When It Comes to Mental Health Problems, The Disability Framework Fails: A Response to Comments

34
1951

On December 8, 2021, my essay appeared on MIA (“When It Comes to Mental Health Problems, The Disability Framework Fails”) arguing that mental disorder is not a disability, and that treating it as such is harmful. Over the ensuing weeks, many people responded with thought-provoking comments and concerns. I intended to reply to each of them in the comments section; however, given their number, complexity, and significance, I thought it deserved a follow-up essay.

I appreciate having this opportunity, as it furthers the discussion and it helps me flesh out my own ideas about this very important topic. I hope this “round 2” is responsive to the comments, clarifies my points, and clears up any confusion that may have existed. From the many comments posted, I distilled seven general themes of concern.

Professional vs. Patient

First, I want to caution against the well-known and perennially raised distinction between professional and “patient.” It was implied in many of the comments to highlight the idea that mental health professionals like me can’t understand mental disorder because we haven’t been there, and thus we can’t grasp how disabling it is. However, in fact, many mental health professionals themselves have been at the receiving end of mental health services. I was one who naively reached out for help several years ago, but fortunately I rejected the “treatment” at the beginning of my exposure to the system. Many other licensed professionals I know have also been in the position of psychiatric patient, with some suffering more harm than others.

Perhaps more important than being in the position of a psychiatric patient, an untold number of people, professionals included, suffer from the kind of problems in life that get diagnosed as mental disorder or mental illness without ever seeking professional help. As such, they are truly experts in mental disorder through personal experience, even though they have never felt the sting of psychiatric control.

Therefore, it is unhelpful to make this tenuous distinction between professional and patient. It leads to ad hominem attacks, distrust, and it distracts us from the very serious problems we see in the orthodox mental health industry that professional dissidents like me are trying to resolve. I suggest we abandon it.

Defining Suffering, Illness, and Disability

It is important to be clear in our definitions. If we don’t agree on standard definitions, we cannot discuss the topic being defined and any attempts to reform the system based on these discussions are doomed to fail. If we tried, we’d be talking past each other as each of us would be talking about different things. If we are loose and fast with definitions, we necessarily wade into an intellectual quagmire that we cannot escape. Perhaps this is what causes so much disagreement, not only with the present MIA discussion, but also with the larger discussion in the public arena about mental disorder.

I’m not the absolute authority on definitions (and neither is Merriam-Webster or Oxford), so I can’t put the matter to rest. But I can make suggestions. In my thinking, suffering is the subjective experience of distress. Illness is like suffering, but it also includes a dysfunction in the individual that is responsible for the distressing experience. Disability is the inability to do something because of how the dysfunction prevents it. If we use these definitions, all of us would be experts on suffering since everyone suffers and will always do so. However, we would be obligated to provide scientific evidence of the internal dysfunction before claiming illness and disability. Resorting to science this way is not haughty or fetishistic, as one commenter suggested.

Now I recognize that not all people hold these definitions. From the comments, it seems a few subscribed to the idea that the experience of suffering is synonymous with illness and disability. But that definition would be so all-inclusive that it would lose meaning. Since everyone suffers, everyone would have an illness and be disabled throughout their life. Mental disorder is very real, and I think we can all agree on that. The point of contention is whether it is caused by a dysfunction in the individual, or whether it is a natural and understandable, but problematic, response to difficult social contexts.

Psychiatric Iatrogenesis

Several comments implied that I had ignored the iatrogenically disabling nature of orthodox mental health treatment. I don’t think I did, as I pointed out in the footnote of my December 8th essay:

“For the purposes of this essay, I am excluding the DSM categories that are physiological illnesses….”

My focus is on the problems that are diagnosed as mental disorders, but that do not have any underlying physiological dysfunction – the great majority of so-called mental patients. The effects of psychiatric drugs, ECT, and psychosurgery can be disabling. But they do not cause mental disorder or mental disability. These psychiatric interventions cause physiological dysfunctions in the individual that are experienced as mental symptoms (e.g., anhedonia, akathisia, memory loss). The same goes for people who are diagnosed mentally disordered, when in fact they are suffering from other types of physiological dysfunctions that have mental symptoms, such as hypothyroidism, urinary tract infections, and Lyme disease.

It is illogical to call these mental illnesses or disorders, even though they are formally listed in the DSM as such (e.g., depressive disorder due to another medical condition). It is equally illogical to call their effects mental disabilities. They are physiological illnesses that have mental symptoms, and they would be treated by professionals of those medical specialties involved (e.g., endocrinology, urology). If they reached certain thresholds, they would cause physiological disabilities. When we know lethargy is caused by hypothyroidism, we’d refer the person to an endocrinologist, not a psychiatrist.

Psychiatrists have an important role to play in this situation, but it is not to treat the condition. Their role is to consult in cases of claimed mental disorder to determine if an underlying physiological dysfunction in the individual is the culprit, and then to refer the patient to the appropriate medical specialist. Imagine how wide psychiatry’s domain would be if any physiological condition with mental and behavioral symptoms was considered a mental disorder. Sadly, though, this is already the case.

Disabling Pain

Another concern was expressed in the physiological analogy of migraines, autoimmune conditions, and arthritis, suggesting that the experience of pain from these ailments is the essential disabling factor, not the ailment or dysfunction itself. My first reaction to this comment was that, while true, those things are the result of physiological dysfunctions and, therefore, are not necessarily germane to the idea of mental disability (see the preceding section). Still, this is an enticing idea, and I can see how the emotional pain of fear, shame, and despair associated with the problems diagnosed as mental disorders are thusly claimed to be disabling.

However, we are more specifically talking here about pain intensity, not just pain. There are many painful experiences, whether classified as physical or mental, that we tolerate and that do not prevent or dictate our actions. If they did, there would be an overabundance of disabled people. Fortunately, it is only when the pain reaches such a high level of intensity or abrupt onset that it overwhelms us to the point of reflexively responding with a total focus on reducing the pain, like the nociceptive withdrawal reflex. I agree that those moments of overwhelming emotional pain are literally disabling—we are not able to do otherwise at that moment because of the total and reflexive nature of the response. Yet, those moments are typically short-lived. In most situations, our reaction to emotional pain is not reflexive. We can tolerate it and continue to function, as is demonstrated in many examples.

In the December 8th essay, I used the extreme examples of a person who kills in the heat of passion and someone who complies with a gun-wielding attacker. These people obviously were experiencing emotional pain (rage and terror, respectively) that motivated their behaviors. But had they entered that brief but totally reflexive disabling state or were they able to inhibit their responses? I suppose we really can’t answer that question since it depends on the specific situation and person. But we must admit there have been plenty of cases when people have in fact inhibited passionate homicidal urges and terrifyingly refused to cooperate with an attacker. Still, when murder and compliance do occur in these situations, we can compassionately understand how the emotional pain forms the rationale for action, even if the person did not enter that totally reflexive state and was disabled. This helps when judging them, either in a court of law or the court of public opinion.

It is important to note that the difference between physical pain and emotional pain is that physical pain is about dysfunction in the individual. Emotional pain is not.

Beliefs, Perspectives, Skills

One commenter suggested that mental disability occurs when people lack certain beliefs, perspectives, and skills. But is this a reasonable definition of mental disability? For example, are atheists disabled from attending church because they don’t believe there is a God? Are Libertarians disabled from voting in favor of socialist laws because of their perspective on individual rights? Do we enable them by encouraging different beliefs and perspectives on life?

The same applies to beliefs and perspectives held by those who suffer from emotional distress. A person may believe they are worthless and, therefore, does not speak up assertively or demand better treatment from others. Still, they never lose the ability to do so, just like how the atheist can go to church despite contrary beliefs. Someone whose perspective is that technology and industrialization are the downfall of society and must be violently overthrown, can nonetheless choose not to carry out violent acts, just how the Libertarian can vote in favor of socialist principles despite a contrary perspective on politics.

Beliefs and perspectives form the rationale for action. They don’t enable or disable them. Although very difficult to do, a person diagnosed with schizophrenia can inhibit speech and actions. Someone diagnosed with major depression can get out of bed. Those diagnosed with bipolar disorder can stop spending excessive amounts of money. Despite their beliefs and perspectives, they can act contrary to them. Certainly, they don’t have the ability to just flip a switch and feel, believe, or perceive differently than they currently do. But there is nothing dysfunctional in them that is in charge. They are acting in accordance with their beliefs and perspectives, thus, their desires in the moments of action. Those beliefs and perspectives do not disable them or dictate their thoughts and actions.

Regarding the situation where a person lacks certain skills or knowledge, does this constitute a disability? If I don’t know how to dance the Tango, is it reasonable to say that I am disabled? Of course, I am not able to dance the Tango without lessons, but is this what we’re talking about as disability? What if I don’t know that my phone is ringing in another room, do I lose the ability to answer it?

One’s level of skill attainment or knowledge provides know-how and rationale, respectively, to perform certain functions. But I think it is a stretch to take this to mean they are mentally disabled without the skills and knowledge. The disability would be present if they were somehow not able to perform those functions even with the skills and knowledge. What kinds of skills and knowledge are lacking in people said to be mentally disordered? In my professional and personal experience, I’ve found that the great majority of us have the skills and knowledge to make changes in the way we live life, but we resist employing them because of the sheer difficulty and consequential suffering in doing so – no surprise there.

As with the issues above of definitions, iatrogenesis, and emotional pain, imagine the surplus of disabled people if we applied these criteria of beliefs, perspectives, skills, and knowledge to mental disability.

Misunderstanding My Views

I think I failed to explain my views fully and clearly, as some comments suggested a basic misunderstanding of them. One example was summed up in the claim that mine were “a lot of words for ‘Just suck it up.'” Another responded with “it is not always a matter of ‘just stopping.’” The minimizing term “just” is used in statements like these to imply that I think it is easy for people to change. But my view is the exact opposite—significant personal change is very hard and it takes persistence and a willingness to suffer through the inevitable consequences of changing. But this difficulty does not equal disability.

These and other comments also hint that I am morally judging people as lazy, wrong, or bad, and therefore are to be blamed for their predicaments. It is true that my perspective is consistent with the existential psychology concept of freedom and in this sense recognizes that all of us are responsible for experiencing our lives and making decisions about those experiences – it is something we cannot escape. Still, such a perspective does not involve the moralizing concept of blame or fault.

This is also an empowering perspective. It points out that no mental dysfunction in the individual stands in the way of change, even though we can fully understand one’s actions, thoughts, decisions, and resistance to change.

Conflating Disability Accommodations and Compassion

There were some comments that implied I was advocating for the elimination of aid to people who are mentally suffering. I am not, and I emphasized this in the December 8th essay when I said:

“Human diversity of mental experiences and behaviors can be valued without invoking impairment and disability. Let’s find a different way to assist those struggling with life challenges without branding them with the identities of the disordered, dysfunctional, and disabled.”

I am simply pointing out what I think is a flaw in the current system of assistance. In my view, branding people mentally disabled (i.e., defective) not only lacks evidence and logic, but it also perpetuates the problem. It is the basic scaffolding that supports the harmful treatment of people so diagnosed and the denial of their basic human rights. They are mistakenly considered mentally defective and, thus, viewed incapable of exercising those mental faculties. This includes making appropriate choices for their own benefit and whether they need the “treatment” and “protection” of the mental health industry.

We can honor human rights and aid people who are suffering without resorting to disability as a reason. Can’t we show compassion for people, help them to the extent that we can, and afford them basic human rights regardless of their specific situations? The conventional disability system seems to be the only route at present, and I am suggesting that we start looking for a different way to help people without tagging them mentally and behaviorally disabled.

I’ll end this follow-up essay the way I ended the first one … I realize this is an enormous challenge.

***

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.

34 COMMENTS

  1. “Professional vs. Patient” “I suggest we abandon it”.

    I think that Philip Zimbardo might agree with you, and I guess if we abandon the role of Prison Guard versus Prisoner in our “Correctional Facilities’ much of the violence suffered due to ‘role confusion’ might go away? I note that my brother who worked in the prison system for 25 years, was also at one stage early in his life actually held in one such place.

    I think trying to ignore the power imbalance in such ‘relationships’ (particualrly the more abuse ones) is a bad idea. I suggest we abandon it.

    “My focus is on the problems that are diagnosed as mental disorders, but that do not have any underlying physiological dysfunction – the great majority of so-called mental patients.”

    Don’t you mean ‘any IDENTIFIABLE underlying physiological dysfunction’? The inability of doctor to identify the root cause of the issue, does not mean one does not exist. In fact, I think you point to the ‘problem’ with your following sentences.

    “The effects of psychiatric drugs, ECT, and psychosurgery can be disabling. But they do not cause mental disorder or mental disability.”

    In fact, you may find that many ‘mental patients’ are subjected to these so called ‘treatments’ as a means to cause mental disorder or disability. Side effect if you must, but I think Frantz Fanon makes it very clear that the use of electricity during interrogations was not to cause the physiological harm you speak of, but to use the psychological distress caused by that harm to advantage (what he called ‘psychological services’ of the French government in Algeria). Is the same not true when waterboarding? Little harm physically, but the psychological harm of ‘near death experience’ great for overcoming ‘resistance’ to confess?

    Haven’t got much time so have to leave my comments there. Bit busy trying to over come the trauma of being deliberately ‘fuking destroyed’ by an Operations Manager (as representative of the State) at a mental institution where they subjected me to 7 hours of interrogation whilst drugged with date rape drugs without my knowledge, and with Police weapons pointed at me forcing me to ‘confess’ to my ‘disability’ or ‘disorder’.

  2. Just noticed this in your C.V. Dr Ruby

    “Executive Director of the International Society for Ethical Psychology and Psychiatry (ISEPP)”

    How ethical would it be for a psychologist who was informed of the events I mention above, to be used by Police to find out “who else has the documents?” for them, and to conceal an attempt by police to refer me to mental health services for complaining about being ‘spiked’ before being interrogated. ie this particular psychologist spent quite some time going over the documents they State thought they had retrieved from the nutjob, before sending the fraudulent set to my legal representatives. Questions the ‘client’ would never answer to police spoken about under the false belief that the matters were confidential? same as the use of criminal lawyers by police as informants? (see Nicola Gobbo lawyer X) Clever really, though quite a breach of trust and confidence in my opinion.

    Police were of course concerned when I turned up with those documents wanting to make a complaint about being tortured by them, and so threatened this psychologists family to ensure his silence, and to have him use his position of trust with me to find out who else was aware of their misconduct that had been ‘covered up’ by the State government.

    I get it that he was threatened, but it seems a bit misleading to have someone you claim to be trying to help with therapy, only to exploit their trust to obtain information for police to enable the concealment of acts of torture and kidnapping. Which is exactly the sort of thing you would expect from a government that is enabling torture methods via the Mental Health Act. (the loophole of “inherent in or incidental to lawful sanction” combined with arbitrary detentions making torture available to public officers at ‘street level’)

  3. This new discussion touches on many of the basic issues and problems connected with anyone who seeks to help another out. In so doing, he or she takes the role of “healer” (or helper) more or less forcing the other to admit to being “ill” or needing help.

    When a beggar walks up to me and asks for money and I give him some, while I can assume I have helped him to some degree, I dare not fool myself that I have healed him. If I interact with him in some other way, and later I see him again and he is happy and thriving and walks up to me to shake my hand to thank me, I can then be a little more certain that I’ve healed him. Yet in the end I should be humble enough to remember that I really only helped him decide to heal himself. That is the first barrier that any healer in this field must face.

    If I am a “professional healer” and someone is brought to me who is in obvious distress and I do something to relieve that distress, did I help the one in distress or the one who brought them to me because their distress was upsetting to them? When a doctor sets a fracture even though the patient never asked him to, then the patient heals (or, perhaps, fails to heal), what exactly occurred there, anyway? This is entire realm of concern for many ex-“patients” as they were not aware of ever asking for help and feel the “help” they got was destructive.

    If we can wade through these basic questions of what is help and healing, we still are left with the problem of the skill and exact intent of the healer. And the general agreement – at least on this website – seems to be that professional-level skills and noble intentions are often lacking in the “professionals” that many patients have interacted with.

    This speaks somewhat to the topic of this article: Should a condition of mental distress be seen as a disability? The meanings here become so exacting and intertwined with various legal definitions that I feel unqualified to give a proper answer. But clearly, the “disabled” have been granted access to certain legal remedies in recent years that the simply distressed cannot take advantage of. And to the extent that “treatments” are unsuccessful and the distress becomes a chronic problem, it begins to look more and more like a disability, even though this doesn’t make that much rational sense.

    In this way, we could see the willingness of the mental health community to get mental disorders treated as disabilities as a form of admission of failure. A person with a mental problem should not have to walk around thinking he or she is permanently disabled, yet this aligns with the actual experience of many such people.

    I know a woman who has been dealing with mental-emotional problems her entire life. Though in a perfect world she in theory could have been cured, this is not what happened to her. And though she works 40 hours a week at a real job, she has also developed obesity and other body problems to the point where she has been declared by a doctor to be actually disabled. She no longer has any hope of overcoming her mental conditions, and her physical problems now only add to her suffering. This is a failure of our “system” and I am sure not at all unique or special. And though I am convinced that a professional healer could have cured her long ago, and dug her out of any relapses, the average American – much less Indian or African – has nearly zero access to people that good. The “system” doesn’t aspire to be that good, even though it has that potential.

    So, from my point of view, a wide variety of factors have led us to this unhappy place. People with mere disorders that should be curable are being turned into disabled who can now hope for no better than to get some sort of compensating action from society because of their disability. Of course this whole “framework” does not promote a very hopeful attitude or productive approach for the mentally ill, but is does reflect the sad reality of our current condition.

  4. I missed your first blog, and the active discussion afterwards, and will go back and read it when time permits. But I do have some comments on this blog.

    “we would be obligated to provide scientific evidence of the internal dysfunction before claiming illness and disability.” And this is precisely what the industries that bill utilizing the “invalid” DSM “bible,” do NOT do.

    “Mental disorder is very real, and I think we can all agree on that.” Distress is real, but I’m not so certain about “mental disorder.” My former psychologist finally admitted to me, when I was picking up her medical records, that she believed distress caused by 9/11/2001, shortly after 9/11/2001, was distress caused by a “chemical imbalance” in my brain alone. That, of course, merely proved – all the more to me – that she was a nut job.

    “The point of contention is whether it is caused by a dysfunction in the individual, or whether it is a natural and understandable, but problematic, response to difficult social contexts.”

    Or if the so called “mental disorder” is caused by iatrogenesis. As in my case, where a psychologist misdiagnosed “brain zaps” – a now commonly known symptom of antidepressant discontinuation syndrome – as “bipolar.” The antidepressant, Wellbutrin, was prescribed under the untrue guise of a “safe smoking cessation med,” not for depression, just an FYI.

    “The effects of psychiatric drugs, ECT, and psychosurgery can be disabling. But they do not cause mental disorder or mental disability.” I completely disagree, and even the DSM-IV-TR states:

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

    So even the psychiatrists used to know that calling the common adverse or withdrawal effects of an antidepressant “bipolar” was malpractice. And as to the antipsychotics / neuroleptics, every doctor is taught in med school that both the antidepressants and the antipsychotics can “cause” “psychosis,” via anticholinergic toxidrome.

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

    And the neuroleptics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, as well.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    “In my view, branding people mentally disabled (i.e., defective) not only lacks evidence and logic, but it also perpetuates the problem.”

    No, it creates a problem, so as to distract a person from their real life concerns. As in my case where it turned out, according to my family’s medical records, my misdiagnosing psychologist was actually just trying to cover up the sexual assault of my very young child for her pastor and his pedophile friends. And it is defamation of character to call someone “defective” or “w/o work, content, and talent,” especially, prior to looking at a person’s work. Once my psychiatrist finally bothered to look at my work, he described it as “insightful,” “work of smart female,” and he weaned me off his neurotoxins.

    “I am suggesting that we start looking for a different way to help people without tagging them mentally and behaviorally disabled.”

    Absolutely, I agree, and I believe MiA is trying to do just that … like, for example, pointing out the success of the Open Dialogue program and the Hearing Voices Network.

    I do not see, however, too many of the psychologists and psychiatrists working to find viable alternatives. For example, about twenty years after I was attacked by that first child abuse covering up psychologist, I was attacked by another one. Who freely admitted to me – after I refused to sign his appalling conservatorship contract, disingenuously dressed up as an “art manager” contract – that his goal was to “maintain the status quo.”

    But I do thank you for being one of the psychologists who is calling for real change of the stigmatize / defame and neurotoxic poison – and systemic child abuse covering up – industries.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    The DSM really should be flushed, it’s full of “bullshit,” even according to its former editor. And it lacks relevant information, like about anticholinergic toxidrome, neuroleptic induced deficit syndrome, antidepressant discontinuation syndrome, and the ability to truthfully bill for helping about 80% of the “mental health” industries’ clients.

  5. My weight gain is disabling. It is putting extra pressure on my knees and muscular skeletal frame which in turn causes pain and inflammation which results in a vicious cycle of avoidance of physical activity which leads to more weight gain. I am obese by medical standards. As a result of my obesity I have developed sleep apnea, a swallowing disorder, a chronic cough related to acid reflex as well as a host of negative self perceptions fed by shame and guilt. I identify with proponents of social change who want to remove the shame I feel such fat phobia and fat-shaming in the media. I want full exclusion in society. But will the elimination of fat-shaming help me get up the stairs faster without losing my breath? Of course not. Every person at some time in their life will face severe physical limitations caused by aging–this is inevitable. Some people experience physical disabilities due to self harming activities like like over-eating or smoking. Some people experience physical disabilities due to a tragic accident or iatrogenic harm. People with physical disabilities are in one camp. People with Intellectual or developmental disabilities belong to a whole different camp. People disabled by self harming activity are in another camp. People who are perceived to have psychiatric disabilities are in yet another camp. These camps or tribes rarely dialogue, just like trumpers rarely communicate with neo-liberals. Thanks for being willing to start a difficult dialogue. Hooe you dont get shot down too much for your effort.

    • Wow. The woman I know is in almost the exact same physical condition.
      And her frustration with her situation is likewise upsetting to me.
      For me to know that this started with an emotional-spiritual cause that could have been addressed and handled but was not puts some sadness in my life that I could do without.
      Yet with me it is at least an informed sadness. My challenge now is not to discover what could have been done, but to discover ways to get others to realize that there is something they can do.

  6. Hi Chuck,
    well apparently I missed your original essay, but I’ll take a stab at this one.

    For the last 15 years my wife and I have been walking the healing journey together from her early childhood abuse and extreme dissociation. I do understand your concern. I NEVER treat my wife as if she is disabled or dysfunctional and yet, the simple fact is, right now, she is clearly disabled and dysfunctional, literally. There are MANY basic things she is unable to do right now. Dissociation slices and dices the brain’s ability to access many personality traits and mental functions until those dissociative walls are torn down and the pathways are re-established. It’s not a matter of she could if she just tried hard enough. It’s a matter of those neural pathways have atrophied after 4 decades of disuse and it has taken us 14 years of constant, daily work to begin to reinvigorate them. And though she has come a long way, it’s mind numbingly complex and exhaustively tiring and takes both of us to help her undo the problem.

    But that doesn’t mean i treat her as if she is PERMANENTLY disabled or dysfunctional. I look at the goal, her complete healing, as I walk with her and help her heal and re-establish the mental pathways to access the things she lost to the trauma and dissociation. I never belittle her, but I do accept her limitations for now and i help her heal and grow stronger toward our mutual goal.

    It’s a complex problem and one our culture and the mental health system gets terribly wrong. I sympathize with your desire NOT to label anyone as disabled or dysfunctional because I have NEVER treated my wife that way…and yet, right now, she would definitely struggle, to put it mildly, if she was on her own and had to hold down any kind of a job.
    Sincerely,
    Sam

  7. “The effects of psychiatric drugs, ECT, and psychosurgery can be disabling. But they do not cause mental disorder or mental disability.”

    I think at this point there needs to be a category for people who have been disabled by psychiatric “interventions”. Prior to ECT, even though I had already experienced a great deal of harm from psychiatry, I was still able to maintain a full-time job. After ECT, and several other treatment induced harms including forced antipsychotics, I was no longer able to work. I was actually told by my employer after a year of them threatening to fire me that I should apply for disability (after being called into yet another meeting with my supervisor and human resources, where my failings were listed, where I was humiliated.) I think they saw, as frustrated as they were with me, that there was something wrong with me that I couldn’t control. They were right. I had brain damage. But I couldn’t apply for disability based on that. If I could have, I would have, but no doctor would even certify that I did in fact have brain damage from ECT and psychiatric drugging. I needed to not have to go to work and to still be able to pay my bills and the only way to do this was to apply as someone who had severe mental illness, in my case the diagnoses were borderline personality and treatment resistant depression. As far as social security and all the forms were concerned, I was a person who had severe mental illness and who had not responded to multiple treatments for said illness and so had to finally go on disability. That was not the truth of the situation. The ECT, the forced drugging and the treatment induced trauma is what prevented me from being able to continue to work to support myself. But there was no category for that. There was no one who – even if I were so bold as to make that claim – would back it up.
    It has taken 15 years since that ECT, 15 years of trauma shame isolation fear remorse illness terror humiliation, for me to finally realize that not being able to perform at work anymore was not my fault. It was the fault of the treatment and the people who decided that that was what I needed. There needs to be a category for people in my situation. A quick glance through this website will show any doubters that there are many many people who fall into this category.

    • This is one of many examples of iatrogenic harm that the system then refuses to acknowledge.
      Part of the insult is the harm and the other part is the refusal to admit that harm was done.
      This is a very broken, very toxic system, and it is not limited to the field of mental health.

      • I don’t know that it is up to the ‘system’ to acknowledge anything really Larry.

        The ‘system’ is a means to an end, and your right about it being toxic. It is individuals within that system who are using the ‘loopholes’ to ensure that they never admit to their wrongdoing (both intended and unintended. Concealing motive being one of the very best ‘loopholes’ for doctors. Means and opportunity, but if they keep their mouths shut, you can’t prove the motive).

        True repentance?

        Imam ar-Redha (s) had said, ‘He, who asks for forgiveness with his tongue and does not repent with his heart, mocks himself.’
        “In fact, it is ridiculous or regrettable that man throws himself into disease hoping that he may find the medicine! How much man loses because of this false hope of repenting and how much he commits crimes and sins while he talks with himself that the door of repentance is always open and that he can commit sins now and then he repents!”

        I guess these people who gather together and conspire to ensure that they are never held to account within this flawed system are of the belief that there is safety in numbers. In fact, the fear of that ‘system’ turning against them is what keeps them in their place (as I have found out since my ‘experience’ in observing what happens to whistleblowing police officers who are directed for ‘treatment’. Here was me thinking they had it easy lol And more resources are needed because of the increasing suicide rate?).

        The breach of trust and ‘spying on the confessional’ to overcome ‘resistance’ by ‘mental health services’ and ‘legal representatives’ only works as long as the con is not known by the victims. Those people who were abused by the ‘Church’ only finding out how they had been deceived when it was all too late. The ‘seal of the confessional’ breached to provide warning to the perpetrators, and to ensure that the victims received the ‘treatment’ they required via electricity and forced drugging. This became apparent during the Royal Commission when it was shown that child rape was viewed by the Senior members of the clergy as being a “character flaw” and not a criminal offence. Not the case for those who confessed their sins who were not members of the ‘club’. Only finding out too late about the use of ‘eavesdroppers’.

        And without any proof? I could be called a paranoid as I was when the state “edited” my medical records, and removed the proof of me being ‘spiked’ with date rape drugs before being interrogated for 7 hours. See how that works? Speaking the truth becomes a mental illness requiring ‘treatment’ with just a little bit of fraud? Treatment with the very drug that caused the symptoms they called an illness to start the process? And they call me mad?

        I had “potential for violence, but no clear intent or history”. So people are being force drugged and ‘chemically restrained’ for doctors paranoid delusions? Because without any history what has he got? Only the fabricated evidence that was forged to justify my kidnapping and torture.

        The good news in all of this is that my State representatives have made it very clear what they will do to anyone who dares complain about such treatment. They will “edit” reality, and then “fucking destroy” you and your family should you try and access legal representation or the law (Police actually providing material support to ensure that their offending is not prosecuted. You scratch my back, we’ll scratch yours).

        I think the attempt to ‘unintentionally negatively outcome’ me was seen by some as going a little too far. Why do that when you can gaslight victims to suicide with the assistance of the people they put their trust in (family, lawyers, public sector authorities etc)? Flagged on the police system for ‘referral’ should you try and report their offending, it becomes a self fulfilling prophecy with all roads leading to Rome.

        I must say I do admire the way our Politicians have set the community up in this manner. Denying access to legal representation where matters of torture are concerned despite the articles of the Convention. (they didn’t really mean it when they signed those agreements did they? Of course not, the aim was to create an appearance, and then breach the trust as described in the quote above.) The ‘protections’ of the law (human rights) simply ignored by the authorities (Chief Psychiatrist) while they sort the matters out with “edited” documents and ‘negative outcomes’ (without being able to peer into the heart, one cannot confirm the unintended nature of the ‘accident’s which are occurring. “5 children and 114 adults’ killed by hospital mistakes” our newspapers tell us. That’s the ‘mistakes’ that can be identified mind you, the ones that were “edited” before anyone got to look [as is required by agreements such as the Convention against the use of Torture etc, though ignored when the law is rewritten by the Chief Psychiatrist to remove the legal protections afforded the community by Parliament*] are obviously not included in those numbers)

        * arbitrary detentions and forced drugging’s enabled by allowing mental health services to call police and request assistance with an “Outpatient” (a simple lie to tell). Subject beaten into confession via acute stress reaction, ‘verballed’ and “edited”, and then ‘treated’ for the illness they confessed to.

        https://www.youtube.com/watch?v=oZ9UQKBUrsg&t=4s

        ‘We’re here to help’

    • I also had to rely for many years on doctors, therapists, whatever professionals I was seeing at the time when I got the letter from social security saying that my disability claim was under review. There were all kinds of forms to fill out and signatures that they wanted from so-called experts who would vouch for the fact that I was still severely mentally ill and unable to work. Oh this did wonders for my recovery I’ll tell you that. I felt so good about this whole situation. I hated those people. I hated the forms. I hated the whole stupid game but for my measly social security check to keep coming I had to participate. I had tried to go back to work on multiple occasions and failed probably because of all the trauma I experienced at the job that I tried to keep after the ECT where I was routinely humiliated by supervisors and colleagues, told that I was crazy. When the last social security letter came in saying that they needed to review my disability claim I was completely bedridden. I was in withdrawal from cymbalta, had a fractured ankle that didn’t heal right, and was afraid to leave my house, afraid of my neighbors, certainly afraid of doctors, hospitals and police. I scribbled something on the forms about my current situation and the fact that I was terrified of all psychiatrists and did not at that point have any kind of treatment. I mailed it in a few months later I got a response from social security where they said they decided they don’t need to review my claim at this time. That was a few years ago. Haven’t heard anything since. Just a lovely system we’ve got going here.
      It is a little bit hurtful at this point for someone to say oh if you have mental illness there’s nothing really wrong with you, you’re not disabled. Well what am I then? I’ve been defined by experts my whole life.

    • Me too. I also have been told on multiple occasions that I’m “playing the victim” or “stuck in the past” when I try to recount to anyone my history…because I believe that if they heard it, really heard it and digested it, then they would understand my rage, fear and hopelessness. Instead they immediately try to deflect. I had an appointment with a new physician’s assistant, because I need someone to serve as a primary care provider in the event that I get an infection or something like that, and she started talking about trauma and ACE scores and all these other wonderful trauma-informed things. I told her I’m glad that things are changing and people are talking about trauma now, but that I was harmed many times in many ways for many years by the system when it didn’t acknowledge trauma at all and instead just drugged me and did ECT or whatever it did. She said “we’re not going to talk about that and do a coulda shoulda woulda about the past.”. Oh, very trauma informed. She also offered me Zoloft, which made me realize she hadn’t read my “new patient” forms or had read them but had forgotten what was on them.
      The sympathy that is offered feels like just another form of other-ing. Like saying, “I’m sorry that happened to you” while thinking, “that would never happen to me.”

      • KateL, I read some of your comment history. Feel free to read mine. Would you like to correspond? I could use a “pen pal”, so to speak. Our situations seem very similar. But I have found ways to be happy, in spite of my trauma. Feel free to reply here, and I can try to get my email posted here, if that’s ok.

  8. I agree with you to a point that mental disorder or mental illness are not disability but the way you are going about is a problem.

    Before we abandon professional vs patient paradigm, maybe we need to discuss more and find common ground. “I was one who naively reached out for help several years ago, but fortunately I rejected the “treatment” at the beginning of my exposure to the system. “This experience of yours is quite commendable and may shed some light on what others are trying to tell you. The most glaring question is what did you reject? Be generous we may learn something from you that is quite useful.

    Before we talk about mental disorder and mental illness, perhaps, it would serve the public better or more beneficial, if we agree what is normal? What is health? What are the difference between behaviour arising from normal versus one arising from mental illness and/or mental disorder? What is the difference of completely unable to function versus function at low capacity versus high capacity? Function in this context means: having a job, family, friends, and means to pay for services versus missing one or all of those factors? Why behaviour is not considered? If you are a doctor suffering depression (taking meds/therapy), you are not the same as a person unable to work due to depression – your behaviours of supposedly same condition is extremely different. So, the question is do you really both have depression? What is depression?

    Iatrogenesis means from my experience – if you can heal with words, you can harm with words. If you are arguing against that , please state your position. I think and I could be wrong but your rejection of treatment was probably your own subconscious of realizing the process is biased toward healing and is unconscious of its harm.

    About the pain, suffering etc, rather than putting everything under “mental”, perhaps secondary issues arising from mental disorder versus mental illness may alleviate the confusion. I know reduction is frown upon but there are layers to humanity so which one came first the chicken (depression) or the egg (unable to join the society in any meaningful way).

    Beliefs/perspectives, your example of atheist is straw man’s argument. I will put it this way. As I mentioned above, every single mental condition has extremes: you can have diagnoses for bipolar and be highly functioning person versus bipolar and unable to hold anything. What is the difference between these two situations? If you cannot answer this then the problem is beliefs, culture, subjectivity, objectivity, level of consciousness, experience, maturity, upbringing, and genetics plus infinite factors.

    What is causing the problem is the definition of conditions. Depression makes no sense if one person can work successfully and even in all appearance of purpose has everything while another one is falling through cracks and is struggling with basics of life – getting up in the morning.

  9. Thoughts after second article:

    1. People have been trained by “mental health professionals”, aka – humans – to confuse mentality as being something which can literally become and stay ill, dysfunctional, defective, or diseased. Mentality is not similar to a muscle, a bone, or a brain, in that it is not something physical that can be damaged. Mentality or consciousness seems more akin to a song— it is real, we experience it, it can be moving in a variety of ways— but imagine saying a song is ill, dysfunctional, defective, or diseased. That wouldn’t make any sense to me. It makes as little sense to say these things about mentality in my opinion.

    2. Suggesting to someone that they are not mentally or emotionally disabled, dysfunctional, diseased, or defective can sometimes inspire feelings of offense, contempt, and hostility. Due to the training mentioned in (1.), when someone suggests our mentality is not something that can be defective, what we can actually hear them saying is that our experiences: A. Aren’t serious or difficult enough to warrant our behaviors B. Don’t necessitate the need for help or assistance C. Are born out of our own faults, failures, and weaknesses. Our understandably defensive perception hears, “just get over it”, “just try harder”, “just grin and bear it”, “just man/woman up”, “just be better than you are”. But— what I think is actually being expressed in these articles
    is the exact opposite which brings me to #3.

    3. When we as human beings experience the most profound, difficult, complicated, meaningful, troubling, saddening, devastating times of our lives, our responses to them are natural in all cases. For any other human being to call, define, or label any of our natural human emotional responses to life ill, dysfunctional, defective, diseased, or disabled, is unacceptable. Doing so cheapens and disrespects our natural human experience. I think this is to what the author is speaking.

    When we are deeply struggling to accept and deal with the most difficult experiences of our lives— should we be forced to accept an unscientific diagnosis for our natural feelings and mentality before being able to receive assistance and help? Who really benefits by playing along with the “professionals/industry” who would force us to admit to “having” prolonged grief disorder or “being” bi-polar? While formulating the answer to that question, remember, the DSM is becoming thicker.

    I write, very respectfully, and in full honor of the profoundly difficult experiences people actually have— we are not dysfunctional. We are not mentally or emotionally disabled. We are humans who find ourselves surrounded by a system that trains and compels us to think otherwise.

    We need a new system that isn’t focused on medicalizing and capitalizing on human struggle and suffering— but instead one which focuses on actually helping people navigate and cope with their most meaningful experiences and emotions.

  10. The first essay built a straw man and then castigated it. This essay adds a few additional startlingly crass phrases, kinda sprays some punk graffiti on the straw man…

    My favourite (not the appropriate word) is:

    “If I don’t know how to dance the Tango, is it reasonable to say that I am disabled?”

    I suggest the author spends a little time coming to terms with what a psychosocial disability is, how the psychosocial model of disability differs from the medical model, what it aims to achieve (and what is has already achieved), why the impetus must continue in the direction of increased acknowledgement of psychosocial disability, and finally why psychosocial disability must ultimately attain full equivalence with disability, and not remain as a sub-category.

    In all the countries where psychosocial disability is not afforded full human rights, people suffer unspeakable abuses and agonies. In the countries where people with psychosocial disability are afforded partial or conditional human rights, their suffering and their agonies are still apparent, but overall lessened. Thus the push for unity and the solidarity with disability human rights activists is essential and must not be undermined.

    In the countries where no disability is recognised at all, and people are treated as having no psychosocial disadvantages or impairments, people are treated very badly, very harshly, very inhumanely.

    I do not understand the resistance to humanely acknowledging psychosocial disability, and modeling/remodeling the world in a way that embraces disability and makes accommodations and adjustment and fundamental design choices, in order that a substantial minority are not marginalised, tormented, dehumanised, and compelled to suffer way more than they otherwise would.

    I get no feeling from Mr Ruby that he understands psychosocial disability, has much knowledge of disability history and the human rights struggle, or much awareness of what struggles stigma and discrimination bring about in a person’s life.

    Getting rid of the medical model and labels will not rid the world of the othering of mad people. You can keep the medical model, be done with it, or keep it or be done with it and bring in a therapy model… no matter, because whatever approach, people with certain psychosocial disabilities will be persecuted, discriminated against, aggressed against, maligned, ghettoised, and so on… such that the struggle for human rights will go on, despite attacks and distractions and attempts at belittling and undermining, the struggle for full human rights for people with psychosocial disabilities will endure.

    • This is a good example of how disabling these sorts of experiences can be, and of a problem we should have solved by now, but failed to. Not only does the average practitioner know nothing about the mechanism we call “triggering” but they have no real idea what underlies such experiences or how to remove that problem from the mind. If “mental health” professionals had bothered to figure this stuff out (others already have) they might still lose some people to disability, but they would also have some people who fully recover. The average person in the system today does not have the slightest hope of recovering and faces a lifetime of coping with the damage caused by these experiences. This is the great tragedy created by the greed and ignorance (and apathy?) of practitioners. It need not have turned out this way.

  11. A few thoughts: I am skeptical that we will ever arrive at a satisfactory labeling system.

    I became disabled precisely because no two mental health professionals could agree on what was “wrong” with me. I was given many therapies and prescribed dozens of dangerous medications before I finally put a stop to the insanity, albeit too late. It took me many years to figure out that the damage that was done to me was because I am in many ways an extreme outlier that defies description, particularly by those who have no frame of reference.

    An inventor told me that someone who has a new idea instantly becomes a minority of one.

    I once angrily demanded that a doctor explain why he continued to insist that I was “better”, when everyone else could plainly see how much worse the medications were making me. He gave me a wounded look as if he was expecting a punch to the face and said “I just don’t understand you. You are a free spirit with a healthy ego but poor self esteem.”

    Clearly he doesn’t know any artists. 😉

    How can anyone understand – let alone competently treat – a free spirit when they are not one themselves?

    We put animals in cages and accept that causes Zoochosis in some of them, and yet we deny that this might also be the case with some humans. How do we know that the emotional crises in some of us is not a built-in feature of our species that is a warning system that ensures our survival? Instead we continue hoping that if we persevere along the same path that we will eventually discover the faults within the individual, leaving society to go on as ever, alarm bells be damned.

  12. I really appreciated both your articles. I have experienced my fair share of mental health treatment (see https://www.madinamerica.com/inside-forensic-psychiatry-unit/). I can say that one perspective that I strongly identify with, and that is outside the mainstream disability framework is that of using altered states of consciousness as tools for growth. In my nearly 2 decades confined in a psychiatric detention center, I came to a deep appreciation of the powerful potential for altered states of consciousness, which is what long-term detention is. An altered state of consciousness is neither inherently positive nor negative. However, the interpretation of the individual experiencing them determines how they are ultimately understood. Quite obviously, if we exist in a society that pushes upon us a narrative that automatically interprets altered states of consciousness like “psychosis” “depression” “mania” etc. as pathological, then what chance do most people have to see them as anything else? Furthermore, once one understands the power of altered states, especially “pervasive” altered states like “depression” or long-term detention, then it is apparent how challenging it is to change one’s interpretation in the midst of the altered state. Indeed, training for altered states should occur prior to entry into the altered state. Thus, our problem reveals an added dimension: not only are we conditioned to use the readily available narrative of pathology to interpret the altered states (which in some cases can stay with individuals for life, no matter how unsupported by research it is), but also we believe that addressing them occurs after the fact, not before entering into them. Considering that we will all experience some sort of altered state of consciousness at some point in our lives (which include but are not limited to: grief, drugs, psychosis, depression, sex, joy and love), isn’t it wiser to begin preparing people from an early age to navigate them? Ideally, but that would mean that adults would have to understand how to teach this to youth, and in general that is not realistic with our current cultural attitudes toward altered states.

    If altered states are re-conceptualized as potentially powerful transformational growth tools, then we may very well see a world where “the disability framework” is not overthrown, but falls to the wayside out of a consensus that it is just no longer useful. Indeed, in my experience it is absolutely useless for helping one to successfully navigate an altered state as a transformational growth tool. Thank you for sharing your thoughts on this issue.

  13. I think to some extent I agree but it is nuanced. For me, a person who is on SSDI for the past 25 years and who is chronically depressed, anxious, awkward, nervous, has low self-esteem & confidence, intrusive thoughts and social phobia, and volatile emotions, I do feel disabled because I really can’t function, at the same time I don’t care for the stigma, nor do I subscribe to the notion that I have a disease. I actually have to go see the Psychiatrist tomorrow part of my regular I absolutely dread it because 1. I fear being forced medicated 2. I also know that I need my benefits and I can’t lose them and 3. Everything about going to the mental health care place is very depressing and discouraging to me. I haven’t taken psyche drugs for about 14 years now because of the side effects, I consider my body and mind a temple and they never helped me. I did take them for about 10 years before that. So, my solution to the dilemma would be 1. Unconditional Basic Income 2. Guaranteed Housing 3. Universal Health Care 4. Universal Services including access to a broad range of mental health care services (including exploring new ideas such as one described in “Mad in America” online magazine), but never imposed. In a system like this anyone who struggled with mental health and needed time off from work or less work would still have a basic income, health care and could access mental health services without having to accept a diagnosis if they don’t want one or having to adopt the identity of being disabled. Further no one would need to be means tested to see if they are eligible. Though I really struggle I could do more in my life if I wasn’t frustratingly stilted by eligibility issues. Also, people who need these services and support would be less likely to be judged and stigmatized as lazy or as malingerers since it would all be universal and no reason to complain by outside observers that receivers were unfairly receiving benefits. These eligibility issues would be irrelevant if income & housing was guaranteed and health care universal and there’d be no need to prescribe the label of “disabled” for mental health struggle, a person could simply say they struggle with mental/emotional health issues and leave it at that and function at their own pace.

LEAVE A REPLY