The War on Suicide Is Making Things Worse

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Before her suicide in 2020, streamer Ohlana put out a statement regarding suicide intervention stating that “depressed [people] struggle to reach out in fear the ones closest to them will have cops show up and confine them against their will,” leaving them “alone with their dark thoughts.” They are, as she said, “stuck because they don’t want to be trapped where they just feel worse.”

“It’s not anybody’s fault,” she added shortly before her death. But is it not?

A girl looks sad, blurry through a rainy pane of glass, dark

Currently, in many parts of the world, the penalty for suicidal behaviors is involuntary commitment; that is to say, whether you want to or not, you will be hospitalized. Here in the United States, this often takes the form of a civil commitment order. Subjects can also expect other potential penalties, such as removal of gun rights, denial of the opportunity to serve in the military, and, indirectly, maybe even loss of employment, academic standing, financial stability, and child custody, to name a few.

Carceral suicide intervention is a question of culture and government policy. Advocates say it is a necessary, life-saving measure, even if it is not appreciated in the moment by the person subjected to it. Critics say it exacerbates the issue, making things worse for those in crisis, teaching them and others not to reach out before it is too late.

With the general rise in civil commitment over the past few decades, suicide rates have been increasing. Defenders of civil commitment propose that the situation would be even worse without the penalty in place, but there are many good reasons to indicate this is not the case.

While allegedly intended to help, institutionalizing people against their will does more harm than good. The process of psychiatric coercion is recounted as dehumanizing by more survivors than not. Mental health and social outcomes for those who reported coercion were overwhelmingly negative. Fear can dominate their experience in a coercive environment, prompting people to repress emotions into what’s deemed as sufficiently stable for release. (This can also happen by proxy, where if people know this is what they will face if they open up, they may avoid doing so.) The already-hasty diagnostic process may also be affected by the extreme distress of the committed subject whose crisis, if it existed upon commitment, has been exacerbated; and whose necessary trust in the psychiatrist is transformed into a need to perform normalcy to escape.

All this does, for many, is teach them their feelings are shameful, to be punished, hidden, repressed… which is why, following hospitalization, suicide rates skyrocket. A 2014 study showed that increased contact with psychiatric staff was a massive risk factor for death by suicide when analysing thousands of completed suicides. While those who are more disturbed to begin with are likely to have more contact with psychiatric staff, the authors believed the hospitalizations, particularly if involuntary, constituted a substantial independent risk factor. The study and accompanying editorial note indicated that the trauma and stigma inherent in psychiatric hospitalization were so significant that they likely caused some of the suicides. As Robert Whitaker commented in an article on the Absolute Prohibition site, “[The Danish study concluded] that ‘it would seem sensible, for example, all things being equal, to regard a non-depressed person undergoing psychiatric review in the emergency department as at far greater risk [of suicide] than a person with depression, who has only ever been treated in the community.’”

The only study in my search which produced mixed results for involuntary commitment was a study from 2006 in which they did not distinguish between people who were forced or coerced and those who were not, which muddied the waters. (“Involuntary” means treating a subject as though they are unconscious; that is to say, whether the person wants it or not, they will be treated.) “Retrospectively, between 33% and 81% of patients regard the admission as justified and/or the treatment as beneficial.” However, the biggest thing to note is most people (52-72%) in the study agreed with their hospitalization while it was happening, meaning that they likely would have voluntarily gone regardless of the hold. There is still no evidence of any benefit for people who did not agree with their “treatment,” nor any randomized or controlled trial showing benefit of forced commitment.

If one is still not convinced coercive hospitalization is an independent risk factor, there is further evidence with more controls indicating coercive methods independently increase suicidality. For example, even if suicidality was not present upon admission, suicidal behavior increases after hospitalization, especially if admission was coercive. The smoking gun is a 2019 study from the Harvard Review of Psychiatry which showed that patients who were hospitalized had massively increased suicide attempts and deaths versus clinically comparable patients who were not.

Another issue is that suicide is notoriously hard to predict, even by professionals in the psychiatric industry. This has been shown over decades, as summarized in the 2023 “Report on Improving Mental Health Outcomes” by The Law Project for Psychiatric Rights citing a 2017 meta-analysis of 50 years of research. Evidence from extensive newer research has also shown the struggle to predict self-harm and suicide. A 2020 review in The Lancet showed that “risk assessment should not be seen as a way to predict future behaviour and should not be used as a means of allocating treatment,” in part because “the effectiveness of risk tools in predicting suicide or self-harm is limited.” Caregivers and patients both reported “a lack of clarity on what to do in a crisis.”

People also struggle to predict it in themselves, as suicidal ideation rarely results in suicide (<1 in 14 people with suicidal ideation attempt within the next 2 years). Often, the person is simply in great emotional pain, and subconsciously seeking support; furthermore, even if deep down they want to die, when they will actually follow through is hard to predict. There has never been a controlled study, let alone randomized controlled trial, indicating that coerced patients are helped by this practice, much less the population at large. (One must factor in the suicidal people who purposely evade getting caught so as not to be targeted.) Patients claiming to be helped by coercive practices may be experiencing the placebo effect, as suicide attempts and deaths are so difficult to anticipate.

The lack of evidence for the effectiveness is true in all countries, even ones with better conditions than the United States. In places where use of restraints, forced stripping/other sexual assault, and confiscation of phones are less common, there has still never been quality evidence for the use of coercion in admission. At least with coercion and force in other medical fields, the goal tends to be accomplished; while the patient may be traumatized, the procedure itself likely functions as anticipated. Forced commitment does not even accomplish the goal it sets out to do, which is reduce the chance of patient suicide.

Additionally, in the U.S., proper procedures are rarely followed, and false testimony is accepted easily; it is likely less than 1 in 10 patients detained in institutions meet the criteria for a hold. Recourse is made difficult by common practices, such as banning the exchange of contact information with other subjects and the use of personal phones, internet, and recording devices in psychiatric wards.

Coercive inpatient commitment was never evidence-based medicine, but rather a legal and cultural standard motivated by a misunderstanding of mental illness and human despair. Cultures do not need to penalize suicidality to have effective prevention, and having this policy in place harms far more people than it helps. Italy, for example, which does not use the standard of “threat to self” as a basis for commitment, has a suicide rate of only 4.3 per 100,000—less than one third of the U.S. rate, less than half the global average, and among the lowest in Europe.

Arguably, ableism is at the root of forced intervention, where others determine that those labeled as severely psychiatrically disabled are unable to make their own decisions; or worse, that the comfort of others is more important than the impacts to the person themselves. Infantilization, or even downright objectification, of patients to this degree is not seen in any other area of medicine.

As the “Report on Improving Mental Health Outcomes” points out, disability discrimination towards perceived psychiatrically disabled patients in this manner is discouraged by the United Nations. The World Health Organization concurs. Both organizations have called for the banning of forced commitment on the basis of it being a human rights abuse. Whether suicide is always the result of a psychiatric disorder or not, this is no basis to force or coerce psychiatric hospitalization. Incarceration, even if it is in a mental institution, is not a humane method of intervention.

Survivors of coercive commitment commonly compare it to rape. It is easy to see the comparisons. Something that is supposed to be consensual and trusting is made into a reign of terror. If the subject is coerced into exhibiting signs of responding favorably, this is taken as evidence that it was not a real violation. Data may show the consensual version of each (i.e. hospitalization and sexual intercourse) to be helpful for mental health in ideal circumstances, but it would be a gross misapplication of said data to assume it generalizes when coercion is involved. Quite the opposite is true. Furthermore, the inherent lack of respect may contribute to the experience of coercion itself. For example, imagine you adore your partner and wish to be intimate with them. This may well change if they say your opinion is irrelevant and they will have sex with you regardless of what you think; the sex is involuntary. The lack of respect inherent in such an insinuation is inherently insulting and damages the relationship at its core. The same is true for involuntary commitment.

The same may be said of coercive drug intervention. For a comparison, there is some evidence suggesting moderate use of alcohol may benefit wellbeing; however, may the same be said for peer-pressured drinking or downright spiking? This is unlikely, like with sexual activity versus rape. Hence, study results must always be used in their proper context when discussing interventions; coercive drugging is not the same as consensual drugging. In fact, even outpatient CTOs have substantial, international evidence against their use in systematic reviews and meta-analyses. This is unsurprising to anyone who understands proper mental health treatment and its vital relationship to humanization and trust.

The elephant in the room is: Why do people not want the “help?” Why would one have to force the “help?” The answer often lies in the services provided and the methods used. Rather than an isolating, diagnosis-, drug-, and electroshock-pushing, carceral experience, people often need tangible solutions to life problems, like employment, human connection, and consensual ways to escape difficult abusive situations. This is especially true when patients know the treatments they are likely to be prescribed are proven to increase suicidality. Humanization is most needed at times when people’s distress is at its highest. People do not prefer to be gaslit that their distress must be a psychiatric drug deficiency, especially if they have had experience with psychiatry which created or exacerbated their issues.

In investigating the mental health field and its abuses via civil commitment, journalist Rob Wipond found that organizations which openly opposed the WHO’s and UN’s stance, such as the American Psychiatric Association, NIMH, and others, were all unable to provide quality outcome data showing benefits of forced commitment or treatment. The studies on the topics overwhelmingly show no benefit—that the practices are traumatizing and suicidogenic, not healing. There are other involuntary treatments in medicine, such as vaccinating children and treating heart attack patients; however, these are used because they are effective and appreciated by most patients later on. Neither is true for those coercively subjected to psychiatric detention, and the more coercive the experience, the worse the outcomes tend to be.

Via suicidogenic trauma, terror, and medicine, civil commitment has blood on its hands. Humanization and feelings of control are needed most when a person feels they have lost all meaning. When the alleged answers have proven not only to be human rights violations, but to be medically unsound, they must be done away with. Prohibition and the War on Drugs have long been linked to increased overdose deaths due to stigma, fear, and lack of legal, consensual resources. Likewise, the suicide epidemic can be reasonably attributed, at least in part, to the War on Suicide. The added factors like traumatic hospitalization and many of the drugs themselves being suicidogenic only worsen things further. As Dr. Peter Gotszche states, “Forced treatment kills patients.”

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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.

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91 COMMENTS

    • Thank you Andrew! I talked to one patient who told me how much it felt like a game to try to escape when he was committed for psychosis. It was scary for him. Predictably, he got suicidal not long after being released. He was traumatized. It’s not about deep healing when someone is committed; it’s about acting how others want you to. Thus, despite so many anecdotal reports of people appearing more stable after getting out, actual mental health and suicide measures don’t bear this out. Furthermore, most patients appreciate the commitment even much later on.

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    • Thank you Andrew! I talked to one patient who told me how much it felt like a game to try to escape when he was committed for psychosis. It was scary for him. Predictably, he got suicidal not long after being released. He was traumatized. It’s not about deep healing when someone is committed; it’s about acting how others want you to. Thus, despite so many anecdotal reports of people appearing more stable after getting out, actual mental health and suicide measures don’t bear this out. Furthermore, most patients don’t appreciate the commitment even much later on.

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  1. It seems rather obvious that someone contemplating suicide could truly benefit from talking to someone about what is troubling them. This would require a voluntary, confidential conversation to produce honest talk.

    But the entire mental health profession has no intention of providing any such kind of help.

    Licensed and/or certified by the state, and insured for liability, counselors and therapists of all stripes may promise their clients that their conversations are absolutely confidential. But this is not true.

    For mental health providers are required to violate confidentiality under several important circumstances, including their opinion that the client is “a danger to self or others”; is committing child or elder abuse, has records which are subpoeneaed, or pays with health insurance (MIB keeps credit like reports on health care and makes them available to health and life insurers, employers, employment agencies, and more).

    The new 988 hotline has also been set up to violate confidentiality and report people to the police, who may then initiate a commitment.

    Since the suicide prevention movement seems so awful at preventing suicide, one has a right to ask, “What is its real purpose?”

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    • Thank you Dr. Hoeller! I agree that we need to question what the real purpose of this is. Socially, I read from some people that the purpose of penalizing suicide in this way is to stop people from simply acting out to manipulate others. However, if someone is genuinely suicidal, how is the practice supposed to help? How can a practice simultaneously be penalizing and helpful, punishing and lifesaving? It’s in this dissonance that the explanation of “mental illness” lies.

      It can be speculated that the practice largely exists because it makes hospitals a lot of money, which it does. However, whenever someone is making money, someone else bears the cost. Why aren’t insurance companies throwing a bigger fit? I am genuinely unsure; maybe they fear nuance will be lost on the public, and that they will be slandered as promoting self-harm.

      I appreciate your work with Dr. Szasz a lot. I think a lot points in the article you wrote back in 2022 are relevant here too, though I didn’t touch on it much in the article. Deciding whether someone else’s decisions are rational is dangerous territory when force is involved. Psychiatrists prefer to covertly keep the social order by implicitly assuming that feelings like hopelessness and actions like suicide can never be justified. It’s a form of the just world fallacy. “Symptoms” are interpreted in isolation of causes. Suffering from oppression or abuse is thus pathologized, stigmatizing the individual rather than their greater social context (even when a sociological criticism is sorely needed).

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      • Well, I wrote a comment that more or less I think explains that the involuntary stuff started as a legal liability issue AND the inability to do something to prevent suicides.

        No one is going to be clear about that. It’s worse than that, but it’s in those comments.

        Money of course is an issue precisely because of legal liability. To risk imprisonment doing anything, one has to charge for its risk of happening, regardless of the patients well-being.

        Practitioners and patients become opponents in an economic exchange, they can’t honestly be conceived as willing/free, informed enough participants in those economic exchanges.

        They don’t coincide in a market to do an exchange because they agree. Honestly those exchanges can’t be considered a coincide of interests.

        In economic terms they aren’t trading even if money changes hands. It’s more like extorsion, fraud, assault, burglary and RENT extraction.

        Legal liability has to be charged, like lawsuit insurance, liability insurance, regulation compliance and yes clinical records forgery.

        But regardless where it comes from. There is the issue of sunk costs:

        Many mental health workers already invested in their education for the work they do.

        Many economists, even non-economists might say: sunk costs are not to be considered for the decisions you are taking now.

        Well, emotionally that is difficult to accept, but to continue in the market for human suffering is in fact irrelevant.

        And that leads among other things to coercion, misinformation, deception, dishonesty, barries to competition, asymetries of information, etc. Like “lemmon” markets for human beings in economics metaphor.

        I hope my comments to this post are put in full eventually, I did wrote them carefully, and I do think contribute something that is unlikely to be said openly…

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  2. Great article, I just have several comments I’d like to add, precisely because it is quite good:

    ‘“Involuntary” means treating a subject as though they are unconscious’. That is not true, it means the will of the treated is irrelevant.

    Unconscious in medicine has some specific, sometimes meassurable signs: like brain dead, in coma, stuporous or in delirium (not delusions).

    Even people in those circumstances sometimes expressed a will that has to be respected. In that sense their treatment might not even be INVOLUNTARY.

    And, stuporous or in delirium people have to be treated considering the will they express there at that moment: a practitioner might harm, even kill a patient if their will is not taken into account, even when stuporous or in delirium.

    Imagine a tube has to go somewhere and the patient is resisting: their will has to be considered when trying to “insert” the tube. Some people in those circumstances can’t even be sedated safely without an anesthesiologist, and anesthesiologists tend not to hang around in emergency rooms or outside the operating rooms.

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  3. I haven’t done the math, and I am not arguing that psychiatric hospitalization helps at anything, in the sense that it does more good than harm. But:

    If previous* psychiatric hospitalization increases the chances of dying 60 fold, and depression increases it 6 fold. Assuming they are independent that gives a 360 fold increase of suicide when both present. And they kind of have to be independent since those odds are calculated by some form of regression to be independent from ALL RELEVANT risk factors.

    Otherwise practically and in research will be useless by confounding factors.

    Then if poverty, violence, unemployment, addiction, PSYCHIATRIC MEDICATION, PSYCHIATRIC EVALUATION, PSYCHIATRIC CONTACT, even the nearbyness of a psychiatric hospital increases a given person’s probablity, risk of suicide, then it should be predictable. Just the odds of not doing it seem small. Say each is around 5 fold: 5x5x5…x360 is A LOT. I know some are “just” twice, 2, but…

    But, then, I realized my error: I am assuming psychiatric research is actually taking into account in the meta-analyses and the original reseach, quoted partially, actually ALL risk factors IN the models to calculate suicide risk. Only to come empty handed…

    Then there is this to explain:

    ‘A 2020 review in The Lancet showed that “risk assessment should not be seen as a way to predict future behaviour and should not be used as a means of allocating treatment,” in part because “the effectiveness of risk tools in predicting suicide or self-harm is limited.” Caregivers and patients both reported “a lack of clarity on what to do in a crisis.”’, i.e. models have no usefull explanatory AND predictive power.

    To start explaining: current models predicting suicide risk are only a little above 5% predictive power, taking into account they are biased to come out positively predicting in order to be published. That is, they are likely able in reality to predict less than 5%.

    The lack of predictive power might most likely be because the greater predictors of suicide risk, the really important ones, are actually CAUSED by psychiatric intervention.

    They will never incorporate those to predict suicide risk!.**

    That unfortunately sounds perverse, but it does sound explanatory to me.

    *I say previous, because patients actually DO commit suicide while psychiatrically incarcerated, particularly on weekends and “leaves” of absence. Usually concelead or covered-up in clinical notes, law reports and research. As per the research.

    **See, 360×15 is 5,400. The rated of suicide in the US regardless of age and gender is 15 per 100,000. 5,400 divided by 100,000 is ALSO above 5%.

    Without accounting for age, sex, and all other known “risk” factors.

    SSRIs increase suicide risk at least 4 fold. So, SSRI + previous hospitalization + diagnosis of depression would give a suicide risk of: 21.6%.

    Saddly, doing poorly a guesstimate might suggest putting EVERYONE with THOSE risk factors ALONE under INVOLUNTARY CARE.

    I hope some more mathy fellow does the proper risk estimate…

    Regardless of my fantasies, I think that explains a lot about psychiatrical practice.

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  4. The thing that I think originally drove current suicide uncare is legal liability. Not the false notion held among practitioners that interventions were effective to prevent suicides. Some sometimes express it’s ineffective in achiveing that.

    They were effective to prevent lawsuits and incarceration for practitioners.

    And I am not justifying ANY and ALL practitioners decisions and judgements, but they most definitely do have obligations to avoid suicides when they have no tools approved by research and KOL written guidelines to show, even suggest, they can’t be responsible for someone’s suicide if they do nothing, to begin with.

    That even sounds shocking for patients and relatives: “There is nothing we can do to prevent suicides”. When it in fact is true: they can only make it worse.

    And that was not about power discourse stuff nor human rights, but about legal liability. Now it’s different, but still important to be aware, I think.

    For context, as far as I know: decades ago refusing life saving surgery was not allowed, it was forced, imposed against the patient’s will. Even refusing blood transfusions on religious grounds was “managed” by sedating the patient and kicking out the relatives to do the transfusions…

    Even if he or she was not mentally ill.

    That then was not paternalistic, was intrinsic to the ethical practice of medicine. Morally false even then, but given it was part of the ethical creed, could not be disobeyed.

    Particularly if it was punishable by law. Given it was indistinguishable from denying care, which was in some cases a crime.

    So, law changed, and now refusing treatment is OK, even if life saving.

    So, when it comes to suicide, law has to change, particularly when psychiatry will have to admit it made things worse, and their models deliberately ommited the highest risk factors, which are actually caused by psychiatric interventions.

    That will require a “pacification” process of sorts.

    Like the FARC in Colombia, and many other? crimes against humanity…

    But psychiatry has to come clean, no pacification without disclosure and admission of wrong doing will fly in the modern world.

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  5. “vaccinating children” is actually also about public health. And there’s always the fact that legaly children of vaccinating age cannot refuse consent for medical treatment. Only their parents/guardians can. And when parents refuse mandatory vaccination, that goes against the superior interest of the children. And public health.

    It’s a conflict of interests that has by necesity to be solved, adjudicated by the state, it’s not even left to the practitioners to decide, technically. I am no lawyer, but otherwise a callous society emerges. It sounds like: a parent because of belief leaving a children without food, shelter, etc.

    It is not ONLY about effectivenes, it’s about societies values, the laws that represent those values and the conflict in guarding them for minors when the primary guardians refuse.

    The will of the minor is relevant to HOW, not to IF. Going against his or her will can do harm.

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  6. As corolary, given my fantasies might predict such a high risk of suicide ONLY when taking into account psychiatric treatment AND psychiatric diagnosis factors, regardless of the inexistency of mental disorders, they are empirical ODDs after all, tells me NOT that psychiatry is USEFUL, but people are more willing to be ALIVE, despite such FORCEFULL risks.

    Hyperbolically and euphemistically: “cared” patients die less often that the best attempts of psychiatry. That does not speak to me of the benefits of psychiatry, but of the WILL to LIVE inherent in ALL of US.

    Being alive against those odds does not speak of weakness nor disease, but of STRENGTH.

    Will it be decent, caring, scientific, legal?, justified, HUMAN, when such FORCE is put upon one of US to continue living?.

    Would that not be PROOF the suffering CAUSED by those ODDs is unbearable?.

    I know some suicides are more? irrational, but I am making a CASE against THOSE ODDS, not against ALL suicide.

    QED.

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  7. So, according to:

    https://www.absoluteprohibition.org/robert-whitaker-medical-science-argues-against-forced-treatment-too/

    A person that takes SSRI (6 fold increase), goes into a psychiatrist office (8 fold increase), lands on the psychiatric ER (28 fold increase) AND finally ends up in psychiatric incarceration (44 fold increase) has, just because of that an 887% chance of dying by suicide?.

    6*8*28*44 times 15 divided by 100,000.

    Could anyone explain what I, I, am doing wrong?.

    I guess it looks like almost 9 death sentences?.

    So, only thing, it is only a “small” fraction of the population going the cursus psychiatricus?.

    Or people psychiatrically addressed and incarcerated REALLY do want to live?.

    Of course, the risk calculation caveats still stand. It’s just I am not explaining that.

    Someone elses have to come clean.

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    • Changed my mind!, just to clarify my mistakes:

      The “6*8*28*44 times 15 divided by 100,000.” quoted calculation apparently fails victim of missculation because those risks are linked:

      Just going into a community psychiatric center, psychiatric office, whayamacallit, is close to garanteed to land the goer into with at least one out to psychaitric diagnosis. At least one, I bet in those centers multiple diagnoses are more common.

      That in turn is almost 100% garanteed to land the goer into with a prescription out to for a psychiatric medication. At least one, I bet in those centers multiple medications are more common.

      Then that will lead to more psychiatric diagnoses, more medications, and eventually significantly enough deadly hospitalization during and afterwards. Eventually and speculatively…

      Just going into such places can give the goer into the dungeons of psychiatry a risk, not an individual probability yet, in fact around 44 times, FOLD, higher than otherwise would be.

      Forty four times higher than the baseline rate of suicide in the population, now an individual probability, just not explictly quantified. It just takes time to materialize…

      The 8 times and 8 times and 6 times and 28 times, under that course, in and out, is a proxy for the 44 times. It’s not garanteed to multiply if one starts from a psychiatric community center. But it might if one starts somewhere else, ironic…

      Not the 900% individual probability naively calculated. But it might be true for different pathways to psychiatric hospitalization in Denmark.

      Depression diagnosis in several studies* increases the risk of suicide around 6 fold, even I assume when done by a GP or a social worker. Even self diagnosed by a non-mental physician. It’s a regression metric supposed to be independent of ALL relevant variables.

      And so forth.

      But beyond the criticized calculation I, I, did, self-criticism when nothing more is available is a blessing, the rest of my comments in my previous comment still stand.

      Even a 100%, 200%, 50% INDIVIDUAL PROBABILITY, not risk increases, at the scale of psychiatric practice is bound to burden society and individuals sufferers with such force that makes the case I made solid. I think…

      And I don’t mean risk starting from 15 in 100,000, I mean a person trying to walk on the street with my conservative estimation of depression, use of SSRI AND hospitalization has around 20% chance of suicide. Not increased risk, but individual probability.

      Like:

      6 times 60 is 360, times 15 is 5,400, divided by 100,000 is 5.4% individual probability, not risk increase for individuals with those risk factors!.

      Times 4, FOUR fold because of use of SSRI is actually 20% chance of committing suicide, not merely an increased risk. Add another and another, I think I made a point…

      Now me speculating, hopefully now, correctly:

      The increased risk of suicide might not decrease as time goes by. Sufferers might adapt to living on the edge, and society might do too. Like living next to a powder keg, without actually moving or getting rid of the keg.

      So, when the increased risk apparently decreases over time might be because adaptations from the sufferer and society that inhibit the bad outcome.

      And that might take time, a suicide happening too fast for society and the sufferer to adapt might not be preventable.

      That could explain why, without going into neurochemical kerfuffle suicide increased risk happens IMMEDIATELY after starting SSRI, changing SSRI, tapering SSRI, withdrawing SSRI, going into psychiatric hospital, and just after outing of one:

      There might not be time to adapt for the sufferer and society.

      Not because neurochemical hypothetical fantasious brain adaptations, because the human spirit to survive and care for others.

      Studying that requires first a mathematical model, not more crappy pappy neurochemical pseudoscientific lingo.

      To narrow down what possibly could explain the observations under MY hypothesis. A mathematical model, not a neurochemical one…

      *Oddly enough, per some published research, the 6 fold increase of depression diagnosis, not disease/disorder, lands in the middle of increased suicide risk in the table of psychiatric diagnoses. Between 2, two, the lowest and I think 9 or 12, for “severe mental illness”.

      So, the diagnosis is not strong enogh, it sounds peanuty, compared to 60 fold. But in those case it does multiply. And odder is around the same as medication for depression: between 4, four, and 12, twelve.

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  8. Guessing no KOL is going to explain me, literaly either way then this is coming:

    The weight of the risk factors BY PSYCHIATRIC INTERVENTION, assuming they are independent and accurate NOT leading to 9 death sentences…

    Given the supposition that those calculations represented reality at the moment of calculation…

    ALSO speak, suggest, that SOCIETY from the time of calculation of the risk factors UNTIL the then predictable fatal outcome has mitigated those risks enough for them NOT to materialize…

    Society adapted, reacted fast enough to greatly mitigate those increased risks. It’s been burden by them and it vanquished them with honors. It conquer DEATH better than any MEDICINE available.

    And speaks to me that the network of social care, however counterintuitive for MANY of US, particularly those reading MIA, the MIAsers, has HOLD US with such invisible, counterintuitive, caring and fastly adapting net…

    DESPITE the BEST EFFORTS of psychiatry, NOT because of them…

    That speaks of social progress, social fairness, etc., not of social decay, in a way that as far as I can tell, hasn’t been meassured otherwise.

    But, another of my fantasies.

    I imagine if PSYCHIATRY was not here, where would OUR world would be?. Where those gone by it would be?.

    As a corollary, sociey at large, WORLD society might be struggling to keep up with such barrage of the BEST efforts of psychiatry.

    And that might explain WHY so many wars, famines, mass shootings, rampage shootings, teen suicides, despair deaths, vitriolic rhetoric, polarization, etc. are increasing or being more notorious:

    Something has to give…

    And those are the risks by suicide, those are not the risks of disability, unemployment, early death, aggresion AND violence otherwise…

    So doing the math paints such a HORRIBLE picture, and one so HEROIC at the same time.

    Looking over my shoulder I can imagine, another fantasy, those that preceded me wishing me the BEST of lucks, maybe more… if only they’d known and could do SOMETHING about it…

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  9. I have been ‘suicidal’ for more than 30 years. I know how I would do it. And I’ve even told my wife where to look for me if I go missing…I’ve just learned to deal with those thoughts. Most of the time they aren’t very strong, but they come and go.

    However, last fall I had a panic attack, and ended up in the hospital just to make sure it wasn’t a heart attack. One of the questions they asked was about suicide. It scared me to death that part of me might answer honestly….

    Then I got a cancer diagnosis this past spring. Of course, that increased the suicidality that I experienced. And this past Monday when I finally went in for surgery/treatment, they again asked if I ever felt that way, sigh. It’s terrifying. Of course, someone with cancer, at times, feels suicidal. It’s a huge effort to fight this beast within. It’s a big effort to fight the other things I’ve faced my entire adult life. And so far, I always have fought. But the thought of suicide as a way out if things ever get too bad, has actually kept me alive.

    This is such a screwed up culture that I have to be terrified of being honest…hoping to God I never utter the truth when they ask me those questions, sigh…

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  10. When the social worker in my oncologist’s office asked me if I’d ever had thoughts of harming myself, I made the mistake of admitting to her my previous suicide attempts while telling her I’d lived with chronic suicidal ideation for decades. I told her how surreal it was to be fighting for my life now, how I had so much to live for. But she immediately took a typical psychiatric approach and started asking safety questions so I asked her if answering them could get me forcibly detained in a psychiatric unit. She said they could.

    I find it truly bizarre that at any time I can end treatment and choose hospice, which would lead to the end of my life, but if I were to choose to take myself out more hastily, I could be detained in a psychiatric unit. It makes absolutely no sense to me. My surgeon was already willing to sign me off to hospice as I am stage IV and my life expectancy is short even with treatment.

    I will go to my death failing to understand the way hurting humans are punitively treated by the psychiatric system and the western medical system in general. This makes me so sad.

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    • I do try to put myself in your shoes. And I can feel terrible.

      But, I guess the harm by the War on Suicide is linked with the Euthanasia Omission?.

      And actually SR’s comment and yours do show in a human, undestandable way that suicide thoughts are justified in some cases.

      And it’s persecution, literally, at least in those cases is atrocious. And that does not mean in other cases is not atrocious. It just proves very forcefully a case.

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    • KindredSpirit, I am very sorry to hear of your battle with cancer on top of the other health issues with Lyme. I send you best of wishes and will keep you in my prayers.

      It’s dreadful they will punish someone if you are truthful about your feelings while you are going through a most challenging time in life following a cancer diagnosis.
      I was given a cancer dx with basically a death sentence in 2009. The pathology, pattern and other factors made no sense to me but my questions were dismissed by an arrogant, self-serving, fear mongering oncologist. I dropped one of the chemo drugs (carboplatin) after 2 rounds (due to severe vertigo, tinnitus, gusher nosebleeds and head trauma due to the dizziness) and then quit chemo altogether half way thru. A long story but they used psychiatry against me to fabricate labels and try force more treatments. I was sent to a psychiatrist under the guise it was to “get help with sleep meds” after the steroids and chemo drugs had caused insomnia. I was shocked/confused when the psychiatrist asked if I was suicidal. As I wasn’t I replied “No”. She indicated she didn’t believe me so I reiterated I was NOT suicidal and in an effort to convince her I added that I didn’t have a Will and would NEVER want to die without a Will. When I later got my records I saw she wrote that the only thing stopping me from committing suicide is that I didn’t have a Will. Very scary how these people can totally twist the facts to have it be their own narrative. Take care and best of wishes.

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    • Thank you KindredSpirit. I am so sorry for the position you are in right now. I agree that it’s wrong for government and psychiatry to use force to tell others how to deal with their problems… Problems they have never dealt with and would probably pray they never have to. Every form of suffering now has a psychological label, to the point where if legitimate diseases of the mind truly exist, they are clouded by the vast numbers of cases where people are just… going through horribly tough times.

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  11. Sam and Kindred Spirit I am saddened to hear of your new and for Kindred Spirit continuing issues with cancer. And yes though the medical system is fragmented in many ways the whole issue for wanting not to be is more than punative in thst it is almost a criminal act despite most folks have experienced this type of thinking. The Jewish folk involved in Masada choose death over oppression so it has always been there. How to compassionately coexist with these human emotion and thoughts has never really truly been taken other than perhaps intentional peer support and of course artistic works of all sorts.
    I think if we could talk in honesty to any one having just a damn hard time and listen and not talk back that would help. And isolation and not having others to hear you and at an appropriate time say woah I had no idea and if you followed through I would miss you …… but I hear and honor your feelings and thinking at this time.
    It’s not that hard to do and one just has to be accepting of the wide wide range of humanity and take it as it comes.
    One time as a child I was stating with my grandmother and there was a young disabled man who walked around. My grandmother was getting breakfest and in walked the young man into the kitchen. She just turned around called him by name well so abd so how nice to see you and went on if nothing untoward had happened. It’s that ability I wish you both coukd find to support you now.

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  12. Great article, I just HAD several comments I’d like to add, precisely because it is quite good:

    ‘“Involuntary” means treating a subject as though they are unconscious’. That is not true, it means the will of the treated is irrelevant.

    Unconscious in medicine has some specific, sometimes meassurable signs: like brain dead, in coma, stuporous or in delirium (not delusions).

    Even people in those circumstances sometimes expressed a will that has to be respected. In that sense their treatment might not even be INVOLUNTARY.

    And, stuporous or in delirium people have to be treated considering the will they express there at that moment: a practitioner might harm, even cause the demise of a patient if their will is not taken into account, even when stuporous or in delirium.

    Imagine a tube has to go somewhere and the patient is resisting: their will has to be considered when trying to “insert” the tube.

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    • I agree that people who are experiencing altered states are often harmed by practitioners. It’s like there’s no humanity in some of these “doctors” towards people in psychosis for example. Plus conspiring against and attacking people in psychosis is about the cruelest thing you can do. It makes things so much worse.

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  13. I haven’t done the math, and I am not arguing that psychiatric hospitalization helps at anything, in the sense that it does more good than harm. But:

    If previous* psychiatric hospitalization increases the chances of dying 60 fold, and depression increases it 6 fold. Assuming they are independent that gives a 360 fold increase of suicide when both present. And they kind of have to be independent since those odds are calculated by some form of regression to be independent from ALL RELEVANT risk factors.

    Otherwise practically and in research will be useless by confounding factors.

    Then if poverty, violence, unemployment, addiction, PSYCHIATRIC MEDICATION, PSYCHIATRIC EVALUATION, PSYCHIATRIC CONTACT, even the nearbyness of a psychiatric hospital increases a given person’s probablity, risk of suicide, then it should be predictable. Just the odds of not doing it seem small. Say each is around 5 fold: 5x5x5…x360 is A LOT. I know some are “just” twice, 2, but…

    But, then, I realized my error: I am assuming psychiatric research is actually taking into account in the meta-analyses and the original reseach, quoted partially, actually ALL risk factors IN the models to calculate suicide risk. Only to come empty handed…

    Then there is this to explain:

    ‘A 2020 review in The Lancet showed that “risk assessment should not be seen as a way to predict future behaviour and should not be used as a means of allocating treatment,” in part because “the effectiveness of risk tools in predicting suicide or self-harm is limited.” Caregivers and patients both reported “a lack of clarity on what to do in a crisis.”’, i.e. models have no usefull explanatory AND predictive power.

    To start explaining: current models predicting suicide risk are only a little above 5% predictive power, taking into account they are biased to come out positively predicting in order to be published. That is, they are likely able in reality to predict less than 5%.

    The lack of predictive power might most likely be because the greater predictors of suicide risks, the really important ones, are actually CAUSED by psychiatric intervention.

    They will never incorporate those to predict suicide risk!.

    That unfortunately sounds perverse, but it does sound explanatory to me.

    *I say previous, because patients actually DO commit suicide while psychiatrically incarcerated, particularly on weekends and “leaves” of absence. Usually concelead or covered-up in clinical notes, law reports and research. As per the research, not refered here.

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    • See, 6 fold times 60 fold is 360 FOLD, 360×15 is 5,400. The rate of suicide in the US regardless of age and gender is 15 per 100,000. 5,400 divided by 100,000 is ALSO above 5%. It is 5.4%.

      Those three risk factors are what at least one meta-analysis gave for the BEST model/s for predicting suicide in the “ER”. And of course, I don’t remember it taking into account hospitalization at 60 fold and SSRI at least at 4 fold. Why? I stoped wondering…

      Without accounting for age, sex, and all other known “risk” factors. Some of which change the baseline rate, like age and gender.

      SSRIs increase suicide risk at least 4 fold. So, SSRI + previous hospitalization + diagnosis of depression would give a suicide individual probability of: 21.6%.

      Saddly, for a practitioner, doing poorly a guesstimate like me, might suggest putting EVERYONE with THOSE risk factors ALONE under INVOLUNTARY CARE.

      I hope some more mathy fellow does the proper individual probability estimate…

      Regardless of my fantasies, I think that explains a lot about psychiatrical practice.

      It at least explains the repeated incarceration and the overmedication and the use of neuroleptics and ECT for “treatment” resistant depression.

      Such “treatment” resistant patients might most likely have such HIGH suicide individual probability of suicide, not merely increased risk, BECAUSE PSYCHIATRIC INTERVENTIONS.

      And again, they are not going to put those psychiatric intervention factors into any model. They rather admit quietly defeat AND, like Mr. Aftab suggested FOCUS on treatment resistant depression.

      That more aligned with my arguments, should better be called: increased individual probability of suicide because of psychiatric interventions, not treatment resistant depression.

      QED. out of order, but still…

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  14. As I consideration put forth to parents, teenagers, clinical psychologists, etc., not a recomendation.

    Given my heavily speculative tirades about suicide and psychiatric interventions. Admiting it’s my hypothesis and not a fact nor a theory.

    As a too long didn’t read:

    Maybe to prevent suicides the FOCUS should change from resilience to ADAPTATION.

    Resilience seems to hold for many under the weight of heavily increased risk of suicide by psychiatric interventions (see some of my comments above if curious).

    So the sudden change, and I guess specially if the change affects previous adaptation strategies suggest it might be more productive to focus on adaptation than resilience.

    As far as I poorly remember/understood suicide in some is tiggered by sudden bad news, sudden changes, sudden violence, sudden insult, sudden despair, and sudden chemical changes in the brain, etc.

    And I guess suicide happens when an individual and society is unable to adapt fast enough to such way too sudden changes.

    Aware I don’t like surveillance, and I am not arguing for or against, trying to usefully walk the middle.

    And given suicide is about survival in evolutionary terms, it makes sense adaptation is more important than resilience.

    Without becoming or arguing insensitive stuff like “adaptation of the fittest” in pernicious social discourse.

    From first principles evolutionary theory, without the ugly neo-whatever stuff. Respectfully.

    How? I don’t know, I’m pretty sure someone else has better ideas than me…

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  15. You can also volunteer for psychiatric hospitalization, then realize it is NOT a place of care and concern, NOT a place of safe treatment options, and find you are stuck. In Texas, I once requested that the hospital I was in begin the AMA (leaving Against Medical Advice) paperwork. I had gone through this before, so I knew what was involved. The facility doctor-in-charge took me aside and said, “If you try this, I will take you before a judge and have you placed here INvoluntarily. I will do and say whatever is necessary. And who do you think a judge is going to believe — a MD psychiatrist, or a crazy patient?” I had no choice but to stay. Because involuntary commitment in Texas goes on your permanent record and your rights and freedoms can be taken away on a number of levels. So I “did normal” until I was released a couple of weeks later.

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    • Thank you Donna. It’s unfortunately true that there are penalties even for going voluntarily. In my experience, most people in psych wards aren’t there of their own will, but either were forced in from the beginning or didn’t know quite what they were getting themselves into. There’s also no real ability to build a case from inside the ward, and contesting the psychiatrist can make things so much worse for the victim.

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      • Like being held hostage with deceptive means, under the control of persons lacking empathy, insight and morality, joyfuly displaying impunity, with access to chemical weapons used in ways considered pharmacological torture in the Soviet Union, Africa and South America.

        At least documented and acknowledged there.

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  16. I agree with abolishing Canada’s provincial Mental Health laws to end police apprehensions (this is what they are called in Canada) and Ontario Form 1 and 2. There are great alternatives to police response like TAIBU and Gerstien Centre in Toronto, yet they can’t deal with suicide attempts (just ideation) due to current legislation.

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    • Thank you, Nicole! I agree, and I hope more alternatives keep coming to all countries. People who are attempting, or just attempted, suicide are so vulnerable. Incarceration just creates more shame and trauma, and victims are likely to regret failing rather than attempting. The policy is so dangerous and increases likelihood of attempts after. I hope there’s a massive lawsuit in at least one of our countries soon so that things are changed drastically.

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  17. Fantastic article.

    Thank you, Crystal Nelson, for seeing things from the patient’s point of view and for focusing on something that doesn’t get nearly enough of the right kind of attention. I hope your article helps people see things with more understanding and compassion, especially those who work in the system.

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    • Thank you so much! I really hope so too. MIA has been putting out articles on this topic for years, and I hope at some point enough victims of the system will be heard. Even minute changes like making advance directives able to completely prevent forced hospitalization, and making them commonplace and compulsory, could drastically improve outcomes. There are a few people who report having benefited from coercion, but they are much rarer than the media would like people to think. People should be able to protect themselves from all force and have those directives respected.

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  18. When I was in my early twenties, I called a suicide hotline. I made the mistake of hanging up while on hold.

    They sent the police to my door. When the police approached, I put my hands up, backed away, and said I’d been raped by a cop. So they rushed me. They grabbed my arms, pulled them behind my back, and put me in handcuffs. I was put into the back of a police car where I waited for about twenty minutes before they drove me to the police station, handcuffed me to a concrete table, and grilled me with questions. Eventually they put me in the back of a white van, still in handcuffs, and drove me to a hospital, where I was involuntarily held in the psychiatric unit.

    The moment I was able to speak to a psychiatrist on duty, I told him that I was not actually suicidal, and they’d made a mistake. I said whatever I needed to say. I was escorted to the curb (literally) where I spent the evening sitting and waiting for someone to come and pick me up. That was society’s answer to someone in turmoil: re-enact a trauma, take away all their power, then leave them alone on a curb in another city, in the dark. What… the… f***.

    I vowed never to call for help again. I was a student at UC Berkeley at the time studying psychology and public policy. For my public policy course, I wrote a paper on the 72 hour hold. The problem is that people who’ve never felt suicidal think it’s such a bizarre thing to feel that you must be out of your mind, and if you’re out of your mind, hauling you to the hospital before you off yourself seems to make sense.

    Except it doesn’t. These policies will never change until enough people can empathize with those who just don’t want to be alive any more.

    On a side note, I also got a cancer diagnosis last year, and I was asked about feeling depressed or suicidal. I answered truthfully but used their big black felt pen to write in large letters over the questionnaire “BECAUSE… I… HAVE… CANCER!” As far as I know, they just filed it in a drawer and never spoke of it again.

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    • Thank you for your story, Lisa! That is so heart-wrenching. Police do not belong in mental health and so often aren’t remotely trained to be.

      I’ve noticed a lot more people have been talking about suicidal ideation in recent years. The younger generations seem, on average, more likely to understand, either from personal experience or seeing those around them go through it. Same with commitment. Commitment is so common in the U.S. that virtually everyone I’ve spoken to under about 40 either knows someone well who has been committed or has been themselves. The process is violating, sexual assault is often mandated via stripping, and people are routinely held beyond their holds, turned into slaves.

      Psychiatry labels signs of distress as symptoms, then uses that to call all severe distress “mental illness,” regardless of merit. They then use this so-called “illness” to discredit victims of their field. It’s so dangerous and predatory, but as more and more people are getting labelled “mentally ill” and becoming suicidal, I think the public will understand soon. Critical mass is being reached, as current best estimates show that 75-80+% of people will be “ill” with these these constructed “disorders” in their lives, and suicidal ideation at least once is common too.

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      • I don’t think the prevalence of the thing is going to have much impact.

        Overweight, obesity and hypertension already lowered the shocking bar for widespread diseases in the population.

        The increased prevalence and recognitition of changes in “cognition” as the population ages normalizes the idea that some diseases/disorders can be very common, and that should not surprise anyone.

        Specially when cheap false explanations, as in psychiatry or nutrition/diet can pass muster because critical thinking is diluting among the populace. And the media that could possibly provide in depth accurate analysis has to compete with less than 2 minute videos by influencers paid to promote something.

        Doubly special when, even if the scale tips the other way, alternative explanations, not reasons, let alone causal explanations, will be used to blame mental disorders on sick societies.

        Even obesity, overweight, insulin resistence and hypertension are blamed on sick societies imputed to the fast food/agro bussiness complex.

        And although correctly at least in my opinion, understatement, the relevance comes from admiting, accepting and encouraging the view that mental disorders are as real as diabetes and hypertension.

        Which is provably false just on 2, two, paragraphs of the DSM.

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    • I am sorry about your diagnosis.

      That being said, without diagnosing nor giving medical advice, I did informal searches on cancer, mortality by cancer and benefit of treatment.

      It has been published in mainstreamy media, last I think it was The Guardian or the NYT, both?, that there are overdiagnoses of cancer because early, sometimes spurious detection. Those probably can be found by searching the web for increases in diagnoses among people under 50yrs of age (at “early age” was the spin to publish IMO). It was published not more than 2 months ago.

      Typical of small benefit of early detection and pauper advances in treatment are breast cancer and prostate cancer. Which, to compensate, are not the high mortality cancers I would otherwise worry about.

      Those cancers do cause a significant amount of fatalities. But at the same time, the majority of people with those diagnoses do not pass away because of them. And, I speculate, in many do not cause symptoms or malaise, beyond being diagnosed.

      I am not arguing for ignoring them, nor for overtreating them, while implicitly knowing that the treatment of those 2, two, cancers has not improved much in the last 40yrs. Despite the hype.

      That is clearly inferable from looking at the worldwide mortality of those two cancers, depicted as 5yrs survival from the page Our World in Data. There are published meta-analysis but those have to be read “against the grain”. Just like published research in psychiatry.

      Granted, early detection might seem like an explanation both of increased diagnoses, longer survival and more effective detection/treatment. And pollution seems explanatory for cancers at early age, or more common at “appropiate” age, beyond tobacco use.*

      But from my professional previous expertise, the value of early detection above the harms it causes is minimal in the aggregate of people diagnosed earliER with cancer.

      Typical of that are precisely prostate cancer and breast cancer, which are by far the most common, excluding lung cancer. The only cancer benefiting from early detection seems to be colon cancer, removed at the stage of “polyp”, using, counter intuitively only flexible sigmoidoscopy.

      That recent finding surprised me in the use of flexible sigmoidoscopy, and not full colonoscopy. But it didn’t surprise me on removing colon polyps, that’s a peculiarly unique case among cancers, and it’s removal does not involve “major” surgery, so no surprise there.

      And full colonoscopy does have the risk, even in expert competent hands of colon perforation. So, no big surprise there either. And detection beyond the reach of a flexible sigmoidoscope has always been difficult. No big surprise there either.

      So even in that case, the standing sucessfull one, the benefit of early detection is very, very small when meassured in the population. And unique among cancers, no surprise finding one unique either.

      And lung cancer, again from my previous professional experience, can’t/shouldn’t really be detected early. Precisely because false positives and early surgical treatment of lung cancer is way more aggressive than FOR breast cancer.

      And from my professional experience, even with computer assited diagnoses, early lung cancer detection might be impossible!. The biology of cancer, the exam under the microscope of cancerous and non cancerous lung “lesions”, suggests that population wide through imaging detection, will be so tough to perhaps negate early detection benefits. Because of the harms of early treatment, early intervention AND detection.

      Regardless, again not medically advicing, of what published research and consensus statements, even by the US Preventive Task Force suggest.

      The USPTF, from my around 1 decade experience following their advises went the way of Cochrane described by Peter Gotszche. And at the time I started following it, was quite good!.

      And, again without medically advicing, one of the shamefull periods of my medical practice was precisely doing early cancer detection, of several kinds, shame, shame, shame for me. Briefly, but I did got into the research 15yrs ago, around, younger silly me, and as far as I cursory looked at the current state of affairs has not improved much.

      And the outstanding issues supporting early detection efforts have not been solved, they were swept under the rug of the propaganda for early detection promoted by industry, collegiate medical bodies and the media. Preying on the hightened fear in society to cancer, and demise by it.

      Not unlike psychiatry.

      Which can be tempered, tappered down, by looking critically at the aggregate statistics of cancer, ALL cause mortality, it’s prevalence at greater ages and the lack of progess in reducing mortality by it, in the, at least last 40yrs.

      Not unlike psychiatry, the aggregate statistics as pointed many times at MIA do suggest more harm than good by psychiatry’s interventions.

      *Increased cancer risk beyond tobacco use is around, AFIR, 20-30-50% increased risk, which seems small to not cancer risk, but ALL mortality risk increases by diabetes and hypertension that are at least TWO, 2, fold. And treatment of diabetes and hypertension is relatively safe compared to cancer treatment. And less than 50% risk, ballpark the deduced benefit of nutrition/dietary or life style modifications, that on top, lack causality when used as “treatment” or early prevention

      That’s why I love my fatty tacos, chimichangas, avoiding them will not, in the aggregate, assuming my averageness, lead to demonstrable benefit for me. Saddly, for reasons not prudent to explain, I can’t eat that either.

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    • Thank you Kate! It seems to me the steps are these: 1. Give people in a difficult position psychosis, self harm, and/or suicide-causing drugs. (Don’t tell them how addictive they are and that withdrawals can also be disabling.) 2. If they get these effects, commit them regardless of their will, and perform all the so-called “necessary” assaults. 3. Profit big time. 4. Complain the system is underfunded despite it being one of the most expensive in the world (per capita and PPP). 5. Set up astroturfed nonprofits and beg legislators to try to expand your influence. 6. Succeed because you’ve traumatized, gaslit, and possibly disabled many survivors to the point where they don’t have it in them to fight what you’re doing.

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      • Yes, Crystal, you describe the method of operation perfectly. The final step, I’ve learned, is to make sure that the general public thinks anyone describing themselves as a “psychiatric survivor” or making statements like “it was psychiatry, not mental illness, that disabled me” is not in touch with reality and potentially dangerous.

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        • I wonder why so many people have such faith in the biomedical model despite its catastrophic failures, including but not limited to: treated people having worse long term mental health and social functioning that untreated people with the same problems, and higher death rates! I’m not entirely anti-drug; but, if someone does use them, they should be fully informed and use them as sparingly and short-term as possible.

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          • Because, silly me again, what you are stating is not in the NYT, The Guardian, MSNBC, CNN, etc.

            Not even inTikTok, YouTube, Instagram, Facebook, etc.

            And it will be probably down ranked by algos fighting missinformation.

            ChatGPT sputters in that direction. And alt media won’t peddle that either: it requires the fear, why tone it down?.

            On top of specialized companies that do PR stunts on behalf of less than reputable moral persons or individuals. To exactly downgrade or remove from the nets said evidence/info.

            The Zyprexa papers are a good example of that. And many more.

            On top of companies like now renamed black cube, n s o group, etc.

            But, I am not pointing to loosing grounding. Just collabra… Going the rabbit hole is not my ponting direction.

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          • I agree. It almost seems like a lot of people don’t want to be informed. They embrace whatever psychiatry claims is real.
            Based on what I’ve been seeing lately in the media, incl. social media, “mental illness” is very much in fashion. There’s a young (20s) female comedian named Taylor Tomlinson who discusses getting a bipolar diagnosis, and seemingly never questioning the legitimacy of either the dx or the drugs she’s prescribed. The comments section of her videos is full of people who say that they’re also bipolar and are glad that they share a dx with Taylor.
            There’s a new line of high fashion apparel promoting antidepressants. Cute sweatshirts that just say “Lexapro” or “Prozac” across the front. I really need to remove myself from society at this point. It doesn’t feel safe anywhere.

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        • I can’t respond directly to your Taylor comment, but I totally agree. When she speaks of her bipolar, it almost sounds like she leans into the worst stereotypes of the diagnosis. She can be very funny and it’s sad to see her buying into this narrative about herself. I worry for her in her adoption of the bipolar label and using it to lighten patterns of thought and behavior which can be highly concerning and harmful in the long run.

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      • Withdrawals can be deadly too.

        And addiction is on top of dependency.

        I would add another number, to be callous/indifferent about harms you cause, or even sadistic about them.

        That will keep someone engaged in the harm causing proffiting affair. Best if the practitioner enjoys the practice. Seems reasonable motive to perhaps be explanatory.

        Not intruding, hopefully too much, but like the critiquer is going looser.

        Good thing, I encourage moderation of that, but openness to it. Silly me, like I had something to contribute.

        🙂

        Is being thoughtfull being carefull?.

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  19. When I was in my 20’s, I developed hives daily and after seeing 3 doctors I was finally given steroids. As soon as I finished them the hives came back so I was given more steroids. I then became depressed and suicidal (same thing happened to Jane Pauley and she developed Bipolar Disorder).

    I saw a psychologist and told her I thought the depression was related to the hives/steroids and wanted her to look into it. Instead I was sent to a mental hospital via ambulance. During “group therapy” we were asked to tell our story while medical students listened and made notes. It was humiliating and unhelpful. The following day I was told they were taking us on a “field trip” to play miniature golf. Then they told me that since I had been admitted against my will, I couldn’t go…unless I signed to make it a voluntary admission.

    The psychologist believed that my depression was related to my history of physical abuse by my father. She said I hated my mother for not protecting me. When I tried to tell her that wasn’t true, the antidepressant dose was raised or I got sent to the gym and had to attend a certain number of classes and get signatures to prove that I went.

    At one point I told her that I was having terrible nightmares (which I later found out was sleep paralysis) that really scared me. She asked me what was the worse that could happen. I said, “That I go crazy”. She took her business card, wrote her home phone number and handed it to me saying, “If you go crazy call me and I’ll come get you”.

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    • It is common knowledge that steroids, particularly orally do cause “depression”.

      The old theory was that they disrupted the circadian cycle/rhytm, and that was the dominant theory of depression I think until the 2000s.

      Don’t know if it’s the case for you, but empirically it is a common observation that they cause feelings of “depression”.

      And more speculative, not advising, nor giving a medical advice, but steroids were not supposed to be used for “hives”. In some people caused a severe reaction known as erythrodermia.

      But many people used them, even dermatologists. But it was common knowledge among the devoted to dermatology.

      On a side note, I had a wonderfull, extraordinary short term clinical professor of Dermatology, he was a wizard, a “magister”, literally. Very experienced, and he repeated a lot about erythodermia and steroids for “allergy” or hypersensibility.

      And I read about it and he was right!. He always was.

      Only two clinical professors I met during training never to get it wrong: a dermatologist and a radiologist. And the dermatologist was appreciated by EVERYONE where he worked, a LOT. The radiologist was opposed precisely because he was not only right, but insightfull, and that did not bode well in the prejudice against radiology back then, this was the 90s.

      A dermatologist hero of medicine.

      And to land on relevance, those two medical specialities are objective: what you see is what there is. No imagination, no crazy invented diagnosis, reality as much as your eyes, your training and care can see, unlike psychiatry and clinical psychologist that are imagined, “constructed” in lame terms.

      Only two other specialists made a durable impresion on me, but they were on my field, and I am not talking about it.

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      • I always wonder when I’m dealing with professionals (doctors, lawyers, etc.), if, when they exhibit a particular obtuseness, if they are genuinely ignorant or poorly trained, or just demonstrating their moral or ethical character, if not some kind of power tripping entitlement? Back in the 90’s I pushed back on a doctor that wanted to treat my sinus problems with steroids’, telling her that they caused me to be hyper on the front end of the 10 day cycle, and rather depressed on the back end, and that I preferred another protocol. When I respectfully stood my ground as to my experience of steroids with regard to her claim they “had no such side effects”, she threw the script in the air with feigned exacerbation. On the flip side, doctors have since concurred as much whenever steroids have been prescribed. Now 30 years later, having read hundreds of books surrounding critical social analysis, etc., -and become disillusioned beyond repair, I no longer trust professionals beyond the sunlight of our mutual exchange.

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        • Your options are correct, there is also culture, and the implicit expectation something has to be done about it, and the specialist has to do more/better than the GP/family physician.

          For lawyers there is the acknowledged, sometimes, understanding the legal arena is moving, sometimes quick sandy: strong advice has to have precedent beyond the written text of the law. Which is open to, uggh, interpretation.

          In medicine, on top of the moving sands, there is deception: big pharma does pull huge punches in the medical publishing bussiness. Supreme Courts don’t do that!, in such difficult to see way.

          And, from my biased personal experience, only from Mexico, a little on the US, and from few Universities that do medical teaching: the human material cognitively wise is not that great. Relative to the demands, the requirements of using pharmacology to attempt, at least try, relief. Specially for chronic conditions as allergies.

          On a quiet, whispering voice: And critical thinking without knowing first half 20th century epistemics and scientific revolutions does not… improve… much…things…as…they…stand…today…

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  20. This is a great column.

    Most salient is the fact that suicides increase after hospitalization. If we could better create compassionate and individually tailored treatments then I think results would improve. My hospitalizations were experienced by me as primarily punitive. The facilities were more akin to a prison and there was essentially no psychological care — I was prescribed medications in what seemed more trial and error than scientific but beyond that there was little care.

    I recommend a new book that addresses some of these issues: https://www.amazon.com/WOEBEGONE-autobiography-about-mystery-psychosis/dp/B0CDR3XRX6

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    • Sorry about your experiences.

      But tailored treatment in psychiatry won’t be coming at all.

      The modus operandi is to treat as many as possible, and that is against tailoring.

      Tailoring in my view will take just the diagnoses, not the treatments, to the time where autism was “present” in 1 in 10,000 kids above 5-6yrs of age.

      When depression happened in 1 in a 1,000 persons.

      When bipolar disease, not disorder happened in 1 in 10 depressed individuals, or 1 in 10,000 people.

      And schizophrenia without hebephrenia was a cultural diagnosis.

      Delusions were decades ago culturally innapropiate, I wrote it right, diagnoses.

      And published research in psychiatry seems to be tailored to not be tailorable. So no luck there either.

      The incentives push strongly against tailoring.

      And to my mind there is no alternative medicine, as there is no alternative physics, not alternative chemistry, no alternative mathematics, and no alternative biology.

      Many if not all of those, like psychiatry and clinical psychology, to me are pseudoscientific. And in that regard as disreputable as the paranormal.

      Eventhough I can see, sometimes, the benefit of alternate approaches: just don’t call them science based, evidence based, etc.

      Call them belief based, like religion and philosophy…

      And I am not against talking even arguing about them, unlike many otherwise skeptics. Just, let’s agree, as agreed in the fist half of the 20th century, to not call them scientific.

      And to try to quelch the impression that I am paying lip service to the paranormal:

      Since my late teens I had wonderfull discussions with a group of peers of the most extraordinary kind where I came with the argument that if the paranormally thingies have a will, they will have a way not to be studied scientifically.

      That does not preclude scientific research on the paranormal, but by lack of grounding in reality to their will, it puts them outside the scientific realm. Try to catch a moving sleepery trout in ethereal waters that does not want to be catched…

      And, on top of that, the wlll argument on the suprahuman, the argument from epistemics in the first half of the 20th century was:

      Without knowing how it works, disproving the paranormal scientifically, not empirically, can’t be done. There has to be a “mechanism” beyond doubt to design experiments to disprove.

      The experiment can’t test the experimental methodology, the theory and the argument, i.e. the hypothesis, at the same time. There has to be a theory, as in a series of facts, beyond doubt, that make predictions that are generalizable, and are testable in the real, objective, outside the human mind world.

      That’s how string theory went away in a slow way: beautifull as it was, it never made empirically testable predictions. And grand unification theories appear to go in the same direction. I hope not.

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      • “But tailored treatment in psychiatry won’t be coming at all”

        Maybe it’s because the different mental conditions do share many things…histamine intolerance, neuroinflammation, dysbiosis, low Vitamin D, methylation problems, inability to metabolize Folic Acid properly, MTHFR mutations, etc

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      • My undergraduate major was in physics, and I could feel the strain from the most motivated of the higher level academics to even explain some parts of quantum theory better, let alone the whole of it. I abandoned my main thesis while getting more involved in psych-related studies, but I hope to return to physics on my own terms in due time (though I will remain on a psych professional path).

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    • Thank you DT. They felt punitive because, unfortunately, they are. There is no way to slice it where government-endorsed arrest, isolating incarceration, and coerced or forced drugs/shocks aren’t cruel and unusual punishment. Psychosis, self-harm, homelessness, suicide… the typical things resulting in psychiatric incarceration are presentations of someone feeling hopeless or scared. Punishing people at their lowest like this is a sign of a sick and demented culture.

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    • Thank you DT. Psychosis, self-harm, homelessness, suicide… the typical things resulting in psychiatric incarceration are presentations of someone feeling hopeless or scared. Punishing people at their lowest like this is a sign of a sick and demented culture.

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  21. Thank you for your incisive analysis. Please investigate more carefully the claim that coercion when it comes to vaccination is instead ethically justified, let alone scientifically valid, ‘safe and effective’ (e.g., Drs. Sam and Mark Bailey provide accessible information and criticism for starters). The doctored, fraudulent practices of mental health extend to the medical industry in general, making it a if not the leading cause of death from iatrogenesis (e.g., see the work of Gary Null).

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    • Niko,

      I had hoped that the coercion to get a covid
      vaccine would help people see how wrong it is, across the board, to force someone to put something in their body. I had hoped it would benefit the movement against psychiatric coercion. I guess that would have been too easy :/

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    • Thank you Niko. Vaccines vary in their effectiveness and safety in children. More long-term research is needed on the Covid vaccines, which they had to get out faster than normal ones, and which may cause serious complications in very small children. However, what alternative to compulsory vaccinations (with some medical exceptions/contraindications) in children do you propose? Many of the vaccines are given at ages where the child cannot give meaningful feedback one way or the other. Furthermore, if enough young children don’t get vaccinated for certain things, herd immunity may be compromised.

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  22. A great blog Crystal with insightful information on how damaging the coercive approach is. Mind boggling so-called mental health ‘care’ providers remain so ignorant. The only explanation is they care more about power, control, ego and income than helping people or doing what’s best. It’s farcical and damaging in so many ways.

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    • Thank you so much Rosalee. I also believe that having forced treatment creates such bad incentive structures, and is why we have so many awful psych wards. They do not have to be nice places to get a steady flow of revenue, as many patients are coerced in or have no idea what they’re getting into until suddenly they’re locked in. There is little ability to defend oneself once inside. There is not only zero incentive to heal, there’s incentive to create more trauma to lengthen stays. Workers can also be overburdened, especially when beds are full with many people who don’t even want to be there. Sometimes voluntary patients get turned away too to make room for forced people.

      When psychiatry is free from the laws of consenting exchange, its services have no reason to be helpful or attractive. Helping is disincentivized as time incarcerated is the main factor creating profits. Forced treatment’s existence hurts all psychiatric subjects, including voluntary patients.

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  23. Good work, Crystal. The few times I was so upset I was considering killing myself, I was helped by being able to stay in a place (in Canada) where what I received was a lot of understanding and emotional support, just what I needed. Soteria Houses, initiated by Loren Mosher, one of the most decent and caring psychiatrists I have ever met, do the same thing. The response of the psychiatric establishment was to fire Dr. Mosher from his high-ranking job with the NIMH, and later to defund almost all of the Soteria Houses that had sprung up.. Even back in the 19th century, the Quakers (aka the Society of Friends) ran Quaker Retreats, where troubled people were also helped with emotional support and encouraged to participate in activities that helped them feel and function better. I think our movement for liberation from coercive psychiatry ought to be promoting such places very vigorously. I think this would help people stop believing in the destructive cult of psychiatry and start demanding real help.

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