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It is generally recognized in antipsychiatry circles that antidepressant drugs induce manic or hypomanic episodes in some of the individuals who take them. Psychiatry's usual response to this is to assert that the individual must have had an underlying latent bipolar disorder that has "emerged" in response to the improvement in mood. The problem with such a notion is that it is fundamentally unverifiable.

What are the philosophical underpinnings for what constitutes evidence and how have quantitative approaches so effectively trumped qualitative approaches in applied psychiatry, psychology, and the like? Furthermore, is it possible that quantitative ways of studying human experience may actually promote constricted, myopic views that hurt or oppress human beings? And how does this contribute to a global biopharmaceutical research enterprise reframing the understandable reactions to oppression as being the deficiencies and impairments of its victims?

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.

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.

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.

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.

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.

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?

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.

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.

ProPublica is well known for creating interesting data bases that allow anyone hooked up to a computer to see by name whether a physician is accepting Big Pharma payments — from dinners to speaking engagements to consulting services. What may be lesser known is that occasionally ProPublica will publish other data that when carefully mined can reveal even more about the use of psychiatric drugs especially when there is a public funding source available.

On December 1, Mad in America published an article titled When Homosexuality Came Out (of the DSM). The author is Vivek Datta, MD, MPH, a British physician. The article was also published the same day on Dr. Datta's blog site, Medicine and Society. The article focuses on the removal of homosexuality from the DSM, which occurred in 1973. Dr. Datta discusses this issue and various related themes, and he draws some conclusions that, in my opinion, are unwarranted and misleading.

How do we genuinely heal from the damage of racism and internalized racism, as well as mental health oppression, adultism and all form of oppression? We can change all the laws in the land – and we have changed many laws (civil rights laws, employment laws via the Equal Employment Opportunity Commission and the Americans with Disability Act laws) but that doesn’t change attitudes.

On November 28, Psychiatric Times published an article titled Psychiatric Diagnosis and Treatment of Somatizing Neuropsychiatric Disorders. It addresses the phenomenology, epidemiology, and developmental course of the so-called somatization disorders. Under the heading "Postulated pathogenic influences," the authors present working hypotheses from psychoanalytic theory, learning theory, behavior analysis, social-affective neuroscience, autoimmune sensitization, and theories of dissociation. But they advocate a discussion of the role of medications in "normalizing brain neurotransmitter function."

Depression during pregnancy is an important issue. Depression should not be ignored and depressed pregnant women deserve good treatment and care. Part of that good care, though, is providing them with full and correct information. I care for pregnant women taking antidepressants on a daily basis and too often they tell me that the only counseling they received about the medication was, “my doctor told me it’s safe in pregnancy.” This post will review the evidence in this area and address the counterarguments.

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.

On August 11, Pediatrics, the official journal of the American Academy of Pediatrics, published an article that was based on data derived from a random selection of families concerning their health problems or concerns. Surprisingly, the incidence of disability due to physical conditions declined by 11.8%, while disability due to mental/neurodevelopmental conditions increased by 20.9%. The highest increases were among children under the age of 6, and children from more advantaged homes. At least part of the reason for this stems from the fact that while the prevalence of physical disability is limited by the prevalence of the particular pathology in question, no such limitation applies to "psychiatric disabilities."

The Mad in America Continuing Education Project is preparing for takeoff after months of planning. The project will provide on-line classes on the full range of psychiatric medications, and the ways in which they affect the neurology, physiology and outcomes for people taking them. The overarching goal is to change the standard of practice so that it becomes consistent with well-designed research.

This week we launch Mad In America Continuing Education. It is an enormous privilege to be a part of this project and to proudly announce that the first course offering is a series of lectures by me on neuroleptic drugs. I review the history of the development of these drugs as well as their short and long term effects. I discuss what conclusions I have drawn from the data; I recommend that we need to work harder to keep people off these drugs or – if we use them – to minimize the dose and stop them as soon as possible. But there remain other pressing concerns for those individuals who are currently taking these drugs.

I can feel both dance and music changing and healing my brain’s neurons. Seriously. We can change our brains and I’m doing it. Neuroplasticity. There is a multitude of ways to heal. My self-directed protocol involves many different things.

We are an unlikely duo, sharing secrets only known to insiders, the inmates and staff of Bader 5, Boston Children's Hospital's adolescent psychiatric unit. I am the nurse who blew the whistle that no one heard in 2010, she is the teenager who was imprisoned on Bader 5 for nine months in 2013. We met for the first time on this past Thanksgiving Day at Yale New Haven Children's Hospital, where she has been a *medical* patient for the past nine weeks.

With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them. Despite public education campaigns (or perhaps because of them), the stigma of mental illness is as enduring as it was 50 years ago.

I’ve been arguing against calling this movement that I’m a part of a ‘peer’ movement for a long time. What has happened with Michael Brown in Ferguson, Missouri has helped me to crystallize that point. If we do not see what happens to some of us in the psychiatric system as connected to what happens to others because they are black or because they are transgender or because they love someone else of the same expressed gender (or because they live in poverty, etc. etc.), then I’m not sure any of us really, fully understands what it is we are trying to accomplish at all.

As awareness spreads about there being something wrong with existing approaches to “psychosis” aka “madness.” Interest grows in exploring what to do instead. One meeting place for exploring this question of “what to do” will be the ISPS conference in NYC in March 2015, which is titled “An International Dialogue on Relationship and Experience in Psychosis.” This conference promises to stand out in terms of the variety of voices,  perspectives, approaches and traditions that it will bring together to focus on the deeper issue of how helpers can best understand and interact with those experiencing what is called psychosis.