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This week, JAMA Internal Medicine published online an interesting paper, “Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study.” They found that exposure to anticholinergic drugs significantly increased the risk of developing dementia. This study has important implications for those who prescribe and take psychiatric drugs.

Our newest conference this coming April in Michigan is the high point of a transition that my wife Ginger and I have been making for several years. The origins of the change go much further into the past to sixty-one years ago in 1954 when I was an eighteen-year-old college freshman at Harvard and a friend invited me to join him as a volunteer on the wards of Metropolitan State Hospital. I was majoring in American History and Literature, with little thought of becoming a psychologist and no thought whatsoever of being a medical doctor and a psychiatrist.

In a belated new-year blog, I thought it would be useful to set out what I think someone needs to think about if they are considering taking a drug for a mental health problem, especially if they think they might end up taking the drug for a long time. These are the questions you might want to ask your doctor if you take a ‘drug-centred’ approach to the use of drugs in mental health.

When I was researching Anatomy of an Epidemic and sought to track the number of people receiving a disability payment between 1987 and 2007 due to “mental illness,” I was frustrated by the lack of diagnostic clarity in the data. The Social Security Administration would list, in its annual reports on the Supplemental Security Income and Social Security Disability Insurance (SSDI) programs, the number of people receiving payment for “mental disorders,” which in turn was broken down into just two subcategories: “retardation,” and “other mental disorders.” Unfortunately, the “other mental disorders,” which was the category for those with psychiatric disorders, was not broken down into its diagnostic parts.

And so I embarked on the darkest journey of my life, one for which neither I nor my husband were prepared. I soon found out that there was no one who could help us. The psychiatrists, even the more sympathetic ones, were not making sense to me. I was coming from the business world and I was not used to accepting superficial answers. They could not tell me what was wrong with Helia and why this had happened to her. They could not answer my challenging questions about the scientific research in the field.

While I was in charge of the public systems for both mental health and addictions in Oregon, I found it a challenge to maintain an equal focus on alcohol/drug problems compared to mental health. One big reason for the emphasis on mental health was that the mental health budget was big, about 6 times greater than that for addictions. And that doesn’t even count the hidden funding for psychiatric drugs which probably added another 30 or 40% to mental health —atypical antipsychotics are a lot more expensive than Antabuse.

As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past. While these approaches are not without their flaws, they are often surprisingly insightful. (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)

We live in a culture bombarded by media and sped up by rapid-fire social interactions. It's definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. "Depression" is such a word - it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar -- and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.

The childhood and psychiatric abuse altered my neurological, hormonal and other bodily functions and it was difficult to say which abuse left what mark. The doctors used medication to fix the changes and the taking of prescription pills became a habit. I took pills to calm me, pills to sleep, and pills to make me happy. A few months after stopping all medications, I was a bundle of nerves and I opened the cupboard for a pill. Living on autopilot as I had been doing for so long had to stop. I switched gears from absentmindedly resorting to pills, to purposefully calming myself without using drugs by breathing the way the psychologist had taught me.

In order for you to understand where I am coming from, you probably need to know a bit about how I got here. Throughout my psychiatric training I had always, in the back of mind, this question: What is the difference between my suffering and those of my patients? How come they get all this treatment and I got none? Why do they have a ‘brain disease’ (there was a time when I tentatively believed in this sort of thing), whilst I, who was at times symptomatically severe enough to warrant medication, have no brain disease? The answer seems plain to me now. I had suffered exactly in the same way as many of the people I see every day do, but I had been lucky enough to avoid labeling and drugging.

We often need a new lens to look through in order to grasp a better way to understand, conceptualize and accept the real reasons behind the sometimes annoying and frustrating behaviors associated with child development. As many of you who read my blog know, I have grown tired of the increased trend of early diagnosis of children. I'm all for early interventions to help kids overcome learning deficits and developmental delays, but why — beyond education compliance policy and getting insurance companies to pay for the bill — do we have to label them with a learning disability or permanent mental disorder?

Many of us spend a lifetime avoiding our emotional pain, and it does become more and more toxic as long as we keep it buried. It will literally make us ill, physically and mentally, as Bessel Van talks about in the book, The Body Keeps Score. The little quip, "What you resist, persists" has proven very true in my life. The only way out of that trap is to stop avoiding and learn in whatever way makes sense to us as individuals to feel once again and to embrace and absorb and therefore transform the pain of our lives. This is how I am healing.

The Division of Clinical Psychology of the British Psychological Society published a paper titled Understanding Psychosis and Schizophrenia. The central theme of the paper is that the condition known as psychosis is better understood as a response to adverse life events rather than as a symptom of neurological pathology. The paper was wide-ranging and insightful and, predictably, drew support from most of us on this side of the issue and criticism from psychiatry.  Section 12 of the paper is headed "Medication" and under the subheading "Key Points" you'll find this quote: "[Antipsychotic] drugs appear to have a general rather than a specific effect: there is little evidence that they are correcting an underlying biochemical abnormality."

There were days that I’d wake up and all I could do was cry for no particular reason, just another miserable day of withdrawal. However, the idea of taking photos would get me out of the house. Especially on those days, the absolutely only thing that would get me to move at all was the idea of taking photos. One particular day, I was just crying, crying, crying, and as soon as I got to a beautiful spot that I loved, I stopped crying, took photos, and felt at peace. I even found that the days I felt the worst were the days I took the best photos.

Within the mental health profession, clinicians and researchers who value a system of categorical illnesses and individual defects too often proclaim that the major feature delineating "real psychosis" from other "disorders" is the presence of delusions. Two recent articles in the New York Times exemplified for me how skewed this assertion is. It also led to a greater awareness, more specifically, of how problematic it is to view so-called delusions as meaningless indicators of disease . . . for we all experience delusion. How one experiences the self, the world, and relationships (usually based on our relationships with our caregivers) determines the level with which one must cling to seemingly irrational ideas in order to maintain a sense of order and meaning in the world. Let me explain . . .

There are more and more of us who are determined to build an international movement that doesn’t forget its history, and that reweaves solidarity and community back into a model of mental and emotional and spiritual health. The system we live under is organized to keep a small number of people in control of the rest of us. Those who don’t fit into the model are drugged and silenced. We — the Mad Ones, the ones who have no choice but to feel the suffering of this planet and the people on it — we have a responsibility to create a new world that can hold our visions and brilliance. We have a responsibility to know our own histories of oppression and resistance. We carry with us the memories of the dead, the tortured, the exiled, and the ones whose flames can never be extinguished.

It is encouraging that more and more people - psychiatrists, patients, and researchers – are opposing drug treatments for depression, anxiety, and ADHD. But this is only half the battle. To oppose the level that psychiatry, my field, has sunk to comes with the obligation to right the ship. Obviously we need to recover from practices that violate the fundamental principle of “Do No Harm.” But over and above that, we have to constructively treat and heal the ‘pains’ of our patients.

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.

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.

Yoga helped me explore and reconnect with the body I’d abandoned and abused for years. My pain and sadness had me living exclusively in my mind, my body nothing more than a battleground for my inner wars. Through yoga and meditation, I slowly began to love myself again, learning to treat myself with care and respect. I felt a greater sense of self-awareness, and a sense of connection to something greater. This was a drastic contrast to the days when I felt as if god had forgotten about me, or like I was a mistake not meant for this world.

From 1951, a system designed for heroin and cocaine addicts – prescription-only status – was applied to all new drugs. Why? These were after all the first truly effective drugs in medicine. But the ability to do good came with a likelihood of doing harm. There was a trade-off to be made between risks and benefits. The new complex trade-offs could not be put on to the label of a drug or even captured in a forty page package insert. They needed to be individual to each person.

The version of psychiatry that many professionals, politicians and laypeople would like to be true is that mental illnesses are specific brain disorders with specific drug treatments, to which they are very responsive if identified early. In reality, the way we categorise mental illnesses is arbitrary, and the diagnostic criteria are over inclusive. Whilst psychiatric drugs can be helpful, the dream of a quick fix by targeted drugs has become a nightmare where we often do more harm than good in the way we use drugs, e.g. against depression, schizophrenia and ADHD.

  Editors' Note:  We at Mad in America have all known and loved Leonard. He truly represents the best of why we are engaged in these...

As a person who has been psychiatrized, but hasn’t faced long-term institutionalization, I have to accept that I can’t know that level of loss of power and vulnerability. (But I can tell you even short stays are enough to begin to understand.) And to be a person of color with psychiatric labels interfacing with the police? It’s like the perfect storm. (A type of ‘perfection’ that occurs more often than most, given that people of color are more likely to be diagnosed in the first place.)

For four decades I have been an activist challenging the mental health industry. More and more I feel that the climate crisis should be one of the highest priorities for social change led by people who have personally experienced psychiatric abuse, and our allies. I affectionately call us The Mad Movement. It seems that almost every speaker against global warming ends their message the same way, that we can stop this catastrophe if society has the “will.” I believe that participants in The Mad Movement have an important insight into real sickness in society. As a psychiatric survivor, I have seen too much labeling of creative maladjustment as ill. We need to shake off our world’s complacency and numbness, also known as “normality.”