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For the last month or so, Mad in America has been hard at work building a directory of “mental health” providers across North America (and eventually, we hope, the world) who will work with people wanting to come off psychotropic drugs.  I’ve been honored to have been tasked with the responsibility of building this directory, and I have to say, it’s been inspiring to talk to people all over the country who do this work, and who “get it”.

Two pieces of research have been published over the last two years that should prompt a major reorientation of the treatment of schizophrenia and psychosis, and a fundamental reappraisal of the use of antipsychotic drugs in general. Put together, these studies suggest that the standard approach to treating serious mental health problems may cause more harm than good. Long-term treatment with antipsychotic drugs has adverse effects on the brain, and may impair rather than improve chances of recovery for some. Many people ask me how the psychiatric profession has responded to this data. Surely, they think, it must have stimulated a major debate within the profession, and some critical reflection about why it took so long to recognise these worrying effects? Sadly, this does not appear to be happening.

There’s a fierce debate brewing on Capitol Hill over two competing bills that seek to overhaul our nation’s mental health system. Rep. Ron Barber (D-AZ), a survivor of Jared Loughner’s 2011 mass shooting, has proposed the Strengthening Mental Health in Our Communities Act of 2014, a bill that would provide additional funding for the Substance Abuse and Mental Health Administration (SAMHSA). Barber’s legislation specifically targets at-risk populations who may be underserved − young people, seniors, veterans, and Native American communities − and seeks to provide patient-driven treatment before the illness becomes unmanageable.

For the past several years whenever a critical essay has come along examining the work of Irving Kirsch and his colleagues I have made an effort to examine the validity of the proposed arguments. Kirsch and his colleagues used the Freedom of Information Act to gain access to the unpublished trials of antidepressants and then pooled the clinical trial data – both published and unpublished ─ and analyzed it as a single data set. It is common for pharmaceutical companies to only publish those studies that find their products effective, and to withhold the negative studies, making it difficult to reach accurate conclusions by examining only the published data. Kirsch and his colleagues have reported that in the company sponsored clinical trials, the SSRIs only marginally outperform placebo, with the difference being statistically different but not clinically significant.

My law review article entitled "Rethinking criminal responsibility from a critical disability perspective: The abolition of insanity/incapacity acquittals and unfitness to plead, and beyond" has been published in Griffith Law Review. The article attempts to find a way to deal with concerns for a degree of toleration towards socially disruptive behavior that may be criminalized, without making some people categorically and legally irresponsible as happens with the insanity defense.

I am a psychiatrist who believes that involuntary treatment is rarely effective in the long run but I am also a psychiatrist who sometimes forces people into hospitals against their will.

Academia has long been the official search engine for knowledge. Here supposedly are the ivory towers where seekers after truth, men and women intellectuals, teach new generations and carry out learned research, to add to the sum of human wisdom. It also has a longstanding history of questionable relationships; from those with the arms trade, to continuing over-reliance on big pharma psychiatric research funding.

There is some hullabaloo going on about "prolonged grief disorder," AKA "complicated grief disorder." Yep, another grief-related 'mental illness.'  According to an NEJM blog the "condition is characterized by intense grief that lasts longer than would be expected according to social norms and that causes impairment in daily functioning." I think certain groups are at risk of - again - being diagnosed and "treated" for absolutely normal feelings and experiences after an excruciatingly painful and traumatic loss.

I’ve just finished reading Michel Foucault’s book History of Madness.  It is a tour de force that is at times almost impossible to understand, but I find if I am patient the loose ends usually are brought back together.  It is also highly upsetting to read for me as someone who has been locked up as mad.  The layers of history that Foucault uncovers demonstrate conceptual as well as legal and social forms of exclusion that are with us to the present day, although some of them have become transformed over time.

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.

On January 27 I posted a blog, Maternal Attachment in Infancy and Adult Mental Health, on my website Behaviorism and Mental Health. In this article I reviewed a longitudinal study by Fan et al.  The main finding of the study was: “Infants who experience unsupportive maternal behavior at 8 months have an increased risk for developing psychological sequelae later in life.”

‘Psychiatric prejudice’ is a term being bandied about these days, mainly by aggrieved psychiatrists. Ordinary people, other doctors and medical students are all prejudiced, they say, because they do not appreciate that psychiatry is a proper medical activity, and critics of psychiatry are prejudiced because their analyses undermine this medical point of view. However, many people remain inclined to view the difficulties we label as mental disorders as understandable reactions to adverse life events or circumstances and, importantly, evidence suggests they are more, not less, tolerant of such situations. In my view, there is a role for medical expertise in helping people with mental health problems, but that does not mean we have to call those problems illnesses.

Like you, I have experienced severe cognitive and emotional distress in my life. This distress was sufficient that I once received a psychiatric diagnosis of Major Depressive Disorder and Generalized Anxiety Disorder, though I imagine other diagnosis could have easily been applied as well. I know what panic attacks feel like. I know how it feels to experience a "dissociative episode" from the inside out. I know what it feels like to believe that you are going crazy. I know what it feels like to convulse in sobs so intensely that you tear muscles. I know what it feels like to want to die.

I recently read an article by Fredric Neuman, MD, titled The Use of the Minor Tranquilizers: Xanax, Ativan, Klonopin, and Valium.  Dr. Neuman opens by telling us that benzodiazepines are "Very commonly prescribed for any sort of discomfort . . . They are called anxiolytics, and they are prescribed for any level of anxiety and more or less to anyone who asks for them." Dr. Neuman has been working at the Anxiety and Phobia Center for 41 years, first as Associate Director and then as Director. So when he says that benzos are routinely given to "anyone who asks for them," it's probably safe to say that he's being accurate.

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.

I woke up this morning and there it was again, "I Am Adam Lanza's Mother." This essay is all over the internet, written by a woman who is using her personal story about experiences with her “mentally ill” son, whom she is “terrified of,” to appeal for more dialogue on the issue of mental health. As I write this, her son's picture has been viewed by over a million people. They have read her accounts of what may be some of these young man’s most painful childhood memories.

We’re in scary times. For so many reasons. Perhaps the industrialization of ‘peer work’ should rank fairly low on the scale of scary, but - at least for me - it’s up there.

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 . . .

During my lifetime I have witnessed the fall of Freudian psychiatry and the ascension of molecular psychiatry. Unfortunately, we have gone from the frying pan into the fire. I certainly do not subscribe to old-fashioned psychoanalytic ideas which had been beset by considerable problems throughout the years. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of responsiveness to our patients. I love and value the work of psychiatry. Nothing is more gratifying than helping people heal from painful symptoms, and to fulfill their ability to love and recover their authenticity. I am proposing a new and different paradigm for psychiatry.

Hundreds of people have been given remote control deep brain stimulation implants for psychiatric disorders such as depression, OCD and Tourette’s. Yet DBS specialists still have no clue about its mechanisms of action and research suggests its hefty health and safety risks far outweigh benefits.

Both Michel Foucault and Thomas Szasz dated the beginnings of a distinct Western institutional response to madness to the late 1500s-early 1600s. But while for Foucault it started in France with the creation of the public “hôpital général” for the poor insane, for Szasz it began in England with the appearance of for-profit madhouses where upper class families shut away inconvenient relatives. Regardless of their different ideas on the beginnings of anything resembling a mental health system, both authors agree that it was characterized by the coercive incarceration of a specially labeled group.

On February 18, the eminent psychiatrist Jeffrey Lieberman, MD, former President of the APA, published a video and transcript on Medscape.  The article was titled What Does the New York Times Have Against Psychiatry?, and was essentially a fatuous diatribe against Tanya Lurhmann, PhD, a Stanford anthropologist, who had written for the New York Times an op-ed article that was mildly critical of psychiatry.  The essence of Dr. Lieberman's rebuttal was that an anthropologist had no business expressing any criticism of psychiatry, and he extended his denunciation to the editors of the NY Times.

On July 17, I wrote a post on the use of neuroleptic drugs as chemical restraints in nursing homes.  The article generated some comments, one of which touched on some very fundamental issues which, in my view, warrant further discussion. The comment read as follows: "All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use."

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.

Antidepressants may be effective over the short term, but research is showing that treatment resistant depression has risen dramatically in the past 30 years; evidence that the drugs may be inducing chronic depression.