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Atul Gawande is a physician author whose work has been published in The New Yorker, among other places. In his most recent book, Being Mortal, he explores the complexity of end of life care. In this blog I discuss why I found this book relevant to Mad In America.

It took coming off psychotropic drugs completely for me to become awake. I had the doctor I was seeing wean me off, though she didn’t want to (instead she suggested I take different drugs.) But here I am almost two years later and I am feeling all of my emotions and managing them well. I knew best what I needed, and I trusted myself. Life has shown me that I can endure many trials and tribulations without giving up, and I trust myself today to reach out for help if I need it.

Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and, particularly in the USA, for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? since psychiatric diagnoses have been admitted to be non-valid even by the people who drew them up, professionals should not be offering people the ‘choice’ of describing their difficulties in diagnostic terms in the first place. That would still leave people with the right to adopt whatever explanation suits them as private individuals.

When I was a psychiatric resident in 1971, the treatment for schizophrenia and manic-depression seemed to be very promising. The hopeful period of deinstitutionalization had just begun. It seemed like we were turning the corner. We were emptying out the state hospitals. And let me tell you, they really were snake pits. And the promise was that patients would return to the community. There they would have individual and family therapy; housing; assistance with working; and help with activities of daily living, when necessary. Finally, an enlightened age... finally.

The distribution and demand for psychiatric drugs is at its highest level since their first introduction over 50 years ago. As part of our culture of addiction modern psychiatry, in collusion with the pharmaceutical industry, has greatly expanded and increased the demand for their own particular versions of legal and highly profitable mind altering substances. This demand has become so great that even if the current medical establishment wanted to reverse this trend (something that will never happen), they would now face tremendous outrage from a mass of desperate consumers.

By their own recent admissions, establishment psychiatrists and major psychiatry institutions have been repeatedly wrong about disorder validity, biochemical causes, and drug treatments; and also, in several cases, have been discovered to be on the take from drug companies—yet continue to be taken seriously by the mainstream media. While Big Pharma financial backing is one reason that psychiatry is able to retain its clout, this is not the only reason. More insidiously, psychiatry retains influence because of the needs of the larger power structure that rules us. And perhaps most troubling, psychiatry retains influence because of us—society’s increasing fears and its expanding needs for coercion.

Guilt, shame and anxiety appear in every known culture. Neither children nor adults seem to escape feeling some of these potentially disabling emotions and probably almost everyone has experienced all three. In my forensic experience, even the most hardened criminals who feel no guilt or shame about committing murder are nonetheless likely to feel guilty about something else, such as thinking or talking negatively about their father or mother. They surely feel shame, and overwhelming shame may have ended up fueling, rather than inhibiting, their murderous reactions. Meanwhile, it is highly unlikely that anyone, criminal or not, has avoided feeling anxiety.

In a 1992 essay, British psychiatric genetic researcher Michael Owen wondered whether schizophrenia molecular genetic research would become the “graveyard of molecular geneticists.”1 Owen predicted that if major schizophrenia genes existed, they would be found within five years of that date. He was optimistic, believing that “talk of graveyards is premature.”2 Owen now believes that genes for schizophrenia and other disorders have been found, and was subsequently knighted for his work. Despite massively improved technology, however, decades of molecular genetic gene finding attempts have failed to provide consistently replicated evidence of specific genes that play a role in causing the major psychiatric disorders.

Those of us who critique psychiatry were recently treated to an interesting phenomenon—the publicly available part of the January 2015 issue of Acta Psychiatrica Scandinavica, which contains multiple articles devoted to the question of psychiatry’s “poor image” — how to understand it, how to assess it, what to do about it. The release of this issue is hardly the first occasion where articles have appeared in which psychiatrists have speculated on outsiders’ negative image of the profession. Indeed, more and more, we are seeing such articles together with other evidence that the professionals are concerned. This article probes the collection in question for themes, positions, and framing.

The International Journal of Geriatric Psychiatry published an article titled Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia,  which concludes "Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management." But the participants were not a random selection of people taking the drugs in question. Rather, they were individuals selected because of aggressive behavior, most of whom had been taking some or all of these drugs on admission. So it is a distinct possibility that the aggression was a drug effect for many, or even most, of the study participants.

It falls upon us survivors to prove that we were damaged, and that we aren’t malingerers or attention hounds or “mentally ill”— if we have any energy amidst the maelstrom to plead our case. Because if we don’t, we risk having our narratives rewritten by others’ “good intentions,” misinformed though they may be by the mainstream narrative. People get weird and pushy about this stuff, both because suffering is ugly and because our truth threatens their worldview.

Back in 1983, I put myself in a mental ward. I desperately wanted help with my eating disorder, but no one took these types of problems seriously back then. The ward was rather nice, so I returned many times. Nothing good ever came of it, but I always hoped this time, it will do some magic. Every time I left, I'd realize my eating problems hadn't been solved at all.

Everyone has beliefs that seem too bizarre, illogical, or fantastic to someone else to accept. Religious views, paranormal interpretations, political convictions, interpersonal conflicts — all can put us in a category where other people consider what we think to be incomprehensible. We've learned to co-exist with different beliefs as one of our most cherished values of tolerance in a multicultural society. That lesson can be key for encountering the different realities that in situations where someone is being called psychotic, delusional, schizophrenic or mentally ill. Respect and support may stretch our thinking, but can be vital to recovery.

What if I told you that, in 6 decades of research, the serotonin (or norepinephrine, or dopamine) theory of depression and anxiety - the claim that “Depression is a serious medical condition that may be due to a chemical imbalance, and Zoloft works to correct this imbalance” - has not achieved scientific credibility? You’d want some supporting arguments for this shocking claim. So, here you go:

The psychiatric genetics literature contains few references to specific environmental factors that cause psychiatric disorders, and while researchers acknowledge a role for these factors, they usually claim that environmental causes are mysterious or unknown. As a leading group of psychiatric genetic researchers recently put it, while claiming that schizophrenia “has a substantial genetic contribution,” the “underlying causes and pathogenesis of the disorder remains unknown.” But research suggests otherwise.

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.

This week, MIA featured a news item regarding a recent “proof of concept” study conducted at Washington University of St. Louis to investigate whether nitrous oxide, commonly known as laughing gas, was effective in reducing symptoms of depression. Why is this a problem?

Happiness is the absence of suffering… I’ve since come to realize this aphorism applies also to the suffering I endured while on and coming off psychiatric drugs: When that particular suffering — physical, emotional, neurological, psychological, sociological — had ended or mostly so, I was happy again. It was as simple as that. I was so relieved to no longer be in a state of terror, agony, and agitation, and to not have my life controlled by others (i.e., the “doctors”), that I felt happy — not just by comparison against being miserable, but because it was so enlivening, liberating, and hope-instilling to not be miserable.

In the autumn of 1996, my son was seventeen when he told me one day on the way home from school: “I don’t know what’s happening, I can’t find my old self again.” He’d had a seemingly marvelous summer staying with family in Mexico, fishing and learning to surf. He’d achieved nearly a full scholarship for his junior year at a Boston private school. However, one teacher had observed that, in class, he “sometimes seems to be out of touch and unable to focus his mind.”

NEWS FLASH (North Pole, Somewherereallycold)-- According to sources at the North Pole, Santa is not happy about the growing use of ADHD drugs. As you know, long ago, he had made his list and checked it twice. But with more than 4.5 million kids in the USA alone doing ADHD drugs every day, he has had to redo his list infinitum.

In the post on the debate between Allen Frances and Bob Whitaker, Frances argues that we should all advocate better treatment for those with psychosis. I think that we all might embrace the goal of better, more empathic treatment. However, we will differ on what “better treatment” might entail. I would argue that a return to the state hospital systems of the 1960s would not constitute better treatment.

The mental health industry has a lot to answer. The psychologization of everyday life has eroded the range of human experience seen as normal, disempowered people to manage their own life challenges, professionalized helping relationships and undermined the already decaying support structures through which people found meaning and connection, stigmatized people through psychiatric labeling, led to iatrogenic misery from harmful treatments and traumatized already vulnerable individuals through excessively coercive practices.

Every day for most people, something mysterious begins to take shape that still defies scientists in these times. Although the primary reasons for most basic bodily functions, such as eating and moving, have been known for centuries — sleep, or also known as slumbering or snoozing or napping or crashing — still remains an enigma in many ways

The Finnish Psychological Association held a meeting in Helsinki on 1 Sept 2014 titled “Mental Health and Medicalization.” I spoke at the meeting and four days later I sent a letter to another speaker, psychiatrist Erkki Isometsä. Professor Isometsä replied: “I will respond to it in detail within a few days..." As "Open Dialogue" is essential in science, I have published my letter to Isometsä here as well as on my own website, although I didn’t succeed in starting a dialogue.

The article “Special K, a Hallucinogen, Raises Hopes and Concerns as a Treatment for Depression,” by Andrew Pollack in the New York Times, December 9, 2014, tells how far afield my field, psychiatry, has really gone - that it is even a consideration to use an hallucinogen for the treatment of depression.