The text that follows is the English translation of a speech I gave at The Danish Psychiatry Top Summit in 2024. A video of the speech, with English subtitles, is available here.
The Danish Psychiatry Top Summit (“PsykiatritopmĆødet”) is an annual event that is organized by a social-activist organization called The Social Network (“Det Sociale NetvƦrk”). The summit features professionals, politicians, and people with lived experiences. This year more than a thousand people attended. The summit has historically been centered around improving psychiatry through cooperation.
The Danish psychiatric system has historically been exceedingly change-resistant. As a psychologist who’s spent the last five years debating and criticizing the moral, scientific, and practical foundations of psychiatry, imagine my surprise when an invitation to give a 15-minute keynote speech landed in my inbox. Equal parts flabbergasted and excited, I immediately agreed, even if my 15 minutes were later reduced to 10 minutes with no explanation. Every year, the summit has a theme. This year it was “New winds are blowing.” And admittedly, I wasn’t the only critical voice on-stage. Even the invited psychiatrists agreed that “more of the same will not work.”
I do still fear, though, that the new winds that blow will just blow power into new hands… Instead of dismantling coercive and abusive power that stems from dehumanizing pathologization and professional hierarchies. But I was cautiously optimistic after the summit, as I remain to be, though there’s still tons of work and activism to be done before meaningful change can happen.
We need a revolution. A revolution that everyone can contribute to. And thatās what I would ask your help with here today. Everyoneās talking about change. Changes towards a better psychiatry. A more pluralistic psychiatry. A less medical or more therapeutic psychiatry. But always a psychiatry. This discursive monopoly needs to be broken. And the path to that dismantling of the psychiatric monopoly on mental distress starts with a growth in the number of people clamoring for an alternative, for another place to go in a mental crisis, a place where youāre neither pathologized nor treated for your symptoms. The title for todayās conference is āNew winds are blowingā. But how strong are these winds in fact? Evidently sufficiently strong to blow critical voices up here on stage. Regrettably not strong enough to blow critical voices with lived experiences up here too.
I want to spend the remainder of my time here today talking about why: Why we need an actual alternative if fundamental change is ever going to happen.
Psychiatry takes something that is pretty simple and makes it unbelievably technical and complicated. It is pretty simple to understand what people in acute mental health crises need. We all have the same basic needs when weāre not OK, when life falls apart. And thatās the need for safety. For comfort. For closeness. And for understanding. In that order. Safety. Comfort. Closeness. Understanding.
The very first thing that a mentally distressed person should be met with is therefore reassurance. We need to reassure the suffering person that theyāre safe in the right place: Thereās room for your reactions here. We arenāt scared of or discomfortable with your pain. You arenāt sick. You arenāt disturbed. Youāve probably got a million reasons for thinking and feeling the way that you do. Thatās alright. We donāt judge or condemn that. We only want to offer a place to feel safe right now. And if you find yourself ready to talk, weāre right here and ready to listen.
This is not a method. It is not an approach. This is natural compassion between human beings that is universally valid and useful at all degrees of mental distress. And psychiatrists know this too. At least they do if it concerns their own children. If a professionalās kid comes home from school in an increasingly depressed state of mind, there isnāt a psychiatrist in the world whoād pull out a Hamilton Depression Scale and go: āRight, letās measure your symptoms so I know what to do with youā At least I hope there isnāt. So what would a psychiatrist do were it their own child? Sheād of course look caringly at the child and say: āHeyā¦ Whatās up with you? Are you OK?ā and then offer her time, comfort, protection and care until the child is ready to tell more. She would do that, because thatās crucial information to have. Itās imperative to know what the child is reacting to. Weād act differently if our child were growing more and more depressed if the cause was bullying, loneliness, insecurity, body dysmorphia, performance anxiety, assault, harassment and so on. These are extremely different contexts that warrant very different approaches. But first and foremost the child needs to feel safe, comforted, cared for and understood. And then we need to take action aimed at remedying the causes of the childās mental distress. So why is it that we intuitively know what to do when itās our own family, but fail to provide the same for people we are charged with helping?
The psychiatric system limits its approach to revolve around the reactions themselves. This corresponds to wanting to minimize the childās tears, not with comforting care, but with methods, i.e. pills, electricity and/or therapy. And then sending the child back to the context that causes the childās pain with a āGood luck with your bullies/loneliness/self-worth/trauma!ā
And itās not the fault of the psychiatric professionals that the system works this way. A lot of employees try so hard to be warm in a cold system. But the underlying logic incurs distance. When you ask psychiatric patients who they really liked talking to during a stay at a psychiatric ward, what do they say? They say: Other patients. Their visitors. A porter. A physical therapist. That is: People near them who arenāt tasked with perceiving them through a pathologizing lens that focuses on minimizing symptoms, but who naturally assume that the distressed individual is going through some hardship and therefore is reacting. And yes. These are reactions that we are talking about. Not symptoms. The behavior, thoughts, and feelings of distressed people are always reactions to something. Always. The only place where it makes any sense to label reactions as āsymptomsā is in a system that contrary to all science and reason insists on calling patterns of reactions-to-distress diseases that need treatment. And here we find a linguistic rebellion that everyone can be a part of from this day forward: Symptoms are reactions.
Take for instance the psychiatric professionalās own child again. There probably isnāt a professional in the world whoād think that the most important task is to stop the childās tears in and of itself. Why? Because tears are just that: Reactions. But we could choose to pathologize them if the child was sufficiently anguished. We could dub them symptoms, which would make it our task to quell the stream of tears withā¦Pills? Electrocution of the brain? Therapy? But is that what a crying child needs? Methods to stop the tears? No. It is not. The crying child needs to cry because it ventured out into the world, got hurt, and is now in need of safety, comfort and reassurance. The child will cease crying eventually once comforted. And when that happens the child may soon be ready to open up about the context that caused the tears. This is both true for the crying child and for the mentally distressed adult. Far too many adults have learned to suppress tears, either from a tough childhood with too much neglect and too little safety. Or from toxic masculinity. Or from a lack of love and attention. But believe me when I say that the mentally distressed adult might just as well be crying if she dared. If she felt safe enough. And after a flood of tears itās usually easier to explain, to tell what has happened. This tends to take longer the more intersections and the more trauma there is to tell about. But in the end it is safety, comfort, closeness and understanding that paves the way to healing.
This is jumbled around in psychiatry. In the psychiatric system it is the reactions, be they tears, voice hearing, aggression, self-harm, or anxiety; in psychiatry it is the reactions that are central. Because the reactions, the so-called symptoms, are the building blocks of the diagnostical categories that guide treatment. But this is totally backwards. The reactions are not the most important part of mental distress. And by trying to combat the distressed personās reactions, youāre actively fighting the very survival mechanisms that give rise to those same reactions. You escalate the risk of conflict and oppression by aggravating survival mechanisms.Ā Mentally distressed people arenāt statistically more dangerous than other people. But any approach that is based on fighting natural reactions will tend to create situations of violence where it isnāt the distressed person who does the violence but instead the system that acts violently towards them. Reactions are not to be fought. As caregiving professionals, we need to deliberately practice being with distress. We need to practice the art of pulling a chair up into someoneās darkness and just being in that space without dominating it. This is hard, sometimes. It can be difficult. The darkness may be so horrifying that you feel some of it yourself when you enter someone elseās pain with your guards down. Itās a genuine competency to be able to do that, but it is worth every bit of effort. Sharing someoneās darkness opens the door to safety, then trust, and then towards puzzling the pieces together that may explain what has happened that has brought the person to the cusp of destruction, and this shared grief may help guide us towards the sort of help that the person needs in order to find a path to healing and meaningful existence.
Psychiatry has damaged far too many people by focusing on symptom reduction. Even when successful, the symptomatically reduced individual is still left to the same context that they were in prior to treatment. But now theyāre also told that theyāve got a disorder of the mind. This is not helpful, especially not in the long run, even when the personās symptoms are reduced by rigorous psychiatric methodology. And who is hurt the most by this? The people who suffer the most to begin with. Those that psychiatry would deem the āmost severely illā. The ones whose distress is routinely used as an argument for more psychiatry. These are the voice hearers. The ones with the most and the heaviest adverse childhood experiences. The most marginalized, discriminated, and traumatized. In other words: Those who have the most reasons to react. Those are precisely the ones that are most harmed by ignoring contexts and instead fighting reactions and survival mechanisms with pills, electricity, and therapy.
Ironically, this also means that the people who are best suited for the psychiatric approach are the ones who havenāt got a lot of problematic contexts in their lives. These are the people who have the resources and relationships that a temporary pause may itself lead to sufficient recovery. In those cases, it may certainly be adequate to quell the personās reactions and then send them on their way. But even affluent people can have their lives destroyed by being told that their natural reactions to temporary crises or sudden trauma are symptoms of pathology in need of treatment. If the distressed personās reactions are severe, the risk of harmful pathologization and diagnostically legitimated mental and physical violence increases exponentially. This is a path that leads to disability, isolation, and suicide all too often. Itās tragic, and the tragedy is enhanced enormously because itās often completely avoidable.
Is the psychiatric system able to change at a fundamental level? One can certainly hope. Some of the other speakers on stage today are optimistic, whereas I am more skeptical. But no matter what psychiatry may or may not become, it is my hope that other voices in this debate ā both professionals and those with lived experiences ā will engage with the possibility of alternatives. The development and implementation of alternatives that arenāt psychiatry. The possible benefits from this cannot be overstated. Firstly, we would finally be able to offer different and often better help to those in mental distress. Secondly, successful alternatives would both force and inspire change within the existing system.
Iāve got one minute left of my time here today. So letās return to those new winds and what they may carry with them. If the psychiatric system is the giant ship that currently is the only refuge for drowning people, then new winds may cause that ship to change course. More therapy would change the course slightly. Less psychopharmacy. A bit more peer-involvement. With small changes we can certainly hope that the giant ship will eventually sail in a better direction. But we can also utilize these new winds to fight for something else. We can make sure that new winds also carry new opportunities with them, that actual, context-oriented, peer-based, person- and human rights-centered alternatives acquire appropriate funding.
The truth is that we donāt need more psychiatry. Nor do we need better psychiatry. Itās obviously positive if the captains of the dominant ship are attempting to steer the vessel in a better direction. Great. It was about time! And hereās the best piece of advice I have to offer them: The most meaningful change you can pursue within your system would be to thoroughly train every single employee in trauma-informed care. The universal implementation of trauma-informed care would spare countless patients much traumatization and retraumatization.
But real progress grows if we let new ships set sail that can pursue new directions that may prove to be better alternatives than the pathologizing psychiatric system. That would be meaningful revolution.
Support the rebellion. Support the need for an alternative.
Thank you for your time, thank you for the invitation to come here today. And long live the revolution.
This is moving to read. This guy is absolutely bang on with his analysis of basic human needs because he was observed and understood them, and perhaps has seen that what we call ‘mental illness’ is a derangement of these needs by the social process. I don’t think he is conscious of his achievement and how vanishingly rare it is even for people to understand basic human needs and see when they are not being met in others. He has understood human needs as a human, and it has radicalized his perspective on psychiatry, although this radicalization is actually just the dawn of perfect clarity on the issue. Hate to be a pansy but it actually moved me to tears to read these words, which I now defer to as the simple clear, plain truth – and notice the truth is beautiful, if you can bare it…
“I do still fear, though, that the new winds that blow will just blow power into new hands”
“We need a revolution. A revolution that everyone can contribute to. And thatās what I would ask your help with here today. Everyoneās talking about change. Changes towards a better psychiatry. A more pluralistic psychiatry. A less medical or more therapeutic psychiatry. But always a psychiatry. This discursive monopoly needs to be broken. And the path to that dismantling of the psychiatric monopoly on mental distress starts with a growth in the number of people clamoring for an alternative, for another place to go in a mental crisis, a place where youāre neither pathologized nor treated for your symptoms. ”
“Psychiatry takes something that is pretty simple and makes it unbelievably technical and complicated. It is pretty simple to understand what people in acute mental health crises need. We all have the same basic needs when weāre not OK, when life falls apart. And thatās the need for safety. For comfort. For closeness. And for understanding. In that order. Safety. Comfort. Closeness. Understanding.”
“The very first thing that a mentally distressed person should be met with is therefore reassurance. We need to reassure the suffering person that theyāre safe in the right place: Thereās room for your reactions here. We arenāt scared of or discomfortable with your pain. You arenāt sick. You arenāt disturbed. Youāve probably got a million reasons for thinking and feeling the way that you do. Thatās alright. We donāt judge or condemn that. We only want to offer a place to feel safe right now. And if you find yourself ready to talk, weāre right here and ready to listen.”
“This is not a method. It is not an approach. This is natural compassion between human beings that is universally valid and useful at all degrees of mental distress.”
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Sending you a virtual hug, No-one.
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PS, this is exactly right, that the first need is reassurance, security, and being treated without judgement, being able to go through what you’re going through without being compromised or frustrated by the environment. Not having this is what nearly killed me many times during long years of ‘psychosis’ which in the end I was able to observe, understand and go beyond. I knew I that if anyone was able to help me they could only do so by understanding this basic need of go through and observe and understand, but just needed a safe space to do it in, to confront what was taking place within the consciousness, not to tell me what was happening to me through intellectual theories but to talk it over with me and try and learn and understand with me, because there is probably no therapeutic intervention that suppasses the power of being understood by another, which is the very definition of no longer being alone. This journey of understanding is made impossible when there is judgement, and all the social conditioned assumptions including all psychiatric and psychological concepts are socially conditioned distortions and perversions of the actual facts taking place within the life and consciousness.
But the gravity of this issue cannot be understated. How many millions of people do we think, many of them adolescents, have lost their lives and had to break the hearts of loved ones because of our social want of this basic understanding you are putting forward here? Anyone would learn this simple truth if they had to rehabilitate a traumatised animal – watching such videos really helped me to understand and recognize these basic needs in myself and in all sentient life.
There is no blame to be had for those parents and loved ones who don’t understand these truths. It is our social conditioning which is to blame, not the suffering human beings who don’t understand the insight you have enumerated, because we are conditioned to believe that it is other people who can know, who can advise and understand, even in the case of my own psychological and emotional phenomena which exists in only one place in the Universe, which is in MY awareness. Eastern thought has always been rooted in the understanding that observation of conscious phenomena leads to an understanding and transformation of that phenomena but Eastern thought too has been derailed by the disease of the Western mind and civilization including the hiddious process of social violence we call ‘psychiatry’ which has damaged and destroyed perhaps a billion brains with medication alone, not to mention the psychosurgery and treatments to shock and harm the brain and body which historically constitutes the rest of this malignant social tradition we call ‘psychiatry’ which is unfortunately but one branch of a malignant tree. There is a way out of all of this but it is without words. It is awareness itself, which is how this guy came upon a real set of insights that radicalized him. You don’t get this insight by understanding and agreeing with his words. You get it by observing and understanding, without judgement, your life and the lives of those around you. How simple and yet how radical and vanishingly rare it is for human beings to do that. And how shocking it is and how insane that it’s so difficult to wake people up from the delusions and lies of our culture, even when they only stand to gain, i.e. all the sufferers and their families and friends, and the whole of society which is blighted with every form of dysfunction and malaise as it can’t even stop itself destroying the Earth and all human lives with astonishing and only accelerating speed.
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No-one, I felt more a part of the human race watching tv shows about the rehabilitation of traumatized dogs than I ever did talking to some self-important therapist or psychiatrist. Seeing what healed the dogs (feeling safety, comfort, closeness and understanding) taught me how to heal myself. All sentient beings have a lifelong need for safety, love, understanding and acceptance and anyone who prevents this from happening is committing a serious crime.
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No-one, you are 100% right about observation and understanding. And true understanding needs few words.
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Wow! You too??? I think we may have stumbled on a new therapeutic intervention! I wonder how many others like us?? Interesting! I think understanding these journeys in the lives of dogs must help us to become free of some of our own self-judgements or guilt for not ‘performing’ as we think we should be. I don’t know but wow, I really think this has something to do with the wordless emotional and affective part of us that we share with, I reckon, all sentient life. And no academic is ever likely to understand that one unless they are really passionate about finding the truth rather then demonstrating their cleverness to their colleagues and the public. So yet again this is proof that dogs and at least a few ‘mad people’ have one or two things to teach psychiatry and society!
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So glad we see eye to eye on something obvious to anyone who takes a moment shut their mouths and open their eyes. I think it boils down to this: the human intellect is overrated. Too many people believe the thinking mind superior to the feeling mind. What they don’t see is this: a world of hurt comes from people who think demonstrating cleverness determines worth. Dogs on the other hand aren’t burdened by an intellectual tyranny that dismisses sensitivity, intuition and common sense.
Seeing the condition the dogs were in and how they reacted until they were accustomed to being treated humanely helped me lose a lot of self-judgment and guilt that I knew on some level were not self-created but were in fact from other people angry with me for not only having a mind of my own, but the audacity to actually use it, an anger that seemed almost universal among people schooled in psychiatric thought. Time after time they seemed to think it their business to tell me not only what to feel but how to be, while at the same time their own attitudes and behaviors left a lot to be desired. Dogs have no such arrogance.
So, as for teaching psychiatry anything at all, I think it best to assume it to be (unlike dogs) pretty unteachable.
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So well said.
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No-one, here’s something that reminds of me of what you say about observation and understanding: Teal Swan | How To Love Yourself | PRETTY INTENSE PODCAST | Ep. 138 Danica Patrick
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This essay hits it way out of the park.
Here’s my observation: The significant rise in the number of people in the psy professions beginning in the middle of the last century has led to the exponential rise in the number of people mistakenly believing they are psychologically unwell. Troubled? YES. Sick? NO. Now, what are the chances of this being merely a coincidence??? In my estimation, virtually none.
So, here’s my conclusions: 1) Elitism is very seductive. 2) People don’t need a degree or a paycheck to know how to properly give reassurance.
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Psychiatry and psychology are no longer merely fields of study and research. They are industries built on the exploitation of human misery by elitists motivated by guild preservation more than the good of humanity.
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“When you ask psychiatric patients who they really liked talking to during a stay in a psychiatric ward, what do they say? They say: Other patients. Their visitors. A porter. A physical therapist. That is: People near them who aren’t tasked with perceiving them through a pathologizing lens that focuses on minimizing symptoms, but who naturally assume that the distressed individual is going through some hardship and therefore is reacting. And yes. These are reactions we are talking about. Not symptoms.”
This was my lived experience in the psych ward. Conversing with people who were NOT part of the “psych team”, who didn’t have barriers to seeing who I was made me start feeling safe enough to begin believing in myself again, whereas engaging with anyone from the “psych team” left me feeling othered and therefore profoundly more isolated than when I arrived, the tragic effect being that I left the place never feeling quite the same which means the following: Being held captive in such a place damaged me in ways that were lastin
No “symptoms” means no classification, and no classification means no job, and no job means no money and no money means no gravy train for the professionals. So, is it any wonder psychiatry’s ship never sinks?
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I felt the same way. Judged and stigmatized.
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Good to know I’m not alone. Judgment and stigmatiztion is what passes for “mental health care”.
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CORRECTION: No ‘symptoms’ means no categories, no categories mean no diagnoses, no diagnoses mean no ‘mental illness’, no ‘mental illness’ means no job titles, and no job titles mean no money for the professionals.
It’s no wonder psychiatry’s gargantuan ship never sinks.
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“The behavior, thoughts, and feelings of distressed people are always reactions to something. Always. The only place where it makes any sense to label reactions as āsymptomsā is in a system that contrary to all science and reason insists on calling patterns of reactions-to-distress diseases that need treatment.”
Indeed, today’s scientifically “invalid,” DSM based psychiatric system itself, is insane.
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Thanks for this.
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wow Jonas, No-one and Birdsong nailed it doesn’t even begin to describe what you just did. Yes tears shed this morning in Western Australia. You are all so articulate and true. Thank you K
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I have no heart emoji so here’s a circle instead meaning ‘we’re all one’: o (xxx)
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K, Iām sending you a virtual hug too.
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This was so refreshing to read. It crystallizes so many of the things that I’ve spent so much time learning about and being confused by, and being too inarticulate to express.
The number one standout for me although not the only one in this article is authors suggestion that every professional be trained in trauma responses.
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Don’t know where this is coming from but here goes. The thrust of human spiritual evolution is to harmonize the movements of word, appearance (presentation of the organism), and the inner state of consciousness so that each expresses the other. Where there is contradiction between these elements there is confusion, conflict, obscurity, and opaqueness to others which becomes firtile ground for misunderstanding and dark tricks of the ego. Word is the social accretion of human linguistic forms that coheres the development of all brains around a central unifying structure, which is language, hence the necessity to condition each brain with language. Translation between language ensures their mutual co-ordination across cultures. The harmonization of words and inner state demands only one thing – simple honesty. The harmonization of appearance to others and inner state is what we call ‘authenticity’ which is destroyed by all egoistic motivation and strategy because then your appearance and actions are geared towards the fulfilment of an goal rather then expressing authentically the truth of the inner state. This lack of authenticity is not quite the same as dishonesty, because we have been adjusted to a society based on egoistic motivation and socially conditioned strategy. The correlation between words and inner state and appearance also inevitably rests on the natural freedom of the life system or body, because it is only in this freedom that words and the inner state via perception can understand the disharmonies and dysfunctions in the nature brought about by a history of social conditioning. As we can see in humanity at large, our over-burdened minds tend to gravitate to one pole – either words (thought), appearances (the way I look or seem to others), or the inner state (my own pleasure and satisfaction) have become predominant. They can only be reunited and reintegrated through a journey of perception and understanding which the overwhelming majority of human beings alive today have never known and will never discover. If the human species survives they will not. If they survive the human species will not, and what comes after will be as irrelevant to them as we are to the dinosaurs. Only truth can save them, but for them the truth is what they think and believe, hence is no-where to be found.
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More great observations from No-one.
One can’t help but wonder what’s to become of the human race as it currently exists.
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Beautifully spoken. Thank you so much, No-One.
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Is there anything at all that all human beings agree on, and if so, what is it? You can’t talk of the sanctity of love or life, or the project of a collective society, or the sacredness of Earth, so what point of unity can be found between human beings, something everyone can agree is true? There is nothing, and none can be found until we recognize that truth is not relative. Opinions and thoughts are relative. The truth simply is that whatever we are, without wanting to define or label it, that thing is the truth, because it is the only possible thing you know exists, because it’s what you are – awareness itself, and awareness shows what is as it is, until it is defined or labelled. So the truth is what is as it is, which is what you actually are, what every conscious life is, what everyone you love is, and therefore what we actually are – all of us – is the truth, and a truth that can unite all. But this truth convicts all judgements, because no judgement of what is can possibly be the truth, because WHAT ACTUALLY IS is the truth, not a judgement about what is which implies ignorance, an inability to understand. All judgements are non-factual, are social in origin, are the product of our social conditioning, is the confusing untruth that is responsible for all human conflict and all human sorrow. Because the truth is not sorrowful. Only illusion is sorrowful, and the whole consciousness of humanity is composed entirely of illusion. Only awareness of it is non-illusory, and is the only thing that sets you free of illusion, for you are awareness, not these illusions in your head pretending to be you.
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“All judgments are non-factual, are social in origin, are the product of our social conditioning, is the confusing untruth that is responsible for all human conflict and all human sorrow. Because the truth is not sorrowful. Only illusion is sorrowful, and the whole consciousness of humanity is composed entirely of illusion. Only awareness of it is non-illusory, and is the only thing that sets you free of illusion, for you are awareness, not these illusions in your head pretending to be you.”
What does this passage say to me? That psychiatry is an illusion factory.
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Beauty is objective – we don’t realize that because we confuse attraction with beauty. Nature is beauty, and with it comes clarity and sanity, and that beauty, clarity and sanity is the truth in freedom. Unfreedom destroys not just clarity, sanity and beauty, but also the capacity to perceive and understand beauty directly, and it thereby corrupts, fragments and destroys the one total blissful truth of existence which has been shattering into so many sad fragments of a once perfect life, the sad refuse of a once perfect existence that embraced all things. These are our cherished opinions, conclusions and confused desires, a clinging to which is the tragedy of our times. When all this confusion is gone, the mind is the sky and the whole Universe, and we are all, each one of us, that. The false me fears this as death. The heart craves it as liberation. So let’s smash the artwork factories “and the museums and the galleries. They increase our oppression – lick my face of raw. Kid’s get in – pulled out by parent core, in a gravy of envy, they’re descending!” (Huggy Bear).
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Medical memo: 11/11/2024. Regarding patient number 20520 (United States of America).
The patient is clinically dead, even though there are still vital signs. Half of the cells have become cannibalistic: it’s mass authophagy. If we revive the body we revive the brain which is dangerously diseased and scrambled. If we let the body die the prognosis is certainly fatal. An ethical dilemma ensues. America, wake up and switch on international news. Each cell must find a pulse of it’s own and connect back with the Universe urgently. No time to waste – time itself is a waste, and it’s over.
Signed: Dr The Mechanic of Greek Acrobats and Belly Dancers doing Science in the Night.
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I agree we need a revolution. I and colleagues have made a number of trips to Denmark to offer talks and training in the Power Threat Meaning Framework, which offers a radical conceptual alternative to the diagnostic model of distress. All input has been well-received and I am aware of a number of professionals now drawing on this approach. A Danish translation is in progress. Have you come across this?
Here is one example of a talk: https://www.youtube.com/watch?v=fWAv4IBsCjc
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A revolution toward what? Toward a caring, empathetic, accepting, and giving society?
Sorry to point out an uncomfortable truth, but I don’t see any signs of things moving in that direction.
Humanity has had thousands of years to come up with solutions to suffering and has failed dismally. Pseudo-solutions such as drugs have been around “forever.”
Psychiatry would never have got off the ground if there hadn’t been a real need they were purporting to fill. Most people on psych drugs aren’t forced to take them – they want them.
Until humanity recognizes a purpose in life and can incorporate suffering and its lessons within that purpose, we will continue to drown our sorrows in our drugs of choice be they psych drugs, alcohol, food, or other forms of consumption, all of which just waste our lives.
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Judith, when you claimed that āPsychiatry would never have got off the ground if there hadnāt been a real need they were purporting to fillā, were you alluding to the German T4 program and the historical and contemporary ādiagnosesā of ādrapetomaniaā, āego-dystonic homosexualityā, āautismā and āborderline personality disorderā? Could you clarify how these tragic instances of murder and questionable classifications constitute a āreal needā?
You also stated that āMost people on psych drugs arenāt forced to take them ā they want themā. Are you suggesting that the influence of pharmaceutical advertising, societal and medical coercion, and the involuntary drugging of individuals on neurotoxic prescriptions is truly voluntary?
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I do totally agree with your social pessimism, but on the other hand it doesn’t for me detract from the truth and validity of what he says about the actual real human needs of the sufferer, and bringing that to light is useful as a means of destroying the false if not building the true. I think what is far more important then a social solution is for each of us to understand ourselves what we really need to be well, because in truth we can heal in a more natural, loving and successful way then through psychiatry or any Western treatment modality. Loving and supporting someone, making them feel safe and understood, not judging them and allowing them to go through what they need to, these are the things that really help, and within that some medications like sedatives might have short-term utility just to help someone survive and adjust to the new environment. If society understood this then even though it all breaks down, the human atom it liberates will then at least be able to look after each other in the good, natural, healthy and loving way. So I don’t take away anything from the point you made about the hopelessness of social reform, but even though the solution is discussed in this context I think it can spill over beyond the bounds of psychiatry which is what he advocates also, hence the need to ‘dismantle the psychiatric monopoly’. Thanks for your important point though which we really mustn’t forget it. Hoping for yet another social solution from psychiatry which has a perfect and complete track record of failure is itself insanity, and we have to bite that bullet if we are going to get anywhere with this problem if you ask me.
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“Natural compassion”, as the author states, is the solution to suffering. But this comes unbidden, from one heart to another, no matter the type or condition of a society.
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One can have natural compassion towards oneself, and to others, and that includes feeling compassion for those who, for whatever reason, may be incapable of compassion for others.
It’s compassionate to realize that other people are limited and can’t always give us what we think we need, and this can alleviate our own suffering when we see that (for the most part – I exclude evil people) no one intentionally is hurting us.
However, depending on other people’s compassion to find a way through our own suffering is a guaranteed recipe for staying in victim and “mental ill-health” mode.
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Yes. It’s natural for us to look to others to get our unmet childhood needs met. I think we need support but we have to learn to be there for ourselves most of all.
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Agree 100%.
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Dear Jonas and commenters~ We have a big job on our hands. Yes, stop pathologizing normal symptoms of trauma and grief not to mention social marginalization. In addition, the ādemonizationā isnāt helping either. I envision a bunch of small communities with āgolf cartā transportation, fitness/swimming and companions. The autism community is doing that. We needed to bring compassion to bear in earlier years ie school. Everyday I envision myself as āGrace Pooleā from āJane Eyre.ā ā¦. We can do better than scapegoating the most fragile. ~~~ a mom with broken heart
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Identifying “Autism” as a formal diagnosis reinforces the idea that natural human behaviours are inherently disordered.
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Words like “activism” and “revolution” imply to me that some think a political solution is what will solve this problem. Politics, very roughly, is the process of one individual or group forcibly removing the weapons of power from some other individual or group and taking them over. In politics, there is no guarantee that the new rulers will be more just, kind, fair or effective than the old ones. We just got tired of the old ones. Democracy is only a “non-violent” form of the same process.
My group (and myself personally) thinks what we need is better and widespread education and training. If well-meaning and effective practitioners want to call themselves “psychiatrists” (though I don’t know why they would) I don’t see that as a major problem. The problem is, basically, that a bunch of criminals are posing as psychiatrists and the general public doesn’t know what to do about it. The general public needs to know that psychiatry doesn’t know what it is doing and that people would probably be better off treating each other. The general public needs basic training on workable mental principles so they don’t get fooled by the garbage being churned out by the medicos.
We do have a general problem, which is political, of doctors having too much power in society. This has been evident since they formed into “professional organizations” and probably even before that. It parallels our willingness to give our bodies too much control over our lives. We do need to loosen their grip on political power somehow, but I still see better education and training as the best way forward.
The mind and its treatment has always been a difficult subject because it involves the problem of suppressed memories. When you can’t remember something, how do you know that it really happened? If anyone doubts this is a problem, try to remember being born. I think this problem caused most psychiatrists to just give up.
Others involved in therapy have developed various methods for bringing suppressed memories to the surface. This is only one approach to mental health, but a crucial part of the problem of “mental illness.” There is so much about this that is known but not taught or widely practiced that it’s not even funny. The subject and its practice needs to be opened up, no doubt about that.
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I completely agree, and Iāve been expressing a similar perspective for some time. I believe there needs to be a critical mass of people who begin to question or even reject certain psychiatric diagnoses. For instance, conditions like borderline personality disorder or narcissistic personality disorder might be better understood as manifestations of social pain and relational dynamics rather than discrete medical conditions simply because they manifest themselves in terms of vulnerability and power imbalances in close relationships.
Thinkers such as R.D. Laing, David Cooper, and Thomas Szasz have critiqued the medicalization of social and interpersonal pain, emphasizing that these issues arise in relational and societal contexts rather than existing as medical ‘diseases.’ While the neurodivergent community has often challenged traditional psychiatric frameworks, there is also a paradox: many within the community still seek validation through diagnosis, which complicates the effort to move beyond labels.
Another key issue is the role of psychiatry itself. The idea that psychiatrists function primarily as doctors of the mind rather than true medical practitioners raises significant questions about their authority. Moreover, the global perspective offers valuable insightsāthere are many cultures where psychiatry either does not exist in the Western sense or does not wield the same power. When people in these cultures experience similar challenges, they are not automatically labeled as mentally ill. Instead, approaches like community support or practices such as mindfulness are often used or even arbitration between the family members, leading to a different understanding of mental and emotional well-being.
As social media and global connectivity continue to expose the realities of mental health practices outside the U.S. and Europe, I believe more individuals may begin to question the dominance of the Western psychiatric model. However, this shift could also cause significant dissonance for those who have relied on these frameworks, potentially leading to a collective sense of disillusionment or even shock.
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Psychiatrists believe and want others to believe that they work with the brain and not really the mind. They say the brain is chemically disordered and needs medication to become ordered. They deal with symptoms. The mind is left to psychologists who do psychotherapy. They are the ones that deal with the thoughts and beliefs in our minds. Most psychiatrists don’t do therapy anymore. I guess it makes them feel more like doctors if they just focus on symptoms and medications like medical doctors in other fields of medicine do. The fact that they actually get a medical degree and then specialize in psychiatry adds to their status and authority and in being taken seriously by many people.
Then you have the power of organizations like NAMI that are telling everyone that mental illnesses/psychiatric diagnoses are real and are actually medical problems (chemically disordered brains) like diabetes or other medical problems of the body and people believe it.
So many people rely on the medical model to the point where I don’t think it will change. The medical model allows parents, other family members, schools and society to avoid taking responsibility for the harms they cause others, especially children. More and more people look to the medical model for an explanation for their problems because either they don’t want to deal with their traumas or problems or they don’t want to go against family or society or they hope to be taken more seriously.
People, in general, may judge you less if you tell them that your problems are a result of a brain disorder rather than from fears, insecurities or traumas. People don’t want to be seen as being “weak” emotionally or psychologically. I’ve met people who feel relieved when they are told they have a brain disorder because they thought it was a flaw in their character or personality instead. This is what they were led to believe due to invalidation from others.
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Perhaps surprisingly, research has shown that people judge others MORE HARSHLY when their problems are attributed to “brain chemistry.” Talking about trauma and life difficulties creates empathy. If someone’s brain is blamed, it appears it’s easier for others to distance themselves, to say, “Oh, he’s ‘mentally ill,’ he’s got a brain problem, he’s not like me!”
“Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from ānormalā people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce cliniciansā empathy. This is alarming because cliniciansā empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC4273344/
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This would seem to be a valid point, but the benefits of being validated as a self-determined being seem stronger than the benefits of being able to blame a condition on the body rather than the self. Both approaches have (emotional) benefits, but a more spiritual approach seems to have the superior benefit.
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Excellent essay. Thank you so much. And while the transformation takes place, may the Safety, Comfort, Closeness, and Understanding be accompanied with Access to the medical attention needed to resolve infections and inflammatory conditions that frequently trigger manias, but have routinely been overlooked and neglected in the past and current paradigm. EG: clozapine is toxically inflammatory; I have seen a fully compliant clozapine patient develop multi-organ inflammatory conditions and subsequently florid mania.
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I’m sorry for the professionals who might read this and feel offended, but in my view, psychiatry is the religion of the all-knowing and all-powerful doctor, the god doctor.
It’s a belief. Like materialism and scientism. Or Comte’s positivism. We educate our children according to our beliefs, right? I don’t know how many brain-is-all psychiatrists who practice have children. I think most of them treat their adult patients like children, already. Infantilization. Let them speak.
My point is that such a belief should not constitute a state religion, but should remain a private choice, and the practices linked to this belief should concern consenting adults only.
Child abuse can be physical, sexual, psychological, but also medical or religious. In my view, child psychiatry is child abuse. Stop it.
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Actually there have been several different types of communities in the past set up for those in cris, as utopian. communities, and as a religious spiritual place of community. They all have their drawbacks and issues but look into the old Swiss way of psychiatry where the hospital was a village and staff and patients put on plays and were in bands together after so called hours. The concept of witches is a whole other thread that needs to be focused on as why did it happen how did it happen. Some say the mold on the grains ergot was part of the problems and I would say probably other times and places like the old felt factories and all the painters who ere exposed to toxins through their paint or other materials. Much less the concept of social medicine and. Dr. Jon Snow and how he figured out a cholera outbreak was caused by a poorly designed water pump at a neighborhood well. One needs to think in multi-frameworks and not one and hard to say in each human being what framework is part or a totality in life when crisis occurs. The Beguines in the medical ages were a form of female community deliberately eat away from the church institution. They of course ran into trouble.Now we really do need to check the housing the environmental exposures of folks and not in the medical system at all and everything just not working well and I would say even the rich there is now guarantee that they also are not be used for their financial resources. Morris West not well written but interesting novel Clowns of God puts forth an idea of global communities of the disabled and those who are in essence survivors of all things trauma and the communities developed by a once insider now outsider and his idea after a mentally altered state to permeate for a world that is in descent instead of assent in the typical way of industrialization. and colonialism. One can always hope.
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