Monday, September 24, 2018


Essays by a diverse group of writers, in the United States and abroad, engaged in rethinking psychiatry. (The directory of personal stories can be found here, and initiatives here).

Off-Label in New Zealand

Before the early 1990’s the use of antipsychotic medications was largely reserved for adults with severe psychotic disorders; unpleasant involuntary movement disorders (extrapyramidal side-effects) and cardiovascular risks appear to have largely limited their use outside these disorders. The introduction and intense marketing of what seemed to be better tolerated and safer (now proven not to be), second generation atypical antipsychotics (AAPs) such as risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole from the mid 1990’s led to a rapid expansion of antipsychotic medication use for a wide variety of unlicensed conditions and in more diverse clinical populations.

Stopping the Madness: Coming Off Psychiatric Medications

Millions of patients find themselves caught in the web of psychiatric sorcery - a spell cast, hexed, potentially for life. They are told that they have chemical imbalances. They are told that the most important thing they can do for themselves is to "take their medication," and that they will have to do so "for life." Most egregiously, patients are sold the belief that medication is treating their disease rather than inducing a drug effect no different than alcohol or cocaine. That antidepressants and antipsychotics, for example, have effects like sedation or blunting of affect, is not a question. That these effects are reversible after long-term exposure is.

“Why Wunderink Matters”

Sandra Steingard writes in Community Psychiatrist about Lex Wunderink's study, published in the August JAMA Psychiatry, which found that people who discontinued medication have...

An Intersubjective Approach to Treating Young Children With Autism and Related Challenges

For too many years I was taught and believed that children diagnosed with autism were incapable of learning through the normal channels of relationship. I accepted that they must be taught differently and could easily dismiss their frequent displays of emotional distress as simply a symptom of their autism. This all changed when I attempted to reconcile what the autism intervention and child development fields had to say about what children need for optimal social and emotional development.

Some Thoughts on Insanity Defense

I am not comfortable with an all-or-nothing insanity defense that is both legally and socially stigmatizing because it sets the person apart as someone who is legally determined to be incapable of being treated as a moral agent. This stigma spills over onto all people who are psychiatrized, and it is part of the conception of madness that also ends up serving as a justification for civil commitment, since we are perceived (incorrectly) as outside the reach of ordinary law.

Does Long-Term Use of “Antipsychotic” Drugs Result in More Disability, and More Psychosis?

This sounds like a weird question – everyone knows that psychosis is often very disabling, and antipsychotic drugs are widely recognized for their effects in reducing psychosis in at least most people, and most often taking effect in just a few days. And when people become psychotic again, it’s often understood that it’s because they “weren’t taking their meds.” But what if it’s trickier than that? What if “antipsychotic” drugs make things better in the short term, but make long term problems worse? How would we even know?

November 26, 2010

Bob-- Very interesting case today, a forty-six year-old woman, new patient, overweight, and very pleasant. She is someone who, at first glance, I never would...

New York State’s Assisted Out-Patient Treatment Program: Racial Myths & Other Stereotypes

New York State’s out-patient commitment program, termed Assisted Out-Patient Treatment (AOT), was instituted in 1999 to protect the general public from treatment non-compliant and...

Living in an Age of Melancholy: When Society Becomes Depressed

In a recent Ted Talk, “Depression is a Disease of Civilization.” professor Stephen Ilardi advances the thesis that depression is a disease of our modern lifestyle. As an example, Ilardi compares our modern culture to the Kaluli people — an indigenous tribe that lives in the highlands of New Guinea. When an anthopologist interviewed over 2,000 Kaluli, he found that only one person exhibited the symptoms of clinical depression, despite the fact the Kaluli are plagued by high rates of infant mortality, parasitic infection, and violent death. Yet, despite their harsh lives, the Kaluli do not experience depression as we know it.

Chapter Seven: Becoming Bipolar, Becoming Empowered

A newfound acceptance of my bipolar diagnosis during the winter of my freshman year at Harvard filled me to the brim with a sense...

Why I Became a Critical Psychiatrist

The talk explains my own evolution as a psychiatrist and addresses the development of the Critical Psychiatry Network.  I focus on three main areas: psychiatric diagnosis, the influence of the commercial forces of the pharmaceutical industry on medicine in general and psychiatry in particular, and the evolution of the use of neuroleptic drugs (in that order).

3 Reasons Asking “Why” Can Fuel Problem Behaviors

As a therapist, I was trained to the gills to believe that investigating the reasons “why” a fellow human being behaves the way he does would enable that person to understand himself, which would promote healing and health. We traditionally believe that knowing the reason for one’s behavior will release him from the root of the problem. It took me years to get out from under this philosophy and practice. Along the way, I met many brilliant therapists who admitted that discovering “why” never yielded them the results they were seeking either.

Me, Allen Frances, and Climbing Out of a Pigeonhole

Four weeks ago, after I wrote a blog about a study that concluded there was no good evidence that antipsychotics improved long-term outcomes for people diagnosed with schizophrenia, I was cc’d on an email that had been sent to a number of “thought leaders” about what I had written. At least as I read the email, it put me into the usual pigeonhole for critics of psychiatric drugs: I apparently was globally “against” medications, and I had displayed a type of simplistic “categorical” thinking. All of this led to my having an email exchange with Allen Frances, and his laying out, in his opinion, the considerable "collateral damage" my writings had done.

MIA Continuing Education Moves into its Next Phase

The roll-out for Mad in America Continuing Education courses is moving into its next phase —improved presentation of courses and a more aggressive marketing of what we believe are unique CME and CEU resources for professionals and advocates alike. If I needed any reminder of why our continuing education project is so necessary, all I need to do is continue to read through my Psychiatric Times email.

The Politics of Systems Change: Lessons Learned from the Launch of the DSM-5 Boycott

Machiavelli had it right. “There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order to things.” Ever since we launched our DSM-5 Boycott three weeks ago, we’ve received support from organizations and individuals but have become entangled in more wrangling than I ever would have anticipated.

Please Join Groundbreaking Research on Psychiatric Medications

Psychiatric medications such as antipsychotics and antidepressants account for a huge number of published research studies. This existing research, however, is almost exclusively constrained within a medical model approach, purporting to evaluate medications as treatment for biological brain disorders, and designing studies accordingly. The disease, and how medications presumably affect it, is at the center — with pharmaceutical company financial interests not far behind. That paradigm is starting to change.

Reared-Apart Twin Study Mythology: The Latest Contribution (Part Two) 

In Part One, we saw that the “Minnesota Study of Twins Reared Apart” (MISTRA) of Thomas J. Bouchard, Jr. and colleagues was a behavioral...

Alfred Hitchcock Presents: The DSM-5

What does the new DSM-5 have in common with an Alfred Hitchcock mystery?  They both use a plot device, a “MacGuffin,” to drive the story. Hitchcock explained a MacGuffin as on the one hand “ridiculous”, “non-existent”, “empty” and inherently without meaning, and at the same time the central point around which the entire story turns.  Which narratives, and whose, are served by the "diagnosis MacGuffin”? Are there more socially desirable alternatives to replace this particular plot vehicle? 
escaping cage of mental illness

Towards the Re-politicization of “Mental Illness”

In the models of other social movements, I implore us to advance a multifaceted, structural, cultural, and political analysis of mental illness in America, to illuminate the reality and mechanisms of sanism, and to then envision and implement ways of organizing American life around it that do not limit our potential for flourishing so drastically.

Dear Self-proclaimed Progressives, Liberals and Humanitarians: You’ve Really Messed This One Up

When it comes to psychiatric diagnosis, I can be almost certain that anyone outside of my immediate field of work just won’t ‘get it,’ no matter where they stand on anything else. And not only won’t they get it; they will often actively be one of the unwitting oppressive masses, either through their inaction or worse.

I Talked About Mad in America on WNYC’s The Brian Lehrer Show!

Hey I did an interview this morning on WNYC about my new book, Maps to the Other Side, and told the thousands of listeners to check out the Mad in America website if they want strong and articulate views on what's happening in the world of mental health. I have this exciting feeling that the Icarus Project underground culture is breaking up out of the pavement and crossing paths with the mainstream. Check out the interview here and tell me what you think!

Abolishing Forced Treatment in Psychiatry is an Ethical Imperative

Forced treatment in psychiatry cannot be defended, neither on ethical, legal or scientific grounds. It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true. We need to abolish our laws about this, in accordance with the United Na­tions Convention on the Rights of Persons with Disabilities, which virtually all countries have ratified.

What is in a Name: One Psychiatrist’s View of Psychiatric Diagnosis

What do I tell my patients about diagnosis? I try to explain what a diagnosis is and is not. It is a label that reflects that the person has reported certain symptoms. It is a label for the symptoms not for the person.

9 Questions the US Senate Should Ask Dr. McCance-Katz

Mental health agencies are mainly asking about her positions regarding “recovery” and “peers,” but here are some tougher questions for President Trump's new "mental health czar": Do you support court-ordered psychiatric drugging? Do you endorse the use of federal money for it? Why aren’t non-drug alternatives offered to Americans?

June 17, 2011

Bob-- Here is a letter that I wrote several months ago in response to an early reader of my blog here. She expressed concern about...

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