From Blaming the Patient to Blaming the Brain
The idea of schizophrenogenic or refrigerators mothers was an embarrassing era for psychiatry, and so psychiatrists were only too happy to explore the brain and the genome to unlock the secrets of mental illness. Today, the rhetoric has shifted away from intrapsychical conflicts and traumatic ruptures, and instead aberrant neurochemistry or delinquent genes are held as the source of mental illness. Regardless, the message is clear: mental illness is beyond our control and requires psychiatric intervention. The moral authority the mental health industry claims over our mental life rests on this claim.
Psychiatric Drugs: More Dangerous Than You Ever Imagined (A New Video)
âPsychiatric Drugs are More Dangerous than You Ever Imaginedâ is the newest video in my series Simple Truths about Psychiatry. It provides a simple, direct and inescapable warning about this epidemic of harm induced by psychiatric drugs. The video sounds a necessary alarm about this growing tragedy, involving millions of people and their families, who never foresaw the disabling results of taking psychiatric drugs and giving them to their children.
Trauma and Schizophrenia: The Ultimate Political Battle
This weekend I attended an international trauma studies conference in Miami, Florida, where some of the leading researchers and clinicians in the field of trauma gathered to share their innovative projects and findings. Although there were many worthwhile moments, overall I left feeling paradoxically hopeful, saddened, inspired, and a bit dumbfounded. One study after another was presented on "trauma-related disorders" and their associated treatments, yet there was not a single mention of schizophrenia or its related diagnoses. Four days of trauma discussion and the topic of psychosis was nowhere to be found.
Between Psychiatry and Anti-Psychiatry: Mad in America Opens a Dialogue
Editor's Note: At the Mad in America film festival, Allen Frances, M.D., who was the chairman of the DSM IV task force, participated on a panel of psychiatrists who were asked to respond to the themes explored at the festival and to offer their own critiques of psychiatry. After the festival, he wrote a blog for the Huffington Post, which was partially inspired by his participation at the festival, and he then offered to re-publish it on MIA. It appears below. Also at the festival, Justin Brown sought to hand out a leaflet criticizing Dr. Francesâ writings, as well as his critique of those who criticize psychiatry. We asked him to submit a post for MIA instead, which is published below.
Antipsychiatry Revisited: Toward Greater Clarity
Over the last decade, people have commonly made statements to me of the ilk â âWhat bugs me about antipsychiatry people is they only care about tearing down; there is no commitment to actually helping peopleâ â Which suggests that there is a serious dearth of awareness about antipsychiatry.
Itâs the Coercion, Stupid!
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 âhĂŽpital gĂ©nĂ©ralâ 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.
May the âForceâ NEVER EVER Be With You! The Case for Abolition
A growing body of evidence indicates that forced âtreatmentâ in todayâs mental health system, including all forms of forced hospitalization and forced drugging, may actually cause FAR more harm than good. Recent published studies and articles point towards evidence of physical and psychological harm that, in some cases, may contribute to more suicidality and patient deaths, as well as overall worse outcomes in a personâs state of recovery.
A Discussion of Labels, Part One: Disability
When my son was born six years ago, the word âdisabledâ was suddenly all around me. It came from everywhere â the nurses, the doctors, the physical and occupational therapists, friends and family. I remember looking into his ice blue eyes and so marveling at the lines of white that extended so symmetrically from his irises that I began calling him Star Boy. I felt a new motherâs sense of protection. The label surrounding my Star Boy was a smoke so thick I felt I could barely breathe.
Rethinking Psychiatry
I was honored to both attend and participate in the recent Mad In America Film Festival. I was asked to join a panel of psychiatrists who were asked to respond to the themes and questions explored in the festival. What follows are a lightly edited version of my remarks.
Towards a Hermeneutic Shift in Psychiatry
I know that this might sound odd coming from a critical psychiatrist, but I believe that psychiatry has a future. Furthermore, I maintain that a good deal of psychiatry as practised now is helpful and that many psychiatrists manage to play a positive and therapeutic role in the lives of their patients. However, I also believe that we are at our most helpful when we depart from the current biomedical ideology that has come to dominate in our profession. As a first step, we need to get beyond the reductionism that currently guides most psychiatric research and education.
On Being Sane in an Insane PlaceâThe Rosenhan Experiment in the Laboratory of Plautusâ...
I was honored to present a lecture to the Department of Psychiatry of which Dr. Thomas Szasz was a member. The department has been hosting a celebration of his prolific career. I spoke of David Rosenhan's 1973 "experiment," in which he pretended to hear voices in order to gain admission to psychiatric hospitals. I argue that a 2000-year old stage comedy anticipates Rosenhan's experiment in virtually identical form, but it goes beyond the problems of diagnosis and approaches Szasz's view that mental illness is not a medical matter.
NICE Guidelines for Bipolar Disorder- a Missed Opportunity
There are some things to applaud about the recently released update of the NICE bipolar guidelines, not least the recognition that the diagnosis has been inappropriately applied to children with behavioural problems. Hopefully this will help curtail the worrying trend of using toxic bipolar drugs in this age group. As usual, however, the Guidelines overlook glaring problems with the evidence base for drug treatment in general, and miss an opportunity to stem the diagnostic creep that has come to the UK and Europe via the United States.
The Problems of Non-Consensual Reality
In a couple of weeks, I may see some of you at the MIA Film Festival. I am honored to be on a panel called âRe-Thinking Psychiatryâ with two esteemed colleagues. In advance of the festival, I decided to write about what has been most central in my own âre-thinkingâ: my basic understanding of psychosis - when a person does not share consensual reality. It has been a fundamental re-think: how do we define it? how do we understand it? when do we intervene? how do we intervene?
How Reliable is the DSM-5?
More than a year on from the release of DSM-5, a Medscape survey found that just under half of clinicians had switched to using the new manual. Most non-users cited practical reasons, typically explaining that the health care system where they work has not yet changed over to the DSM-5. Many, however, said that they had concerns about the reliability of the DSM, which at least partially accounted for their non-use. Throughout the controversies that surrounded the development and launch of the DSM-5 reliability has been a contested issue: the APA has insisted that the DSM-5 is very reliable, others have expressed doubts. Here I reconsider the issues: What is reliability? Does it matter? What did the DSM-5 field trials show?
A Critique of Genetic Research on Schizophrenia â Expensive Castles in the Air
In the light of the much trumpeted claims that recent research has identified genes for schizophrenia, it is important to review the track record of this type of endeavor. Despite thousands of studies costing millions of dollars, and endless predictions that the genetics of schizophrenia would shortly be revealed, the field has so far failed to identify any genes that substantially increase the risk of developing schizophrenia.
Stranger
I am quarantined in Stabilization. In front of me an old woman with cherry lipstick and a clipboard asks questions about sexual abuse, but my mind is through the square window on the door behind her. In that room I see a steel bed surrounded by emptiness. On top of it lay leather straps that are uneven in width where theyâre wearing thin. Each strap has a set of holes to fasten the buckles tight, and I can see quite clearly that the ones nearest the end are circles while the ones furthest away have stretched into ovals. Tonight will be a Haldol night.
Antidepressants and Overall Wellbeing
There's an interesting article in Psychotherapy and Psychosomatics. It's called The Efficacy of Antidepressants on Overall Well-Being and Self-Reported Depression Symptom Severity in Youth: A Meta-Analysis. The authors concluded: "Though limited by a small number of trials, our analyses suggest that antidepressants offer little to no benefit in improving overall well-being among depressed children and adolescents." In the Discussion section of the paper, they stated, "We found no evidence that antidepressants offer any sort of clinically meaningful benefit for youth on self-report measures of depression, quality of life, global mental health, or parent reports of autonomy."
Trauma, Psychosis, and Dissociation
Recent years have seen an influx of numerous studies providing an undeniable link between childhood/ chronic trauma and psychotic states. Although many researchers (i.e., Richard Bentall, Anthony Morrison, John Read) have been publishing and speaking at events around the world discussing the implications of this link, they are still largely ignored by mainstream practitioners, researchers, and even those with lived experience. While this may be partially due to an understandable (but not necessarily defensible) tendency to deny the existence of trauma, in general, there are also certainly many political, ideological, and financial reasons for this as well.
People Who Find Psychiatric Drugs Helpful
On July 28, I published a post called Simon Says: Happiness Won't Cure Mental Illness. The article was essentially a critique of a post written by British psychiatrist Simon Wessely, that essentially said that all psychiatric treatment alleviates suffering and makes people happier. The falsity and self-serving aspect of this contention is glaringly obvious, and I drew attention to this. My essential point is this: psychiatric drugs; illegal street drugs; alcohol and nicotine, all have in common that they confer a temporary good feeling. That's why people use them. But they also have in common that they are toxic substances, and if taken in sufficient quantity over a long enough period, they will inevitably cause organic damage.
Taking an Entry Point: On Investigating the Psychiatric-Pharmaceutical Complex
There are various ways to analyze an institution like psychiatry. One of the most common is by mining examples. You might, for example, talk to few survivors who seem to embody what befalls most folk subject to psychiatric rule. Or, you might pen a stirring phenomenological account based on your own experiences. Here, I will introduce you to the bare beginnings of an inquiryâone that I found myself falling into but a couple of weeks back. The entry point is the arrival of a letter.
Anti-Psychiatry
From time to time, I find myself feeling the urge to articulate my views and delineate them from people with whom I may be identified. Rightly or wrongly, I feel that way with this website. Although the goal is to have wide ranging goals there is nevertheless a distinct perspective represented here. I feel the urge to articulate where I part ways with some of the views expressed here. I do this in the spirit of discourse. I am not certain I am correct. I may someday change my mind. I am just expressing my perspective.
Playing the Odds, Revisited
It is hard to believe that a year has gone past since I posted Playing the Odds: Antidepressant Withdrawal and the Problem of Informed Consent. The feedback I received underscored the more controversial aspects of SSRI toxicity. Common themes concerned the abrupt onset of new symptoms 3 to 12 months after stopping the drug, reinstatement of the drug failing to help withdrawal related symptoms, the possibility that withdrawal-related symptoms can persist indefinitely and concerns about using benzodiazepines to help with tardive akathisia.
The Use of Neuroleptic Drugs As Chemical Restraints
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, itâs very one-sided and could be considered biased in that itâs written by a psychologist. Iâve seen many patients and families benefit from their use."
Illegal-Psychiatric Drug Hypocrisy, & Why Michael Pollan is Smarter than Me
Before Michael Pollan gained well-deserved respect and influence authoring five bestselling books about food, he got my attention in the late 1990s writing about American illegal-legal psychotropic drug hypocrisy. Then he stopped writing about it. If he had continued his assault on American drug hypocrisy, he likely would have been attacked by many psychiatric drug users, mistaking his confronting this hypocrisy as challenging their decision to choose psychiatric drugs.
Consent and Psychiatry: Problematizing the ProblematicÂ
It is rare to get involved in a dialogue over psychiatry without sooner or later someone defending the use of such âtreatmentsâ as ECT âas long as they are consented to,â with the term âinformed consentâ periodically employed. Herein lies the context for this piece. The issue that I want to probe, to be clear, is not whether force should be usedâfor of course it shouldnâtâbut the thorny issue of consent itselfâwhat exactly constitutes consent and what other issues besides consent are critical to factor in when considering what it is and is not legitimate for a âmedicalâ professional to offer.