A Conversation with Nev Jones

Sandra Steingard, MD
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Editor’s Note: This conversation arose after Vice published an article about the “The Movement Against Psychiatry.” Sandy Steingard and Nev Jones, who have both contributed to Mad in America through blogs and/or continuing education courses, were both quoted in that article.
Sandy:

We “met” sometime in 2012. You sent me an email in response to several of the blogs I had written on Mad in America. You were critical of some things that were—and remain—important to me: Anatomy of an Epidemic and Open Dialogue. At the time, many people were critical of my blogs but I was struck immediately by several things. First of all, you were not critical of me; it was clear that you were interested in a serious engagement about ideas. Second, you were approaching all of this from a very different perspective. Third, I was struck by your keen intellect. This led to an ongoing conversation that continues to this day and has been extremely valuable in my own intellectual development. I am wondering if you would expound on any of these ideas, either as you raised them way back when or as you consider them today.

Nev:

In the case of both Anatomy and Open Dialogue, I’d say that my underlying concerns were (and to some extent still are) similar—but these are also concerns, to be fair, that have always had as much or more to do with the way Anatomy and OD have been taken up in popular discourse (versus their original articulations). This in turn has always raised questions in my mind about the author/founder versus the life of ideas once they circulate in the world, and what responsibility, if any, the former bear. But this is a complex topic, unresolved in my mind.

Meanwhile, my direct concerns were three-fold: first, oversimplification. Psychosis, for starters, is singularly heterogeneous, encompassing wildly different symptoms or experiences, levels of distress, and trajectories over time. We know there are demonstrable biological mechanisms at play in some cases (e.g., anti-NMDAR encephalitis) while voices can easily be induced through very short-term sleep deprivation and certainly also acute trauma. Social and structural factors—poverty, exclusion, deprivation—can of course also profoundly influence these experiences. And people react and respond very differently to various interventions, including antipsychotic drugs but also different psychological therapies (including cognitive remediation). And there is also a reality of very severe, enduring psychosis, the existence of which likely has little or nothing to do with exposure to antipsychotics or the lack thereof.

And overall, there’s so much we don’t know, so much we don’t understand. So, acknowledging heterogeneity, acknowledging a very high degree of uncertainty about just about everything, including ways of addressing long-term disability—I personally see this as the necessary starting point of any discussion. Instead, at least at the time, I think it was common to see Open Dialogue deployed as a quasi-magical bullet and means of (for some people literally) eliminating psychosis. And likewise, I felt that many people took up Anatomy as ostensible proof that antipsychotics were the primary cause of sustained or chronic psychosis (through supersensitization) and also that the case was more or less settled with respect to long-term iatrogenic harms.

A further concern is that, in both cases, a kind of “medication-centrism” seemed in play that in fact provided a potentially dangerous alibi for investments in social welfare, and programs to support those with long-term disability, as well as a kind of “invisibilization” of the fundamental role of poverty and structural marginalization (and the neoliberal economic policies responsible for them). Turning to Open Dialogue, for example, the idea that one could relatively neatly import an intervention from a rural, culturally homogeneous region of a high-income Nordic state with universal healthcare, robust social welfare systems, tuition free higher education, and so on, to parts of the US with deep poverty, entrenched structural racism, urban violence, etc., seemed like a fantasy.

Sandy:

It might be helpful for me to address why for me, as a psychiatrist, the questions Whitaker raised in Anatomy were important and why they have led to a shift in how I think about the drugs we prescribe.

Prior to reading Anatomy, I was already alarmed at the influence the pharmaceutical industry exerted on the practice of psychiatry (and, to be fair, the entire medical enterprise). When the newer antipsychotic drugs (APDs) were introduced in the 1990s, I was initially hopeful but then I observed leaders of my profession seemingly colluding with the pharmaceutical industry in playing down their harms and supporting the expansion of their use. Prior to the approval of the newer drugs, leading psychiatrists were promoting low-dose use of APDs in recognition of their many harmful effects. Over time, this message was lost and a more promiscuous approach to prescribing proliferated. I never thought that was supported by the evidence base and it upset me. But Anatomy raised another concern, namely that their long-term use might worsen rather than enhance long-term outcome. Up until then, I agreed that these drugs (albeit at low doses) should generally be continued long-term to prevent relapse. I found Anatomy well-referenced but I read it as a hypothesis—a call to further study, a question as to whether this issue was as settled as most psychiatrists believed it was. I did not find that I could easily dismiss these concerns and that led to my reviewing many of the articles cited, talking to colleagues, and deconstructing my view on the optimal use of these drugs.

But I agree that what I read as a call for further study, others read as a more definitive statement. I also think that you and I were talking to different groups. I was talking to psychiatrists and was frustrated by their general readiness to dismiss these ideas without further exploration and I gather you were talking to others who (in our opinion) may have been too eager to embrace them as definitive. We were both frustrated but at different kinds of reactions to the book. I have valued our exchanges because they helped me to think critically and expand my horizons for critical inquiry.

I agree with you that psychosis is so varied that it is difficult to offer one guide to treatment. It does not comport with my own observations that all psychosis can be explained entirely as occurring as a consequence of a person’s life experiences. Nor do I think that exposure to psychoactive drugs accounts for all psychosis. But I do think that over decades, social influences on the development of psychosis have been minimized and psychosocial interventions have tended to be focused on rehabilitation and psychoeducation. In a general way, the skills required to help people make sense of extreme states have atrophied among members of the professional community. Most clinicians and families are taught to think about psychosis in medical terms and I think this is the direct result of a limited narrative regarding our understanding of these kinds of experiences. I have also come to believe that minimizing relapse risk might be not be the highest priority for everyone. This has important and serious implications for psychiatric practice.

I agree that while I find Open Dialogue (OD) to be of great value, I feel caught sometime between those who think that either there is not enough evidence to support it yet too costly to fund studies that might provide such evidence, on the on hand, and those who idealize it and overstate our current knowledge base about it, on the other. I also have serious worries that if it is taken up without adequate attention to the way the drugs are used, the excellent outcomes reported in Western Lapland will not be replicated. But again, I became interested out of my curiosity and what I thought was an imperative to learn about other ways of working with people who were experiencing psychosis and it was that curiosity that also led me to Hearing Voices groups and Soteria.

Nev:

These comments are so helpful.  First, it occurs to me that while you read and absorbed Anatomy as a practicing clinical psychiatrist who up to that point operated under the assumption that antipsychotics were essential to the treatment of psychosis for most people, I was coming from a place of intimate awareness of how painful any decision about initiating or sustaining antipsychotics nearly always is—for those experiencing psychosis, for their families, for other loved ones and close friends. And part of that is because just as “schizophrenia is not an illness like any other,” psychiatric medications are not medications like any other. Because in this domain, we’re up against what philosophers have described as the “hard question of consciousness”—how the “mind” and “brain” are related. And because this question sometimes seems irresolvable, society tends to fall back on dualism. And not just mind versus brain but a whole series of linked constructs: “mind” entailing constructs like activity/agency, moral responsibility, psychological therapy or self-help; and “brain” connoting passivity, freedom from responsibility, moral exculpation. And thus to choose to take an antipsychotic, or be seen as taking an antipsychotic, at least in social circles that have strongly embraced a “psychological” perspective, that choice easily becomes tied up in a moralizing, even neoliberal discourse. Hence the phenomena of “pill shaming.” And then if we introduce the argument that antipsychotics not only signal weakness but are actually “causal” contributors to chronic psychosis, then we make a set of decisions that are already deeply painful even harder. And, critically, I therefore think the standard of evidence, the depth of understanding, needs to be very high before we unleash these kinds of ideas on the public. And I don’t think we’re there by any stretch. As I said before, there are so many gaps in our knowledge and we cannot say with any certainty that any given person is better off discontinuing versus continuing antipsychotics. Hence, of course, my particular concerns about Anatomy and the way it was being read.

Second, I suspect we’re in agreement regarding the importance of addressing poverty and structural racism (and of course one of the clearest manifestations of structural racism is the interlocking nature of poverty, class, and race), but I feel much less certain that addressing “medications” is actually a central piece of what we need to do. I’d almost call it more of an epiphenomenon. Addressing medicalization (or more precisely medical reductionism), on the other hand, is certainly critical. But here, I think, a huge part of the problem (and I’m largely following Helena Hansen’s argument in pathologizing poverty) is that contemporary welfare (workfare) policies operate in a way that first pushes people who are poor to claim disability, and then traps them within a disability-driven welfare system; similarly, the criminalization of substance use and (minor) drug trafficking, which have led to the highest rate of incarceration of any Western high-income country, and so disproportionately affected people of color, particularly black communities. In my mind, the importance of addressing these carceral and welfare policies are way higher on my list of priorities [than medication prescribing practices].

Sandy:

Since the idea of this conversation came about as a result of the Shayla Love Vice article, I also wanted to circle back to that. We were both interviewed and while I appreciated the breadth of the article, I found it hard to understand the sequence or overarching theme of the piece. It may be that I am too immersed in this topic but it troubled me that there appeared to be an implied link between Scientology and critical perspectives. Also, I greatly value the work of Whitaker and MIA and I thought they were both treated unfairly. Your comments about Anatomy were critical; you were quoted as saying that Anatomy is “just packed with misinterpreted, misunderstood studies that Whitaker uses to make claims that I think are demonstrably untrue.” In the context of what you wrote above, is there anything you would want to add here?

Nev:

Yes, regarding the Vice article, I think my general reaction to that piece (and most mental health journalism I read) was, “Ah, this is why I’m a researcher and not a journalist.” In other words, I think the slow, rigorous, peer-review process involved in academic publications is really helpful—we have to review the literature, demonstrate understanding, and describe our methods and approach in a transparent way. Journalism, on the other hand, has none of the safeguards of qualitative research—there’s rarely anonymity, nothing like formal “informed consent”—and the goal most often seems to write a story that appeals to a popular audience, or that the author and/or editor imagines will. Thus “the story” becomes the focus rather than a careful, critical attempt to articulate themes (as well as thematic tensions) within a given set of interviews.

So much of my actual conversation with Shayla focused on the consequences of political polarization (about medications, diagnosis, etc.) and the need to get beyond this and the challenges of doing justice to all sides; and this perspective is largely absent. Instead, a few sentences, stripped of their original context, are deployed in ways that seem less about doing justice to my perspective and more about carrying a certain narrative argument that the journalist wanted to make.

As I’ve already mentioned, I do disagree with various arguments embedded in Anatomy, or at least find many of the arguments over-stated, or perhaps, as I’ve explained earlier, at least start down a path that ultimately de-centers issues of fundamental importance to improving the outcomes of people with psychosis/schizophrenia in the US. But then it’s more when I think of the way that some people have read (and interpreted) Anatomy—i.e. as definitive proof rather than a hypothesis-generating text—that I’ve tended to feel the most frustrated and concerned.

Regardless, while I could certainly criticize the way the excerpted quote you mention is deployed, and question what it was Shayla Love thought this would achieve, I obviously also bear responsibility for saying it. And use of such strong language—”fighting words” even—actually violates my own principles of engagement and I would say in retrospect that it reflects frustration with threads within popular discourse that it’s unfair to ascribe(?) so strongly to Anatomy. And like Awais, my concerns with Mad in America, when I have them, are squarely with some of the blogs, not the scientific team, which does fantastic work and includes a number of very talented doctoral students. So all in all, it’s unfortunate the way this played out, which doesn’t seem to have contributed to greater dialogue—except maybe as the impetus for this conversation…?

On the topic of “public uptake,” however, I’m really interested in your thoughts—for example, with respect to “medication-centrism.” What should our priorities be, from your perspective, and what are the risks of centering or prioritizing the topic of medications?

Sandy:

Right now, I do not know of any way to talk about reform of the mental health care system without addressing racism and the profound disparities we have in the US in outcomes among different groups. Addressing poverty is a part of that but we need to address structural racism. You are among the many who have taught me of the value of including those with lived experience into every part of our system—from working directly with individuals to developing policies, to setting research agendas to conducting research. Antiracism would also mean that BiPOC are also included, not in a tokenistic way but in all aspects of the system of care. I admit that I am worried that when we talk about access to care and problems of incarceration and poverty, if we do not also talk about the highly medicalized narrative that has taken hold in the US (and elsewhere), we might do as much harm as good. So I do not consider this an either/or proposition but a both/and. If, in my own writing, I focus on drugs, it is only because that is where I have some expertise. When it comes to dismantling hierarchical and racist structures, I support it but I am a student, not a leader.

I have two final questions for you. The first is what your priorities are for the future. The second is how MIA might be helpful in advancing these priorities.

Nev:  

When I was working in California, one of my projects investigated the impact of cumulative structural disadvantage (including structural racism, exposure to community violence, incarceration of family members during childhood, migration in adversity, individual trauma, and so on) on the outcomes of young people treated in specialized early psychosis programs. I looked at both engagement with services and outcomes. And the data I collected suggested that any effect of level of symptoms (impairment/distress) disappeared when we added cumulative disadvantage to our models. So, it seems to me, if the goal is really to provide better support to people, and to change outcomes, it is essential that we address these underlying conditions and the way they not only affect risk but also ongoing experiences. (For example, imagine trying to “manage” paranoia when you’re living in a neighborhood in which there’s a factually huge risk of getting shot just walking to the bus stop. Back when I was in Chicago, I literally heard this from research participants on the South Side, and in a couple of cases their voices actually played the role of warning them when it was unsafe to go out.) Addressing education and employment—access, affordability, and support—are also fundamental.

My more “privileged” perspective on change is a different form of de-pathologization: beginning to see the experiences that get labeled as psychosis as rich, complicated, meaning-laden, and fundamentally bound up with identity and selfhood..and thus centering meaning-making in clinical contexts, rather than reductionistic forms of therapy or intervention that primarily aim to contain, ameliorate, or enable “self-management.” I also feel that these experiences need to be brought back into the fold of human experience and culture.

And finally, certainly seats at the decision-making table for those with personal experience of significant psychiatric disabilities and intersecting experiences such as homelessness, living in subsidized housing, disability-based discrimination, and poverty. And of course, ensuring racial/ethnic/cultural minority representation and leadership within this mix. And I think we need to make sure that we are not excluding perspectives that we disagree with. In fact, they’re arguably the most important and represent the places where we have the most to learn.

How can MIA contribute? Obviously there’s a very diverse mix of voices represented in current blogs, and the science team does really great work. But perhaps an even more explicit focus on user/survivor-led research? And more efforts to visibilize major policy issues (such as healthcare and welfare reform, underlying drivers of structural racism, macro policy issues more generally)? But also I would say explicit efforts to bring “critics” into the conversation (more university-based psychiatrists and researchers, for example)—and not just the choir, but rather, as I said above, creating dialogue among those with significant differences of perspective but doing so in ways that are generative rather than competitive. Not a debate but an opportunity for deeper (collective) reflection?

But back atcha. What is your vision?

Sandy:

As someone who is critical, I often get asked about my vision and I struggle with an answer. One idea that I have advanced is the merger of Joanna Moncrieff’s drug-centered approach to psychopharmacotherapy and need-adapted treatment (NAT). I have written about this elsewhere, but in brief, this offers a way to reduce the reliance on a faulty diagnostic system and offer the space and time to discuss with individuals and families these extremely complex matters that you have raised. Psychiatric practice has evolved within the medical system where one—and this is anyone who bills an insurance system!—is obligated to arrive at a diagnosis and treatment plan quickly. Even if one does not adhere to an essentialist notion of mental disorder, the processes of assigning diagnoses tends to reify them in the minds of clinicians, individuals, and families. You write about agency and I have come to believe that we need to try to maximize a person’s sense of agency. You have also addressed how difficult it is for humans to tolerate uncertainty. NAT (Open Dialogue is the most widely known type of NAT) values uncertainty but, as important, it offers a place to discuss it and manage the difficulty of not knowing. It is less hierarchical and will encourage clinicians to tilt towards humility in their work. With everything we do not know, I believe the best clinicians are the ones who embrace humility.

Beyond that, I think people need to listen to people like you. I am most excited about the work coming out of groups who have been—in varying degrees and ways—marginalized: people with lived experience, people of color (including professionals). This is likely to be published after I have retired from clinical work and I think the future is with you and not me. In that spirit, let me say that I remember when you first emailed me. I hope I am not too much of a fangirl by saying I have kept those emails and still learn from them. In the spirit of everything I have just written, I offer you the final word.

Nev:

Okay, last word! It’s going to be “dialogue”—because I think that greater user/survivor leadership and influence are absolutely critical, in part because of such a long history of exclusion and marginalization. But at the end of the day, we all need to join together to enact deeper social change.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

49 COMMENTS

  1. Sorry Nev, but “pill shaming” is not a phenomenon of note when there are laws being enforced to drug people in their own homes with these brain-damaging drugs. Until this legal(!) discrimination and violence against disabled people is ended, my concerns lie with the people who are having their bodily and mental autonomy violated in one of the cruelest ways imaginable in the name of moralistic hand-wringing, when the ONLY opinion about what they should or shouldn’t take rests entirely with them. There is enough pro-drug shrill propaganda out there; just turn on your TV, where you can hear any number of ads for the latest psych drug.

    • “Pill-shaming” is a nasty term for objecting to others poisoning themselves. I never use the term “gaslighting” but maybe I should make an exception here. We’re talking about chemically distorting one’s consciousness in order to be less sensitive to the painful demands of a toxic society. Does anyone speak of “alcohol shaming” or “cocaine shaming”?

  2. I don’t think that Nev sees what Anatomy of an Epidemic is about, it’s simply what it is, reporting the statistics of what correlates with the increase in mental illness, and how anti-psychotics being prescribed, being recommended to the extent that they are and also being forced on people contribute to that. Those are facts, that’s not hypothesis. And Robert Whitaker isn’t at all trying to eradicate any use of anti-psychotics, which from Nev is used against him, as if that’s the result of his books. Because it ISN’T the responsibility of people who have have their whole life harmed by anti-psychotics to have vital information that could have prevented this pushed to the side because someone feels that it’s pill shaming. Or that because information that was suppressed when shared prevents those who would have been helped by anti-psychotics, when would such information be withheld ignores the whole consequent spike that clearly correlates with anti-psychotics.

    I also find it a mental fabrication to say that Open Dialogue imported here is a “Fantasy” (something that TRULY IS hypothesis, which she uses as an excuse to dismiss something that’s completely valid), because she finds that: “the idea that one could relatively neatly import an intervention from a rural, culturally homogeneous region of a high-income Nordic state with universal healthcare, robust social welfare systems, tuition free higher education, and so on, to parts of the US with deep poverty, entrenched structural racism, urban violence, etc., seemed like a fantasy.” That’s really quite aggressive dismissal of something that has been proven to work, and that HASN’T been tried in the US, simply because it’s not as pro drug as mainstream treatments promoted by pharmacy guilds, and the economics that sells drugs. And for her to stereotype Finland, deny that the same distress could happen there in other ways than happens in America, because in America we have:”deep poverty, entrenched structural racism, urban violence, etc.” as an excuse in dismissing as “fantasy” something that has been proven to work, that’s beyond concern, and is more actual paranoia masked with fabricated concern. Sorry. I have to call it for what it is here. And if it worked where there’s according to her less societal distress then why wouldn’t it work where there’s more societal distress. To simply dismiss even trying it and then calling it a fantasy facilitates what? There’s not enough resources to easily try it out!?

    What goes on then when someone has other ideas that should be tried out or investigated, that then is called a “fantasy” and are dismissed as such, when they come for help in working those ideas out as a patient? And are met with advice and ideas listing their own thoughts as a “fantasy” rather than what they propose should be looked into, tried out, given leg room like anything else. Soteria project hired people that were egalitarian, simply interested in what another said, the weird stuff: everything, and this cost less money and was more effective. Is that another “fantasy?” That also is something that was dismissed, although proven to be effective. A “fantasy.” How would this compare to a clinician patient relationship when someone proposes something? As if this can be known beforehand whether it has relevance or would work or help, and instead dismissed as a “fantasy.” Or listed as a fixation, when someone really feels it should be given legroom. In the same fashion, in that “rural, culturally homogeneous region of a high-income Nordic state with universal healthcare, robust social welfare systems, tuition free higher education, and so on” a region, where they don’t have .7 % of the people in jail, don’t maintain the death sentence, don’t incarcerate under inhumane conditions people for the length of time happening in the US, that it’s a fantasy a less severe penal system would work here with our: ” deep poverty, entrenched structural racism, urban violence, etc.” Whether she believes that or not, it’s the same argument so many people use to excuse the US incarceration level.

    It’s not as if Open Dialogue wouldn’t give people a chance of, as Nev states: “beginning to see the experiences that get labeled as psychosis as rich, complicated, meaning-laden, and fundamentally bound up with identity and selfhood..and thus centering meaning-making in clinical contexts, rather than reductionistic forms of therapy or intervention that primarily aim to contain, ameliorate, or enable “self-management.” Which Nev says is the change she wants to see.

    Open Dialogue already does that, and gives a person the place to feel safe to start finding the means to express their identity and selfhood.

    When something works it works, it’s really easy to make up intellectualized arguments that sound plausible as to why something won’t work to avoid the challenge a different method offers to what one has become invested in, and has a vocation in.

    And I’ve gone on enough now about “fantasies.”

    • I would add that suggesting Open Dialog might work is no more of a fantasy than suggesting that taking antipsychotics for the rest of one’s life is a viable solution for most people. Or more of a fantasy than NOT telling clients the known potential adverse effects of the drugs being recommended because it might make them decide not to cooperate. Or the fantasy of choosing a list of undesirable behaviors that tend to occur together and calling it a “diagnosis” and then claiming that “it” is caused by a “biological brain disease.”

      The entire enterprise of psychiatry seems to be founded on fantasy. Not sure why trying Open Dialog would be any more fantastical than what is already accepted as “standard treatment.”

      • “Or more of a fantasy than NOT telling clients the known potential adverse effects of the drugs being recommended because it might make them decide not to cooperate.”

        That’s where the US system falls down and Australia is advancing. By being able to put it in their food or drink without their knowledge they get the advantage of the drug without the belief that it might do them harm.

        I did ask at one point why it was considered that should I not wish to drink alcohol at a party, that a psychiatrist knowing that I would enjoy the party better with a ‘few under my belt’ should be allowed to have me held down and forced to drink half a bottle of Bourbon.

        In fact, given this line of reasoning, what is the problem with this guy?

        https://www.ausdoc.com.au/views/her-own-words-registrar-assaulted-oncologist-tells-her-story

        A quarter of the dose I was ‘spiked’ with. He didn’t wake her up with a tazer pointed at her. And she wasn’t thrown into the back of a van by people armed with guns and transported to a place where further assaults could occur out of the gaze of her loved ones.

        Just ‘spike’ them. It saves all those problems of explaining the possible side effects and long term consequences, and the resulting behaviors can be documented as being symptoms of an illness and then used to justify forced drugging. Works a treat where I live. And much worse than being incarcerated for a crime you didn’t commit. being accused of theft one can deal with, there are lines that define what is and isn’t stealing. But being accused of ‘paranoia’ for example when you have been ‘spiked’ with benzos, but the people who did that have the power to conceal the truth……. your truth speaking becomes the crime you are punished for. And should you start acting strangely and making a few late phone calls, well you deserve everything you get.

  3. I thought I was finished, and then remembered there was talk of “magic bullets.”

    Here, from Nev:

    “And overall, there’s so much we don’t know, so much we don’t understand. So, acknowledging heterogeneity, acknowledging a very high degree of uncertainty about just about everything, including ways of addressing long-term disability—I personally see this as the necessary starting point of any discussion. Instead, at least at the time, I think it was common to see Open Dialogue deployed as a quasi-magical bullet and means of (for some people literally) eliminating psychosis. And likewise, I felt that many people took up Anatomy as ostensible proof that antipsychotics were the primary cause of sustained or chronic psychosis (through supersensitization) and also that the case was more or less settled with respect to long-term iatrogenic harms.”

    This is quite amazing, actually, that the real thing that’s common, and that is prevalent worldwide in “developed” countries, and that people are confronted with, aggressively indoctrinated about, and intimidated with, is the magic bullet that psychiatric medications get rid of “psychosis.” What Open Dialogue does is to show a way that statistically DOES help with psychosis, rather than the true magic bullet of the chemical imbalance theory, which truly delves into the area of “there’s so much we don’t know,” because the whole story of how that works doesn’t add up to what the medications really do (they cause chemical imbalance rather than to treat it), nor do the statistics add up to getting rid of psychosis in general because they lead to more disability, relapsing, loss of life etc as well as a spike in the occurrence given the general implementation of the chemical imbalance theory as treatment in psychiatric diseases, and so all that’s left is that for those who it seems to help “we don’t know how it works.” In contrast what we DO know is that Open Dialogue statistically is more effective, in fact is effective rather than causing more of the problem it is said to heal. And Anatomy of an Epidemic also simply shares information that was there to clearly see, and should be shared so that it’s known, explaining the whole spike in mental illness. Anatomy of an Epidemic simply showed the correlation with the implementation of anti-psychotics and the increase in relapsing, disability, and statistic occurrence of the disease or diseases psychiatric medications were said to heal, since both ADHD medications and anti-depressants could and did and DO lead to further diagnosis where anti-psychotics end up being prescribed.

    And no I don’t think it’s open minded to convolute informed consent with information, that when warned about, people would correlate with “magic bullets” to avoid what they are warned about. In fact that’s quite reckless to negate such needed input, for whatever excuse, for anyone to make an informed well thought out decision. As well as it being recklessly dismissive to not promote methods that have been shown to work, against those that are accepted, but haven’t been shown to work but for a minority.

    There you have “magic bullets.”

  4. Nev–the phenomenon of pill-shaming is used to shut down opponents of forced drugging people who identify with being helped by their drugs have ample social sites to validate their need for greater social support other than MIA.

    My daughter valiantly tried–for seven years–while locked up in our states most restrictive facilities and as a group home resident — to advocate for her right to reject anti-psychotic drugs while receiving validation of her very real and obvious (to those of us who know her well) psychiatric drug withrawal symptoms as well as support to recover from the trauma of seclusion, isolation, restraints, forced injections, forced group therapy, forced baby-sitting, intrusions on her privacy at the most intimate level. How can you sit in your ivory tower and criticize this site with its life-saving (for some) validation of our loved one’s iatrogenic harm as well as a much needed source of daily inspiration for some of us to get through the day of supporting someone who has been so severely traumatized by her treatment that she can careful function in society.

    It seems that you have become out of touch with those who identify with having been severely impaired by trauma which is primarily iatrogenic.

  5. Nev– I am still shaking my head wondering how a disability rights advocate could argue that this site needs to be more inclusive of the voices of people who identify with being helped by drugs, How do you propose doing this? Censoring comments or blogs, regulating the number of pro-v.s anti-drug comments and/or blogs? The voices of those who identify with being permanently socially disabled by their treatment by force needs to be heard even if it makes some disabled people uncomfortable. This is a cross-disabilities dialogue. I’m down for that conversation! it

  6. Nev– I am still shaking my head wondering how a disability rights advocate could argue that this site needs to be more inclusive of the voices of people who identify with being helped by drugs, How do you propose doing this? By silencing the voices of another self-identified iatragenically disabled folks? Censoring comments or blogs, regulating the number of pro-v.s anti-drug comments and/or blogs? The voices of those who identify with being permanently socially disabled by their treatment by force needs to be heard even if it makes some disabled people uncomfortable. This is a cross-disabilities dialogue. I’m down for that conversation! it

    • Posting as moderator:

      I want to be clear that voices of those who feel they are helped by psychiatric drugs have always been welcome here. It is admittedly sometimes a challenging environment, as they will hear stories and feelings which don’t comport with their experience, but attacking or downgrading people because they choose a pathway that includes psychiatric drugs is never accepted here. Now if someone starts arguing that people HERE need to accept their reality and validate the reality of DSM diagnoses or something of the sort, they’re going to be in for an argument. But civil exchange of views is the central theme of the comments section, and no one is allowed to be censored or attacked for having a contrary view.

    • OK I’m seriously confused by all the mad moms & mad mothers at MIA, one of whom I don’t think likes me too much. At any rate I usually am sympathetic to all your comments, including these.

      I don’t know where the authors would get the idea that comments by those who have been “helped” by neurotoxins are excluded from MIA. Could it be there really aren’t that many out there, or that those who have been convinced they have been “helped” are unable to articulate exactly how?

      • hi oldhead
        I love your stuff here I’m not your not liker
        I am angry a lot of the time just had major surgery which I found out yesterday was not cancer. I was thinking I had finally been killed by psychiatry and the 24/7 stress caring for my son profoundly disabled by the direct actions of psychiatry and it’s well paid hangers on such as the above. The piece above incensed me because it was so patronising and I had no energy to keep rewriting politely.
        So no I am not a disliker of you or your comments I love your pithy directness in an age of fake doublespeak

        • Politeness is the bane of our existence is a world with so many serious things to deal with. Thanks for the validation.

          Years ago I made an acerbic/ironic comment about drugs that unfortunately rubbed against the grain of another mad mother, whose daughter had been similarly damaged. But I don’t recall which “mad mother” incarnation that was. I’m sure there are quite a few.

  7. A 450 page research book is “oversimplification” while a psychiatrists “you are ill therefore you are ill take these great drugs because we cherry picked a few corporate clinical trials.” Is what exactly? What do we call it when highly unequal standards are applied?

    If you admit the decision is painful why does psychiatry lie and withhold facts about it from people? Something being painful does not excuse them manipulating people to take as you say “painful” addicting drugs. Drugs that Anatomy showed cause only long term harm.

    Psychiatry are the ones who lied about a chemical imbalance to get people on the drugs. They are the ones who force people to take the drugs. People with these labels don’t get insulted for taking the drugs; they get insulted for being off them. Your “pill shamming” comments are you blaming others for the actions of psychiatry. Just like psychiatry blames the effects of their drugs on the people taking them.

    If you really believed the standard need to be high to release these kinds of ideas to the public you’d be attacking psychiatry. You know the people who lied to slander hundreds of millions Who lied to get hundreds of millions addicted to drugs. Who gave millions brain damage from their drugs. Those ideas were the dangerous ones. Correcting those ideas are only dangerous to those benefiting from the lies.

  8. Difficult piece to stomach.
    It is never dialogue to try and chat with an abusive industry that will not say they were wrong.
    How can Nev say:
    “And overall, there’s so much we don’t know, so much we don’t understand. So, acknowledging heterogeneity, acknowledging a very high degree of uncertainty about just about everything,”

    And yet criticize anatomy? And yet speak of “medicine”? Medicine for the unknown?
    And so they see something in a “psychosis” brain, yet never consider that it might simply be the product not the cause, And I did in fact get the news that “it” is also seen in other brains.

    Saying “there is so much we don’t know” is a cop out when really they know nothing. Knowing where the smell center is, is not knowing the mind.
    Knowing where the moon is, is not knowing infinity.

    And I find absolutely nothing intellectual about definitions given in an unknown area, given and presented to a greater public as facts when there is absolutely no science backing up the biases.
    I realize that if one has made a career out of bias and money spent on school, and has come to wonder at all the continuous suffering and more suffering from the horrible drugs and that despite the “identifications” and “treatments” of these disorders, an industry is making it worse….well of course sometime around the age of maturity which might be 40, one just cannot make peace with the contradictions.

    But what can one do? Reform what? I am not sure that “Anatomy” was for further research, and was not Hypothesis. Why the projecting? In psychology, this phenomena is well known and it is amazingly visible within the MH industry.
    I think there is a great difference between “rethink” and “reform”.

    • replying to streetphobia (the reply box is not working) loved your comment above and completely agree. Someone recently told me I should try to understand the point of view of the psychiatrist who destroyed my son and my entire family. That person was my son who is still left with more compassion than I will ever find and can find no anger for what happened to him.

      • madmother13

        Psychiatry has to be totally stripped of it’s facade and that includes the critical psychiatrists and psychiatrys so called complaints procedures – which are just an extension of their closed cultures of abuse used to further label/condemn their victims – and the truth of the matter exposed to the wider public. Psychiatry can not live without it’s closed cultures of abuse, lies and systems it’s calls ‘complaints procedures’ to cover up.

        I urge everyone to pass out and would hope people could print/pass it out at demo’s – THE most important history of psychiatry:

        http://breggin.com/wp-content/uploads/2008/01/psychiatrysrole.pbreggin.1993.pdf

        “The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by someone else. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures, provided the patients and places, and decided the methods of killing; they pronounced a sentence of life or death in every individual case; they were the executioners who carried out or without being coerced to do so surrendered their patients to be killed in other institutions; they supervised and often watched the slow deaths.”

        Fredric Wertham

        “Almost no one stopped to think that something could be wrong with psychiatry, with anthropology, or with behavioral science. The international scientific establishment reassured their German colleagues that it had indeed been the unpardonable misconduct of a few individuals, but that it lay outside the scope of science. The pattern of German anthropology, psychiatry and behavioral science continued essentially unchanged, and it will continue so, unless a substantial number of scientists begin to have doubts and to ask questions.”

        “It seems to be that to reduce other people to the status of depersonalized objects is of no help whatsoever to them” (p. 101). Trying to view people “objectively” can be demean-ing in itself [44]. It also tends to lead toward further degradation of the individual into subhuman status.”

        Benno Muller-Hill

        “Lifton is silent also on one of the most important issues surrounding the psychiatric crimes in Germany -the failure to bring psychiatrists to justice at the Doctor’s Trial. This was due in part to the fact that Leo Alexander, a staunch supporter of eugenical and biological psychiatry, was the chief investigator of psychiatric crimes. Alexander was a primary source of information for Lifton’s book. We must ask, ” Is there a basic moral flaw that underlies the ethical failures of psychiatry”? One fundamental flaw is the reduction of the human being to an object devoid of inherent worth or inviolability [44]. In Muller-Hill’s words, “It seems to be that to reduce other people to the status of depersonalized objects is of no help whatsoever to them” (p. 101). Trying to view people “objectively” can be demean-ing in itself [44]. It also tends to lead toward further degradation of the individual into subhuman status.”

        Peter Breggin

        • Thanks for this Street.
          I grieve because I have seen how a teenager went from smoking pot to uttering some religious devotions, in the church he was raised and how it led to the bible thumpers to cry foul.
          How that went to taking the most gentle person and subjecting him to becoming even more gentle. It went from sitting in a car and his body going into such rigid spasms that his mom would stop the car so he could lay on the boulevard for all to see.
          And they all gazed upon him and thought he was “mentally ill”. It was only the psychiatrist that knew better. It was he who knew that his pill lobotomy was worse than any knife could be.
          And how does that psychiatrist ‘feel’ when he sees the flat gentleness. Does the psychiatrist ever consider his own child? It is most obvious that the shrink feels absolutely nothing. He is not capable and very scary to think of him marrying, raising children.
          Like something robotic and who knows, perhaps they are.

          And critical psychiatry understands somewhat, but they rationalize that they can make a difference and reform, or as they say, rethink. By now I think it is obvious that Psychiatry is toying with all the rethinkers, because the capable rethinkers and dialoguers and criticalists are not jumping into the very dirty water and helping. In fact it’s an effin job.
          We pay critical psychiatry to end this mess, not critique it. We pay to raise it at national levels. It has been debunked so why are we still here?

        • “Psychiatry can not live without it’s closed cultures of abuse, lies and systems it’s calls ‘complaints procedures’ to cover up.”

          I don’t know that people who have not been subjected to psychiatric abuse would understand the significance of your comment in this regard streetphotobeing.

          I think back to the ‘process’ and providing ‘procedural fairness’ by following the rules. I advance to speaking with legal representatives at the Mental Health Law Centre who take the ‘facts’ from me, engage in an ‘agreement’ with the people who tortured and kidnapped me to accept fraudulent documents and then find a way of providing me with no assistance and ensuring that no other legal representative in the State does either.

          An absolute freeze on anyone getting access to the courts which would allow the lies to be exposed to the public. Are they even aware that should they refuse to speak to police, they can be handed over to a ‘mental health professional’ and their refusal to confess will be seen as a symptom for which they can be ‘treated’ until they do? Combine this with “proceeds of crime’ legislation and you have a system implemented against the Jews (and others) by the National Socialist’s. Refuse to confess to police to a crime which will allow the State to remove all your property? You are handed over to mental health and tortured until you do confess. Then they can remove your property. See the problem? The public don’t.

          My “refuses to answer re substance abuse” a question if police had asked I would be allowed to refuse to answer on the grounds that I might self incriminate. So police have the Community Nurse ask it, and should I refuse to answer in police presence, that refusal is then used to have me incarcerated and force drugged against my will until I do? And consider this Community Nurse knew more about the substances I was abusing than I did, he knew I had been ‘spiked’ with a date rape drug.

          When the question was asked by the Community Nurse (re illicit substances) I ask that I be allowed to speak to a lawyer, which of course they would not allow me to do, because they were subjecting me to an interrogation whilst I was ‘spiked’ without my knowledge. Would they need to inform my lawyer of this fact? They certainly made sure they didn’t find out later by providing them with fraudulent documents. And I believe that this was done so that they didn’t have to perform their duty, and could then take the information they had obtained from me to assist the hospital in their ‘fuking destrution’ of me. Imagine that sort of betrayal from your own legal representative.

          Think that’s bad? Take a look at what was done when their attempt to pervert the course of justice was exposed, …….and then cover up …….again.

          Imagine, the psychologist who I had explained to, over a period of a year and a half, about what had been done, becomes an informant for the police to assist in the further concealment of these crimes. “Who else has got the documents?” he asks me after I have gone to police and shown them they had not retrieved the real set of documents showing the ‘spiking’, and when I tell him who else? He becomes afraid for his family and finds a means to throw me under the bus (I appreciated the tip off my beige cardigan wearing friend lol). The amount of buses I am being thrown under you would think I would be dead by now. Seems someone is watching over me.

          Point being that in Australia your right to ‘priviliged communications’ with doctors is not being respected, and they can (lawfully) be coerced by police into providing them with confidential information. There’s a little fact that slipped under the radar in the news. (see ACC v Stoddart High Court of Aust HCA 47 of 2010. where the decision provides “No spousal privilege in common law in Aust”, and if that falls, ALL privileged communications fall, and can be subjected to coercive methods to extract information, aka they can threaten your doctor, LAWYER or priest to obtain information who may become afraid for their family)

          Haha, too late once you have walked into the Venus Fly Trap and made the mistake of trusting.

          • For people who are new to this and may think all this is unbelievable when we talk of torture. This is one of the best examples of what is going on in UK psychiatric ‘hospitals’, it’s actually even worse than he dare speak, much worse, I’ve nodoubt he is thinking of his job:

            Mental Health Advocate speaks about forced medication and coercion in the Mental Health system.

            https://www.youtube.com/watch?v=FixPywJfOOw

  9. “The charge is that of conscious participation in a Nationwide, organized system of cruelty and injustice, in violation of every moral and legal principle known to all civilized Nations.”

    “The principle of criminal law in every civilized society has this in common. Any person, who sways another to commit murder, any person who furnishes the lethal weapon for the purpose of the crime, any person who is a accessory to the crime, is guilty.”

    https://www.youtube.com/watch?v=wgvR67Ktwio

    I guess with the passing of a Euthanasia Act I can no longer consider myself to live in a “civilized society”. Yes they failed in passing the forced sterilisation of children without parental consent clause in the Mental Health Act, but like Little Richard “You keep a knockin” I’ve no doubt they will be back to try again, soon. Perhaps they can use the “enhanced coercive methods” available to get a signature?

    https://www.youtube.com/watch?v=PcJrExewkYA

    Not words you hear said to mental health services in my State. They are literally snatching citizens from their beds with no reason required, drugging them covertly with benzos (signed for post hoc by a Doctor you never met) and causing “acute stress reactions” to aid in the interrogations. (arbitrary detentions and torture now a reality)

    I look forward to the day when someone has the courage to stand up for “justice, truth and the value of a single human being” again. But it sure as Hell ain’t where I live. A complaint about public sector misconduct such as torture (or political views not authorised by psychiatrists) justification for incarceration and forced ‘treatments’. Well, after the fraudulent narrative has been manufactured by the State. Human rights lawyers (Mental Health Law Centre enables torture via their negligence and slander of their own clients) lmao. You people are an absolute disgrace to humanity

      • This is why they have built closed cultures of abuse – the worse it gets the more they make a locked up prison. The acceptable – acceptable to psychiatry that is – face of psych criticism are psychiatrists and psychologists who call themselves critical psychiatrists and critical psychologists. What they really do is provide the smoke screen – they present an acceptable facade rather like Downton Abbey written designed and directed to make you admire them and enforce the social hierarchical deference of the UK, whilst they destroy the lives of their own servants to save their social reputation and run a drug torture chamber in the basement.

    • It has been established that they are. There are many psychiatrists who know it is, but try to navigate that arena. I’m not sure why a “good shrink” would try and protect the industry. But it is super important to belong. It is a human need to stay with the one’s one identified with. It protects the fabric of identity. It is only for the strong to stand up. So much might unravel.

    • Why is it offensive to ask if psychiatry is dangerous? Why don’t we get into it – this is an important question.

      This is an “offensive” question all the sudden after years of MIA discussions? I would think it would be considered platitudinous by now.

      Eye of the beholder.

    • It should not be offensive to the very practitioners who know psychiatry in and out but cannot bring themselves to say it bluntly.
      In sexual preferences it is called, coming out.

      I think psychiatry seems to think that we pretend that suffering does not exist. How they justify abuse which comes in even labeling, in the context of suffering is beyond rational. It is dogma and religion. Their brand.
      In fact, a shrink does not have to use a label, and he can use the label “anxiety” for anyone he sees. (for insurance purposes) Since we know that out of the thousand labels out there, any drug will do. They don’t even care if the damage is horrid, they are too stupid or stubborn to not name that damage “MI”.

      And I wonder how a critical psychiatrist would objectively look at a damaged by drugs person? How would they look at a person who internalized a label?
      Subjects literally go from internalizing to more internalizing.

      Then someone comes and gives a great piece of writing, wholly needed writing, great critique, and the writing gets pulled. Because it was inflammatory. So are my posts.
      In fact, it is inflammatory to bring it up, so what was the alternative? The alternative was for me to say nothing, be a good little girl because speaking out, getting enraged is the sign of bi-polar.

  10. The Shayla love article is journalism of the worst type no wonder RW is annoyed. read it fully to learn Nev Jones’s views on MIA and it’s contributors and the dangers their views pose in her opinion as a psychologist. And yet the future apparently is “safe in her hands”…alternate reality ???!

  11. Sandra, this is personally to you. I’m sure you are trying your hardest to change the paradigm, envisioning that somehow psychiatry itself can be worked with. To help them have insight into the bigger picture.
    I understand more or less the position you are in.
    But I do think that critical psychiatry becomes it’s own job, with psychiatry happily dancing along.
    It becomes a theatre of sorts with patients still being gazed upon, by both disciplines.

    I can only hope that somewhere along the line the slow whittling can enlighten some privileged to hand out “diagnosis” and drugs. Because it is a HUGE privilege to gaze upon a play and have our critique matter.

    But just as critical psychiatry criticizes psychiatry, which is seen as allowable, so then should the experiences and views of anyone. Who sets the bar as to what is allowed as criticism?
    If critical psychiatry believes they can reform psychiatry, alone, without other voices, then let us see the product.
    In fact, I doubt whether critical psychiatry will get anywhere without survivors or “dissidents”, those “radical voices”.
    But no one wants the dissidents or survivors to have “control”. Someone always has the more “rational” view.
    I mean, why are we here? Why are there no anti-cardiology ideas out there? Although come to think of it, since medicine became involved more and more in psychiatry, they deserve a second gander.

    It is not a secret that doctors are getting more and more discouraged. They are discouraged by the lack of difference they can make, the lack of self discipline in society, the lack of science.

    It would be a grand day if psychiatry and critical psychiatry got together and addressed the politicians and people, to explain what they are “treating” and how it affects those that are “treated”. Where does that leave the “ill” and suffering?
    Perhaps therein lie some answers as to where money and new ideas, new ways of looking at people begins. Why would a government be opposed to opening up alternative schools for children? Not because the children are “ill” or suffer ADHD, ADD, but because they are different.

    We simply cannot any longer go by the paradigm of psychiatry. It’s not working, never has. Oh trust me, I read “studentdoctor” and see their linear thinking, their very narrow privileged views, views of “we are working on it and science has come so very far, and “ventricles”, and “what about if a person with “schizophrenia” has a killing voice”. Always using the “S” cards.
    We cannot keep “treating” people with chemicals to do stuff inside their brains of which we have no knowledge. It’s insane and one would think that psychiatry would willingly run to politicians and say “look guys, we have encountered a huge problem and we need to try something else, and since we believe that early environment is conducive to general contentment, we will boycott all service until you help us”

    Why not? Because lobbying the politicians does not result in pay.

    And you mention that consumers want drugs. Children do not. And this is the biggest sign of all that psychiatry is a huge sham. No one concerned with human life would ever use a child as a pawn. No one would ever put that child on speed. NO ONE.
    And thousands of shrinks, millions of kids and teens are on chemicals they never sought out. That is Psychiatry, using the “S” words to throw chemicals onto babes of the earth.
    So what are we criticizing?
    Pills? Or the paradigm. And no, they will never understand.

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