December 6, 2019, marked the launch of Mad in Norway. After weeks of planning and incredible effort from a group of dedicated people, we are happy that MIA’s mission to ‘rethink psychiatry’ has reached Norway.
But it did not start here. At least not for many of us. For me, doubts about the medical model in mental health have been at the forefront of my thoughts for most of my career. It is only in the past few years that it has been possible to speak about the issues in public.
Something is Wrong Within the Field of Mental Health
All over Norway, professionals, researchers and most of all, people with lived experience, all have their story on how they came to the conclusion that the medical model in mental health does not work. Ever since I graduated, I had a great curiosity to figure out what really helps people, which led me to countless conversations with people who had recovered both in spite of the mental health system and with help from it. It became clear to me that there was something fundamentally wrong with the way we approached these problems, and I became convinced that there had to be a better way.
I soon discovered that people from all over the world had come to the same conclusion. In 2016, two books were translated into Norwegian and the release was marked with a seminar and a panel debate. I was invited to sit on the panel and got the chance to meet the two British authors. I had already read their books with great interest. Peter Kinderman’s A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing and James Davies’ Cracked: Why Psychiatry is Doing More Harm Than Good give a thorough account of why we should leave the diagnosis-based model of mental health behind and aim for something better.
Reading these books empowered me, even though the knowledge they contained was not new. I was familiar with Robert Whitaker’s Anatomy of an Epidemic and with the growing number of books, blogs and articles on how the field of mental health has gone astray. But the fact that more and more professionals were speaking and confirming what the survivors of psychiatry for a long time have known to be true, gave me the courage to speak out as well.
A Different Way of Helping People
At the time I was the leader of a community-based service that offered services for all kinds of mental health problems, substance abuse, prevention, social interventions and public health. My early conviction that there had to be a better way had led me, together with my colleagues, to build a service based on feedback from the people we were going to help, and that took account of what mattered to them. Diagnoses turned out to be of very little importance, so early on we decided not to waste time using diagnostic assessment tools, and we did not diagnose in the medical sense. We collaborated with people, understanding their problems from a humanistic perspective and helped them based on both their and our knowledge.
My newfound courage from the book releases and my experiences led me to write a piece about why we should dispense with psychiatric diagnosis. It was published in a national newspaper, and I was invited to speak on national TV about it with more media attention following. This was, however, not without cost. Soon after speaking out I was put under review by the health authorities. The review lasted a year and found me and my service guilty of breach of conduct and breaking the law for not diagnosing.
This devastating conclusion could have closed the service in its current form and forced it into a diagnostically-based way of working. Luckily, with all the attention and support the service had gained through the years, leading national politicians came to our rescue. The Minister of Health had previously visited the service and stated that the whole country should work this way. A paper was issued from the Ministry of Health that said that you should diagnose, but not always. We were off the hook, and it was a small step towards having a choice on how to be treated within mental health services, at least in the communities.
Within the hospital system, the diagnosis-based paradigm still forms the foundation of their work. But things are also happening there. The medication-free initiative in Norway started as far back as 2011 when five user groups got together. They spent years lobbying for medication-free treatment and succeeded in getting the Minister to decide that all public mental health regions should offer medication-free treatment and the first one opened in Tromsø in 2017. More units are now offering medication-free treatment, and this has raised the debate about the effects of psychotropic medication.
The system will not change from within. There are too many benefits to professionals with the most power when upholding the existing paradigm. There are clinicians working within the system trying to push forward change, but they need help from the outside. We need a clear change in the law that acknowledges a humanistic approach to mental health problems, that is not based on diagnoses. This would give people real choices on how to be treated.
To Be Part of a Movement
We have had successes in Norway, but there is still a long way to go. Services are still rooted in the medical model, and forced treatment is violating basic human rights. But those who speak up are no longer alone. In fact, we are growing in numbers to such a degree that we can neither be ignored nor ridiculed. As psychiatrist Magnus Hald from the medication-free clinic in Tromsø says “…we have been able to address this question of how drugs are being used, getting this on the agenda. That might be the most important thing we have achieved, is to be part of a movement, nationally and internationally, for this development.”
In September this year, the International Institute for Psychiatric Drug Withdrawal held a meeting in Gøteborg, Sweden. Forty international experts came together to discuss how to best help people getting off psychotropic drugs and changing our current diagnosis-based paradigm of mental health. As one of the attendees, I got a chance to talk to Robert Whitaker about starting a Norwegian branch of Mad in America with the aim of raising the debate even further in Norway and eliciting real change.
Mad in Norway
On the train back home, I wrote an e-mail about the initiative. I reached out to the people I have gotten to know through my career that were in some way opposed to the medical model and wanted change. This was a mix of people with lived experience, their relatives, clinicians and researchers. Would they join me on this adventure? The response was overwhelming. Many of them were almost sitting at the edge of their seats waiting for such an initiative and were ready to get to work.
After the initial e-mail, more people wanted to join, and these highly engaged people constitute the editorial board and writers of Mad in Norway. Together we want to push forward the change that is necessary for the mental health field. We believe that the current diagnostically based paradigm has comprehensively failed and that the future lies in non-medical alternatives.
Mental health and wellbeing touch on all aspects of life and the field needs to acknowledge and act based on this fact. Multiple disciplines must collaborate with the people seeking help as equals, putting the person seeking help in the lead position. No professional group should have power over others to define people’s struggles and what constitutes good help.
People should have real choice. The research and knowledge about how to work differently are already there. Now we need politicians and policymakers to force the change and make it happen in the established services. Mad in Norway will be a leading voice in ensuring this change.