Editor’s Note: In a recent MIA Report, psychiatrist Jim Phelps and Robert Whitaker each offered their opinions on this question raised by Phelps: Does MIA do more harm than good? Now, in this “dialogue,” each offers their perspective on a recent paper published by Nassir Ghaemi in Acta Psychiatrica Scandinavica. Ghaemi, a professor of psychiatry at Tufts Medical School, concluded that psychiatric drugs, except for lithium, do not provide a long-term benefit and thus should mostly be prescribed for short-term relief of symptoms.

Ghaemi’s Analysis Tells of a Failed Paradigm of Care
By Robert Whitaker

The understanding that has animated Mad in America since its inception has been this: Our society has organized its psychiatric care and use of psychiatric drugs around a false narrative, one out of sync with the scientific literature. In this paper, Nassir Ghaemi—even while viewing psychiatric disorders through a disease lens—has for the most part validated that understanding.

Robert Whitaker

What gives his paper particular importance is that Ghaemi is a prominent academic psychiatrist, with notable standing within the profession. If his peers were to take his analysis to heart, American psychiatry would need to radically change its prescribing practices.

The conventional narrative tells of how the introduction of chlorpromazine into asylum medicine in 1955 launched a psychopharmacological revolution. Psychiatry now had disease-specific drugs to prescribe: antipsychotics, antidepressants, and anti-anxiety agents. After the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual in 1980, the public was informed that psychiatric disorders—schizophrenia, depression, bipolar, ADHD and so forth—were discrete illnesses of the brain, caused by chemical imbalances, with psychiatric drugs fixing those imbalances, like insulin for diabetes. A second generation of psychiatric drugs were touted as safer and more effective than the first generation.

When I first waded into reporting on psychiatry, nearly 25 years ago, I believed that narrative of progress. But when I dove into the scientific literature while writing Mad in America and Anatomy of an Epidemic, I came to see it as a historical delusion, one that had brought prestige to psychiatry as a guild and profits to pharmaceutical companies, but, ultimately, harm to our society and our public health.

For the past 10 years and counting, this website—with its reports on scientific findings, publication of blogs and personal stories, drug resource pages, podcasts and so forth—has sought to flesh-out that “counter-narrative.” Ghaemi’s paper tells of “truths” found in the scientific literature that are central to that counter-narrative.

To wit:

  1. Psychiatric drugs are not antidotes to any known pathology; they do not fix chemical imbalances in the brain.

Ghaemi writes:Biologically, antipsychotics are mainly dopamine blockers and standard antidepressants are mainly monoamine agonists. After their introduction in the 1960s, corresponding theories arose regarding the dopamine hypothesis of schizophrenia and the monoamine hypothesis for depression. Half a century of research has disproven these hypotheses: dopamine overactivity and monoamine depletion are not parts of the pathogenesis of schizophrenia and depression, respectively.”

2. The DSM does not tell of “validated” illnesses.

Ghaemi writes: “Another feature of the inability to develop drugs for psychiatric diseases, as opposed for purely symptomatic benefit, has to do with the poor validity of psychiatric diagnosis using the official nomenclature of the American Psychiatry Association (APA), the Diagnostic and Statistical Manual 5th edition (DSM-5). As discussed in more detail elsewhere, the process of defining DSM-5 definitions has been influenced heavily by non-scientific factors, and has not proven successful in biological and pharmacological research. However, the APA is fully committed to the DSM-5 ideology, and unwilling to allow more scientific approaches to diagnosis.”

3. Psychiatric drugs (other than lithium) do not provide a long-term benefit.

Ghaemi writes: “Most psychiatric drugs have not been proven, in properly designed randomized trials, to improve the course of any illnesses they are purported to treat; specifically they have not been shown to prevent hospitalization or extend life, as many clinicians believe.”

4. Drug-discontinuation trials, which are said to provide evidence for maintenance use of psychiatric drugs, are invalid and biased by design.

The evidence for long-term maintenance use of psychiatric drugs comes from randomized “discontinuation” trials. Patients who are good responders to the drug are randomized to either continued use of the drug or are withdrawn from the drug, with the latter group said to be a placebo group.

Ghaemi writes: “Non-responders to the acute treatment are not included in the maintenance phase. Hence this design is biased from the start by excluding acute symptomatic non-responders . . . A final feature of relevance is that the randomized discontinuation design almost never has failed to show benefit for any drug in which it is used. A design which provides efficacy for any drug under any condition is not a scientifically valid design, since it cannot falsify its hypothesis.”

  1. Psychiatry needs to rethink its use of psychiatric drugs.

Ghaemi writes: “Short-term symptomatic benefit should not be presumed to provide long-term disease-modifying benefits in psychiatry. Since most psychiatric drugs are symptomatic, they should be used mostly short-term rather than long-term, and at lower doses.”

As can be seen, his paper tells of pathologies that remain unknown; of a diagnostic manual that is invalid; and of drugs that do not provide a long-term benefit. In short, his paper tells of how our society, for the past 65 years, has organized its care around a false narrative, which told of drugs that were antidotes to discrete illnesses and provided a long-term benefit, as they reduced the risk of relapse.

I am sure that many MIA readers and critics of psychiatry will disagree with some elements of Ghaemi’s paper. For instance, Ghaemi doubles down on the belief that there are discrete underlying pathologies to major psychiatric disorders that remain to be discovered and thus could be targeted by new drugs. I also think that his assertion that lithium provides disease-modifying benefits over the long term can be questioned, given that bipolar illness today runs a much more chronic course than manic-depressive illness did in the pre-lithium years. But those disagreements are not the point here. Ghaemi’s paper tells of a failed paradigm of care, and in so doing, it echoes MIA’s mission statement:

“We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.”

One final note. This is part of a “dialogue” about responding to published articles in the scientific literature, and given that Ghaemi has asserted findings that I believe to be true, I could be said to be suffering from “confirmatory bias” in my response. That is indeed an element that is going to be present in any dialogue about differing responses to findings published in scientific journals.

Agreeing on 90% Yet Portrayed So Negatively: Time for a Shift in Emphasis
By Jim Phelps

Astounding, breaking news: two psychiatrists in 90% agreement with Robert Whitaker. No wait, lots of psychiatrists. Wait, wait: the majority of psychiatrists?

Jim Phelps

Right. Most of us agree that the DSM definitions of depression are not based on biology. We recognize that DSM diagnoses sound like diseases but they’re not the same as diagnoses like appendicitis or pneumonia.

Most psychiatrists would agree that we don’t fully understand what’s different in the brain of someone who is severely depressed; or someone who is having extremely disturbing thoughts, out of their control; or someone who is so anxious that they cannot leave their home.

Likewise, we would agree that because we don’t fully understand what’s different in the brains of people with a mental illness, we don’t fully understand how our treatments work either. We know that neurotransmitters are affected, but then what happens? The downstream effects quickly disappear into the unknown.

Many actually agree with Dr. Ghaemi and Mr. Whitaker that it’s not clear whether long-term use psychiatric medications is clearly better than not using those medications beyond a short-term intervention. (The story for lithium is different, for people who can take it without daily or dangerous side effects, and there are many such people).

Some of us are even thankful for Robert Whitaker’s sustained efforts to increase awareness of the risks of some psychiatric medications—e.g., that severe antidepressant withdrawal is common and often more extreme than recognized 10 years ago.

At the same time: I began this exchange with Mr. Whitaker because I fear he overstates psychiatry’s problems. Terms like “historical delusions”, “false narratives”, and a “failed paradigm of care” reflect passionate concerns—understood. And… this inflammatory language stirs others’ passions, potentially interfering with decisions readers and their loved ones may face, now or soon: what are they to do when they are experiencing severe mental distress?

They could:

A. Do nothing and hope it resolves. It might. Physical illnesses, even broken bones, occasionally heal on their own. With 86 billion neurons, something will “break” from time to time. It might get better on its own. But just as for some bone fractures, medical help may be needed.

B. Rely on social support: love from understanding family and close friends; strong personal connections, like church, colleagues at work, or friends at school; online groups; and community resources (e.g., mental health centers with peer counseling, social workers, supported housing and work opportunities).

C. Begin psychotherapy. Choosing the right kind, and finding a good therapist, can be challenging, but done well, therapy is better than pills for some forms of mental distress and equally good—with fewer risks—for many other forms. And… there are some forms of mental distress that very few professional therapists would take on by themselves: delusions that are potentially dangerous or significantly interfering with a person’s ability to function; the fully manic phase of bipolar illness; depressions with such low energy that participation in therapy is not possible; or suicidal thinking with a plan and means at hand.

D. Find a psychiatrist. Good luck with that, unless you’re in a large eastern U.S. city, or abroad in a country with an excellent health care system. Even if you can find one, without being hospitalized, there are still many choices to be made: which medications should be considered? How long to take them?

Evaluating these options requires learning more about them, and careful comparisons of potential outcomes—not emotionally driven decision-making. To be truly helpful, Mad in America should help readers with these kinds of decisions, not fan flames. Consider two common examples.

First, depression. There are many kinds. The DSM is supposed to help sort them, but can confuse rather than clarify the picture. What is a “Mixed State,” for example? The simple answer: it’s depression, with some over-energized symptoms at the same time (agitation, irritability, anxiety, weird insomnia, can’t concentrate because thoughts are all over the place). Doing nothing, or relying on good social support, might be enough for a mixed depression—sometimes. Some forms of psychotherapy, like “Social Rhythm Therapy” would help, if you can find a therapist who knows this technique. (That is so rare, I made a video to help people with the core ingredient, Sleep Control for Mood Stability). If one must add a medication, should it be an antidepressant or a mood stabilizer?

For mild to moderate depressions, forget the medications, amen. (Together we could work on convincing primary care providers about this). Even for severe depression, if safety is not an issue and therapy can be fully utilized, Options B and C may be sufficient. When to use an antidepressant, and for how long, requires careful, personalized decision-making—which many psychiatrists do (granted, not enough. Find a young one if you can).

Second, delusions. First: is this a delusion or could it actually be true? Next: a belief in something like mental quantum tele-transport does not necessarily require treatment. Thoughts like  “oh, don’t worry, I can give away all my savings because I can make it all back anytime I want in just a few days” might be managed with aggressive social interventions. But delusions that significantly affect a loved one’s function or safety, right now: what is a family supposed to do? If they have been reading Mad in America, they might be very hesitant to take steps that could protect lives. Starting a dopamine-blocking medication doesn’t mean committing to use it for years.

Mad in America’s blogpost regarding Dr. Ghaemi’s article declares “Psychiatric Drugs Do Not Improve Disease or Reduce Mortality.” It reached my national newsfeed, so presumably reached thousands of eyeballs. For people who face difficult decisions about a loved one with severe depression or dangerous delusional thoughts, this may have been confusing and frightening.

Many psychiatrists—I hope it could be most of us—are not like the psychiatrists described in many MIA posts. We understand that there are huge gaps in our knowledge. We’re listening, looking at outcomes short and long, and actively re-thinking our approaches as we go.

We and MIA could chorus together: psychiatry is not needed for the majority of mental problems, amen. But we are needed, sometimes. Don’t increase stigma toward all of us. Shift the emphasis from what we don’t know and have gotten wrong to what needs to be gotten right: helping people for whom waiting it out, or good social support, perhaps with the right psychotherapy as well, is not enough. What are they supposed to do? Let’s talk about that.


  1. R.e. “psychiatric alternatives”. There’s also nutrient therapy. Although it drives main line psychiatrists into a frenzy (no pharma company bennies, no freebie trips to conferences in warm places during winter), it frequently works where “standard treatments” don’t.

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    • As a nurse practitioner actively practicing in the trenches w people who suffer from addictions and as a former mentee of Nassir Ghaemi I have been able to use what I have learned in the real world. I am extremely conservative in my prescribing practices and thanks to his tutelage I and many of my patients are grateful for being exposed to his philosophy.

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    • Dear Bcarris,

      I like your notion of healing. There needs to be many different kinds available.

      You may read from my comments, which have probably slid now way at the foot of every other comment, that I have been in desperate schizophrenic psychosis. I have been barely clinging on. But after a few years off medication I have sadly chosen to go back on antipsychotics. Since making this decision, all by myself, I have felt huge relief.

      No doctor or psychiatrist knew I was dying let alone told me to go on pills. My decision came to me alone in the half hour I had left before taking a lethal overdose. I am sorry I did not arrive at this choice to go back on antipsychotics sooner as I really do need more than cheap affirmations to get me steady.
      I am glad some brave souls piped up from time to time in the comments sections with their balanced views that told of some people with severe mental illness needing medication to exist at all. Cancer chemotherapy and alcoholism are not without risk either but no one is telling those people not to choose what may get them through a hurdle. The adverse effects of some potions can be sorted out later. I only had less than an hour to live.

      When the Hoover Dam explodes maybe you will remember some of the advice I gave.

      Please say no more to me. I am listening only to my own intuition from now on. My comment wants no reply from anyone. Not one.

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  2. Good stuff, thanks to both of the authors.

    I appreciate Jim’s perspective insofar as it’s always good to hear what ‘the other side’ has to say. Two comments for his piece:

    1) While it could possibly be the case that “most psychiatrists” understand the points that Jim makes in his first few paragraphs, I’d submit that there’s no evidence of this based on how the overall field of psychiatry operates. One need look no further than the widespread use of psychotropic medications in this country, all of which invariably treat symptoms rather than root causes. Simply understanding something isn’t sufficient unless it results in a change in treatment approach.

    2) In this vain, the rest of the article implicitly focuses on treating symptoms rather than identifying (and rectifying) root causes. (This is an issue with western medicine in general – psychiatry is simply the mental health version of what we were already doing for chronic physical ailments.) Let’s look at trauma – how it causes these dis-eases, and how its treatment can resolve them. This stuff has been researched to death, and has been written about for decades by the likes of Gabor Maté. The science isn’t even controversial in a lot of cases – it’s just not taught in medical school.

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      • What I mean is that I do have a chemical imbalance and I do have schizophrenia and I appreciate what Jim Phelps is saying. I feel that no one who does not have this illness should tell people who have it what it is.

        No one is asking people who feel they do have schizophrenia for their opinions on it.

        Is that because we are now deemed too mentally ill to speak to since we believe we have the illness we know we have?

        Are we deemed a disappointment to society all over again? Our actual own voices are being hushed and patronized as if we are pre-schoolers, losers, vagrants, imbeciles.

        Many people with schizophrenia are academics, lawyers, psychologists, literary giants, priests, scientists, expert artists, musicians, homeopaths, herbal medicine specialists, poets..

        ……but we are not regarded by the planners of the brave new world. Those puppets on strings!

        Is NO ONE on our “side”?

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  3. Jim Phelps says: “To be truly helpful, Mad in America should help readers with these kinds of decisions, not fan flames.”

    This statement is not only UNTRUE, but also defamatory towards any FAIR evaluation of the content of Mad in America (MIA) over the past decade.

    MIA has published an enormous amount of content that provides real world examples (both theoretical and practical) about how to survive and overcome mental states of severe psychological distress. This includes a plethora of alternative types of NON-psychiatric drug related therapies, AND personal stories of recovery (that includes stories of those who were harmed by the medical model approaches).

    At times, MIA published numerous stories of those people who found the short term and very cautious use of psychiatric drugs helpful in their journey to “recovery.”

    An absolute necessary part of that information MIA published over the past decade has been the dangers associated with the use of ALL psychiatric drugs. This is because NO ONE ELSE on the planet (except for a tiny group of authors of books and activists) was alerting people to these dangers.

    We cannot discuss this entire topic without addressing just how pervasive and prolific the entire medical model has become in the world, AND how this creates a gigantic “path of least resistance” even for more well informed clinicians.

    I worked for 22 years in a community health clinic in New Bedford MA., and watched the takeover of the medical model and the rampant uncontrolled growth of psychiatric drug prescriptions I worked with more than two dozen psychiatrists and nurse practitioners in that period of time.

    The few drug prescribers that I respected (including several who read Robert Whitaker’s books etc.) STILL, despite all their attempts at being a careful prescriber of these drugs, would get caught on a dangerous “path of least resistance.”

    There were so many people coming into the clinic in distress (many already on these drugs) and already deeply indoctrinated by psychiatry’s and Big Pharma’s “chemical imbalance” theory.

    This is a PR campaign never seen in human history before, to the tune of several hundred billion dollars, that has come to totally dominate the public narrative around anything related to “mental health.”

    Even the so-called informed drug prescribers could not avoid getting caught up in the “RABBIT HOLE” of psychiatric drug prescribing. This is where one drug is not “working” and causes all kinds of uncomfortable (and sometimes intolerable side effects like ‘akathisia”), and one NEW drug, or COCKTAIL of drugs is prescribed to deal with the so-called “symptoms” caused by the initial drug.

    Neither Robert Whitaker OR Jim Phelps discussed (above) how so-called more benign and “careful” prescribing of psychiatric drugs on the “path of least resistance” often leads to the extremely harmful and dangerous “RABBIT HOLE” of drug prescribing.

    There have hundreds of stories and comments by MIA writers and readers detailing stories of the harmful and dangerous “rabbit hole” of psychiatric drug prescribing that has led to sometimes decades of personal suffering and anguish.

    When Dr. Phelps says: “When to use an antidepressant, and for how long, requires careful, personalized decision-making—which MANY [my emphasis] psychiatrists do (granted, not enough. Find a young one if you can).”

    This is simply wishful thinking on his part, and a fundamental untruth about the state of his profession. Anyone who has worked around psychiatrists in hospitals and clinics knows that they are clearly on the “path of least resistance ” of drug prescribing and more often than not, start people down the dangerous “rabbit hole” from which many victims never return. This fact includes even a few “well meaning” and partially informed (about psych drug dangers) doctors.


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    • Richard,

      You make a great point about even the short-term use of psychiatric drugs. As many authors of personal stories on MIA have written, it was an initial prescription, often for a minor problem, that led them down the rabbit hole–to a more severe diagnosis (hello bipolar), and years on multiple psychiatric drugs. That is part of the “risk” in the risk-benefit equation that comes with initial prescribing of a psychiatric drug, which certainly isn’t incorporated into prescribing practices.

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      • As one of the millions of people who had the common adverse and withdrawal symptoms of an antidepressant (in my case, disingenuously given under the lie that it was a “safe smoking cessation med”) misdiagnosed as “bipolar.”

        I will say the reason so many on MiA are justifiably angry with the psychologists and psychiatrists is because their nosing themselves into our private business can and does destroy our lives. My misdiagnosis destroyed my marriage, not to mention I was made ungodly sick, via anticholinergic toxidrome poisoning – the typical result of today’s “gold standard bipolar treatments.”

        And to this day, I cannot do a show of my work – some of which visually documents my journey and escape from psychiatry’s iatrogenic bipolar epidemic – without being attacked by a “we want to maintain the status quo” psychologist, wielding a classic thievery/conservatorship contract, all dressed up disingenuously as an “art manager” contract. Since when is functioning as an attempted thief considered “professional”?

        And even being able to medically explain the malpractice, does not get one an apology, nor justice. Both the psychological and psychiatric industries should apologize – to all their clients and former clients for your bad protocols and outright scientific fraud and lies. And, since you’re all raping our economy for your malpractice insurance, your malpractice insurance should be used for what it was intended.

        The psychological and psychiatric professions have yet to apologize, make proper amends for the harm they’ve done to innocent others, or change from their evil ways. That’s why there is still justified anger.

        And the DSM “bible” thumpers do need to de-“partner” themselves from the mainstream religions, since too many psychologists and psychiatrists do function as systemic child abuse and rape cover uppers, for the mainstream paternalistic religions – a “dirty little secret of the two original educated professions,” which has totally corrupted my childhood religion.


        And given the reality of the iatrogenic etiologies of the two “most serious mental illnesses.” (The antipsychotics can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.) I’m not certain there actually are “people for whom waiting it out, or good social support, perhaps with the right psychotherapy as well, is not enough.”

        And, honestly, the unrepentant psychological and psychiatric industries don’t know either. Be honest, and end the “big lies.” And until the psy – “professions” repent and change from their evil ways, there will be people who are justifiably angry with them.

        Although, I guess it’s good that some – or maybe even “the majority of psychiatrists” are starting to wake up, Jim. But we do need all the non-medically trained, DSM deluded, “mental health professionals” to wake up to the systemic scientific fraud and lies of the psychiatric DSM, too. Which will require confession and repentance by the psychiatrists. And likely, the flushing of psychiatry’s DSM, billing code “bible.”

        Thank you, again, for all you are doing, Mr. Whitaker. Thank you for letting me share my disgust, get my anger out in writing as opposed to some non-productive manner, and letting me share my medical research findings … in as much as you’ve done.

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      • Almost every drug used to treat bipolar disorder was involved in some form of criminal settlement and lithium is the only drug that I don’t feel defrauded me. It was easy to understand why it would work. Learning how all those elements around it helped my mental health benefited my health more than any other treatment. Unlike prescription drugs they can be altered on a seasonal basis more in line with our seasonal changes. Lithium seems like a great candidate for microdosing studies.

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  4. MIA’s blogpost states, “Psychiatric Drugs Do Not Improve Disease or Reduce Mortality”.

    To which J. Phelps responds, “It reached my national newsfeed, so presumably reached thousands of eyeballs.”

    “Thousands of eyeballs”??? Heavens to Betsy!

    But THAT’S the point of MIA, to “reach thousands of eyeballs” –

    J.P. continues with, “For people who face difficult decisions about a loved one with severe depression or dangerous delusional thoughts, this may have been confusing and frightening.”


    Again – THAT’S the point of MIA, to “reach thousands of eyeballs.”

    NEWSFLASH – People in distress are ALREADY confused and frightened, which is EXACTLY why they NEED to know ANY AND ALL viewpoints and approaches. And mainstream psychiatry’s not doing that. But MIA sure is, which (is it possible???) might giving more than few mainstream psychiatrists a bad case of GAD –

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  5. J. Phelps says, “We and MIA could chorus together: psychiatry is not needed for the majority of mental problems…” –

    “…chorus together…” Really. And for WHOSE benefit? I don’t think MIA needs mainstream psychiatry’s help in informing people of this –

    Phelps continues with, “But we are needed sometimes.”
    “Sometimes”? I consider “rarely” to be a far more realistic statement.

    J.P. then pleads, “Don’t increase the stigma towards all of us.”
    “…increase the stigma”? It’s about time most psychiatrists got to know what THAT feels like.

    J.P. finally instructs MIA to, “Shift the emphasis from what we don’t know and have gotten wrong to what needs to be gotten right:” –
    THAT’S mainstream psychiatry’s job. NOT MIA’s –

    And as for “….helping people for whom waiting it out, or good social support, or perhaps with the right psychotherapy as well, is not enough. What are they supposed to do?”
    They already know what to do, which is consult a mainstream psychiatrist, which is WHY people need MIA –

    And finally, I hope MIA never makes it it’s job to advertise ANY of mainstream psychiatry’s irrefutably dubious services.

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    • “J.P. then pleads, “Don’t increase the stigma towards all of us.”
      “…increase the stigma”? It’s about time most psychiatrists got to know what THAT feels like.”

      LOL ! That did sound pretty rich didn’t it !

      “J.P. finally instructs MIA to, “Shift the emphasis from what we don’t know and have gotten wrong to what needs to be gotten right:” –
      THAT’S mainstream psychiatry’s job. NOT MIA’s –”

      ‘Mainstream’ psychiatry has historically and internationally not been the one’s to change anything for the better. The Italian psychiatrists Franco Basaglia was the exception to the rule. A true liberator who fought in the resistance against Fascism in Italy in WW2, and he carried right on with that. There are some other humane psychiatrists out there but mostly, as in Italy, it’s needed citizens to demand and peacefully force human approaches into the country. Think of slavery that went on for 500 years. Blacks were told “you can’t change anything” then MLK and a whole lot of others turned up. Same with bigotry against the mentally ill. The bigots, or those who work for bigots, won’t change it just like they were not the one’s to change anything in deep south 1950’s America. It took civil rights workers and a whole lot of sacrifices. Blood, sweat and tears to change that.

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      • “‘Mainstream’ psychiatry has historically and internationally not been the ones to change things for the better.”

        This is true. But I don’t look for psychiatry to change, because they’re way too indoctrinated themselves, and trying to have a rationale conversation with most of them is one of the quickest ways to lose your mind.

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    • Joshua asks three long overdue questions:

      1. Why do we tolerate any psychiatric drugging?
      Because people believe the lies they’re told: “These correct a chemical imbalance”, and “You’ll need them the rest of your life” –

      2. What would have to be proven to put a stop to it?
      The fact that psych drugs often do little more than placebos and carry significant risks has already been proven, but getting the word out can take a while, and don’t expect psychiatrists to do it –

      3. And what does this indicate are still the unstated assumptions about it?
      That mainstream psychiatry’s a field to be trusted –

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      • Yes, Birdsong, it is because people believe it. And so the appeal of the drugs seems to be very much the same as the appeal of street drugs and alcohol.

        So we need to attack this at the level of the government and its licensees, while we also need to reach out to those who believe in it.

        I think what this problem indicates is that yes we don’t want to trust Psychiatrists, but I would also say that we should not trust or license Psychotherapists. And I would also say that this is closely related to Munchausen’s Syndrome By Proxy. This is usually being perpetrated by a parent. But in a similar sort of way our whole society has turned against the homeless and made their status into a mental health issue. And really with anyone, if they are not a happy camper that is made into mental illness and into cause to talk to a psychotherapist.


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        • Joshua says, “…we should not trust or license Psychotherapists” –
          Absolutely, because psychotherapists are drinking the DSM kool-aid, too.

          And as for Munchausen’s Syndrome By Proxy. That’s a good description of what many psychiatrists and psychologists do to their “patients”/clients. And it’s a great way for politicians to blame others for their own policy failures.

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          • Joshua says, “…we should not trust or license Psychotherapists” –

            I agree, because most psychotherapists are drinking the DSM kool-aid, too.

            And as for Munchausen’s Syndrome By Proxy – that describes how a lot of “mental health professionals” relate to their clients. And it also describes how some politicians blame the homeless for their policy failures.

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  6. Once again, our fine readers have already raised several points I was going to make, one of which is that if Jim Phelps actually reads Mad in America, he would already know that we report on science- and experience-based alternatives to conventional psychiatry on the regular. Some of these, like Open Dialogue, even make limited use of drugs!

    As for the ‘scary’ headline over Peter Simons’ report on Dr. Ghaemi’s article, don’t shoot the messenger. It’s an accurate description of what he said…sometimes the truth hurts.
    But I mainly wanted to answer Phelp’s question about what people in distress and their families can turn to when non-psychiatric approaches are insufficient. Has he not heard of the integrative/holistic approach –particularly Functional Medicine?

    When I suffered for months without relief from what he would call a Mixed State depression –tearful and hopeless, yet extremely anxious, restless, and insomniac–I stumbled into an integrative psychiatrist. Besides doing a detailed personal intake interview, he tested my blood for everything under the sun, looking for underlying health issues that could be affecting my moods and behavior (which, at times, was bizarre). I was then provided a personalized and evolving treatment plan that involved nutritional and hormone supplements to address various deficiencies and excesses and support my nervous system: vitamin B12, progesterone, inositol, calming herbs and amino acids like ashwaganda and tyrosine, and more. (I was already on low doses of psych drugs, which he monitored and later helped me taper off of.) Finally, he consulted regularly about me with a new talk therapist I’d found and was seeing twice a week for the psychological side of my crisis. This individually tailored, ACTUALLY bio-psycho-social approach led to both my recovery from “mental illness” symptoms, better overall health, and tools I use to help myself during tough times even now.

    I urge Phelps to seek out functional medicine practitioners/integrative psychiatrists to learn from them and apply these principles in his practice.

    One last thing: I get the sense that most people come to Mad in America not as newbies weighing options but as people all too experienced in dealing with the mainstream mental health system. They’ve tried it and didn’t like it, and are now seeking answers and alternatives.

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    • Yes there’s a thousand different helpful healing regimes out there. Psychiatry, and by extension the materialism/reductionism/Scientism mob, have created a literal blockade against what they deem to be “pseudoscience”. It’s all really psychological projection from insecure types who are not very healthy themselves (BTW i’m generalising Mr Phelps, this is not personally directed at you, I’ve never met you). I’ve been shocked by the way victims of psychiatry are left in agony for years and never told that Homeopathy, Chiropracty, Chinese Medicine, Ayurvedic medicine and a zillion other things can and do work. The more ancient healing arts have been around for millions of years, way longer than Allopathic medicine and psychiatry who are really the new kids on the block.

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  7. This is not like buying something someone cooked up in their kitchen meth lab. This is made in sophisticated and government licensed labs, and the doctors who prescribe it carry government issued medical licenses.

    I mean, some people will prescribe alcohol and street drugs for themselves. And this is always going to be hard to contain. But these psychiatric neurotoxins are being prescribed by people who hold government issued medical licenses. So we should be able to completely shut that off. Doctors don’t bleed people anymore and they don’t endorse cigarette brands anymore.

    Given that there is no actual medical condition and no benefit to the patient, and that it is being done by people holding government issued medical licenses, it falls clearly within Nuremberg Precedent for Crimes Against Humanity and War Crimes. There is no Statute of Limitations. No one is exempt from the law, and the penalties can be severe.

    And right at this time California Governor Gavin Newsom has almost gotten legislation passed to create special courts to subject the homeless to forced psychiatric procedures.


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    • Heroine is probably VASTLY safer than psych drugs by this point (and no I am not recommending it). I myself use Dark Captain Morgan Rum as a major pain killer, in strictly limited quantities, only in the evening, never in the day. It’s still dangerous stuff potentially, just as Fentanyl is. But alcohol, as man’s most ancient pain killer, is safer than prescription opiates. However, of course, anyone can end up becoming an alcoholic. It’s only a stop gap measure. I’ve actually recently found the source of the pain to be a neck/spine problem and am seeking a Chiropractor. As to California there’s another side to it. Heart Forward (Kerry Morrison) is changing everything – https://liberation-map.michaelzfreeman.org/wiki/index.php/United_States_of_America

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      • Michael, yes street drugs are often safer then prescription psych meds. But the real issue is that street drugs are crime, so it is hard to control.

        But prescription psych meds are entirely a government operation from end to end. So we should be able to shut that down hard. And because of the government licensing it is Crimes Against Humanity and this is in no way lessened when parties are consenting, or even begging for it.

        As far as Kerry Morrison and Heart Forward, this is the first I have heard of it, and so I am not sure what to make of it.

        I am not sure where Gavin Newsom is getting his Psychiatric Police State ideas. Seems like it is probably Mark Ghaly, but I also find this Thomas Insel to be very frightening, downright Orwellian.


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  8. Thankyou dear Robert Whitaker for being a pathfinder out of psychiatric medication over prescribing and withdrawal under resourcing.

    May I be curious?

    You seem to be “for” the short term prescribing of antipsychotics and antidepressants in crisis intervention. Why?

    My inkling is that if you comfort someone who is severely psychotic and it does no good that a rather Chaplinesque prop wallop with an altered state can buy some time because it gives the exhausted brain something else to play with besides blowing up a train. In old Hollywood westerns there was the trope of the slap for the hysterical nubile female homesteader or the rag in the mouth after a bottle of whiskey for the removal of an Apache arrow flint from the gold prospector. Substances and thumps given to bring people back from the edge of a cliff have an ancient heritage amongst the human species. I am not saying it is wholesome or even forgivable. I believe in non violent approaches to all conflicts. I just acknowledge that people can disappear inside themselves at risky moments, like before a building or dam collapses, and it can be better to do the old fashioned thing of bringing the lost back to their senses. Medics know this in an ambulance before someone vanishes into coma-land. Vets also know this in agriculture. A fallen creature sometimes need help getting up or it will die. A startle or a cushion of valium might cause enough of a brain detour to get off the stuck record of a death wish. Then there is the power of placebo. How creepy is it that that the human brain can do its own brain mending on sugar! But the trick with placebo is just that…it involves trickery. The DSM and a magician psychiatrist are the same as a shaman in the dazzling confidence trick of linctus or leaf. So is romantic love a placebo trick for the brain. And alcohol. Booze is used for relief of stress from a disaster and quite often that becomes a rabbit hole to life long addiction and brain damage, to say nothing of marital damage and child neglect.

    The severely ill will always need some quick solution to the immediate emergency. You are quite right to argue that many emergencies may be caused by iatrogenic or withdrawal states preceding. But long before psychiatry was invented people have been going imbalanced from one reason or other. The DSM was a go at listing all that. A list is not who later calls a list gospel. A book is not who takes it way too seriously. Yes there have been decades of people who took that book too seriously. I think the penny dropped thanks to your great efforts and dedication. But everyone has their own free right to absorb any book as if it is bath water to the spongey brain. To say people cannot love their own choice of book is itself probably from the influence of not enough good books. Back to short term medications, they are obviously “treating something” when severly ill people beg for something to take the edge off. It is easy to dismiss the abject misery of people’s cliff edges when we live in an easy flat topography.

    I went up a mountain today because I felt really seduced by the impulse to euthanize myself because of my hallucinations. The mountain is so easy for lovers to fall in love in because it is a scenic evocation of heaven. The mountain is so easy for the dejected to die on because it is high enough to reach heaven by jumping off any one of its scenic cornices or sills or peaks. It is my therapy chair. Or a gigantic grassy primal scream bean bag. I am always accompanied by my angels, who cannot decide things for me but offer jokes to bolster my fortitude. I said to them that if I ever do succumb to a cold night of the soul on my beloved mountain, from sorrow at my symptoms, then I should like to haunt that mountain to heal people like me before they even think of wanting to die. Life is too precious not to marshal one’s resilience and keep trying to see the mountain as a romantic beauty spot instead.

    An hour into wallowing in the afterglow of the wish to end my life I saw a helicopter. My angels and I wondered what was up. The helicopter hovered at some distance over one peak and then I knew some poor morsel of humanity must have slipped and broken a bone. In an instant I was crying, not at wanting to die but at how endearing humans are to go to all that trouble to save a wounded human. The helicopter was like a dinky toy at that distance but I saw a dot slide elegantly down a rope, followed later by a stretcher. So many miracles playing out in one revolving swoosh. The miracle of the stranger’s consideration who used the miracle of their phone that called the miracle of the helicopter that contained the miracle of the man of medicine who knew the miracle of the human body and took the miracle abseil down into danger and miraculously bound the broken one up like a lost lamb and miraculously took him to a miracle hospital. I knew it was a man patient, because right at the beginning of this spectacle I said to one of my angels…

    “Go go go there now and please help them!”

    To which the angel came back ten minutes later and said…

    “He is bald”.

    This was to let me know the angel really had flown over and so I could check the veracity of this in the evening news items.

    As I felt reassured that the man would be operated on and proceed to a full recovery, I wondered what an overly woke slant on that would have been. The helicopter may have been polluting the air. The driver may have not wanted to pick up a communist hiker with a broken bone or a capitalist hiker or a black hiker or a rich white male affluent hiker or a disabled hiker or radical hiker. Or people might say the hiker should not be on the mountain since it was not their mountain and since if they were on it they should have been working in a long shift at a carpet manufacturers rather than being a tourist costing air rescue teams a fortune to save them and if they stumbled it was probably due to obesity or dizziness from recreational drugs or going on mood pills or coming off medication. All of this could be true…

    But to see the world as miraculous IS the greatest placebo.

    Robert you are a diamond on the tree of life. You should get a Nobel prize. I say this sincerely. But a Nobel is not for things achieved but the bridges those achievements make.

    What is a bridge? A place that lets you leave the past behind and move forward to the future. Mixed feelings occur at that crossing over. Loss of what was and excitement at what is to come. Loss and exitement are so neatly adjacent in the middle of the bridge that loss seems exciting and excitement appalling. But a bridge can also be between two “sides”. A bridge can span between two neighbouring warring people or countries.

    “Hoover Dam!” say the angels, tugging at my ear lobe. I have to repeat them.

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        • Not entirely true, Daiphanous Weeping. I clearly recall reaching out to you when you threatened to stop commenting here. True, it was “leaving MiA” that you were threatening, and not self-euthanization explicitly, but you implied being ready to check out of the party. I’m pretty sure you even commented back to me. I still wanna meet you, or at least email-chat, whatever…. You’re even more pretentious and verbose than I am! And that’s saying something! So, PLEASE!
          >[email protected]<

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          • I have done two suicide notes today. One for mother. One for my child. I have done an envelope with my bank details in it and stuck these to a wall so they will be easy to locate. I have done my laundry, as discussed, it was not a year ago, it was yesterday. I have packed warm clothes for the scenic spot. I do not want to be found by people until it is late. I have put a bag for puking in. I have laid myself foetal on the floor four times today to see if being curled up will be possible as a way of life. It does not stop the hallucinations marauding me every few moments as it has for twenty years. No medication helps. No hospital will not medicate me. No hearing voices groups are not pushing a woke anti schizophrenia agenda, a trauma agenda is what interests the chattering experts. I love life abundantly. I have a beautiful home at last. It is gorgeous and makes me happy. There is a rug I want to embroider. My hallucinations wont let me. There are books I long to read. My hallucinations wont let. There are paintings I want to paint. But my hallucinations wont let me. There are neighbours I want to socialize with but my hallucinations wont let me. Last night I wrote some cards to them to explain that if they have been hearing shrieking and sobbing it is because I am shouting at the awful crawling sensation on my body and so I am hourly fighting to live…to live…to live. I told them not to worry but just ignore it. I do not want to trouble them. This morning the cards went in my bucket because I reckon that by tommorrow I will not be here and the house will be quiet. If I have been darting in and out of the comments section it has at times been because I love life and love people. But my hallucinations seldom let me get a paragraph out. I keep saying goodbye either because I cannot take the lessons, in my utter despair, or I cannot take being confounded by hallucinations whilst I just want to speak. But more recently I say goodbye because I cannot go on living with my schizophrenia hell.

            I say none of this to extract pity. What point there ever was in pity vanished for me probably seventeen years back or eighteen years back. I do not like being a victim. I want to be everyone’s saviour. Jokingly, that’s a schizophrenic delusion of grandeur. Helping people has been the one consistent thing to keep me going. Lately the hallucinatons will not let me hold a phonecall or even hold an opinion. Quite why I can type at all is because my thumb on this phone is making jabbing typing actions like drumming one’s fingers. The monontony is comforting. I do have angels and they try to help but they cannot do much more than a wistful breeze can. The angels tell me you all think I am a greedy liar and that you think I have no illness at all.

            Im sorry but people do not nonchalantly spend a sunny afternoon in a gorgeous flat in a lovely life writing two suicide notes to two people who have lost enough already in life.

            I see the road ahead for humanity is hopeful but not without gruelling social mayhem and destruction. I see the huge global flood coming and the unmentionable dam explosion and a terrible dictator instituting a regime full of public executions. And none of that deters my wish to stay strong and help people. None of it. But I cannot live with twenty four hour a day blizzards of hallucinations. There is no Soteria House near me. There is no Open Dialogue near me. I already have a psychologist a psychiatric nurse and a psychiatrist. They are as helpless as I am to get me better. And before anyone says those people have made me schizophrenic I say my schizophrenia came before I saw anyone like that. They do not give me antipsychotics because I have asked not to have them. For three years they have honoured this my request with integrity. What will they think when I am no longer existing? They are all lovely people. Infact I know no people on the planet who are not lovely people. Annoying yes, but loveable somehow. Talk talk talking here is my staying on the phone. But a life needs more than staying in rigid fear of moving off the phone. A life needs to begin to live. I do not want to euthanize myself, I want to begin to live. After twenty years of misery I fail to see how that will be possible, tomorrow, next week, next month, years more of horrific hallucinations.

            But…I shall try to mince through another day. It is all about the day. The day is my deity.

            Wish me luck.

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          • I am so sorry to hear how distressed you are feeling! It sounds like you have a great love of life. I hope that will sustain you. While I don’t know what it’s like to have your condition, I do know what it feels like to wonder if life is worth living. I will be thinking of you today.

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    • Jim phelps you may like to click on my name Diaphanous Weeping here above to take you to a comment thread I have been having with Steve. I believe it is interesting.

      Some say psychiatry is a belief system. I say so is antipsychiatry. If antipsychiaty wanted to be anti belief it would dispense with the “psychiatry” bit of its title. In a family home one sibling can be a believer in “Dad” and the other sibling can be “anti Dad”. But the true purpose of being “anti” is to move away from what belief you are anti towards and build your own shrine and put your better god on it. That is all you need do. Create a heaven here on Earth, as you might want it. But a building of a belief is not robust if it is only to be about critiquing what it thinks are wrong beliefs, ie the disappointing Dad.

      I have MY OWN belief.

      I believe I DO have a chemical imbalance that causes me to have to know I have a chemical imbalance. So it lands on me in these two ways of my KNOWING.

      I have only a loose loyalty to the cult of science. It is a great cult I enjoy immensely but I am able to stand back from it at times to question its vogues and latest trends.

      I cannot now remember why I am talking to you…

      Oh yeah…


      We have dear Robert to applaud for that. He spotted the Diptheria in the water supply and the wooly thinking that ignored those ominous signs.

      But Robert and I maybe differ in one aspect. I DO believe my mental illness IS real despite what a gazillion objectors to my reality say. I DO call it schizophrenia. It exists. This opinion is not negotiable. There comes a point where a cripple says they are a cripple despite what all the books say. I am not going to airbrush the word schizophrenia or get rid of it for some one who just does not like me.

      I only have this to say on this…


      In Divinity college there was a tutorial on how impossible it is for those OUTSIDE a belief to argue or debate sympathetically with those INSIDE the belief. Those OUTSIDE Ann Frank’s attic will tend to call her belief unacceptable by THEIR world view.

      A Rabbai or priest is like a hero to those INSIDE a belief. So a psychiatrist is like a life saver hero to some INSIDE there medical belief.

      In my youth the symbol of the healer doctor was revered and I do not think this reverence for doing good is a wrong. Yes, you can argue that much bad has come out of naive trust. But the wish people have to adore their own choice of hero seems to me to be a part of wellbeing. I do not want someone elses hero shoved at me. That would make that hero my tyrant. But the freedom to choose your own Dad seems important if we are all to tolerate each other’s “differences”.

      Having a Dad. Having a hero. These are healthy things to like.

      BAD BEHAVIOUR that gives BAD TREATMENT is NOT healthy.

      But even there, just because a pub sells spoiled beer does not mean the pub is not a place some people want to sit in, whilst ruminating on philosophy, or angels, or writing a delightfully girlish Anne Frank journal.

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      • Just so you know, Daiphanous Weeping, yes, I believe that you believe that you have schizophrenia, and that it’s caused by a chemical imbalance in your brain.
        Me, personally, I think that you’re too intelligent & creative for most people, and that you have too few peers. Like none, maybe, except here at MiA….
        That’s not all, of course, but….still! ttyl

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  9. Miranda,

    Thank you for explaining in detail your experience with functional medicine/integrative psychiatry. I’m thrilled it worked so well for you. It’s what medicine should be! And I’m glad you found a helpful talk therapist, too.

    Acupuncture was very helpful for me, as was my discovering the root cause of my problems was traumatic stress, not the mainstream mental health narrative of chemical defect.

    Thank you again for sharing what helped you. I’m sure it will change someone’s life for the better.

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  10. Jim Phelps’ admission that most psychiatrists agree about the invalidity of diagnoses and uncertainty about how the brain and the drugs work can’t be taken seriously or as sincere when in practice most psychiatrists will not tell a “patient” who sits across their desk the same.

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  11. “passionate concerns—understood”

    With all due respect: I don’t think you understand at all.

    If someone wants to take psychopharmaca of his own volition and given an accurate picture of what is to be expected, that is entirely fine. I think most people on here agree with this view.

    What very much isn’t fine is psychiatry using force completely arbitrarily and in blatent disregard for their victims rights.

    Now I do not know what has happened to you in your life and there may very well have been hard to tolerate times, but for me, the week I was locked away in a psych ward for no reason, was the worst experience of my life by such a margin that I can’t even compare it to anything else I have experienced.

    So, no, you do not understand. You do not understand the fear. You do not understand the pain. You do not understand the harm. You simply do not understand.

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  12. Sounds like psychiatrist Jim Phelps is desperate to have himself and his profession be taken seriously despite the fact that any real scientist, journalist, or critical thinker would be hard-pressed to find ANYTHING that psychiatry has proclaimed in the last century – from its DSM, to its chemical imbalance theories, to its treatment proclamations, etc. — which has proven to be scientifically true.

    Phelps tells us that Robert Whitaker “overstates psychiatry’s problems” and that Whitaker is “inflammatory” to describe psychiatry as a “false narrative,” and a “failed paradigm of care.”

    If psychiatrist Jim Phelps wants to be taken seriously at all by Mad in America readers such as myself, he needs to respond to this question: How much does an institution have to get wrong for that institution to lose its authority?

    If the truth for Phelps is that no how much psychiatry gets wrong, he can never come to the conclusion that psychiatry perpetuates a “false narrative” and a “failed paradigm of care” because coming to that conclusion would mean, in his words, “throwing the baby out with the bathwater,” Phelps will never be taken seriously by Mad in America readers such as myself.

    Real scientists are open to the necessity, at times, of rejecting an entire paradigm — religion believers are not.

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  13. While I commend Jim Phelps for his more progressive views on the state of psychiatry and the use of the DSM and mind-altering drugs, I have not found his views to be widespread based on recent experiences of family and friends. I know many people who are still being drugged with numerous drugs and told to stay them forever due to “damaged brains” and “chemical imbalances.” And if indeed “most psychiatrists” believe as Jim Phelps does, then why do they continue the extensive use of drugs, ECT, TMS, and Ketamine? It seems to me that as a field, psychiatry continues to hold on to the view that depression and other states have a biological basis and one of their magic bullets is bound to work—-or else the patient is labelled as having a “treatment resistant” condition.

    My psychiatrist told me I had a damaged brain and would be chronically ill if I refused medication. I’m happy to say he was wrong, and I’ve been drug and depression free for over 20 years. Lastly, I know of no friends or family members who have ever been given fully informed consent when told to take psych drugs. One friend who was recently hospitalized asked me “What’s informed consent?” That’s why so many of us are here at MIA—we’ve experienced the dark side of psychiatry and are happy to explore other options.

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    • Ann, I know you mean well. I know you’re a good person. You’re polite. But you’re also wrong.
      As in *WRONG*. There is ONLY a “dark side” to psychiatry. There is no “light side”.
      Psychiatry is the manifestation of greed, ignorance, hatred, and oppression.
      Psychiatry itself IS the DARK SIDE….

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  14. I appreciate Robert’s work and even a response in the article from a psychiatrist. The drug angle is important but why this has come to pass seems to get left out. Some of it is pharma. Some of it is money. But most of it is bigotry. It was Franco Basaglia who cracked it with his analysis of coercive Italian psychiatry that cited Sartre’s work about antisemitism. Mental patients are discriminated against by bigots just as African Americans can be or Jews. The crucial difference being that mental patients don’t know they are being subjected to bigotry like a black man would have known in deep south 1950’s America. So if those in distress were judged by the content of their character, not the colour of their distress/trauma/MH then dodgy drugs would simply not be used because their life would be as valued as that of any other human being.

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  15. Recovery for me meant coming off the very disabling antipsychotics BUT also figuring out through trial and error how I could overcome my dreadful (withdrawal) anxiety. Once I had the basic tools I didn’t need anything else (especially professionals).

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    • Joshua, I do not accept your authority on an experience of schizophrenia that you have not had. Of 100 people with schizophrenia ONLY 3 percent will be aggressive. The other 97 percent endure their colossal suffering with better grace and respect and good manners than anyone in the rest of the human population. Suffering either turns a person vindictive or suffering dignifies a human. Always one or the other.

      I prefer a path of dignity.

      Joshua, I did recently say in a comment to you that I do not want your responses to my comments. Leave me alone.

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  16. My conclusion now is that most of psychiatry could easily be changed to the title ‘don’t know’. This is a problem that few mention.

    I read a neurologist a few years ago saying that much of her work was about not knowing and working within that space. Sometimes a known organic cause proves to be correct for the suffering person. Or further down the line some new information becomes available.

    The problem is that in the uncomfortable place of not knowing, claiming to know feels better but is a huge barrier to learning.

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  17. I am an LCSW-C. I spent 13 years in treatment foster care, as a social worker, supervisor and program director. I never saw any credible evidence that most psychiatrists share Jim Phelps’ point of view. In my experience, if most of them at least share his doubts, they keep them on the down low with their friends. Patients get told: they have chemical imbalances; “mental illness” is a physical disease like diabetes or heart disease; psych drugs are safe and effective; psychiatric drug research is reliable science, etc.

    Even most so-called enlightened psychiatrists, if you scratch the surface, aren’t much different from the others when it comes down to what they do with their “patients” (see some of the comments above). For years I attended continuing education presentations at Sheppard Pratt Hospital – while occasional presenters (Bessel van der Kolk) offered viewpoints that were meaningfully outside conventional psychiatry, a number that purported to do so, did not.

    Psychiatry and PhARMA are a massive juggernaut enforcing their orthodoxy by spending more on promotion than on research, and (especially PhARMA) using their overwhelming finances to make it prohibitive for mistreated patients to seek redress in court. Some states’ and U.S. attorneys general have challenged PhARMA in court, but this is not the rule.

    Even if most psychiatrists do share Dr. Phelps’s opinions and doubts, it really doesn’t make much difference to “patients” and the general public. PhARMA’s lobbying and PR machine overwhelm any but the bravest and most resourceful psychiatrists (Sandra Steingard, David Healy, Peter Breggin and some others – all of whom have written for Mad in America). A psychiatrist who speaks out risks getting fired; others like Breggin and Grace Jackson, have had to fight to keep their medical licenses. It is simply an extremely risky career move for most psychiatrists to say out loud what Dr. Phelps says.

    PhARMA and Psychiatry assiduously enforce their orthodoxy. They allow some deviation – psychiatrists such as Daniel Carlat get away with presenting themselves as critics and non-conformists, but they still take care to allow that some psych. drugs are effective, and “mental illness” is a brain-based physical illness.

    The private opinions of psychiatrists will make little difference to those who suffer mental problems unless they speak out forcefully – as a large and persistent group – in newspapers, on TV, in medical schools, peer reviewed journals, the political arena. That isn’t happening any time soon – most psychiatrists know their careers would be destroyed.

    I am grateful for those psychiatrists who have spoken out, but they are most certainly not in the majority.

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      • Thanks, Steve.

        While I’m at it, I left out a glaring fiction psychiatry routinely pushes at “patients” and the general public: they know (per then-head of NIMH Thomas Insel in 2012) that the DSM has terrible validity problems, and that only by manipulation of the numbers can it be called reliable. Yet “patients” are constantly told they “have” DSM diagnoses of bipolar, schizophrenia, depression, anxiety – virtually never being apprised of DSM’s manifold problems.

        Along the same lines: I once gave a training for a group of 40 to 50 treatment foster parents – none had ever been told by a psychiatrist of the adverse effects of the psych meds given to their foster children.

        One last thing: most antidepressant prescriptions are written by primary care doctors. Has there ever been a concerted effort by psychiatrists to educate these doctors that depression is not caused by a serotonin imbalance, or that antidepressant clinical trials do not show what PhARMA says they do? (See Irving Kirsch’s The Emperor’s New Drugs, and recent meta- analyses).

        Psychiatrists like Dr. Pies, claim that good psychiatrists are more sophisticated that those in my experience. I doubt there are many – certainly that they are not in the majority. My work was in Baltimore – our foster children were seen at Sheppard Pratt, the Kennedy-Krieger Institute, Johns Hopkins Hospital and the University of Maryland Hospital. There may have been some exceptions to the general pattern, but over my 11 years doing treatment foster care, I can think of only one.

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        • I found the same thing with foster youth or their parents or foster parents. No one was really given informed consent. One facility had a “clients’ rights” sign on every wall that said they had the right to know the intended benefits and potential adverse effects of any medications they were given. When my CASA volunteer asked the therapist when that had happened for her charge, the therapist said, “No, we never do THAT! They might pretend they had the side effects or decide not to take the medication!” Which is kind of the point of “informed consent,” isn’t it? That was the attitude I met every day. Doctors knew best, people needed to do as they were told or horrible consequences would ensue, and anyone who said otherwise was brainwashed or “anti-science” or just didn’t understand how important these “meds” were. Yet 9 out of 10 kids stopped their “meds” or cut down to one almost immediately after they escaped foster care, and very few that I knew of suffered any adverse effects in the long run. And when asked at multiple “foster youth panels” what kind of intervention they found most helpful, not one of them ever mentioned “medication” as a key to their success. It was always a person or a relationship that they identified as what helped them through. Sometimes a therapist, but never once a psychiatrist or his/her “medications.”

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          • Steve,
            Thanks for your comment. It mirrors my experience. The “mental health” system (basically the “psychiatric” system), is overwhelmingly stacked against any real change, and punishes those who don’t comply.

            When I was doing foster care, every child entering the system was required by the state to undergo a “psychiatric evaluation.” Given the usual 10 to 15 minutes (max) for psychiatric visits, this had to be crazily superficial. Kids came out labelled “oppositional defiant disorder” or “bipolar disorder,” with little or no apparent attention to their impoverished, violence-scarred, trauma-ridden homes, or to massively under-resourced community situations. And of course these labels brought with them scrips for psych drugs.

            It seemed to me that if a child was sad (why not, given her/his life experience and then landing in foster care?), and he/she also got violent once or twice (again, why not, given his/her circumstances?), he/she was labelled “bipolar.”

            I attended children’s periodic court review hearings, and always feared we would get disciplined for doing whatever we could to keep children off the drugs, or at least keep proscribing down to a dull roar. I always feared WE, who spent dozens and dozens of hours per year with children and their foster parents would be sanctioned for not fully embracing the drug paradigm, while psychiatrists who saw children once a month for 10 minutes, sometimes sitting with their backs to the children and their foster parents, sometimes typing at a screen without looking up, were free and clear.

            Just one time, we got a psychiatrist to take a child off her meds – turns out she was not “retarded” as she was diagnosed (that was due to the antipsychotic she was on). Another time, we reviewed the child’s chart, history of trauma, relationship with family, peers and school, the ongoing success of our psychosocial program, the adverse effects of the drug the psychiatrist proposed for her – and when the social worker attended the next med review, her presentation was dismissed out of hand. This guy, who had spent maybe a total of one hour (over many months) with the child, did not care what a licensed clinical social worker, who regularly did hours of in vivo therapy with the child and her foster family – paid no attention.

            One parting shot, and then I just have to give it a rest: it appeared to me that the large majority of social workers either didn’t know that antidepressants did not correct imbalances, or didn’t care. I wrote a program policy that no med changes could be made without the presence and approval of our social workers – I think some did what they could about this, but to little effect. My impression was that most willingly went along with the system, chalking my trainings with them up to my having a bee in my bonnet. I think the majority of licensed counselors and psychologists may have some doubts about psych drug, but most basically go along with the system. That’s how it goes with PhARMA’s billions and psychiatry’s steely grip on the system.

            I appreciate how Dr. Phelps has worked and expresses his opinions out loud. But untiil massive numbers of psychiatrists take a stand, things will not change much.

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          • All I can say is, I totally shared your concerns and experience. What the kids said counted for nothing, parents or foster parents were snowed under with technical terminology and fear mongering, and anyone calling out the ill effects of a particular case of psychiatric drugging was in for an attack.

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          • I had to cut off contact to a neurologist relative over this issue. He said informed consent simply is not possible without medical school. I understand his point but at least be honest about what you don’t know. Imaging technology has advanced enough to justify advanced imaging for mental illness.

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          • Actually, advanced imaging has contributed to proving that the DSM concept of “mental illnesses” is complete bunk for almost all so “diagnosed.” It is showing that folks with the same diagnosis have almost nothing in common, except for common damage from the drugs they may be taking.

            And my retort to your neurologist relative is this: I’m a very smart person. If you can’t explain it to me, it’s probably not because I can’t understand it. It’s because either you don’t want me to know, or you don’t understand it yourself.

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  18. 1. Lithium citrate and carbonate may be a great deal cheaper than any other routinely prescribed psychotropic drugs.

    2. Any (perceived) adverse effects of either salt are relatively unlikely to be “treated” with further prescriptions of more expensive drugs.

    3. It has been suspected that perceived improvements in the condition of at least some of those whose diets have been supplemented with daily doses of some salt of lithium may occur because those people were suffering from deficiencies of magnesium which lithium may be capable of at least partially offsetting.

    If this is so, then those appearing to respond positively to daily supplements of salts of lithium may (alone?) have been exhibiting signs of true brain (or “neurological”) disease, supporting Szasz’s assertions that, absent any true diseases of the brain, what are called “mental illnesses/disorders” may be better calked “problems in living” – even if the problems are perceived to be problems not by the person’s themselves but by others…

    Awfully grateful for most magnificent MIA , lectures and books by Robert Whitaker, as well as for his unique exhibitions of how to somehow manage keep ego out of the most intense discussions, all provocations notwithstanding.

    Thank YOU!


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    • I think lithium was a missed opportunity to focus more on natural treatments as opposed to patented pharmaceuticals the body has no experience with. My personal experience is that foods high in B vitamins and electrolytes help me manage my mood fluctuations in a way I can adjust as needed unlike pharmaceuticals.

      ‘Problems in living’ sounds a lot like how ‘failure to adjust’ is used to turn behaviors that are beneficial during millions of years of evolution but suddenly abnormal in an industrialized world. My body tends to respond to the sun and not to a clock that is arbitrarily changed by an hour twice a day.

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    • I agree. The MIA site carries several recent reports that conclude imaging for psychiatric purposes is misleading and, well, pretty useless. I would add, worse than useless, because imaging is often used to lend the sheen of science to psychiatry’s biology-based paradigm.

      Among the problems with imaging: there is always a lot of extraneous “noise” in the images. Multiple methods are used in an attempt to filter out the “noise” so some semblance of order can exist upon which to compare “ill” with “normal” brains. Researchers cannot agree on which of these methods to use, and depending on which method is chosen, the results can be completely different from each other.

      Also, where imaging produces “differences” between “mentally ill” and “normal” brains, the difference is simply between group averages, and a very large number of individual “normals” have scores that fall in the “mentally ill” classification, and vice versa.

      Unrelated to imaging, it surprises me that Dr. Phelps agrees that most mental problems don’t require psychiatric intervention. I whole heartedly agree with him. But how can there be any real appetite among the majority of psychiatrists for this proposition? Widespread recognition of this would lead insurance not to cover the many things psychiatry is now involved in, and psychiatry would have to relinquish its position as the 500 pound gorilla and the “mental health” room. I don’t believe there is much chance of institutional psychiatry making such a move, PhARMA giving up its tool for marketing meds, and individual psychiatrists giving up their current livelihoods. A major reason psychiatry turned to the medical model decades ago was that it was losing market share to talk therapy.

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      • Imagining can be misleading in all areas of medicine but psychiatry has very little objective data to work with. Currently describing symptoms to psychiatrist is about as useful as trying to describe the color blue to someone who has been blind since birth. Excessive unnecessary imagining can be harmful but it is minimally invasive and provides information that can be reviewed by more than one individual for interpretation. It probably is not very useful right now but neither are the invasive medications. As we all know profit is a major driver American healthcare and we’re pretty hard to make profitable which is why we’re either ignored or drugged. I feel like a psychiatrist justifying their profession but imagining is highly profitable and has the advantage of being minimally invasive. It may require new techniques and take milli9ns to establish the needed imagining data base but I’m pretty sure my manic brain will look quit different when compared to my depressed brain.

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      • Peter, thats a GREAT comment, and I am in 99% agreement with everything you say. EXCEPT that 1%…..
        You use the false, fraudulent, deliberately deceptive piece of psychiatric word salad “meds”, or “medications”. You’re not a paid PhRMA shill, are you?
        No, I didn’t really think so.
        So, NOT “MEDS”, or “medications”, but rather, DRUGS ARE DRUGS ARE DRUGS ARE DRUGS ARE DRUGS ARE DRUGS…and psychiatric DRUGS are ALL NEUROTOXINS. Well, 99% of psych DRUGS are neurotoxins.
        Please adjust your brains language software accordingly.
        Thank-you Peter!
        Great comment, btw!

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        • Bradford – Good point. I try to be careful to put quotes around all of the phony psych language, because it’s really about people being people, and that’s the best way to talk about it. No dx’s, etc – we live, we feel, we think, we love, we strive; we need to care about and show ourselves to, depend on and support each other far more than our cultures permit. I will remember to say “meds.”

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      • I knew mainstream psychiatrists were in for a big disappointment when they announced they were going the high tech route. And since good sense has no place in mainstream psychiatry, they were off and running! …. ’cause those big, expensive machines excited them! …and if they worked, they could finally take their rightful place alongside their medical brethren! …but this was not to be….

        Didn’t they already know the brain’s a gelatinous mass, the pictures of which would be too vague to be open to anything other than interpretation, and, just as likely, misinterpretation? And what would they have done if the images were more visibly tangible? Probably something along the lines of a high tech lobotomy – and just as injurious.

        Too bad they couldn’t stick to their Rorschach tests –

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  19. No, you dont get it, dude! Both meds and “meds” are the SAME THING!
    BOTH meds & “meds” are deliberately misleading euphemisms created by PhRMA, to $ELL DRUG$!….
    And medicalize for profit off peoples suffering.
    Psychiatry DRUG$ people!
    How can they be meds, or “meds”, – same thing, – if there is NO BIOLOGICAL MEDICAL CONDITION? No medical, chemical, physical aspect to ANY so-called “mental illness”….

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    • I think he meant he’d use quotation marks to show disbelief or contempt for the word usage, to indicate irony. But I’m with you, why not call a spade a spade and just say “drugs,” unless you’re referring to someone else’s use of the term? The truth is generally better than beating around the bush.

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  20. Bradford and Steve,

    I never use med or medication in conversation, including with social work “clients” or others struggling with mental/emotional issues. Instead, I either say drugs, or psych drugs.

    Writing here, where I address a variety of readers with varied beliefs, I use some “mental health” system words, not because I endorse them (I don’t), but to try to communicate effectively with as wide an audience as possible. As you can see from my entries above, I put these terms in quotes as short-hand for writing “so-called” in front of each term. I think in the context of my entries here, it is clear that my meaning is, in fact, “so-called” – indicating that I don’t accept these terms as valid.

    Bradford correctly pointed out that I didn’t make clear that med was one of these psychiatry-system words which should be challenged. I agree with Bradford that I made a mistake, and as I prefer using med rather than drug in this kind of writing, I will correct my mistake by putting it in quotes – “med.”

    I appreciate you both, Steve and Bradford, for your ideas and your passion for what MIA stands for. Steve – check it out – you yourself used med a couple of times in this thread too, but your meaning comes through strong and clear.


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    • I am sure I’m not totally consistent, and you’re right, it depends a bit to whom I am talking. For some, they will be less able to hear what I’m saying if I use the term “drugs.” I try to use quotes whenever I use the term, but sometimes, I do get on a roll and get sloppy!

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  21. As a psychiatrist who has taken many CME training programs through Nassir Ghaemi, I would have to agree with the “failed paradigm of care” argument. Almost 2 generations of psychiatrists since DSM-III-1980 have been incorrectly trained to think of “depression” in overly broad terms and mania in highly restrictive terms with little understanding of “mixed states”, the most common presentation. I review many of these issues in blogs at:

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