Editor’s Note: Over the course of several months, Mad in America is publishing a serialized version of Sami Timimi’s book, Insane Medicine. In this chapter, he discusses deconstructing diagnosis, the nature of psychological injury, and how identifying a problem can become a self-fulfilling prophecy. Each Monday, a new section of the book is published, and all chapters are archived here.
This chapter is based mainly on my decades of clinical experience. I outline some insights that have helped me develop a particular philosophy that I use to guide my practice. It’s a philosophy that developed over time and the technical aspects should not be seen as a new or alternative model; simply a mish-mash of collected ideas that I often draw on in the heat and improvisational space that makes up the messiness of the clinical encounter.
I consciously steer away from McDonaldised paradigms (diagnosis followed by specific treatment) as I fear the potential for trapping patients and unnecessarily creating long term customers.
The main orientating principles are:
- Deconstructing diagnosis: A relatively straightforward matter as I explain later in this chapter.
- Understanding the relevance of psychological injury: Anyone working in mental health services knows that the majority of those who use our services have had more than their fair share of difficult and upsetting events in which they experienced having little power to influence what happens to them. I prefer the term that psychologist Dr. Eric Kuelker uses of “psychological injury” to that of “trauma,” partly because I’m concerned about how trauma gets reified (this is where you turn an idea into a concrete object and so lose an understanding that it is an idea as opposed to a fact that we can see, measure, and manipulate) and partly because psychological injury keeps open the experiential aspect where, for all sorts of reasons, we each have different things that we might find upsetting or emotionally overwhelming.
- Working on the therapeutic relationship: What connects as a way of “being with” one person or family will not be the same as another. Each patient and/or family I see will form a unique relational “fit” with me (and any co-workers). Getting feedback as to whether what happens in the session is matching what works for them and being alert to possible “relational ruptures” are important aspects of building alliances. This means that all treatments are “co-constructed” and require finding ways for patients and families to feel heard and involved in the therapeutic process. It means being prepared to change tack based on feedback and sometimes it also means giving them the choice to see someone else if for whatever reason we can’t get the relational fit to work.
- An awareness of culture and context: It’s always worth remembering that we professionals are relatively unimportant in the big picture of peoples’ lives. Their real-life histories, beliefs about what might be helpful, availability of a supportive social network, cultural values, and so on are much more important influences. Furthermore, the services we work for and professional trainings we receive, are themselves embedded in institutional structures with their own peculiar cultural beliefs and practices. We cannot escape that therapy/treatment exists in specific contexts, as do patients’ lives. These contexts have a major role, not only in how we construct the narrative of what the nature of the problem is, but also in how change happens or how things might be seen differently. These background contexts are things to be kept in mind, helping to imagine what in the patients’ context may help or hinder and what in our service context may help or hinder. When patients improve, they own the agency for achieving that. It also means we should not burden our patients with our own narcissistic need for them to get better.
- How a problem, once established, perpetuates itself in a process I call “the problem becomes the problem”: As a consultant, I often see patients who have more long-standing problems. I have become aware that “the problem becomes the problem” is the treatment trap that I think mental health services are good at creating. I will expand on this later in this chapter.
The evidence-based discussions I have made in the book thus far have an important bearing on my understanding of patients’ dilemmas as well as my understanding of the potential role for professionals like me. You may have already picked up that my understandings lead to a major obstacle.
Patients and professionals alike expect me and the service I work in to operate in the medical model framework that has been sold to the public. They understandably imagine that the patients’ difficulties can best be understood and “treated” through obtaining a correct diagnosis (which will provide the explanation) and following this, a specific treatment that addresses the diagnosis. These days, that often includes the expectation that there might be some medication, given that psychiatric medicines have now been culturally imbued with magical powers.
This popularised dogma has had even worse consequences for young people, as individualising the problem and seeing it as residing within the child detaches them, for both understanding and help, from their social network, including their family. Young people of course rightly have limited autonomy as most of the important decisions in their lives will be made on their behalf by those who care for them.
Like me, I suspect that most mental health practitioners often feel like a fraud. If they don’t, then they should. They know our treatments are largely superficial managerial strategies of the type that drive us to distraction when performed on us by our corporate managerial b*llsh*t. Despite all these drawbacks, compromises, and conflicts, I believe that it’s still possible to create a therapeutic space where non-pathological and potentially helpful conversations can take place.
Deconstructing the diagnostic model in mental health is a relatively straightforward process. Selling a non-diagnostic-based model of thinking about the problems being experienced is a more difficult thing, particularly when seeing people who have already been given a diagnosis and cultured by the system they have been involved with into medical model thinking.
In order to deconstruct psychiatric diagnosis, all you need to do is explain a “truism” and repeat it whenever it becomes necessary, such as when people slide back into causal diagnostic thinking. Explaining the truism goes something like this:
I would just like to explain to you something to help you understand about psychiatric diagnoses. They’re very different to those we find in the rest of medicine. As you know, I have no particular blood test, brain scan, or any other investigation I can do that will allow me to understand whether there is anything going on in your son’s body and brain that can help explain why your son is sometimes finding it difficult to make friends or concentrate in class.
You see, psychiatric diagnoses are basically shorthand descriptions of whatever the problems are. This shorthand description just describes certain behaviours or experiences that sometimes go together.
What psychiatric diagnoses don’t provide is an explanation of why those behaviours are happening. Because a psychiatric diagnosis can’t tell us anything about the cause, it’s strictly speaking not really a diagnosis. That’s why it’s confusing, I think, to call it a diagnosis, because in the rest of medicine you can carry out tests on the body like blood tests or scans to help understand what’s happening that causes symptoms.
So, in the rest of medicine, diagnosis is a way of explaining what’s abnormal and the treatments you get are usually diagnosis-specific. If you have high blood pressure, you get a treatment to reduce the blood pressure. If you have a bacterial chest infection you get a treatment that kills the bacteria and so on.
Because we don’t really have diagnosis in psychiatry, our so-called diagnoses don’t tell you anything about what’s going on in your brain or body. As a result, our practice is all just based on an opinion. Opinion is all we have. It also means that none of our treatments are actually diagnosis-specific. This means that what might be going on and be helpful for one person with a particular diagnosis may not prove to be the case for the next person with the same psychiatric diagnosis.
Diagnosis in psychiatry helps us describe a problem, badly in my opinion, as no two people with the same diagnosis are ever the same, but doesn’t help us understand the problem or what might be helpful. That’s a much more individual thing.
Most people seem to understand and accept this sort of explanation. Sometimes, it needs further elaboration and sometimes it needs to be repeated in different ways, particularly for those who have been used to thinking of the problems diagnostically. For those cultured by previous service-input into thinking diagnostically, it’s common for them to have internalised using the diagnosis as an explanation—as in, “He can’t make friends because of his autism,” as opposed to using more ordinary reasoning such as, “He can’t make friends because he’s shy.”
When people lapse into these types of diagnostic-based explanations I often (but not always) offer a gentle reminder that diagnosis describes (badly) a problem but doesn’t provide an explanation. I am regularly surprised and encouraged by how well many people negotiate what must be a confusing and disorientating experience of moving from seeing a clinician who works in a diagnostic framework to seeing someone, like myself, who seeds the idea that they don’t have the explanation they thought they had.
It seems to work well with some, because people often welcome the switch from clinical narratives constructed around managing certain behaviours and experiences, towards one that is more centred on the uniqueness of each person and their family, and where the possibility that “this doesn’t have to be long-term” is being opened up.
Unlocking the long-term trap
As I have described, there are a number of constructions that have influenced the theoretical frameworks that guide my practice. I’m now going to expand on two of the specific (as opposed to general) principles that can help begin to sketch a pathway out of a long-term treatment trap.
This is my primary way for dealing with the “why” question. This is the closest we can get to a diagnosis. What is more important than whether it is “true” (something that cannot be established), is whether it may help construct a narrative that is helpful.
Research evidence shows that the clearest association between likelihood of psychiatric problems and possible causes is events and situations that increase our emotional arousal. Diverse experiences of all sorts from potentially traumatic events, all types of abuse, discrimination, bullying, living in violent neighbourhoods, unemployment, and so on, are all associated with a greater likelihood of experiencing mental distress.
Here I find the concept of “psychological injury” helpful. It seems that the way human beings are built follows the simple dictum that “when bad things happen, we feel bad.” People don’t necessarily make those connections. It’s also often the case that it’s after the psychologically overwhelming experiences have long since passed that the distress is more noticeable.
While we’re trying to survive, we’re in survival mode, and our mental state may not have the space to think about and reflect on the experience. However, in the aftermath, what can happen is that our mind tries to protect us and it does this by anticipating the possibility that the painful experience, the psychological injury, will happen again and so takes action to try and avoid this.
For example, if you’ve been hurt in a relationship, then you may want to be close to someone again but be very concerned about being hurt again. So your mind might react, once you start feeling close to someone, by backing off and keeping a distance from them. Your instinct may go further, perhaps even focusing on aspects of that person you’ve got close to that you don’t like, or even fantasising that they have those aspects and betrayals on their mind, because it’s easier to deal with separating from a person who you don’t like than a person you love.
To the other person your behaviour might now appear unpredictable, irrational even. Repeat this a few times in relationships and you may have lost the link with the original psychological injury (particularly if it occurred in childhood) and it now seems to confirm that there is something “wrong” about you.
Psychological injury has more lasting effects the younger you are when it happens to you. There is a whole area of research called the Adverse Childhood Experiences (ACEs) research. These ACEs have been found to be associated with an increase in the prevalence of all sorts of poor health outcomes in future adulthood. Furthermore, the more ACEs a person experiences, the greater the likelihood of having adverse health outcomes as adults, including the full panoply of psychiatric presentations.
One of the things that can happen when a child experiences psychological injury relates to their developmental level. Children are developmentally “egocentric,” and the younger you are the more this is the case. Children live in an action-based world where the things that happen around them are an extension of their internal world. Their real-time here-and-now emotional reactions have a more powerful effect than any capacity to think about their context.
They have not yet developed the ability to take a step back and see the bigger picture of what is happening, such as understanding that their parents’ arguments are not their fault. This means that you experience the bad things that happen to you and around you as being, in some way, caused by you. This then sets up an unconscious blueprint, often at an embodied level beyond language, which manifests in how you sense the world, where you experience that bad things happen because there is something bad about you.
As an adolescent, young adult and older, this feeling can have an almost superstitious ambience where you imagine that you’re destined to attract bad things to happen. This type of scenario leads to self-blame and self-loathing, as well as a desperation to believe it’s not true that you are the cause, that bounce off each other and lead to various strategies, from using substances, to self-harm, to withdrawal, and even to “manic denial” (grandiose feelings of super-competence) in attempting to calm these horrible conflicting feelings.
Please remember I am not outlining an essential truth here, but more a framework that is at least compatible with the evidence and that allows for a philosophical position that enables a narrative that can “ring true” and provide and construct meanings and interpretations that may prove helpful. As with the “the problem becomes the problem” principle, what I have outlined is not unique and has much in common with many actual therapeutic models (for example the Power Threat Meaning Framework).
The problem becomes the problem
The “why” question (such as “why do I feel like this” or “why does my son behave like this”) is often felt to be the most important question for us professionals to answer in order to know how best to help. Being set up as part of a health service means that our customers and referrers often assume that this is what we first do.
But, in a medicalised, technicalised model this is the first step, if you’re not careful, to an insidious trap. Becoming preoccupied with the “why” question can create the long-term patient. An initially innocuous problem can multiply, thicken, and crystallise. Our sympathy, empathy, and desire to help may accidentally burden the patient with baggage they never needed.
How can you help people look beyond the why question and the search for a diagnosis? Apart from using the formulation discussed earlier to help people link psychological injury to some aspects of their suffering; a simple deconstruction often suffices. So, you can explain that,
As we have discussed, the way we are built as humans means that when bad things happen and we find ourselves emotionally overwhelmed, we feel bad. That feeling bad often happens after the unhappy experiences end, as our mind tries to protect us from these things happening to us again.
However, we can waste a lot of time and energy trying to put our finger on exactly what caused us to feel the way we feel now. We might then end up doing something that looks like peeling a never-ending onion. Each layer we peel away, reveals another layer and then another and then another. Our lives are made up of so many interacting influences from the genes we inherit, the pregnancy, to how our parents were at the time we were born, what else was happening in our family, neighbourhood, then school, and friends, and so on.
We are much more than the sum of the sum of the many parts of our lives. Unpacking that jigsaw puzzle to work out what each bit contributed to becomes as complicated as working out the ultimate meaning of life. However, not identifying the exact cause does not mean there is nothing you can do about your distress. We nearly always don’t know the exact cause, just some things that may have contributed.
There is one thing I can reassure you about though—there is certainly nothing wrong with your brain.
I have come to the conclusion that becoming preoccupied with the “why” question can lead to a trap that our existing mental health ideology can prop open and which swallows you up when you walk through its door. It can help invigorate the reinforcing cycles we get drawn into by our reactions and attempts to deal with the emotional intensity that we are told is a sign of something being wrong. The mental health system’s technical model has the effect of disconnecting us from our resources, disempowering us from an appreciation of the humanness of our experiences, and trapping us in a philosophy that leads us to become long-term patients.
There are a number of influences helped me understand how this reinforcing cycle develops and how clinical practice can accidentally replicate and reinforce this. These insights have also helped me develop an alternative approach that may help some people come out of these cycles.
The first of those influences comes from the early family therapy pioneers. They began looking at patterns in family relationships and in the wider system around them and wondered whether the problems families were experiencing came not from an obvious cause, but from how family members reacted to the problem they were experiencing.
Perhaps, they thought, the problem was not the problem, but how the family went about trying to solve the problem was. Perhaps their attempted solutions accidentally reinforced the problem. This shift in the clinical attention away from focusing on the why question or the immediate problem, and trying instead to help a family change those patterns they developed in response to the problem, represented a radical modification in therapeutic aims.
Another influence comes from narrative approaches to therapy. Narrative and solution focused models understand that we don’t discover essential truths about our experiences, but instead create versions of them through the lens of the various stories we use to make sense of our situation. This means that we “socially construct” what we believe.
Where do we get our socially constructed stories from? They will be extracted from the multiple stories we are exposed to in our lives. Our own stories about ourselves will have been highly influenced by what others have said about us (for example, our parents), what they continue to say about us, and our subjective interpretation of these. It will also be influenced by the social stories we hear more widely (for example, from the media).
When we experience a problem, it’s not surprising that we turn to these sources to try to make sense of what is happening and to imagine how we might come out of this distress. There are usually multiple, but certainly not infinite, stories available in our personal and cultural surroundings. Many of us may turn to a medicalised model and wonder whether this is a sign that we have this or that disorder, perhaps after consulting Professor Google.
Narrative and solution focused models are aware of how these cultural stories skip over issues of power and have embedded within them various cultural constructions and suspicions and so reinforce cultural stereotypes of, for example, class, gender, race, and sexuality.
However, narrative approaches are also aware of how the clinical space is itself culturally constructed. It understands how medical model stories encourage the “thickening” of certain “problem-saturated” versions of our story. It’s very easy for us as practitioners to dance along to this framework and add further layers that reinforce the disempowerment that the problem-saturated story encourages, as we further embed the idea that the patient has a disease that requires specialist expertise to identify and treat.
There is more than one way to describe each situation. Awareness of the cultural nature of the stories and clinical spaces we inhabit allows the practitioner to also notice other versions that are not so visible when a “problem-saturated” story is dominant. Practicing with narrative awareness allows me to notice patients’ and their families’ resources, strengths, unique insights, and existing resilience. It reminds me that stories of suffering are also stories of survival. We can act as witnesses of the suffering, but also as documenters of survival skills and abilities.
Another influence came from the “hearing voices” movement. I have learnt a lot from those who have had psychotic experiences and recovered or maintained good enough functioning to become trainers and teachers. They helped me understand that even phenomena we consider to be psychotic can have important personal meanings that may not be immediately apparent, but can be valuable to a person, not just a symptom. Their work also helped me understand that the therapeutic aim should not be that of eliminating the voices, which mainstream models only view as symptoms, but of helping the person understand and accommodate to them.
Anthropological work on hearing voices has reinforced this opinion. For example, in an interesting paper, researchers described how hearing voices is experienced differently among people who reside in different parts of the world. In their study, people in the US universally experienced their voices (or what a psychiatrist would classify as “auditory hallucinations”—an abnormal perception of voices that do not come from any real person) as dangerous, unwanted, and something you should be striving to get rid of.
In the developing countries in this sample, participants experienced voices in more varied ways. Participants in the US were more likely to use diagnostic labels and to report violent commands than those in India and Ghana, who were more likely than the Americans to report rich relationships with their voices and less likely to describe the voices as the sign of a violated mind. The Ghanaian and Indian samples were also functioning much better in their day-to-day lives than the American sample.
As I developed my confidence in working with those who experience voices and other phenomena considered to be psychotic, I began to understand that better outcomes can be achieved by helping the person see their voices in context and change their relationship to their voices (or other psychotic phenomena). Instead of viewing them antagonistically as something they shouldn’t have and should be afraid of, they could find ways to feel irritated rather than afraid, and even engage in useful conversations with them.
Pretty much everyone I have met who was experiencing psychotic phenomena, whether voices or otherwise, had experienced their fair share of the ACEs I mentioned earlier in this chapter. I learnt to explain to people with such experiences that we all have unique ways of responding when emotionally overwhelming things happening to us. Often when we are experiencing them we are in survival mode. Afterwards our mind uses its own particular ways to try and prevent us being hurt again.
This can come out in all sorts of phenomena that is unique to each individual as we are all “wired” differently. Some people get lots of headaches, others can’t stop talking, some find themselves avoiding people, some start using substances to drown out feelings, and some start hearing voices telling them not to trust others.
In accordance with hearing voices practice, I try and help the person “humanise” each voice. I ask them about characteristics of the voice, whether they are male or female, how old they imagine they are, what sort of mood they have, what sort of voice is it, does it remind them of anyone, etc. I ask about how the person feels about each voice and what they hope to change.
Because we are in a culture that fears voice hearing and sees this as a symptom of the most dangerous and severe mental illnesses, it’s not surprising that many have been scared by such experiences, have not wanted to tell anyone, and were hoping that something can be done to get rid of the voices. I explain how voices can emerge from our unconscious and represent parts of ourselves, often aspects we’ve tried to repress. They are real and have meanings. Much of the work then involves helping them change their relationship with their voices, so that they don’t have to feel scared or controlled by them.
As I see under-18s, this is usually done together with at least one of their family members (unless of course the person doesn’t want to involve their family for very good reasons), so the conversations involve a person who can contribute to making links, finding new meanings, and supporting the task of helping the person change their relationship to, and feelings they have about, the voices. The less controlled and tortured by the voice the person feels, the less distress about the voices they experience, and eventually the voices start to lose their power as they become more varied and less persecutory.
Another influence on me was growing up in Iraq as a youngster. There is a strong belief in many Islamic influenced cultures in “fate.” Even though I’m not religious, certain values and practices I grew up with have had lasting influences on me. One such feeling I regularly get is that I may not understand why something has happened the way it has, but there is a higher reason/purpose that is beyond my comprehension.
For many Islamic cultures, fate is what is pre-written by god to befall us in our lives. It has meanings that we will not comprehend. I still have that feeling in me, even though I don’t share such a belief. But that feeling helps me get through difficult times, because somewhere inside me I have this conviction that things are meant to be and will work out.
It’s not the passive, learnt helplessness of “I cannot change anything and have to accept things will always be sh*t,” it’s the more optimistic “I have to trust that bad things have meanings too.” The belief in the deep designed architecture of fate has allowed people in those cultures greater resilience in the face of adversity and suffering. It allows people to accept pain, tragedy, and suffering, without magnifying it into narratives of personal disease, dysfunction, and despair.
Another influence that further helped me understand how our relationship to a problem has a big impact on how that problem manifests itself was understanding insomnia. I used to get insomnia frequently and would struggle with it. Then one day my wife said “you do like to make a fuss about your sleep.”
It was just a throwaway comment. I think it must have played on my mind because I recall a few days later having something of an emotional epiphany (I don’t know how else to describe it). I understood, at a level beyond language and the intellectual, that my struggle with insomnia was because I was struggling with insomnia. I understood how, after a while, insomnia causes insomnia and to interrupt that process, I had to stop taking it so seriously and refrain from trying to find a solution to it.
Let me explain. Insomnia first happened because I got stressed and upset and had things on my mind, so that I sometimes had trouble falling asleep or would wake up in the middle of the night and my mind would spring into action about whatever it is that was preoccupying me and I couldn’t then get back to sleep.
After a while, it was the fact that I couldn’t get to sleep that kept me awake. I would worry whether I was going to have another sleepless night. I might do some clock watching, thinking another hour had passed and I still hadn’t got to sleep, but I had to get up for work in four hours. If I woke up and saw that it was only 3am, I’d wonder if that was it for the night. Even though I’m highly sceptical when it comes to mainstream media, now of course I was noticing reports and articles about how we all need our sleep and how lack of sleep causes all sorts of problems.
So now I start to look for ways to solve this, because insomnia is now achieving the status of a problem that is interfering with my daily life. I read articles about dealing with insomnia, change bits of my lifestyle, download apps, change my bedtime routine, and so on. Some produce an improvement (which may be just coincidental), but after a while the insomnia just comes back.
My relationship to insomnia—in other words, my feelings about insomnia—was now veering towards the hopeless. I felt I had a problem that I couldn’t shift. It had started to occupy an increasing amount of mental space.
My wife’s comment and my subsequent emotional epiphany ruptured the hypnotic attachment I had developed to insomnia. Insomnia doesn’t deserve the status of a problem needing a solution. We are pretty resilient as humans. Ask any parent of a baby or young child, we can still operate effectively on very little sleep.
Now I could see that insomnia is a pain in the backside, but nothing more than an ordinary experience. I had placed insomnia into the category of “a problem,” then of “a problem affecting other aspects of my life” and then of “a problem needing a solution.” For my life to improve I felt I had to eliminate the problem. I had to be rid of it. It was no longer an ordinary and understandable experience—it was now a symptom to be treated.
For my wellbeing to improve, I had to stop viewing insomnia as a problem that needed to be solved. I had to change my relationship, my feeling, toward insomnia. Insomnia was just an understandable reaction to a situation. It was in the realm of the ordinary. I didn’t need a strategy for it. The more I looked for a solution, the more I strengthened the belief that insomnia was a problem. The more these solutions didn’t sustain, the further I was falling into my problem-focussed trance, with hope sapping away about the possibility that life could ever be better.
And it turned out to be as simple as that. Once I stopped viewing insomnia as anything other than ordinary and/or understandable, as not a problem, as just something that I have to accept comes and goes, then insomnia stopped causing insomnia. Now I do have nights when I don’t sleep well, for whatever reason, but other nights are fine. I don’t clock watch anymore. If I don’t sleep, I don’t sleep. I don’t whoop for joy after getting a good night’s sleep or become despondent after a bad night. Intermittent insomnia is just a part of my life as I suspect it is for most people from time to time.
These various influences have taught me a number of things. Firstly, most problems that become what we consider and categorise as mental health problems start as understandable and/or ordinary reactions, often to psychological injuries. Secondly, we are all highly influenced by the cultural stories about how we are meant to be. The spread of “mental health awareness” has sensitised the population to becoming suspicious of our ordinary and/or understandable emotional reactions and seeing in them potential disease, disorder, dysregulation, and dysfunction. We now scrutinise our emotional states and see in them, or in those we care about, a possible mental disorder.
Thirdly, once we start treading down the path of “there is something wrong with my emotions and/or behaviour” we risk entering into the Alice in Wonderland rabbit hole where the problem becomes the problem. Being anxious becomes anxiety provoking, being depressed is depressing. We enter the hall of mirrors where our problems are detached from the ordinary and stare back at us, mocking our attempts to ignore them.
We develop an antagonistic relationship to aspects of our life, particularly our emotional life, seeing them as possessing qualities of disease, accentuating our suffering, and sucking out meaning from the experience beyond that of a potential medical or psychological “abnormality” that needs solving and/or removing.
Fourthly, you enter into the market place of McDonaldised medicalisation where the array of brands (diagnoses) and brand products (medication and therapies) are offered. Once co-opted into brand consumption, alienation and antagonism toward your emotional life is further strengthened. The ordinary and/or understandable becomes a meaningless symptom or set of symptoms needing a treatment to get rid of them.
You are now entering into the dangerous territory of the alienated. You are set up into fighting and trying to control, suppress, eliminate aspects of your emotional life. Your relationship to and feeling about your problem occupies more mental space if the solutions offered don’t work or only provide temporary respite.
If that’s the case, you are now ready for the fifth stage: entry into the world of the chronic patient, waiting for the right expert, brand, medication, or therapy to quell the disorder that keeps rising again and again. The original issues are long since gone. The problem has become the problem.
This understanding has made me much more aware of how services can accidentally make your mental health worse. I began to understand why we have such poor outcomes and why the volume of those disabled by mental health “disorders” has mushroomed in tandem with the amount and number of treatments we are providing. Mental health services, it seems, are often bad for your mental health.
In Part 2 of this chapter, we will explore working with medication and how to withdraw from psychiatric drugs.
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.
This reminds me of:
“All shall be well, all shall be well, and all manner of things shall be well.”
Julian of Norwich, Revelations of Divine Love
I’ve been passed around in the mental health care system since I was 6-years-old, so 22 years now. The “it’s a chronic condition that you’ll have for the rest of your life” mindset was ingrained in me until pretty recently.
I used to have these battles with acronym-named, invisible foes — GAD, MDD, OCD, ED-NOS, AVPD, DPD, PSTD — before I started reading Mad In America and realized that, at the end of the day, they’re all just feelings. And feelings come and go, sometimes for reasons we don’t understand.
Once I took the blinders off and saw myself as more than just a list of diagnoses that would last forever, I, shockingly, started feeling better.
I think part of the reason why people flock to diagnoses is because they’re very neat and orderly, while the human experience is often chaotic and messy. It’s a way to compartmentalize emotions that feel like “too much.”
This entire series has been really eye-opening for me and I thank you for writing it.
Neat and orderly diagnoses can make such a mess! Love the human experience in all of it’s chaos and messiness… and orderliness returns. May you continue to feel so much without judgement.
And it’s insulting to Donkeys, who made this game up!? Pins too, and Tails. And even Keys, thanks to DonKey…
Sami, another fine, brilliant job. Not because you are academic, because you have the ability, the gift to think and so:
“Like me, I suspect that most mental health practitioners often feel like a fraud. If they don’t, then they should. They know our treatments are largely superficial managerial strategies of the type that drive us to distraction when performed on us by our corporate managerial b*llsh*t. Despite all these drawbacks, compromises, and conflicts, I believe that it’s still possible to create a therapeutic space where non-pathological and potentially helpful conversations can take place.”
I think that the “possibility” you speak of, is not another creation of “system” or “way” of doing stuff. The ability to reason, to think cannot be trained unless it’s already within a person and they are gently ushered towards that in early education. A shrinks own background, his own injuries are much at play in the human interactions, so it is ALWAYS unfair to think of the “patient” as the only injured party in the room. Or the only “mental” or the only “ill”.
As you say, if we have not felt ourselves as fraud, then we should. Therein lies the potential to establish something in common.
You really hit the nail on the head with “the problem becomes the problem” and I wish systems and not just psych saw this. Right down to the family.
And so we can look at the client as having had a problem and how that can indeed be their main problem. Yet the system itself has a huge one.
And you are very generous as to what can be thought of as having possibilities to change, and you are correct that yes changes can happen, a process and evolution, but you have to realize that clients come to you. Psych does not. Psych never says “I feel like a fraud, I need help to help my clients”. “I want to do things differently”. In fact most people that do go to see psych or even experience “psychosis” or severe fear, are a step closer to insight.
Whatever the word “insight” means. It is one word that has been cheapened so much. It is a word that is personal, not to be used over others. It is forever in process not to be defined.
There are always a hundred possible comments to your articles. The best one I can possibly leave is that I think you are one of the most forward thinking, in the present kind of guy, shrinks, I know.
” I began to understand why we have such poor outcomes and why the volume of those disabled by mental health “disorders” has mushroomed in tandem with the amount and number of treatments we are providing. Mental health services, it seems, are often bad for your mental health.”
This IS how it is. It is not because you are a psychiatrist that I put so much value on your books, but rather due to content. The sanest books I’ve read in what seems forever. Solid.
Sami Timimi, along with Lucy Johnstone and Mary Boyle, will be speaking at an upcoming virtual event: A Disorder for Everyone – Change is Coming! on February 12, 2021. Robert Whitaker, Mitzy Sky and and Dr. Rosebert will join them for a panel discussion. Anyone can attend and you can pay what you want. Sign up here!:
I tried to get a ticket, but it will not accept my postcode. It seems to be set up for british postcodes?
There’s a drop-down menu to choose language/location if you’re not in the UK. Should be a great event. There’s also a poetry event on January 22 that anyone can attend. Previous events I’ve attended have been amazing!
Thanks 1Wayfarer, I’m in Canada and attended the last one. It was great!
Thank you Wayfarer
Dr. Timimi, Another exceptional chapter. It resonates on many levels.
“When bad things happen we feel bad”. Yes indeed.
Reminds me of a tweet from Dr. Umesh Prabhu – “Any fool can make things complex and complicated. It takes a touch of genius to make things easy and effective”.
Psychiatry must stop the insanity of labelling ordinary, understandable feelings as “disorders” that need drugging. My brother “felt bad” because his marriage ended and his ex-wife moved away with the children. He was referred to a psychiatrist for his temporary low mood, labelled, drugged, given ECT and died at 40.
I relate to having issues with insomnia in cancer treatment due to chemo and steroids taken to mitigate gastrointestinal damage from chemo. I also coped with an abusive oncologist who refused to explain anything or answer any questions. I was then sent to a psychiatrist under the deception it was to get “help with sleep meds” for the insomnia but it was to have 4 labels put onto my electronic records and an array of psych drugs prescribed because I asked questions and wanted to make decisions that were right for me and my circumstances. The name of your book “Insane Medicine” is very fitting. Thank you for making it available on Mad in America. I hope many get to read it.
Well Rosalee anyone, especially women that like answers are not liked, and there are punishments.
I found that trying to explain how a Doctor was not being honest, makes other “doctors” super angry.
I love everything Sami says here, except for, AND someone else wrote a blog on this “idea”, the idea of reference to “psychic injury”. Nope, not good enough. All psych would do is rename it “injury” and “treatments” are the same.
This renaming works for Sami and his clients, because Sami is using it personally, between him and a client… outside of some ridiculous paradigm.
Psych takes over every word, every opportunity and completely ruins the original meaning. We don’t need more words to give over to them which they change anyway, to keep othering people.