Blogs

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).

Short Notes from a Muddled Island (with apologies to Bill Bryson)

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There has been quite a bit going on in the UK mental health world of late, and MiA already shares some of this in the form of open letters from Anne Cooke, et al. and Richard Bentall. Both are responses to a series of BBC programmes. In their letter Kinderman, et al. also make reference to a recently published report; The Five Year Forward View for Mental Health. This has been published by a so-called independent body; The Mental Health Taskforce to the NHS in England. Readers would find it encouraging; it refers to a need for closer attention to early intervention, to the need to address stigma, for a focus upon life’s transitions, and innovations that could support recovery, personal autonomy and well-being. What happened? Nothing!

Social Services and Psychiatry

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The controversy surrounding Justina Pelletier and her family has expanded its scope in recent months, and has now become a general public scrutiny of Massachusetts’s Department of Children and Families. I think there’s a very real risk of confusing some issues here. Every state in the US has a social services department, one of whose statutory responsibilities is to investigate reports of abuse and/or neglect. The system isn’t perfect. But this I do know: the spotlight has been taken off psychiatry. This is critical, because without the “diagnosis” of somatic symptom disorder and the subsequent allegation of medical child abuse, none of what’s happened to Justina and her parents could even have gotten off the ground.

September 18, 2010

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Dear Robert, I just finished Anatomy of an Epidemic while on vacation. I am a family physician (and writer) practicing in Colorado.  For years, my practice...

A Great Strategy Meeting is a Meeting of Minds

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Conferences, trainings and seminars can play an important role in changing the culture of a community. As Margaret Mead said: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” The work is formidable but the results… man it is worth it!

More Delays on Sandy Hook Reports

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The Sandy Hook Advisory Commission (SHAC) and the State Child Advocate's office still have produced no reports, and the deadlines continually come and go, with virtually no interest on the part of Governor Malloy or Connecticut state lawmakers. What is of interest, though, is the complete run-around and disconnect by those involved in producing the reports.

Complexity

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The movement to radically reform the modern mental health system is rooted in a desire to offer people going through emotional distress a wider variety of options for care. As a society we have largely shifted to a model of care that is limited to a select few options that primarily advocates the use of strong psychotropic drugs and simplistic diagnostic labels for complex and widely varying narratives. The stigma of going on an antidepressant has been lessened to such a degree that one out of nine people in the US now takes this class of drug. In the context of this astronomical growth in drug-based therapy, reformers are rightly calling for a dramatic reappraisal of how we are treating emotional distress.

The Church of GSKology, Part 2

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A century ago Freud and Jung made us aware of the biases underpinning what patients say. Not everything should be accepted at face value. In particular claims of abuse may not be based on reality. We needed experts – analysts – they claimed, to tease out what is real from what is not. The Catholic Church was once intensely hostile to Freud, but when it came to child abuse adopting a Freudian approach was very convenient. But while Freud essentially denied that real abuse was taking place and got away with it in his life-time, the Catholic Church has learnt to its cost that many claims of abuse are real.

All Sorts of Realities

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In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series. In this final post I want to discuss how realistic this paradigm of care is.

Many Ears Make Light Listening

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When we share our stories publicly, whether in speaking, writing, or another art form, we acknowledge we are part of something bigger. We are aware we aren't the only ones who have been abused or witnessed abuse, or who are scared to let go of our ancestral shame and fear. We are, rather, part of an entire generation, an entire society that is moving away from silence, blame and abuse. In sharing our stories, we instantly recover from a big hunk of loneliness, loneliness that might not be so easily resolved sitting in a room across from a professional, with a few non-offensive art pieces on the walls. We acknowledge that every single one of us who experiences physical or emotional symptoms is holding onto things for others, in our bodies, and together, word by word, we can break free.

Elimination of Bias, Not Disclosure of Bias, Must be the Standard

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Disclosure is an insufficient strategy for mitigating bias because bias does not result from the concealment of financial ties but from their effects. Even worse, social psychologists have demonstrated that when individuals disclose a competing interest, they give even more biased advice.

Real Psychiatry and Darwinian Evolution are One and the Same: Molecular Psychiatry has Missed...

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The basic principle for the development of human personality is the very same as for Darwinian evolution. In our quest to understand human biology, we have lost our way. We are looking in all the wrong places. The human organism from the beginning adapts to its salient environment. We can trace our adaptations from a zygote, to an embryo, to a fetus, to a newborn, a baby, a toddler, a child, an adolescent, all the way to adulthood. This also tells us how psychiatric problems arise, and informs us of the appropriate and effective treatment.

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

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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!

3 minutes to Create Medication Optimization for the Whole US

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My last blog on this site was about how our federal and state governments are looking to make huge changes to our health care...

September 21, 2010

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Dear Bob: Today, fittingly, was a very psych heavy day at my clinic. I saw the whole gamut of patient situations, patients (and their conflicted...

A Rorschach Test for Psych Drugs

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On October 23, the New York Times ran a very nice feature story about a Los Angeles woman, Keris Myrick, who, even though she...

November 1, 2010

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Bob-- Since we've started posting these letters, I've had a number of readers responding to me and asking about my strategies for withdrawal. As you...

The Children Lead

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How is it that we allow the agendas of others to occupy our childrens’ minds? Is it possible that a stranger can know our child better than we do? Is there anything a baby needs to learn that can’t be taught by being held in a parent’s arms? Because my children’s eyes and ears and thoughts are on me every day, they are key players in my ongoing efforts to live a right life. I count on their eyes and ears and thoughts to shore me up during times of temptation. They always lead me home.

September 27, 2010

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Bob-- I would guess that as I am typing this, you are in the midst of a spirited defense of your book at the conference....

March 15, 2011

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Bob-- I want to share with you a success story that has played out over the last three months. I have been working with a woman...

A New Model of Service

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What should the relational and emotional stance of the therapist be? Just who exactly is the therapist in relationship to the person coming to see the therapist? What is the therapist's job, exactly? What should the therapist's disposition be toward the person sitting across from them? What kinds of assumptions or presumed power come with the label therapist and are those assumptions harmful or helpful?

January 17, 2011

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Bob-- About a month ago, I started caring for a fifty-five year old Filipino woman. She speaks English well, though with a heavy accent. She...

Letters from the Front Lines

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I saw a patient recently, a 35 year-old woman who needed a refill of her Zoloft.  She been started on it four years prior,...

Madness Radio: Sharna Olfman on Medicating Children Diagnosed Bipolar

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Professor Sharna Olfman has researched and written extensively about children in society, including education and sexuality, and her perspective on so-called bipolar disorder is...

One Year of Mad In America

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In January 2012, Mad In America went live with a handful of bloggers and the mission to become a central community in the effort to rethink and transform the paradigm of psychiatric care.

I want to offer some thoughts and figures about where we've been in the past year and what we are growing into.

Then I want to ask you for money.

Better Living through Chemistry?

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Reading the article “Risky rise of good-grade pill” in the New York Times on Saturday once again raised the philosophical issue of how to...