Introducing ‘Brainsplain’

Morgan Campbell, MD
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It was my final psychiatry rotation in medical school, and my job was to tell an Iraq veteran about Post Traumatic Stress Disorder. Although I wore a stethoscope and deepened my voice, the veteran had greater authority on PTSD. She handed me a scientific paper with the newest research on her condition, and I realized she had paid about forty dollars for the article. Gatekeepers (like me!) and paywalls discourage the public from evaluating publicly-funded research. I was stung by the injustice.

A crazy idea came to me: video reports on new findings in psychiatry, featuring interviews with the public. I’m excited to now be doing this video project, called Brainsplain, in collaboration with MIA. In these videos, end-users of mental health resources critique the latest psychiatry research. I summarize new mental health investigations, and patients evaluate the significance. They share their hopes for future therapies and for changes to culture. They also assess ethical issues raised by the research.

My desire to let the public weigh in on research and therapies is rooted in my prior career as a hospice chaplain. I wanted to know why Latino people rarely used hospice, so I joined a Latino Women’s Healthy Heart Council. An older woman leveled with me, “We’ve been handed brochures, but hospice hasn’t offered real partnership where we get to have a say.” Sales-based “outreach” had marginalized these potential users of hospice. They were being treated like passive customers, rather than respected decision-makers and shapers of intensely personal services.

With this feedback, I invited families from minority communities to lead discussions with hospice doctors, nurses, and chaplains. Families talked about their values and traditions regarding end-of-life. After we started including input from black and Latino families, more came to us for end-of-life care. The enduring lesson was that when communities feel stigmatized, patronized, and disenfranchised by the healthcare system, they must be given a platform to express their values.

While doing this work, I noticed a primary care doctor at every meeting for Latino health. His passion to empower Latin American women kept me coming back, even after my hospice project. This doctor did not wear his white coat, and he had nothing to sell. He simply shared developments in medicine, and asked Latino women about their health priorities. He was building a true partnership with the community, in a way I’d never seen. I told him, “I need to be part of this.” He encouraged me, “If you want to devote your life to marginalized patients, consider medical school.” I applied and enrolled.

In my training on the hospital wards, the patients labeled “difficult” were the most compelling to me. These were the psychiatric patients. The power gap between providers and those receiving mental healthcare was a yawning canyon. I saw no equivalent to the Latino Women’s Healthy Heart Council for these disenfranchised people.

Then, when that Iraq veteran sparked the idea for video reviews, I immediately began explaining new research to people I met, and asked to record their opinions for public consumption. I go to VFW posts when research is conducted with veterans. Sometimes I set up a video camera in a public space and invite strangers to talk. Those affected by mental health conditions line up to have a say on what happens with psychiatry research. For example, a philosophy graduate student reflected on a pilot study of a behavior-based therapy for depression: “Why just a pilot study!? When can there be serious funding for less-invasive therapies like this one?” He added, “I go to a psychiatrist with deep questions of the mind, and the answer is always, ‘Try this drug.’ There’s always funding for that answer!”

The interests of institutional medicine can differ from the priorities of patients. Leaders in academic medicine may overvalue new, profitable therapies. Doctors may have different tolerance for risk compared to their patients. Diagnostic categories, while useful to providers, can add to disease burden of patients when labels feel like name-calling.

We accept that the people who evaluate the latest gadgets, movies, and restaurants are end-users of these products and services. The reviewers are not engineers, marketers and business owners. And yet conversations about the significance of new medical research are almost entirely carried on above the heads of patients, who are only later given pre-packaged sales pitches when therapies hit the market. Doctors and researchers often “declare” that they have “no conflicts of interest.” But conflicts of interest are inherent in jobs that are directly and indirectly funded by the business of medicine, and in an academic culture where it’s taken for granted that providers and scientists — not patients — should have control.

It’s time to demonstrate the same respect for the public that we show for scientists and doctors. By engaging directly with patients, we can learn the wants and needs of healthcare’s most important stakeholders. Conversations can reveal unanticipated insights that surprise even the patients. I hope these Brainsplain videos will foster a more honest partnership between the healthcare establishment and the public. I’m eager for your input.

188 COMMENTS

  1. Love this idea and the philosophy behind it, and I enjoyed the video.

    I’m very interested in psychedelic therapies, to get past blocks inside ourselves, but believe they should be used in conjunction with an established high-trust, empowering, and non-coercive relationship with a trained therapist, in a safe environment.

    • GREAT IDEA! I LOVE THIS SO MUCH.
      “It’s time to demonstrate the same respect for the public that we show for scientists and doctors. By engaging directly with patients, we can learn the wants and needs of healthcare’s most important stakeholders.” This is so important and while it’s get that trauma-informed frameworks are emerging if it’s not trauma-informed change, not just trauma-informed care, meaning conversations between and with people happen most impacted, it will just be new vocabulary. Thank you for this important focus. I found this piece linked on ACEs Connection. Please post all of your video links there as well. I’m so excited about this series. I’m going to go share on Twitter right now. Cissy

  2. I’m not much of a fan of psychiatry Doc, so the idea of making a 6 foot rabbit who never wears pants, and occasionally dresses in womens clothes into a star? Meh, ain’t gunna work. But I do consider myself to fit into the category of difficult 🙂 Ask Yosemite Sam lol
    As far as the idea goes, its gotta be better than the current system of giving patients a voice via a pet rock.

    Good luck.

  3. I was at independent selfsupporting meeting of a group of people about a year ago, during which the most extreme traumatic and personal experiences were shared in a factual and friendly manner. When I shared that they had “discovered” that the drug “Ecstasy” could give people the ability to share personal stories and connect – everybody in the room burst out laughing.

      • “Unintentionally Negatively Outcomed” – really? Is that a thing? Totally new one on me. Sounds like an awesome euphemism: he wasn’t harmed by being hospitalized, he experienced an UNO! That’s right up there with “Treatment Resistant Depression” in terms of obfuscation of the truth.

        • The term used in a report by the Chief Psychiatrist was unintentional negative outcomes to describe the people who were having their necks broken during restraints. Setting situations up that end in the outcome of death of the patient, but you can’t prove it become unintentional negative outcomes.
          In my case while the State is trying to conceal the use of torture and kidnap, the doctor with the problem arranges an unintentional negative outcome. No motive as its being covered up, and with no motive a crime hasn’t occurred, just a terrrible accident. If that makes sense.
          Our politicians staffers tend to cringe if you use the correct terminology.

  4. What a brilliant idea! And very-well executed. I hope this takes off and becomes a regular feature.

    Psychiatrists get shunned here often, so, while noting the background to how the idea formed, it’s good nonetheless that this is being fronted by a would-be psychiatrist. It’s in all our interests to get behind substantial reform. And to do that means confronting a lot of controversy.

    Although, I hope the initiative doesn’t descend into a New Age melodrama and keeps its feet on the ground.

    Best of luck!

  5. “When labels feel like name-calling”. What a great header for an MIA post. Hey, wait a minute. Labels ARE name-calling. This leads us to the punch line. How about the latest developments in slander? Marginalization? In slander we trust. Liberate people from the patient role, and in the process, you cease marginalizing people, and you get rid of slander. Uh, I get it. We’re not that advanced yet. I guess a few more upgrades are in order first, and the final upgrade will take you to “heaven”, or, at least, out of service, and into “disuse”. Gee, you’d think we were already there, what with the latest developments in loonybird management.

    • I’m proven well for 30 years as a result of not taking “medication” (in Ireland). In 2016 my GP (in the UK) gave me a sheet of paper though not realising, that at the end of the sheet, it stated “that the patient had an undisputed diagnosis of schizophrenia”.

      How do I argue with that?

      I don’t have a Diagnosis of Schizophrenia, my GP Surgery altered the record to match an “assumed” Diagnosis on the system, and I have other worthwhile evidence as well.
      I will be “arguing”.

    • Frank,
      How does PTSD lead to name calling? It’s a description of someone who is suffering from trauma with very specific symptoms of avoidance, changes in mood/cognition, intrusive thoughts, etc. The truth is that PTSD sufferers are in distress and looking for solutions to feel better. Stating someone has PTSD isn’t slanderous. Actually, the PTSD label is one that most folks perceive as being least stigmatizing, unlike Borderline PD, Bipolar, and Schizophrenia.

      • But here is the problem with making PTSD a diagnosis, imho. PTSD is the normal response on the part of a person who has experienced something that totally overwhelmed them emotionally and psychologically. Notice the operative word here is Normal, it’s a normal human response.

        It should not be pathologized by making it into something that is bad or wrong, which is exactly what making it into a diagnosis does. Why are we allowing something that is normal to be pathologized? This has absolutely no place in the DSM and the DSM has no basis for existing in the first place.

          • Stephen,
            I agree with you that folks with PTSD dx shouldn’t be placed on strong psychotropics. We do tend to try and “put a lid” on many symptoms with drugs, and too often it doesn’t help and can make things worse.

            While I agree that in the short-term people who display PTSD symptoms are having a normal reaction to a scary event(s), if the symptoms persist and cause the person loss of being able to function in everyday living, then it goes beyond what is normal IMO. When someone is disabled by chronic and persistent night terrors, panic attacks, excessive fear, intrusive memories, extreme avoidance, etc. it is not simply a “normal” response for these to continue. Most people who come back from war, for instance, do not meet criteria for PTSD. Only a minority do, just as a minority of people will experience more long-term symptoms described in the DSM. If PTSD were “normal”, then most people should be expected to develop these symptoms after a traumatic event. But that doesn’t happen.

            While I’m cognizant and concerned with labels, I find the PTSD diagnosis to be very accurate and fitting for people who experience these symptoms. When we say something is “wrong” with someone with PTSD, that isn’t exactly the case. PTSD is simply describing the functional impairment the person is experiencing. Clearly they aren’t functioning like others do without the symptoms. I think we can agree that is true.

      • Some people, given various diagnoses, bipolar, schizophrenic, schizo-affective, ADHD, etc., would rather be called PTSD sufferers. Okay. I don’t have a problem with that, and if it allowed them to bypass the pharmaceutical end of things, so much the better. I just see PTSD as another label and an excuse. “I’m not so resilient, you see, I have PTSD, and that explains why I’m spending the rest of my life in counseling.” Personally, I’d rather “waste” my time having fun.

        Trauma also serves as an excuse to bring in the medical profession with their primary forms of treatment (confinement, drugs, shock, and basically physical trauma). Oh, yeah, and I almost forgot…talk. Sure, see if you can find the “health” in that, or the end of it. “Liberation”…doesn’t tend to enter the picture.

        I don’t see myself as so “needy”, but perhaps I’m “deluded”.

        • Frank,
          I see all of these labels as various responses to trauma. The issue is that some of the symptoms people experience are horrid and not fun, which is why they seek professional help in the first place. If you think PTSD is “an excuse”, then clearly you haven’t experienced it yourself or have known anyone who has. Your tone sounds judgmental, as if someone would choose to suffer like that! By the way, the whole point of psychotherapy for trauma is to help someone empower themselves and create meaning and purpose in their lives after the trauma. It isn’t intended to enable clients to make “excuses” for why they are “sick.” A good trauma therapist will validate the pain, help the person to retell their story if needed, and to assist the client in seeking out meaning and purpose in life again. Judith Herman’s book Trauma and Recovery does a good job describing the process. As a final note, very few people in the MH system stay in treatment their entire lives. That is a small minority.

          • I’m generally following Thomas Szasz who pointed out that all survivors of the WWII era could technically be called “trauma” survivors. I just see it as theoretical. Bounce back, and so much for trauma theory, don’t bounce back, and you must have “mental illness” “PTSD” or whatever is the proper terminology now. Some people don’t want to bounce back after all.

            My experience with the mental health system has been different than yours apparently, I’ve seen all sorts of people who have spent much, if not most, of their lives within it. I’ve also seen people leave it in adolescence, and come back to pursue a career in it, or “‘recovery’ advocacy”, “peer specialist support” or whatever. I just think we’re talking about something else besides “disease” until the “treatment” has managed to physically injure its recipient.

          • Frank,
            All humans are trauma survivors because we are alive and experience terrible loss, scary events, etc. The point is that some of us bounce back more easily than others do. We don’t know why that is, but clearly there is a phenomenon where some people don’t develop chronic and debilitating symptoms and others do. It’s not exactly like people choose to have nightmares or flashbacks and others don’t.

            It’s frankly BS to assert that some people “don’t want to bounce back.” Some people don’t know how to. What you might be referencing is learned helplessness, which also comes from childhood trauma and the MH system which can foster this belief within some people. Clearly many folks feel dis empowered, and any good therapy will help to address this issue.

            Regarding peer support, these are folks who have benefited from “treatment” genuinely believe that it’s helpful. I’ve seen many clients get much better and want to help others do the same. I see nothing wrong with this. While the MH system didn’t work for you, it works for plenty of others. If the system were really that bad as you say, then one would think there would be more of a public outcry. It’s a small minority of people who have been really injured by the system who are wanting the system to be abolished. But the truth is that the vast majority of people find some usefulness in seeing therapists and doctors.

          • I would say the vast majority find it neither particularly helpful nor particularly unhelpful. Most drug regimens are taken for only a few months and discontinued, and most therapy these days is a couple of months at most. I think there are lots and lots of people in distress, and they seek out help or they don’t, but I think the long wait list probably reflects the isolation and unmet needs of most of society that people are seeking to meet at the mental health clinic. Some people do find some help there, and I agree that most are not dramatically injured, but in talking to many, many hundreds of people over time who have sought out therapy, the average person has not experienced any breathtaking life changes as a result, one way or the other.

            The part that is harder to gauge is the impact of the DSM mindset on society at large. It’s possible that one reason for the increase in demand for your agency’s services is simply that the marketing of “mental illness” has led people to believe that any time they feel anxious or depressed or angry, they need professional help. What with 20% or more of the USA “diagnosed” at any given time, it seems like there is a lot of push in the direction of “getting help”. I don’t think this is a legitimate gauge of how helpful the services really are overall.

          • When I was locked up in the loony bin, there were some people there, a few, who felt they’d found their niche in life. What a great situation, huh? Three meals a day, no work if you didn’t want it, all your needs looked after, etc. Such wasn’t my perspective at all, but there were people there who saw it that way. I don’t think things have changed all that much.

            I’m not out to sell treatment. I can’t say the same for you. Not selling treatment, I don’t need any rationale for doing so.

          • Frank,
            These days the vast majority of mental health treatment is outpatient and voluntary. What I am talking about is this type of treatment. I’m not selling involuntary, forced inpatient treatment. I, like many others, support people’s choice to attain voluntary treatment if they feel they need it. that is all. And truth be told I don’t need to sell it at all. My clinic has a wait list of 1-2 months to get an intake, so we have an ample supply of people who want the support.

          • *whistle*

            Why does anyone, who has no “sickness”, visit a medical clinic? I suggest that some of the people entering your clinic are doing so under compulsion from someone and somewhere. What am I supposed to say? Get well soon? Perhaps that insight you expect will arrive eventually, perhaps not. In any event, I’m glad that I’ve not been forced onto such a waiting list as you’ve got.

            Google gives “wildly unreasonable, illogical, or inappropriate” and “arousing amusement or derision; ridiculous”as definitions for absurd. Isn’t such a word a fitting description of your medical clinic for the unsick. If I’m going to “waste” my time, let me do so by having fun, not by being corralled into such idiotic reeducation camps.

          • Frank, so what should people suffering from PTSD symptoms do? I guess from your perspective they should just stop making excuses and pull themselves up from the bootstraps since they have a fake illness? You clearly don’t agree with the current system, which is fine. But what is your alternative for these folks who are clearly suffering?

          • Shaun, I don’t buy into this idea that either you accept a diagnosis or you are somehow telling people to pull themselves up by their bootstraps. I’m guessing Frank’s answer would be to find support among your friends and associates, though of course, I could be wrong, and Frank is capable of answering for himself. That may or may not be realistic for everyone, as some people have limited support or need support that the average person can’t usually provide. However, the idea that the only two options are professional intervention and bootstraps is a meme heavily used by the psychiatric industry to promote their own agenda, and I find it kind of repugnant at this point to make it seem that critics of psychiatry are advocating that as the only other option.

          • Shaun, I am commenting on several of your thoughts.
            Any psych dx is a snapshot of someone in a moment -it does not hold true forever or in the next thirty minutes. A broke arm is a broken arm that can be seen on X Ray even after the body has been submersed in a bog centuries after death.
            So even the use of PSTD has concrete issues. In regards to your opinion that not all humans involved in war exhibit that label- it depends.
            The British Government had problems with returning vets in WWI – and during the war the military had an advanced program to treat soldiers who were suffering from so called battle fatigue- ah another problem with labels- they can change and fall in and fall conviently out of favor. The main aim of the program was not to resolve but to make them ready to return to battle. Any knowledge that was gained was either buried or lost.
            So although the returning vets did not fit a label of battle fatigue – there were no more battles- they were unemployed and had so called unruly issues. Wonder why?
            The government as so many institutions do too many many times gathered them to form a security force in Ireland which was in the midst of one of a zillion rebellions. They became the Black and Tans and wrecked havoc and further trauma on the Irish people – a so-called moral harm type of period.
            Trauma signs and symptoms does NOT neccesssrily be OVERT it can be subtle and life long and for those with either wealth, or power, or those with strong support networks, or those with a healthy environment, or those with a strong educational background, or those with a special talent or gift, or those with just sheer good luck, it can be there but not exposed and or kept in quietly or loudly hidden by themselves or others.
            The mass 1960’s youth movement where did that anger and energy come from? My guess is 90% had a parent or parents who were somehow directly negatively affected by WWII.
            Not speaking about trauma is still living in a silent prison of trauma.
            Some sex abuse survivors if they do tell especially those with clergy or other dominant societal offenders take thirty or more years to tell the truth and many go to their grave effectively still silenced by the offender and or the system that refused to acknowledge the truth of the trauma cannon.
            And once one is medicated one is usually stuck in the system because of the medication.
            There is NO institional method that is acknowledged by the MH system to Eliminate the Label and diagnosis and or use the medication as a true short term solution.
            The MH system now plays the productivity game – at least at my last job – where workers are made to have high productivity rates or literally be fired.
            It actually works better to see clients for decades rather than not.
            I only worked in one program that was as trauma based as possible at the time where there was a time limit involved. Then for awhile short term treatment was in and they changed the program time frame. The wink wink here was – they will always be back.
            This is too long- Icould write a book but your journey is still in the making think more, research everywhere, and we survivors not only have knowledge but deserve much much better than what we were given. Restitution’s are needed.

          • You’re working on a rationale for this thing that is paying your salary, ShaunF, but that you say you are not selling. Okay. It doesn’t concern me. I’m neither selling, nor buying, treatment. I don’t have to come up with a rationale for a person’s buying habits. I don’t work in a clinic, and I don’t want to work in a clinic.

            Once it was shell shock or battle fatigue, but definitely war related, but now that you’ve got “trauma informed care”, it isn’t necessarily a way out of military service that we’re talking about. Adverse childhood experiences explain, as if they wouldn’t, adverse adult experiences, alternately referred to as “trauma”, or everything related to mental health treatment.

            I’m neither seeking nor receiving mental health treatment, and I’m fine with that. As for alternatives, neither seeking nor receiving treatment is the alternative that works best for me. For now (& for always), I think I will stick with it.

          • Catnight, well said. I think basically all human distress is trauma-related. The way that trauma manifests, however, is different from person to person. The fact is that most people will never develop full PTSD symptoms. Other may develop depression or anxiety or addiction or……I will tell you that the clients whom I see who have severe PTSD tend to deal with the same set of symptoms for years if not decades. While change occurs all the time, for some people this process is a very slow and painful one.

          • Yeah, but what applies at age 10 or 11 shouldn’t apply at age 30 or 40. Should any fair maiden find herself in distress, harassed by your typical, or atypical as the case may be, Dastardly Dan, I don’t see social services as her knight in shining armor.

            Anxiety is human, not pathological, and people have been allotted all sorts of time to deal with it. Once upon a time, not that long ago, it wasn’t even considered pathological, and people got along as best they could.

            I’m not here to prescribe a course of action to you. You can figure these matters out for yourself. Ditto, yours truly.

          • Frank, not all anxiety is created equal. Some anxiety is pathological when it creates profound disability. Just ask anyone who is agoraphobic or who has severe obsessive thoughts and compulsive behaviors. But I’m sure you think those aren’t real problems, right?

          • Steve,
            “Shaun, I don’t buy into this idea that either you accept a diagnosis or you are somehow telling people to pull themselves up by their bootstraps. I’m guessing Frank’s answer would be to find support among your friends and associates, though of course, I could be wrong, and Frank is capable of answering for himself.”

            I’m not making this argument. Frank made a comment which I was responding to. During this conversation Frank has made no clear argument for alternatives to conventional MH treatment for people who are suffering from distress. I find this line of thinking all too often on MIA, where people say “abolish the system” but offer few ideas as viable alternatives. Frank is also dismissing the reality that PTSD symptoms and other symptomatic profiles do cause real distress and disability in peoples’ lives. This is a fact whether people want to believe it or not. Psychiatry is not the primary cause of most people’s suffering. I get that some people think conventional MH treatment doesn’t help and makes things worse, but the reality remains that the vast majority of people keep coming voluntarily and ask for services.

          • Steve, you make good points. I don’t see any objective way for the MH system to gauge how effective it is. All I know is what people tell me and what I see happening around me. The reality is that people do ask for and want treatment because they are suffering. I think we help some people lessen their suffering, but there are also plenty of people who drop out of treatment or don’t show or report any noticeable improvements. The truth is that the MH system cannot remove childhood or adult trauma, which I think is at the root of why people come see us to begin with. We can help treat it through treatments like EMDR and TREM. I do know that pills won’t do it.

          • I couldn’t respond below your statement where you stated that you don’t think that many people from the armed services are coming back traumatized enough to get the great label of PTSD. If this is the case, why did so many veterans who came back from their experiences in WWII and the Korean conflict and Viet Nam hardly ever want to talk about what they experienced? The only people they seemed to be willing to talk with about their experiences were other veterans and I think this was because they felt that only others who’d gone through the same terrible things would ever understand. I believe that many more veterans are affected than you begin to imagine and you won’t see them wherever you work because they’re not going to show up there.

            I not only work on units in the “hospital” I also work in Admissions. I meet numbers of people brought from jail and prison who are veterans. The number keeps growing as the months go by. I remember one young man, a truly impressive young guy who was brought to us from prison. He was a veteran and had spent six months in solitary confinement, not because of anything he’d done but because he couldn’t stand being around anyone. He was so traumatized that he couldn’t stand human interaction. Those of us in the department knew his situation so we didn’t talk to him and there were only two of us in the room with him. He asked if he could use the restroom which of course we had no objections to. He went in and after ten minutes he still wasn’t out. finally the nurse knocked on the door and opened it and the young man was curled up in a fetal position in one of the far corners of the bathroom and was sobbing quietly. It was heartbreaking and heartrending. The presence of two people was more than he could deal with.

            I don’t have a car and use the city bus to get to and from. I’ve met a number of vets at the bus stops. Many have lost limbs or have TBI’s. One of them sticks in my mind. He limped across the street towards where I was at and sat down next to me on the bench. He used a cane and had a prosthetic leg, one arm was stiff and fairly useless, and he’d lost one of his eyes. We sat there together in silence for a few minutes and then, without looking at him I said, “How many tours of duty?” He told me three, two in Iraq and one in Afghanistan. We didn’t talk about his experiences in those far flung places but did discuss the struggle he was going through with the VA to get ongoing treatment and his benefits. I have deep respect for this man whose name I don’t even know. And near the end of our discussion I asked him if what the United States was doing in those two countries was really accomplishing anything of merit. He laughed quietly and then stated that the US government doesn’t even have a clue about what’s happening or what they’re really doing in foreign lands. He felt that things would return fairly quickly to the way they were before American intervention the moment the last of our troops boarded the transport planes to leave. How do you deal with that probability when you’ve sacrificed an arm, a leg, and an eye for something that was most likely useless?

            So here is my last contention. Not only do our women and men in the armed services get traumatized dramatically in numbers far greater than I believe you realize, there is one last further indignity that they must endure. They must fight the VA tooth and nail to get any real help and no one will employ them. It is no wonder to me why they are ending up where I work to be warehoused and drugged with neuroleptics and to be told that they are faulty and broken because they were not resilient enough to withstand the trauma that they endured because our government sent them to these places. They sacrificed themselves and what their future lives were going to be like because our government just couldn’t resist the temptation to step in and try to run countries and entire cultures of people that we don’t even have any understanding of.

            Enough, I will get down from my soap box.

          • I would add to this that the statement that “most vets don’t come back with PTSD” shows a huge part of the problem with diagnosing people. We have selected out a certain proportion of people who have the most extreme reactions to warfare and tell them that they have this “disorder,” and those who don’t “qualify” are considered to be “normal.” As if there were some LINE we could draw, and decide that some people are “overreacting” when they are across this line, and that those who DON’T cross the line are AOK. This is, of course, utter nonsense. EVERYONE who experiences warfare is damaged, EVERYONE is traumatized, except perhaps those (if such exist) who were so damaged beforehand that killing people doesn’t bother them that much. Ironically, with the current diagnostic system, the psychopathic killer is the one who is considered the MOST normal, as s/he doesn’t have any reaction to killing and watching people be killed.

            Additionally, those who don’t meet the criteria for PTSD are given the message that they have “successfully handled the transition” back to civilian life, and the damage that has been done isn’t validated or brought to light, because, after all, to talk about this stuff is to admit that you are “disordered” and “need professional help.”

            The problem with returning veterans who qualify for a PTSD diagnosis is not that they have reacted too severely to warfare – it’s the warfare they were exposed to! And those who don’t qualify were also traumatized by that same warfare. It reminds me of being in school, when I was quiet and did exactly what the teachers told me. They all assumed that I was AOK and that the kids who were acting out had problems. In actual point of fact, the ones who acted out were probably a lot mentally/emotionally healthier than I was, because they objected to the arbitrary, authoritarian and at times outright abusive behavior we were exposed to, while I pretended it was not a problem while seething inside. But they’d be the ones getting diagnosed with “disorders” because they didn’t force themselves to fit into the status quo.

            I’m the last person in the world to suggest that returning veterans should “pull themselves up by their bootstraps.” But I don’t support making people feel wrong or “disordered” for finding the experience of orderly and intentional violence and killing disturbing to their sense of meaning and stability in life. ALL veterans deserve support, and it should start by an acknowledgement that warfare SUCKS big time and that having negative reactions to being forced to experience such systematic violence is completely normal and expected and not a manifestation of something “wrong” with the person having those experiences, even if they are pretty extreme experiences.

          • Stephen,
            I am in full agreement that our troops are traumatized by the horrors of war. My point is that most of them still do not meet criteria based on the DSM for the diagnosis of PTSD. I believe many of them meet criteria for other diagnoses, such as addiction, depression, generalized or social anxiety, agoraphobia, and so forth. The truth is that depending on how war vets are treated after their duty plays a large role in how well they function afterwards. WWII vets were heralded as heroes, given jobs, started families, etc., and we saw very few of them become homeless and hopeless like many of the more recent war vets.

            Vietnam vets, on the other hand, were called baby killers and spat on when they returned because the public sentiment was strongly apposed to the (stupid) war. Events like the Mai Lai Massacre didn’t help the public’s image or trust in the troops, but I believe most troops were not intentionally killing innocents. Regardless, Vietnam vets weren’t treated by American society like the vets that served before them. Even look now at how John McCain is treated in some circles by supposed patriots.

            And of course the VA falls way short of supporting troops once they’ve been harmed by war. We value troops when they are healthy and serving, but when they are sick and retired we discard them. Reminds me of how we treat the elderly.

          • Steve,

            “Ironically, with the current diagnostic system, the psychopathic killer is the one who is considered the MOST normal, as s/he doesn’t have any reaction to killing and watching people be killed.” No, that is funny. If they don’t feel empathy for others and get some sick enjoyment over watching people suffer or die, then they probably meet the criteria for Antisocial PD which is considered the most difficult to treat because we haven’t found a way to cure people from being cold and heartless.

            “Additionally, those who don’t meet the criteria for PTSD are given the message that they have “successfully handled the transition” back to civilian life, and the damage that has been done isn’t validated or brought to light, because, after all, to talk about this stuff is to admit that you are “disordered” and “need professional help.””

            Well just because they don’t meet criteria for PTSD it doesn’t mean they don’t have other challenges coming back from war, like depression or addiction to alcohol. Also, while I don’t know for sure, I doubt providers are exactly using the language as you describe. When someone has very bothersome symptoms, such as those associated with PTSD, they do FEEL disordered because they aren’t functioning like they once did. They are damaged and injured by trauma. Of course the situation is what caused these symptoms, but nonetheless it is the individual who is needing the help to heal. I know myself and many of my colleagues don’t see people we see as “disordered” but rather “disturbed” by their experiences and symptoms. I would be surprised if the VA is shaming people for having these symptoms which meet DSM criteria. But hey I could be wrong.

          • I have no problem with “damaged” or “injured.” I do have a problem with somewhat arbitrarily deciding who does or does not qualify for being “injured enough” to deserve compassion (if they even receive compassion for a PTSD diagnosis, which for many doesn’t happen, either). And saying that others may qualify for different diagnoses clearly misses my point: these people are harmed by being in a war zone and killing people and watching people be killed or maimed around them. They are all damaged in some way by this experience, or so I have to imagine. It seems very odd and counterproductive to me for vets to have to “prove” that they “have PTSD” (or some other form of “disorder” approved by the APA) before they qualify for help. (And again, I’m not commenting on the quality or effectiveness of said help, which has been copiously covered in other posts). Why doesn’t ANY vet returning from service qualify to get ANY kind of help s/he believes s/he needs WITHOUT ANY KIND OF STIGMATIZATION OR DISCRIMINATION based on being “diagnosed” with some “disorder?” Why don’t we call it “Fucked over by warfare disorder” and leave it at that? At least that label puts the blame where it belongs – on the incredible traumatic stress of war, rather than the “weak character” or “disordered brain” of the person who has to live through that particular form of nightmare.

            And everything I’ve said goes times 5 for kids who were traumatized by their parents or other adults. Let’s diagnose them all with “fucked up childhood disorder” and “treat” the parents or other adults who screwed them over. Sure, they all deserve help and support, but there is no need to blame them for having a bad reaction to being treated like crap.

          • Should military personnel be screened for “psychosis risk disorder” and put on anti psychotics before ending up with Fuked over by Warfare Disorder. Couple of good docos about Afghanistan, Restrepo and one done by the Danes (forget the name). Give a fair idea of how to survive the experience and rotate back to the real world.

        • I don’t share, ShaunF, your belief in profound and pathological anxiety. Anxiety is something we can and do get over. I’m not going to make any of it insurmountable.

          I’ve never made an argument for alternatives to conventional treatment unless by conventional treatment you mean forced treatment, and if forced treatment were outlawed, we wouldn’t need alternatives to forced treatment anyway because forced treatment would be, as it should be, criminal.

          I am admittedly not a believer in the great God “mental illness”. I’m not a believer even if you call that deity “mental distress”. You apparently are one of the “faithful”. So be it. You have your belief, and I have my skepticism, my disbelief. It is a disbelief that hasn’t let me down yet.

          If 80 % of the people, more or less, see no need for “mental health” mistreatment. The majority don’t keep going voluntarily and asking for services. It is the majority that doesn’t receive “mental health” mistreatment. I don’t have a problem with being in that majority, and I don’t have a problem with being in the minority as far as “service users”, so-called, or, “consumers”, so-called, go. I have no interest in accepting a label, taking drugs, and being treated for some mythological affliction or another. It’s not, for the time being, a fancy in which I chose to indulge.

          • Frank,
            One, most conventional treatment is voluntary. Two, anxiety is on a spectrum, some of which is very mild and some of which is quite debilitating. I think if you’d talk with some of my clients you would see that this is the case. I don’t believe in “mental illness.” I believe that mental distress is real and damaging in peoples’ lives. That is all. It’s great that you don’t want traditional “treatment” for yourself, but it doesn’t mean that everyone else feels the same way.

          • One, we don’t have folly today, we have voluntary treatment instead. Two, people need to learn to put their anxiety in perspective so that it isn’t debilitating, and so that it keeps to the milder end of that spectrum you mention. Were I to list things I find important, I wouldn’t make one of those things charting the longest distance between any two points. I think it can be easy for people to get stuck in the mental traps they set for themselves, however I think it relatively easy to spring those traps. It is not even mysterious to me that some people don’t manage to do so. You’re in the “mental distress” business, not me. I know there are people who are distressed chiefly because they have someone like you to attend to that distress. Okay, it’s all yours. You’re the expert, “with lived experience” I presume, go to town, but leave me out of it. The fact that there are people who think they need the help that never seems to do it for them doesn’t really interest me in the slightest. Of course, I imagine there is always going to be a market for ever present basically ineffectual would be assistance. It’s just one of those things I personally have no interest whatsoever in consuming.

          • Frank,

            “people need to learn to put their anxiety in perspective so that it isn’t debilitating.”

            Yeah, and how do you propose they actually do this?

            I wonder how you would talk to a childhood molestation/DV survivor. “You know, Sally, really you just need to put all this fear you have in perspective. You aren’t being molested any longer, and your husband isn’t beating you anymore, so you are safe now. Got it. Quit worrying and move on with life.”

            Frank people have real reasons to be scared or to continue to have persistent anxiety or depression, and sometimes that fear gets to the point they no longer are able to work, have friendships, socialize, pay bills, take regular baths, etc.

            You’ve made it clear that the MH system isn’t for you, and you seem to indicate that you have found other ways of dealing with distress that don’t involve the system. Great! Now, others can find their own path that works for them. I have no interest in recruiting people into the system that don’t want to be in it.

            I myself won’t be in it much longer, either, as I am frustrated with the bureaucracy, focus of quantity over quality, lack of time I get with my clients, being required to use the DSM, psych drug focus, and so forth.

          • My job not being talking to child molestation domestic violence victims, it is not an issue with me.

            Bureaucracy, focus on quantity…, lack of time…, DSM requirement… drug, drug, drug mentality, etc. Apparently all is not so well in mental health clinic land after all. I rest my case.

          • “My job not being talking to child molestation domestic violence victims, it is not an issue with me.” But you say that they need to learn to deal with their anxiety. So how would you suggest that someone deal with their anxiety who went through something like this? I doubt you’ll give me an answer because it seems you aren’t offering any solutions for chronic, debilitating anxiety. But it sure seems like you have concluded that it’s the suffering individual’s fault for not figuring out how to quell their anxiety. What does “put it into perspective” even mean? Well I tell you this is one thing we offer in therapy, but I get the sense you are against this treatment as well.

          • Abuse victims are not unique in experiencing anxiety. I’m not in the business of blowing up and exaggerating all sorts of human experiences. Bad things happen to good people, and there are bad people in the world. Put it into perspective means anxiety doesn’t have to dominate your life. I’m against treatment for me. Anybody else can do as they will. You’re getting out of the business anyway. Good. Maybe you will get over promoting it, too. I’m not a “seeking therapy” type of person, and I don’t need to hear it 24/7.

          • I doubt you’ll give me an answer because it seems you aren’t offering any solutions for chronic, debilitating anxiety.

            Maybe because only a foolish or erratically self-promoting person would presume to answer such a general question, as the answer will be different for each person experiencing such anxiety.

          • Or to put it another way, the problem isn’t that people with anxiety don’t need assistance, it’s the idea that we can somehow classify ALL people who “have anxiety” as needing the SAME assistance, which I believe is observably false. And in my view, the very act of classification of people as “having anxiety” immediately takes it out of the realm of normal human experience, which as Frank points out, is also not coherent with observation of human reality.

            This does raise a serious question, though, and I’m going to ask it here: if I’m understanding the abolitionist position correctly, all forms of professional psychiatric/psychological assistance are eliminated. So where do you see the support for people who are struggling to survive for psychological/emotional/spiritual reasons coming from? I am genuinely interested in hearing your thoughts on that. I actually think it’s an important question, since the most common argument from the “reformer” point of view is that people need something when they are unable to cope with the expectations of society, and if we remove everything, where do people go?

            Naturally, I am not getting into the question here of why we have a society that drives so many people “around the twist,” as they say. I’d love to reform our corporate capitalist marketing-based exploitative social status quo. But supposing that would take more than a couple of months, how do we help the casualties in the meanwhile? Seriously very interested in hearing anyone’s thoughts on this matter, especially those on the full abolitionist end of the scale.

          • Anxiety isn’t a disease. People have had simple cases of the nerves since time immemorial. Anxiety is programmed into our biology. Anxiety aids us in survival and adaptation. Make a disease of it, and the promoters of this disease make money off of it while the “sufferers” assume the position, so to speak. Everybody is anxious and foolish when young. Anxieties people get over with experience. Folly, too. If they’re smart that is.

          • Oldhead,
            “Maybe because only a foolish or erratically self-promoting person would presume to answer such a general question, as the answer will be different for each person experiencing such anxiety.”

            No, I never said that there is one answer the question I proposed. But the fact remains that if someone is suffering from severe anxiety or something else very disturbing, they may want or need assistance in coping with this real pain. That is the point. I frankly don’t care where people get help and support, but it is clear that many folks need this outside of their friend or family groups, because what they get from these circles is often unhelpful or completely minimizing or damaging. Most of my clients come to me because they don’t get what they need from other areas of their lives.

          • ShaunF “voluntary treatment” is illusory. It looks like volunteering, because the person walks into a clinic on their own two feet.

            The involuntary part is the now socially acceptable pressure to “seek help from your doctor,” or maybe work performance is putting pressure on you to seek help, or perhaps your parent, teacher, boss, spouse, even child is pushing you towards the door of that clinic.

            It is, somehow easier and encouraged in our society to push someone towards a professional, than it is for a friend to admit to a friend, “I can’t get up off the floor,” or “I’m afraid to leave the house” or (insert whatever difficulty / challenge is being faced here). Or, for a friend to say, “I’ll stay with you for the next 48, 72 hours – or a week, if needed, and help you work this thing out.”

            The entire society makes certain that the feet walking up the path to the clinic has plenty of pressure behind it (I might lose my job, my spouse, custody, again, insert stressor here).

            We don’t have safe places to go to let the madness take us, and just be mad until the madness passes. It will pass, especially if it is faced instead of buried.

            We don’t have space in our society to just “freak out” and shake and dance and move out the anxiety, trauma, stress. We’re not allowed to take a month off work or school to cry, scream, rant, rave, draw, paint, write, dance, shake & express that which is troubling us.

            So – I see the pressure to go to a clinic/therapist/psych-anything as actually “pulling the bootstraps up.”

            “I have to function, so I’d better see a professional who will ensure that I do.” That’s the bootstraps, and it’s actually the “easier” path based on our societal norms.

          • The involuntary part is the now socially acceptable pressure to “seek help from your doctor,” or maybe work performance is putting pressure on you to seek help, or perhaps your parent, teacher, boss, spouse, even child is pushing you towards the door of that clinic.

            Exactly, and there are many other examples which illustrate that the notion of “voluntary treatment” is mostly an illusion. Not to mention the specter of forced treatment looming in the background should one “choose” to opt out.

          • Dr Strangelove
            Deterrence is the art of producing in the mind of the enemy ….. the FEAR to attack.

            Oh and gentlemen you can’t fight in here, this is the War Room lol

            Woops sorry, this was meant for my Friends of Psychologists of Guantanamo Bay group. Oh well, might make sense anyway

          • Jancarol,

            You make good points.

            ““I have to function, so I’d better see a professional who will ensure that I do.” That’s the bootstraps, and it’s actually the “easier” path based on our societal norms.”

            Let’s be clear, though, that I as a professional don’t have the power to “ensure” that people function. All I have the power to do is listen, validate their feelings, provide encouragement, and provide potential resources in the community to help the person get their basic needs met.

            When I say voluntary treatment, all I mean is that the person ultimately decides to walk through our doors without being forceably coerced into doing so. They could not come, and possibly deal with other life consequences as a result. I don’t control that as a counselor. If someone says they are here willingly, I take that at face value. If they say they want to work on X, then I can be here to walk on that journey with them. If they say I want to be closed from treatment, I will close them.

            In life it’s near impossible to say any behavior is 100% voluntary, since we are products of our environments and we are conditioned to behave in certain ways by our families, communities, law, etc.

            I would just note that there is a huge difference between involuntary commitment at a hospital vs. outpatient clinic.

          • I would just note that there is a huge difference between involuntary commitment at a hospital vs. outpatient clinic.

            I’m trying to stay out of this so as not to “trigger” anyone, but couldn’t just ignore this statement. Anyone else care to address this?

          • Well, I think there is a pretty big difference, in that someone in the hospital involuntarily can’t legally leave and has many rights taken away, and is often acted upon violently or abusively without recourse.

            This is not to say that pressure, manipulation, lies and chicanery don’t happen in an outpatient setting. It’s just that a person can walk out the door without consequence, unless of course they say the “S” word or act “psychotic” enough to allow someone to call the cops on them. And that last part wouldn’t be possible without involuntary commitment laws.

            I’d say at the least that it would be a whole lot easier to take on the psychiatric establishment if involuntary commitment was no longer an option as a tool of “enforcement” of their “treatment.”

          • Oldhead,

            Most people in outpatient treatment are there because they choose to be there. Versus involuntarily inpatient which one would have to go to court to fight to get out of. Of course there are exceptions where people are on a short-term cert on an outpatient basis, and they’d have to also go to court to get off the cert. I don’t support certs, as I think they are ineffective and we shouldn’t forcing anyone to take psych drugs they don’t want to be on.

            I’m curious, it seems that by your response you think they are not that different. Can you say more?

          • I gotta challenge this notion of “voluntary” that keeps getting tossed around. When basic needs like one’s housing, or income, or medical benefits (some folks have physical conditions that require this) are contingent upon accepting “treatment,” as they too often are, just how voluntary can that really be? Refuse “services” and lose your place to live, or your check, or your access to your medical doctor.

            There is nothing “voluntary” about it when the consequences of refusal are that dire.

          • That is an excellent point! It is absolutely true that many “mental health patients” have their livelihoods threatened if they fail to comply with “treatment recommendations.” Sometimes it’s less overt force than implication and manipulation: “I guess you can go off if you want to, but you know what happens when you try that – you’ll probably end up being thrown out of here and living on the streets, and back in the hospital. And you know how disappointed your mom will be if that happens…” Sometimes it’s literally, “If you don’t do as I say, you’ll be out of the program.” That certainly is not a “voluntary” situation!

          • there is a huge difference between involuntary commitment at a hospital vs. outpatient clinic.

            The phrasing here implies that it is comparing involuntary inmate status to involuntary outmate status, which is what I was responding to.

            Also, ditto on LS’s comment.

          • LavenderSage – strewth! There is economic truth there.

            I have friends who are terrified to quit their drugs, because they will lose – exactly that – housing, income, and go from being “drugged but surviving” to “stressed and homeless” which can’t be good for mental health.

            This is true in Australia as well as the US (I have a friend in each with this pressing issue). If you are no longer “bipolar,” or, if you are a “bipolar” but refusing treatment – it is a dangerous place to be in.

            You may still be “disabled,” as in, unable to work or function in “normal” society – but those benefits get ripped out, and you’re stuffed.

          • thank you, oldhead, and thank you, JanCarol. That one’s been brewing sround in me for awhile now. Sometimes it takes me a bit letting my feelings percolate through my thoughts before I put words to it, but then I respond pretty clearly.

            One more “voluntary” scenario I forgot to add: the one where the school staff basically threaten parents with a medical neglect report to CPS if they don’t go along with having their “disruptive” child assessed.

            (and, as Steve has pointed out before, nobody ever assesses the educational environment that kid is trapped in and reacting to…)

    • Good point, Frank!

      My problem with psych labels 1. They cause people to assume horrible stuff you have never done. Guilt by association. 2. It’s like calling someone a “liar” instead of saying “you lie.”

      In an ordinary court of law you are tried for actions you have committed. Then you are only punished till you have paid your debt.

      According to Mainstream Psychiatry you are the crime. You can never pay the debt for the sin of existence.

      Like something out of Kafka.

      • Very Kafkaesque. I think it was pointed out long ago, the presumption is that there is something wrong with a person, and that’s why and how they get fingered by the mental health coppers. You don’t enter the system because somebody presumes there is something right with you. You can flip the switch on that one though. Perhaps there is something wrong with the people doing the presuming.

    • That sounds great, Fiachra.

      Some people have found profound benefit from controlled, therapeutic use of psychedelics in safe settings, benefits they were unable to achieve despite their best efforts in other contexts. This is different from ongoing dosing with drugs. Many cultures have utilised psychedlics as a part of healing rituals for centuries.

      I believe this is a choice that people should be allowed to make for themselves, fully informed of potential risks.

    • He actually goes out and talks with people which is more than most psychiatrists do. Having been trained as a hospital chaplain in clinical pastoral training I suspect that his chaplaincy training gives him a lot of insights into not only the people who he works with but insights into himself too. I suspect that his training for chaplaincy work is a plus since one of the major things that chaplains do is to actually LISTEN to people when they need to tell their stories.

    • Unlike many psych doctors you are interested in patient input–after diagnosis. I hope it helps people.

      You’re teetering dangerously close to the Kool-Aid here. If one is presenting oneself as a “doctor treating mental illness” all the caring and personality in the world isn’t going to change the fact that this is fraudulent and misleading, thus unlikely to truly “help” anyone. This is not (primarily) a struggle against bad people but against a deadly ideology. By purporting to “diagnose” “patients,” no matter how kindly or gently, one is complicit in the inherent deception of the psychiatric/”mental health” narrative.

      • By the way, when you responded to Frank about peer workers it sounded to me like you were saying that peer workers go back into the system to work because they liked their treatment and think that the mental health system is a great thing. Perhaps I am not understanding you correctly.

        I must state that I became a peer worker, not because I like the system or that I liked my so-called “treatment” that I received while held in the very hospital where I now work. I became a peer worker to battle from the inside against what I experienced as no “treatment” at all but a sham of treatment. I work within the system like some of the French people in the French Underground. I never liked the system and do not like the system now. The reason that I work within it is to endeavor to get people to realize that they don’t have to look to the professionals in the system to think for them and to make decisions for them and to learn helplessness from them. I work to walk with people so that I might encourage them to empower themselves for one person can never empower another person. Each person can only learn to empower themselves. I work within the system but am not part of the system for to do that I would only be parroting the disempowering message of the system itself. I work within the system but not as a part of it to share with people that they have gifts and talents and abilities and are not the helpless individuals that the system believes them to be. I am not a peer worker because I loved my “treatment” and because I love the system. I work in the system because it’s time to take it down and all I can do is my insignificant little part by showing people that they can do for themselves rather than depending on the useless “mental health” system.

        I don’t think that I’m very successful at achieving my goal. All I can do is to work with one person at a time to get them to believe that this is not all there is in the world for them. Not all peer workers are in the system because they love it.

          • What I’ve found is that the peers who come back into the system who want to actually help people regain their lives and move forward leave their positions because traditional institutions like the one where I work are not about to let them do real peer work.

            As Steve stated these places see peers as another way to bolster the message that “patients” need to take their drugs (without ever telling them how damaging the drugs truly are to them, and forget informed consent…LOL. ) We’re never supposed to truly listen to those who are non-compliant and we’re never to agree with them, even though they are often correct and right on target about what’s being done to them. I must always be very careful the words I choose to use and how I structure those words so that the person I’m being with understands that I’ve really heard them and yet I can never be accused of inciting the “patient” to do something the staff disagrees with.

            I feel like Sir Thomas Moore when Henry VIII tried to get him to say anything that could be used against him to bring him to trial for treason against the Crown because he didn’t agree with what Henry was doing. There are cameras and microphones everywhere where I work and the people monitoring the audio say that you can truly hear a pin drop. It’s a very tight line that I walk because if I’m fired I’m of no help to the people on the units. And yet they must know that I stand with them without being able to state that plainly.

            The peer workers that you’re talking about have no problem staying and becoming quite popular with the staff because they are willing to take part in the coercion that’s perpetrated against the “patients” on a daily basis. They have no problems parroting the mantra about “always take your meds” and are true believers because they themselves are on the meds. That’s fine by me but I was trained as a peer work that you were never to push your agenda or ideas on any of the people you are working with and for. So, I find this to be a real problem. Going shopping with people and taking them to their doctor’s appointments is fine but I wasn’t cut out for that kind of peer work. My frustration is that you can’t really do true peer work in most traditional institutions or settings.

          • Most peer support people don’t have the aim of knocking down the system.

            Which is why Stephen stands out above the crowd when it comes to integrity, from what I can see.

          • True, Oldhead. Very few people work within the system with the intent of challenging the status quo. Stephen does stand out, and should be commended. I am doing this now in small ways and I see how nearly impossible the task is. I talk to my boss and I just want to scream sometimes. I see why people like yourself feel the way you do. I hear comments like, “This client has X diagnosis, so you should try to get them to see the doctor because they should be on an antipsychotic.” There is a certain narrative that is created with diagnosing, and quickly “professionals” like my boss think they know what is best and the right treatment for the client. In this regard no doubt there is a tremendous amount of ignorance, hubris, assumption, and arrogance in determining what the appropriate treatment should be. I do see why people think this kind of treatment is overrated and actually dangerous. My clients who get off psych drugs often look and feel better, but I’m pretty sure my boss wouldn’t understand why this is the case. They are clearly indoctrinated in a profound way.

        • I think a lot of “peer workers” went into it for the same reasons you did. I think they also experience similar frustrations, based on my limited experience talking to people who have occupied those roles. It’s true, there are some who go into it because they want to enlighten everyone how important it is to “take your meds” and follow the program. But I think it’s more common that the system does everything it can to make sure no real “peer support” happens outside of the confines of the dominant pseudo-medical paradigm. I can see why some see this as “collaborating,” but I totally see and recognize your courage for fighting behind enemy lines, as I was there once myself, and it is no fun at all!

          • Steve,
            I’ve yet to see this in practice. Most peer support folks I’ve met are doing the job of a quasi-case worker, such as taking clients to doctor appointments, talking to them, meeting with them in the community, riding the bus together, etc. I think a lot of this depends on the setting and treatment program goals. The truth is that there aren’t that many peer support jobs out there. They are still a small minority of the total number of employed folks in the MH system.

          • Thanks for your support and I agree with what you state about the system making sure that no real peer support takes place outside of its control. The thing that I like about Sera Davidow is that she keeps pointing out that peers may be in the system but they are not of the system. She was one of the people who inspired me to begin working on the inside of things.

  6. Stephan, I always reading your comments and I thank you for your well written manifesto.
    I have issues with peers support in some ways but you are witnessing in your work place. I am so sorry you are not seen as the gift that you are.
    You could easily be co- managing an unit and really shine.
    The fear of professionals has prevented so much good from happening.
    Why not Peerand Professional Managed Units at every hospital and do an evaluation of comparison and contrast?
    Of course the administration already fears the outcome and are barricading every level and type of access for any other option.
    Thanks for your work but I wish better for you and please take care of yourself.

  7. The euphoria and excitement described are interesting in the context of trauma informed care and the impact the polygonal theory of nervous system structure and function, has had on clinical practice.

    Professor Stephen Porges paper on love as as an emergent feature of the mammalian nervous system, talks about our capacity for proximity behaviors & whether we immobilized in a body-mind state of fear or love.

    A paradox of human motivation & perception that is explained as the vagal paradox of our tenth cranial nerve.

    While, from the decade of the brain that was the 1990’s, so much technical data has emerged that it will take more decades for these revelations to filter into our common consciousness.

    In the meantime we will carry on will the perception that seeing word’s is a true perception of reality & not simply a medium of communication.

    Yet, is the word consciousness the experience of consciousness?

    As they say in the East; easy to see, easy to do, hard to be wise. Or as the prophet said; they seeing see not and in no wise perceive.

    “We are all in a posthypnotic trance, induced in early infancy.” -R. D. Laing

  8. Without even needing to glance at the endless back & forth on predictable issues, let me simply say this:

    I encourage survivors not to engage in seemingly (to some) innocuous surveys or requests for “survivor feedback” on projects which are clearly designed to further psychiatric/”mental health” influence and “effectiveness.”

    Psychiatry cannot be “made better,” and if it were it would be even more dangerous. By participating in such projects, even if the people running them seem like nice guys, the end result is that the fact of your participation will be used to imbue the results with “credibility.”

    • Good point oldhead.

      Don’t ya just love the way they twist these things around? “Your products are sh&t” becomes, “consumers state that our products serve a number of useful functions” just don’t mention it is as manure lol.

      One of the best I heard was from our pollies. They introduced the new MHA with the party line of “there are added protections.” Note they stopped there and failed to mention that those protections were for doctors against being prosecuted for abuses. But the community felt so much safer.
      With a 200% increase in ECTs over the past 9 years there were worries about the use of this on teenagers. They were reluctant to do it given the possibility of prosecution. There was the “added protections”. The gates were opened with immunity.

        • Something along the lines of ‘Doctors report this highly effective and beneficial treatment is being denied to those suffering. Not a lot from the actual ‘consumers’ who seem to have trouble remembering their own names.
          And hey, who could deny that a 12 year old understands the consequences of consenting to such treatment. Not like there is an imbalance of power here when the doctor is telling them something.
          It will be interesting to see the data in another 10 years as to the level of increases in this. 1000% is my guess.
          Oh wait, they did publish an article on the front page. A nurse in uniform who had undergone ‘treatment’ and explained how wonderful her life was now. The timing of this article was surely a coincidence though.

  9. @Steve: This deserves a new thread, it’s not just a top-of-the head matter:

    if I’m understanding the abolitionist position correctly, all forms of professional psychiatric/psychological assistance are eliminated.

    There is no unified abolitionist position at the moment, but this abolitionist would heartily disagree with this. “Psychiatric” and “psychological” are not synonyms or even similar. If by “psychological assistance” you mean counseling not presented as “treatment,” this is not within the sphere of psychiatry, which purports to be medicine. So while some anti-psych people may also oppose all “therapy,” this is not a defining aspect of AP per se, and numerous AP people are or have been in talk “therapy,” which after all is simply two people talking.

    As for your other more crucuial question, I’m surprised you don’t know the answer but will address it when I have more time later today.

    • OK Part Two:

      So where do you see the support for people who are struggling to survive for psychological/emotional/spiritual reasons coming from?

      First, this assumes that anti-psychiatry means anti-counseling, which is not true. However the larger question here — “where will people find emotional support without psychiatry?” — can be approached from several angles. But it is primarily based on two specious assumptions: a) that psychiatry IS providing “support” to people, however poorly; and b) that the purpose of psychiatry is to shepherd people through troubled times. Once one understands that the primary purpose of psychiatry is NOT to “help” people but to keep them in line, and that it is NOT a branch of medicine but of law-enforcement (written and unwritten), the illogic of such a question becomes apparent.

      I’d love to reform our corporate capitalist marketing-based exploitative social status quo. But supposing that would take more than a couple of months, how do we help the casualties in the meanwhile?

      Who says “they” can be helped when the objective conditions creating such misery continue unabated? Why should it be our responsibility to perform miracles? We are all casualties of capitalism to some degree and have a joint responsibility to help one another through the storm as we seek to overthrow it. The system is killing people as we speak and will continue to kill people until it is stopped. In the process people will continue to go mad and die, and as in all such crises people support each other the best way they can. But until the system is defeated there will be no rose garden. This can only happen via strategic mass organizing, not impulsive actions by individuals or self-appointed saviors of any sort.

      This all reminds me of the old joke about a guy searching for his keys under a streetlight, who when questioned about where he thought he dropped them says “down the block — but the light’s better here.” It would be nice to think that there’s an answer to be found in the Yellow Pages to the obscene horrors of capitalist oppression other than defeating it once and for all — something that might allow us to compartmentalize, kick down the road and continue to avoid what is actually the defining challenge of our evolving civilization.

      If it were only that simple.

      • I appreciate the fleshing out of your views. I do believe that QUALITY counseling has a role to play for people lacking support systems or struggling with complex issues that might be difficult to impossible for a friend to really get their heads around. Unfortunately, the operative term is quality. So much of the counseling world has been coopted by the DSM worldview that it is harder than ever to find someone who is empathetic enough to really sit with a client in his/her darker emotions and not try to “fix it” by some magical intervention. The DSM provides excellent cover for any “professional” to react to a moment of discomfort by blaming the client or his/her “disorder” for the behavior that is disturbing and then send a psychiatrist or other doctor in to snuff out the inconvenient feelings or behavior. There are still quality counselors out there, but if you can’t really shop around, it can be dangerously misleading to assume that the person you are assigned will really know how to be helpful.

        I do think that it is vitally important to help empower anyone who has the rising awareness that their distress is not theirs alone and that the system in which we are all expected to participate is largely responsible for the rising levels of distress and confusion that we see all around and inside us. I think it’s part of the process of fighting capitalism – if people don’t know what it is they are fighting, they won’t make very good warriors. I suspect you are not in disagreement on that point.

        • I don’t think that there should be a field called “counseling” either if you get right down to it, as this separates the individual from the whole of humanity as a “special case.” It is not a weakness to crumble under the onslaught of oppression, it’s part of the nature of being human. Some people can handle a little more than others, that’s the only essential difference between counselor and client. We should learn how to “counsel” each other.

          But people need something in the meantime, some protest. But as Che said, revolution is not a garden party. If that something could be found outside the realm of total liberation we wouldn’t need to have this discussion.

          • I agree Oldhead, but we are not there yet. We have to learn how to “counsel” each other, that is how to listen, empower, support, understand, untangle, accept, befriend, liberate etc. That also entails understanding the different ways we are affected by oppression, and how to effectively dig ourselves out.

            That takes a lot more than intuition It requires understanding that we are different and that there is not just “my way” but a whole smorgasboard of options and that what is helpful for one person may not be for another.

          • We need to see ourselves as more than a collection of individuals however, and to address the commonalities of our oppression. We learn by doing. Actually we just need to retrieve our innate humanity, which includes the capacity for empathy and support.

          • I was talking about the movement opposing capitalism. I’ve been involved on different fronts – we have a number of different groups where I live.
            I’m not involved in the “psych survivor” movement here. I like some of those who are also involved in the wider movement, but most aren’t. I don’t like the gossipy, power-tripping, treachery that goes on within it. There is no bigger picture. There isn’t even anything remotely coherent by way of vision. Most seem to want more psych services, or to get resources to compete with the current one, but with very similar power dynamics to that which they wish to supplant, just with themselves in control – meet the new boss same as the old boss….

            edit to say that this was supposed to reply to oldhead 8.27 not the comment it ended up under

          • Damn, this is getting confusing. I have no idea where this is going to end up. I’m also not sure who is responding to who.

            To Oldhead 1.10am
            I agree that any political psych-survivor movement needs to see a bigger picture, demonstrate where psychiatry fits into that picture, and join the wider struggle. This would also have the advantage of building alliances sharing resources etc.

            Aint happening much round my way.

            I think the left (to be clear the political anti-capitalism movement)needs to be more inclusive and supportive. I don’t mean turn into some kind of self-indulgent self-help, tissue-passing blub fest (if I’m reading you correctly in your criticism).

            Where I am, it has mainly evolved from a background of “union hard-man” politics. Most of those original men had wives who looked out for what they needed without being asked, and who provided a good deal of emotional work/ support without appearing to, and kept the home fires burning. Which allowed them to be tough, and to not acknowledge that they were vulnerble and needed care.

            I’m pretty familiar with the territory of this kind of politics but believe it needs to evolve and that being supportive is not synonymous with being pathetic.

          • @out — I don’t think we’re arguing about much of anything here; I am in agreement with most of what you say.

            As for the movement-at-large (which to be effective must evolve as quickly as possible into a mass revolutionary party or other organization), I agree that mutual support must be part of the struggle. What I’m objecting to is the abstraction of “support” as a separate function independent of the entire context of struggle.

        • I agree with both of you.

          I’ve been part of that “mass movement” for quite a few years now – as (we all are) – the walking wounded. I could have really used the support I’ve finally found for myself recently, as a wounded individual, 25 years ago. I could have been a hell of a lot more use to the movement and to myself.

          There is good help out there in some quarters for people who are severely wounded and in terrible pain, though only very rarely anywhere near the mental health system. Pain to a point is motivating, after that point it is simply debilitating.

          The movement itself needs a lot more awareness and compassion, and strategies for mutual support and living together in the present, the future we want to create. It also needs to wake up to the fact that where there is the potential for power there will be people who join-in to take it, not to further the cause. It also needs to understand that it is not weak to need help.

          • “The movement” doesn’t really exist as an organized force however, it’s currently little more than a concept. But a true anti-psych movement would not be an extended “support group”; it would be part of a larger liberation movement which specializes in addressing the particulars of psychiatric oppression as it fits into the larger scheme. “Support” should occur within the context of shared activity, not as an end in itself.

          • There are always groups spontaneously (or perhaps even more contrivedly) erupting of people reacting to psychiatric assault, torture and destruction calling themselves antipsychiatry. You can catch some of them on YouTube, a few individuals at MIA, scattered websites around the world, etc., etc. I call that a movement, but it’s kind of hush, hush. Antipsychiatry is taking a lot of flack now a days from a lot people blaming it for a lot of things. Social service cuts, non-compliance, poor outcomes, excessive medicalization, increased suicide rates, homelessness, prison overpopulation and so forth. I guess the only answer is we aren’t THAT antipsychiatry.

          • Generally speaking “movements” have goals other than mutual back-scratching. I think the whole idea of “support” needs to be “rethunk” as well. Personally I would object to the expectation that I should “support” anyone who feels miserable about their life — some people should, and deserve no sympathy, especially when it emboldens them to continue with destructive behavior.

            People blaming “anti-psychiatry” for the failures of the system is both amusing and encouraging to me. It’s sort of like Democrats blaming the Russians for their losses when the truth is staring them in the face and laughing at them.

          • Just sayin’ — everything has its place. “Support groups” are not “movements,” although movements should attempt to be supportive. But if Hitler had secret personal insecurities should he have been welcomed into a support group while still functioning as fuhrer, and his confidentiality respected?

  10. Well so much for true intersectional dialogue. Despite his reliance on diagnostic toolShaun at least takes time and energy to reply- thanks for that.
    I think this thread covers a lot of bases old and new.
    I would love to have some Vets speak and dialogue with them. Way backs out ten years ago a mother who lost a child to suicide was telling me about the suicide issue in the VA. I would submit unless you have been in country there is no way any one can get the experience and peer relationship might be very important but I don’t know.
    There is trauma but there is also the spiritual mindset but I don’t have a good sense of what is what. Druids use to intentionally create a psychotic type of experience. So there is that whole realm that is never accounted for by most professionals.
    There is the whole epigenetic issues of trauma generations in the making with the whole world of isms that so many people deal with and have to deal with still today. Lynchings and Detention Centers and forced marched exiles.
    It would be nice to hear a We have no idea and let’s do a remake with a three year review with everyone involved.
    Some folks are helped by mainstream folks and processes but that is a very narrow spectrum and why not use everything?
    Healing has always been needed because human life just ain’t easy.
    The corruption and sense of do harm rather than do no harm just needs to stop.

    • Thanks Catnight. I only rely on DSM categories because my current job requires me to do so. I don’t buy into the DSM, and I tell my clients such these days. I hope we can one day get away from all these labels, because I don’t see how they help and often cause more harm than good.

  11. Stigma and psychosis: when medical labels injure
    https://www.madinamerica.com/brainsplain/
    In reference to the above video:
    Unfortunately, as usual, this limited perspective fails to acknowledge the fact that the experience called psychosis, are documented to be caused by:
    dehydration,
    lack of sleep,
    chronic stress,
    being on a ventilator or being in hospital,
    exposure to toxins,
    vitamin deficiencies,
    adverse reactions to street and prescription drugs
    and can be a result of the normal sequalea of a bona fide medical illness such as thyroid storm or Myxedema psychosis as one of countless examples.

    The favoring of trauma and spiritual theories and those who willfully and in far too many cases, callously exclude proven medical conditions as causal agents, is not only unethical, discriminatory and exclusionary; it blocks MILLIONS of would be allies who have been medically psychiatrized and harmed.

    The symptoms of real medical diseases being misdiagnoses, labeled and mistreated as “mental illness” it is the unspoken – unspeakable truth being banned from the discourse and it is harmful to us all.

    There is no “psych” brain disease, everything that happens in the “mind and psyche” takes place in the human body and as such, all “psych dx” are medical and all psych abuse is medical abuse. It takes on average 7 years to get an accurate diagnosis.

    I understand this exclusion as a misunderstanding and knee-jerk reaction to the misguided use of the biological medical model that abuses millions of people. But real medical diseases do not belong in the same category as fake “MI”’s. They are completely separate in that they are testable and provable.
    The movement itself and the group think leaders refusing to hear, consider and ostracizing people with real medical conditions being misdiagnosed, psychiatrized and abused by psychiatry need to stop this. The political and social justice you claim to seek can only exist in a climate commitment to equity, diversity, and inclusion, the whole truth and nothing but the truth.

    Stop cherry-picking the facts to support the limited, lack of understanding and lack of inclusion this movement currently revolves around. An honest, fulsome holistic body, mind, soul approach that encompasses the entire person is far more accurate, honest and will garner better solutions to the crisis at hand.

    • It takes on average 7 years to get an accurate diagnosis.

      WTF is an “accurate diagnosis”? Two words that don’t go together from what I can see.

      Also there is no “experience called psychosis”; this is a catch-all term used to describe not only the effects of the things you mention but infinitely more. It is a term used to imply understanding where there is none, or very little.

      • If there’s no test that can prove any “mental disorder” whatsoever, how can there be an accurate diagnosis? Just because a lot of people want to be bipolar, and find the doctors to rubber-stamp their self-diagnoses, doesn’t make it real. Sure, it’s trendy to want to have the government set you up with a “mental disability” permanent vacation, and call anybody who objects “stigmatizing”, but the whole thing stinks to high heaven. Look into any microscope, and you won’t find those little mental disorganizers anywhere, and the defective genes the authorities go on about, they can’t pinpoint them either. They are saying much the same thing they were saying a hundred, two hundred years ago, we must be on the brink of some major discoveries. Don’t recognize bunk for bunk, and we could be in the same situation two hundred years down the line.

      • Thanks for pointing that out. I should have clarified that statement of fact, refers to a diagnosis of a bona fide, provable medical disease, vrs an imaginary “mental illness” that I am fully aware, does not exist. It should be shocking to learn that the average lag time on getting an accurate dx is 7 years and in many case, longer- especailly for women who are over-represented as “mental patients” because Gp’s fail to address mandatory testing and typically dx most people with any symptom categorized as “mental/emotional” as a “MI”.
        I make the point to (likely prematurely) draw a distinction between the incompetent, substandard medical services, and fraudulent, incompetent “mental health” services, BOTH of which cause disability, addiction and early death.
        I use the term “experience” of psychosis, precisely because it is simply a cluster of symptoms and not a disease.
        Unfortunately, as always, the legitimacy of my point, that the “experience” of psychosis is actually known to be caused by countless everyday occurrences is a fact that Dr. Campbell failed to note to the collective detriment. My point remains, important.

  12. OK maybe I’m slow or something — I was wondering what the disinfomercial for Lancet Psychiatry was doing at the bottom of the MIA home page when I realized this is what this article is pushing. So, despite assurances to the contrary, the marriage of MIA and psychiatry appears to have taken a great leap forward.

  13. Hi shaun f,
    my wife has d.i.d. Let’s just say there is much, much, much more that can be done to completely heal the PTSD symptoms and undo the long-term effects of the dissociation that always result to a lesser or greater degree depending on a number of factors. But it’s not quick or easy, and it uses attachment concepts that a paid therapist simply can’t emulate no matter how much isstd.org tries to bring the language into their articles. But you can facilitate what is needed so that other SO’s wouldn’t have to figure it out on their own. It’s been years since my wife/the other girls (alters) have experienced the worst of the PTSD symptoms like flashbacks, panic attacks, agoraphobia, etc, because I learned how to apply the concepts of safe haven, affect regulation, primary attachment figure and proximity maintenance into my relationship and so when those phenomenon were occurring, I would envelope them during the mental/emotional storms which allowed them to process the intrusive memories behind all the stuff going on externally. Now the mental hurricanes are little thunderstorms if/when they do happen, and it takes much less effort to pull her through them…but that’s just basic attachment concepts that we all need someone to lean on at times. At this point, she’s learned enough from what I did for her, that she returns the favor when I’m struggling.

    As for the long-term effects of dissociation, that’s an entirely different beast that’s really hard to grasp unless you have intimate access to every alter and can see how each mental-distress issue is often, partially or wholly connected to one of them because they ONLY control part of the brain’s ‘geography’ for lack of a better term. Anyway, we used the concepts of neural plasticity to help re-connect the various ‘alters’ once the majority of the trauma was resolved, but the process of them learning to connect so that one ‘alter’s’ issue (say eating disorder issues) can be balanced by another’s strength in that area…is a frustrating and long-drawn out process…but my wife/my girls are slowly getting there.
    (edit: I guess I’ll add, since most people don’t rise to the level of my wife’s d.i.d., that the partial dissociation that all of us experience to greater or lesser degree depending on the individual trauma we have experienced, still affects the mental-health issues in a similar manner that you are likely to see in your practice…)

    I wish you well. Sorry this is the abbreviated answer, but don’t let your detractors get you down here. Not everyone believes mental health issues are caused by the mental health industry. My wife was never in the system at all.
    Take care,
    Sam

          • “Mental health” is impossible, just as is “mental illness.” I really have nothing to add to this, it’s just basic. Others can explain this just as well as I if they feel motivated to do so.

          • Steve McCrea,
            I’m not exactly sure where you are going by charging shaun f with being a strict materialist…

            My layman’s understand of dissociation and how it works as I’ve helped my wife is that the brain/mind reacts to trauma off all sorts by sequestering the experience of that trauma in the absence of that experience being properly processed. Over time if this experience is not brought back to the forefront and dealt with, the neural pathways begin to atrophy according the principles of neural plasticity..and so the brain/mind because of its natural inclination to sequester all trauma eventually ‘hardens’ the dissociation until those ‘walls’ become quite difficult to breach.

            The last 10 years I’ve had to provide the safe place my wife needed to open those trauma events back up so they could be processed…but even after the memories were processed and re-evaluated and the pain and lies and terror calmed, the effects of the dissociation, the neural atrophy, continue. In fact, it is the dissociation that has been far more difficult for me to help my wife undo than the original trauma. And it is the dissociation, imo, that causes so many of the mental health issues that people complain about because the brain/mind gets divided up as pathways atrophy and with the various divisions the mental faculties and abilities to deal with life become truncated as well.

            Not sure if that makes sense, but it doesn’t make me a materialist to understand that dissociation is a natural reaction that the brain/mind has toward all trauma which then hardens over time because of the principles of neural plasticity.
            Sam

          • I don’t “charge” Shaun with being a materialist – there’s nothing inherently wrong with being a materialist, it’s a legitimate philosophical viewpoint to assume. I’m just reminding him and other readers that it’s not the only viewpoint, and checking to see if that is, in fact, where he’s coming from. I’m not a materialist myself, so it may be that disagreements he and I encounter come from diverging views on the nature of the mind. It’s not intended as a slam or criticism, just a clarification.

          • I don’t think that’s what Steve means but I guess he can speak for himself. However

            the brain/mind reacts to trauma off all sorts by sequestering the experience of that trauma

            You are equating brain and mind here, as many do, but this is simplistic at best. Brain is material, mind is abstract. You may also be assuming that the brain runs the mind, which is by no means a given.

          • You are correct. I absolutely distinguish between the brain, which is an observable organ of the body, and the mind, which is a conceptual phenomenon which science has only the vaguest grasp upon, of they have any grasp at all. It is psychiatry’s insistence on failing to make this distinction (in addition to baldfaced greed) that leads to their complete inability to do anything helpful for human beings beyond temporary suppression of certain thoughts and feelings through chemical/mechanical means.

          • Hi Oldhead,
            after I made that comment, I realized I did make a few errors. And maybe I didn’t answer Steve’s point, but mine is still valid as the topic of dissociation comes up repeatedly and what exactly it is…

            You are correct that I that I didn’t differentiate between the mind/brain…I thought about that all night…and it’s not because I don’t see a difference. However, you are incorrect that I think the ‘brain runs the mind.’ Actually I would probably argue the opposite. The mind runs, or maybe more accurately, ‘uses’ the brain, however, the brain IS an organic body and like all the rest of our body it is ruled by the principle of ‘use it or lose it’ but when it comes to the brain we speak in terms of ‘neural plasticity.’ And so if I had to clarify what I said last night, I would say the MIND likes to sequester all trauma that isn’t properly processed…but over time that propensity causes the BRAIN’s neural pathways to atrophy…and that is where the dissociation takes place, as the pathways become harder and harder to access.

            It is a physically painful process (as in debilitating headaches) for my wife to reinvigorate those pathways as she accesses sequestered memories and then begins to make vibrant connections between all the girls. All 8 girls work every day to invigorate those pathways between them so that they collectively have access to all the abilities that each girl controls individually and/or partially.

            So thank you for pointing out my lack of clarity even if you assumed the opposite of what I meant.
            Sam

          • Samruck, I don’t assume anything about your particular circumstances as they are frankly quite outside my sphere of reference. I was just focusing on the conflation of brain and mind, which is almost universal it seems. I think we’re likely on the same page here at least theoretically, as I tend to believe that the brain merely channels the activities of the mind at the corporeal/material level of existence, but that life energy resonates at many other levels as well.

        • I will point out that we are now making arguments regarding philosophy, not science. In science, a proposition is considered false until it is proven, not true until it is not. If a scientist proposes that such a thing as “mental health problems” exist in a physical sense, it is his/her responsibility to show evidence that supports this, as well as looking at any other compatible explanation and proving that they do NOT explain the data at hand.

          Statements about the presence/absence of God are entirely philosophical/religious in nature. That you choose that particular analogy I think says a lot about the ground on which psychiatric diagnoses now stand. There is a hell of a lot of faith, and little to no science involved. The fact that such phenomena as anxiety, dissociation, hallucinations occur is not proof of “mental illness.” It’s simply a recitation of observed phenomena, such as “stars appear at night in the heavens.” The DSM diagnoses are exactly that – descriptions of observed phenomena, with no scientific analysis of why these things occur or if even more than one manifestation of these phenomena would necessarily have the same cause. The DSM itself admits as much. So were not talking science here. We’re talking beliefs.

          • Oldhead is not playing, but I’ll play. How about this?

            Dissociation comes when the inner and the outer worlds don’t match, are out of balance. Some could call this “cognitive dissonance,” and the variance can be so extreme that it leads to disruptions in “normal” functioning and extreme states. (these things you call “disorder,” but are really healthy ways of surviving trauma, stress, imbalance, conflict.)

            You can drug the extreme state, or you can try and resolve the variance by connecting the inner world to the outer. First, as samruck so aptly described, this requires a safe space. Then, when a caring helper listens, and listens and listens and doesn’t judge – pieces will start to make sense and begin to link to the outer world. Olga Runciman describes this process well, as building a bridge between the individual and the community.

            “Medicine” and “Corporate Psych” are rarely interested in the intense care this requires; it’s hard to see the profit motive in non-drug safe places in the system. But that is what is needed in order to work through the distress, instead of repressing it.

            I am guessing that this is why the success of MDMA in PTS (I refuse to call it “disorder”), as it speeds the process of opening the inner to facilitate building these bridges.

          • Well said, Jan Carol,

            but I can I tweak what you say based on how it’s worked with my wife?

            When the trauma occurs and the mind begins to sequester the unprocessed memories…those memories essentially get frozen in time and, thus over time, there becomes a disconnect, as you say, between the inner and outer worlds. Once I realized that the dissociation had caused her to be internally trapped in the past, then I could understand her reality….and instead of arguing with her about it, I joined her in it and provided her the safety that she didn’t have originally…and once I did that, she was able to begin to process things in light of my presence in her inner reality. In other words, I changed the equation of the past by gently joining her in it.

            So I would say the disconnect isn’t so much ‘the dissociation’ but it is the result of how the dissociation works.
            Respectfully,
            Sam

    • Sam,

      Thank you for taking the time to share your story. I can’t imagine how difficult it is to support someone like you do who experiences severe disassociation.

      I do think it’s important to recognize, like you said, that we all experience some level of disassociation. I certainly did some of this in my childhood, sometimes out of boredom in school, other times due to by home life dealing with an alcoholic parent. Disassociation can keep us “sane” in a world which is often crazy. The problem is that for some people they lose control the ability to bring themselves back to the present moment with their core self. I do believe we all have parts, and these parts come out at different times for different reasons. When we are under duress, it is more likely that whatever MH symptoms we are likely to experience will come out in an effort to cope. I, for example, deal with anxiety, and when I’m under more stress I tend to excessively worry about things out of my control or worry about my own decision making. Luckily when my anxiety flares up I’m still usually able to function, but I know not everyone is in this same category.

      I do think you make an important point, too, that many people who suffer from various maladies, like dissociation or chronic suicidal thoughts, never have been in the system. I have met many clients over the years who have suffered for decades without asking for any professional help. Clearly the cause of their suffering was not and never will be psychiatry, therapy, or psych drugs.

      I believe that childhood trauma is the number one cause of human suffering, and the consequences of such treatment in childhood is why people feel disturbed and ask for professional help in the first place. No doubt the mental health system is problematic, as MIA as clearly elucidated. I am disturbed by the excessive use of psych drugs, and I also know that it does provide real relief for some people. I feel torn about the way we “help” in the modern world. I see why people are critical of the system. I also think, however, that the system is not the root cause of most of life’s problems.

      For people who have been stuck in the system for decades, nevertheless, they are likely to be victimized by the horrid “side effects” psych drugs create. These folks are justified in their anger at the system. I have met such people my my work and here on MIA, and am angered myself when I see ambivalent responses from supposed helpers. These providers seem to just accept that the pros outweigh the cons of such “treatment”, but what is key here is they don’t have to live with the consequences of whatever chemical compounds their clients are ingesting. Psychiatrists will never get TD, akathesia, metabolic syndrome, or diabetes from prescribing pills. No, it’s their “patients” who do.

      I wish you well, too.

      • These folks are justified in their anger at the system. I have met such people my my work and here on MIA

        This is offensive and invalidating of the perceptions of psychiatric survivors and other “such people”; it implies that our anti-psychiatry positions and deconstructions of the “mental health” meme are based on emotion rather than reason, and is a convenient and typical way of avoiding critical discussion.

      • Psychiatry and the “mental health” system may not be the cause of all psychological and emotional distress in the world and not every person who experiences such distress is or has been in the system. But you sure as hell don’t want most psychiatrists nor the system to get their hands on you because you can lay money on it that your issues will only become worse to deal with once they get hold of you.

        I guess each and every person must define what is actually helpful for them. My tendency is to wonder if they truly do believe that they’ve been helped and are being helped, or if they’re too afraid to not believe this. It’s scary for some people to even try to contemplate that things might not be the way that they’ve been convinced that they are. I know people who are afraid to even think about trying to get off the drugs psychiatrists put them on, even though those drugs cause them great and significant physical health problems. They may even lead to their deaths. But they won’t even think about living a life without the drugs. I don’t know; I often struggle with this and force myself to accept their explanations without trying to analyze them. But I must admit that secretly I don’t really believe them. Shame on me.