Blogs

Fifteen years ago this month we were sitting together in the basement of Peter’s house. We had felt a sense of despair at the widespread misinformation and atrocious stereotypes that were dominating media coverage of mental health at the time. We felt that our profession had a responsibility to challenge these stereotypes, and that as psychologists we had something unique to contribute. That was the time when research into the psychology of psychosis was beginning to burgeon, and many of our findings challenged not only the stereotypes but – perhaps more significantly - much ‘accepted wisdom’ within mental health services as well.

In many respects it is difficult to fault the report Understanding Psychosis and Schizophrenia, recently published by the British Psychological Society (BPS) and the Division of Clinical Psychology (DCP)[i]; indeed, as recent posts on Mad in America have observed, there is much to admire in it. Whilst not overtly attacking biomedical interpretations of psychosis, it rightly draws attention to the limitations and problems of this model, and points instead to the importance of contexts of adversity, oppression and abuse in understanding psychosis. But the report makes only scant, fleeting references to the role of cultural differences and the complex relationships that are apparent between such differences and individual experiences of psychosis.

On August 11, Pediatrics, the official journal of the American Academy of Pediatrics, published an article that was based on data derived from a random selection of families concerning their health problems or concerns. Surprisingly, the incidence of disability due to physical conditions declined by 11.8%, while disability due to mental/neurodevelopmental conditions increased by 20.9%. The highest increases were among children under the age of 6, and children from more advantaged homes. At least part of the reason for this stems from the fact that while the prevalence of physical disability is limited by the prevalence of the particular pathology in question, no such limitation applies to "psychiatric disabilities."

The Mad in America Continuing Education Project is preparing for takeoff after months of planning. The project will provide on-line classes on the full range of psychiatric medications, and the ways in which they affect the neurology, physiology and outcomes for people taking them. The overarching goal is to change the standard of practice so that it becomes consistent with well-designed research.

This week we launch Mad In America Continuing Education. It is an enormous privilege to be a part of this project and to proudly announce that the first course offering is a series of lectures by me on neuroleptic drugs. I review the history of the development of these drugs as well as their short and long term effects. I discuss what conclusions I have drawn from the data; I recommend that we need to work harder to keep people off these drugs or – if we use them – to minimize the dose and stop them as soon as possible. But there remain other pressing concerns for those individuals who are currently taking these drugs.

I can feel both dance and music changing and healing my brain’s neurons. Seriously. We can change our brains and I’m doing it. Neuroplasticity. There is a multitude of ways to heal. My self-directed protocol involves many different things.

There are many similarities between mental health oppression (which is an umbrella terms for what this blog/web site is about) and racism. I invite readers to contemplate the similarities and differences in these pernicious forms of oppressions. Sera Davidow has begun a wonderful MIA blog-discussion on this. (Thank you, Sera.) In the mean time let me admit to my own racism. Here is what I wrote previously. I offer it as an invitation to racism 101.

It was the first time in my Klonopin journey it occurred to me the problem might not be inherent in me. The problem might actually be the Klonopin. Convinced my very life was at stake, I made the firm decision to get off the stuff once and for all.

We are an unlikely duo, sharing secrets only known to insiders, the inmates and staff of Bader 5, Boston Children's Hospital's adolescent psychiatric unit. I am the nurse who blew the whistle that no one heard in 2010, she is the teenager who was imprisoned on Bader 5 for nine months in 2013. We met for the first time on this past Thanksgiving Day at Yale New Haven Children's Hospital, where she has been a *medical* patient for the past nine weeks.

With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them. Despite public education campaigns (or perhaps because of them), the stigma of mental illness is as enduring as it was 50 years ago.

What would happen if a team of highly qualified psychologists joined up with a team of people who knew psychosis from the inside, from their own journey into madness and then recovery – and if they collaborated in writing a guide to understanding the difficult states that get names like “psychosis” and schizophrenia”?

I’ve been arguing against calling this movement that I’m a part of a ‘peer’ movement for a long time. What has happened with Michael Brown in Ferguson, Missouri has helped me to crystallize that point. If we do not see what happens to some of us in the psychiatric system as connected to what happens to others because they are black or because they are transgender or because they love someone else of the same expressed gender (or because they live in poverty, etc. etc.), then I’m not sure any of us really, fully understands what it is we are trying to accomplish at all.

When we are emotionally dysregulated or in an otherwise emotionally reactive state we act impulsively and without consciousness or interest about consequences because we want relief from that momentarily intolerable emotional state. We cannot imagine an alternative in that moment. Until consciousness comes to such behavior we effectively have no choice.

Often it is a relief to get an understanding of how we have developed a psychological problem, and it is especially good if we can feel that there is a reason for the problem that it is understandable. When I suffered from a phobia, it was a relief to understand that I probably had linked fear to an insect when I was a child. And it was even more satisfying when I understood that there was nothing wrong with my brain — that the problem was in what I had experienced. It was in my “software.”

What began as a story of self-discovery, spiritual awakening, and healing written only for family and friends evolved into a memoir reflecting my path towards liberation that other people might find useful on their journey of awakening to the person they were born to be. A power greater than myself became a wind under my wings moving the creation of this memoir forward. The story was enhanced by the process of creative expression that deepened the intimate look at my experience of loss and grieving that were intertwined with my liberation journey.

As awareness spreads about there being something wrong with existing approaches to “psychosis” aka “madness.” Interest grows in exploring what to do instead. One meeting place for exploring this question of “what to do” will be the ISPS conference in NYC in March 2015, which is titled “An International Dialogue on Relationship and Experience in Psychosis.” This conference promises to stand out in terms of the variety of voices,  perspectives, approaches and traditions that it will bring together to focus on the deeper issue of how helpers can best understand and interact with those experiencing what is called psychosis.

Some readers of Mad in America may be aware that Scientific American published a short blog by me on 17^th November 2014 - Why We Need to Abandon the Disease-Model of Mental Health Care. This blog was rather wonderfully (and slightly embarrassingly) described by Phil Hickey on his website, Behaviorism and Mental Health, as “an important milestone.” My blog attempts to summarise many of the key points of a perspective widely shared on Mad in America: 

The fundamental stance of bio-medical psychiatry remains unchanged since my grandfather’s time – “mentally ill” people managed like stock portfolios, reduced to diseased brains and bundles of genes and biochemicals that can be quantified, manipulated and cured “scientifically” by bio-tech and surgical interventions. Magic bullets as magical thinking.

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.

A new generation of multilateral and bilateral trade agreements is likely to significantly threaten access and cost of healthcare, and limit signatory Governments sovereignty to prioritise health care policy to protect and improve the health of citizens. The Trans Pacific Partnership Agreement (TPPA), a Pacific Rim regional trade agreement involving 12 countries — including New Zealand, Australia and the US — is one such agreement, and it has the potential to significantly alter the domestic environment for health policy-making.

Conflict is a pervasive human phenomenon that is at the heart of much distress and misery. Unfortunately, it is also seldom recognised; obscured by categories of disorder spelled out in systems such as the DSM, or brushed aside by other, fancier (but less accurate) ways of describing psychological turmoil and discontent. The source of psychological distress is not an ill, a disordered, or a dysfunctional mind but a conflicted one.

Based on any data from any country it is clear that we have a problem. Mental illness is on the rise. Researchers in the emerging field of nutritional psychiatry have documented the benefits of micronutrients to treat mental illness, showing that micronutrients help treat depression, stress, anxiety and autism and ADHD. Not a single study shows that the Western diet is good for our mental health. Many questions remain to be answered, but we can make some recommendations.

Psychiatry clings to the broken brain theory, because without it, there is no justification for the employment of medical techniques in this area. Without the broken brain theory, psychiatrists are unnecessary, and even counterproductive. In their hearts, all psychiatrists know this, which is why they never address the fundamental question: why should all significant problems of thinking, feeling, and/or behaving be considered illnesses?

An ever-growing number of people are aware that something’s horrendously wrong with psychiatry — survivors, families, professionals, psychiatrists themselves. Of these a subsection has become actively involved in trying to bring about change. All of which is good. This notwithstanding, sincere and dedicated though almost everyone is — and it is clear that people are — only a tiny percentage of these are pressing for anything truly transformative.

On November 16, 1989 in El Salvador, liberation psychologist Ignacio Martin-Baró was murdered by a Salvadoran government’s “counter-insurgency unit” created at the U.S. Army’s School of the Americas. This year, 25 years after his assassination, peace and justice activists around the world will honor Martin-Baró. Embarrassingly, the vast majority of U.S. psychologists and psychiatrists know nothing about Martin-Baró and liberation psychology. Why would mainstream mental health institutions keep U.S. psychologists and psychiatrists and the general public ignorant of the life and work of Martin-Baró?