A Deeper Dive into System Change in the Mental Health Paradigm

Robert Nikkel, MSW
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For the past several years, my blogs have centered on a topic that is admittedly not the most exciting—how policy can affect practice, especially in public mental health systems. Distilling my 50 years of experience with a combination of direct work with people, several management positions within local and state organization and those nearly six years as a state mental health and addictions commissioner, I think I learned a number of lessons in this process about system changes. But I haven’t taken a deeper dive into strategies, especially focused for advocates who seek significant and even radical changes. I think it’s now time.

A first consideration is to define system change. Most readers of this blog would probably agree that the paradigm of care that grows out of the medical model is the biggest challenge to confront. If it was dismantled and replaced with something much more attuned to the desires of people who have been harmed in one way or another by psychiatry as we have known it, we would have the truest form of system change. For some, this would mean abolishing psychiatry itself. For others, it would entail a radical reorientation of traditional psychiatry to one focused on recovery, trauma-informed care, peer supports and minimal use of psychotropic medications.

A second set of considerations is this—can systems change? And is it worth trying? I know that I am seen as a hopeless reformist to many, that it is a waste of my time and, far worse, it is raising unrealistic hopes that a totally dysfunctional misguided system can be changed or even should be in existence. I will acknowledge that I may be completely off base and even if not, the radical criticism of a system that has failed so many is an essential counterbalance to my views. Related to this is the question of whether the principles of an organization like IDHA (The Institute for the Development of Human Arts) can apply these lessons in some way to efforts to change systems of mental health care. It is not mine to say but from my perspective as a former mental health commissioner, I think they could and I hope to demonstrate that to some degree in this blog.

Efforts to reform should recognize that we are talking about changing cultures—whether these are clinical practice cultures, financing cultures, policy cultures, or social cultures embedded in the larger community. And it’s really a combination of cultures that overlap and reinforce each other. Changing cultures is an uphill and long-term battle.

I do find myself thinking differently than many colleagues about systems change, having become, unintentionally, a state mental health commissioner. Looking back, Lesson 1 is that system changes don’t happen without the creation of partnerships with key partners like program directors, other state and local agencies (like child welfare, corrections, public health), politicians like federal and state legislators and county officials; advocacy organizations, union leaders; progressive medical organizations like the National Physicians Alliance. And numerous individuals and organizations including (many years ago) the Mind Empowered, Inc (MEI) and more recently the Oregon Consumer Advisory Council (OCAC).

This point was driven home to me when I was fired for pushing for better ideas about how to integrate mental health, addictions, and dental health into broader physical health reform. My ego was a bit hurt. So I went home and before I could forget them all, I wrote down all the things I’d accomplished. The first person I showed them to was my wife and colleague in almost everything I did, Dr. Gina Firman Nikkel. She tactfully but quickly brought me to my senses by telling me I hadn’t achieved these things alone—they came about because of the efforts of so many other people—in the categories I just mentioned.

Here are a few concrete examples of changes through partnerships we were able to make over the nearly six years of my tenure. Some of them were system changes, most were probably more preludes to broader reforms. The first example was closing the children/adolescent units at Oregon State Hospital. We got every single child and adolescent out of intensive medical care and obviously stopped any more kids from becoming “state hospital patients.” At least for these young people and their families, a pretty dramatic change. None of those who needed intensive services ever needed to carry around the identity of having been a state hospital patient. Being served and supported closer to home also has made a considerable difference in their lives. I think we still have a ways to go in terms of a closer look at how psychiatric drugs are used there but that is a discussion I am starting to have with the executive director.

The funding we accessed for increasing safe and affordable housing was another initiative that made life-changing differences for people who otherwise would have continued to find their lives almost unmanageable. This required careful partnerships with federal housing resources and local builders and county mental health programs. It was clearly a move toward social determinants of health care and there has been increased interest in the changes to systems that these resources make possible to consider.

Peer supports has been a long-term interest for Oregon and me. This goes back 30 years to the Community Survival Project (operated by MEI) that demonstrated how people who had been state hospital patients themselves were the most effective supports in getting people out who had been stuck there for long hospitalizations. So a funding partnership was created with a state agency deeply involved in forensic issues and it led to funding Dual Diagnosis Anonymous. DDA has grown to include 4,000 people who now get critical needs for attachment and authenticity met. If you doubt the impact on people’s lives, just ask them. There are groups that have spun off from Oregon’s version in about 20 other states now, plus a dozen meetings in London and more developing in Scotland, Germany and other places in Western and Eastern Europe. There are bills introduced in both the Oregon and Washington legislatures to establish peer respite centers. I doubt that many readers fundamentally disagree with the radical changes that are represented by peer services.

Lesson 2 is that not everything one works toward will result in immediate large system changes. But you never know for sure at the time which are which. It pays to go ahead and play the cards you’re dealt. System changes we didn’t get to are admittedly some of the most challenging. As I have noted above, changing from the medical model to one based on social and environmental conditions is the most important. These are the kinds of changes that will require work with local, state, regional leaders, managed care organizations, other advocates, legislatures, parliaments and other state, provincial and national lawmaking bodies.

Lesson 3 applies to these kinds of system change efforts: Know your lawmakers and other elected officials who have direct control over mental health policies and programs. In the US, work on legislative initiatives. They are the ones who sponsor bills, expect careful analysis of bills, arrange for hearings, and all the other sometimes behind-the-scene activities to get major system changes accomplished. Lawmakers must get inspiration and often basic information to counteract the distortions they are likely to have and which have often been shaped by commercial interests.

Lesson 4 fits with Lesson 3: Know your numbers. That includes knowing how the current budgets work, where the revenue comes from, where it goes, the number of people served in the existing and usually (though not always) dysfunctional system. If you are proposing or advocating for major changes in how the system operates, know what the new approaches will cost and be able to back up your cost estimates. Be able to project short-term as well as longer-term budget impacts. An overlooked and often deliberately hidden budget cost is that of psychiatric medications. Finding this information is a challenging first step. Estimating what savings could be made must take into account the fact that people already taking these drugs must withdraw gradually. It is likely that significantly curtailing use of medications for people coming into the system will lead to more savings but will also require parallel changes in attitudes and knowledge for practitioners. And it will require more knowledge and result in more resistance on the part of those who prescribe the drugs.

Lesson 5 is to master knowledge about outcomes. These are of two types—”process” and “functional.” Many of the outcomes that are commonly accepted are “process outcomes” such as the number of people hospitalized, the number of people who get different levels of care and various kinds of procedures. While these are necessary, they fall short of those that are most meaningful—”functional outcomes.” Functional outcomes are those that make real differences in people’s lives, like how satisfying life is, health status, employment, income, and even measures like life expectancy. Sometimes certain process measures actually reinforce the most unacceptable functional outcomes. A perfect example of this is that Oregon’s health reform’s single mental health “outcome” was the number of people screened for depression. The problem being that this usually led to prescribing antidepressants, which research shows clearly leads to poorer functional outcomes like depression, increased suicidality for many, and withdrawal symptoms for about one half of those who are started on these drugs. Lesson 5 then is—don ‘t settle for process outcomes, push for the measurement of functional outcomes. Finally on Lesson 5 it is critical to know what constitutes well-designed and unbiased research into outcomes. And one missing piece in far too much research is that it assesses short-term outcomes rather than mid- to long-term results. This will also put you in a much stronger position to counter the often sloppy and short-term research funded by commercial interests.

Lesson 6: A basic decision is to know whether policy or practice changes can be made without going through the legislative process. Sometimes changing laws is necessary but it’s very challenging and usually time consuming. An example of a policy change that could lead to practice changes is drastically enhanced informed consent standards and/or expectations. I believe that if people were really properly informed on what to expect from these drugs, they would be much less likely to accept them. For this reason, the Mad in America Continuing Education project has a series of six webinars focused on this issue and could become a leverage point for these changes. Another psychiatric drug policy change would be to advocate for what I call a “MedMap” process to be implemented in every mental health program. This would require tracking of which prescribers are prescribing which drugs in what dosages to which people. I learned recently that this approach was taken a number of years ago in the reform of a state facility under pressure from federal mandates and that it resulted in a drastic decrease in the use of psychiatric drugs. Of course, we can expect great resistance from these kinds of changes, but they do not really require changes in laws in order to implement if advocacy is carefully constructed and implemented.

Lesson 7 is: Know how to get information to key players. They often don’t know what they don’t know. Administrators and clinicians don’t have much time and too often just don’t have much interest in keeping up with the field, particularly good research on outcomes. I shouldn’t be anymore but I’m always surprised to learn that most administrators and state leaders have never heard of Robert Whitaker’s books. Give them Anatomy of an Epidemic. Medical staff in particular have a hard time learning new things—Gabor Mate calls it “intellectual armor.” But by developing relationships and credibility, advocates can bring key leaders up-to-date on critical information sources. In this process, recognize the culture you’re dealing with. This is awkward to say but most of them wear nice clothes and they’re used to dealing with other people (providers, lobbyists, etc) who also wear nice clothes. So, unfortunately, things like appearance, clothing, communication style, conciseness are significant factors in whether we’re taken seriously.

Related to Lesson 7 is Lesson 8: Know what to expect from state mental health leaders—they’re usually short term, highly political in nature. They are bombarded with problems of all kinds—learn to respect their time crunches, learn their biases, find out what got them appointed—there are usually agendas that they’ve been given to address. But one of the worst things is to not expect anything. I believe most state mental health commissioners can do far more to change systems than most people, including them, recognize or expect. One key strategy is to know about any federal mandates that aren’t being addressed—it does happen, so one of Saul Alinsky’s Rules for Radicals is “make the system follow its own rules.” A recent illustration of this came from the Mad in America Continuing Education webinar—child welfare agencies have federal mandates regarding the overmedication of kids but it’s commonly known that the mandates aren’t being followed. To this end, understand what’s driving the resistance and create sound arguments about why they should be addressed: fiscal, loss of control to the feds, etc.

Lesson 9 is to know when to pursue top-down and when grassroots is better. Grassroots is always important to cultivate, having numbers on your side is important and also, it can help gather information you wouldn’t otherwise be able to have. I have heard my colleague and fellow board member with the Foundation for Excellence in Mental Health Care, Dr. David Healy, say that we expect too much from top-down approaches and his Rxisk.org project provides the kind of grassroots information about psychiatric drugs and their effects that is essential to making changes.

Finally, Lesson 10 is to be prepared for subtle and not-so-subtle discrimination—unspoken is sometimes most powerful—”once a mental patient, always a mental patient.” I heard just this week a mid-level manager state that many people believe “most advocate leaders are really personality disordered, not mentally ill.” We have to find ways to manage the totally justified anger you already have or will feel. In dealing directly with those in power, be aware that they will overinflate any anger they sense from you and become more defensive than ever. Not that anger should never be shown, but it’s probably best tied to stories of actual abuse, physical and emotional.

Others can add their own lessons. This is by no means a complete list but if it serves as a starting point for more system change work, it will have served a purpose.

35 COMMENTS

  1. Most readers of this blog would probably agree that the paradigm of care that grows out of the medical model is the biggest challenge to confront.

    Not so here, hospitals, as a rule, don’t take prisoners, not unless those hospitals are “mental hospitals”, or “psychiatric institutions”, do they take prisoners. What am I saying? The “medical model” thing has to be, in large measure, tongue in cheek. The real issue we are dealing with is the “violence card” being played because that is the thing that allows these institutions, to express their own variety of violence, and to take prisoners. “Mental hygiene”, as it used to be put, is associated with “public safety”, and so, you’ve got this matter of getting people ‘off the streets’ who scare other people. I think that could only be medical in a peripheral sense. Why punish sick people? Something underhanded is taking place. Just what is it? I couldn’t say, but the aim is not literal “medical” care, it’s figurative “medical care”.

    Outside of that, I worry about your efforts directed towards systemic change increasing the immensity of the gargantuan creature that is devouring us. The size of the system has grown exponentially with time. What can we do to halt this breakneck expansion of the system? Labeling people “sick” who are not physically sick is called medicalization, and many efforts at reform have only succeeded in furthering the cause of medicalization.

  2. “Most readers of this blog would probably agree that the paradigm of care that grows out of the medical model is the biggest challenge to confront.”

    Nope. That’s not even close.

    One of the biggest problems to confront is the proliferation of articles like this one that advocate for critical or reform psychiatry. Critical or reform psychiatry perpetuates and reinforces too many of the false notions of psychiatry. Critical or reform psychiatry, like psychiatry, is a major part of the problem. There is no sense in talking about solutions to problems that a person hasn’t even begun to understand.

    The so-called “paradigm of care that grows out of the medical model” is not even remotely the problem. In fact, it is an obfuscation of the problem. The problem is psychiatry itself.

        • Opinions are a dime a dozen. It’s truth that we’re after. The attempt to reform or rehabilitate psychiatry is tantamount to the attempt to reform chattel slavery in the South or to rehabilitate Nazi prison camps. I’m content to leave it in the Lord’s hands because truth and justice will prevail in the end, and psychiatry will be exposed for what it is, namely, a pseudo-scientific system of slavery that masquerades as a medical profession.

          • Yes.
            The truth is the “medicines” given/forced on people correct nothing. There is no pathology to correct. The chemical imbalance is a filthy lie. And the only way to think straight is to flee the SMI Lobotomizing Machine.

  3. “we expect too much from top-down approaches,” very true. And the entire DSM based “mental health” system is a top down system. The DSM “bible” was written by those at the top of the psychiatric field. The DSM was written by profit motivated psychiatrists, who were taught in medical school that both the antidepressants and antipsychotics can create “mania” and “psychosis.” As even partially confessed to in all the DSMs, prior to the DSM5. From the DSM-IV-TR:

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    And all doctors are taught about anticholinergic toxidrome in med school, which clearly states that both the antidepressants and antipsychotics can cause “psychosis.” But this is not mentioned in any of the DSMs.

    https://en.wikipedia.org/wiki/Toxidrome

    I appreciate all your complex advise on how to reform today’s psychiatric/”mental health” system. But, sincerely, given the psychiatric holocausts in Bolshevik led Russia, Nazi led Germany, and now America, and all of Western civilization. And a desire to nip the current psychiatric holocaust in the bud.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    I must confess, I agree with the decent dissident psychiatrists, who do know “The institutions of psychology and psychiatry are not going to do it [make the needed changes]–they’re too invested in the status quo.”

    I’ve spoken these hard, scientific realities with too many doctors, pediatricians, psychiatrists, “mental health” educators, psychologists, et al, who are either so deluded by their systemic “mental illness” DSM beliefs, or too greed oriented, to want to change the system. I want them to stop defaming and poisoning our children, and they admit they can’t, because “it’s too profitable.”

    So I’m to the point, I don’t think the “mental health” system is worth trying to reform, or can be reformed. Especially since at it’s core, the “mental health” industries’ primary societal function has always been, and still is, as a child abuse and rape covering up system.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

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

    And this has resulted in huge societal pedophilia and child sex trafficking problems, even according to world leaders.

    https://globalfreedommovement.org/putin-blasts-euro-western-culture-of-pedophilia-and-satanism/

    https://www.nytimes.com/2018/04/11/us/backpage-sex-trafficking.html

    Our society is NOT best served by reforming industries whose primary actual function over the past hundred years is covering up child abuse, while aiding, abetting, and empowering the pedophiles. Our society is best served by starting to arrest and convict the pedophiles, and stop defaming, poisoning, torturing forever, our child abuse survivors.

    My point being, reforming industries that have no scientific validity, and also have as their primary societal function, an illegal function, are not worth reforming. It’s time to get rid of our “mental health” industries. Whose primary societal function has been for over a century, and is still today, illegally covering up rape of children.

    Why? Because to this day, NO “mental health” worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER. Unless they first MISDIAGNOSE all child abuse survivors with one of the billable, but “invalid,” DSM disorders.

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

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

    Our “mental health” industries have always been, and are still today, child abuse and rape covering industries, thus are not worthy of saving.

  4. To call it a “paradigm of care” is so far removed from reality, it’s almost insulting. Especially if we consider “schizophrenia”. In the 50’s, with the invention of neuroleptics, EPS symptoms were considered proof of a therapeutic effect. If the patient wasn’t displaying obvious signs of severe brain impairment, it meant the dose was too low.

  5. “….it’s (anger) probably best tied to stories of actual physical or emotional abuse.”

    Okay. So is anger justified after being lied to and about? Being called hopelessly insane and drugged out of my gourd and having my system wrecked so I can’t leave the house some days thanks to 25 years on a cocktail?

    Would you say Dr. Farid Fata’s victims were justified in their anger?
    https://en.wikipedia.org/wiki/Farid_Fata

    Google the name and read the horror stories of those he crippled and killed for dollars. That is the psychiatric racket. Only it’s legal when shrinks do it. 🙁

  6. Bob,

    There are other paths to social change besides policy change and practice change. As R Buckminister Fuller says, ““You never change things by fighting against the existing reality. To change something, build a new model that makes the old model obsolete.” That requires building a new system, not changing the old system.

    Furthermore, all your 10 steps related to lobbyists and laws and budgets, sure I’ve been working for free on this for about 20 hours a week for years and I’m on top if it. But guess who has 9 paid lobbyists who work on fat salaries and work 40 hours a week and just counter-vent everything I do? The provider lobby.

    And these public health foundations are still funding the PROVIDERS to do the advocacy work.

    How you supposed to do these 10 steps WITH NO MONEY????
    And where is the funding for advocacy? It’s going to the providers.

  7. Mr. Nikkei, I applaud your willingness to share the slow, often tedious, almost microscopic changes that you’ve observed & have as goals. To be engaged in the psychiatric system, AS IT IS, not how it should be, is daunting & thankless.

    The “perfect paradigm” is individually, idiosyncratically described. Many insist it MUST be ‘all (abolition) or nothing’, some support a reformation of sorts.

    The insistence of one’s own strong feelings as the only TRUE path for everyone else, parallels the absolutism (nothing more than opinions-diagnoses & treatments- by psychiatry) that they’re railing against. Irony squared.

    If nothing else I’ve learned from psychiatry (besides the danger I experienced), Talk is cheap…actions are the credible currency.

    When so much profit, cultural mores, & institutions are the target, change comes one small event at a time. Hard work involving showing up everyday and tackling the status quo is massively difficult.

    T. Roosevelt’s “The Man in the Arena” gives me inspiration. I’m sure you’re familiar.

    Kudos to you & your efforts.

  8. Robert, what can I say here?
    You are spouting old stuff here behind the curtain of an accomplished Social Work career.
    However,
    You knew when you entered Social Work, it would not be what administration level you would achieve but how high could you manage playing the political game. You were male and you were white. You did well.
    Most folks here are unaware that Social Work originated with mostly white rich women but not all, not all. Emma Lazurus of the Statue of Liberty fame was one I would guess – who just began working in the tenements. Jane Addams and others pushed to get it recognized as a real profession. And then 1960’s?the administration role went almost all male. There were some females in my time but the stats screwed male.
    I think in the 1930’s and later some of the male social workers left for other professions, in the legal and medical realms. For awhile, in my era, there were JD/MSW degrees but that would create problems maybe?
    What I suspect you know and what you write here I would guess are two different things- the washed laundry hanging outside or the dirty laundry hidden in the attic with the dead skeletons.
    These are the topics I would hope we could get from you if you decide to climb down and unzipp the curtain and pull out the hidden laundry and finally get it washed and bury the dead with all due dignity and respect.
    1) Sex abuse of clients in all the associated agencies. This happened with the entire spectrum off staff. Not all agencies, and not all staff who worked in any agency. It is still a verboten topic but it is there and it is time for it to come out.
    And yes, one never knew who, what, when, where, and how until one stumbled upon it by hook or by crook but it is and was an issue.
    2) Impaired professionals. Whether through trauma- primary, secondary, or tertiary experiences it is there and so often not treated fairly.
    Substance abuse issues. How to handle and what really are the stats here?
    3) How to handle abuse and neglect by unliscenced staff members in institutions or agencies, or group homes for those who are deemed through age or disability as unable to care for oneself?
    And again, trauma plays a very large role here. Any caretaking can cause burnout or I would say secondary or tertiary trauma and how staff to the janitor and cooks are treated portends how the clients are treated. Abuse and neglect can be very much top down problems.
    4) Inability for the Social Work profession and perhaps others to own their own life traumas and own life recovery episodes. Why does one go into Social Work and in particular areas- we all have narratives that link us to our own or other life stories. Let’s tell them and not hide them. My best guess is that one of my respected Social Workers of all , worked with traumatized mothers for a reason- there was a need in her or a need in me that created a desire and yes sometimes a good deed or two because of that narrative.
    5) Use of Peers and Volunteers in agencies. This maybe probably should not be combined but both populations seem to have been poorly used at times. Again the concept of Famy Therapy or Organizational Theory or the old proverb about the fish head rotting first. Maybe not you since you have written here but I don’t know your state or locale so maybe there still is some sort of honor code in the so called Mental Health professions.

    6) In my times in the system as a person supposedly in need – I was pushed in and did not walk into it because so called friends were concerned and had no idea I was actively getting support for the traumas in my life but they took it upon themselves not only to intervene in my own agency but to intervene in my husband’s and mother’s.
    They also had no idea of my professional knowledge base and that I would never ever do to a client or human being what they did to me.
    And the worst part was I sustained serious trauma from their interventions and actions and the treatment was just as damaging or worse. I found out often in life if something happened to me I am usually not alone
    7) And my guess is trauma is not the end all or entire issue. There are so many possibilities in our world for people to enter altered states.
    So in light of all this, I request you and others in positions of power to wade in the wasters and get off the boats you all are riding.
    Create a paragraph of “ I have stains on my hands ect…
    Create bridges instead of walls.
    Create truth not more baggage.
    And please read RFK’s address to the folks on the night of MLK Jr’s death.
    There were no acts of violence in that city, the only city in the nation not to be affected by traumatic violence.
    It can be accomplished. You all have st least one example.Make it so.

  9. Excellent collection of facts! I was so glad you got number 5, the value of functional verses process outcomes! This is so critical! To reform, recreate, or overcome the medical model or current “system” is a great question to prompt action, thanks for your work on this, amazing read!

  10. I am not one for change from within a system. Does history support this or not?

    There are three ways towards real systemic change:
    1. Holding actions, like demonstrations keep the resistance together in instances of threat.
    2. Education: raising public awareness of problems and solutions, hopefully to create a change in consciousness.
    3. Creation of viable alternatives that work so much better than the system, that they are in place as the system crumbles.

    These ideas come from Joanna Macy, and I apologize if I got parts wrong here.

    My focus is on the second and third above.

    I write extensively, answering many questions, as an “expert” on psychosis for the forum, Quora.com. I’ve nearly 500,000 answer views. And I am a member of the growing Facebook group, Drop the Disorder (https://www.facebook.com/groups/1182483948461309/), now with over 9,000 members, both professional and of lived experience.

    As an alternative, I participate in the peer support movement, but fear this is being co-opted with required trainings and certifications, followed by paid jobs with medical institutions requiring employees to toe the line.

    If others have ideas on how to change the system or create alternatives, I’d like to hear about them.

    • Don

      I for one have to agree with you that change cannot be affected from the inside; it just doesn’t work. I don’t know how the French Resistance did as well as they did against the Nazis!

      Secondly, I would affirm your fear that the peer movement has been co-opted with all the certification/training requirements. In my state the requirements are not greater than those set for nursing or social work! Most peers aren’t swimming in money so that they can afford all the trainings and requirements. This is done to keep people out. And you are correct in that when we do get in an institution the expectation is that we won’t do any advocacy work for people nor will we speak out against the abuses nor the chicanery and blowing of smoke!

  11. We have to take a stand, zero contact or cooperation with the mental health system, with Psychiatry, with Psychotherapy, or with Recovery.

    We have to work solely in the realm of political action. And some first good projects would be to put some Psychiatrists, Psychotherapists, and Gov’t supported Recovery Programs out of action.

  12. Don , glad to hear your voice. I am very leery of any social media these days. But if you feel it works for you, great.
    PD. Your thoughts are important but I am going to say one needs to merge with other causes that touch on your own. Politics can make strange bedfellows and one most always be aware of what is liable to happen underneath the covers.
    In our country, we now have children and or families held and experiencing much of what we survivors have experienced in a similar but different realm.
    If we all in our various viewpoints consolidated around helping these people out it would be a win / win situation. No politician or founder or professional can understand their experiences – but we can. If we help then we can gain legitimacy for or own past histories. And then our voices cannot but helped but to be acknowledged.
    And fighting for another cause sometimes is just less triggering and can energize instead pull one down in the crap.
    I think PD this is what happened in the femanist beginnings. They fought against the instituting of slavery and then realized oh there are other forms of slavery as well. But the anti slavery campaign gave females a field to begin to gain creedence.
    And we are still fighting for equality for females and other gender issues, and on and on for racism and environmental issues and there is an infinite number I fear at times. But something to focus on and get out of one’s own pain. But maybe a way forward with a possibility of real change and more than just small pats on the head and a treat or two.
    And maybe pick a cause any cause and walk into it and or then at a good time – I know this because I have experienced being held without freedom to leave and then maybe the fruit will be ripe to be picked.

  13. Rachel777 wrote: “Yes.
    The truth is the “medicines” given/forced on people correct nothing. There is no pathology to correct. The chemical imbalance is a filthy lie. And the only way to think straight is to flee the SMI Lobotomizing Machine.”

    “There is no pathology to correct.” How do you know this?
    Insisting that there isn’t a pathology in *any* person is akin to insisting that there always is. It may be that in some people it is an as yet unknown pathology that is causing their problems and there is plenty of early evidence for many many factors that may give rise to schizophrenia. Toxoplasma gondii being one.

    Schizophrenia is a collective noun.

    As is personality disorder.

    And depression.

    All the above are collective nouns for things that are tentatively understood.

    • So do you believe in the chemical imbalance myth RR? (The APA does not.) I ask this because you left this as part of the quote from me you take issue wiih.

      If they don’t know WHAT the pathology is how can they correct it–assuming the a priori assumption is true? They are likely exacerbating the original complaint and/or adding new ones.

      Lyme disease, anemia, Hashimoto’s are indeed physical problems that cause messed up thinking. None are treated by shrinks.

  14. Just two nights ago I was talking to a friend who is deeply committed to the idea that there is mental illness and that people need access to psychotherapists. He was greatly offended by my view that there is no such thing as Mental Illness, and that psychotherapy is inherently abusive and worthless.

    But he fights for all the therapy time he can get. He is a member of Kaiser. So I guess it is managed care, not services on demand. So they only get one session every 8 weeks.

    Not sure if that would even let therapy work the way it is intended to. Therapists seeing too many different clients.

    He is attached to the idea that he is Bipolar, resistant to my arguments against that.

    He wants to be in a Kaiser Recovery Program, because he was using crystal meth. He said he did not want to go through withdrawals outside of such a program. But they have not let him in, and he has had to go through withdrawals.

    So I ask him, why do you want to be in the program. Sounded like he wants to talk to their councilors.

    So I asked him, does it matter if they let you in in 3 months, instead of right now?

    He is still committed to the concept of mental illness, and to psychotherapy. Seems like it is this idea that we all need to improve ourselves, see difficulties as always being due to our own personal limitations.

    He resists the idea that the issues which cause people distress are better looked at as legal and political issues.

    He says he has depression, like that is a clinical condition. I tell him that Peter Breggin has written that people are depressed because they are leading depressing lives. He does not like that. I tell him that Breggin, drawing from Foucault, has written that the original reason for Psychiatry was to make justifications for incarcerating people who are breaking no law, such as homeless people for panhandling.

    He does not like my idea that most of these issues come down to the middle class family, and that child exploitation should be tortious, and that disinheritance should be abolished.

    As I have seen, child exploitation is far more serious the more money the parents have. I hear of trust funds, foreign living and foreign private schools. But my friend has not had the chance at a post secondary education, and he has earned his living at blue collar and menial jobs.

    But he does not like the idea of going after parents legally, not at all. Sees even that kind of an idea as something which should be corrected by a psychotherapist.

    His whole life is on standby and is sinking now, over access to “mental health services” and to Kaiser’s recovery program and councilors.

    I have also encountered a second person who has really shaken me up, a woman, maybe late 20’s. People say she is “insane”. And I have seen her try to steal things from people and try to get people to take sides and start physical fights between men.

    This person is totally gone. I can’t see psychotherapy being effective on her, even as it is intended to. I doubt that she would remember what she had said 10 minutes ago. Only interest she would have is if she could get psych drugs, or money for street drugs.

    So you can see that the probability is that they would put her on psych drugs. It makes it easier for police, paramedics, and psych hold ward techs to deal with her.

    But I still don’t think this is right. She was not born that way. “Insane” is just a common term. It does not actually mean mental illness, not in todays lexicon.

    So psychotherapy would not work, and I am opposed to psychotherapy anyway. Over some things they could incarcerate her, but such still requires evidence, where as the drugs do not. Don’t have to resolve any he said she said stuff. Just give her the drugs, and convince her that they are good for her. And as I have seen, most of those on them readily accept this idea. The psych drugs, from my view, have the same sort of appeal as street drugs and alcohol.

    Should have interventions at earlier ages.

    In J. K. Rolling’s novel “A Casual Vacancy” they follow a girl from age 6 to 16, who is really difficult. They do try to work with her in the school system though. Its not drugs and it is not really psychotherapy. Its just school counselors. And then one guy has gotten her onto the girl’s rowing team. Seems to be doing well with that. Earlier intervention into the home scene with the drug addicted mother would have helped. But this does not mean that the mother should be exonerated financially, though I think she has nothing.

    This one 16yo old girl and her history are having a huge effect on the towns politics. They see her as emblematic of the children of low income people, and so they want to keep such out of their town’s school system. Earlier intervention and resources would have helped. But to me this does not mean Psychiatry, Psychotherapy, or Psychiatric narcotics.

  15. Wake Up Robert Nikkel MSW !
    Urgently necessary to be put out of action for crimes hard to believe, including sadism torturing severely injured car accident victim. Info off of business card follows.
    PeaceHealth Medical Group___BEHAVIORAL HEALTH SERVICES
    Roberto Cruz Barahona MD____541-222-2185 OFFICE___541-222-2194 FAX
    CONSULTATION-LIAISON PSYCHIATRY
    ADDICTION PSYCHIATRY
    peacehealth.org
    3311 RiverBend Dr.,Springfield, OR 97477
    Sincerely,
    Fred Abbe

  16. I think the consensus here is very clear. Of course this is only my opinion, but I think the real change is going to come from the underclass, the poorest of the poor, many of them mental patients or ex-patients. This is where I personally see the largest revolt, and it is already starting. What is the word sociologists use? Proletariat.

    We can certainly eat their cake. What is going to happen, though, when we refuse their Kool Aid?

    Public health experts who deal with statistics are often saying that the poor do not have access to health care, or shall I say, “health care,” and see doctors less often, and therefore, must be very unhealthy. But no. The Revolution is already starting. People are finding that a lot of natural medicine is cheap or free. The best of it you will find in your grocery store, but the free stuff is priceless. Like, say, sunshine. Hugs. Your dog. Okay, okay, agreeably, dogs do cost money, but it’s a small price to pay for saving your own life.

    • I think the real change is going to come from the underclass, the poorest of the poor, many of them mental patients or ex-patients. This is where I personally see the largest revolt, and it is already starting. What is the word sociologists use? Proletariat.

      The proletariat have “nothing to lose but their chains” said Marx; this was echoed by the mental patients liberation movement: “Psychiatric Inmates Unite — You have nothing to lose but your restraints.”

      The “change” needed here is not a new “model of care” but the end of the entire paradigm of “care-givers” and “care-receivers”; that’s something that should be taken for granted as part of being human.

  17. Julie wrote, “…I think the real change is going to come from the underclass, the poorest of the poor, many of them mental patients or ex-patients. This is where I personally see the largest revolt, and it is already starting.”

    YES!

    It’s got to be that way!

    Those below the working class (proletariat) are called the lumpenproletariat ( under the proletariat). And that comes from Marx and Engels in the 1848 Manifesto.

    Marx described lumpens as “alcoholics, drifters, and those only occasionally employed”. He saw lumpens as having no political consciousness. And most interestingly, he saw this lack of political consciousness as the main thing which separated lumpens from the proletariat.

    Fast forward though 100 years to Frantz Fanon in Algeria, he saw that the proletariat were being coddled by colonialists. So he saw the revolution as coming from the lumpenproletariate, or the underclass. He described this as “those ejected from family and clan because of capitalism”.

    I find this most interesting, capitalism breaks up families and clans. And the underclass is the result. And it is from family and clan that one will find condemnation.

    Fanon described the underclass as Pimps, Prostitutes, Drug Dealers, and Petty Criminals. And said that instead of in the town with running water and electricity, they tended to live in shanties outside of the town’s boundaries.

    And then he said that the underclass can indeed have political consciousness, and it can take actions which are highly disruptive and highly revolutionary.

    Strikes no, and voting does not do much, but the underclass can really cause a lot of trouble.

    I say that we need to look at all of these matters in ways similar to how Fanon does.

    Fanon was a Psychiatrist, in charge of their Psychiatric Hospital. The French prosecuted that war by torture, like electricity, water boarding, and then once someone talked, they would be guillotined the next morning.

    Fanon was treating both the tortured and the torturers, and often in the same day.

    He wrote about this, and showed how absurd the mental health model was. He would eventually resign from that role.

    I know this is controversial. As I see it, Capitalism and the Middle-Class Family are two sides of the same coin, and that coin is named, “Self-Reliance Ethic”.

    Mental Health, Psychiatry, Psychotherapy, Recovery, Life Coaching, Motivationalism, and Salvation Religion are the tools to create and manage a huge underclass.

    So for those of us impacted by these, or who just object to this, we need to see this as a Revolutionary Struggle.

    Thank you for your post Julie!

  18. Watching a presentation now where someone connected with local government is talking about “mental illness”, as though that is just something we are supposed to accept. And explaining that this is why someone was jobless for many many years.

    Again, they turn poverty into a mental health issue, and people just go along with that.

    Any supportive talk about Mental Health, Psychiatry, Psychotherapy, Recovery, this is just supporting abusers!