On MIA Radio this week, MIA’s Akansha Vaswani interviewed Dr. John Read, a clinical psychologist at the University of East London, about the influences on his work and research on mental health over the years.
John worked for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, in 1994, where he worked until 2013. He has published over 140 papers in research journals, primarily on the relationship between adverse life events (e.g. child abuse/neglect, poverty, etc.) and psychosis. He also researches the negative effects of biogenetic causal explanations on prejudice, the opinions, and experiences of recipients of antipsychotic and antidepressant medication, and the role of the pharmaceutical industry in mental health research and practice.
John is on the Boards of the Hearing Voices Network – England, the International Institute for Psychiatric Drug Withdrawal and the UK branch of the International Society for Psychological and Social Approaches to Psychosis (www.isps.org). He is the Editor of the ISPS scientific journal ‘Psychosis.’
What follows is a transcript of the interview, edited for clarity.
AV: So thank you for being with us here today, Dr. Read. We are interested in hearing more today about your varied areas of research. Before we dive into that, I’d like to ask how and why did you get involved in critiquing mainstream psychiatric practices? What were some of the questions that intrigued you initially when you started working as a clinical psychologist?
JR: Okay. I think I got into psychology because like most teenagers, I spent a lot of the time trying to figure out why all the adults were screwed up — when I was on a good day. On a bad day, I spent a lot of time figuring out why I was so screwed up. On most days it seemed like the whole world was a bit of a mess.
The communication was not good within my own family, which I had some inkling was to do with my father being a fighter pilot in the Second World War and continually losing and seeing close friends shot out of the sky. He was fairly non-communicative, and understandably so, but I didn’t know that as a child. He explained it to me later. I think that generation had a lot of that sort of thing going on.
I think most teenagers struggle at times and I thought, rightly or wrongly, that one way to deal with it would be to study psychology and try and understand myself and people a bit better. Unfortunately, undergraduate psychology didn’t teach me anything about this very much at all. It was all to do with perception and rats and God knows what. Except for one major influence during undergraduate studies.
By accident, I think, I discovered Ronald Laing’s writing, who in the 1960s and 70s was one psychiatrist who was making sense, to our generation anyway, about what causes madness. He wrote wonderful books describing families and how once you saw a “crazy” person in the context of their family, they didn’t look so crazy anymore. It was a major influence for me and then I ended up going to the States to train as a clinical psychologist.
AV: So you read R.D. Laing as an undergraduate?
JR: I discovered R.D. Laing during my undergraduate years. It was the only piece of the whole three years of psychology that was of any interest whatsoever. The rest of it, even the (as they call it) abnormal psychology was all about diagnoses and it might as well have been a psychiatry textbook, which is still the case actually.
Most psychology textbooks are horribly biological and have very little psychology in them, interestingly. So yeah, Laing I discovered about the age of twenty and later on in my life, I was lucky enough to meet him and spend some time with him shortly before he died, which was a great honor and privilege.
AV: So one area you said that you were reading about that was different was about the influence of family in the development of difficulties. What were other things that piqued your interest that were not biological at the time?
JR: Well, at the time, I just always found “craziness” interesting. I think most people find madness interesting. There are two types of interests — the sort of interest that terrifies you or makes you want to keep the distance, unfortunately, and the sort of interest that makes you want to get closer to it. I’m not sure why, but I always wanted to get close enough to it.
I just found it more interesting than depression and anxiety and things like that. In fact when I was a clinical student and we had to do our first interview in front of all the staff through the one way mirror, all of my colleagues were terrified that someone with psychosis would show up and I was terrified that someone without psychosis would show up and sit down and say, “I’m depressed because my girlfriend’s left me,” and I would say, “so what?” (laughs).
Obviously, depression and anxiety are very serious things. But I always just found hearing voices and believing that the CIA is out to get you and that red lorries are particularly significant, so much more interesting. I think possibly because I felt a bit crazy myself at times. Since my very first job (actually, before graduate training, I had a job for a year in New York in Montefiore hospital in the psychiatric ward there) I think I really enjoyed that. Partly because it was reassuring to know that there were people even “crazier” than I was so they didn’t seem that odd or strange to me. The idea of, for instance, spending a lot of time wanting to kill yourself, I mean, I’d spent a fair amount of time as a teenager thinking about that.
But again, I think a lot of teenagers do that. So I think part of my fascination was around my own stuff, trying to understand my own difficulties and my fears and all the rest of it. Some of it was just because it just seems to me inevitably fascinating why some people hear voices that other people can’t hear. I didn’t know at the time that only in the developed world is that considered a sign of an illness.
In most cultures, that’s considered quite normal and some people hear voices and some people don’t. So later on, I’m jumping ahead, but later on, I spent 20 years in New Zealand and Maori people think it’s perfectly normal to hear voices and worry about people who don’t hear voices. But at the time I didn’t know any of this.
AV: So it sounds like you took some degree of comfort in being around madness.
JR: Yeah, that’s a good way of putting it. I mean, obviously, it can be scary as well. I don’t want to romanticize it unnecessarily because some people hear voices that are absolutely terrifying, telling them awful things to hurt themselves, hurt other people. But they also hear good voices, voices reassuring them, telling them that everything’s going to be all right.
I eventually came to understand it as pretty much very similar to dreams — only doing it when we’re awake. We all have dreams that are pretty psychotic if we’re honest. Since Freud, we accept that they have some meaning if we can figure it out. But if we have those experiences when we’re awake, we’re told that they mean nothing. There’s just something wrong with our dopamine system. It has nothing to do with our life experiences or our circumstances, which of course is nonsense because all the evidence shows, I now know, that it has everything to do with our life experiences.
AV: I’m curious about whether, as you were going through your own issues at the time, you were ever given a label or diagnosed in any way?
JR: No, I managed to stay clear of mental health services. I did see a counselor at university. I remember getting up the courage to go see a counselor who saw me for one hour and said I wasn’t quite mad enough. It was very busy and I wasn’t quite mad enough to warrant his services (laughs). I didn’t know whether I wanted to be reassured or not by that. In other words, he had more, more… he was one counselor for the whole of the university back in those days, so I didn’t quite qualify.
So no, I never picked up a diagnosis. But like the rest of us, if I had come into contact with psychiatry, I would have several diagnoses. Most of us are on several pages of the diagnostic and statistical manual. And as I say to my undergraduate students, if you can’t find yourself in the DSM anywhere, then you really need to get a life.
AV: It affirms your personhood in some way.
JR: Yes, yes.
AV: And so going back, you came to the United States to study clinical psychology and what were some of your influences there?
JR: Well, I was very lucky, I was at a University in the United States where the clinical program was wonderfully eclectic. So we had staff who were fluent in psychoanalysis, in Rogerian stuff, in behaviorism. Cognitive therapy was only just beginning — that was a long time ago. But there was a whole range of different approaches all respecting one another, which is why I’d come away from Britain to train.
At that point in history, British training was entirely behavioral. It was trying very hard to be a science and to compete with psychiatry because it thought psychiatry was a science, which it isn’t. So everything was very behavioral there, which can be useful, but that’s a very narrow way of looking at human beings. It was a wonderful training in many different models — family therapy, couples therapy, sex therapy. I was very, very lucky and had a small cohort of just eight other students who were all lovely people. It was a very special time.
AV: So that was 2 years, or you did a PhD there?
JR: I did a doctorate in clinical psychology. So it was a total of five years, master’s and then three years after that.
AV: And then what happened after that? Where did you decide to go from there?
JR: Back to England then for a while. Worked in the NHS as a clinical psychologist there for several years and then our family (we had young kids) moved to New Zealand and ended up there for 20 years and only came back to England four or five years ago.
AV: So can you tell us a little bit about what were the differences you observed working in the NHS in England versus working in New Zealand?
JR: Well, they are very similar actually, the mental health systems. New Zealand has modeled itself largely on the British health system so you’ve got the same sort of dominance of the biological model, overmedicating people, over-reliance on diagnoses in both systems. Within that, you’ve got pockets of wonderful people or small groups of people trying to do therapeutic work anyway, despite the nullifying effects of an overly medical model.
So they’re actually quite similar. As I mentioned before, one difference in New Zealand was Maori ways of healing — people tried really hard to integrate those into mental health services and that was a very positive influence because they have a much more holistic approach, including looking at spiritual issues. They never ever see the problem as located inside one individual, which I had never done anywhere. But it was very gratifying to see this whole culture just assuming that if there’s a problem, you need to get everybody together to talk about it.
And when I say everybody, I mean everybody. They had this concept of Fanaa which means extended family. So they would just get together; it could be 10 people, 15-20 people, and they would just sit and talk about it in the context of the meaning of what’s going on for that person, and the intergenerational meaning, trying to figure out where it’s come from. Is it some sort of a gift? Is it some sort of punishment? I wouldn’t necessarily understand or agree with all of their conceptualizations, but the point is they started from the premise that however odd the experience, it has meaning and that meaning could be figured out collectively.
That was the healing process, which is so far removed from the western view of a biological problem that is in the individual or there’s something wrong with their brain or their genes. And the answer is chemical — their chemical solution or electricity doesn’t work. No one can admit that. So that was wonderful. Although obviously, Maori people had an awful time at the hands of white people arriving and colonization. Nowadays in New Zealand, there is a genuine attempt to integrate and to learn from one another. And, Maori are incredible. I don’t know if forgiving is the right word, or willing to share their knowledge, which is amazing given how they’ve been treated. That was an important difference.
AV: So how did being around Maori people and their practices influence your understanding of madness or psychosis or hearing voices?
JR: Well in some ways it didn’t change it, it sort of confirmed it. Because I’d always assumed and worked on the premise that voices and delusions do have meaning and that they come from life experiences. If you listen to what the voices are saying and ask the person who the voices remind them and all of that, they tend to make perfect sense. Not always and sometimes the person might not want to tell you or might not want to know themselves because voices can operate as a defense against what’s gone on in the past.
I guess the way they challenged me is that I always assumed that voices ultimately were internal experiences that we project onto the world and then we hear them coming back at us, but that they are actually part of ourselves. Whereas some Maori would sort of get that, but some would say, “No, no, these are actually really messages from ancestors, you don’t understand, John.” Then I wouldn’t know what to do with that because I don’t believe in that sort of stuff. Doesn’t make them right or me right. So that was an interesting challenge when they said no, it’s not just that there’s an internal experience projected. These are real messages from real people who are dead sometimes. So I just had to sit with that without necessarily believing. I may be wrong. I’m not a very spiritual person, I’d like to be but… (laughs).
AV: So if you were working with someone, say who had that belief, you’d be able to sit with it?
JR: Yes, and I’ve just remembered, the only time I ever heard voices (and this kind of contradicts what I’ve just said) was when a very, very good friend was killed in a car accident, and that night he came to see me to say goodbye. I still get teary thinking about it.
When that happened, with all my knowledge and experience and work that I’d done for so long, I still got scared and I thought I was going crazy. I had to settle down and say, “for God’s sake, John, it doesn’t matter. He’s either there or he isn’t, just sit down and listen to him.” So that kind of doesn’t make a lot of sense given that I don’t believe in that (laughs) but he came to say goodbye anyway so that’s that.
AV: I mean it in some ways it kind of fits with what you’re saying. It was a powerful enough experience that it entered your consciousness or unconsciousness in some way.
JR: Yes, I think just accepting other people’s experiences and other people’s explanations of their experiences. So another major influence on me in that regard was American psychiatrist Loren Mosher, who started the Soteria house. He set up a couple of houses where people with diagnoses of schizophrenia could just be without being treated or without anybody trying to fix them.
The criteria for working there was not whether you had a degree in psychology or psychiatry. It was whether you could sit with extreme states and not be freaked out. That was the criteria for working there. He called it “being with,” which is quite a simple term and that had amazing, amazing results. At least as effective as treatment as usual on symptoms and far more effective than treatment as usual in terms of quality of life and friends and getting back to work and those sorts of things.
So, it’s interesting, I just realized my first two references I identified for you were both psychiatrists, which is interesting because I’ve spent half my life criticizing psychiatry as a profession and calling it a pseudo-science and so forth but there you go (laughs).
AV: But they stepped out of the margins of their own. . .
JR: Yes, they did, and they paid a price for it as well. Loren Mosher was head of schizophrenia research at the National Institute of Mental Health and in the middle of doing all this research at Soteria house, he went on holiday and came back and his desk had been cleared. They just fired him because he was showing a non-medical, non-biological approach worked better than the drugs and that was just intolerable to the profession of psychiatry, so they fired him.
He wrote the most wonderful resignation letter in the history of resignation letters to the American Psychiatric Association. It started with, “I didn’t realize the letters now stand for the American Psychopharmacological Association.” I suggest everybody look up resignation letter — Loren Mosher.
AV: Maybe we’ll put a link to that with this episode. So as I’m just hearing from you, I’m wondering about why you think that we, as a society, are so afraid to embrace non-biological interpretations of mental health?
JR: There are different layers of reasons. I mean the simple answer is the power of the pharmaceutical companies and their endless propaganda, especially in America, more so in America than elsewhere. The influence they have over mental health professionals and particularly psychiatry, which basically sold its soul to the drug companies about thirty or forty years ago and has now forgotten what a proper professional boundary is between itself and a profit-making organization. So that’s one level — it’s a very powerful political and economic force — promoting simplistic biological explanations for human distress.
At a more psychological level, I think that for all of us, when we’re in distress, there’s something attractive about not having to think about the bad things that have happened in our lives, the bad things that are happening now in our lives, our fears, the things we don’t like about ourselves, and all of that yucky stuff that is painful and upsetting. It’s attractive to just accept, you know I’ve got this thing, I’ve got this diagnosis, this illness or something. I can’t help it. It’s not my fault. It’s really simple, I know what I’ve got. I know what’s causing me to be upset, and I know what the solution is.
It’s wonderfully simple intellectually, but it’s also simple emotionally and as much as you don’t have to feel anything, you don’t have to explore anything. Well, it’s the quick fix and I think we all have some responsibility for that. I mean, people (we all) when we’re distressed, we go to the GP who is a doctor, even though these are not medical phenomena. These are human reactions to life, I think. We all trot off to the GP and tell our GP and we’re disappointed if he or she doesn’t prescribe something for us.
There’s also something reassuring about having a medical label, I think. In the short term at least, it tells you that other people have got the same thing, so you’re not alone. It suggests to you that the doctor knows what it is. Now you go to a doctor and the worst thing you want to hear after you’ve told them what’s wrong with you — you don’t want to hear, “I don’t know what that is, I’ve never seen that before.” That’s scary.
So to hear, “What you’ve got is a major depressive disorder” or “What you have is borderline personality disorder” — all of these somewhat meaningless labels, which sound like medical diagnoses, but then they’re not of course and they have very little science behind them, can be quite reassuring in the short term. That is until you realize the stigma that goes along with them and the fact that actually, they explain nothing at all. But it is attractive. It’s simple. You don’t have to explore the messy parts.
Also, it’s attractive politically, for politicians, because let’s suppose we’ve just had our latest figures come out in England that there is now one in six of us on antidepressants in England. It’s about the same way where you are, similar levels. Now let’s suppose that that’s a genuine need, one in six of us are actually clinically depressed to the extent that we need a chemical intervention, which of course is absolutely rubbish despite Brexit and Trump and all those depressing things going on.
I don’t actually think that one in six of us are clinically depressed. Let’s suppose we were — that would mean, if those things are socially caused, that then politicians would need to do something. They would need to do something about the social causes of depression like poverty and child abuse and violence against women and all of those things.
But if we can convince ourselves and politicians that actually these are not social problems, these are illnesses, you can’t prevent these things. There’s just a certain proportion of people who are genetically predetermined to become depressed, then we don’t need to put more money into making the first five years of life safe for our children. We don’t need to reduce poverty, we don’t need to reduce violence, etc., etc. So politically, the biological model is very convenient for politicians. They don’t have to do anything about all this human distress.
So for those reasons in combination with the fact that it’s a very powerful and attractive model, that’s why it is so hard to move it despite all the research evidence showing that the model is wrong — that there is very little evidence. They are now conceding that there is no chemical imbalance for depression, which they have promoted for the last 30-40 years. We’re even beginning to hear now that, “We have never said that there’s a biochemical imbalance with depression. This is the sort of myths that antipsychiatrists like you, John, put about, that we used to say that there’s a chemical imbalance,” which is so bizarre.
Just yesterday, the BBC, which is usually quite a good, reliable source of information, had one of our lead psychiatrists announce how you can cause depression in a petri jar with chemicals (laughs). Unbelievable. And saying that most people in England who are depressed are not on antidepressants yet. This is when we already have one in six on antidepressants.
So that means he just told the country, on our respectable BBC channel, that the actual figure that needs to be on antidepressants is more than one in three. That’s effectively what he said. And given that these drugs are prescribed to women twice as often as men, he’s obviously, therefore, recommending that every other woman should be on antidepressants. It’s bizarre. He’s literally, he’s claiming to be explaining to people the chemistry behind depression.
AV: That’s really interesting. We were speaking about the reasons we don’t want to buy into non-biological explanations and as you were talking, I was also thinking about family members because – going back to what you were talking about family earlier – when someone is distressed and the psychiatrist or doctor gives a label, family members are reassured as well.
JR: Yeah, yeah, and that’s how they’ve got to children, isn’t it, with ADHD for instance? You show me a child with a diagnosis of ADHD and I’ll show you a family that needs some help of some kind. One of the problems with identifying the family as a cause or solution is that it’s seen as family blaming, and we’ve been told we mustn’t blame families. Well, that’s very well, that’s all good, but sometimes families do need some help.
Rearing kids is not always easy and if you’ve got a kid that, for whatever reason, is a bit busier or a bit more impatient than other kids, it’s difficult. But the answer is not to give them amphetamines. I think in some states in America, I was reading, one in four boys under the age of 11 are now on Ritalin. In England, we’re not quite that bad, but we’re catching up rather fast, unfortunately.
But that idea that troubled kids have mental illnesses is particularly disturbing and then you’ve got teachers on the lookout for it and diagnosing it when it’s not there. I mean there’s an interesting history to ADHD. When I was training, the diagnosis used to be called minimal brain dysfunction. It turned out to be so minimal they couldn’t find it. So they changed the diagnosis to ADHD.
But yes, so you’re right, families can find it reassuring to have a psychiatric label for their children and then that explains all the family’s problems. Ronnie Laing and other people back in the 60s were writing, and Lyman Wynne and family therapists were writing, a lot about the identified patient and we were taught a lot about that in my training. It’s not talked about so much anymore, but the function of having one person in the family who is “messed up” is that it explained away everybody else’s problems; “If only little Johnny didn’t have ADHD our relationship would just be fine. We’re so stressed by little Johnny.” Whereas it might well be the other way around.
AV: Right, and I think expanding that to something you were saying earlier, a lot of the families that have problems also live in a society that has a lot of problems. So for example, families who live in situations of poverty are more likely to be diagnosed. So there’s that bidirectional influence there as well. So even if we’re looking at families and thinking about how to do it in ways that are non-pathologizing of families, I think again it’s a social problem, not a family problem.
JR: That’s right. Mental health problems are far more common in poor families. Poverty statistically is the most powerful predictor of just about everything. Certainly, health problems, depression, psychosis, but the other thing you said about families is that most often the sort of problems they’re struggling with are intergenerational.
All parents do the best they can by definition. Most parents who are finding it difficult to parent, probably, not always, but probably had a difficult childhood themselves and weren’t parented particularly well themselves so they have no role model for what being a good parent actually is. This isn’t about blaming anybody. This is about identifying intergenerational patterns.
Very often combined with poverty, as you mentioned. I did find that these patterns can be broken. But unfortunately, in our current model, the only thing it is interested in intergenerationally is genetics and the illusion that these things, depression or schizophrenia or whatever, have genetic components to them. And the evidence for that is so weak, it’s laughable.
Unfortunately, research projects with a huge proportion of money still go toward genetic research. Even in my own area of research, for the first 80 years since it was invented, they were looking for “the” schizophrenia gene. They finally gave up on that and now they’re looking for the interactions of lots of smaller genes if you’d like to put it simply.
I asked at a conference recently, how much longer they will need to get to the end of this research and they said, “Oh about 20 years.” And I said, at the end of that, how much of the variance do you think you would have actually explained? And they said — they had a big think in a little conference — and then they said “About 17%.” I said, at that point, can we have all the money back — the millions and millions that have been wasted?
What were they ever going to do if they found the schizophrenia gene? It’s about narrowing the gene pool? Well, I mean, in your country some genetic counseling is going on. I think it’s totally unethical to just sit people down and say, “Because you’ve got this thing called schizophrenia, maybe you should consider not having children.” That’s appalling.
AV: At this point. I think it would be interesting if you could speak a little bit about your research on trauma. We were speaking about family and the impact of poverty and I know you’ve done a lot of research on the impact of traumatic or adverse experiences on mental health problems.
JR: Yeah. Mostly in relation to psychosis. So this all came about during the 20 years I was working as a clinical psychologist or a manager of mental health services in the United States, New Zealand, and then England. Time and time again, I would come across people who would be quite psychotic but if you could establish a relationship — and that’s the hard part sometimes — they would tell you their life history. Not always, but very very often, pretty awful stuff had happened. It was clearly linked to the voices that they were hearing and so forth.
When I got back into academia after 20 years of working as a clinical psychologist, that’s what I wanted to research. I was surprised, as there were a few studies out there linking child abuse to psychosis, but nobody had reviewed them or pulled them together. So we did that first, that was back in 1997.
It’s a long time ago; we started on this journey and then started doing some small scale studies looking at the relationship between child physical abuse and child sexual abuse. We were a bit slow to include neglect and emotional abuse. The relationship was very, very powerful whichever way you studied it. More and more people started doing that around the world and by 2005 we put out the first large-scale review of the literature, which really got the whole issue on the map.
Child physical and sexual abuse are incredibly predictive of psychosis however you measure it. Whether you go down the diagnostic route, which is not really scientific, or whether you go down to the relationship with specific experiences, like hearing voices or having paranoid delusions, the relationship is extremely, extremely strong. Much stronger than anything similar on the biological side of any biogenetic predictors.
That obviously was somewhat controversial to start with and we had the family-blaming accusation thrown at us. We had the “Well you shouldn’t talk with schizophrenics about these sorts of things. It will just upset them.” We had the “You can’t believe them. If they tell you that they were abused as a child. It’s part of their illness.” This makes me extremely angry. That’s the ultimate blaming the victim.
So not only have people gone through these awful experiences and gone “crazy” as a result of them but the people who are supposed to heal them are telling them it didn’t happen. That is unforgivable. Of all the things psychiatrists do that makes me the angriest. I think it’s a little better now partly because we have managed to get this on the agenda. It’s not seen as quite so controversial as it was 20 years ago.
On the other side of all this research is the public’s beliefs about the causes of madness and I’m going to bring these two things together. When you ask the public, using proper surveys of the public around the world, what causes psychosis (or anything really, certainly depression but including psychosis and schizophrenia), the public in every country except one — and you’ll be able to predict which country that is — 24 countries now, they say it’s social causes.
They say it is caused by loneliness, poverty, abuse, violence, war, trauma, rape, stress at work. They also include at the bottom of their list some biogenetic stuff. They don’t think it’s all psychosocial, but their primary way of understanding madness is that bad things happen and they make us crazy.
The exception is our friend the United States and I think that is largely because of the endless bombardment by drug company reps and television, and because you have the most biological mental health system and also the view of the world. But, by and large, this idea that bad things happening is what drives us crazy is only foreign to one profession.
So it’s only 1% of the mental health workforce, which is psychiatrists, that doesn’t get that madness’s is caused primarily by human interactions and bad things people do to one another or unfortunate things like losses and so forth. They are so out of kilter with the rest of the population and that means they’re out of kilter with their patients because they just cannot grasp what this angle is about.
They have no idea about what they call antipsychiatry, which is their label for dismissing everybody who criticizes them. They don’t grasp that the people and their families and just about everybody has a rationale. If you hear voices or you’re paranoid, it’s because bad stuff happened. They are the only ones who don’t get that and they have a wonderful defense against it because if you sit there and say, “No doctor, actually I’m hearing voices because this, this and this has happened to me.” They say, “Aah, so you also have a lack of insight,” which is a symptom of the illness that you say you haven’t got. There is no way out of that.
That is an evil thing to do to somebody who’s vulnerable and upset and is trying to tell you their story and is saying, “No, I haven’t got schizophrenia. Nothing’s wrong with my brain. It’s just because this, this and this has happened to me,” and then that proves that you have an illness; that’s a horrible thing to do.
AV: It’s a power dynamic, right? Because if the doctor tells you this, you’re going to discount your belief or your explanation for someone who knows better and who has seen this before, as you were alluding to earlier.
JR: Yes. It’s not okay that they do that. It must be very dissatisfying for them as well, I think because they never get to experience that closeness that psychologists and therapists and counselors and people in general experience when you’re sitting with someone you care about and you’re trying to understand what’s going on for them and you’re listening really hard to their story and trying to make sense of it with them. They don’t get to experience that.
All they experience is this fear and distance and this objectification of people. It must be a terribly unsatisfying job, I think. Then they get some criticism as well and they have no idea what that’s about. They cannot grasp it, “Why are people so cross with us?”
It’s quite funny actually because what they do with that is the same thing they do with the distress that they want to keep a distance from — they label it, they call it antipsychiatry. They say, “Aah, now I know why you’re upset with me. You’ve got this thing called antipsychiatry, which is causing you to question my judgment. Aah, aah, it all makes sense now.” It’s so pathetic.
AV: I was reading something you wrote in 2005. This was my favorite line from a brief piece in the British Psychological Society. This line that said, “Life events have been relegated to the role of triggers of an underlying genetic time bomb.” I think you’re right. We are talking more about trauma and stress and adverse events but more in the sense of (and I think this is the name of that article) the bio bio bio model of madness.
JR: Well that was not my phrase. I stole that phrase. I have to give credit where credit’s due. That came from the chair of the American Psychiatric Association that year — Steven Sharfstein — who was a very brave psychiatrist and wrote a piece in Psychiatry News. He was trying to tell his colleagues to wake up and stop being so passive about the role of the drug companies and so forth. He used the term bio-bio-bio model — just to give credit where credit’s due.
Yeah, this underlying genetic time bomb thing. All the textbooks — psychology textbooks, nursing textbooks, psychiatry textbooks — they all talk about the biopsychosocial model and the stress-vulnerability model. So people say, “Oh well we’ve already covered that. We covered the psychosocial in the biopsychosocial model.” But that mode just says, if you haven’t got a genetic predisposition that these things are not valid, which is also a lie — there’s a downside to being old because you remember these things.
in 1977 when two psychiatrists (Zubin and Spring) wrote the first paper on their biopsychosocial and stress vulnerability model of schizophrenia they said that the vulnerability part in that stress-vulnerability equation doesn’t have to be inherited. That can be acquired by trauma.
So both sides of the equation can be stress related. Which is common sense — if you’ve been done in as a child at age two, three, and four really badly and repeatedly, you’re going to be more sensitive to stress when you’re eight and ten and twenty and so forth. So the stress-vulnerability model can be all stress but the biological psychiatrists just stole that idea and said, “Well obviously the predisposition, the vulnerability part is genetic.” In that model, Zubin and Spring said that vulnerability can be acquired. That’s never mentioned anymore. That just disappeared. That was whitewashed out of history.
AV: So the field has been talking about these issues for a long time and now we’ve come to this point in 2019. Where do you think we’re going from here? I know you do so much research and there are colleagues of yours who do so much research and are bringing what we’ve been speaking about today to the fore. Where do you think we need to move? Where do you think we’re moving?
JR: Well, first of all, I don’t think that things are going to change because of the research. In a way I don’t think we need any more research about what causes what — I think it’s pretty clear what causes what. So the barriers to change are not the sort of barriers that can be broken down by research papers. Yes, it’s important to do the research and keep establishing what we’ve been talking about but change is not going to come from that because we’re up against the drug companies.
We’re up against a powerful profession that is effectively operating on behalf of the drug companies now and they are not embarrassed at all by the lack of evidence for their treatments. They don’t seem to care about that. So mental health services are not evidence based at the moment. It’s going to have to come from social struggle and work in the media. The sort of stuff that Mad in America is doing and its affiliates all around the world.
The sort of stuff that the Hearing Voices Network is doing, which is the most exciting change in mental health. They wouldn’t want like me to call them mental health services because they’re not. In fact in 20 countries now, there are people who used to be labeled as schizophrenic and drugged up to the eyeballs and locked up for large proportions of their life, refusing to go along with all that and coming together to support one another — 20 countries! That’s very, very exciting. That’s where the change is going to come because ultimately we’ve got to start just saying no to the medications. Not all of the time. Sometimes they can be helpful, but certainly, to the extent that we are medicating ourselves as a society, it’s ridiculous.
We all have a role to play. But I’m hopeful at the minute. For instance, in Britain, in the last year or two, I’ve been more involved with the antidepressants, which is somewhat new for me, because there’s a big push here to do something about the overprescribing and about the new research that’s coming out that’s showing that people are really struggling to come off these drugs. But it actually isn’t so new — it has been around for a long time, but no one’s paid any attention to it and the Royal College of Psychiatry here in Britain has actively denied the withdrawal effects.
So we’re having a bit of a rerun at the minute about what happened with Benzodiazepines in the 1980s when everybody’s said, “Oh, they’re not addictive what’s the problem?” So they’re doing that at the minute. But we’re winning, we’re clearly winning. There are media stories almost all the time now about the research.
We’ve done some of the research worldwide, my colleague James Davies and I. We did a review of all the studies showing that shows that over a half of the people when they’re trying to come off antidepressants will have withdrawal effects and about half of those describe them as severe. You have the national government guidelines saying the opposite, saying that they only last a week and it’s very minimal.
It’s been an interesting struggle to expose how this came about because we’ve learned something about the national guidelines. When they were written in 2009 — we used the freedom of Information Act here — they have to answer our questions. We asked some of them to send us the research supporting our national guidelines saying that they only last a week. They had to acknowledge that there wasn’t any, they just made it up. And these are the guidelines our family doctors rely on.
On the positive side, we have an All Party Parliamentary group in our parliament which is focused on prescribed drug dependence and they have managed to get the Public Health England, which is a branch of the National Health Service, to do a review of prescribed drug dependence, including antidepressants. So that’s going on at the moment. NICE, our National Institute of Clinical Excellence, which is the NICE guidelines, are reviewing their guidelines. The media is full of stories now about people struggling to get off antidepressants and how overprescribed they are.
Again we’ve got this one profession holding out and insisting on behalf of their employers (the drug companies, to be blunt about it), it’s not a problem. They should have more people on antidepressants. They are just getting left behind. They’re making themselves pretty much irrelevant to the debate. So we’ve won the public battle and as I said already, the public already knows what causes depression. The public doesn’t think it’s a chemical imbalance. They never believed that.
I’ve been engaged in a struggle now, for probably 40-50 years, and it’s a hard one because in that time I think things have only slightly got better to be honest. We will now see, for instance, the beginning of the decline of antidepressants. They’re already lining up the next wave of biological treatments. We’re also trying to get rid of ECT, of course — that will come before the end of antidepressants, that’s my prediction.
But they’re lining up new ones. So the latest one just got approved — this ketamine nasal spray for God’s sake. That is unbelievable. Ketamine is a hallucinogenic and has been used as a horse tranquilizer. It’s a street drug and I don’t doubt for a second that if you put some ketamine up your nose, you’re going to feel good for half an hour just as if you’ve snorted some cocaine you’re going to feel good for an hour or three hours. But as a medical treatment for a mental illness, it’s insane.
We all know it’s a parallel to replace ECT when that fades out. They’ve already got this low-level brain stimulation. So you’ve got this 1984 image I have when people who are depressed, they can stimulate themselves, they have a little button in their pocket and every time they start to feel down they can press the button and it just zaps their brain a little bit. That scares the hell out of me.
Obviously, if you’re depressed and it works, maybe it will help some people. Coming back to your original question about why this model is so attractive, it’s because it actually isn’t difficult to artificially make people feel better. Half of us are doing it every weekend with one substance or another. To artificially make yourself temporarily feel better, it’s not difficult. But to do it on an ongoing basis without damaging the brain, we’ve never found a way to do that.
AV: One of the other questions I had was just about the journal you’re the editor for, Psychosis. If you want to speak a little bit about what kinds of research you try and get published there?
JR: Yeah, I’m very proud to be the editor of the journal Psychosis, which just celebrated its 10th year. This is the journal of the International Society for Psychological and Social Approaches to Psychosis, which is a wonderful organization with branches in about 25 countries.
There was clearly a gap in the journal market (if I can use that term) because most scientific journals in the area of psychosis are horribly biological or mostly psychiatry. American General Psychiatry, British General Psychiatry, and all of the leading journals have been quite slow to publish psychosocial research in terms of causes or solutions. There was an obvious gap to fill.
We publish a whole range of stuff. We publish traditional quantitative and epidemiological studies, but we also like to publish qualitative studies where people have interviewed 10-15 people about an interesting topic. Every edition also has at least one first-person account, usually of people who’ve had psychosis and been through the mental health system talking about what causes psychosis in their lives and how they felt the mental health system treated them — not usually very well. Sometimes we have mental health professionals as well, telling their stories about what it’s like working in the mental health system and so forth.
An interesting story: when we started out, some people in our society thought we wouldn’t be able to be financially viable if we didn’t have drug company advertisements like all the other journals. I had said that I wouldn’t be the editor if that was the case, so we had to resolve that somehow. I wrote to the publisher, Routledge, and said, “What do you think? Is it viable to have a mental health journal without drug company advertisements?” They wrote back this beautiful letter saying, “What is it with you mental health people? How do you think physics journals and geology journals and every other science in the world survive without drug company money? Of course, you don’t need drug company money.”
So that was the solution. So we will not ever have any drug company ads and/or people writing who have conflicts of interest. So we’re unique in that, not quite unique, there’s still one or two that don’t and it’s very important. Hopefully, it’s a useful space for people to publish their journey, including beginning researchers. Sometimes it’s hard to get their first article published.
AV: We’ve covered a lot of ground and thank you so much for opening up and sharing so much of your influences. I think it was very helpful to me, as a beginning psychologist, to have this conversation with you on a personal level.
JR: I’ve enjoyed it. Okay, thanks. Bye for now.
MIA Reports are supported, in part, by a grant from the Open Society Foundations