A few weeks ago on the MIA site, Robert Whitaker analyzed a recently-published review of studies of antipsychotic use. The review concluded that there’s not much evidence that antipsychotics help much in the short term. Since they’re so commonly used, you’d think that the evidence would be pretty strong backing up their use. You might also think that anyone reading that review who prescribes antipsychotics ought to start re-thinking what they do. We’ll see about that.
Whitaker’s article generated a variety of comments, including one from me, my first contribution to MIA. There were several responses to my comments, and I found these exchanges challenging and thoughtful.
I’ve practiced psychiatry for over 4 decades, mostly in outpatient settings, and I’m firmly convinced that scientific approaches to psychiatry (and medicine in general) are helpful and necessary. But science is far from being some revealed truth that should be worshipped, so we have to figure out where it belongs in mental health care. I’m also convinced that both psychiatrists and others have all kinds of misunderstandings and biases about what science says. That is one of the important obstacles to working in a collaborative way. My goal here is to shed some light on how psychiatrists try to use science. Some of that helps patients. Some of it doesn’t. I also want to say some things about what makes for good science. Good science wants to move us closer to truth, and understands that even being proven wrong is a step forward.
Full disclosure, I don’t consider myself a scientist in the usual sense, but I know a lot about what makes scientific findings more valid and useful. Oddly enough, some findings may be valid but not useful. People are complicated and nobody wants treatment that is dictated by science alone (the human connection is essential). Besides, that’s a very boring and unsatisfying way to practice psychiatry!
No doubt science is not the only way we know things. Some things we know using logic. Some things we intuit or just have a feeling about. Some things we’re taught and we accept them as knowledge. Some things we can know using our five senses. Some may come from religious training.
For some things, using a scientific approach is best. The big question is what are those things. Sherlock Holmes said that if you rule out all the other possibilities, then the one that’s left must be the truth. The hard part is how do you rule out those others, and can you be sure you’re not missing still others? All the other ways of knowing are more based on our individual experiences. Science tries to say—not always successfully—“let’s not make this personal and let’s try to agree on a way to narrow down our question”. If person A had a terrible experience with an antipsychotic, and person B had a wonderful one, what can we conclude? Only that antipsychotics can do good and bad things. It’s not much help to person C. The more experiences with antipsychotics we can collect, the stronger conclusions we can draw. So what’s the best way we know to collect that information?
The randomized, double-blind, placebo-controlled trial (RDBPCT) is the best way we know of to try to isolate one factor from the others. It’s not the only way, but other ways make it harder to draw valid conclusions. Back in the early 20th century, they were doing political polling by calling random people and asking them questions. Seems unbiased and fair, right? But back then, not everybody had a telephone at home, not everyone could afford them. So the “random sample” was biased—and not on purpose—to get opinions from people in better financial shape. What about other people? They were left out, so all you could say is that richer people tended to support candidate X. But that’s all you could say. You couldn’t say anything about the whole population.
Studies that aren’t randomized, or double-blind, or placebo-controlled can still shed light on things, but you have be even more cautious about drawing conclusions. Same applies to case studies, or other reports of individual experiences with psychiatric care.
Back to antipsychotics. I’m not going to re-analyze either the specific studies reviewed by Whitaker, or the original authors’ conclusions here. I am going to say a few things about what goes into doing a good study, and the importance of interpreting studies in an even-handed way. I’ll refer to Whitaker’s report at times here.
A study that compares 2 treatments, or a treatment with placebo should strive to compare apples to apples. This is harder than it seems. How similar or identical do the apples have to be? What differences can we assume don’t matter?
A designer of a RDBPCT says “let’s (1) find a group to study that are a similar as they can be, (2) divide them in half randomly, and (3) give each half either treatment or placebo, (4) be sure no one knows who got treatment or placebo, and then (5) measure to see if there’s a difference or not.” Seems simple enough, but let’s go through these factors a little.
If we want to study a population of people with schizophrenia or schizoaffective disorder ( like the study we’ve been referring to), we need to be sure the diagnosis is accurate, meaning that we trust someone to make the diagnosis, including not missing other diagnoses that might muddy the waters. The more people you have making diagnoses, the more the chance that errors are being made, that the diagnostic process may vary. (That’s even more of a concern with studies collecting data from different countries and cultures.) I know we have the DSM, but even that leaves room for interpretation. We can either trust the “apples’ designation fully, partly, or not at all.
And it’s not just collecting people with that diagnosis. It’s being as sure as you can that those people are similar in some other ways, because some of those other ways might affect how they do with treatment or placebo. Because we know that socioeconomic, medical and ethnic factors impact schizophrenia, we’d like to have all of these “apples’ similar in that way. Some factors we can think of might not matter; we probably don’t need an equal number of right- and left-handed people. And they don’t need to have the same religion, as far as we know so far.
Some people might be recruited for the study but decide not to participate. Might they be different in some important way from those who opt in? Could be.
Are the subjects for the study being paid? If you’re paid, perhaps you’re more likely to want to not only complete the study, but also to give answers that you think might make the researchers happy (even if you’re only guessing about that). We’ve known for a long time that research subjects are prone to this ( even if not purposely).
True randomization ought to be pretty neat and clean, but what if, once randomized, some people drop out of the study? This almost always happens to some degree, and it’s going to affect the results. Let’s say we study 100 people, 50 in each group. Suppose we find group A has better outcomes than group B, but half of group A dropped out and only 3 did in group B. That’ll need an explanation.
It may be the case that no one knows who got placebo or active drug, but we know that drugs often have side effects. Placebos can, too. How can we be sure that side effects don’t affect the outcome measures? If I’m getting side effects and I think that means I’m getting “the real thing,” I’m likely to let that affect my view of how I’m doing when the researchers ask me. Also, how do the researchers know if I’m really taking the treatment in the prescribed way?
And who decides what outcome measures to use? There are oodles of validated, standard rating scales for almost all kinds of psychiatric disorders, including schizophrenia. And measures to identify side effects, too. Both provide a way to collect information researchers hope will show the pros and cons of the treatment. But a rating scale might not capture what is meaningful to a patient with a given condition. It might, say, show that a person’s hallucinations are decreased, but maybe that doesn’t matter to that person as much as whether, say, they’re getting along better with their family. To the researcher, the person is better, but the patient, if asked, might say they see no difference. But that will go in the “benefited” column.
Oh, and who is paying for the study? A big pharmaceutical company? Are they putting their thumb on the scale in some way? Maybe we should say that any study funded by them is automatically one we should ignore. I wouldn’t say that so absolutely, but I do want to know that from the get-go. And we know that drug companies have been known to prevent publication of negative studies of their drugs; there are some ways around that, but it’s complicated and beyond the scope here.
Someone might read this and understandably conclude that doing RDBPCTs are so full of problems that even trying them is doomed. I know I can find flaws in just about any study I see. And I’ve not listed here every kind of flaw I can think of.
So here’s where I come down on this. What follows applies to other studies that are not RDBPCTs. I think it applies also to other medical and psychotherapy studies.
We—all of us—in every part of our lives—have to decide who’s trustworthy and who’s not. Some of us are trustworthy about some things, but not so much about others. The more someone (or some part of society, like psychiatric care) gives you reasons not to trust them, the more you either have to erase them from your life or take some time with that person (or that psychiatric study) to decide if you can trust them in that instance. If you like your psychiatrist, but s/he doesn’t return your call in a timely way, you can get a new one, or decide that the benefits of that person outweighs this flaw. And so it is with research. If finding a flaw is only about a “gotcha” moment, take a step back.
Very few people are really skilled in making sense of published psychiatric research. It’s probably an open secret that that applies to most psychiatrists (therapists, too). Few would admit it, but I believe the vast majority of us read relatively few studies from beginning to end. And all of those statistics will make most eyes glaze over. Most will either read the introduction and the conclusion to get the gist of it, trusting that the study didn’t have huge flaws. Most will trust the editors of the journal to have done that work for them. If I’m familiar with one or more of the researchers, or the place where the study was done, that’ll affect how much faith I have in the study.
But what about non-psychiatrists who are trying to make sense of RDBPCTs and other research? A few things to think about:
(1) Never rely on the title of the article alone. This also applies to headlines in social media, TV reports, and any other shorthand story. They’re too often after your attention, not about educating you.
(2) Think about how much you trust the source of the information about the study. Your psychiatrist, or therapist, or family doctor may—or may not—be a reliable interpreter of some seemingly important research. If you read Whitaker’s analysis, how much did you trust him? How much did he trust the article he analyzed?
(3) I said earlier that every study has flaws. Don’t let that be an automatic disqualifier of its findings. Many important and patient-helpful studies have flaws, and if we just ignored them because of that, there’d be more suffering than there is now. Ditto for a Pharma-sponsored study. We all have our own flaws, and we’d not take it well if our own work or words were discounted because of that.
(4) Some people, based on their experiences, have some powerful criticisms of psychiatry, and some are cynical, too. Fair enough, and so to think that that might make someone more likely to see (and perhaps magnify) flaws in research shouldn’t be a shocker. We are all prone to see what we want to see and not see what goes against what we already believe. Just human nature.
(6) It’s not often noted, but almost every study I’ve ever read has a section in which the authors discuss (a) what they already know to be some of the flaws in the study (b) how those flaws limit the strength of the conclusions they draw and (c) that their study is not definitive and how it should stimulate more studies. I can’t think of another line of work where the workers routinely include some self-criticism and humility about what they’ve done. I think that’s praiseworthy, and you won’t hear about that on TV or in social media posts about these studies.
(7) It’s pretty hard to do good scientific research. Imperfect but good research has gone a long way, in my view, to make things better for many people. I wish it were even more helpful, but I think that reflects, mostly, how hard it is to understand humans and the tedious detail involved in doing any good work. And I’m not so naive as to think that research can’t be misused, or that some make a lot of money doing it. They don’t have to be saints, but then again, thankfully, neither do you or I.
My bottom line echoes what you might remember Ronald Reagan saying in a very different context: “Trust, but verify.” I presume a researcher or research team is motivated more by trying to do good than to do evil until I have evidence—more than a gut feeling or a general distrust—otherwise. I expect to find flaws, and then I need to discern if the flaws are minor or worse.
Usually, what I want to know in these studies are these: (1) how close to apples vs apples did they get? (2) are the outcome measures meaningful and did they look at function, not just symptoms? (3) how bad were the downsides of the treatment? (4) were there a lot of dropouts—and why? (5) was the study done for a long-enough time? Depending on the study, I probably will wonder about other things, especially whether it should change something about how I work with patients.
The most important thing to know about a study is where the funding came from. Good research is expensive – getting enough people, making quality controls, following up.
One research paper I remember coming from the tradition of the replication crisis is that the biggest correlation to the result of a paper is who funded it. Sometimes this is covert – if a therapist runs their own study on their proprietary technique, that’s a funding bias too. And big pharmaceuticals currently don’t have an obligation to published failed trials, so they could run 20 and only publish the 2 whose results benefited them.
As you said, it’s a murky field. I have a math degree and my mind still goes muddy at messy statistics. I think in the future we need to build more trust in science, which means removing as much bias as possible. I hope RFK Jr and Dr Bhattacharya move in this direction at least.
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Hi Richard Moldawsky… Your article seems to be about “not offending anyone, not hurting anyone.” I understand what you mean. Your article is very well written. Thanks.But you seem to be ‘undecided’ about the ‘harms’ and ‘not being prescribed to anyone’ of psychiatric medications.
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My call to all psychiatrists is here: Stop prescribing toxic psychiatric medications that are ineffective in treating mental illnesses and are extremely dangerous and lethal to both brain and physical health. Even famous psychiatrists, doctors and/or journalists such as Robert Whitaker, Joanna Mouncref, Peter Gozche, who have revealed the harmful effects and lethality of psychiatric drugs, can say that “some psychiatric drugs may be beneficial for some people” (even though they know that psychiatric drugs are lethal).
This is actually an illogical theory. On the one hand, you’re going to expose the harmful effects of psychiatric medications… and on the other, you’re going to say, “They might be beneficial for some people.”
I now understand perfectly well why mainstream psychopathic psychiatry has survived until now and continues to poison and kill people. If you expose the harms of something… if you claim that it is beneficial for some people… then no one will believe you. This approach is the biggest trump card in the hands of mainstream psychopath psychiatry.
There is something I learned. So. One thing I’ve learned: Prof. Dr. Peter Breggin, the world-renowned psychiatrist who has been given the title “the conscience of psychiatry,” never prescribed psychiatric drugs to his patients again after exposing the horrific harms of psychiatric drugs.
This is the definition of an “HONEST PSYCHIATRIST.” Peter Breggin was a psychiatrist who was well aware of the deadly harms of psychiatric medications and who served as an expert witness in court for years. No one knows the current state of health of Peter Breggin, now in his 90s.
If you’re looking for an “honest psychiatrist,” you can find Peter Breggin and others like him who don’t prescribe psychiatric medications to their patients. No psychiatrist who prescribes psychiatric medication is an honest psychiatrist. They can whine and sweet-talk all they want, but the outcome remains the same.
1) None of the psychiatric medications can or do cure mental illness. And it doesn’t cure anyway.
2) All psychiatric medications produce effects similar to those produced by illegal street drugs. They numb the brain.
All psychiatric drugs do is numb ‘healthy brains’. They then (usually after long-term use over months and/or years) inflict damage (chemically induced brain damage) on the healthy brains that have been ‘numbed’.
Every psychiatrist knows how psychiatric medications work. They work by numbing healthy brains. This numbness causes individuals to calm down. This calming process then translates into the lie that psychiatric medications treat mental illnesses and are beneficial for some patients.
This is a massive (huge) deception. Because of this massive deception, people’s healthy brains are being deliberately damaged (chemically induced brain damage). The claim that “some psychiatric medications are beneficial for some people” is a deception. This deception is something mainstream psychopath psychiatry enjoys. It suits their interests. Because… they prescribe toxic psychiatric medications to their patients in large quantities. And to be able to inflict damage (chemically induced brain damage) on their healthy brains… that would be another step forward.
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All psychiatric medications are LEGAL DRUGS. They are ‘pillified’ versions of illegal street drugs like marijuana, heroin, and cocaine. They are sold LEGALLY in pharmacies. Indeed, just as we combat illegal street drugs, we must also combat psychiatric medications, which are “legal drugs.”
‘Psychiatric medications are more dangerous than illegal street drugs.’
Because they easily enter every home. It can be purchased from pharmacies with a psychiatrist’s and/or doctor’s prescription. And people are being poisoned by these toxic psychiatric medications. Both mentally and physically.
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The best (or worst) thing psychiatric medications do is… damage (chemically induced brain damage) to people’s healthy brains. Not to mention the various fatal diseases and deaths.
A) Probably… EVERY DAY, hundreds of millions of people around the world… are subjected to chemically induced brain damage (chemical lobotomies) from psychiatric medications.
B) And probably… Of these hundreds of millions of people —at least more than 1 million— EVERY YEAR get caught permanent chemically induced brain damage from psychiatric drugs.
It’s also important to know this fact. Probably… Today, there are individuals with intellectual disabilities who must spend the rest of their lives in mental health facilities such as mental hospitals, psychiatric hospitals, nursing homes, retirement homes, and rehabilitation centers. It’s important to know that psychiatric medications may be what enabled the vast majority of these individuals to undergo chemical lobotomies.
And also in the psychiatric outpatient clinics and wards of state and university hospitals… and in community mental health centers… subjecting people to ‘chemical lobotomies’ with psychiatric drugs continues apace.
Do you know how terrifying this situation actually is? We can safely say that psychiatric medications are/could be the reason why most, if not all, of these people are in this situation (causing them to suffer permanent chemical-induced brain damage).
And because psychiatric drugs are still widely used… it’s not difficult to predict who will be affected by the chemically induced permanent brain damage (chemical lobotomy) caused by psychiatric drugs.
Today, anyone taking psychiatric drugs… is a to catched candidate for the chemically induced permanent brain damage (chemical lobotomy) caused by psychiatric drugs tomorrow (usually in the long term). It’s only a matter of time before they get a chemical lobotomy.
And it will be inevitable for them to end up like the millions of other innocent mentally disabled individuals who end up in mental hospitals, psychiatric hospitals, nursing homes, retirement homes and rehabilitation centers.
And those responsible for this are the mainstream psychopath psychiatry gang. And so are the psychiatrists who prescribe psychiatric drugs. Furthermore, those who remain silent about these issues will be doctors (the mainstream medical community), governments, states, mainstream media, politicians, and society itself.
As a final word, Psychiatry is an industry, not a medical field. It is a money-making industry. The harm it inflicts on humanity is countless. Psychiatry should be prosecuted for the harm and genocide it has inflicted on humanity. Psychiatry should be removed from medical schools…
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Richard Moldawsky, thank you for your article. It contains information that will be helpful in my own work. I will try to evaluate it. Thanks again. Best regards.
With my best wishes. 🙂 Y.E. (Researcher Blog Writer (Blogger))
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No offense, Richard, but psychiatry is an iatrogenic illness creation Ponzi scheme. The ADHD drugs and antidepressants can create the “bipolar” and “schizophrenia” symptoms. And the antipsychotics can create “psychosis,” via anticholinergic toxidrome, and the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.
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Reading this blog lulled me into an almost drug-like sense of feeling “What’s all the fuss about? Everything seems just fine in the land of psychiatry…”.
But then I woke up and realized that the author’s seemingly impartial, sing-song approach is probably the way most psychiatrists soothe themselves from having to repeatedly pretend to know more than they actually do.
And if I were he, I would allow myself to entertain the possibility that maybe my own “patients” are the most reliable research subjects of all.
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Clarification: The author’s seemingly impartial, sing-songy approach is probably the way most psychiatrists lull themselves into believing they know more than they actually do.
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“Good science wants to move us closer to truth, and understands that even being proven wrong is a step forward.”
So the so called “mental health professionals,” whose DSM “bible” was debunked as “invalid” in 2013, need to garner insight into reality.
“No doubt science is not the only way we know things. Some things we know using logic. Some things we intuit or just have a feeling about. Some things we’re taught and we accept them as knowledge. Some things we can know using our five senses. Some may come from religious training.”
So the Holy Spiritual blasphemers of the “mental health industries” may want to repent, and change from their “unforgivable” ways?
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I think the author of this blog needs to face the fact that psychiatry is glorified drug pushing—no matter how many research papers he reads.
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In my opinion the really crucial thing is to respect patients’ autonomy, to treat everyone as a unique individual and not to be pessimistic.
I was diagnosed with paranoid schizophrenia in 2012. I decided to come off the prescribed neuroleptic (against psychiatrists’ advice) because I saw absolutely no point in “maintenance treatment” (my psychotic symptoms had disappeared) and the side effects were horrible in my case. Since that time I have never had a relapse. I am happy and able to work at a job which requires a high level of knowledge and skills (my employers have no idea about my diagnosis).
I am sure that I did the right thing when I decided to come off my neuroleptic. Psychiatrists who wanted me to keep taking it did not think about the impact of the neuroleptic on my life, brain and health. They also wrongly assumed that every patient had the same priority – to minimize the risk of a relapse (though there are even people on neuroleptic injections who have relapses) and to hide any possible sign of being different from “normal” people.
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What you say Dr is very reasonable. It makes me ask—how do you said justify treatment without consent?
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Thank you for bringing up the all-important question of consent. Or more specifically, access to INFORMED CONSENT for the people who really matter.
You’ve brilliantly highlighted the way so many supposedly rational people misuse their power of reason.
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Birdsong, I am not sure if you were replying to my comment, but I totally agree with you: informed consent is crucially important! And in my opinion NO ONE (even people who have committed crimes) should be forcibly drugged.
There is absolutely no moral justification for forcing people who have not done anything wrong and who are not violent to be on neuroleptics. Most people don’t realize what effects these drugs have (and some people are particularly negatively affected by them).
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Joanna, I agree. Drugging someone against their will who isn’t violent is very wrong, especially for extended periods of time.
It’s also very wrong how often most doctors are ignorant of the serious side effects common to neuroleptics, something that unfortunately makes their version of informed consent a sick joke most of the time.
Most of the time the use of neuroleptics is unjustified.
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Yes, Birdsong – doctors should actually use these drugs themselves to see their effect. One psychologist in my country has done it and realized how neuroleptics are impacting patients. It’s a pity that there are very few people like him!
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It’s disturbing the way so many psych professionals seem to automatically tune out people who complain about the distressing ways neuroleptics affect them.
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CORRECTION:
You’ve brilliantly highlighted the way so many supposedly rational psychiatrists misuse their reasoning powers, most likely stamped out of them early in their psychiatric residency program by their most likely pharmaceutically-groomed higher-ups who not only “teach” them the ins and outs of “biological” psychiatry, but pretty much control the fates of their so-called “careers”, a process that leaves most trainees with an intractable amount of obsequiousness to what they’re led to believe is actualscience.
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Clarification:
“… a process that leaves most trainees with an intractable amount of obsequiousness to what they’re led to believe is “actual science.”
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As a non medical scientist let me make a few suggestions that may help you.
1. The premise that you are dealing with a medical issue aligns with your position as a medical professional. May I suggest that you start with a more general goal of finding ways to improve your patients. While it is true that patients may lack insight, it is also true that a patient who is recovering has an insight into the factors which are helping this recovery. Doctors used to treat scurvy with citrus fruits as they knew it helped patients although at the time the doctors knew nothing of vitamins. So knowing what helps patients and using it not only helps treatment but also gives you an indicator of underlying causes. By looking at common factors in numerous recoveries you can avoid subjective bias.
2. It has been long speculated that alienation is a factor in mental illness but with no agreement in the source of this alienation. My own personal experience and my experience helping others revealed to me that the source of the alienation is not important as you are dealing with a feeling and not a neurosis. 70% recovery is possible by providing a safe space and an inclusive relationship. A supportive non judgemental relationship reduces feelings of alienation and reverses the patients reaction to this. Further focusing on the source of the alienation risks increasing this feeling as you are serving your Ego needs and not the needs of the patient.
https://psychrights.org/research/digest/effective/APAMonV31No2.htm.
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Thanks, Eric.
I, in spite of being a medical professional, do not believe that all patients I see have ” medical issues.” I agree that the goal is to be helpful, which means I don’t presume that a problem is medical. More important is how the patient views the problem; that is the starting point, and I routinely ask – on day one – how the person thinks about whatever’s going on. S/he could tell me it’s a chemical imbalance; that’s the starting point – not the end – of the conversation. S/he could tell me the problem is a bad boss; again, that’s the starting point. My style is that it’s a longer conversation before we even consider meds ( if we ever do).
2.I agree that many feel alienated. Again, that’s a starting point. Alienated from what? for how long? what does the person mean by that word? Part of creating the safe space is taking the time to be sure I understand the patient’s language as best I can – and that the patient knows I’m trying to do that before jumping to some quick fix.
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Richard thenk you for taking the time to respond and I am glad we agree on the importance of helping.
A wise man once said “the more severe the mental disorder the lighter the touch”. A person diagnosed as Schizophrenic will greatly benefit from a supportive helpful inclusive relationship, which has the potential to reverse feelings of alienation, while intrusive probing of his past has the potential of making him worse.
If you are interested in research into why people recover from regressive psychosis I have experience you might find useful.
Contact me at [email protected]
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Eric, supportive, helpful and inclusive relationships are crucially important, but it can be very difficult to form such relationships. Not everyone diagnosed with schizophrenia has access e.g. to a peer support organization. Not everyone makes friends easily. And poverty often makes it difficult to socialize.
Moreover, people may get trapped in abusive situations precisely because they are isolated and desperate to have a supportive relationship in their life.
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Joanna, I totally agree with all that you said. I had a brief regressive psychotic experience in 1978 and was fortunate to be treated with a brief course of anti-anxiety medications and also escaped the Schizophrenic label. Unfortunately my history was discovered, greatly exaggerated and spread among friends and family. It took me 40 years to completely discredit the rumors and begin to make meaningful relationships. However since the original article was about Psychiatric research my point is that why patients recover is a neglected area of research. Courtney Harding and others have published papers in this area and these have resulted in the recover movement. I personally have focused on this for forty years and along with my own experiences have developed an Existential understanding of what is commonly referred to as Schizophrenia which fits the recovery evidence. It might not fit everyone but by focusing on successful recoveries it holds a lot more promise than chemical straight jackets.
Congratulations on overcoming your trauma and escaping psychiatric/pharmaceutical complex. I wish you all the best in the future.
https://www.madintheuk.com/2024/08/rethinking-schizophrenia/
[email protected]
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Eric, thank you so much for your reply to my comment, for your heart-warming words and for sharing your own experiences.
I am very sorry to hear that some people decided to use your story to vilify you and damage your reputation. Great to know that you have been able to overcome this experience which must have been very painful.
Fortunately very few people know about my psychotic experience, but I sometimes suspect that it negatively impacts the attitude of some of my relatives towards me. I have also learnt not to share my story with other people, even when I see them as close friends.
Psychosis still tends to be perceived in a negative way and as a sign of lifelong mental illness, unless a person is obviously successful and popular. This is very sad because this means that many people – like me – are literally afraid of sharing their stories in public (I am not using my real surname on this website). People “with lived experience” are encouraged to share their stories at a mental health conference in my country, but the organizers clearly don’t take into account the danger of stigma.
I totally agree with you that there is not enough research on patients’ recovery – and especially on recovery without the “chemical straitjackets”, as you aptly called them.
I am going to read your article and I, too, wish you all the best in the future!
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This blog is a beautiful example of the way most medical doctors rationalize the irrational—the irrational being their urgent need to uncritically believe in psychiatry’s pharmaceutical propaganda, an ailment seemingly common to most psychiatrists, only understandable once you realize it’s a carefully crafted form of self-preservation.
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Dr. Moldawsky finds solace in his field – and enough ambiguity – in the well known vagaries of carrying out minimally biased, unconflicted scientific research and laments the public’s naivete regarding understanding such research. As a practicing psychiatrist, he also represents acceptance of individual rights being involuntarily relinquished, as well as the right to be so personally empowered. However, irrespective of science’s general, eternal and difficult struggle toward truth (which we must certainly applaud), biological psychiatry’s pharmacopeia’s scientific evidence is of the weakest, most ignorable kind, is only autocratically integrated with patient care, and the research outcome for which isn’t remotely productive of patient cure/wellness. The legitimacy/necessity of biological psychiatry, which glorifies (essentially the control of) human “behavior” – at the expense of human subjectivity – remains unchallenged bedrock for Dr. Moldawsky, though his guild has no redeeming therapeutic (much less scientific or even philosophic) understanding of either the word “mental” or “illness”, much less ‘mental illness’. Surely, throughout human history, we humans have persisted struggling (and suffering) meeting life’s challenges through the values of mutual care, compassion, and love – notwithstanding, and even acknowledging through shared sympathy, the profound mystery of our existence about which science hardly scratches the surface. True honesty, including scientific, will recognize biological psychiatry, and the system it tyrannizes with it’s ‘mental illness’ plague, irrespective of undoubted good intentions of any given practitioner, is an invalid, unscientific mythological – though undoubtedly profitable – substitute for such human values, and needs to exit the field of our (very subjective) lives. We can do better.
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I think this article overlooks the most important point: psychiatric protocols and decisions are NOT made based on scientific results! Or to put it another way: there are certain very strong assumptions operating in the psychiatric worldview (the DSM categories are scientifically valid, “mental illnesses” as so described are biological in origin, reduction of “symptoms” as identified in the DSM is the most valid measure of “success,” etc.) and the research, even if it’s otherwise done in a clean and legitimate manner, is automatically biased by these assumptions and therefore leads to wrong conclusions. As an example, if “ADHD” is a “neurological disorder” in all cases, then stimulant “medication” can be shown to “reduce the symptoms” of this “disorder.” However, long-term studies have shown repeatedly that the “treatment” of such children with stimulants does not lead to substantial improvements in any long-term outcomes that most people would value (completion of school, enrollment in college, reduction in delinquency, higher self-esteem) despite the “symptoms” being “reduced” by the drug substantially. I’ll leave the reader to imagine and enumerate the many possible reasons why a child may be seeking attention and stimulation, but I think it’s fair to say in this case that “symptom reduction” serves primarily the needs of the institution (usually schools) who recommend it, and leaves the actual client in no better shape for being exposed to a fairly dangerous brain-altering substance for many years.
So by choosing to measure “symptom reduction” as the main outcome, research favors legitimizing the DSM categories and validating drug “effectiveness.” If different “outcomes” were chosen the results would vary dramatically. But these assumptions are not challenged by the article, and are rarely if ever challenged by mainstream researchers. Those who do challenge them are attacked or ostracized, as Whitaker was from Day One, despite the excellent scientific basis of his theses.
Oh, and there’s also the fact that legit research is intentionally ignored by the establishment. Hard to pretend you are being scientific when you dismiss inconvenient data in order to justify continuing your current practices. I will ask how many psychiatric drugs were said to have “minimal side effects” and “no dependency” only to be later shown to be addictive or cause Tardive Dyskinesia or otherwise do known damage that was denied.
I could go on, but I think y’all get the gist. There’s no point in doing “science” if you start with heterogeneous non-scientific groupings, limit your findings to the things you want to find, and deny the reality of research that doesn’t validate your reality. Psychiatry is the farthest thing from scientific, and no amount of double-blind studies can alter that fact.
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“Psychiatry is the farthest thing from scientific, and no amount of double-blind studies can alter that fact.”
Yes, but why not just call out psychiatry for what it actually is: legalized drug pushing. After all, even nuance has its limitations.
But perhaps asking psychiatrists to step out of their quasi-scientific comfort zone is too much to ask.
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I would have to disagree with your approach, particularly your emphasis on randomised controlled trials. The success of treatment for psychological distress is very heavily influenced by the factor unique to the individual – E.g, nature of distress, personal preferences, personality style, life circumstances. RCTs are not very useful in this field, because they involve aggregation of statistics for analysis, and that aggregation erases those individual factors. Consequently, an RCT can say very little whether a treatment would be useful for an individual suffering some form of psychological distress, because it does not analyse the most important factors.
Additionally, I think theoretical problems are another serious issue. To research the treatment of psychological distress, it is critical to have useful theories of psychological distress, which can be measured with useful and valid construct.
I do not think the theoretical models that are currently used in this research are very good. There is a focus on monolithic “disorder” constructs, which are usually questionable and do not effectively model human experiences. The measures also have major issues with theoretical validity. As such, the outcomes of studies are not very useful. Finding a statistically significant reduction in a metric like the Beck depression inventory and concluding this means there has been an improvement in a “disease” called “depression”, does not say very much about actual people’s experiences.
My view is that high-quality qualitative research is needed to create theories of psychological distress that are more accurate and useful, before quantitative research can be productive. Also, I think that research methods that capture individual factors, such as case studies, are more useful for informing clinical practice. I think RCTs are only useful for validating and quantifying subjective drug effects, and are not appropriate for evaluating the effectiveness of treatment.
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Finally some signs of intelligent life.
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Jane, I really appreciate your comment. Yes, statistics don’t reflect factors unique to individuals when it comes to recovery. And I, too, value case studies much more than statistical research.
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Jane DRF –
thanks
I agree with you about some of the limitations of RCTs, which is why I said that science is not to be worshipped and that RCTs are one way to get information, not the only one.
I would add that it’s simply not the case that RCTs are only good for drug studies; there are some others the compare psychodynamic psychotherapy with cognitive psychotherapy for anxiety disorders, just as an example
I think we have to also say that individual factors, important as they are, help us with the person in front of us, but not so much with the next person who has a whole different set of personal situations and problems and strengths.
Personal anecdotes mean a lot, but how do we take person #1’s story and reliably use it for person #2? Maybe we can’t, other than to be reminded that #1 and #2 are different, and there’s not much else to guide us.
I’d be interested to know if you know of the kind of research you think ought to be done. If we all don’t have enough in common, we can’t be studied as a group of any kind.
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We can’t. As Milton Erickson said wisely, we need to reinvent therapy for every client! The idea that there is one “scientific way” to help people who are having emotional difficulties is actually a ridiculous concept! That’s why the DSM categories are a waste of time. What good is a “diagnosis” that tells you neither why the condition arises nor what can reliably be done to resolve it? It’s a farce!
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Steve, you’re talking as if we humans don’t have anything in common. Not sure if you mean that, but the implication of that might be that if a therapist is successful with patient A, it’s random that they’ll be able to help patient B. Ditto for the unsuccessful therapist. We do know that successful therapists have some things in common.
If we have to reinvent therapy for each patient ( and in a sense I agree), it makes me wonder how and who would teach people how to be therapists. I’d be daunted to be a therapy trainee and be told I have to come up with a brand new therapy for each new person. Wouldn’t you? I’d need at least a framework, so I’d be curious to know how you might teach that.
Just for the record, I am not – never have been – an apologist for DSM. I think it, like most things, can be useful if we also acknowledge its limitations.
This problem is not limited to psychiatric diagnoses; two people with diabetes can be in wildly different states of health or disability.
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Richard, you don’t have to reinvent anything. But you do have to know how to leave the preconceived notions psychiatry fills your head with at the door enough to really see and truly hear what the person in front of you is trying their best to say.
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I don’t mean that at all. Not sure where you are getting that. What I mean is that there is no FORMULA we can follow that will help everyone.
As to how we could teach people to be therapists, I agree that this is a difficult, almost impossible task. What the training would need to do is to teach the therapist how to recognize and set aside their own preconceived notions and biases and truly be there to hear what the client has to say. There are certainly situations where past experience helped me know what to do in a current circumstance, but absent the ability to truly connect with the client in their own space, any such experience is pretty much useless. This is why some folks have advanced training (Ph.D. or Masters) in counseling/psychology and are terrible therapists, whereas volunteers at the crisis line I worked at with backgrounds in engineering and/or computer science seemed to be extremely competent in helping out. It is to me an illusion that one can be trained in a particular “school of thought” and apply this thinking universally to all clients with any level of success. My experience is that starting with a “beginner’s mind” and knowing that we DON’T know what to do just yet is the key to success. But this requires a humility and a level of personal security that can’t be trained into someone. Maybe making sure therapists get good therapy before they start is the best chance of creating this. But of course, they’d have to have therapy with a person capable of doing all of the above or their “therapy” won’t make a difference.
It’s a conundrum. But it’s best we acknowledge the observable truth that training people to “do therapy” doesn’t really work very well.
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And under what circumstances do you see the DSM as being useful?
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Richard, take my word for it:
Insulting people with stigmatizing labels is useful only for people who like hearing the sound of their own voice utter medicalized gibberish.
P.S. Clinging to rigid assumptions builds invisible walls.
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CLARIFICATION:
Insulting others with stigmatizing labels is useful only for those who find uttering medicalized gibberish comforting.
P.S. Listening with an open mind is a much better way of making sense of what seems intolerable to oneself.
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I don’t think you can reliably apply what you learn from one person to another. But I think that by understanding the unique experiences of a large number of people, you can identify patterns and develop useful knowledge about people’s experiences of psychological distress, including an understanding of its variations and nuances. These, in turn, can be used to inform clinician’s efforts to help a person in psychological distress, by applying that knowledge to analyse their situation and gain a better understanding them and their needs. Obviously, that is a process that needs genuine understanding and curiosity – It will always be as much about the therapist’s interpersonal approach as it will about understanding any theory.
As for what research I would want done, it would mostly be qualitative psychological research.
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Thank you, Jane, you said it better than I could have. Experience leads to generalized knowledge that is useful, but there’s no one way to approach everyone that will ‘work,’ and “the therapist’s interpersonal approach” really is the key to success! And I also like the emphasis on “curiosity” – one can’t learn if one thinks s/he knows all about the area before s/he starts!
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I’ve never understood medical doctors’ distrust of anecdotal evidence.
Where on earth do these educated fools think their research data comes from?
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Richard, knowing the difference between cynicism and skepticism is a very useful skill to have when trying to make sense of just about anything.
P.S. Nothing’s more cynical than psychiatry’s DSM.
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I’m glad that my blog has stimulated a lot of comments. It’s tempting to respond to each of them, but an ongoing give-and-take with the commenters is tough to keep up with. I’m going to say a few things here by way of acknowledging what you’ve written; I might ( not promising) to make future ones, so please don’t read anything into what future comments I don’t respond to. I promise to read them all, however.
(1) There’s lots in psychiatry and the mental health field to be critical of, and I have been one of its critics when I’ve seen us fail. I’m not writing to defend it, but, as I see it, trashing the field has limited value.
(2) We all have our biases and blind spots. I know some of mine, but I’m sure not all. That’s true for all of you, too, I bet.
(3) My experience is that most in the field are neither evil nor dupes of Big Pharma, the APA, nor worshippers of the DSM. Maybe you know some who are evil or dupes, and I would join you in saying those people shouldn’t be practicing. I have known a few myself.
(4) The DSM is not a bible. It’s a partly helpful, partly unhelpful way to talk about patients. It’s more helpful with schizophrenia and bipolar and some anxiety conditions than it is with mood or personality disorders, or ADHD. That’s an incomplete list. We are stuck with it for billing purposes until something better comes along. It’s a big moneymaker for APA, which troubles me, and it’s part of why I’ve not been an APA member for over 40 years.
(5) It’s a cliche to say that we are a polarized society in many ways, and I guess one of them includes how we all think about mental health care. Good vs evil, freedom vs totalitarianism, clear-eyed vs naive: I think it’s unhelpful to frame things so simplistically. I know that trying to stake out some common ground, disagreements included, can appear unprincipled or chickening out. I just don’t buy that.
(6) I’d be interested to know if there are things you’d like to have me write about in the future. Please understand that I’m wanting to bring some perspectives to the table that don’t already have voice on MIA. Not promising to respond to any of your suggestions, but I value my audience. Thanks.
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I would like to hear more specifically how you see the DSM being helpful in such situations. I acknowledge that folks acting within the insurance system need to use the codes to get paid, but for my money, that’s about what they are good for. “Diagnoses” never entered into any therapy I engaged in except to tell them I was billing the insurance company or to explain to them what someone else had labeled them so they’d understand the descriptive and subjective nature of the labels.
I’d also love to hear a response to my answer to your question about how to train therapists. Jane also made a fantastic reply which said what I meant even better, and I think it is deserving of a reply, even if it’s “Well, I don’t know how to do that.”
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If I tell a colleague who also treats the same person (like a therapist or a PCP), using DSM provides some ( not complete, don’t go there!) common ground to begin a collaborative discussion. As I said, for some diagnoses, it’s more helpful, and for others, I don’t bother and use other language.
As for training new treaters, you have to define the scope of what your program trains treaters to treat. If you opt not to call them illnesses, fair enough, but you have to somehow be able to say “we’re training people to help with problems like X or Y or Z,” using non-illness language. One could say “problems in living” a la Szasz, which is reasonable. In the world as it is, it would be a challenge to find people or institutions to fund it, don’t you think? Even most current psychology. or social work training programs can’t escape some form of DSM-type targets of treatment.
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The fact that “the system” uses DSM codes for billing is no excuse for giving them more validity than they merit. You’re saying we shouldn’t train people to do quality therapy because the system won’t pay for it???? Isn’t that a pretty damned good reason for scrapping the current system and starting over? You’re sunk in the trap of thinking of “mental illnesses” as medical problems. For the most part, they are not. When they are, the DSM system actually discourages looking for the REAL biological reasons by providing a pseudo-biological “treatment” for a pseudo-biological “disease” which they have no understanding of how to cure or often even treat! But we can’t get funding for actual effective treatment? Something is pretty rotten in Denmark, Richard. I don’t think you’re really facing what we’re up against here. The fact that we’ve all been brainwashed into DSM-style thinking and are forced to employ it to get paid by insurance companies is CENTRAL to why the numbers of “mentally ill” are rising despite (or because of?) the increase in “treatment” rates. It’s like the Sufi parable about the guy who lost his key in the house but is looking outside because the light is better there. We won’t find any answers until we stop pretending we have them, and we won’t improve the situation until actual successful interventions are funded with the money retrieved from the current massive waste of billions on stuff that simply isn’t effective!
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Gee, Steve, I thought you were asking me a reasonable question when you wrote “I’d also love to hear a response to my answer to your question about how to train therapists.” I gave you what I thought was a reasonable answer, but you flew right past that, as if I were some staunch defender of DSM and the current establishment. After our exchanges, you ought to know that just lumping me in with those you oppose is both unfair and guilt-by-association. From my standpoint, it seems you really didn’t want to hear what I said, but wanted another chance to make your own points. This is exactly – exactly – the kind of thing that we both ( yes both of us) deplore when it happens between those who are seeking help and those who profess to want to provide it, that someone has “THE ANSWER” and the other person just needs to acknowledge it.
Black-and-white thinking is a trap and a danger, as I’m confident you well know.
What makes it so hard to say “I don’t fully agree, but you have a point.”? You asked me a fair question, I gave you an answer, and if you re-read it, I bet you’ll say to yourself the solution is not as simple as erasing DSM and having no clear plan to replace it with something better.
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Your answer sounded like you were saying what I proposed was impossible. I think you’re over interpreting – what I was saying was, your suggesting that this would be DIFFICULT TO FUND was essentially giving in to the idea that the current paradigm is unassailable, not that you were defending it. Sorry if it came across that way. My point is that we should FUND WHAT WORKS and stop PAYING for things that don’t work or make things worse. I hope you would agree with me there!
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Richard, many thanks for your comment. You say that the DSM is helpful with some diagnoses like schizophrenia. In my opinion the current DSM definition of this disease is much too arbitrary. I had severe psychotic symptoms (hallucinations and delusions) for about a month many years ago (in 2012), but I seem to have fully recovered since that time. In any case I have never had a relapse and I am able to live independently and work, though I have not been using any psychiatric medications for many years.
Let me add that at the beginning of my psychotic episode I was using a medication which might cause hallucinations and a psychotic disorder (Malarone), but psychiatrists who diagnosed me did not take this into account.
In my opinion there are at least four possibilities: (1) I was misdiagnosed (and this is what one psychiatrist told me many years later); (2) I did have schizophrenia, but I recovered; (3) I have not recovered, but my symptoms don’t significantly impact my functioning; (4) “schizophrenia” is a highly questionable concept.
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Re ” I’d be interested to know if there are things you’d like to have me write about in the future. ”
As a Psychiatrist writing in MIA you have certainly stirred a hornets nest of opinion and even rage however as one who is critical of Psychiatry an insider view of how psychiatry miss uses science may be more constructive.
1 Specifically your emphasis on drug trials while ignoring NIH funded Longitudinal studies into recovery. What is more important helping people recover or suppressing their symptoms?
2 Generally how confirmation bias and group think are destroying Psychiatric Objectivity. Maybe not personally but their effect on the group.
3 Refusal to question their basic premise that we are just biologically evolved entities. When all else fails question basic premises.
4 The physical sciences have been successful in understanding the material in material terms therefore the immaterial should be addressed in immaterial terms not in material terms. Mental illness used to be divided into organic and functional. I believe this is a more useful model than an unproven all is medical model.
Another subject the group may benefit from is how institutionalization effects the staff. Much has been written about the patients while ignoring the staff. Some self reflection here maybe insightful.
Eric Setz
[email protected]
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How about an investigation into how and why psychiatrists got the idea that patients would “need psychiatric medication for the rest of their life” without any long-term studies to support this bogus claim?
Because if you don’t start there, you’re wasting everyone’s time.
IMHO.
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Hi Eric – I’ve read your post from the other day. You’ve given me some things to consider for future blogs.
We know that MIA is aimed, as it says in its mission statement and posting guidelines, at “rethinking psychiatric care.” I take that to mean that this site is about identifying what’s good and effective, what’s bad and ineffective about psychiatric care, and how it can be improved. I get that some people think the whole system has to be dismantled and that posts on MIA are solely to be describing the bad and ineffective, and that anyone who has a more nuanced view is either naive, evil, or otherwise not worthy of being heard. That’s not consistent with the posting guidelines, nor with how I view things. I suppose that anything I write from here on in will be met with some reactions not in keeping with the spirit of MIA.
With regard to your specific suggestions-
1) my blog mentioned drugs, but most intentionally not as the core of my discussion of research, which I carefully mentioned can be used for non-drug treatments. It was not my aim to get into longterm studies, so not fair to say I “ignored” them. It’s another topic, deserving of its own discussion.
2) Not sure what evidence you have that confirmation bias -which is a problem for everyone, including many posters here – has “destroyed” objectivity. I agree it’s a concern, maybe we differ on the extent of it.
3) I can’t count how many psychiatrists I’ve known. I can’t speak to your experience, but the next one I meet who believes we are “just biologically evolved entities” will be the first. I’ve never heard anyone say or even imply that. I don’t believe that anyone teaches that, either. Doctors who seem to do ‘only meds’ may appear to think that, but I believe it’s an illusion.
4). As just said, the medical model is – I mean this sincerely – NEVER taught as the sole approacH, even if it might look that way sometimes. The organic/functional distinction still has some usefulness, but since there’s so much disagreement as to how to draw that distinction, I’d say that it’s still used when it”s helpful and not when it’s not.
Your comment about staff in institutions is interesting, though not one I know lots about.
I appreciate the exchange. You deserved a thoughtful response. Please understand that I am happy and willing ( as I have been elsewhere in my career) to point out problems in our field. Those who want to hear me only focus on what’s wrong will, in my view, simply be exercising their own confirmation bias and that won’t make things better for those do need and deserve help ( and I don’t mean meds).
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Richard, if the medical model is never taught as the sole approach, why is there so much overprescription of psychiatric drugs, usually for years on end?
I think it’s reseasonabe to assume that confirmation bias on the part of physicians leads to this reckless practice. The fact that most psychiatric drugs are prescribed by GPs is no excuse for it.
I think you really need to step out of your comfort zone and realize how widespread the overpresription of psychiatric drugs is at the present time, because without an honest acknowledgment of this, there is no “re-thinking psychiatry”, in my opinion.
Dismissing this issue is highly disrespectful both to me and the tens of thousands of others who’ve paid the price for psychiatry’s pharmaceutical recklessness.
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Richard, you don’t come across to me as someone particularly interested in meaningfully probing into the serious problems psychiatry creates for people’s lives and health.
The vibe I get from your blog is pretty much “business as usual”.
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Let’s agree – if we can – that there is overprescription of psychiatric meds. We both, probably, have our own sense that that’s the case. Fair?
We could say that no one, ever, should be prescribed meds unnecessarily and certainly never coerced into it. Still on the same page?
The world isn’t perfect, so bad things are going to happen, even though we wish they never did. I think it’s a fair question to ask how much overprescription goes on. So I ask respectfully, since you say there is “so much” of that, how much overprescribing is there in your view, and how do you come to that conclusion? I do not know the answer. I know we all have our experiences and hear stories of others. We can’t ignore that, but it’d be nice to have some data to work with. Do you know of some?
I’m asking because the solutions to a huge widespread problem should be different from the solutions to a problem that occurs mostly, say, in hospitals or prisons or nursing homes or foster settings, and not so much elsewhere. I’m not saying I know the extent of the problem, so I’m asking, respectfully, what you know and how you know it.
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Richard, I don’t the have data, and neither do you. But that does not mean that overprescribing and the resulting addiction to psychiatric drugs isn’t a big problem.
My question for you is this: if overprescribing and protracted withdrawal weren’t a serious problem for a substantial number of people, how do explain the existence and rapid growth of online support groups dedicated to psychiatric drug tapering? Clearly they are meeting an urgent need establishment psychiatry isn’t adequately addressing—a problem that psychiatry itself is responsible for.
According to AI:
* Surviving Antidepressants has tens of thousands of members, many navigating years-long tapers from medications they were told were “non-addictive”.
* A study of 16 Facebook tapering groups found over 67,000 members, with annual growth around 28%.
* Mad in America’s withdrawal resource hub and TaperClinic offer structured, expert-led tapering support—because psychiatry rarely does.
* Many members report being dismissed or misdiagnosed when they tried to explain withdrawal symptoms to their prescribers.
* The groups often fill in where psychiatry has left a void: informed consent, long-term follow-up, and individualized taper plans.
* If withdrawal were rare and mild—as some establishment voices still claim—these groups wouldn’t exist, let alone thrive.
*Psychiatry’s reliance on randomized control often excludes long-term, real world tapering experiences—leaving survivors to crowd source their own science
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Richard, to me you don’t seem all that attuned to the way psychiatry distorts emotional suffering and objectifies those who experience it.
I believe that’s the heart of our disagreement.
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Richard,
I appreciate you taking the time to write a considered response.
As to #3 and #4, it may not matter a lot what is taught, the choice to rely on “medications” as the first line and often ONLY intervention for “mental illnesses” makes any other non-medical-model considerations moot. I have known a large number of psychiatrists from my work in the child welfare system, and can count on one hand the number who actually prioritized non-drug analysis or interventions for foster youth, ALL of whom were certainly victims of childhood trauma of the most serious kind, both by their birth families and by the process of removing them to foster care. I’ve also spoken to dozens, maybe hundreds of foster youth, and have not met one yet who felt their problems or issues were mainly addressed by psychiatric diagnosis and “medication.” They were addressed by changing foster homes, by being adopted, by being empowered by attorneys or CASA volunteers to be their own advocates, by being particularly cared for by an excellent caseworker or social worker, according to the kids themselves. I’ve also encountered many kids being damaged by the “medical model” assumptions inherent in the label-and-drug process: kids becoming diabetic, becoming psychotic, relapsing into eating disordered behavior thanks to stimulants, becoming suicidal, having constant hand tremors and akathesia, among others. NONE of the situations I just mentioned were addressed by the MD psychiatrists whose drugs were creating the problems. ALL were resolved by advocacy by the CASA volunteer or by the child’s own decision to stop following the MD’s instructions.
So whatever the training, my experience is that in practice, most psychiatrists (at least the ones treating foster youth) are in fact quite committed to the “medical model,” but don’t even attempt to provide informed consent, let alone analysis of social factors contributing to the youth’s difficulties. Multiple foster youth have reported to me being told they were depressed “because you have a brain chemistry problem.” They were often incredulous, saying, “So they are telling me that my BRAIN is the problem, that if my BRAIN were working properly, despite being abused at home, removed from my family, moved to multiple foster homes, separated from my siblings, grandparents, relatives, forced to change schools multiple times… despite all of that, I’d NOT be depressed if my brain were working properly???!!”
It appears to me from my experience and the stories I hear that, notwithstanding the “bio-psycho-social model” claimed to be in use, most mainstream psychiatrists use the “bio-bio-bio” model and view ALL “mental illness” as problems with the brain. It is hard to see how any kind of change can happen in the field when the majority of practitioners fail to address or even consider the kind of psychosocial issues that are often behind or exacerbating the “symptoms” they are trying to suppress with their biological interventions.
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The problems of psychiatric care in institutions are serious. It’s my impression ( not data-based) that there’s way too much emphasis on behavioral control, and the pressure on docs to medicate is therefore higher, even when non-med approaches may work better and are safer. Some institution staffs are unable, unwilling, or otherwise stretched too thin to give those approaches more time. The docs who work in those places tend to have to see many kids in a short time, don’t know them too well, and are trying, sorry to say, to keep the staff happy. The docs really don’t have other tools to use in those circumstances, making it look like their framework is narrowly biological. I agree it’s not good.
I get that you have a lot of experience in those settings ( I have been a CASA, too). I don’t think that generalizing to the broader range of psychiatric practice is a step you can take without taking into account
that kind of setting. Ditto for prison and nursing home care. It’s a lot harder for docs in institutional settings to feel like those are “my patients” than in most other kinds of psych settings. It’s a much bigger issue than the biological focus alone.
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Or to put it another less charitable way: It’s a lot easier to dehumanize clients who are involuntary and don’t have advocates there to stand up for them.
It seems you are willing to give other practitioners the benefit of a doubt in most cases. Years of experience disabused me of such notions. And the docs “not having other tools” is clearly a validation of my assertion that they only see biology as the cause. I’ve also had many a conversation with psychiatrists about these questions (I’m pretty assertive), and have gotten very bio-based responses. For instance, I talked to one guy (whom I actually liked quite a bit) about PTSD. He’d made it clear he thought biological brain differences were the main issue for psychiatrists to address. I asked him, “Well, in PTSD, there has to be a traumatic event to trigger the reaction. Doesn’t it seem like the traumatic event should be considered the primary cause?” His response was, “Not everyone gets PTSD from the same level of trauma. There MUST be something different in the brains of those who have that reaction.” See what I mean? No consideration of cultural context, of personality features, of social support networks or the lack thereof, of prior trauma, of resilience factors – no psychosocial analysis at all. Just, “They react differently. Brains must be different.” And this was one of the more educated and rational psychiatrists who was mostly in a research role, not overwhelmed by clients.
I do agree that lack of staff training in observing and intervening is a big issue. But isn’t that the psychiatrist’s job, to train them or make sure they have training? For example, the kid I mentioned with the extreme hand tremor was on four drugs, two antipsychotics and two mood stabilizers. All four had involuntary movements as potential side effects, and two specifically mention hand tremors in the product information. Yet the psychiatrist, when I told him we were concerned about side effects, said, “We haven’t noticed any side effects!” The hand tremors were obvious and the girl was spending a huge amount of energy trying to stop or disguise them, and she found it embarrassing that it was occurring to her. But the staff told her it was because she was “nervous”. The CASA spoke to the line staff, and they said they were NEVER told about potential side effects to watch out for when a kid started a new drug.
So at a certain point, we’re no longer talking about being overwhelmed. In the above case, we are talking about overt neglect and violation of the child’s right to informed consent (she was 14 and that right was posted on the “clients’ rights” posters all around the facility). Of course, once we convinced the psychiatrist to reduce the risperdal and lithium, the hand tremors decreased markedly. But they still told her it was nervousness, despite the clear scientific evidence it was not. This goes beyond being biologically oriented and moves into dehumanization of the client, as I mentioned above. No one should be treated that way, no matter how overwhelmed the staff is. Frankly, I think saying the doctors don’t have tools or enough time is pretty much an excuse. They ought to have other tools if they receive the training you assert is standard. It seems they are simply not applying them, and blaming the clients’ brains when their approach fails or creates other problems.
You also failed to address the overt claims that were frequently made to foster youth that despite massive trauma, they had “brain problems” that needed drugs to resolve. This is both a philosophical failure and further evidence of a lack of application of the supposed tools these psychiatrists were trained with. It doesn’t take a rocket scientist or a lot of extra time to recognize that the foster youth needs an acknowledgment that his/her distress is very real and is NOT the result of bad brain chemistry. It’s not an inability to do so that is the problem. It is either an unwillingness or a lack of empathy, and I truly believe and observe that the DSM diagnose-and-drug paradigm both allows for and increases the likelihood of such dismissive behavior on the part of ostensible professionals.
And I’ll end by saying that it’s not the client’s job to “be fair” or “understand the limitations” of their caretakers. Harm is harm, no matter why it happens. As an old friend of mine used to say, “It doesn’t matter why the milk truck doesn’t make it to the refrigeration center, the milk still spoils.” Clients who have been harmed, in particular, should not be expected to “be reasonable” about the professionals who failed them. We as professionals need to absorb their anger and critiques and reexamine our practices, not make excuses for bad service.
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Richard, you’ve asked for suggestions.
But what about the suggestion I’ve already offered, which is knowing the difference between cynicism and skepticism?
Why am I repeating my suggestion? Well, in my view, anyone who dismisses serious doubts and criticisms of psychiatry as “simplistic” or “trashing psychiatry” has yet to learn the difference between cynicism and skepticism—which, by extension, means they have a great deal to learn about the problems inherent in psychiatry itself.
In any event, it’s also my view that the last thing the world needs is yet another psychiatric apologist. And perhaps that’s why psychiatry essentially stays the same.
So, what DOES the world need? Information that lets people know that there are MANY VIABLE ALTERNATIVES to establishment psychiatry: somatic work such electro-acupuncture, yoga walking, spending time in nature, avoiding caffeine and alcohol, journaling, discovering spirituality, confiding in friends or family or finding online support groups.
P.S. Psychiatry no longer controls of the narrative, something people are slowly realizing that, for the most part, is to the good of mankind.
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Hi Birdsong –
here’s what you wrote earlier–
“Richard, knowing the difference between cynicism and skepticism is a very useful skill to have when trying to make sense of just about anything.”
Now you’ve said that that was a kind of suggestion – I didn’t read it that way and it wasn’t written as one. I agree that there’s a difference and I’m reasonably sure that I know the difference as you clearly do.
I agree that there are many viable alternatives to establishment psychiatry. If one size fit all, there’d be just one thing everyone should do.
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Richard, how does that justify:
1) The gross over prescription of psychiatric drugs?
2) The large number of people now suffering life-altering side effects and/or protracted withdrawal?
3) That the majority of psychiatrists or general practitioners do not provide adequate informed consent about the possibility of potentially life-altering side effects or protracted withdrawal?
4) That the majority of psychiatrists and general practitioners neglect mention the many no-drug alternatives?
These are the harsh realities too many people are wrongfully forced to face because of psychiatry’s neglect despite what you seem to think are its benign intentions.
P.S. It might do you some good to consider this:
If psychiatry weren’t causing so much undue misery there’d be no need for MIA.
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Richard, I find it telling that you haven’t addressed any of the four questions I posed. Could that be because you don’t know what to say—except to criticize the critics?
I also suggest that in the future you refrain from using deflective terms such as “black or white thinking”, “simplistic” or “trashing psychiatry” to characterize critiques as these terms aren’t neutral; they function rhetorically to subtly discredit critics of psychiatry by framing them as irrational or extreme.
One of the most effective therapeutic skills is to recognize that what may seem irrational or extreme to you as clinician may, in fact, reflect the truth for millions of people whose experience with psychiatry reflects the lived reality of psychiatry—one many, if not most, psychiatrists are unwillingly to face.
I invite you to revisit the questions I asked and respond to them directly. That would be a more constructive and respectful way to engage with those whose experiences challenge the status quo.
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I’m not here to defend psychiatry, so please don’t put me in that position.
There’s not a single thing you’ve written that suggests to me anything other than a contempt for the field, and I would not presume to try to offer you an alternative idea until or unless you displayed the slightest evidence of a view that differs from yours in the slightest.
Not all exchanges are productive, and I have no wish to persuade you that there might beg other ways to think about these issues.
I respect your views and assume they are based on what must have been horrible experiences. I don’t expect this to be any consolation, but I don’t believe they are universal.
It’s your right to respond to this, but please be aware that I don’t intend to respond again in this chain. If you re-read all the things you’ve written to me and imagine they were written to you by someone else, that might help you see what I mean.
I wish you well.
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Richard, psychiatry deserves all the contempt it receives.
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Problems inherent in psychiatry:
1) Operates from a biological framework that has yet to be proven biologically despite billions of dollars over many decades.
2) Condones the use of stigmatizing labels that harm more than help because they have no biological validity.
3) Prescribes addictive substances claiming these “correct chemical imbalances”.
4) Seeks to protect its own guild more than the people it claims to serve.
Seems like psychiatry already has all the ingredients to epistemically gaslight the uninformed.
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I would add 5) Diverts attention from significant social issues and interpersonal issues that can and should be addressed if we really care about “mental health,” whatever that means.
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Agree 100%. The systemic denial of social-emotional reality is what psychiatry does best.
It’s psychiatry’s own brand of lunacy.
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“Some people, based on their experiences, have some powerful criticisms of psychiatry, and some are cynical, too.”
Conflating realism with cynicism is psychiatry’s own brand of lunacy.
It’s refusal to let go of its own cynical attitude towards those who disagree with it reveals its defensiveness more than any commitment to truth.
P.S. Any cynicism towards psychiatry is psychiatry’s own fault.
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Psychiatry as an industry has proven quite cynical!
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That’s because the very nature of psychiatry is cynical—a reality many more people are finally discovering with each passing day.
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It is very cynical to claim “knowledge” you don’t have just so you can sell services or drugs, and to attack those who point out reality as somehow “insane” for not going along with your propaganda.
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Propaganda works wonders for psychiatrists who don’t like admitting there’s little justification for the majority of its so-called “medications”.
This being the case, it’s highly irresponsible and deeply unethical to prescribe substances that are known to not only cause life-altering side effects but are also highly addictive when numerous non-drug alternatives exist.
But propaganda works wonders for psychiatrists who already know the answer to the following question: “What is psychiatry without its drugs?”
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They made a choice back in 1980 to go down the medical pathway. It has not worked out, but now they are so financially and professionally overcommitted (sorry, bad pun!) that they can’t afford to back away from their belief system, no matter what evidence contradicts it. The financial incentives are all on their side, and they’ll continue to pass off this DSM/biological BS as long as it pays well. THAT is cynical, I suppose. But it seems to be the truth!
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Cynicism gets a bad rap. But if critics of psychiatry are labeled cynical for questioning the DSM or the medicalization emotional distress, then what do we call a system that pathologizes normal reactions to adversity, pushes drugs with known harms, and deflects accountability with vague promises of “future research”?
The truth is psychiatry has long operated with its own kind of institutional cynicism—one that prioritizes billing codes over healing, compliance over autonomy, and symptom suppression over understanding.
Needless to say, there are times when cynicism makes all the sense in the world.
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CORRECTION:
The truth is psychiatry has always operated in its very own orbit of INSTITUTIONAL NARCISSISM—one that places psychiatrists at the very top of its INSTITUTIONAL PONZI SCHEME—something that actually makes cynicism a sign of “mental health”.
IMHO.
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“Made You Worse”, latest short video from Dr Josef @taperclinic
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Richard, how do you make sense of a world full of people needlessly prescribed cocktails of psychoactive drugs for years on end when there are no definitive biological tests to prove their necessity?
No need to answer if your explanation is as evasive as your blog.
P.S. Being evasive may be comforting, but it makes no sense when people’s lives are on the line.
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“How similar or identical do the apples have to be?”
All studies have Inclusion/Exclusion criteria that must be met.
“Are the subjects for the study being paid?”
The FDA frowns on paying subjects so it isn’t done much.
We did a study on people who twisted their ankle and had to return to the Immediate Care 1 week later. But if the ankle is better people won’t come back, so the study paid them $50 if they came back. Other studies gave people who didn’t have transportation bus vouchers.
“but half of group A dropped out and only 3 did in group B. That’ll need an explanation.”
If you loose patients because of serious side effects, it has to be reported to the IRB and if they think it is unsafe they won’t allow the study to continue. All investigators are also notified of serious side effects. However, if you loose patients for silly reasons then you and your study coordinator didn’t do a good job selecting patients and they may not offer you more studies.
“Also, how do the researchers know if I’m really taking the treatment in the prescribed way?”
Patients are told to bring the bottles back at every visit and you count the pills and record it. They are usually given diaries to record any side effects and missed pills. The study sponsor hires a company that monitors paperwork and pill counts.
“It’s not often noted, but almost every study I’ve ever read has a section in which the authors discuss (a) what they already know to be some of the flaws in the study ”
Those aren’t flaws, they’re limitations. Excuses as to why they didn’t do better. It’s like saying we would have done better if we had more patients or the study was longer than 6 weeks.
“have to decide who’s trustworthy and who’s not.”
You’re right. I wouldn’t trust a guide on making sense of research written by someone who admits to reading few studies from beginning to end.
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thanks for these constructive comments
Just about any study, even an excellent one, will have flaws and/or limitations. The challenge for me is to what extent those feature still allow me to make good use of the findings. Neither patients nor providers should feel like a study has to be squeaky clean to be helpful.
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Every study has limitations. Honestly acknowledging them is good science.
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The biggest limitation is that most psychiatric studies are just snapshots of the honeymoon phase—brief windows that ignore the reality of long-term harm, along with the possibility that some people might have improved without drugs at all.
Good science doesn’t pretend to predict what only time can reveal. So the truth is, no one needs a tutorial on psychiatric deflection.
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… IMHO.
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Richard, you say you’re not here to defend psychiatry, but that’s exactly what your blog attempts to do.
Emphasizing the complexity and limitations of randomized controlled trials may sound balanced, but it’s also a convenient way to distract from the impossible-to-deny reality that psychiatric drugs have in many instances caused more harm than good—harm that too few psychiatrists are willing to acknowledge, either to themselves or to their “patients”.
Being even-handed sounds great, but why should anyone trust research trials on psychiatric drugs when the majority are financed by pharmaceutical companies and/or reviewed by psychiatrists with ties those same companies—especially when psychiatry also has a long history of diagnostic overreach?
So please tell us all:
Which part of this sorry situation spells “good science” to you???
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Searching for words, psychiatry has violated the trust of everyone. It has no right to have so much power.
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I’ve taken the time today to read your MIA contribution in 2022 detailing the tragedy of what your daughter and your family went through for so long. I can tell that it impacted all of those who read it back then and commented on it.
I’m sure to say that I, too, am sorry for what you went through (and still do endure) pales in comparison. But I offer my condolences and sympathies here nonetheless.
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“All the research aspects that I’ve been dealing with in my career as an investigator, the source came from clinical experience. If you don’t have that, you end up doing studies that may be elegant and may be rigorous, but they have no relevance to what clinicians do.” – Giovanni Fava
“Psychotherapy and Psychosomatics: End of an Era for Independent Journals?” An Interview with Giovanni Fava, Mad In America Podcast.
“A Different Psychiatry is Possible”, Giovanni Fava, Mad In America Podcast
“Our RTC Fetish: How the ‘Gold Standard’ for Research Has Led to A Societal Delusion About the Merits of Antidepressants”, essay by Robert Whitaker
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Fava is brilliant.
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TOTALLY 🙂
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I have been a fan of Dr Fava and that journal for a long time, and I’d heard the MIA podcast with him not long before I wrote my blog. As I re-read what I wrote, he and I – both clinicians – are on the same page as you two about the importance of research being clinically relevant. Controlled trials are not fully transferrable to real life, but they are not without some value.
Ditto for a single patient experience.
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“Controlled trials are not fully transferable to real life, but they are not without some value.”
Value to whom? To the psychiatrists paid to interpret them, or to the patients who are essentially made into guinea pigs by their local psychiatrist???
Psychiatric hedging has become a medical specialty all its own.
And no amount of “nuanced” scientific hindsight can repair the damage psychiatry’s already done and continues to do.
It’s hands down the most scientifically reckless branch of medicine, and it’s continued overreliance on RTC’s continues to harm many.
Psychiatry’s day of reckoning is long overdue.
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Here’s my Not-So-Randomized Controlled Prediction:
Psychiatric drugs will someday be known as The Opiod Crisis, 2.0
It may take another 10 to 20 years, but you can bet there won’t be any signs of it ever happening from psychiatry’s beloved “Randomized Control Trials”.
As the saying goes, past is prelude.
So when the day comes, I wonder how psychiatry’s defenders will attempt to explain away the thousands of lives YET TO BE RUINED from its over-reliance on its so-called “Randomized Control Trials”, here in the U.S. and around the world.
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Definition for Psychiatric Hedging:
A term used in philosophical or critical circles to describe a subtle rhetorical or institutional maneuver in psychiatry where professionals or researchers hedge their claims to maintain authority while avoiding full accountability:
*Ambiguous Language in Diagnosis or Treatment: Clinicians say a drug “might help some people”, or a diagnosis “could explain these symptoms” without committing to clear outcomes.
*Scientific Ambivalence: Researchers may acknowledge flaws in psychiatric studies, (e.g., small sample sizes, biased funding, poor outcome measures) but still conclude that treatments are “promising”, or “worth considering”.
*Ethical Deflection: When confronted with harm by psychiatric drugs or forced treatment, some professionals hedge by saying “It’s complicated”, or “We must balance risks with benefits”, rather than addressing systemic failures.
*Institutional Self-Protection: Psychiatry as a field may hedge its public messaging—acknowledging critiques (e.g., overmedication, diagnostic inflation), while continuing the same practices under new branding (e.g., “precision psychiatry”, or “integrative psychiatry”).
Here’s my definition of Psychiatric Hedging: It means rearranging the chairs on the Titanic while insisting psychiatry is unsinkable.
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Some researchers believe…
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You mean like in a religion?
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Absolutely. But framed as “science”.
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🙂
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Birdsong, I would add that the “balancing of risks with benefits” seems to never take into account the situation of individual patients – what THEY see as risks and benefits. In my own case there was simply no benefit of “maintenance treatment” and at the same time there were huge risks – both health risks and a very negative impact on my life quality.
Psychiatrists did not see me as an individual and seemed to pessimistically assume that I would be unable to cope with life without neuroleptics. One psychiatrist even claimed years ago that I could develop “drug-resistant schizophrenia” if I came off neuroleptics.
I am sure that there are many people who don’t realize that they would not have a relapse of psychosis if they came off psychiatric drugs. The risk of a relapse seems to be hugely and deliberately exaggerated. Patients should be able to decide if they want to have “maintenance treatment” (despite all its risks and negative impact) instead of being coerced into it.
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The CLIENT should be the one who “balances the risks with the benefits.” Too many doctors, and especially psychiatrists, seem to think THEY get to make this assessment. It’s their job to outline the risks and benefits for the client. The client then gets to decide what the balance is. This is too often forgotten!
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I could not agree more, Steve. I personally have no problem with the term “patient”. “Client” seems to imply that a person is paying for services. In the context I am used to (the public health sector) the term “client” does not seem adequate.
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Joanna, pessimism is built into psychiatry. I think that’s the crux of why I found it so demoralizing.
I felt I was seen as an individual, but as an individual who was less of an individual for feeling overwhelmed, because that’s all it amounted to. Not one psychiatrist ever asked what was going on in my life. And none of them asked about any physical problems that had everything to do me feeling the way I did.
I relate to what you say about neuroleptics. I think it’s malpractice for any medical doctor to make such negative prognostications when there are no tests or research to back up their conclusions for their diagnoses or drugs, drugs that are essentially painkillers that chemically lobotomize people. Neuroleptics certainly did that to me.
It’s very troubling how psychiatrists tell people that relapse is a foregone conclusion. And even if it were, I can’t figure out why the possibility of that happening scares them so much. It’s really a situation that needs time and safe place to run its course.
I don’t see psychosis as an illness. I think it’s a sign of extreme psychic stress that could be caused by any number of things.
My maternal aunt had a psychotic break for which she was hospitalized for at least a couple of weeks. The psychiatrist at that time (early eighties) told my mom that it was just situational. Today she very likely be told something very different.
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And even if a psychosis returns periodically, I don’t think it justifies doctors reacting like chickens with their heads cut off forcing people to take substances that have serious health risks.
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Birdsong, thank you so much for your comment. Your aunt’s story proves that psychiatry has gone backwards in many ways. As an example, I often encounter the idea that “schizophrenia” is a “brain disease”, though it has never been proven and though patients usually don’t undergo any tests on their brain before being diagnosed with “schizophrenia” or similar disorders.
Like you, I think that psychosis is very often caused by traumatic experiences. There are also probably some cases linked to the use of street drugs, certain medications etc. and other factors unrelated to trauma.
Yes, I, too, feel that neuroleptics chemically lobotomize people – at least this is how I felt. I simply no longer felt like myself (in a way I felt dead inside) and this was a very distressing feeling. I know that this was not merely depression because I don’t feel this way when I am depressed. On neuroleptics all my emotions were numbed.
I am not at all surprised by what you are saying about your own experiences. During my psychotic episode no psychiatrist tried to find out if something might have triggered my psychosis. I guess that it was both because of their beliefs on the causes of psychosis and because I probably fit into their stereotypes of a “schizophrenic woman”.
And when psychiatrists asked me questions about my life after my release from the hospital, these were very superficial questions and they did not seem to genuinely care about the problems caused by neuroleptics. E.g. when I told a psychiatrist that I felt constantly exhausted, she advised me to go on long walks, though even walking for 10 minutes was difficult to me on neuroleptics.
You know, I don’t even think that the possibility of a relapse scares psychiatrists, unless the patient is prone to violence and might be dangerous to others. I guess that they assume that their patients – especially middle-class patients – are very afraid of a relapse. And psychiatrists probably also assume that “unmedicated” patients will keep generating costs because of frequent hospitalizations etc.
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I worked with kids in foster care taking Zyprexa or other fat-inducing antipsychotics, and saw psychiatrists frequently put them on diets and exercise regimes, never telling them that their weight gain was caused or exacerbated by the drugs. I saw one case where a kid in recovery from an eating disorder was given stimulants. When she stopped eating, they treated her like her ‘eating disorder’ came back, rather than recognizing (as my CASA volunteer observed and informed them) that her loss of appetite was due to the foolish decision to give her stimulants! Another kid became psychotic on stimulants (which happens in close to 7% of the cases, per a Canadian J Psychiatry study), yet she was given a psychotic disorder NOS diagnosis and prescribed antipsychotics. She only stopped being psychotic after SHE decided to stop all the drugs! Another got diagnosed with diabetes, which disappeared when she stopped taking Seroquel at the CASA volunteer’s behest.
The ability and willingness to ignore the obvious connections between drug administration and behavioral/physiological adverse reactions seems endemic to psychiatry. If the person gets better, it’s always attributed to the drugs, but if they get worse, it’s “the disease” rearing its ugly head, even if the drugs are the obvious cause.
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Steve, what you are saying is so true – the negative effects of psychiatric drugs are either blamed on the “illness” or treated dismissively.
I would add that even if a person is not on fat-inducing antipsychotics, the idea that a healthy diet and some exercise always leads to weight loss is one of my pet peeves. And when people diagnosed with a mental illness are overweight, psychiatrists, social workers and other people may treat them even worse because of fatphobia.
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Quite so. It is a typical “blame the victim” scenario, and blaming fat people for being fat due to some character flaw is very much accepted in our culture.
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I see what you mean, Joanna, about doctors not being scared of someone relapsing. But I think on some level psychiatrists have to be scared of something. Why else would they think it’s okay to drug people with harmful substances indefinitely for something that can’t even be tested for? Psychosis must scare them.
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Steve, I don’t think it’s a stretch to call what you witnessed as criminal.
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I don’t either. Knowingly creating harm through fraudulent representations and blaming of the victim. Particularly egregious when the clients are young and involuntary, not in a position to defend themselves or often even understand they are under assault.
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It IS an assault, a chemical assault. I hope someday drugging children will be a classified as a felony.
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Birdsong, regarding psychiatrists’ attitude towards psychosis, I have three hypotheses.
I think that some psychiatrists worry about the risk of suicide or violence towards other people. If a person diagnosed with mental illness has not been prescribed neuroleptics and then kills him/herself or attacks someone else , the person’s psychiatrist can be taken to court.
In my opinion this could be prevented if a person who wants to come off neuroleptics was (1) assessed for risk of suicide or violence; (2) required to sign a document stating that s/he is aware of the possible risks linked to psychosis.
My second hypothesis is that some/many psychiatrists are indeed scared and/or repulsed by psychosis.
My third hypothesis is that some psychiatrists are simply controlling and perhaps even cruel. What I have noticed in my case is that I annoy some people and such people can even become emotionally and verbally cruel towards me, as if something in me triggered their cruelty.
When I decided to come off neuroleptics, I saw a psychiatrist in the private sector, hoping that he would be more open-minded and realize that I don’t need these drugs. One of his questions was: “Do you always talk so much?” He seemed very cold. He claimed that if I developed “drug-resistant schizophrenia” after coming off neuroleptics, I might need ECT. I guess that I annoyed him and this is why he wanted to scare me into staying on neuroleptics.
Another psychiatrist seemed literally angry with me. I don’t know what triggered his anger – the fact that he could sense that I was not a “compliant” patient or simply something about me which seems to trigger some people.
At my former workplace there was a colleague who seemed to hate me (this was not only my impression: another colleague quoted something cruel he had said about me – according to him I was completely incompetent as an academic). I have no idea why he was so hostile – I had never done anything wrong to him.
I mention men in my examples, but I have come across some women who were just as hostile. Who knows, maybe it is true that every person has his or her spiritual/psychological energy – and that some people have a very negative reaction to my energy because it is completely different from their own one.
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You are a truth speaker. Those afraid of the truth will find you threatening and often be hostile toward you. I’ve found the same myself. I’m a perfectly kind and cooperative person in general, but I speak up when something is wrong. And some people (especially doctors) seem to have difficulty with this concept.
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Joanna, I agree with all your hypotheses.
Some psychiatrists are scared of being sued, some are repulsed, and others are controlling or perhaps even cruel. I think they are all despicable because they all comes from selfishness and cowardice. Bottom line, I think you have to be a controlling person for all three.
Each requires the worst kinds of people: selfish, cowardly, arrogant and cruel. Psychiatry is tailor-made for people who have these qualities, in my opinion.
My sense is most psychiatrists expect patients to worship them (narcissistically gratify) and can sense who will and who won’t.
I’ve also been in situations where a person decides to act hatefully towards me for no reason. It’s a horrible feeling. It’s really puzzling when it happens because I keep to myself. I chalk it up to their being miserable. It’s like the bullies in grade school who pick on kids they know are easy targets; they seem to have been born with a sixth sense for picking up on someone’s spiritual energy and don’t like it if it doesn’t match their own.
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Birdsong, it is so good to come across someone who understands my experiences with hostile/hateful people. Yes, I, too, think that these people must be miserable, even if they seem very confident and popular. I agree with you that they are very good at identifying “easy targets” – people who don’t seem to have any allies brave enough to confront the bully.
Yes, I increasingly feel that some people are repulsed by others’ spiritual energy. One thing I have learnt is that I no longer try to reason with hostile people or to talk to them in a friendly way. This has simply never worked in my case. In general, the idea that if we treat others with kindness, they will soften, is unfortunately not always true.
I personally think/hope that there are psychiatrists who are not selfish and who are genuinely convinced that they are doing the right thing. But in my opinion even such “nice” psychiatrists are too cowardly to question mainstream psychiatry and guilty of hugely underestimating the negative impact of psychiatric drugs and of being patronizing. Most of them seem to assume that they know better what their patients need.
I am sure that even in my case many (if not most) psychiatrists would be reluctant to admit that I have been harmed by a pessimistic and stigmatizing diagnosis. They would probably focus on things which make me different from typical people and see them as signs of my “illness”.
I have met one psychiatrist who openly said that I have been misdiagnosed, but he wanted me to take antidepressants – so he, too, was unfortunately corrupted by the system…
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Thank you, Steve, I really appreciate your comment! Yes, this is what I have noticed – some people seem to get really angry and hostile when I simply say the truth (even if I say it very politely). They may also sense that I am in general a very independent-minded person and that I am not trying to please people with a high status.
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Steve, I have recently had a thought-provoking experience. A man in my region has recently opened an art gallery in a village and there has been an article about it in the local newspaper. The article mentioned some paintings by “a former patient” from a large psychiatric hospital in my region.
Strangely enough, the name of the patient was never mentioned – not even under photos of his works in the article – though the gallery owner was quoted as saying that he wanted to organize exhibitions of these paintings in galleries in other countries. This struck me as very strange.
I emailed him and asked if he knew the patient’s name and any information about him. As it turned out, he did not know anything – and somehow did not seem to see it as a problem. He claimed that the paintings were probably made by a well-known artist who spent many decades in the same hospital.
I happen to be familiar with that artist’s works and I very politely pointed out that the paintings from the new art gallery had been probably made by someone else. In fact, at that time a therapist was running an art therapy workshop in this hospital. I also added that I would love to visit the art gallery with my mum when she comes to my country next month.
Interestingly, I got no reply to that email – it was strange because the art gallery owner earlier seemed very friendly and polite. I now think that he might have found it strange and even “rude” that I had disagreed with him on the identity of this artist 🙂
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Joanna, psychiatrists are fed misinformation, so at the end of the day whether or not they are nice doesn’t really matter, in my opinion.
It doesn’t help that psychiatrists are trained to believe that their word is gospel, which they ignorantly believe their questionable data proves, something that explains the almost uniformly patronizing attitude even the nicest ones have towards those who question their data, and also explains why people like us are generally perceived as children who need instruction and “guidance”, a patronizing attitude I sensed throughout this article.
I was struck by your saying, “I am sure that even in my case many (if not most) psychiatrists would be reluctant to admit that I have been harmed by a pessimistic and stigmatizing diagnosis. They would probably focus on things which make me different from typical people and see them as part of my ‘illness’.” This to me reflects the pessimistic lenses most psychiatrists wear. And it’s also the reason I think seeing a psychiatrist is the worst thing anyone can do.
It’s galling (but not surprising) that even though the psychiatrist who said you were misdiagnosed still wanted you to take antidepressants. And you are right — it reveals that he, too, was corrupted by the system. But it’s also a perfect example of how their “medicating” patients makes them feel good, which I think is the reason most psychiatrists don’t mind doing it.
Spiritual energy is a very interesting term. I don’t use it very often, but I don’t doubt its reality. It’s something people sense before their conscious mind is aware of it. Feeling someone’s vibes is a truly mystical phenomenon.
I find it bizarre how often some of the least self-aware people (something I think most psychiatrists are) can sense others’ energy without even knowing it…
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… which means it’s safer to be around those who intuitively know that humans are energetic beings first, cognitive interpreters second, and NEVER see them as a “disorder” that needs to be drugged.
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CORRECTION:
It’s galling (but not surprising) that the psychiatrist who said you were misdiagnosed still wanted you to take antidepressants.
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Birdsong, yes, this psychiatrist claimed that an antidepressant would help with my social anxiety. First of all, I don’t think that it would be helpful (my social anxiety is linked to various negative experiences and can’t be cured by a psychiatric drug).
Secondly, I know how difficult it can be to come off antidepressants. And thirdly, I found it very disappointing that he wanted to keep increasing my dose, though I had not asked for it.
And yes, I think that medicating patients unfortunately makes most psychiatrists feel good!
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Birdsong, yes, “nice” psychiatrists can harm people as much as cold and callous ones, but I think that in every situation it is much better if people show us respect and at least some empathy.
I think that there are psychiatrists who are not patronizing. I actually did not find Richard’s article patronizing – I feel that his intention was to provide some guidance for people who try to understand studies on psychiatric drugs. Unlike many (most?) psychiatrists, Richard did not imply that patients diagnosed e.g. with schizophrenia should be on antipsychotics/neuroleptics until the end of their life.
I think that we should be fair to Richard – and I really appreciate it that he has found the time to reply to some of the comments under his article, including your very critical ones. Some authors of articles published on the MIA website don’t respond to any comments.
You say that “seeing a psychiatrist is the worst thing anyone can do”, but I have to disagree with you. E.g. for a psychotic person it can be actually very dangerous not to have any contact with the mental health system.
Shortly before I was involuntarily committed I planned to travel to another part of the country without telling anyone where I was going. It would have been very dangerous for me (I was a young woman in the midst of a severe psychosis) and terrified and devastated my family. As controversial as it may sound on the MIA website, I think that I had to be hospitalized in order to be somewhere where I was safe (I could not stay at home because under the influence of my “voices” I became convinced that my mum wanted to kill me or to push me to suicide).
And in the case of people who are very depressed and thinking of taking their own life seeing a psychiatrist or going to a psychiatric hospital is certainly not the worst thing they can do. I think that it is important not to demonize psychiatry and psychiatrists. There are plenty of people who have unnecessarily started taking psychiatric drugs, but there are also lots of people who have very serious and very dangerous mental health issues.
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Joanna, I agree with some of what you say, but not all of what you say.
You are right: people in the grip of psychosis, or perhaps even just mildly so, would do well to be in close contact with people familiar dealing with someone in such a state — compassionately and knowledgably — with a strong emphasis on preserving an individual’s autonomy as much as possible. And while I’m delighted that you were helped by competent people, the fact remains too many others aren’t nearly as lucky as you were.
I did sense some condescension in Richard’s blog, which I realize could have a lot to so with the mindset that I bring to the table. And I shouldn’t take it for granted that everyone has a basic familiarity with the scientific method and how it accounts for variability. But even if I hadn’t, that wouldn’t have removed what I find so objectionable in Richard’s blog, namely the disturbing complacency seemed to permeate it.
It came across to me as yet another one of psychiatry’s attempts to explain away the harms it has done and continues to do; in other words, inconclusive results are to be expected, which, while true, avoids the reality that Randomized Control Trials for psychiatric drugs have been almost routinely designed to bring about favorable results that are meant to obscure what the data actually says.
So, for me, the subtext of his blog seemed to say, “It’s not that cut and dried, so psychiatry’s really not at fault”, which in my opinion comes across as a plea for leniency the field of psychiatry does not deserve.
Finally, I don’t think I’m being unfair to Richard — quite the opposite, in fact, because I think it’s fair that he learn to never underestimate the understandable rage many people feel towards psychiatry. And I also think that a truly humble, compassionate, open-minded psychiatrist wouldn’t have shut me down the way Richard ultimately tried to do.
And for what it’s worth, I think it unfair to conflate disagreement with unfairness.
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Birdsong, I am absolutely not implying that the mental health system respects people’s autonomy. What I meant is that in some situations seeing a psychiatrist is certainly not the worst thing a person can do.
As I explained, things would have turned out much worse for me and for my family if I had not been hospitalized. Birdsong, before I was hospitalized, I was at home for many days and I was not improving. As I said earlier, I even started seeing my own mum as a terrifying and cruel enemy.
If I had really travelled somewhere without telling anyone where I was going while being psychotic, it could have ended in a tragedy of some kind. Being involuntarily committed was a horrible experience, but I was much safer in the hospital than I would have been completely alone and far from my family while going through a severe psychosis. People who are psychotic can be very vulnerable.
To return to Richard, I don’t find his article patronizing. And he is definitely right in pointing out that “We are all prone to see what we want to see and not see what goes against what we already believe.”
You say that Richard “shut you down”, but I did not see the situation in this way. He only said that he was not going to keep responding to your comments.
For you Richard is above all a member of a profession you loathe and this influences your attitude towards him. As you say yourself, you wanted him to feel your rage and he had the right to find such a conversation unproductive. I think that you would understand it if you put yourself in his shoes.
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Joanna, you make the claim that “in some situations seeing a psychiatrist is certainly not the worst thing a person can do”.
I think the Personal Stories section in Mad in America casts serious doubt on that claim.
It also begs the question: if that were true, how do you explain Mad in America’s existence?
I think I understand Richard all too well in that I believe he deflects critique by invoking complexity, as if ambiguity absolves psychiatry’s harms—a tactic commonly used by psychiatry.
And I also think if he truly put himself in my shoes, he would understand me as well.
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Clarification:
Joanna, I think the very existence of Mad in America casts serious doubt on your claim, as does the existence—and need—for other psychiatric survivor platforms such as Mind Freedom International, the Hearing Voices Network, and the International Society for Ethical Psychology and Psychiatry, all of which explain the creation of Critical Psychiatry.
In other words, if psychiatry were merely imperfect, there’d be no need for entire platforms devoted to institutional critique and survivor testimony.
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Birdsong, I would like to strongly emphasize that I was not “lucky”. I experienced a severe psychosis, I was involuntarily committed for more than a month (in bad conditions) and forced to take neuroleptics which had horrible side effects in my case.
In the hospital I did not have my own room and I even experienced some violence from other patients. I was often terrified and the staff did not treat me with respect. I could not leave the ward or even go outside for more than a month. I did not know how long I would have to stay in the hospital. Moreover, the schizophrenia diagnosis had a very negative impact on my self-esteem for many years.
When you say that I was “lucky”, I feel that you are unfortunately much too dismissive about my experiences. My experiences in the mental hospital were not positive. As far as I know, you have not experienced psychosis and treatment on a locked ward.
What I was trying to explain is that hospitalization was better for me than not being hospitalized. And there are many other people who say the same – I am not an exception. I was not implying that being on a locked ward was a good experience.
However, I have actually met many people (diagnosed with schizophrenia) who talk about their stay in a mental hospital in a positive way. One person said that the hospital was like a refuge to her and she had even made some friends. Birdsong, I think that you have simply never been in a situation where the only safe space available to you was a mental hospital.
I don’t feel rage towards psychiatry and psychiatrists, but my lack of rage does not prove that I was “lucky” or that I did not suffer. In my opinion feeling rage is not a good thing, unless it motivates us to change our life or others’ lives.
I sometimes feel that in discussions on MIA there is a pressure to embrace certain beliefs on psychiatry. If someone tries to bring a more nuanced perspective on the basis of his/her experiences, s/he unfortunately risks being dismissed as someone who “has not really suffered”.
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Birdsong, I have never implied that the staff in the mental hospital was “competent”. I did not praise them. What I said is that being in a hospital was much safer for me than not being hospitalized. You have clearly never been in a similar situation and this influences your perspective.
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I have always thought we needed safe spaces for people to go to when they are feeling or acting out of control, but to unlink that from “diagnosis” and “treatment” unless that’s something the person wants or relates to. Folks can write “advance directives” for times they are unable to decide. But it’s certain we need safe spaces for people to destimulate from whatever is upsetting them. The idea that being held in such a place necessitates drug “treatment” is where I object to the process.
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Birdsong, I do understand your reaction to Richard’s article. It was certainly not critical enough of psychiatry and neuroleptics.
However, I still think that Richard did not “shut you down”. In my opinion his tone was respectful and he simply did not want to continue a conversation he found unproductive.
By the way, it seems that you have not noticed that Richard has not been replying to everyone’s comments under his article. If you feel that he has not shown you enough compassion, what about people who did not get any reply from him? Well, I think that we should remember that people are only human and don’t always react in the way we would like them to react 🙂
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Joanna, I ought to have spoken more precisely.
I meant you were lucky in this way: some people are hospitalized indefinitely. You got out. Some people don’t. In that respect I do see you as lucky.
I’ve stated previously that people experiencing psychosis would be better off being around those familiar dealing with people in psychotic states—compassionately and knowledgably—preserving as much of an individual’s autonomy as possible. If that happens to be a hospital, great. But, as you well know, healing environments aren’t the norm.
I didn’t mean that safe places aren’t needed.
I wasn’t wanting or needing compassion from Richard. I was annoyed that he refused to directly address the questions I posed. And I don’t think his last reply was intended to show compassion. I think he replied to voice his displeasure at my insistence that he answer my questions.
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Joanna, you say that I clearly have not been in a similar situation and that this influences my perspective.
For your information, I have been involuntarily hospitalized, and it was not an experience I care to repeat.
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Joanna, I’ve never disputed how horrific your time in the psychiatric ward was. But you were able to resume your life. Not everyone can. For many, psychiatric hospitalization is more traumatizing than the crisis that led them there. It leaves many fractured—emotionally, relationally, even neurologically. Some never regain the autonomy they once had. In other words, it doesn’t just fail to help—it breaks people.
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Short video from Dr. Josef Witt-Doerring’s series on Youtube:
“I don’t trust Harvard doctors, and here is why”
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Short videos from Dr. Josef Witt-Doerring’s series on YouTube:
“Here’s how psychiatric meds trap people in a cycle of dependence”
“Here’s how doctors tricked 14% of Americans into taking antidepressants”
“Doctors Can’t Ignore This Anymore”
“Walking away from depression”
“How healthcare keeps you sick”
“Trust the FDA regulators? This might change your mind”
“95% Wouldn’t Need Meds If We Did This”
“The Hidden Cost of Psychiatric Meds: Your Freedom!”
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Short videos from Dr. Josef series on YouTube:
“Psychiatry has a diagnosis for everything…”
“What if your diagnosis is just a side effect of another drug?”
“This 1 common lie from doctors…”
“Treating Patients with Diet Superior to Medications for Psychiatrist”
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Dr. Josef’s videos are brilliant, Birdsong, many thanks for mentioning them!
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You’re so welcome, Joanna 🙂 His longer videos are amazing, too!
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Yes, Birdsong, I have started watching the one on nutrition, it is quite interesting!
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🙂
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Making Sense of:
“How NORMAL People Get TRAPPED On Psychiatric Meds For LIFE”, from Dr. Joesef’s series on YouTube
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“I Trusted Doctors. Then I Nearly Died”, short video from Dr. Josef’s series on YouTube.
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CORRECTION: “I Trusted Doctors. Then I Nearly Died”, long video from Dr. Josef’s series on YouTube.
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“What If It’s the Meds? How I Overcame ‘Treatment Resistant’ Mental Illness: Laura Delano’s Journey”, YouTube video from Metabolic Mind
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Birdsong – I’m responding here to what you just posted about prescription drug withdrawal. The site somehow wouldn’t let me respond directly to that post, so a couple of points.
(1) I agree that withdrawal is a significant problem that many psychiatrists weren’t prepared for, so it’s natural that patients would look elsewhere for answers
(2) When these meds were first introduced – and were not studied for possible longterm dangers and problems getting off them(as is true for ALL meds of ALL kinds) – psychiatrists did not have any information to prepare patients for those kinds of problems. The lack of information was partly because longterm studies would have slowed the process of making those drugs available to people who would benefit. This is a problem with drugs of all kinds throughout medicine. When there is pressure to find helpful treatments, not everybody wants to wait for longterm studies before approving them. That’s not a simple matter.
(3) So yes, this is a big problem that psychiatry wasn’t prepared for. It was not done with either malice or willful ignoring of available information. Most of us heard from patients about these problems, and that led to greater awareness and research as to how to anticipate and educate
(4) There is good-faith difference of opinion about how long people should take meds. I personally have been in the lead on trying to get people off meds. I will tell you that there are many patients who are reluctant or even refusing to consider even small dose reductions, not wanting to upset what they see as the balance they have achieved. There are some patients who are, on the other hand, in such a hurry to get off meds that they’ll do it – against my cautions about the wisdom of tapering – that they will have more severe withdrawal as a result. This is not blaming patients, but it’s what can happen because I do respect their autonomy to make choices, even ones that are risky.
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Patients’ resistance to stopping psych drugs has to be seen in context – if they have been told they will “relapse” and that their “brains are broken” and they have “diagnoses” that are vague but purportedly permanent, of course, they will be reluctant to reduce or stop drugs, ESPECIALLY when most have not been really given the opportunity to explore alternatives.
I used to work at a crisis line. Got a call one time from a person diagnosed with “major depression.” She was in a panic. She’d been trying different antidepressants for over a year, done 5 or more as I recall, and had no benefits. She felt like there was no hope, that she’d be depressed FOREVER!
I stopped her and asked, “Has anyone told you that there are other things you can do besides antidepressants for depression?” She paused for a moment. “No,” she said very calmly. “Well, there are,” I said. “Oh,” she said. “Well, THAT’S good!” And we talked about other options and she already felt a lot better. This discussion must happen, of course, BEFORE antidepressants are ever prescribed. It did not, and in my experience, if one sees a psychiatrist, it almost never does. If one thinks their only hope is antidepressants, of course, they will resist coming off of them. And yes, that IS blaming the clients!
Additionally, how do you know that the failure to discuss withdrawal problems was not done with malice or ignoring of information? Peter Breggin reported convincingly on antidepressant withdrawal, with good research references, way back in 1992. It is only in the last few years that withdrawal effects finally appear to be STARTING to be taken seriously. I still talk to plenty of people who are never informed of any possible withdrawal effects.
Again, it appears you are making excuses for professional failures. Are you suggesting that between 1987 and 2025 there hasn’t been PLENTY of time to research withdrawal effects, or that most psychiatrists ought to have been well aware of this problem (internet withdrawal groups have been around for decades)? Why is it so important to you that we “be reasonable” about the obvious failures of the profession? At what point do we stop assuming there is no ill intent and begin to face the fact that financial conflicts of interest have colored and distorted the psychiatric worldview so that drugs are, in fact, hugely favored without strong data supporting their efficacy?
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Richard, thank you taking the time to reply to me. I really appreciate it.
I’m familiar with the points you’ve made as I come from a medical family.
And while there’s truth in what you say, I think Steve’s more nuanced explanation better reflects the complicated reality most patients face.
I also deeply appreicate knowing that you made an effort to de-medicate patients whenever possible. But it would mean much more to me if you stopped making excuses for psychiatry’s collective irresponsiblity.
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… and more importantly, it’s collective LACK OF ACCOUNTABILITY.
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If, as you seem to suggest, being charitable or reasonable is not called for, but contempt and condemnation are better tools, I hope that you have some ideas about how to make things better once you feel you have fully expressed that contempt and condemnation.
Even if you are 100% correct, and I know some others think you are, it seems that you might have some duty to go beyond that in hopes of improving things for people in need. Refuting each of my points as inherently invalid doesn’t make for much of an exchange. but it does give you a chance to express that contempt and condemnation. And there you stop. Since you seem to think that being charitable and reasonable are unhelpful, maybe you have some unreasonable and uncharitable proposals to offer.
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I am NOT expressing contempt and condemnation. I am observing factual reality. It seems you are the one attempting to show contempt for the logic I have presented. For instance, you claim that “new drugs” means that doctors don’t know the information regarding withdrawal effects. I showed you that Prozac (marketed since 1987, almost 30 years ago) had been shown to have withdrawal effects as early as 1992. That is factual, not contemptuous or condemning. Yet your comment condemns me as “uncharitable” for not allowing psychiatry off the hook for this clear, observable and measurable failure.
Being reasonable and charitable can be helpful to a point, but we have to start with being honest with ourselves. It does not scan that psychiatrists didn’t notice for 20+ years that SSRIs had serious adverse effects. The only logical conclusions are that 1) they chose to ignore that information, or 2) they actively suppressed that information because it didn’t fit with their philosophical and/or economic model of reality. Making excuses for this failure does not lead to improving things for people in need. Honestly confronting the facts of inherent conflicts of interest and the actual PRACTICE of psychiatry in the field (vs. what you say the training is or should be) is essential to improving things for people in need. Nothing will change if we professionals make excuses for ourselves or blame clients for the behavior that our model has encouraged them to adopt. It’s a not a matter of contempt, it’s a matter of RESPONSIBILITY. Professionals are responsible for the results they obtain. If folks suffered adverse effects or withdrawal effects for decades and mainstream psychiatry failed to notice or intervene, the fault lies with the profession/system, not the clients/patients. I think that is a VERY reasonable proposal, that we start by relying on the actual known DATA rather than pursuing what is most economically or socially rewarding for the industry. No contempt, simply an insistence on holding ourselves responsible for our own results.
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Birdsong and Steve– You two and I have had over a month of (to me) exchanges. Despite our differences, I have had the idea that if we were to sit down together and not be limited by the reality of the MIA site, we’d find more common ground that it sometimes appears ( at least to me). My sense is that we all have a pretty good idea where each of us stands on things.
I’ll add that I bet that there aren’t that many psychiatrists who get on this site, much less do a blog as I did. I say that to remind you that the others whom you’ve seen do bad things are not too likely to read MIA. I’m not going to be as broadly critical of the field as you might have me be, which is way different from excusing bad behavior or saying the whole field is sort of contaminated by greed, malice, or Pharma. You’ll have to trust me, if you can, when I say I have a reputation for calling out bad stuff. I have listened closely to my patients over the years and they would tell you that what you’ve seen and experienced with others doesn’t apply to me despite my flaws.
I’m contemplating another blog contribution in the next few weeks. I hope it’ll be useful even though you shouldn’t expect me to talk about how bad psychiatry can be. MIA has plenty of that already. I don’t see life or psychiatry or people in black-and-white terms; to me, that just adds to the divide between us.
Feel free, of course, to respond to this if you wish. I will read it, but after these many back-and-forths, I don’t plan to respond here again. Not at all personal. I’m going to bet that not too many bloggers here have had so many exchanges with readers.
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Richard, I was just about to write a comment telling you that I respect you as a psychiatrist for caring enough to be a part of MIA and taking the time to thoughtfully answer comments.
You seem to have a good heart.
I believe you when you say you have a reputation for calling out the bad stuff. And I also think you are right: if you, Steve, and I got together we’d find more common ground than it appears.
I feel badly for being so confrontational with you. Please understand where it comes from.
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I do appreciate the honest response. I should have acknowledged you for both being willing to come here and for challenging standard practice yourself. I’ve been in the position of working with the system and I know it takes a lot courage to speak up and question the status quo.
Actually, I DO think we’d have a lot to talk about and if we were going to revise the system, you’d definitely be the kind of person I’d want to be planning it with.
And for the record, I don’t have any expectation that ALL psychiatrists act in any particular way. I had any number I used to work with who were open to feedback and a couple who worked with me and others on implementing a law to protect foster youth from over-drugging for behavioral reasons. My comments were mostly motivated by the seeming dismissal of the POSSIBILITY that there are, in fact, some in the field who DO engender ill intent or at best neglect, and that many of them have been quite powerful in influencing our cultural views of emotional and behavioral challenges without much respect for the actual science involved. I don’t think we make any progress without dealing with the “bad apples” in the barrel, especially if they are people with lots of influence in the field.
Looking forward to your next blog and thanks for being willing to engage with us despite having to face some pretty intense feedback!
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“Antidepressants don’t save lives”, video short from Dr. Josef
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“How Antidepressants Are Fueling The Veteran Suicide Crisis”, interview with Derek Blumke from Dr. Josef’s series on YouTube
* Be sure and check out Dr Josef’s podcast series called “Side Effects with Dr Josef”
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“… we’re not talking about looking for better efficacy here. We’re talking about those who have been harmed that have not been listened to and have been gaslit and ignored.”, Derek Blumke, from a video interview from Dr. Josef Witt-Doerring’s series on YouTube
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