I have sometimes stopped en route to work, unsure how much longer I can continue. There is a sense of betrayal to my father and grandmother by working in a profession that failed them and is the only medical specialty to have its own survivor movement, not from the illnesses it hopes to treat, but from the ministrations of the profession itself.
Is "co-production" public service citizen involvement? Is it individual, ‘responsibilised’ health and social care consumerism? Is it power shifting to communities through participatory governance? Perhaps it’s the ultimate post-modern policy concept. But can it work for mental health?
Forced treatment in psychiatry cannot be defended, neither on ethical, legal or scientific grounds. It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true. We need to abolish our laws about this, in accordance with the United Nations Convention on the Rights of Persons with Disabilities, which virtually all countries have ratified.
We have come to believe that technology can eradicate all human suffering and provide unblemished and everlasting happiness. We have paid for this irrational expectation with our autonomy, our dignity and our ability to endure.
This is the final of four installments about the bizarre, ongoing conduct of psychiatrists at Upton House, an Eastern Health psychiatric facility in Melbourne, and the collusion with their conduct by all relevant agencies. This last installment will document the failure, so far, of the State and Federal Governments to intervene in even this most extreme and blatant example of abuse of power by psychiatry. If I, as a Professor of Clinical Psychology with 40 years clinical and research experience in this field, can be so easily dismissed/ignored by the relevant systems in Victoria, what chance do the average users of mental health services and their families have of being heard in this State?
For a long time I have felt that there just isn’t a good enough and long enough study on the pros and cons of long-term antipsychotic treatment versus reduction and discontinuation in people who have psychotic disorders, including those who are classified as having schizophrenia. Moreover, there are increasing reasons to be worried about the effects of long-term treatment with antipsychotics. I put this case to the UK’s National Institute of Health Research recently, and proposed that they fund a trial to assess the long-term outcomes of a gradual programme of antipsychotic reduction compared with standard ‘maintenance treatment.’ The NIHR agreed that this was an important issue, and that a new trial was urgently needed. The RADAR (Research into Antipsychotic Discontinuation And Reduction) study officially started in January 2016.
I am trying to demonstrate, in a series of installments, how in the 21st century we still often fail to establish effective safeguards for the rights of people who end up in our psychiatric systems. This particular example is taking place in 2016, in Melbourne, and involves over 50 consecutive electro shock ‘treatments’ and multiple, sometimes very lengthy, periods of being tied to a bed. In this third installment, I offer my interactions with another body who is supposed to protect our rights when under the ‘care’ of psychiatrists, the Mental Health Tribunal.
I do not wish to discuss an individual patient. I wish to discuss the conduct of the psychiatrists at Upton House, Dr Katz in particular, who have been responsible for the administering of over 50 ECTs consecutively to a patient, and have reportedly repeatedly restrained this patient to a bed, on one occasion for approximately 60 consecutive days.
Following Richard Bentall’s inspired Open Letter to Stephen Fry, we – a group of people who have (and still do) use mental health services, who work in mental health, or who work as academics... or fall into more than one of those categories – have decided to write a parallel Open Letter to the BBC and other media organizations about their coverage of mental health issues. We need as many signatures as possible!
Stephen Fry’s exploration of manic depression (in the current BBC series on mental health, ‘In the Mind‘) has drawn both praise (because of his attempts to destigmatize mental illness) and criticism (because he appears to have a very narrow biomedical understanding of mental illness). I have sent an open letter to the actor which challenges some of his assumptions about mental illness, and offers a very different understanding to that promoted in his recent television programme.
The 90s were labeled - rather optimistically - as the ‘decade of recovery.’ More recently, recovery has been placed slap bang central in mental health policy. Is supporting recovery pretty much good common sense? Or is the term being misused to pressure those suffering to behave in certain ways?
Over the past few weeks I have been witness to, and increasingly involved in trying to stop one of the most extreme examples of psychiatric brutality I have encountered in my 40 years in this field. And I have encountered quite a few. I suggest you sit down before watching and reading. This is not your usual, run-of-the-mill psychiatric abuse story.
In the 40 years since I was wrongly - and catastrophically - "diagnosed" and "treated," I've seen one after another announcement of supposed "progress" in the "science" of understanding and treating "mental illness" come and go — first trumpeted, then with nary a mention, failing to hold their ground and falling away to the mists of time along with the people and the lives they'd ruined. People will continue to suffer and die if the public do not wake up and have the courage to act as a caring community, and stop regarding human problems as "diseases" to be "cured," rather than as challenges that we share.
When the idea that selective serotonin re-uptake inhibitors (SSRIs) might make people feel suicidal first started to be discussed, I admit I was sceptical. It didn’t seem to me the drugs had much effect at all, and I couldn’t understand how a chemical substance could produce a specific thought. Because these effects did not show up in randomised controlled trials, they were dismissed and few efforts were made to study them properly. Then some large meta-analyses started to find an association between the use of modern antidepressants and suicidal thoughts and actions, especially in children.
If antidepressants are effective, and people with depression are more likely to be prescribed them, then you would expect the consequences of depression to start to lessen. One of those consequences, according to government statistics, is being out of work. But what we see is quite the opposite: Increasing use of antidepressants correlates with increased numbers of people with depression who are out of work and claiming benefits, and increasingly on a long-term basis. And this is at a time when disability due to other medical conditions has fallen.
Health systems are extremely hierarchical and, rather than empathy, the dominant approach to people's difficulties is based on top-down management practices which assume experts know what is best for people. I am hopeful that we can help people within the mental health system and other parts of society to strengthen their empathic ways of relating. However, I've noticed how easy it is for me to get self-righteous about mental health workers who are more 'medical' or 'expert-lead' in their approach. I realise that if I really want to help change things for the better I, too, will need to understand people who seem to be my opponents.
This means that what ADHD proponents present as validation of a diagnosis of a real and treatable disorder is in fact a placebo effect caused by an ostensibly scientific label, which exists in synergy with an efficient, legal drug. The ADHD label produces this placebo effect because its diagnosis is based on behavior that in reality could be observed by anyone. What is observed sounds "scientific"; it is easily understandable and highly obvious. When the diagnosis is turned into an action plan, we forget that there is nothing scientific about it and that its evaluation is purely subjective and clinical; that it creates a great many false positives, and that a drug prescribed in half of the cases indeed does have serious side effects.
I want to tell you about a magical tool I use particularly for navigating challenging situations. It's called Non violent communication (NVC). It's a way of understanding and communicating that I've found particularly useful in situations of conflict. I've hyped it up in the first sentence as a magical tool but like all useful things, it's got its limitations too. I guess the key is how and when to use it. So what am I talking about?
We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.
In Part One of this article series, we reviewed the contemporary research into the links between psychosis, problematic family dynamics, and other forms of childhood trauma. After reviewing this research, we find that a very interesting and important question emerges: What do all of these have in common? In other words, is there some common denominator that all of these types of trauma and patterns of problematic family dynamics share, a single underlying factor that makes someone particularly vulnerable to experiencing a psychotic crisis? Indeed, I believe that there is.
This is a very important, well-written book which should become essential reading for anyone involved in the healing arts, since suffering is - or should be - at the heart of our endeavors. Suffering tells us what’s really important to us, and our approach to it tells us what we’re really made of.
Several of us involved in RxISK.org monitor other groups setting up to offer information on medicines. Some of these, like eHealthMe, offer useful information. As ever, though, pharmaceutical companies are in there early. The Brintellix website is a masterclass in how to appear patient-centered, and patient-friendly. How to move with the times and make the new way of doing things yours.
In New Zealand, the government is passing legislation called the Natural Health and Supplementary Products Bill that will limit access to minerals and vitamins. While safety and efficacy are important, this Bill will ban for sale many NHPs that New Zealanders rely on for their health. In so doing, it will ban all of the formulas for which there is scientific evidence of benefit for mental health. We have some evidence that the result could be tragic.
There are very few things considered more taboo in the world of mental health than the suggestion that problematic family dynamics can lead to a child developing a psychotic disorder. And yet, when we look honestly at the history and research of psychosis and the broader concept of “mental illness,” it becomes apparent that there are few subjects in the mental health field that are more important. I’d like to invite you, then, to join me on a journey into this taboo territory, dividing our trip into three legs. In the first leg (Part One), we’ll go back in time to explore how such a crucial topic has become so vilified, and then embark upon a flight for an aerial view of some of the most essential findings of the last 60 plus years of research that look at the links between problematic family dynamics and psychosis.
The strongest evidence we have as to whether a drug causes a problem does not come from RCTs or any other controlled study but rather from good clinical accounts. Even if RCTs were done by angels, so there was no hiding, no miscoding, nothing untoward, RCTs can still hide adverse events. The onus is on large and powerful corporations who have a lot of resources to pinpoint the populations where the benefit is likely to exceed the risk, if they want to continue to make money out of vulnerable people.