Saturday, May 25, 2019


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).

Rethinking Cost Containment in Publicly Funded Psychiatric Drug Budgets

Given my experience as a state level administrator several years ago, I have continued an interest in the way which public expenditures for mental health reflect a variety of interests — usually in an attempt to limit expenditures from the state coffers. One of the areas of greatest concern to state legislators each session is the cost of participating in the Medicaid program. A significant portion of state mental health budgets, especially for community mental health programs, is in this pot of money. And psychiatric drugs are a major expense in state Medicaid program. As I will point out, however, there are major advocacy groups who want to expand, not limit access to these drugs.

Why I Have (Mostly) Given Up on Diagnosis

Every year about this time I review my template file for new client notes. It has blank sections for name, presenting concern, history, plan, and a number of other categories. This year I found myself staring at it, considering whether a revision was in order. And the category that leapt out at me was “Diagnosis.” The truth is, I seldom use it any more.

Twin Method Assumptions are Indefensible, but are Useful to the Rich and Powerful

The wealthy, and the institutions they finance and promote, look favorably upon research whose authors claim that economic disparities are rooted in biology, and are not harmful to humanity as a whole. But there are countless obvious real-world examples showing that political policies, social struggles, and public health programs, including those involving the adjustment of income differences, lead to improved health and well-being.

Can Psychosis be Treated With Nutrition?

We are immersed these days in the erroneous idea that only randomized placebo-controlled studies (RCTs) constitute scientific data. We will discuss the origins of the over-reliance on RCTs in a future column. For now, we shall simply assume that many of our readers understand that a well-documented case study can provide information relevant to many. And so, we would like to tell you about a Calgary-based child who we refer to as ‘Andrew’.

Goodbye to Ken Braiterman

This is a memorial to my friend Ken Braiterman who was a long time member of the mental health civil rights movement. He was a best friend/ally/coworker/enemy of David Hilton, who lost his life to mental health civil rights battles. Ken wrote a great series of posts about David's struggle with advocacy.

Time to Abolish Psychiatric Diagnosis?

‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong - scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress.

Do We Underestimate the Benefits of Antidepressants?

On April 19, 2014, The Lancet published an article titled Do we underestimate the benefits of antiddepressants?, by German psychiatrists Mazda Adli and Ulrich Hegerl. The authors argue that randomized controlled trials (RCT's), as currently conducted, systematically underestimate the benefits of antidepressants and overestimate the benefits of psychotherapy. But what's interesting is that in all the years that pharma-psychiatry was churning out its fraudulent, spurious and self-serving "findings," I never heard of a single complaint from psychiatry about these kinds of methodological issues.

Not Seen

I am The Invisible Woman. A woman with a nice enough bag, a calm demeanor, and well-put-together clothes (they are not “odd,” they attract no attention). You might see me walking my dog near where I live, smiling at my neighbors, making small talk. People make all sorts of comments to me about the crazies. It never occurs to them that I might be among this so-called population.

The Shameful Story that Runs and Runs: A Review of The Bitterest Pills

If the blimp that is psychiatric treatment were a passenger aircraft, the authorities would have grounded it many years ago, but still it continues to inflict harm on countless thousands of people. I read Joanna Moncrieff's latest book with a growing sense of anger and shame. The roots of drug treatment in psychiatry are thoroughly rotten. They sustain the decaying trunk of psychiatric theory and practice through misrepresentations and untruths; it is snake oil peddled by quackery.

The Psychopathology of American Life

‘I’m severely depressed.’ These were the words that Donesha*, a 35 year-old African American woman repeatedly uttered to me.

First They Ignore You: Impressions From Today’s Hearing on H.R. 3717

As I walked alone up the stairs to the Rayburn House Office Building this morning to attend the hearing of the Energy and Commerce Subcommittee on Health on H.R. 3717 - the Helping Families in Mental Health Crisis Act - I thought about how I wasn’t truly alone. In spirit with me were all the people who had experienced scary, coercive, and dehumanizing interventions in the name of help. In spirit with me was every mental health provider who went into the field hoping to really make a difference in their communities, but became cynical and discouraged in the face of so many broken systems and broken spirits.

Playing the Odds, Revisited

It is hard to believe that a year has gone past since I posted Playing the Odds: Antidepressant Withdrawal and the Problem of Informed Consent. The feedback I received underscored the more controversial aspects of SSRI toxicity.  Common themes concerned the abrupt onset of new symptoms 3 to 12 months after stopping the drug, reinstatement of the drug failing to help withdrawal related symptoms, the possibility that withdrawal-related symptoms can persist indefinitely and concerns about using benzodiazepines to help with tardive akathisia.
young girl at a window on rainy day

7 Tasks for a Parent Whose Child Is Diagnosed with a Mental Illness

When I teach workshops or lead discussions on coming off psychiatric drugs and alternatives, there are invariably parents present who are at loose ends. They want to know how best to help their children, and how it can be possible for their child to live without medication. Here are seven ideas I share with them that may also help you.

In Search of a Hundred Miles of Gratitude

I woke up to the sound of steady rain. Outside, four inches of snow still lay on the ground from the previous weekend. The temperatures had remained just above freezing, and the rain that was scheduled to come would likely only be intensifying as the morning wore on. But I had committed to the long run, knowing that my training was as much about being prepared for anything as it was for preparing my body for the actual number of miles to come.

INTAR 2016: A Global Call for a New Paradigm In Psychiatry

“We need a new paradigm,” said Alberto Vasquez, research coordinator of the office of the special rapporteur to the United Nations on the Rights of Persons with Disabilities. “People are clamoring for change. We want to see something else.”

Why We Must Strike the Terms “High Functioning” and “Low Functioning” from Our Vocabulary 

As I have various discussions about mental health and disability on the internet, I am disturbed at how many people continue to use the terms “high functioning” and “low functioning” when referring to people with psychiatric or other disabilities. I have heard people refer to their family members as “low functioning.” I have seen these terms used by advocates to bully and discredit other advocates who critique calls for increased levels of involuntary treatment as “high functioning” individuals who don’t know what they’re talking about.

Making the Invisible, Visible

A memorandum submitted on the Children And Families Bill by the UK ADHD Partnership (UKAP) recommended that regulations issued to accompany the Children and Families Bill should include a requirement that “all children who receive two fixed term exclusions from school are screened for ADHD and, if appropriate, an assessment process for ADHD initiated.” The UKAP certainly appears to be a group the UK parliament should trust and, on the face of it, there is no reason that parliament should not adopt their recommendation. Except that the UKAP appears to be a front group for pharmaceutical company Shire, who manufacture the ADHD drug marketed as Vyvanase in the US and Elvanse in the UK.

Shamans and Psychiatrists: A Comparison

The Scottish Anthropologist Ioan Lewis, wrote the book Ecstatic Religion in 1971, in which he suggested a ‘shaman is not less than a psychiatrist, he is more.’   He claimed psychiatry was just one of the functions of the shaman, and he invited comparison between shamans and psychiatrists.  Some diagnostic criteria for schizophrenia appeared rather similar to the desired conditions of shamans in an altered state of consciousness.  Other terms used (and misused) for therapeutic practitioners included: native or traditional healer, medicine man, witch doctor, soul doctor, sorcerer, magician, spirit medium, exorcist, curer, diviner and diagnostician.

I Wonder if There is Some Axis II Going on Here? Further Thoughts on...

This blog was prompted by an invitation to do a guest post on the site of one of my favorite bloggers, 1 Boring Old Man. This is my response to the notion that there are certain conditions - Schizophrenia among them - that correspond more directly to biomedical conditions

Thar’s A New Sheriff in Town!

As a longtime participant in the conversations here on Mad in America, I’m very excited about taking on the role of moderator for the MIA discussion boards. MIA considers the community discussions to be integral to its mission to serve as a forum for “rethinking psychiatry,” and I am assuming this role at a time that the organization, in response to the reader survey we conducted, is striving to make the discussions more welcoming to all.

Principled and Loving Support: The Greatest Gift We Can Give 

"D" had attempted suicide a few days ago and remained in the hospital due to medical complications from the suicide attempt. I listened. I told D how much I cared and was ready to come and get D if that was what D wanted, and D could live in my guest bedroom for as long as D wanted. It’s been a few days since I made that offer – an offer I have never before made to anyone. I have clarified for myself the intent of my offer. I will soon share my intent with D, and writing this now is my effort to clarify my intentions
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National Institute of Mental Health Violates Law on Posting Clinical Trial Results

Last year, over twenty major institutions worldwide jointly committed to posting the results of all their clinical trials within a 12 month time frame. NIMH’s frequent failure to do so is especially concerning because evidence distortion appears to be remarkably widespread in journal articles discussing trials of psychiatric drugs.

Science and Pseudoscience in Psychiatric Training: What Psychiatrists Don’t Learn and What Psychiatrists Should...

Evidence based care is supposed to drive up standards, ensure uniformity, establish best practice, guide clinicians and protect patients. This should be celebrated. Instead, evidence-based mental health is openly disparaged, and when psychiatrists don’t get the results they want, they ignore them, suppress them, or denounce them. These attitudes have repercussions on the training of psychiatrists.

Avoiding Stress After Diagnosis

I am constantly around people who build their lives around negative beliefs. More specifically, I am around people that build their lives around being “broken” because of something they identify as being a “brain disease.” It breaks my heart to hear the way people view themselves.

What is Critical Psychiatry?

Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and chapters in books, hasn’t been written by academics, sociologists or cultural theorists. It has emerged from the pens and practice of a group of British psychiatrists.

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