Foreign Correspondents

by Eugene Epstein, Manfred Wiesner, and Lothar Duda Over the past 50 years, the psychiatric and psychotherapeutic discourses of the western first world have infiltrated...

I am walking through my local park in Copenhagen, Denmark, early in the morning breathing in the fresh smell of damp soil and late summer blooms. I am thinking about my thesis that I have just handed in and the fact that if it is passed I will be a certified psychologist! But, I will not be just any psychologist. I will be Denmark's first official 'Mad' psychologist, joining the ranks of others such as Rufus May, Eleanor Longden, Arnhild Lauveng, and Pat Deegan.

Of all the beliefs that I have had about my experiences, the belief that I was ‘schizophrenic’ was the most damaging. In adopting the story that others told about me, and abandoning my own sense-making process, I held on to a belief that both hid my traumatic life experiences and rendered them irrelevant. Does it matter if we sometimes slip into the language of illness when we all agree that these experiences are meaningful, personal and have value? Yes. It does.

I am a very optimistic psychologist, but with reason. For 25 years I've been working with people who have had psychological problems in every conceivable area. Many psychologists have problems with burnout, especially early in their careers. For me, this has been very different. By using the treatment techniques that I do, I feel anti-burned out. It is so gratifying to see people get out of their serious problems, that I look forward to every day of clinical work.

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.

People have used psychoactive substances to dull and deaden pain, misery and suffering since time immemorial, but only recently, in the last few decades, have people been persuaded that what they are doing in this situation is rightly thought of as taking a remedy for an underlying disease. The spread of the use of prescription drugs has gone hand in hand with the increasing medicalization of everyday life, and a corresponding loss of the previous relationship that people had with psychoactive substances.

I hope this will be of help to people who hear voices and their friends and supporters. I also hope it will be helpful to the voices which are parts of many people's lives. Many voices I have come across and the people that hear them are convinced that their voices are spiritual in nature. I take an agnostic position on this, and therefore endeavour to respect different spiritual understandings. My intention is not to explain all voices psychologically but to help people make peace with their voices so they can get on with their lives.

‘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.

Tension mounts across the ideological divide as D-Day (DSM-5 Day) approaches. The APA has powerful allies on its side. President Obama has just launched Decade of the Brain 2 with the announcement two weeks ago that heralds the arrival of BRAIN ( Brain Research through Advances in Innovative Neurotechnologies). If that’s not enough, those who believe that science will ultimately explain madness can always rely on the media to fawn at their feet.

One of the suggestions in the comments from my last post has really got my imagination going. Chaya Grossberg suggested that we can all edit Wikipedia entries. I went in and got surprised at how easy this was. Then I checked the hit rates on Wikipedia to see how big an impact this could have, and I was totally amazed.

In 2009, my friend Leonie’s 22-year-old son Shane killed himself and another young man after taking Citalopram for 17 days. Eighteen days after Shane’s death, Psychiatrist Dr Michael Corry publicly stated his view that he could not have done what he did had he not been on Citalopram. Initially Leonie admits to thinking he was mad. How could medicine prescribed by a doctor have anything to do with what had happened to her son?

On 6 January 2014, I published the article “Psychiatry Gone Astray” in a major Danish newspaper (Politiken), which started an important debate about the use and abuse of psychiatric drugs. Numerous articles followed, some written by psychiatrists who agreed with my views. For more than a month, there wasn’t a single day without discussion of these issues on radio, TV or in newspapers, and there were also debates at departments of psychiatry. People in Norway and Sweden have thanked me for having started the discussion, saying that it’s impossible to have such public debates about psychiatry in their country, and I have received hundreds of emails from patients that have confirmed with their own stories that what I wrote in my article is true.

As we approach world hearing voices day 2013 Karen and I are in Canada. We have just enjoyed running a preconference workshop for about 100 people in Winnipeg. I am sitting in my room before breakfast writing this piece and as I sit I am thinking back twenty-three years ago; I am in a psych unit in Manchester and I have a new support worker called Lindsay. By then I had been a psych patient for almost ten years and was fast approaching spending the rest of my life in the system. My support worker had convinced me to go to a new group that was starting in Manchester called a hearing voices group.

We suspect that many people would benefit from an alteration in diet and there is certainly growing evidence that improving diet affects physical health. Whether that is true for mental health needs to be more rigorously tested, and we are encouraged that there are studies currently being conducted around the world attempting to manipulate diet to directly test this hypothesis.

Until recently the history of psychiatry was a neglected backwater whose murky depths were explored largely by psychiatrist. The impression conveyed by books such as Tuke’s Chapters in the History of the Insane in the British Isles, Macalpine and Hunter's Three Hundred Years of Psychiatry: 1535 - 1860, Berrios and Freemen's 150 Years of British Psychiatry 1841 - 1991, or Fuller Torrey and Miller's The Invisible Plague, is one that sees psychiatry and modern systems of mental health care as the inevitable outcome of progress through scientific thought, a (white European male-led) narrative from darkness and ignorance to enlightenment and knowledge.

The Movement for Global Mental Health's objective is to ensure that people living in low- and middle-income countries have access to the best and most effective modern psychiatric drugs and therapies. In pursuing these objectives it assumes that to do so is a neutral project beyond political concerns. China Mills’ book Decolonizing Global Mental Health challenges this view.

Large numbers of studies are being conducted with many claiming internet use causes structural changes in the brain similar to those found in the brains of drug addicts. No snorting, smoking or injecting required. You just have to look at this drug for long enough and your brain is damaged. Is it possible your laptop and mobile phone are the crack cocaine of gadgets?

The Critical Psychiatry Network is concerned with the way the controversy over the publication of DSM-5 is being portrayed in the media and by some academic psychiatrists. The issues raised by the DSM are complex and require careful and studied consideration. There are two aspects in particular that concern us. These relate to the portrayal of the controversy as a guild dispute, and the polarisation of the debate as one of nurture versus nature.

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.”

Recently the problem of publication bias has been shaking the foundations of much of psychology and medicine. In the field of pharmacology, the problem is worse, because the majority of outcome trials (on which medication approval and physician information is based) are conducted by pharmaceutical firms that stand to benefit enormously from positive results, and run the risk of enormous financial loss from negative ones. Numerous studies have found that positive results tend to be published, while negative ones are quietly tucked under the rug.

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.

We have just celebrated the anniversary of the rapidly expanding global Hearing Voices Movement which was founded more than twenty-five years ago following the ground-breaking research of Professor Marius Romme and Dr Sandra Escher. Romme and Escher have advocated for a radical shift in the way we understand the phenomenon of Hearing Voices; in contrast to traditional, biomedical psychiatry which views voices as an aberrant by-product of genetic, brain and cognitive faults, their research has firmly established that voices make sense when taking into account the traumatic circumstances that frequently provoke them.

It has been a good time to bury controversy. With all eyes on Washington and the fallout from the publication of DSM-5, over here in England the Institute of Psychiatry has been discretely sending out invitations to a lecture. This is not a public lecture; it is by invitation only. And who is the esteemed guest? None other than Professor Charles Nemeroff M.D., Ph.D.

Right now in Britain there is a controversy shaping up between the commercial and financial interests of big managed-care corporations and the need to care for vulnerable people in the community, people with conditions like dementia and long-term psychoses. Conflicts of interest are nothing new in the contested field of mental health, but this one threatens not only quality of care, but the well-being of low paid workers, mainly women, who are employed as support workers.

Those of you following our posts on Nutrition and Mental Health know that we ended the last one, on ‘history’, by saying that the two of us are essentially devoting our research lives to re-inventing the wheel. It is old knowledge that good nutrition is essential for mental health, and it is really old knowledge that improving nutrition can improve mental health. We are going to spend the next few blogs outlining the science and rationale that supports the role played by nutrition in wellness as well as the expression of mental illness. This information will provide modern scientific validation for the conclusions drawn by some of our ancestors, described in the previous blogs.