCITED to hear there was something else she could do. No one ever bothered to tell her that she had options.

            Glad to hear your clinicians are up on the BS involved in DSM diagnoses. I hope it spreads!

        • Before the mid 1980s people were only normally prescribed anti depressants in hospital. Depression as an illness has now been turned into something very serious that anyone could have. Family doctors have also been sucked into the delusion.

          • If you aren’t into “therapy” you shouldn’t be forced. We definitely agree there.

            Frankly I think life coaches would be just as helpful. Plus they don’t work with the Disease Model.

          • You better watch yourself, Rachel777. I hear that you can be moderated for not encouraging therapy, and the continual expansion of the “mental ill health” system, as doing so is likely to be perceived as a personal attack on the endless consumption who those who partake of such.

          • Oh, please! Don’t know where you’re hearing this, Frank, but there is no moderation for content, just violating the guidelines we all agreed to. Do you see anything about “discouraging therapy” in there?

          • I don’t know where you’re coming from, but I was accused of personally attacking someone when I had personally attacked nobody, so I guess you need to be looking a little closer at the fine print to find the reasoning for my being censored. I certainly couldn’t find it.

          • Hmmm, that doesn’t sound right. I’ve certainly seen plenty of articles and comments criticizing therapy and advocating for a wide range of other alternatives, including the abolition of the mental health field entirely. But I trust you and I’m sure you would not make up something like that, so it’s a bit puzzling to me.

          • I guess for me the question is more is the person attacking the comment/concept or the person making the comment. It is easy sometimes for one to drift over into the other. I’ve been moderated a few times myself, but it always made sense to me (even when I didn’t like it or might not have interpreted my comments that way). But it seems a pretty grey line to me. Tough job being a moderator. I’ve been there on a very different kind of site. Kind of like being a referee – no matter what call you make, someone’s gonna be yelling at you.

          • To Frank and Steve,

            At 2 o’clock this morning, nearly 16 hours ago, I wrote in a community elsewhere about the community here at MIA. I am slightly stunned to read Frank’s comment! It’s as if he must surely be a member of the community where I spoke about MIA lol! Or, he and I both have made the same observations over the years.

            I did note that upon my recent rearrival to this community I have found that the moderation standard seems a bit more lax (although Frank HAS been moderated within this article). The moderation here had been so tight and stifling in the past that it’s no wonder this community stagnated!

            Lastly, I’ve been reading Rachel777’s commentary. She’s wonderful! What a gem. GOOD comments, Rachel777!

            Frank, consider yourself validated. I know precisely what you mean.

            Steve, as always you’re another true gem of the community. All of the Steves here are!

            Keep fighting the good fight, everyone!!

          • Thanks.

            I’m not trying to be difficult. I had a number of comments to this blog moderated, and I was trying to excuse it for awhile, but then it happened again, and I thought for no real reason. Perhaps if I squint at the guidelines long enough I can find it.

            Always love your comments, Rachel.

            Steve, if my comment above gets “moderated”. Remember what I wrote.

          • Hi all,

            I want to clarify that it is perfectly acceptable to criticize the mental health field/industry on Mad in America – in fact, that is the purpose of our site!

            However, it is against our posting guidelines to call mental health professionals or mental health consumers derogatory names. I moderated two comments calling mental health professionals “the mental health gestapo” and mental health consumers “wastrel.” Please make sure to keep your comments and criticisms respectful.

            Best regards,

            Emily Cutler
            Community Moderator

          • “‘Mental health’ gestapo” I feel is a legitimate comparison, especially considering the close ties between psychiatry and the Holocaust. Plus this doesn’t sound like it’s directed at a particular person, and it may represent someone’s personal perception or experience of psychiatry, which should not be invalidated.

            I agree that victims of psychiatry (“mental health consumers”) should not be subject to personal insults, but unless it’s directed at a specific person I don’t think this falls within the realm of a personal attack either.

          • I, for one, find the moderation in this community to be oppressive, stifling, discriminatory, overly sensitive, conducive to too much of a “safe space” where reality is blotted out, too sterile…

            It’s a “mental health facility” when it used to be an awesome college university with bleachers and a library and a garden and extracurricular activities.

            I’ve just hung a couple of framed pictures on the wall! I’ve been to therapy (where my little inner artist was forced to exist and grow!).

            Mostly I’m a comedienne but perhaps my artist wig will have to suffice for this task.

            Anyway, y’all be civil now ye hear? Muchas gracias!

            ~ Alive In America

          • I’m against “consuming” “mental health” BS. As I’ve been trying to explain, Is there another way to put it? I did not direct any sort of ad hominem attack against any person in particular. Doing so would have been a personal attack as you put it. I would prefer to see the numbers of people receiving services for imaginary “diseases” diminishing rather than increasing. Of course, you must be well aware by now that the customary treatment for some of these imaginary diseases are known to cause real injury to the human anatomy. Oh, well, life goes on. Death and dying, too.

            You’ve got a lot of people here in the treatment business. Where would they be without it? You’re also visited by people in the career “consumer” business. Where would these numbers be without it? Certainly not higher than they are at present. Something to think about for sure.

            I think the real fight has to be directed against the “mental health” movement. It is not a “mental health” movement at all, it is a “mental health” treatment movement, and the first precondition for treatment is a “mental illness” label. Sell labels and sell treatments, and where do the numbers go. They go up.

            Two states, as well as having psychologists and psychiatrists installed in their school systems, observing and monitoring behavior, are making “mental health” a required subject. What do you think this will do for the numbers? Well, let me tell you, it is not going to send them down.

          • Hi all,

            Frank, it is perfectly acceptable to critique the receiving of mental health services as you have above. What is not okay is calling mental health consumers derogatory names such as “wastrel.”

            Oldhead, it is also acceptable to make arguments, as you have done above, as to why mental health professionals may be similar to the gestapo. But it is against our posting guidelines to refer to all mental health professionals as “the gestapo” or “Nazis.”

            The key here is to stick to criticizing ideas, industries, systems, organizations, etc. and not individuals. I hope that makes sense.

            Emily

          • Well if mhp’s can’t be referred to that way, especially in light of history (and when it represents someone’s personal experience), no professional should be able to make blanket statements about “clients,” hence most of shaun f’s insulting and dismissive statements should be deleted too. I would like to see the specific guideline supposedly being applied here. Is the possible reason for this that shaun f has been “reporting” comments?

          • Oldhead, it sounds like it’s really hard for you to hear differences of opinion. This is the internet, and not everyone agrees.

            I would also love to see your evidence in my posts that I’m insulting. Please, go for it. I’m happy to defend myself. If you look at the pattern of your posts towards me, it sure seems you are doing your best to simply make me go away because you don’t like what I’m saying.

          • No, please don’t go away — your posts make my points better than I could myself. They’re valuable instructional material for those developing an anti-psychiatry perspective. Especially when you clearly don’t even get how condescendingly you come across.

            P.S. Someone should introduce you to Brett Deacon, you would get along spectacularly.

          • Like I said earlier, I would appreciate you back up your claim that I’m insulting. I’ll be waiting. And by no means do I intend to insult anyone, and I sincerely apologize if I’m upset anyone who has been harmed by the system.

            If you think it’s insulting because I have said that many of my clients report improvement in the current system, that is just purely fact. Some people do actually find their symptoms subside and attain improved outcomes with current treatments. If you find that offensive, well I then I think you are hypocritically being dismissive of the very people you seek to protect.

          • Hey Oldhead I’m still waiting for any proof that I’m writing insulting comments. You are very good at making accusations but can you actually back them up? Tick, tock.

          • And to be clear, Oldhead, I haven’t reported any comments on here as being inappropriate. I have expressed the feeling that I’m attacked in some posts, but I have not contacted the website admin. Your unjustified comment above just one more example of you making assumptions about me.

          • I accept your disavowal. I hardly think it was an unreasonable suspicion, considering your general attitude.

            Insults are in the eye of the beholder, and I don’t have time to catalogue every bit of barbed innuendo in your posts here. It’s an open book for all to see. Besides you pretty clearly wouldn’t get it anyway, as Steve and others have tried to soften up your ego here to no avail.

          • Oldhead, just as I figured. I guess I would think that if I’m making regularly “insulting” comments you could easily find examples to show me. Like I said before, if I have made hurtful comments, I am happy to rescind them and apologize.

            This kind of situation reminds me why internet conversations are too often pointless. I’m pretty sure we’d be interacting better if we were face-to-face because it would encourage more respectful dialogue. It is similar to political cultural wars that exist in America today. Us vs. them. Never goes well because people become defensive and stop listening.

        • I’m sorry to hear your experience is so negative. Unfortunately the mental health system has remained connected to the DSM. I hope one day that changes. You are right that relationships in everyday life are probably more meaningful than relationships with one’s therapists, but I wouldn’t discount therapeutic relationships, as I’ve seen many benefits for individuals within this framework. Therapy isn’t for everyone, but for those who engage in the relationship, I know real positive change does occur.

    • Thomas Szasz did write his book awhile back, but hey, consider, what was formerly NARSAD (National Alliance for Research on Schizophrenia & Depression), now called Brain & Behavior Research Foundation, did a survey of psychiatrists a few years back in which they came up with a Top Ten “mental illness” myth list. I feel that that list was a response, in part anyway, to an even earlier book by Szasz. You may remember it, in fact, it was published in 1961 under the title The Myth of Mental illness. The Myth of Psychotherapy was first published in 1978. I don’t see how this difference of opinion differs appreciably from that difference of opinion

  4. I don’t know what get a real job means? Low income individuals in my community cannot access any other mental health treatment than what we offer at my facility. I know I am doing good work, so I don’t care what people like you think since you are responding based on strong emotions. Good luck in your journey.

    • Shaun, my biggest problem with counseling is the way it sold out to the bio-bio-bio model. Most of my therapists would ask if I was “meds compliant” remind me to set “realistic” goals for myself and only to date other mental patients. My last counselor told me repeatedly to go out and fornicate before I got too old. I wasn’t the only patient she gave this advice to despite our religious beliefs and protests.

      I fired her. Looking back, therapy had become counterproductive since I talked my problems to death instead of fixing them or learning to accept and cope. I’m not against (good) counseling though. At least the voluntary kind.

      Many benefit. I did. For a time.

  5. Oh it’s great c working at the center and not even beginning to describe in detail.

    Fine after while. On one occasion we went to park and had picnic and therapy. We made real tomato ketchup p c said. Smiles and good times after all it was over as last year we did it too.

    Then scene was viewing walking to their car and I was just about to pack all the agency belongings and head back there. It’s something I’ll always remember and then tada hhmmhh. It was totally worth it. The day went great.

  6. It seems that the overriding concern here is getting insurance to pay for counseling (which is a more realistic term than “therapy” in any case).

    Debates about “psychotherapy” are meaningless in that the term has endless variations, definitions and underlying ideologies and/or philosophies. And ultimately the deciding factor in whether the process is of any value is the individual counselor, not the “technique.” One person’s “CBT” is another’s “transactional analysis.” Plus, as with psychiatry, “therapy” is a metaphor.

  7. Shaun f, you said “most of us professional therapists don’t adhere to the medical model much”. When you think that people respond based on their “strong emotions”, then you have ignored the whole context of the discussion, blamed people for being irrational and you as the authority had nothing to do with their reactions – that is exactly what the medical model does

    • When I’m told by some, Gerard, to “get a real job”, that is clearly emotional. I’m a therapist who works in a setting which some on this site wouldn’t support, but so be it. I don’t pretend to be an authority with my clients. Too bad you can’t ask them how I treat them and our work. It seems many on this site are hostile to people in my position because they’ve had poor experiences in the MH system, but I’m not responsible for your trauma. I think it’s called projection. If you want to alienate potential allies to your cause, you are always going to be a group with little power and influence over how the system works. Keep attacking people like me, and you’ll be talking to yourselves about how horrible the system is but nothing with change. Enjoy that.

        • Human beings are emotional. Frank is a human being.

          If by emotional you mean raving hysterically, no he was not.

          MI Experts can be pretty emotional. But since they don’t have to worry about being locked up, drugged, or shocked their emotions consist of getting angry and offended at their patients’ complaints at the way they are treated–the lack of these wretches’ gratitude, honor, respect–maybe veneration…Hey, is a little burnt incense too much to ask for?

      • If you can acknowledge that people have been abused and traumatised by the system then perhaps you can be more respectful of that instead of calling people emotional. One wouldn’t expect that from someone who refers to themselves as “people like me”

        • Gerard, no doubt people have been abused and traumatized by the system. People have also been abused by their family systems, criminal systems, school systems, religious systems, political systems, and just about any other system created by humans. As a species, we are highly flawed and thus we damage each other. I hope one day we can find away to stop traumatizing each other, but I fear that day is much too far away, if it ever comes.

          Regarding calling people “emotional”, I was only referencing Frank’s comment that I should get another job. The reality is he doesn’t know what I do or how I treat my clients. He clearly doesn’t know that I cherish my time with my clients, that I don’t define them by their diagnosis, that I ask what happened to them rather than what is wrong with them, that I respect them as autonomous, intelligent humans who simply have been traumatized by a toxic world.

          • Good on you for the work you do. Many people have and will continue to benefit from counselling/psychotherapy (or whatever we want to call it)

          • Thank you, Gerard. I do try to do good work, but I do fear that the system most therapists find themselves in is tainted by the medical model and pills. We are told by our masters (payers, management) that brief therapy sessions are effective, even for people with complex trauma histories. This flies in the face of reality, and I struggle because I know that community mental health in America is the only viable treatment option for those who are low income. Everyone deserves access to quality care, and to care which does no harm and gives them adequate space and resources to heal. I doubt that any antidepressant, for instance, will help a trauma survivor heal from their emotional wounds. It may for some help them to come to therapy more often because they may have more energy, but it isn’t going to “fix” anyone. I believe that at the very least healing can take longer than it needs to because clients cannot come in as often as they wish for therapy. This is sad and frustrating.

          • Frank was angry. I’m angry. But not at you. Or any individual per se.

            I appreciate how you try to help people, Shaun. I would not want your job. The model you are forced to work with is a great way to keep people helpless and childishly dependent. Therefore it must be frustrating for you.

          • We’ve got a major medicalization problem. One is tempted to use words such a pandemic. Thing is, that’s rather absurd, isn’t it, as before you have a pandemic, first you need a “disease”? My position is merely that if “help” it is I would be offering, it would not be “help” to increase the numbers of people claiming to offer “counseling” to people with fake diseases, nor the numbers of people claiming to have fake diseases that might be, with time, miraculously “cured” through “conversational” means.

          • This thing is not letting me revise my comment, and so just let me say, “help” is the word the system most often uses to force treatment on people who don’t want to be treated. That kind “help” all kinds of people, including myself, can do without.

          • Rachel777, I would disagree that the system keeps people helpless or dependent. Actually, we offer and provide services to assist individuals increasing their independence through vocational counseling, education specialists who help people connect with local colleges and training programs, teach people new skills with computers, cooking, budgeting, etc., assistance with attaining basic resources like housing, benefits, medical care, furniture, clothing, food bank, and so on. Most of my clients tell me that they greatly appreciate these opportunities, since they often cannot find these resources in the community. And one thing to keep in mind is over 99% of individuals who take pills at my center do so voluntarily. The only people who may not would be those on a certification from my states’ court system, and even then they can refuse and go back to court to fight the order. I do not think anyone should be forced to take pills that they don’t want to take. Also, many of my clients eventually opt to stop pills, in part because they believe they’ve received relief in other areas of their lives and don’t feel the need to keep taking them. I encourage all my clients to get off meds if they feel it is in their best interest. I am not in the position to tell people what they should be putting in their bodies, other than more fruits and veggies! lol I’ve also had clients who have gotten mad at me or their doctor because we felt it wouldn’t be in their interest to prescribe medications.

          • Wow, 99% voluntarily? I find that more than a tad difficult to buy into. Do you actually have figures on that, or is that just your impression?

            Furthermore, how many of those “voluntary” clients have been lied to, pressured, misled, partially informed, or not informed at all about the effects, potential adverse effects, possible long-term deterioration, withdrawal effects, other treatment options, non-treatment options, etc.? How many were told or learned elsewhere that they had a “chemical imbalance” and had heard drug advertisements telling them that drugs were the main or only answer? How many were told that this was not really known to be the case, and that doctors actually have little to no idea what a “mental illness” really is? How many were children or others not in a position to provide genuine consent? Do you have any stats on those questions?

            Your post sounds like an advertisement for your treatment center. I seriously doubt there is a treatment center in the USA which gives 99% of its clients full informed consent about psychiatric drugs and alternatives, or even comes close to doing so. There is plenty of solid evidence that clinicians are not very good at evaluating the value of their own services. My personal experience tells me that those who ARE good at evaluating this are generally very humble and recognize fully the possibility that they may feel great about providing services that the clients actually are not benefiting from.

            I have been trying to feel sympathetic to your position, as I recognize that there is high potential value in QUALITY therapy with a gifted individual who is able to connect emotionally to his/her clients. I was fortunate to have found such a person myself in my 20s, back in the 80s when most therapists used psychodynamic approaches and a year or more was considered a normal length of therapy. But I can guarantee you that your clinic is not filled from top to bottom with such capable clinicians, because my experience tells me that they were never common and are becoming rare as hens’ teeth. And because such clinicians are to a person EXTREMELY skeptical about the current paradigm of care, and are generally quite original in their approach to each individual and are not committed to a specific “school” of therapy, it is highlyk unlikely that a community clinic would appeal to very many of them.

            Your confidence in the current model of therapeutic delivery at your clinic creates great skepticism in me as to your ability to be objective about the services your clinic provides. Again, this is not because I feel hostile to you OR to the concept of therapy – it’s just that the percentages say that your view has to be grossly overinflated.

            Perhaps I am wrong and your clinic is an impressive outlier. Nonetheless, your comment that you don’t see the system as keeping people helpless and dependent seems very far beyond your own ability to observe. There are many, many commenters here who have been the recipients of such services, and I take their word for their experiences as being the most valid source of information available. The number who report intentional and extensive efforts to create and maintain dependence and helplessness and total, unquestioning compliance with the authorities, is quite impressive. There are a handful who felt they got good services, and there are a larger number whose experience was mixed, but the majority report at least at some point serious pressure to limit their dreams as far as education and employment, to get onto social security/medicaid, to expect to be on psych drugs for the rest of their lives, and most report rather extreme measures, including often incarceration and enforced “treatment” with drugs, as the typical response to any attempt to empower themselves to move beyond what the system provides.

            While there can be at times a perhaps excessively rigid (IMHO) hostility toward any kind of ‘treatment’ from some posters here, my sense is not that you are experiencing hostility for being a treatment provider, but for trying to defend a system that has committed egregious harms against many people who post here. If you’re unable to accept the viewpoints of those who were so harmed, it is difficult to see how you will be able to engage in any kind of productive discussion on this site. I think the #1 value that underlies Bob Whitaker and the entire MIA community is that clinicians should not empowered to define their clients’ experiences for them. It appears to me that you have not embraced that value, and hence, you garner a lot of negative comments. Read some of Sandy Steingard’s or Johanna Moncreif’s comment threads and you will see a big difference.

            A little humility goes a long way, especially for folks like you and me who have not been on the receiving end of the ‘helpful services’ that “the system” provides, often without the consent of the “helpee.” I think we need to listen first and incorporate the reality of the commenters’ experiences into our own worldview. I hope you can hang around long enough to do that, but really, I don’t think it’s proper to blame the posters for responding the way they do if you’re not willing to listen to and validate their direct, personal accounts of their own experiences.

          • Oh, and by the way, I’ve historically been a treatment provider, including doing involuntary hospitalization evaluations, and nobody here has ever been particularly hostile toward me or my views on the possibility that people can be helped by quality communication and emotional connection. Some have disagreed with me on the hows and the whys of it, but no one has rejected my views out of hand or personally attacked me for having a different viewpoint. I think it’s because they feel that I understand and deeply care about their viewpoints and experiences and craft my posts accordingly. As a capable ‘mental health professional,’ it seems that applying your skills in human relations that you use in your therapy practice might help your messages be more readily received. Could be wrong there, but it might be worth considering.

          • Steve, I’ve already explained my position on other posts on why I have felt hostility, so I won’t say anything more about that. I can say I do listen to people, and I also make up my own mind like everyone else does about what is right and wrong. Regarding my last post, my 99% estimation is simply based on people who aren’t court ordered to treatment (on a 3 or 6 month certification). You are right that informed consent is lacking, that drug advertising is misleading, that family/community coercion is a factor as well.

            The vast majority of people who come into our clinic WANT to see a doctor about various options, per what they tell me. And many of my clients tell me that they feel better on medications. If I am to respect client autonomy, then should we be so dismissive of people who actually think they feel better on psych drugs? I have had many clients tell me that without drugs like Lithium they would not be able to function in society. It think it would be inappropriate of me to tell them that it’t really in their best interest to be off a drug that they’ve been on for years that they tell me they want to stay on.

            From what I see today the MH system is making more efforts to support people in full recovery, meaning that they wouldn’t need our services for their entire lives. Again people are entitled to their opinions about the system, and I do find the system I work in is probably more progressive and forward thinking than others I guess. At the end of the day I do think we’d all be better off severely restricting drug-based therapy for mental health, as evidenced by the experiences by the MIA community and what has been documented as problematic effects of these drugs. I am disturbed by drug effects like metabolic syndrome. I am also disturbed because doctors continue to guess as to what might help someone feel better, which basically means they are doing experiments on people. I do tell my clients that it is “trial-and-error” and that they may not find any relief from such “treatment” and will probably have “side effects”. Many of them still want to see a doctor anyway. I am glad that more people are coming to our clinic just asking for therapy. I do wish I could provide weekly therapy to all my clients so we could adequately work on their traumas, but I guess some therapy is better than none as long as it’s provided in a thoughtful fashion.

          • Well, I can’t say my experience is very different than yours regarding clients “wanting” drugs. I think it is an unfortunate “side effect” of the cultural shift toward believing drugs are the answer to everything, brought to us by our lovely pharmaceutical corporations in concert with a very corrupt psychiatric profession. I simply don’t believe it’s possible that these folks would all “want” drugs without the advertising. 80% of Americans believe that depression is caused by low serotonin, even though that idea was debunked scientifically in around 1985. What does one do about that? There is a much bigger picture here that I think we have a responsibility to attack. I encourage you to have a look at Julie’s article on Lauren Slater’s new book to see how a person who ‘Needs her drugs’ is living her life.

            Have you read “Anatomy of an Epidemic”, by the way?

          • Shaun F your center must be radically different from any I have ever gone to.

            I read an article by a therapist complaining about how childish and irresponsible his clients were. I wish I could find it. It was in Intellectual Takeout, but their archives are very hard to navigate.

            He sees the problem many “ex-consumers” here do, but can’t add two and two together. He just face palms and wonders where the four came from.

            Drugs aren’t about increasing independence, function and responsibility but making people passive and submissive. Hence childish and dependent. The Parent/Child relationship inherent in the system of MHCenterWorker/Consumer also causes this. Along with negative self fulfilling prophecies upon being “diagnosed.”

            I always LOATHED my drugs. They made me feel horrible. But I believed my psychiatrists and took the pills in good faith. 25 years of taking neurotoxins religiously as penance for the sin of being “defective” with a hereditary brain disease that turned out to be a harmless little joke the APA decided to pass off as hard science. A little metaphor. A funny gag.

            None of us are laughing!

          • Steve, this article sums up how I feel about the book. Some great points in Anatomy and others that are pretty weak:https://www.huffingtonpost.com/dj-jaffe/book-review-anatomy-of-an_b_1071163.html

            You are right that the world we live in promotes psych drugs. I don’t deny that. What I would say though is that clients who’ve been on these pills for years still see value in them. Many take them for a period of time and then stop, with mixed results. I encourage any of my clients who think the pills do more harm than good talk to their doctor about titrating off of them. I think that the pills too often get in the way of therapy, because some of them do numb people out to one degree or another. I agree with you that we should always challenge the status quo, as clearly we need to improve the system as it stands now. Deinstitutionalization was good and needed, but what replaced it is also inadequate and often unjust (e.g., jailing people, not offering sufficient resources and services, etc).

          • Rachel, I am saddened that your experience was so terrible. I can say that many of my clients who are on psych drugs do work and have quality lives. The ones who struggle with instability the most have severe trauma histories and usually are in poverty. These risk factors are significant IMO. There are many variables which contribute to suffering, and over time my hope when working with clients is that they know they are safe in my presence and that I genuinely care about them as equal human beings.

          • There aren’t many therapists posting on this site for a reason. I’ve felt attacked on here multiple times because I don’t agree 100% with what is posted on here. If you alienate potential allies like myself, I believe changing the MH system will become even more unlikely. I never said anyone is ungrateful but rather shortsighted in their attacks. Your perspectives won’t be heard by the masses if you don’t change your attacking and dismissive tone. That I’m confident of.

          • Ain’t talking to the masses right now, people are talking to you and responding to your apparently unconscious condescending tone, which seems to reflect your actual beliefs. It’s always interesting when we’re scolded by “mental health” professionals to show “respect” or else…what? You’ll stay the same?

            “Potential ally” — interesting concept.

          • Oldhead, you don’t know me, just as much as I don’t know you. I would hope you would understand that coalition building is important in creating lasting change, and frankly fringe groups rarely, if ever, get anywhere because they aren’t big enough (e.g., the Libertarian Party in the US). To fight Big Pharma will take an army, which is something that is missing from the anti-psychiatry movement.

            When you cherrypick my comments, you are ignoring many of the ideas which we actually have in common. This has too often been my experience interacting with people on this forum. It seems that I’m a target for hostility and frustration. I have no ill will towards you or anyone else who has been harmed by unjust systems. I believe everyone deserves dignity and respect. I also think that respect goes both ways, and if I feel I’m being disrespected by anybody, I’m not just going to sit quietly and say nothing. You can accuse me of anything you want, but just know that it’s your subjective opinion based on very little actual knowledge of me as a person.

          • I always find it telling when people here try to deflect a point by making it all about themselves and their sense of being “personally offended” or “disrespected.” When “professionals” do this it’s unprofessional to boot.

            So you’re raising an army? I think that violates MIA guidelines.

          • Oldhead, there you go again. Now you are calling me unprofessional simply because I happen to experience hostility on this website and actually say something about my experience. That is telling. I am not deflecting. It is clear you don’t see your role in creating hostile communications on this site. I’ve seen you make comments elsewhere here where you clearly are derailing conversations. I assume you get some amusement out of it, but it’s counterproductive. I’d be curious what your ultimate goals are. I mean, do you really want to see serious reform in the way mental healthcare is provided in this world? If so, I’d suggest you change your tactics. If not, then keep being antagonistic. If you seriously think I want to raise a literal army to fight big pharma, that is pretty funny. It’s called a metaphor.

          • I mean, do you really want to see serious reform in the way mental healthcare is provided in this world?

            Absolutely not. I want to see the concept of “mental health” thoroughly exposed and debunked. (“Mental health” is the mother of all metaphors btw.)

            I’d suggest you change your tactics

            As in “I trust you’ll make a wise decision”?

            If not, then keep being antagonistic.

            Spoken like a true authority figure.

          • Oldhead, I don’t see mental health care going away anytime soon. I find much value in it from a therapy standpoint. Many of my clients have healed their emotional traumas through treatment. I don’t care for the DSM, as it’s clearly a very flawed document. Hopefully one day we have actual science to prove what is and isn’t a “mental disease”.

          • Hopefully one day we have actual science to prove what is and isn’t a “mental disease”.

            We already have linguistics experts (i.e. “language scientists”), who will assure you that the very existence of a “mental disease” is literally impossible.

          • Well, clearly brains are implicated in human behavior. I don’t think hearing distressing voices, for instance, comes from our toes or elbows. We simply don’t know enough how the brain works and why some people experience “symptoms” that others don’t. There is still a lot to learn in that area, which is also why I’m increasingly uncomfortable with the system pumping people full of psych drugs when we don’t know these answers.

      • People are going to spend their lives constructing and repairing “psychological injuries”, or pretending to do so. Doing so wasn’t always the industry that it has grown into today. I would call this endeavor somewhat impractical and absurd, to say the least; however, it does give people something to do. I just wish they could be doing something sensible instead, and that despite the “disability” alibi.

      • “It seems many on this site are hostile to people in my position because they’ve had poor experiences in the MH system, but I’m not responsible for your trauma. I think it’s called projection.”

        I would not call it projection. They know who you are, what you believe, what you represent, and what you mean to them. You personally are not directly responsible for trauma you witness and interact with in this community. The trauma preexists you but you’re representing the source of harm. You’re not capable of identifying with the detriment of the industry you’re a willing member of. That’s the kernel; in order to bring an injurious industry to an end, victims of the industry hold the belief that people who work in the industry should acknowledge the harm and voluntarily stop participating. You’ll resist the call because you have favorable working experience. It’s that very limited utility of the industry that keeps it alive.

        • It’s not as simple as an African American hating Whites because he was threatened by KKK members or a woman hating men because she was raped. When therapists and other mental illness professionals comment here and boast about their expertise, they’re choosing the role of the “Expert” lecturing the mentally/morally inferior.

          I try to be just and charitable. Their desires to help are likely genuine. Even if they are as misguided as a 19th century doctor putting leaches on a cholera victim to purify his body of bad blood.

          Nevertheless they come across like the ladies in “The Lovers of the Poor” by Maya Angelou.

          • Rachel, I don’t boast about my expertise. All I’m sharing is my experience and what my clients have told me. I don’t see myself as superior. I have also been a client of mental health services, where I have received mixed experiences. Again, perceptions on internet forums can be misleading and false.

            I do find it interesting that my clients’ experiences are minimized by MIA, but it does go against the grain here. Many of my clients tell me that without the MH center that they do not believe they’d have jobs, housing, and stability. That is the truth.

          • Nobody said your clients didn’t value your services. I specifically addressed that elsewhere. If they didn’t like your services, they’d leave and you wouldn’t hear a thing, would you? Additionally, you are assuming other clinics provide similar levels of respect to clients at yours, which you have no reason to assume. Furthermore, clients have a habit of telling their providers what they want to hear, especially if they can sense that their clinicians need that reassurance. So the situation is much more complex than you describe. You make it sound as if clients being dissatisfied with the MH system are outliers. I can tell you from talking to many hundreds of clients that this is not the case. This is where you are sounding insulting to those who are not satisfied with their services. It feels like you’re dismissing their complaints by saying things like “I do find it interesting that my clients’ experiences are minimized by MIA.” A subtle but pretty barbed comment attacking the entire community here, or at least suggesting that those who post here are, as I said, outliers or extremists.

            I continue to note that you avoid commenting on the very critical question of whether you think depressed people all have something/the SAME thing wrong with them, regardless of external circumstances, and that they all need “treatment” of a similar sort (therapy and/or drugs). I find it interesting that you choose to avoid that particular question despite several attempts from me to get it answered. My guess is that your answer is “yes” but you either don’t want to admit it to yourself or don’t want to admit it to the commenters on this thread.

          • Steve,
            “Additionally, you are assuming other clinics provide similar levels of respect to clients at yours, which you have no reason to assume.”

            I’m not at these facilities, so I have no idea. I do believe that many people have had bad experiences within the MH system, including my own. And I know that many people do have positive experiences.

            “It feels like you’re dismissing their complaints by saying things like “I do find it interesting that my clients’ experiences are minimized by MIA.” A subtle but pretty barbed comment attacking the entire community here, or at least suggesting that those who post here are, as I said, outliers or extremists.”

            What I’m trying to convey is that my personal experience working with clients doesn’t exactly fit the same narrative here on MIA. I don’t recall seeing commenters on MIA recognizing that it’s reasonable or even possible that many of my clients would have positive experiences in the MH system. When I talk on this subject, it seems ignored or minimized. That is all I’m saying.

            “I continue to note that you avoid commenting on the very critical question of whether you think depressed people all have something/the SAME thing wrong with them, regardless of external circumstances, and that they all need “treatment” of a similar sort (therapy and/or drugs).”

            NO, I do not think depressed people all have the same thing “wrong” with them. I simply don’t know what is going on in their brains and bodies. What I do know is that they are usually suffering from some sort of trauma, despair, or mental pain. I don’t believe SSRIs or SNRIs are the answer, which is the opposite of what most psychiatrists would think. Treatment should be geared towards the individual not towards the so-called diagnosis. Life experiences cause depression.

        • Heavens,

          Like I’ve said elsewhere on MIA, I have mixed feelings about being in community mental health. I probably won’t be there much longer, because I do have genuine reservations about continuing to diagnose based on an unscientific process. The DSM is not helpful or necessary for treatment. I don’t see how pathologizing individuals’ traumas makes sense or helps them to move forward in their lives.

  8. ‘Psychotherapy’ is a private, confidential, conversation which has nothing to do with illness, medicine or healing -T. Szasz.
    Read James Hillman Re-visioning psychology to know what rational theologians (medicine law theology) have done with human psyche (psychological man).

  9. This stuff deserves a new thread.

    If I am to respect client autonomy, then should we be so dismissive of people who actually think they feel better on psych drugs?

    Most people would feel better on drugs. A few snorts of coke or speed might make my day (and night, and the next day and night) as far as my “feelings” might be concerned. Personally, I made the decision decades ago that I’d rather stay alive, and not just as a shell of my former self. The obvious point is, should someone’s claim that they “feel better on drugs” be seen as an indication that they need drugs, or as an indication that they have a drug problem?

    You are right that informed consent is lacking, that drug advertising is misleading, that family/community coercion is a factor as well.

    Oh yeah, that. But otherwise…

    Steve, I’ve already explained my position on other posts on why I have felt hostility, so I won’t say anything more about that.

    Felt hostile or felt hostility? At any rate, Steve, better bug off with the suggestions, you don’t want to be triggering anybody.

    • Oldhead, so you think the effects of coke and an SSRI are similar?

      Most folks I see who say their drugs improve their quality of life function better–eg, they keep jobs, have better relationships, seek higher education, etc–on psych drugs. Usually for illicit drug use that isn’t the case. I’ve never seen anyone on meth or crack doing well, whereas with mood stabilizers and SSRIs I’ve seen very functional people.

      I don’t feel triggered, Oldhead. I think your posts continue to make my point that you are trying to get me to react rather than try and have a civil conversation. I’m happy to discuss the merits of our different points of view in a respectful manner.

        • It doesn’t surprise me, Oldhead, that you didn’t answer my original question and diverted the conversation. I don’t feel threatened, I’m asking genuine questions. However, I don’t see us ever having productive conservations given your general responses, which is fine.

          I don’t see adderall takers losing teeth and becoming homeless as I do with meth users, but go ahead and compare them if you wish. Meth users don’t know what dose they are taking or what is in the drug. At least stimulant users know the dose.

          • What was the question? The thing about coke/meth vs. SSRI’s? I’d prefer the coke or meth, if I had to choose between heart damage and brain damage. Freedom of choice. With psychiatry it’s more like Sophie’s choice.

          • Well, your brain won’t function without a working heart. Also, to equate SSRIs to coke or meth is interesting. At least the former has some studies to back up their use, whereas the latter has never been shown to help people function better in the long run. Users have no clue what is in their meth or coke.

          • It’s easier to detox from meth or coke, but they are ALL potentially deadly drugs. You apparently don’t read much here except your own posts.

            Your heart won’t function w/o a working brain either. Which is worse?

          • But why would you prefer to have a damaged heart over a damaged brain? Seems like you should want neither. But I guess coke and meth make someone feel high, so there’s a benefit there. SSRIs don’t give people that same feeling of pleasure that other drugs do, including benzos and opioids.

            I think meth and crack addicts may disagree with you. Many of them keep relapsing and many die.

            You are right that any drug is potentially deadly, including OTCs.

          • Actually, there is no evidence that SSRI users are better off in the long run, and some that suggests they may be worse off (in terms of being less likely to recover). So the analogy to street drugs isn’t really that much of a stretch – they do create dependency and withdrawal, we do develop tolerance to them, and they do apparently create some long-term damage to the brain. Just because they don’t make you euphoric doesn’t mean their effects on the brain are any different than street drugs – they just affect a different part of the brain. Neurological down-regulation is still in play, and the long-term effects of down-regulation are very similar for cocaine, stimulants, and SSRIs.

          • SSRIs don’t give people that same feeling of pleasure that other drugs do

            Guess that makes them the perfect drugs for a puritanical culture — no pleasure involved, but keeping people zombified just enough to make widgets for the rest of their lives without complaining about being bored or unfulfilled, as such considerations are selfish and bad for business.

            Congratulations btw shaun, looks like this off-the-cuff excuse for dialogue has made Enrico’s article MIA’s “most popular.”

            @Steve — Isn’t one of the aspects of “spellbinding” as described by Breggin the inability to recognize that the drug is making you worse?

          • Anafranil made me higher than a kite. Zoloft provided a warm, tingly, erotic glow for over a month. Ever heard of an SSRI triggering a manic episode? Great way for shrinks to bag more “bipolars.”

          • Psych drugs don’t cause tooth loss?

            Uh, not being able to salivate does cause dental damage. A lot of “mentally ill” folks are toothless even in their thirties. My teeth were great–genetics–but they went to pot as a minor side effect of my treatments.

            And not being able to work can lead to homelessness too. Folks at the MI Center mostly live with aging parents/group homes/homeless centers/or HUD. Better than a 3 x 3 box you say? Yes, but not by much. Plus no one will rent to you if you live on SSI. Thanks for the stigma shrinks.

            Most SMI’s are really just involuntary drug addicts. Including me. Pretty sickening. I never would have taken street drugs voluntarily. Thus the lies about how the pills were “medicine” curing the “chemical imbalance” and preventing brain damage.

            I don’t like liars!

          • Rachel, you are right that the chemical imbalance theory has yet to be proven, and may never be. You are also right that psych pills do cause damage, such as tardive dyskinesia and metabolic syndrome. Usually people who are on psych drugs also have fewer resources, such as regular access to a dentist. I found this to be the case with most of my clients. Also, many of them do not floss or brush regularly (heck, many people with resources fail to do this), so that also contributes. Meth users also don’t do regular dental hygiene since their focus is on getting more of their drug rather than on healthy self care. People do get apartments on SSI in my community, but waitlists are too long because there is an affordable housing shortage. No doubt people with “disabilities” are discriminated against, and we need to work on making sure that everyone is treated fairly when it comes to access to housing.

          • Interesting statement. “May never be.” Do you hold out any kind of hope that the “chemical imbalance theory” MIGHT be proven valid? To me, it is completely illogical. Why would we assume that all people who experience anxiety or depression do so for the same or similar reasons? Do people feel pain for the same reasons? Do people feel joy for the same reasons? It makes zero sense that something as biologically essential as anxiety or depression or high activity levels could ever be reduced to an “imbalance” or any universal cause, or could even be clearly identified as “excessive” by any reliable measurement that could ever be invented. It is simply a fantasy (IMHO) to think that any kind of generalization can be made about why people feel chronic depression, for instance. It may be a result of early childhood abuse, lack of sleep, feeling trapped in a boring job, low thyroid, being involved in a violent or abusive relationship, lacking essential nutrients, being lonely, feeling out of control of world events… the list could go on and on.

            The fact that some people feel better (or less bad) when taking a particular drug is not an indication of anything specific wrong with them, any more than finding aspirin or tylenol a relief is an indication that someone has a broken bone vs. muscle aches vs. the flu. Johanna Moncrieff has written very effectively on this point – you should read some of her stuff.

            Again, I think you’d do very well to listen to some of the people who have experienced DBT and CBT and EMDR. Some have found any of these helpful, and some have found them to have little to no effect, and some have found them damaging. It seems to me that you feel empowered as a clinician to decide that “these things are not damaging” and regard any reports of harm as outliers. It comes across as dismissive of the experiences of those who have “been there.”

            I’m glad you understand some of the barriers that people diagnosed with “mental illnesses” often face. At the same time, I am not sure you come across as really understanding or WANTING to understand why so many folks here object to the entire system and don’t see things like “CBT” and “DBT” as much different than the drugs. There is still a disrespect, an air of condescension/superiority, and implied “put down” in the whole dignose-and-treat process, even if there may be some services offered that could be helpful under the right circumstances. For many people, the idea of being considered “broken” or “damaged” or “emotionally disturbed” is in itself enough to be traumatic and diminishing, and sometimes pretty insulting. It’s as if some other person gets to tell you what the “right” reaction to a traumatic event or an entire traumatic childhood should be, and you are judged inferior because you didn’t react in the “right” way. For this reason, I eschew DSM diagnoses at all turns and consider them a fundamental evil of the system. They warp how we think about people and how people think about themselves. They are ultimately dehumanizing labels, and even when I had to use them to get reimbursement, I always explained to my clients that they were just names and numbers that I had to submit so I could get them the kind of help THEY needed, and that it was THEIR job to define what (if anything) was wrong and what kind of help was actually “helpful.”

            BTW, I notice that you never told me whether you read Anatomy of an Epidemic yet. Just wondering…

          • Steve,

            We simply don’t know what is really going on in the brain. We have much to learn. We do know, however, where pain is felt in the brain (thalamus then cerebral cortex), where addiction impacts brain activity, and so on, so we know some things. I highly doubt that depression resides anywhere else than the brain, since no other organ is as complicated or connected to the CNS as the brain. People don’t hear voices, for instance, because their ankle is sore. In any case, I do believe that one day science will show why some people experience mental health symptoms and others don’t.

            I think it is completely inaccurate to compare psych drugs with DBT and CBT. They are nothing alike. One is empowering and the other encourages people to be passive. I understand that nobody will ever completely agree on what “treatments” are helpful. But for people so point out all the horrible effects of pills yet at the same time say how terrible basic therapy treatments are like DBT, I find it difficult to take at face value. DBT doesn’t inject anything into anybody’s CNS. DBT actually encourages people to find ways to empower themselves. I would say that it isn’t these treatments that are problem, but rather how these modalities were implemented or forced upon people. No treatment should be used to bully people or demean them. Any good clinician will be effective at helping individuals to empower themselves rather than traumatize them further. ‘

            And yes I’ve read the book. Did you see my post from the Huffington Post? I think it does a good job of summarizing my thoughts on the book.

          • I did not see your Huff Post article. I’ll see if I can find it.

            I think again you miss my point. At a certain point, it doesn’t matter what “services” you offer if the context in which they are offered is not workable for the person seeking it. No doubt, you have many people who continue to use your services for extended periods of time, and no doubt, they mostly find it helpful or they would not continue. I am not telling you that CBT/DBT are THE SAME as psych drugs. I’m asking you to open your mind and LISTEN to those who are telling you why it did NOT work for them, rather than generalizing that “these things are not damaging.” Heavens to Betsy gives a great example above – she needed help with a domestic abuse situation, and was provided with CBT or DBT. NOT GONNA WORK! Again, you can claim these are all “outliers,” or you can start to realize that there are some who do NOT avail themselves of your services or anyone else’s because they don’t meet that person’s needs.

            We’re going to have to part company on the idea that somehow “science” will discover “why people are depressed.” In my view, as I explained above, there is no logical reason that anyone truly dedicated to the requirements of science could possibly believe such a thing is possible. To even DO a scientific study with humans, you’d have to establish a homogeneous group to study, and as I clearly outlined, “depressed people” is not a homogeneous group. Now there may be a SUBGROUP of “depressed people” that actually have a physiological problem, but this subgroup is more likely to be divisible into half a dozen or a dozen or more subgroups ALL who have different problems, just like 10 people presenting with shortness of breath will have 10 different reasons that explain it. This is why “shortness of breath” isn’t a diagnosis – it’s not a homogeneous category. The idea that all people with “major depression” will all turn out to have the same problem is even LESS likely as that all 10 people turning up with chest pain will have the same needs and treatment.

            And stretch yourself a minute, here. Isn’t it a bit disrespectful to suggest that a person who has lived a life of trauma and abuse, who learned distorted coping measures and never knew a healthy relationship in his/her life, has something physiologically WRONG with him/her if s/he has learned not to trust authority figures or not to ask directly for his/her needs to be met? Doesn’t it seem much more likely that s/he learned some crappy things from experience, some of which might be valuable to retain but some of which that person might wish to “re-learn” at his/her discretion? And would this person really be likely to respond to the same “treatment” as someone whose thyroid is out of whack and who can’t sleep well at night as a result? Or a person who just found out that s/he has cancer and has 6 months to live? How on earth do you think that those people all need the same “treatment?” Is there something “wrong” with finding the fact that you suddenly are going to die in half a year in a slow and painful manner extremely depressing, even to the point of considering suicide? Is that really the same as feeling like your life isn’t worth living because you have no friends and a dead end job? Or feeling like you’ll never recover from the flashbacks and anxiety you experience as the result of being raped by your abusive husband?

            You sound like a kindly person, but I gather you are still really connected with the idea of diagnoses and treatments, and don’t see how that, for at least some people, the very ACT of being “diagnosed” for a “mental disorder” could be demeaning and insulting. I see it very differently. I find that labeling people tends to leave them feeling negated and misunderstood. I find that reaching out to them and having them tell me what’s going on and what they want to accomplish and what they think might help to be much more humane and effective.

          • You gotta be kidding me. You’re DJ Jaffe? No wonder I feel like I’m swimming up the river. Your reputation precedes you. I understand why we are unable to communicate, but I feel like I’ve been scammed. I am no longer surprised at your lack of compassion for those harmed by the psychiatric system.

          • Steve,
            A diagnosis can be damaging to someone’s view of themselves. I hear clients say that they feel perpetually “screwed up”, which sometimes has to do with the diagnosis, and other times has to do with their childhood and adulthood traumas of people treating them without respect and making them feel unworthy, unsafe, unloveable, etc. I have had clients who say they feel relieved to have an answer to explain their symptoms and thus feel some relief. I would prefer, like I’ve said before, to never diagnose anyone. Everyone is right on MIA who say the DSM isn’t a scientific book and shouldn’t be treated as fact. Diagnosing is completely unnecessary when working with clients.

            I totally agree that context matters when it comes to treatment. I am responding to some people on MIA who do essentially equate drug therapy with CBT/DBT etc. While I understand you aren’t making that comparison, I have seen others do it in the past on this forum. Heavenstobetsy’s story is an example of where the system clearly fails and harms people. DV survivors should be treated with the upmost respect, which means first making sure they are safe and have the resources to get their basic needs met. Trauma treatment should always start with safety, then move on from there. Nobody should be coerced to start treatment they aren’t ready for. We need to be truly client centered, which in my view means fully listening to our clients and hearing their point of view and then set up treatment and support which is consistent with their needs and wishes.

          • I would prefer, like I’ve said before, to never diagnose anyone.

            So then what apparently compels you to do so anyway, and by what authority?

            (PS I have once again started a new thread at the bottom….)

          • Oldhead, clearly you haven’t read my posts clearly. I diagnose because I have no choice in the system I am in. The government, HMOs, doctors, and the law all support diagnosing. In fact, all the the western world supports diagnosing to one degree or another. If low income individuals are going to get services, they need a diagnosis to be enrolled. Plain and simple. I am not in a position of power to change how the whole world works.

            I don’t see a new thread at the bottom.

          • Steve, I don’t know what you are talking about? Just because I don’t say what you want me to say doesn’t mean I don’t have compassion. Re-read my posts and tell me again I don’t display compassion towards those harmed. I’ve repeatedly said that I deeply care for anyone who has not been treated with dignity and respect. I have also pointed out that many people I’ve seen over the last 15 years have improved and feel much better because of the treatments they’ve received and the support they attained in the community. That message isn’t a popular one on MIA. It seems that there’s an all-or-nothing mentality that I simply cannot get behind on either side. I definitely know of people who think pills are harmless, which is also ignorant. I see the points both sides make and fall somewhere in the middle. Sorry to frustrate you so deeply. I’ll probably stop posting here and just read the articles, because clearly these conversations are counterproductive. Have a good day.

    • So much for not subscribing to the DSM 5 manual!

      Denial, denial, denial…

      No one I ever met in the Center or Clubhouse was gainfully employed. Ditto for those at NAMI and other places. Robert Whitaker’s research supports what I also saw.

      I got my BA IN SPITE of psychiatry. And all my case workers/social workers/treatment team flunkies/bureaucrats did their best to discourage me. Scared my college degree would make me uppity. Then they claimed my college degree as THEIR success story.

      Like running a marathon with a ball and chain.

  10. ‘Your heart won’t function w/o a working brain either. Which is worse?’

    If you drink alcohol as well, you could get both brian and heart duffed up good and proper:

    https://www.healthline.com/health/depression/celexa-alcohol#celexa-and-alcohol

    “Other reactions

    Alcohol and Celexa can mix in other dangerous and deadly ways. Side effects of combining the two can include:

    irregular heart rate
    amnesia
    coma (loss of consciousness)
    convulsions
    hyperventilation
    severe heart issues
    death”

  11. Why would we assume that all people who experience anxiety or depression do so for the same or similar reasons

    The reasons for fear or pain may be different but the physical infrastructure for processing the information is the same. So no matter the “content” of the inner experience, it is all processed via the same physical structure, i.e. the nervous system primarily. While the “information highway” is the same, the nature of the traffic changes. Blaming the processing center (brain) for the information it is processing is what psychiatry does with its biochemical “theories” (actually tawdry hypotheses).

  12. Well now we know “Shaun F” is a fictional persona for none other than D.J. Jaffe. Not sure what he does for a living, but it looks like PR rather than therapy. Remember that when you read his claims about the haven of love and joy where he works.

    The guy is completely ignorant of “minor side effects” like tooth loss and lowered cognitive functioning. That’s my charitable spin.

    He wants more HUD ghettos to stuff people in. Pretty generous.

    But some would like alternatives to these roach-infested slums. Is he aware that the MI system ensures you’ll never find gainful employment? Does he even care?

    Tell a lie often enough and even you won’t know truth from fantasy. 🙁

    • You are incorrect, Rachel. I don’t know who DJ is, but he certainly isn’t me. I am a therapist in a community mental health setting. Choose to believe it or not. You and many people on here are making plenty of false assumptions about me and my beliefs, but keep going if you wish. It is clearly some fun entertainment for you. Also, you are incorrect about affordable housing. There are some very nice buildings being built by nonprofits around the country. Maybe do some research on the subject if you want to learn more. And finally our center helps people to find gainful employment; we have a handful of vocational counselors who help people in getting meaningful jobs.

      • shaun,

        You claimed to be the author of an article on Huffington Post,

        “And yes I’ve read the book. Did you see my post from the Huffington Post? I think it does a good job of summarizing my thoughts on the book.” https://www.madinamerica.com/2018/06/busting-7-myths-practice-psychotherapy/#comment-134338

        You subsequently posted a link to an article which you claimed was your own article, https://www.madinamerica.com/2018/06/busting-7-myths-practice-psychotherapy/#comment-134346

        Why are you now denying that you’re DJ Jaffe?

        EDIT: were you referring to commentary you made on the Huffington Post article, rather than being the author of it? That would make sense. I’m sure the community will appreciate the clarification.

        EDIT: I just visited the Huffington Post article. I don’t see a comments section there.

          • Thanks for clarifying.

            EDIT: So, DJ Jaffe’s Huffington Post article did a good job of summarizing *your* thoughts, is that correct?

            A bit baffling. The way you worded it makes it seem very much so that you are the author of the article.

          • Sorry, my bad on that one. Still, referring to Jaffe as representing anything close to your views puts us at very distant ends of the “respect for the experience of the recipient” spectrum. Jaffe’s review seemed confused and unfocused, and at times he clearly was promoting his own “we know better that the clients” viewpoint, as he always does. You seem to have an agenda, too, and you reflect it by choosing not to respond to certain central points I have made. It seems clear you are more interested in promoting the interests of therapists and mental health professionals and seem very uninterested in talking about very important philosophical questions like why the f*&k anyone taking a remotely scientific viewpoint would ever expect all depressed people to be suffering from the same difficulty. But that’s your decision. It just makes me feel like I wasted a lot of time talking to you, because you don’t seem to be nearly as open-minded as you think you are.

          • Steve,
            Well you and I agree on a couple things. We both feel that others have ignored central points we’ve made and feel we’ve wasted our time. I am relatively open minded, otherwise I wouldn’t be reading Mad in America. I am open to challenging my views, but you really don’t know me, so it’s easy to jump to conclusions.

            I have real reservations about the MH system as it stands now as I’ve made clear in other posts. I also, on the other hand, see how the system helps people in my community. Both CAN be true. I think that’s the problem I run into on both sides of this debate. I talk to some of my colleagues, and if I say anything challenging about how we operate (diagnose, prescribe, etc), I often receive responses which are defensive and sound like denial. I see the same phenomenon here, where I say anything positive about the system–like we help people find housing or that many of my clients say that they find real benefit from medications–and I also get snark. I feel like I can’t win with either group. I see validity in both points of view, which is a difficult position to be in. So be it I guess. I’m on my own journey as everyone else.

            I doubt I will be in the HMO/medical model-dominated system for much longer, because I do have serious concerns about continuing to work in a model which pathologizes and over-medicates. I think at this point the whole world is over-medicates rather than dealing with the root of most human suffering–trauma and dehumanization. I do my best to be compassionate and show care towards my clients, but nobody on here will ever see that unless they are in my office with me.

      • No, shaun f is NOT D.J. Jaffe. This is beside the point.

        The amazing thing is that shaun would cite THE D.J. Jaffe as an “authority” (rather than a potential defendant), and on MIA of all places. Hard to describe that as anything but tone deaf.

        • I think it shows where he’s coming from. It seems to indicate a person who feels superior to his “clients” and is unwilling to listen to any feedback from his or any other participant that undermines his view.

          He did, however, post the Jaffe review when I asked him for a link to the Huff Post review he’d written. So he at least suggested that he’s Jaffe. Not that it likely makes much difference. He’s coming from the same kind of viewpoint.

          • Nope, I don’t feel superior to my clients. Quite the contrary. I am impressed every day with their resilience. I feel they have more strength than I do, because they have survived so much horror and trauma. I couldn’t imagine coping with what they deal with on a daily basis. That is the truth.

          • I’m talking about clients’ negative feedback about the mental health system. And my questions about the heterogeneous origins of the so-called DSM diagnostic categories.

          • Steve and Rachel,

            I saw this article online and found it thought provoking: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060802/

            I plan to facilitate a conversation about the points made in the article and by MIA members to my team members. I think it brings up some very important critiques of the DSM. All I can say to both of you is that I’m trying to challenge myself, my views, my perceptions of these important matters.

            I feel as though I know very little at this point; after reconsidering everything I’ve been taught, both from my schooling, my clients, MIA, and my bosses, I have to consider the reality that the DSM is harmful and that pills don’t usually help and too often cause a host of terrible effects and withdrawal. I have been paying more attention to my clients commentary about their pills and what it does to them, and I can say for certain that many of them say they dislike how they feel on them and that they would prefer to be pill-free. Some still tell me they like them, but many do not. I’ve been advising my clients to seriously consider titrating and to consider other ways of trying to feel better. If I’m also honest with myself, I know that many, if not all, have my clients have been mislead about the chemical imbalance argument and that pills, like SSRIs, are relatively harmless. They clearly aren’t. I used to think they were, too, because that is what I heard from doctors. They seem most concerned these days with opioids, benzos, and stimulants, but the truth is they should be equally concerned about all the pills they prescribe given the short- and long-term effects. The medical model in mental health does seem to be on very shaky ground.

        • Oldhead, I only referenced that specific article on the critique of the book. I don’t agree with everything Jaffe has to say. Jaffe clearly does believe that mental illness is a real thing, whereas on this forum people believe otherwise. I see merits to both perspectives.

          I’ve worked with people who were suffering severe psychosis, so I have a hard time believing that mental illness doesn’t exist at all. I’ve seen people pissing themselves, thinking the TV is sending them special messages, thinking the government is listening to them through their phones, walking the streets at night talking to themselves, yelling at voices, thinking they are talking to celebrities, hearing voices to kill themselves or others, and so forth (most of these examples are people not on pills). I worked with the homeless population for a decade and saw them suffer immensely. So yeah forgive me if I don’t believe everything MIA has to say on the subject of mental health and what constitutes actual illness.

          • I’ve seen people pissing themselves, thinking the TV is sending them special messages, thinking the government is listening to them through their phones, walking the streets at night talking to themselves…

            Yeah there are some real crazies out there. As one with experience with all these things, I say congratulations on the most mentalist statement of the month!

            As I recall, Jaffe also advocates turning over chairs before the cops come to convince them that a family member is violent. (Or was that one of his NAMI cohorts? Anyone care to expand on this?)

          • Madness exists. Self deception. Harmless kinds like “Aliens are talking through my TV set.”

            Rapists who convince themselves the girl wanted the rape and they were curing her of frigidity.

            We also find this in “doctors” who ignore how sick and stupid long term druggings make those beneath them–deluding themselves into thinking it’s okay to live in segregated slums and die before 53.

            Insanity cuts both ways.

          • “Harmless kinds like “Aliens are talking through my TV set.”

            Well, most of the people I’ve seen seem quite disturbed and scared by the notion that anyone is talking to them through their TV set. They are also disturbed when they hear voices telling them they should die, kill others, that they are stupid, etc.

            “We also find this in “doctors” who ignore how sick and stupid long term druggings make those beneath them–deluding themselves into thinking it’s okay to live in segregated slums and die before 53.”

            I agree that too many doctors ignore or minimize the long-term implications of the “treatments” they prescribe. They don’t want to believe they are causing harm but as evidenced by the experiences from folks on this website and elsewhere, they certainly do harm innocents with unnecessary pills.

      • Thanks for clarifying, you aren’t Jaffe. But it makes little difference.

        If someone said, “I’m not a member of the KKK, but read this piece by the Grand Wizard. This sums up my own views on race relations…” Well, he MIGHT be a racist. Even if he is not a member of the KKK or the leader himself.

        • I owe you an apology Shaun. Since you obviously don’t know anything about Jaffe beyond that review he wrote, you can’t be held responsible for the nastier stuff he has pulled.

          Not least was launching an “anti-stigma campaign.” What was his plan?

          Since only the “untreated severely mentally ill” go on shooting rampages–Jaffe claims–NAMI can prevent gun violence and stigma by telling the public that the SMI were ALMOST safe but only when drugged.

          This is simply not true. Harmless madmen have been recorded throughout the centuries. Francis of Assisi was one for a while. Many–not all–shooters were receiving psychiatric care. And continually promoting the violent madman trope in the pubic consciousness will not end discrimination. They always assume you’re “off your meds” no matter how religiously you take them. After 22 years of strict “med compliance” I know.

          About my comment above, I refer to the idea that aliens were talking through the TV as harmless because it only bothers the hallucinator. I knew one man who heard voices from the set telling him he was a wonderful guy who would become President and save the world. He enjoyed these voices.

          • Thanks Rachel. No worries. I should have been more thoughtful before I posted anything from Jaffe. Honestly I wasn’t aware of all his beliefs until after I posted his article. I think I was being ignorant and I look forward to continuing to learn on MIA and elsewhere on alternative perspectives on the MH system and drugs. I used to think it was all so benign because that was what the medical model thought me, but clearly I was taught wrong. Be well.

    • Streetphotobeing, you are correct that encephalitis could be an explanation for psychosis, and should be ruled out if many of the symptoms are present. The difference in my example is that many of the people I describe are older, male, chronically homeless, and do not have many of the symptoms associated with this type of infection, like seizures. One of my greatest frustrations, however, is that medical providers do not rule out all the major explanations for symptoms. We should always do a full medical workup with blood labs and a physical before starting any medication, but this just doesn’t happen in Western medicine. We should be making sure someone doesn’t have a thyroid imbalance, for instance, when looking at depression.

      I will also add that attaining spinal fluid from someone is is presenting with psychosis in an outpatient treatment center is impossible. Many people experiencing psychosis would also not consent to such a procedure being done. This procedure would have to be done in a surgery center, which is not where most people with these symptoms would voluntarily go. There are some practical limitations doing full workups on individuals, and I’m not exactly sure what the answers are about this issue. Is there a blood test that can rule this out?

      • Yes there is. And there are many other issues that present as psychosis perhaps the most telling and maybe common is withdrawal from benzodiazepines which includes toxic psychosis:

        https://benzo.org.uk/BNF.htm

        “DEPENDENCE AND WITHDRAWAL

        Withdrawal of a benzodiazepine should be gradual because abrupt withdrawal may produce confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens.”

        Also Akathisia which amounts to toxic psychosis at it’s worst is preventable by a pharmacogenetics cytochrome P450 test which pretty much no one gets.
        Plus avoiding all things which block the metabolising enzymes such a valerian found in common sleep remedies such as Nytol.

        • You are right that benzos present real problems. I’m talking about people who aren’t on any prescribed pills and still present with severe disorganization and psychosis. I fully agree that pills create a host of problems for too many people, and this should seriously be looked at.

      • It’s way too long and inconsequential a thread to check whether this is totally accurate, but I don’t remember taking any jabs, just giving shaun enough rope to highlight the obvious. I don’t think any of my posts were even angry ones, and I certainly don’t harbor any hostility towards shaun. He’s a product of the system that trained him.

  13. I have thoroughly enjoyed reading the various discussions at the end of this article – while at times some of it has seemed a little confrontational I think its mostly been quite respectful and shows a range of feelings and perspectives.

    I have worked for many years across various mental (ill) heath services in various roles including my current role as a therapist although personally speaking I dislike the title therapist and think of what I do more as a temporary compassionate helper – I also think that if we had cultures whereby human wellbeing was front and centre, with people actually having time to care and share with each other these roles would be a thing of the past.

    Long before clinical psychology spawned the hundreds of ‘talk therapies’ we now have we had human beings harming and helping each other, its just what we do, if we have the time/energy to care that is.

    Caring like almost everything else has been turned into commodity to be bought and sold, someones job – Jobs cause huge harms to the majority but where is the debate on these harms? – the massive Gallup poll done a few years ago covering hundreds of countries and millions of peoples attitude to working life revealed that only 13% of people are enjoying their work – for the rest they say are ‘sleep walking’ through their days disengaged, bored understimulated, numb others still actively hate their daily grind. Not that we needed such a poll, its quite obvious if you just allow yourself to reflect on your own work history and listen to what others say about work.

    it seems to me that it is quite easy for people within services/roles that have been elevated to relatively respectful if not revered positions to also inflate what they believe they can achieve through talking/listening to someone. Training, supervision and associating with other therapists just reinforces these beliefs and I’ve met many a therapist with almost god like beliefs in what they do – after all we are constantly told to ‘trust the model’ and ‘sell’ what we do with absolute belief that it works – ‘research says’ ‘NICE guidelines say’ etc.

    Therapy as an activity usually takes place within a consulting room model devoid of context beyond the persons own limited story of self/world, biased and blinded by culture and a therapeutic industry that essentially tells us its not the world but our interpretation of the world that is at fault and all you need to do is harness some will power to change.

    Furthermore most of the mental (ill) health workers I know are themselves suffering with various levels of burnout and major stress because services are more like production lines of suffering – especially in the UK with IAPT.

    All anyone cares about in IAPT is ‘outcome measures’ meaningless scores on two self assessment measures the PHQ9 and GAD7- no matter if you are crushed by the culture if enough people pleasing can be stimulated in session and you score below ‘clinical’ then we have winner and you are now in ‘recovery’ another empty term, for how can you recover from the cultural disorders that impact us all to differing degrees throughout our lives.

    Its also worth remembering that therapists themselves are no better equipped than anyone else to cope with life stress and cultural disorder – get the right or wrong conditions in life and we also suffer just the same as anyone else and no prior knowledge of theory or techniques will help us much.

    This stress is clearly evident in services daily – spend just a few moments listening to therapists and you will often hear judgments that this or that person has a personality disorder or comments like how do they expect to get better if they aren’t doing their homework or taking their medications etc.

    That word medications is something I think we really need to stop using along with anti depressants and anti psychotics -and the disgusting personality disorder label – it seems whenever we use these terms we perpetuate a harmful myth and contribute to free advertising for drug companies and personal pathology – they are drugs, that sometimes help and it seems to me more often than not hinder and harm.

    • Great post! You have encapsulated my own feelings about the “therapy industry” quite well. I had to leave the field eventually because I could not stand it any more. A little dose of humility would go a long way, but humility seems to be anathema to those who are invested in “the system.” It’s the only place I know where you can screw your client over and then blame them or their “treatment-resistant depression” for your own failure.

      • Hi Steve, thanks but I wish it wasn’t so! Buying into the entire industry/ system is hard not to do – I must admit when I first began reading the critical perspectives and reflecting critically on my own work it was really hard to do. However once my head was lifted from the deep sand of training and constant association with believers I could not put it back.

        Its quite a lonely place to be because I often share articles and ideas from this site and other places at work and hardly anyone is willing or has the time to engage in a discussion. Reminds me of a quote, something about it being difficult to get people to understand something when your wage depends on not understanding it. I actually had one supervisor some years ago tell me he is pleased there’s such a thing as ‘mental illness’ because it keeps him in a job.

        It seems many mechanisms like self interest and the power of conformity ties us to so much cultural toxicity its staggering to me – i’m pleased you managed to escape it Steve.

        I do what little I can to help those I see but I stress its so very little – The thank you cards and letters I get from people while appreciated serve to remind me of just how disordered the culture is.

        I think it is sad that so many people can be so thankful for so little and time and time again people minimize their own prolonged hidden heroic courage in the face of overwhelming adversity that would have crushed me to pulp. Instead they are full of thanks for something they believe I have done.

        The cultural esteem and powerful story of talk therapy and the industries drugs and labels serves to help in this personal minimization by creating a narrative or a sort of dot to dot picture to colour in- the culturally induced crushing of self esteem ensures these stories are often believed in – while many people have no one they can turn to for trusted solidarity many people do but feel unable to share because they understand that those family members and friends are also suffering.

        So we are encouraged to turn instead to we ‘mental health professionals’ we ‘experts’ ‘therapists’ ‘traumatologists’ ‘psychotherapists’ ‘counselors’ it all sounds so reassuring so certain and technical.

        yet behind the welcoming smile of the expert is a human being, someone probably suffering or soon to be suffering and just as lost and in need of support, solidarity and compassion as everyone else.

        • Very well said! And I would add that the less “professional” (in the sense of “distant” and objectifying) the professional is and the more human the professional comes across, the more successful the intervention. Which makes one wonder, is the real problem a lack of human connection?

          • agreed the more human and connected the better – and yes connections and or the lack of connections is the major theme of Johann Hari’s last book titled lost connections and I think its certainly a major issue – we have such potential and if our needs for connections currently missing were met would we really need a mental health industry?

            I wonder have you any book recommendations Steve that helped in your journey to change? or is there a recommended books section on the site?

            these have all helped me

            By David Smail – Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress

            The Origins of Unhappiness: A New Understanding of Personal Distress

            By Paul Maloney The Therapy Industry: The Irresistible Rise of the Talking Cure, and Why It Doesn’t Work

            By James Davies Cracked

            by Ethan Watters Crazy Like Us: The Globalization of the Western Mind

            be well

          • It’s hard to pick one book. I suppose Alice Miller has been one of the strongest influences on me (The Drama of the Gifted Child), but far from the only one. I think I got most of my insights from my own therapy (back in the days when therapists still asked questions and listened to their clients) and from working with people over many decades. I was fortunate to start in the “mental health” field with almost no training, so I went with what I observed and learned from the clients I was talking to. I don’t think there is a better teacher than approaching the person needing help with humility and creating a safe space where they can honestly explore their own intentions and motivations and fears. What I found is that almost all behavior, no matter how odd it seemed to me, made sense from the point of view of the person engaging in it, once I understood their lives well enough. I’d say that’s where most of my learning originated.

    • I totally agree with both of you, Steve and Chris. More and more I am seeing the MH system the same way. I will add that therapy still has value to those who need compassionate and empathetic people in their lives. In the West in particular we are isolated and not supported by our communities like other parts of the world. My clients tell me that they cannot tell other people in their life what they’ve told me because they will be judged, blamed, further stigmatized, etc. The best work I can do is to let my clients know that their story matters and that they deserve compassion rather than self-blame and judgement. I do agree that there is a certain dependency on the system that too often takes place, and that many clients do not give themselves credit for their hard work to feel better (I’d say much of this belief derives from childhood trauma and invalidation).

      Profound trauma often leads to a weak belief in self, believing that one is unworthy, inept, a fraud, and so on. These core beliefs are tough to shake for any of us. Due to my own childhood trauma, despite what others have told me about myself and my own accomplishments, I still struggle with some of these beliefs that there’s something “wrong” with me. I’m not sure if anything will “fix” this feeling I have about myself. I’ve seen some great therapists but still struggle with self-confidence and worth. I know that nothing is a panacea for human suffering.

      Thanks for all the great dialogue. I am glad to know I’m not alone in my challenges.

      • Hi Shaun – yes sadly it does seem that in our alienated fear filled world that therapy for some people might be useful some of the time in some ways depending on the context and what is on offer.

        Alas its mostly at least in my experience short term therapy and I think sometimes it might cause more harm than good – take for example those suffering as you have suffered with childhood trauma – this might have been multifaceted and the persons current circumstances might also be horribly harmful to them and so they are referred to IAPT for say counselling, EMDR, CBT, EFT etc. These suffering people often with decades of trauma and ongoing major stress will be offered around 10 x 50 minute sessions. less than half a day in someones life to address a lifetimes suffering.

        is this not unethical? dangerous? gross false advertising?

        people are often just beginning to feel that they can say more than they may have said to anyone before and its time to leave – we’re told by management that people can re refer and they often do and the cycle continues.

        I also don’t think it necessarily takes a profound trauma to crush esteem because many people if not most of us are suffering what I think of as millions of paper cut trauma’s – family lives being witness to parents being broken down by their awful jobs, ships passing in the night, financial battering, poor housing, a school system that cares not a jot about each person’s possibility but only in targets, image and feeding our young through the sausage machine of the system soaked with comparisons, pressure and stress. zero community life, lack of meaning, loss of contact with nature, self and others, constant and relentless advertising and consumer culture with its illusions and manipulations and images of happiness and success. The cult of the individual and delusion of the hero the self made man the me me me mantra.

        Then when crushed and confused send us to therapy, drug us, label us – all focused on the individuals supposed maladaptive self – no one has time to take a wide angle zoomed out approach helping the person place their tiny lives in this broader cultural disorder context soaked through with powers so vast its hard to comprehend – so its all about the persons disorder and how we experts can somehow help them and delude ourselves to get on with it.

        When can we start to diagnose and treat the many cultural disorders all around us?, to see more clearly that if we take a beautiful flower and place its roots in turds, its leaves in pitch dark then pour feed on it we are not really helping except maybe helping to maintain the status quo and the killing of possibility.

        • I agree with much of what you just said, Chris. Our culture/economy is detrimental to well being on many levels. We probably also need to get away from “evidenced based practices” for the most part with therapy because in my experience it isn’t what clients want or find beneficial. I think therapy can help some people figure out how to make sense of this crazy world that works for them. Short-term treatment is en vogue because this is what payers will cover and everyone thinks doing the EBP’s will lead to good outcomes for most people. I think if you are dealing with minor issues, then yes. But for complex trauma survivors, short term interventions like SFBT and CBT rarely work.

          You threw in EMDR. I don’t see that as a short-term fix for most situations. More like 6-12 months for the people who have multiple serious traumas. The nice thing about EMDR is that it’s non-pathologizing and reduces the client’s “need” for psych drugs or long-term treatment. As an EMDR practitioner, I can say that I’ve seen people quickly start feeling better about their trauma and/or themselves after doing as little as one session with a light bar. I think EMDR out of all the interventions I’ve learned is the most promising for delivering on it’s promises of long-term symptom relief.

          • are these the words of a believer ,’I can say that I’ve seen people quickly start feeling better about their trauma and/or themselves after doing as little as one session with a light bar. I think EMDR out of all the interventions I’ve learned is the most promising for delivering on it’s promises of long-term symptom relief.’
            imagine that ‘one session with a light bar’
            did you train with the real Yoda?
            I’ve a friend that swears bruises have materialised and dematerialized during processing – I love the benny hinn side kick = fire on ya! ‘tapping in resources’ thats right you can just tap em in – well I can do it for you cheers me right up

            https://www.youtube.com/watch?v=bKAI8Yqa2bs

            hail from which star system have you traveled?
            we’ve got trauma creep, in fact we’ve got the insatiable creeping psychiatry defining he landscape we haven’t imagined yet

          • Chris,
            I get you are skeptical. In the instance I’m talking about this person had a single event trauma of an accident. I don’t see it as some magical cure all, but I have seen the evidence that it’s beneficial to people. To me that is what matters.

  14. Thank Steve i’ll check the book.

    This idea of insight is interesting. it seems to be at the centre of most therapeutic approaches, the desire to invoke in someone the all important ‘ah ha moment’ as if this can somehow make change happen or follows from it.

    When I reflect on my own experiences and the years of working with many others insight seems a mystery-Observing my own life and the glimpses of the lives of the people I see, it seems clear that we often have clear awareness or insight into an issue of great harm, be it a relationship, attitude, behaviour, belief, situation etc – we can also reflect on it, talk about it, describe it to others,sing songs about it and yet continue with predictable certainty to repeat it – until somehow it changes – once change (if change happens at all) happens our minds automatically populate a story for the change, often a story about something we have done, an act of will, but is it?

    or is it more that things, happenings (life) happen to and through us but are not directed by us at all – the age old free will conundrum seems to be leaning more towards determinism – I sometimes see life and what happens to us as seeming random and mostly luck – ‘I’ appear to be here to bare witness to what is.

    reminds me of some couples conselling I had many years ago that I partially remember.

    I used to think an insight I gained during this therapy was key in what seemed like my decision to end the marriage – but when I step back from this and consider the massive complexity of influences external and internal most of which is completely and utterly beyond my awareness I wonder how can it be? – I recall the therapist accurately paraphrasing my words back to me and this seeming to me like an ‘ah ah moment’ and a decision made to walk away. While it of course influenced me, given the weight of all other influences was it not insignificant? but maybe the esteem I had for therapy at the time imbued it with meaning and power and the cultural reverence for therapy created a story for me.

    who knows hey.

  15. Chris,
    You did not bother to ask me the context of what I was saying about EMDR. You don’t seem particularly interested in learning about my experiences with it, which is your prerogative. You allude to psychiatric “creep” even though psychiatry has nothing to do with EMDR.

    I don’t believe that therapy is the end all and be all for all human suffering. I think it helps some people feel better. That is about it. And of course it can do more harm than good.

    • I see what you mean Shaun and its probably a bias from me to listen only to respond – do tell me about your experiences with EMDR? just before if even some of these are right then its a wonder we can communicate at all https://en.wikipedia.org/wiki/List_of_cognitive_biases

      I have also had experiences – some telling experiences are when i’ve got a sense of a good alliance I will ask for honesty from the person about their open views about what we did – I recall asking this of a person at the end processing ‘installation of future template’ etc this session would have looked like a text book treatment success, suds gradually lowering, emotional soothing, narrative moving from anxious stress to distant, calmer not as bothering etc.

      This person explained they thought it did nothing at all but what they did find useful was the chance to speak some truth to someone deeply curious and caring for them in a relatively safe space. This could be done by family, friends, the broader community – if we had communities and time to engage each other more compassionately in cultural possibilities that created better conditions for trust and cooperation to flourish.

      I think David Smail had it right when he said all any therapy can offer is some comfort, clarification and encouragement but these are all transient and suffering can heighten once the talking and listening, waving your arms around stops – and yes for some lost souls this can be a life and death connection but on the whole are we helping to placate and mystify, minimize and emphasize according to our models and formulations rather than help with expanding outsight into the political and class awareness, media studies and ideologies, the way mental health industries shape the cultural narrative about what is and is not mad or abnormal – this from a largely white middle class american mans view – already throughly biased and blinded by the cult of the individual the super hero the self starter, biased to extroversion and social Darwinism, Benny Hinn putting fire on pastors, just access your deep well of will power and force your will on the immensity of all that is .

      now I wonder if you had heard these words spoken in the context of a first therapy encounter – what model might you use to treat me?

  16. Chris,

    Communities, friends, and family don’t want to hear about people’s trauma in general. Most of my clients also don’t want to burden their loved ones. Frankly when my clients have told their family about the trauma they experienced, particularly sexual abuse, it was not taken seriously or minimized, which created further harm and traumatization. I have little faith that my clients will be able to find adequate replacements for therapy if they had to find support elsewhere.

    Regarding what is considered “abnormal”, much of it has to do with the distress that the symptoms cause someone. This is usually when people seek treatment because they are unable to work, hold down relationships, or have other hardships due to their symptoms. There are plenty of people who hear voices, for example, but aren’t disturbed by the experience. These folks rarely seek out treatment.

    Almost exclusively I work from a Rogerian framework. I figure if I can emulate UPR, genuineness, and empathy, that is probably the best I can offer anybody. I try to keep it simple and most clients seem to respond well to this. I have a handful of clients whom I currently do EMDR with; I am still learning quite a bit about EMDR and it’s usefulness (or not). I know my training got EMDR for his PTSD and found it immensely beneficial, so he got trained himself and believes very much in it. I’m definitely not there yet when it comes to fully believing in EMDR. I think it probably does help some people, but I’m particularly skeptical that it can help almost any condition under the sun like some proclaim. I think it’s best for single event traumas like car accidents. We shall see over time.

    • apologies if some of what I said last night seemed a little annoying Shaun – note to self don’t engage in online discussion after more than 2 drinks.

      I agree with you that few people now would feel able to share with trusted friends and family and neither would many people feel they had time or confidence to simply listen and be present. However this is not because of some lack of relevant expertise but more a product of the cultural disorders that we live with – what did people do before ‘services’ and look at the evidence we’ve had 100 yearsish of clinical psychology, longer with psychiatry and we have dozens of drugs – hundreds of talk therapies – and yet things are clearly getting worse, suffering increases year in year out – much like hysteria at the turn of last century was the common cold of the age now depression is meant to be – you have a better chance of recovery from psychosis or so called schizophrenia in the third world than in the first – how can this possibly be?

      we have all been trained to give our power away to the experts – oddly at the same time many people when consulting other experts in medicine for example we might well have done some homework and come with informed questions – mostly not so with psychotherapy – its mysterious, maybe this is all to do with how embedded and revered its become within the culture – or normalized – at least in the west – and now the talk of ‘evidenced based’

      There are plenty of cultures that would see talking to a stranger outside of the community/family as nuts, and others still that would feel talking it over and ‘expressing and reliving trauma’ also unhelpful and possibly harmful.

      it seems the massive efforts over the years from the west to go help in disaster zones say the Indonesian Tsunami likely cause more harm than good- Ethan Watters outlined this well in his book Crazy like us – he documents the arrogance of western therapists and therapy agencies descending on the country bringing their supposed modern scientific tools and techniques to enlighten the indigenous people- sure some of this was done with genuine care but so much was also seen as an experimental zone whereby self interest was the main interest to study and try out their wares on a disaster zone. most could mot speak the language or had any clue to the local customs and cultural norms and assumptions that were utterly different to their own – individualism over collectivism, the language of trauma etc but they dove in anyway so sure of themselves.

      It just seems to me that we’ve got many cultural disorders that are left largely in the dark by therapy because we are all looking at personal disorder or in some way just helping the person to adjust to their situations – not see beyond into the powers shaping and controlling us all and reposition the limitations of the individual in this context – while perhaps at the same time exploring how collective change happen, the history of grass roots movements to bring us what we take for granted today – at least in the services I know this would never be touched beyond the superficial because we’re all educated in personal disorder ‘ I have depression’ etc – ‘I need help’ so in this way services consciously or not reinforce these cultural assumptions of individual fault and personal responsibility to change self, to adjust

      the mantra of the modern worker seems to be ‘you’ve just got to get on with it’ and while we all struggle to get on with it, suffering increases year in year out.

      so me and you Shaun are part of a system that helps to maintain not change the status quo so we’re all vulnerable to more harm than is needed.

      self interest ties us all to this toxicity – i’m a ‘consumer’ have a mortgage, have wants and desires constantly stimulated by cultural disorders etc.

      • Chris,
        Haha. This is also why it’s a bad idea to shop on Amazon after two drinks. Impulse buying is so easy to do with a click of a button! No worries.

        You make some very valid points. Modern society is oppressive on many levels. Additionally, since the twentieth century people started living significantly longer, and many of us, particularly in the West, had more time to think and ponder existential issues than in the past when we were hunter gatherers. Our mind makes us uniquely susceptible to overthinking and being too much in our heads (meaning, it’s hard to be mindful and be in the present moment). Humans are complicated and we’ve created complicated systems and technologies as a result, much of which has unintended results.

        Regarding society, one challenge I believe we face is that often people have nobody safe to turn to when in distress. Church used to be a source of community connection and support, but fewer of us are practicing, and those who are can become subject to abuse themselves (e.g., recent Catholic church cover up and molestation scandal). It also doesn’t help when young people are scared into submission with some religion which threatens them with hell and damnation if they don’t do as they are told, e.g., not be gay.

        Dysfunctional families/intergenerational trauma (eg., severe abuse, molestation, invalidation) are often the reason I see my clients in the first place. It would be wonderful if my clients, or anybody, felt they could lean on their families when they need love, support, and non-judgement. But to be frank in my experience personally and professionally, it is rare to find such a situation. Usually when people try to be honest about how they feel with family and friends, they are told they are “crazy”, “lying”, “wrong”, “have a drink”, or experience some other invalidation, which just adds further pain to the situation. Most people don’t act like counselors are trained to do (act like Carl Rogers). Most of our family and friends have preconceived notions of who we should be or how we should act. I as a counselor don’t have such agendas (other than to help the person move in a direction that feels right to them). I listen to them, validate their pain, and normalize their humanity without ridicule or placing blame onto them. This is what most of us want from our loved ones, but too often we get the opposite messages and thus feel worse about ourselves. Furthermore, there is so much history between family members, and thus people can quickly become defensive, blaming, shaming, and so on. I would never tell most of my family members how I really feel. I would either get no empathy and/or they would tell me “to get over it.” These are the messages that too many of us get from “loved” ones.

        One message I try to get across to my clients is that it is not they who are sick but rather the culture and environment which is toxic. I explain this is a good explanation for why they feel bad, why the struggle, etc., because they aren’t well supported by their communities, families, etc. My sense is that most of them still blame themselves, because this is the message they have received for virtually their entire lives.

        Regarding developing countries, it is like these individuals live on a different planet. I think 40% of the world doesn’t have access to clean water on a consistent basis. There are countries in Africa where life expectancy is around 40 years. When you are in this kind of environment, survival is always at the forefront of your mind. For most of us in developed countries, where we live in individualistic cultures that support a narcissistic attitude towards self, this is ripe for anxiety and depression. We have social media which continues to send us messages that we are inadequate, not attractive enough, not wealthy enough, not fun enough, not smart enough, etc. We have a lot of time to sit and ruminate, both about the past (which often causes feelings of depression) and the future (which causes feelings of angst and worry). If we haven’t figured out how to use our free time, it can literally drive us mad! And the 24 hour news cycle does nothing positive for our psyche, as it is distorted and superficial.

        All humans are self-interested, and you are right that this self-interest can keep corrupt and toxic environments afloat (e.g., Nazi Germany). I believe that I’m doing my part to help people tap into their inner strength and to help them see their gifts. I view my job as instilling some form of hope. I don’t believe this as some radical change for the world, but for the individuals who see benefit in this work, it can be life changing. I have worked with clients who after years of being in abusive relationships, eventually left and found more contentment in life (and safety!). I have worked with others who have gone back to school, started new friendships, stopped abusing drugs and alcohol, become more assertive, etc. I cannot possibly take credit for their hard work and efforts, but I do believe I played a small role in some of these positive changes that they made happen in their lives. These aren’t trivial changes, either. When clients who have experienced significant life trauma come to therapy, progress is usually going to be slow. But those who stick it out for a period of time begin to shift their view of themselves and thus their confidence to empower themselves to make changes that will better their lives in one way or another. I try and be careful not to make folks feel dependent on me, as I emphasize personal choice, responsibility, and freedom when doing therapy. I don’t tell them they are weak or need someone else to prop them up. I simply reflect what I see in them that they may not easily validate or notice was is within themselves. I hardly believe that this type of perspective is supporting the status quo. If I were truly supporting the status quo, I would be much more of a “company man” and telling people that it is they who are sick not the system.