Psychiatry Needs a New Metaphor

Scott Hall
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Metaphors are used extensively in medicine to simplify, communicate and synthesise complex and emotionally laden concepts into more palatable forms. Images of engaging in a ferocious battle with cancer or an immune system marching as a valiant army against disease convey predictability and reassurance. However, metaphors are deceptive, in that they imply detailed understanding of phenomena which have not been fully elucidated.

In this essay, I propose that the metaphor of “mental disease” is doing more harm than good. Rather than being a tool for communication, it has crossed the boundary from a metaphor to a theory that underpins much of what happens within public mental health services. This places psychiatrists in a position of dutiful compliance with what is essentially a fallacious model.

I put forward an alternative metaphor for psychiatry which is aligned with the less well-documented surgical model (as opposed to the traditional medical model) and is complementary to the concept of recovery. Injury (as opposed to disease) is approached in a pragmatic and personalised manner. Symptoms are recognised as forms of communication and coercive approaches are used in a truly proportional manner. Treatment follows ethical principles and normal human psychological processes rather than being directed toward an elusive disease.

I conclude by outlining a potential role for psychiatry in expediting change in the delivery of mental health care.

The Mental Disease Metaphor in Action

A key concept that psychiatry has bestowed on society is that of mental disease. Central to this concept is the identification of symptoms (or “psychopathology”) to support the existence of disease and the use of various forms of leverage/coercion to achieve “insight” (acknowledgement of having mental disease). I use the term “mental disease” as opposed to mental illness or disorder because the concept that has emerged within psychiatry is closer to the Oxford English Dictionary’s definition of disease:

“A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.”

The persistence of the mental disease metaphor suggests that it serves a purpose of some kind. A smoke-and-mirrors scenario exists whereby labeling a person with mental disease seemingly sanctions the following processes:

  1. Selected forms of human suffering, behaviour and moral breaches are split off and described as “psychopathology.” This in turn can be attributed to defects in a person’s brain. This is synonymous with the concept of “mental illness,” which the Australian state of Victoria’s Mental Health Act defines as “a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory.” Similar descriptors form part of mental health legislation elsewhere.
  2. Social causes are acknowledged as contributory, but it is implied that they act on an already diseased brain.
  3. Sometimes spurious links are made between mental disease and potential harms to satisfy legal criteria within mental health legislation.
  4. Society is largely absolved of blame because the person has a diseased or dysfunctional brain.
  5. Autonomy and individualism are celebrated as cornerstones of society but are coupled with an expectation of personal responsibility. Any change to this relationship would be deemed a challenge to the idea of free will, so we accept it as a given (“that’s just the way it is”). One possible exemption from personal responsibility is the concession that one has a mental disease.
  6. The cause of mental disease is purported to be complex, involving some sort of mix of genetic susceptibility, dysfunctional neurons and brain chemistry. We are told that scientists are working diligently to solve this conundrum but that for now, we must make do with what we have.

Scientific advances based on the concept of mental disease have been modest at best. Developments in fields such as psychopharmacology, psychology, neuroscience, and genetics have been more impressive but they do not appear to correlate with mental disease entities.

This has been partially acknowledged within the field of psychiatric research, in that traditional diagnostic classifications (e.g., DSM or ICD) are being challenged by alternative classification systems based on specific brain processes (e.g., the Research Domain Criteria). Evidence is conspicuously absent that a disease process akin to a form of cancer rears its head and causes aberrant cellular or chemical processes manifesting as schizophrenia, bipolar or personality disorder.

The mental disease metaphor unravels when you scratch the surface, yet it has persisted, perhaps because it gives the appearance of being a potentially solvable problem. It provides something to fight against and satisfies humanistic desires for order, equilibrium, and taxonomy. Finally, it serves to attribute causation to something other than society.

While I am not implying that the concept has been contrived with sinister intent (e.g., as part of a government conspiracy), one would be forgiven for thinking this. When patients make such pointed observations, they are often told their opinion is delusional.

Proponents of the metaphor assert that disease models have been an effective banner for advances in medicine. For example, cancer (an umbrella term for a diverse range of diseases with a similarly diverse range of etiologies) has attracted iconic status with funds and public support flowing toward it. We frequently read headlines boasting of advances in medical science leading to increases in life expectancy for those who are diagnosed with various forms of cancer. It is not surprising that the field of mental health looks toward that of cancer and collectively thinks “we’d like a piece of that.”

However, many would argue that the degree of human suffering associated with cancer has not changed over the years. If anything, it has increased, along with the plethora of costly, complex, and heroic treatments being offered.

Moreover, the diseases that fall within the descriptor of cancer usually have well-defined pathologies and are universally caused by out-of-control cell replication. This is not the case with mental disease.

Mental Disease as the Foundation for Mental Healthcare

As a secondary effect of the metaphor, mental health services become implicated in a complex merry-go-round of causation that ultimately results in attribution of mental disease to individuals who behave or think in certain ways. They can be persuaded, leveraged or coerced to take “treatment” of varying kinds. For example, being spoken to, contained, or prescribed medication.

Psychiatric wards operate so-called “acute care models” and there are few long-term supported residential placements affording asylum in the true meaning of the word. They can become pressure cooker-like environments where a harsh version of the medical paradigm operates, subliminally communicating messages such as “take this (medication),” “behave this way” and “don’t say that” all delivered in a locked setting. So-called “restrictive interventions” involving seclusion (essentially being left alone for long periods in a small, locked room, often with no toilet), restraint (being tethered to a bed), and the injection of medication whilst being held down (usually by security guards) are not uncommon.

Emergency departments and hospital wards around the state also deliver restrictive interventions under the auspices of “duty of care” if patients do not comply with what is deemed to be in their best interests. While the practice of seclusion and restraint are recorded for patients subject to the Mental Health Act, restrictive interventions in other settings go largely unmonitored.

In community mental health settings we subliminally communicate: “I know life is unfair, but this is because you are categorically different (on account of having mental disease)… here is some support and treatment for your mental disease… now accept your place in society, find a niche or catch up with your mentally normal peers.”

Unsurprisingly, such demands or assertions are sometimes countered with a negative response. If treatments prove ineffective, people are often labelled “treatment resistant” and may be offered sympathy, “support,” or more complex (and sometimes harmful) medication regimens. If they do not cooperate with the process above, it may be implied that they are non-engaging, lacking insight or having impaired capacity. The merry-go-round may serve professionals (e.g., getting paid, deriving esteem), families (being partially absolved from blame), and society (splitting off and labelling “sick” members as such).

Unfortunately, it does not serve those labelled with mental disease well, although it is argued that they obtain certain primary and secondary gains such as sympathy, care, and financial support.

The mental disease metaphor lays an unstable foundation for the practice of mental health and many of its initiatives, movements and “brands.” The Early Intervention in Psychosis movement created a brand that conjures up images of intervening early and preventing a disease process in vulnerable young people. Forensic psychiatry purports to diagnose and treat similar disease processes that cause people to commit crimes.

Similar narratives have been created for other factions within mental health. The most widely publicised misuse of the mental disease metaphor has been by pharmaceutical companies, who have marketed drugs purporting to treat mental disease. We are all aware of the adverse consequences and huge financial gains that have accompanied this excursion.

It is possible that the metaphor has helped to attract healthcare resources toward mental health. It creates a depersonalised “enemy” against which we can put up a fight. I am consistently amazed by mental health workers who go above and beyond with the aim of helping those who are suffering. They are often taking a leap of faith and have confidence that the person will get better. For some, this faith is due to their belief in the concept of mental disease.

It is possible that a simplified model for considering human suffering may be necessary, or else we are left to embrace too much uncertainty which could overwhelm or evoke cynicism. The underlying fear may be of learned helplessness (i.e., that if things seem insurmountable, we may give up, lose faith and stop trying).

Laying Foundations for an Alternative Metaphor

Is it possible or even necessary to challenge a concept that is so ingrained within society? And to what can we change it? Sudden paradigm shifts tend to occur at times of war, revolution or natural disaster.

Many consumers of mental health services are socially, financially and educationally disadvantaged, such that they find it difficult to integrate within mainstream society. The 10-25 year reduction in life expectancy is a widely publicised statistic but it is often attributed to mental disease rather than social and medication-related causes.

Policies such as abolishing private education, expanding social housing and introducing inheritance tax would arguably provide a more efficient means of closing the gap but in the current climate of populism, society does not seem to have an appetite for social engineering approaches.

A more evolutionary (but inherently slower) approach may involve providing and promoting an alternative metaphor. From a strategic perspective, if an alternative metaphor is to promote change it should incorporate key elements of the existing metaphor but with subtle modifications (specifically, in the role of coercion and the use of symptoms as a proxy for disease).

In an alternative model, symptoms could be acknowledged as simultaneously being indicators of illness as well as forms of communication. Similarly, coercion could be seen as a “necessary evil” which is humanised and minimised by judicious application of the concept of proportionality. These ideas are elaborated further below.

Coercion and proportionality. 

I often experience the mental health system as excessively coercive and inflexible. If this perception arises within someone working in a senior role, I struggle to imagine what it feels like to be a consumer receiving coercive treatment. In the state of Victoria, the rates of community coercion are amongst the highest in the western world, as are the rates of the use of restrictive interventions in hospital settings.

I believe that there will be a role in mental health services for coercion and temporary deprivation of liberty for the foreseeable future, but the current system encourages these approaches as a first port of call for severely distressed people. Frontline workers are often placed in a position of brinkmanship where restrictive interventions are used preemptively because of a reciprocal sense of fear (i.e., staff fear patients, and patients fear the system).

Frameworks to incorporate proportionality exist within most mental health legislation, but the inclusion of mental disease as a key criterion serves to dilute it. In practice, proportional use of coercion could facilitate a move away from the principle of community coercion (community treatment orders) and whole-population approaches (which by definition seek out new “cases”). Determination of a person’s capacity to make important decisions is a more equitable test to sanction deprivation of liberty than the current process of determining presence or absence of mental disease.

Symptoms as forms of communication

Phenomena that psychiatry labels “symptoms” are also forms of communication. They allow people to convey the uncommunicable and, if received appropriately by a recipient, facilitate the discharge of emotion. The act of compassionate listening and giving of medication that I observe between patients and nurses daily is just one example of this interplay.

This process does not always follow the idealised, harmonious dynamic outlined in the nurse/patient example above. We often see discharge of anger toward the self and others in hospital or within relationships and families (what is now termed “family violence”).

Mental disease is possibly a modern-day correlate for what would have previously been labelled “bad” or “evil.” Bad and evil necessitate punishment, forgiveness or religious explanations whereas mental disease requires treatment. Interestingly, society seems to be clear that family violence, paedophilia and drug use are bad (or evil), hence there is little appetite for including these social phenomena within the mental disease metaphor.

Expressed opinions, regardless of whether they are labelled delusions, overvalued ideas, hallucinations, or cognitive distortions, are always associated with emotion or affect. There are a variety of techniques, procedures, and behavioural technologies that allow discharge of bad feeling into a therapeutic relationship without causing undue harm.

Sadly, these are rarely incorporated into service design, models of care, or the built environment within mental health care settings. Most mental health personnel and teams are not trained or experienced in these approaches. They are often overworked or exist within high-pressure, protocol-driven environments; hence, their work involves internalising others’ trauma, contributing to so-called “burnout.”

A Surgical Metaphor for Psychiatry

I have outlined personal observations of social, anthropological and psychological processes that occur in clinical settings and assert that they fall within a spectrum of normal behaviour in people who are under acute or chronic strain. If nothing else, psychiatric research has demonstrated that people are neurologically diverse and there is significant overlap between diagnostic entities. It would follow that there is similar variation in behavior and internal experience in response to injury.

A surgical metaphor for psychiatry embraces the idea of illness behaviour being a response to adversity, damage, or disruption in “normal” people (i.e., an injury) without the assumption that symptoms are part of a chronic disease process. Injuries can be induced suddenly (acute) or may be historic in nature (having formed into a scar or a walled-off collection). Very severe injuries may require life-saving approaches in the acute phase, but once stabilised, an adaptive process can begin.

Prevention of future injuries could become the responsibility of government and society through public health initiatives, rather than mental health services employing surveillance and monitoring of individuals.

Assessment would involve determining the nature, degree, and etiology of the injury and offering treatments in a proportional manner. Treatment may involve short-term approaches to the injury (consistent with suturing and healing by primary intention). Some injuries could be acknowledged as being too severe to be “closed.” Leaving a wound open, providing supportive treatment and waiting for a scar tissue framework to form may be the preferred approach (similar to healing by secondary intention).

The surgical metaphor has the potential to be a sophisticated endeavor that could harness technology, resources, and social buy-in. We could make it abundantly clear that we are in the business of suturing up, draining, and supporting psychological wounds rather than retreating to the paradigm of treating or preventing mental disease.

On a systemic level, we could acknowledge that much of our work is directed towards the psychological injuries caused or maintained by social inequity and trauma rather than being due to a dehumanised disease process.

Redefining the Role of Psychiatry Within Mental Health Services

My own experience as a psychiatrist has been of negotiating an often-unwanted obligation to uphold the mental disease metaphor as a valid theory. It remains at the core of psychiatric training and, in common with other forms professional training, concepts are instilled through a process akin to religious indoctrination.

The internal and interpersonal conflict that arises when explaining behaviour as a manifestation or “relapse” of mental disease can be tempered by conceding its metaphorical nature. Most psychiatrists are trained in proportional approaches to treatment and alternative theories for understanding our patients, but the mental disease metaphor is often prioritised. Clinical approaches comprising time-limited medication use, tailored psychotherapies and care planning systems can be delivered with precision and fidelity without interpreting symptoms as a proxy for mental disease.

Most psychiatrists can identify with the feelings of frustration that arise when the most appropriate or least restrictive forms of treatment cannot be provided in a personalised, proportional, and coordinated manner due to a lack of resources. Most are aware that the costs of treatment per patient may be equivalent or less than the unit cost attributed to treatments in other areas of medicine. These are uncomfortable comparisons to draw, but they reinforce the need to demand parity between mental and physical health when it comes to allocation of healthcare resources.

The rush toward developing specialist services based on the mental disease metaphor should be reconsidered. Such a tendency toward splitting off and specialization may be based on mimicry of other medical specialties, but may also be due to dissatisfaction with the underlying theory of mental disease.

Whole-population approaches that identify “cases” under the banner of mental disease (or the potential for developing it) may do more harm than good. For example, the rapid expansion of early intervention services may be creating “cases” of mental disease which would otherwise abate or resolve spontaneously. We need to get the basic elements of mental health care and theories that underpin it right before creating subspecialties and yet more “centers of excellence.”

Mental disease is a powerful metaphor which, for all its faults, has allowed psychiatry to exist within the prevailing model of healthcare delivery. However, it is not serving our consumers well. Medicine has a great deal to offer the field of mental health, and, in particular, those individuals for whom distress, patterns of thought, and behaviour have become engrained, persistent, or have subsumed one’s identity. It is the systematic, scientific approach, as well as the compassion and safety offered by healthcare systems, that are beneficial—not the concept of mental disease.

Psychiatrists are in positions of leadership within mental health services and hence in a unique position to bring about change.

I am aware that this opinion piece may do no more than reiterate the approach that many psychiatrists adopt in their day-to-day work. However, the extensive use of metaphor in psychiatry is not clearly articulated in most training curricula, nor is it openly acknowledged within the profession or in public-facing forums.

If nothing else, writing this piece has allowed some clarity in my own mind that a surgical metaphor for psychiatry is a more pragmatic, realistic, and honest one than that of mental disease. It is consistent with the concept of recovery, and conveys humility in the face of complexity.

34 COMMENTS

  1. The classification of perceptual disorders as diseases helps the psychiatrists, not the patients. It caused and causes enormous amount of suffering to people who have had a history of going to psychiatrist and being put a psychiatric diagnose. Like me, they may desperately have tried to hide this experience to other people, as most people change completely their attitude if they hear someone has such a label. When someone finds that you’re “mentally ill”, they suddenly become patronizing, arrogant, even aggressive, if you don’t show renouncement to your status as normal person.

    And what is worse, in many cases such labeling causes even more distortion of reality, as people with little reference tend to abandon their own judgement for the judgement of their psychiatrist. During my staying in mental hospital, I have noticed that most people brought there was entering with mild problems that lately turned worse, even disastrous and I attributed this to the acceptance of diagnose by those patients.

    It may be only a terminological problem, but for the sake of peoples’ feelings and health, the current terminology should be abolished.

    The excuse that “psychiatric disease is a disease like any body disease” doesn’t help at all. If psychiatrists want to protect their patients from marginalizing and stigma, they should accept the proposal mentioned in this article

  2. Very interesting article. When you write:

    “On a systemic level, we could acknowledge that much of our work is directed towards the psychological injuries caused or maintained by social inequity and trauma rather than being due to a dehumanised disease process.”

    I would go further and add that these injuries are caused by the medical system, the psychiatrists and the pharmaceutical companies.

    I am convinced without any doubt that one of the biggest problems in the medical system is caused by big pharma selling and wanting to keep selling billions of neuroleptics and anti-depressants, benzos and opioids. The push is influenced by greed. The labels are inaccurate and studies rushed.

    You walk into the door and, yes, they will find a problem for you.

    Polypharmacy. Yikes…what kind of medicine is that? Push a pill, pop a pill, put a patch…yippee, let’s all make a ton of money. We’ve got lifers.

    Where has the scientific method gone? I wish doctors would practice poly lab tests. Let’s test for Parkinson’s, for vitamin D deficiency…so on and so forth.

    It’s easier for a shrink to say “You’re depressed. You need some medication.”

    Next.

    Next.

    We have to make our own decisions and stop letting doctors breath down our throats with their delusions.

    How about talking with patients? Could that make things betters (without drugging them first?)

    It’s like the consumer drink RedBull. I wouldn’t touch that stuff with a ten foot pole. It doesn’t matter though what I think – because millions of people will buy that drink. But if a young person came to the ER with a RedBull induced pyschosis, I wouldn’t put the person on anti-pyschotics for the rest of his or her life for that injury.

    People have been injured by the forced medicating that doctors have done. Especially in the psychiatric wards (but also at gp’s offices, clinics…).

    The numbers don’t lie. Everyone is selling this crap.

    We’re dealing with systemic abuse. It is systemic abuse to label and to coerce. Anyone who’s been in a ward knows it’s like being in jail.

    I find that shrinks use the DSM like a chart. Check this and check that. Yes, for this, no for that. Then their buddies check yes for this and no for that.

    The bland leading the bland.

    Meanwhile, the patient gets no lab tests. He/she gets a good DSM report but no lab tests.

    Makes no sense.

    I apologize – I am rambling.

    The other point I wanted to make is about grief, for example. Every person will experience grief. Why does that get labelled “depression”. There seems to be a huge over lap with every day experiences in one’s lifetime and the use of the DSM.

    That’s where I find big pharma is at fault. They want to sell their stuff at large, for everything. And if it INJURES the consumer/client/patient – well, prove it. It’s a reversal of the burden of proof. Try and find an expert willing to go against big pharma.

    They are the Al Capone of yesterday yet they don’t go to jail and get syphilis. The push of pills is a huge factor in the health system. It’s not just altruism for the big guys.

    I agree with most of your article but I would add that doctors, universities, the FDA, etc…have to become more diligent, vigilant and with more integrity.

    It’s a shame of sham that we have right now.

  3. Hi Scott,
    Although you wrote a piece that sounds highly intelligent,
    and I read it twice….the first time it sounded better than when I read it the second time.

    I don’t know who will ultimately decide that there was “injury” and how does that “injury” present itself?
    Do we leave the “medical doctor” to establish injury and the “proportional” treatment?

    ” Assessment would involve determining the nature, degree, and etiology of the injury and offering treatments in a proportional manner. Treatment may involve short-term approaches to the injury (consistent with suturing and healing by primary intention). Some injuries could be acknowledged as being too severe to be “closed.” Leaving a wound open, providing supportive treatment and waiting for a scar tissue framework to form may be the preferred approach (similar to healing by secondary intention).”

    I cannot objectively be assessed. That is where you practitioners won’t back down from, since you believe that you are being “objective”, when in fact YOU created a list of conditions, disorders, injuries, ailments, illness, diseases, of the Mind/brain 🙂 and you also created the symptoms to go along with each pathology.
    But low and behold, they overlap, so now we have 5 disorders within our injuries.

    It makes not an iota of difference on metaphor and the one thing that is injurious and needs surgery is the DSM. IT IS the cancer, and IS the biggest reason you guys cannot agree within your community.

    When people come to you for help, you have no business telling the person they are “injured” or “sick”, at least if you agree that suggestions can impregnate a mind.

    Bottom line is, the change needed is that you can start coming up with something that states EXACTLY how it is. And that is, that you don’t know.
    You cannot look at a person objectively, you are judging them according to your criteria. It is not science and even if there was, the injury has to be made up first, purely from observing.

    Symptom expression, distress most certainly can be seen, however, what it means absolutely no one knows and is a process unique to that person’s diversity.
    We can still admit to not having a freakin idea, and yet try to help and I assure you, the outcome would be better than it is now.
    Where o where on the spectrum of normal do I fit in? Who allows me to pass normal?

    • And I want to add, that although I believe you believe that you are not involved in something
      dehumanizing, because you see suffering and since you have no answers, you buy into what you went to school for.
      So in that sense, you are innocent. However, it is evident that you have some insight and are trying to
      sorta fix stuff. But further from target you can’t be.
      Saying that, I do hope you actually ‘help’ some clients, hopefully all of them and I sincerely hope you never assess them as being too severely injured to just leave the would open, and form scar tissue.
      Because you see, it is in your assessment you ERR.
      It is NOT objective in any sense. And you seem to be trying to form “conclusions”, yet sticking with the old paradigm, thinking HOW we say things will make the difference. THAT thinking proves to me, that if I say certain things in certain ways, out of that, you decide to assess.

      Just by reading my typing this, you might think that you know me.

      “Most psychiatrists can identify with the feelings of frustration that arise when the most appropriate or least restrictive forms of treatment cannot be provided in a personalised, proportional, and coordinated manner due to a lack of resources.”

      There is a good reason psychiatry is frustrated. That frustration and their own confusion about their effed up paradigm, is constantly reaped by clients.
      No sane rational person could possibly believe in the messed up system, but that system has been around in one form or another. It is what we do best, we judge, we assess. According to our safety.
      I judge psychiatry as harshly as they judge others. I do however not need 8 years of psych ed to judge and I wholeheartedly believe I am being objective in my judgments.
      Because I too have education. I too am the “qualified observer”.
      I however have no licence to disqualify your belief or experiences.

  4. Psychiatry does NOT need a “new metaphor.” It simply needs to die.

    The term psychiatry itself is as much a metaphor as is “mental illness”; it refers to the “field of medicine” which “treats” these “mental diseases.” As such it is inherently based on acceptance of (hence part of) the “mental illness” metaphor, hence illegitimate on it’s face.

    Also, even if a “new metaphor” of some sort were to be adopted it would immediately be concretized just like “mental illness.” Funny — in my college abnormal psych 101 text “concrete thinking” is considered a “symptom” of “schizophrenia.”

    • Sorry to steal your thunder oldhead.

      Actually, the term psychiatry is even more atrocious than that. The word literally means “medical treatment of the soul.” Let that sink in for a minute.

      There are hoards of these “soul doctors” meandering around disguised as real doctors. Does any one of them know what a soul is? Does any one of them have any idea what it would mean to treat the soul medically? Psychiatry is the biggest sham ever pulled off in the world’s history. It is simply astounding how many people have been deceived by it.

      • Is delusional to believe that following an university can make you understand the millennia old secret of human nature and can make able to express considerations about others.

        Who wrote the books after which they learn and who taught their teachers the knowledge which supposedly makes them have a superior vision? Some extraterrestrial civilization?

        These guys are among the less read segments of the population, otherwise would realize they are just a ridiculous and infantile know-it-all ‘professional’ group. Psychiatry gave nothing to humanity, not even as cultural contribution.

      • The con has been around a long time.

        https://en.wikipedia.org/wiki/Three-card_Monte

        its the added benefit of being able to force people into a rigged game that is somewhat unique in these times we live in. And of course it is this ability to use force that keeps others at bay, knowing they too can be forced into the rigged game and “fuking detroyed” as it was described to me by the Operations Manager of one of these facilities. I guess at least she was not trying to deceive anyone that what they were actually at this place was ‘medicine’, they’re just destroying anyone who doesn’t agree with them, and has the audacity to complain about being ‘spiked’ and ‘verballed’.

        From what I’ve observed family members are being used as ‘shills’ in these short cons, and quite prepared to go along with the ‘dealer’ (how appropriate lol) for a perceived benefit. The backstabbing not considered conspiring if the ‘mark’ is labelled “patient” prior to running the con.

        I half wondered if this article was a ‘bait’ and watch the nut jobs respond.

        • Nah Boans,
          Not bright enough to use bait.
          Same as the “leading questions” a shrink asks.
          Every idiot thinks the questions they ask are stupid and have a goal,
          yet one tries to be a mensch and figure that perhaps they “get it”, they get it that we “get it”, but they truly don’t.

          It is beyond help because the kids going into psychiatry are hurt and no one informs them of their own hurts. It’s perfect.

      • “Actually, the term psychiatry is even more atrocious than that. The word literally means ‘medical treatment of the soul.’” One psychiatrist confessed to me that psych means ‘mind,’ and a tryst is ‘to f-ck,’ thus psychiatry is to mind f-ck a person. And that is what psychiatrists do.

        And the truly atrocious part of psychiatry is that when you read their “bible,” you realize the psychiatrists only believe in physical symptoms, they don’t believe in the soul or mind, concepts which are not physical in nature.

  5. Dr. Hall, I applaud your courage in writing this article. We are hard on members of your profession here at MIA. But if you will take the time and trouble to read through some of our heart breaking stories you may understand why.

    I assume you mean well and want to help people. But here are some problems with the system you are working with. Not just the mind altering drugs used to treat distressing thoughts and feelings.

    But psychiatry attempts to use the Linnaean System to categorize human suffering and bad behaviors. It’s really like mapping constellations in the sky. No–not all “mad” behaviors are just social constructs. The stars in the sky are very real. But human beings are the ones drawing the lines between the stars to make pictures of hunters, bears, princesses, etc.

    Those of us labeled do not find them conducive to reintegration. They harm our relationships, prevent us from gainful employment, and can cause homelessness from lack of income and discrimination from landlords. (Not enough HUD for everyone categorized as SMI anymore.)

    For starters, do you have any idea how horrible it is to have your friends and family turn from you in disgust and loathing because you have been categorized as a monster by a respected professional?

    Ironically the more “pro psychiatry” a group is the worse they treat someone classified as “severely mentally ill.” It did not help that my “meds” caused seizures, ridiculous weight gain, and made me act weirder than ever due to hindering my thought processes. These helpful pro psych people insisted the weight gain was all my fault and everything else was proof that I was “noncompliant” when the exact opposite is true.

    And how is labeling someone “schizophrenic” or “bipolar” for life supposed to motivate them to change? It’s great for aiding “meds compliance” and “insight.” But neither equals improved life–either in quality or quantity.

    I no longer act bipolar. But no doctor would ever pronounce me cured because the DSM 5 states that that is impossible. They label me based on certain “symptoms” yet when these symptoms are gone they refuse to acknowledge a misdiagnosis or pronounce me cured. This happens all the time for those who escape the system.

    All my psychotic mania was caused by a reaction to Anafranil. Most doctors argue “Well it just unmasked the illness already there.” Guess what? I remasked it by going off the crap that caused it to begin with.

    Since all psychiatry offers is “controlling the symptoms” shouldn’t we try what works instead of rigid, mindless adherence to status quo that isn’t helping people?

    Even in the Victorian days psychiatrists distinguished between the harmless and the violent “lunatics.” Yet now they lump harmless, but lonely eccentrics into the same category as serial killers regardless of any history of violence or current behaviors.

    Ironically, by treating dangerous criminals as though they were sick, members of forensic psychiatry treat law abiding citizens as though they were dangerous criminals by calling them sick–and encourage our communities to do likewise.

    Don’t we deserve to be judged on the content of our character rather than because we once scored 6 out of 9 random emotional/cognitive traits on an arbitrary chart decades ago?

    Even those of us who choose to remain consumers are greatly upset at how those like Tim Murphy, Fuller Torrey and others scapegoat us for all society’s evils. Even if we continue taking our drugs our neighbors will view us as would-be-killers. How is such education of the public helpful to anyone but those seeking to further their careers in politics/psychiatry?

    When we “deteriorate” so we can no longer maintain basic levels of self care let alone hold down a job our pro psychiatry neighbors will often blame us for “non compliance.” Or–at best cluck their tongues. Saying, “It’s just the disease.”

    I did indeed go through a rough patch at 20. I could have used some real help from someone who cared. Instead I got psychiatry. 🙁

    I have indeed been properly punished for my depression and anxiety. Because mainstream psychiatric treatments are punitive rather than restorative in nature.

    Still alive. But it’s not a good life.

    I won’t blame you for what men like Torrey and Murphy have done in “educating” the public to further their careers. That would be unjust. But it is also unjust for law abiding citizens to be blamed for the crimes of every serial killer and mass shooter who happens to be diagnosed bipolar or paranoid schizophrenic regardless of the individual’s behavior.

    • “But no doctor would ever pronounce me cured because the DSM 5 states that that is impossible.”

      Believe it or not, my psychiatrist actually claimed “recov’d [bipolar] disorder” on my second to last appointment with him. Although I then confronted him with all his delusions about me written into his medical records. Which turned him into a dangerous paranoid schizophrenic, who wanted to re-neurotoxic poison me. Thus I had to leave him.

      And I did eventually get a PCP to take the “bipolar” misdiagnosis off my medical records years later, by medically explaining the psychiatric malpractice to that doctor. The antidepressants create the ‘bipolar’ symptoms, and the antipsychotics create psychosis, via anticholinergic toxidrome. That ethical PCP even had me teach one of his students that, now that we all live in the information age, sometimes the patients will know more than the doctors.

      • Rachel: “But no doctor would ever pronounce me cured because the DSM 5 states that that is impossible.”

        Someone Else: Believe it or not, my psychiatrist actually claimed “recov’d [bipolar] disorder” on my second to last appointment with him.

        Sigh. While I call myself “undiagnosed,” I believe my medical chart says “Managed with supplements, exercise and other natural means…”

        Once you get that label, it’s hard to get rid of it.

  6. Dr. Hall, acknowledging it’s harmful to label people with a “mental disease” is a good start, better than the majority of psychiatrists out there and I commend you for that. I was dealt a double whammy – first the fraud of a contrived cancer diagnosis and then the fraud of psych labels to force me to undergo what was unneeded cancer treatments. I was shocked to discover a person doesn’t even need to report or present ANY so-called “symptoms” to get labels; simply having issues with insomnia from the chemo and steroids is enough to get you 4 psych labels and prescribed multiple psych drugs. Even if you are a rational, responsible person who simply wishes to make their own well thought out decisions about cancer treatments, they easily lie and make up whatever psych “symptoms” they choose in order to slap DSM labels on you to strip you of your autonomy.

    “When patients make such pointed observations, they are often told their opinion is delusional.”

    Yes, and this is particularly disturbing because it’s often the psychiatrist who is delusional about the person’s reality and the causation of any problems or distress. I learned psychiatrists easily chart lies and that psychiatric labels are used as weapons against you if you dare try make your own decisions on cancer treatment (decisions fully supported by your GP) Given there is SO much dishonesty, control, arrogance and rigid, black and white thinking within psychiatry I don’t know they could make, or would even want to make, a paradigm shift as outlined here but I appreciate your thoughts and efforts in that regard.

  7. You can’t drive a car up the side of a building, but that doesn’t mean there’s anything wrong with the car. It wasn’t designed for that. People were designed to be in groups of families or tribes, with close cooperation, knowing each other, and making their living by division of labor. When that’s missing, the mind detects a hostile environment, and puts up defenses designed to make us survive. Fear makes us sensitive to threats, depression keeps us out of view and therefore safe. Volatile feelings change our strategy to meet the perceived dangers. We only can find dangers by comparison to our experience, so we may make mistakes, but it’s the best we can do. Here we are surviving, and they say there is something wrong with us because we couldn’t do without our needs, the ones “they” have but we don’t.

  8. Your article seems to me to open some new horizons. Thanks!

    I was looking for words that might be used instead of “mental illness.” Would one have a “mental injury,” or just an “injury?” To me words are important.

    And what of a person who feels good about themselves and their behavior, but society (psychiarty) doesn’t agree? Someone who doesn’t mold to consensus reality?

    I suggest that what is “injured” is society and not individuals. In my opinion, capitalism the way it’s practiced is the cause of most mental problems and life issues. You do mention populism, but don’t seem to have a model for societal change that might limit or end the need for individual care, be it for an injury or for a “mental illness.”

  9. Actually the Georgians (early 19th century Britain) had a better way of viewing extreme states than 21st century psychiatrists IMNHO.

    Today’s APA composes lists of arbitrary traits their elite group deemed unacceptable and votes into existence.

    In Georgian England, madness was as madness did. “Diagnosis” was composed solely of behaviors. Way more honest than our system. Once the extreme behaviors stopped you were no longer considered mad. And you had to be very weird to be considered mad.

    Ordinary “consumers” you regularly meet at NAMI or mental centers would be too rational to qualify in that era. Even those visibly muddled by the ball and chain treatments of today.

    A certain Shaun S. commented here that psychiatry needs to distinguish between the consenting and nonconsentual “consumers.” I heartily agree with him on that.

    But I think it is far more important to distinguish between the dangerous and the harmless.

    The pop culture narrative (touted by celebrity docs–experts in showmanship and propaganda) is that all the treated are harmless and safe to be around.

    All the undrugged are dangerous and a public menace. Black and white thinking to put real, complex human beings into little boxes where the Benevolent All Knowing Psychiatrist will keep them forever. Amen.

    The evidence (statistics, long term studies, empirical) tells another story.

    All people deserve to be judged on the content of their character. Not the claims of some bureaucrat in a lab coat who doesn’t know them from Adam.
    Harmless eccentrics, trauma victims, and those with head injuries should not be categorized with violent criminals. In claiming to be merciful to the latter psychiatric law proves itself neither merciful nor just to the former.

  10. Scott,
    I’m wondering since we are thinking about changing words, why is “injury” better than
    “musings”.
    Is it because you still believe that the person across from you is injured or sick from injury and you are not?
    You simply have different “injury”, which might not impact your job as a “therapist”, a “healer”, an “informed observer, an “objective” observer”.

    I am your observer, I observe your writings “objectively”. My personal emotions, training, beliefs, prejudices, etc etc have no role in my observations of you or psychiatry.

    Although, most likely someone observing me would say that my observations of even my own experiences are “subjective”.

    That is how it is with words. They are great in debate. However, words do NOT change practice or belief. They are an attempt to further the belief…to ingrain it more deeply.
    People do this when they see holes, or they see it’s not working any longer.

    All cults come with deep belief and huge fallouts. Eventually the cult leaders panic and try even harder.

    Also, it’s NOT a black and white world is it? Psychiatry/psychology loves to use the B/W thinking as injury, yet in doing so, is Black and white in it’s very diagnosis, and will interpret someone’s thoughts as B/W, and take that interpreted morsel to “diagnose”.

    That is an example of B/W in action, not just thought. Psychiatry remains the “offenders” of the things they seek in others.

    To be even of little help to others, one really has to pluck the thorn from one’s eyes, and I guess most shrinks really believe they have done so.

    It is such a pompous, grandiose idea to think oneself able to diagnose humanity, that when realization kicks in, it is most like a huge embarrassment to be of such a club.

    I hate to be judgmental and am aware I am thus.
    And as “mental illness” has caused psychiatry to be judgemental, or simply furthered that pathology or helpful trait, I remain judgmental of those who absolutely disgustingly RUIN not just one, but many lives in the process of being not observant, but judgemental with legal impunity.

    I however can only judge psychiatry and it’s useless paradigm wordy smears for myself, and for those I love.

    I care about the meek, the vulnerable, and they are the very last group I would harm.

    It disgusts me that words are looked for when we need such massive insight into the barbaric uninformed practice of psychiatry.

    I had to get that off my chest. Perhaps 500 years from now my words will have made a bigger difference than “injury”.

    I hope you changing your word “mental illness” into “injury”, subtly, within your heart/mind, actually transforms itself into something helpful for yourself. But I would hate for my kids to see someone who looks at them as “injured”.
    Hate to have others tell my kids they are “broken”.

    If one likes to breed hopelessness, those kinds of words are perfect. However, if one is normal, one usually likes to build people UP, not agree with them about their brokenness.

    • Ironic how according to psychiatrists “black and white thinking” is a sure sign of one of those pesky things they label “personality disorders.”

      And a sure symptom of “schizophrenia” is the inability to distinguish between the metaphorical/abstract and the concrete/literal.

      But my apologies to any any well informed psychiatrist reading this. I acknowledge that you never made that mistake but only cited the “chemical imbalance metaphor” in order to dupe prospective customers and the public.

      Hmm.

      1. Lying without remorse for self gain.
      2. The belief that might makes right. The rules do not apply to you.
      3. No regret or remorse for the people you have hurt.
      4. Convincing someone they are worthless, inferior, insane.
      5. Self pity when called into account for how you have harmed others.
      6. Extending cordiality, respect, and regard toward some–but exhibiting harshness, cruelty, and inhumanity to those in a group you regard as weaker and less than human.

      Now what “mental illness” would these be “symptoms” of?

      Anyone want to take a guess?

      😀

      • I don’t think there is a MI which harms and dehumanizes so many.
        Perhaps they are the governments patsies.
        It seems the government likes dumb thugs to pretend to the public that there is a point to it all.

        And the dumb thugs are not as dumb as they look, they have cheques. And immunity from labels lol.

    • Hey Sam –

      I mostly agree.

      I do think that this is progress in the mind of Dr. Scott Hall, however.

      In this one thing: a disease is a permanent, disabling horror. A label that follows you all the days of your life.

      An “injury” is temporary and can be recovered from. Like Rachel said, “I was mad, but I got over it.”

      This might remove some of the harmful labels that Rachel is protesting. And people can be expected to get better.

      it’s not the final answer, but a step in the right direction.

      • JanCarol, I agree with your comment that “it’s not the final answer, but a step in the right direction”.

        I have a background in statistics and the current model is that everything or virtually everything is an “illness” and in most cases there is no “cure”.

        For the last year or so, I have told several lay people and also people somewhat familiar with the system that a big problem is with the model.

        If you look at the physical health model, if you say someone is physically healthy, the lack having an illness — and they lack having physical injury.

        That is, if someone is in a car accident and has a shattered leg and a collapsed lung, you wouldn’t say they were “ill”, but you wouldn’t say they were “healthy”.

        If someone came up and beat you with a bat and caused severe bruising or broken bones, medical personnel would recognize the person has significant injuries. There may be several ways (treatments) for dealing with the situation, but at least there is not just the possibility of recovery, but even the probability of a full recovery.

        My experience of a severe stress breakdown (or breakthrough) fits much better as an “injury” than an “illness”. I have even used the phrase “ego collapse” and “fracturing” to talk about my type of experience.

        People don’t talk about “curing” an injury, we talk about how to “heal” an injury which leads to recovery and a decent quality of life (which is totally missing from the biomedical model).

        From what I have read of other people’s experiences from comments on the MIA articles, many of those experiences don’t seem to fit the description of “injury” either. So as an assessment, a person shouldn’t be shoved into one of those categories either of “illness” or an “injury”.

        But at least pointing out that the current model doesn’t even begin to address injuries, it blows a pretty big hole in the current model. And with a wide, gaping hole in the model, there can be tremendous opportunity for improvement and redefining things.

        And again, as a statistician, I am all for blowing holes in the current model.

        Of course, that’s just my take.

        • If the current model simply adopts the word “injury”, instead of “illness”, we are still at the same place. Psychiatry owns every word in the dictionary and those it designs, and defines it’s meanings.
          Words have and never will be enough to somehow change the current model of othering.

          An injury will simply be said by them as being too deep to heal, and can only be managed with their methods.

          It will still result in discrimination of the worst kind.

          It will still result in an “injured” person to be questioned more about perceived physical pain than the unlabeled “normal” person.
          It will still result in the “injured” person not being worthy of equal law application.

          It is still a label, Psychiatry is the problem.

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