Saturday, December 10, 2022

Comments by Gary Sidley, PhD

Showing 70 of 70 comments.

  • A tribute to Matt Stevenson by Jo Watson and Gary Sidley from the ‘Drop the Disorder’ Facebook group:

    We never met Matt Stevenson face to face. But despite the 3700 miles between our homes, Matt has succeeded in leaving a legacy that will forever endure.
    All our interactions with him occurred via social media, and included both individual contacts and collective debates within the ‘Drop the Disorder’ group.
    Gary first touched base with Matt in April 2016 when he – using the name ‘BPD Transformation’ – expressed support for Gary’s maiden MIA blogpost and highlighted the ‘claptrap’ of politicians who refer to ‘those with serious mental illness’. On the same thread, Matt illustrated his zany humour by suggesting that psychiatrists were ‘covert emissaries sent by super-advanced aliens’ with the aim of drugging everyone on earth so ‘we won’t be able to resist when the alien invasion comes’. Matt became a regular responder on Gary’s subsequent MIA blogposts, his feedback always remaining courteous even when energetically challenging the bits with which he disagreed, and usually supporting his arguments with references selected from the psychotherapy literature (of which he had a deep knowledge).
    Jo found Matt hugely supportive and encouraging during the early days following the group’s creation and developed a friendship as the months progressed. As a nocturnal person, Jo often chatted with Matt during the night (it would have been daytime for Matt in Washington) and found his genius philosophical banter & obvious passion for change intoxicating. Matt would make her laugh and inspire her in equal measures.
    There was never a shortage of Sun Tzu quotes, it seemed like Matt had one to cover any situation!

    We feel privileged that he opted to join our ‘Drop the Disorder’ Facebook group where he quickly became a valued ally in the ongoing struggle to counter the dominance of biomedical and diagnostic approaches to human suffering. Within the group Matt was involved in multiple conversations, always demonstrating an engaging combination of compassion, humour and knowhow when responding to other people. Since his death, we have received many messages from group members expressing sadness and shock, as well as reflections on their individual relationships with him; in particular, his passion and integrity have been highlighted.
    Despite the pain we feel about Matt’s tragic death, we can still smile at the above recollections, and recognise how privileged we are to have had the opportunity to share many communications with such a worthwhile and courageous human being. In contrast, we feel intense rage when we reflect on the implications of some of our email discussions a couple of weeks before he ended his life.
    Matt had contacted us to ask our opinion on a research paper that provided a systematic review of the literature on ‘recovery from schizophrenia’. He told us he’d been ‘struggling to resolve some concerns’ about this paper, in particular the 13% recovery rate cited therein. We responded, pointing out the major flaws in this study that had led to its unduly pessimistic and misleading conclusion. Matt’s reply, the last we heard from him, delivered in his usual respectful way, was: ‘Thank you this is very helpful. I appreciate you going into a lot of detail on everything. I’m going to take some time to think about what you said’.
    We are left thinking about the central importance of maintaining hope when people are suffering emotional distress and overwhelm. How can it be that contemporary psychiatric practice is dominated by a biological paradigm that inherently stymies the aspirations of people through their array of hope-quashing assumptions of biogenetic deficits, and associated mantras such as: ‘brain disease’; ‘severe and enduring mental illness’; ‘life-long condition’; ‘personality disorder’ and ‘chronic schizophrenia’? Matt knew, intellectually, that this medicalising of human distress was pseudo-scientific nonsense, but – as described in his final letter shared by his sister Cathrerine after his death – he had heard these doom-laden messages from psychiatric professionals so often that they were now etched into his core and thereby resistant to rational challenge.
    Micheal Cornwall’s words in his recent blog written in memory of Matt resonate painfully..
    ‘Tragically, their grossly untrue views about us, that they impose on us, can become as destructively powerful as if they have cursed us.’
    In keeping with many more of Matt’s friends and allies, those of us involved in the ‘Drop the Disorder’ will strive, as Matt did, with passion, humour and regular philosophical quotes to channel our sadness and rage in a constructive way by continuing his fight for a greater recognition of the importance of adverse life experiences in the development emotional distress.
    Matt’s legacy will live on in the collective struggle for change and in any changes that these efforts may bring.
    Drop the Disorder

  • Hi Auntie
    Are you the person who draws those wonderful cartoons illustrating the various nonsenses of psychiatry? If so, keep on getting them out there as I suspect this medium can be more powerful than words alone.

    And I totally agree that educating the public & countering the myths is a crucial aim, as is increasing the credibility of those critical of/opposed to psychiatry.

  • Kindred – The main problem – as you make clear – is the misinformation around mode of action (restoring balance, countering a chemical imbalance and other such nonsense). People need to know the truth i.e. that all psychotropic drugs produce an abnormal state of mind (plus of course all the short- and long-term side effects and discontinuation problems). So for me, informed choice is the key. We’re not going to be able to put the genie back in the bottle regarding these drugs, so our challenge must be to inform the general public and counter the psychiatry/big-pharma lies. Armed with accurate information, I would respect the rights of any individual to ingest them just as I would do with regards to alcohol & street drugs.

  • Mary – Many psychiatric and psychological services already ask for feedback (at least here in the UK). However, I’ve always felt that the information gathered is usually of little use, not least because the comments are almost always about how well or badly the traditional service was delivered rather than raising the possibilities of a radically different approach.

  • I think some confusion may arise from my us of the words ‘radical change’, where I’m referring to how we can achieve a radical change in how we respond to human suffering, not a radical change to psychiatry per se. (The former could, arguably, be achieved in the absence of any form of professional psychiatry/mental health service).

    And as far as psychotropic drugs are concerned, my main concern is around the lies that big pharma & psychiatry use to push them to ‘consumers’ (with their spurious claims to be restoring balance). I would, however, defend the right of anyone to ingest anything if they so wished, whether that be alcohol, cannabis, or psychotropic drugs.

  • I acknowledge that it is futile to debate with some of those with a vested interest in maintaining the status quo (although, I have wasted my time on Twitter doing exactly this!). Nonetheless, I’d like to think that the vast majority of people on this side of the debate would want to achieve some meaningful change away from bio-medical dominance and that we could find some common ground

  • You make some valid points. I recognise the distinction you make around the different groups of ‘service users’ and agree with you that there is no requirement for specific ‘mental health’ legislation. I’m not sure what you’re trying to say regarding ‘alternatives’, nor why you would see initiatives like Soteria House & Open Dialogue as less likely to form pernicious collaborations than drop-ins & peer support.

  • Fiachra – The status quo is defended to the hilt. Another tactic used by supporters of traditional psychiatry – one that I’ve recently experienced on Twitter in response to this article – is to accuse me of ‘doctor bashing’ and/or of being involved in a ‘turf war’ between professionals. (Such responses enable them to avoid having to address the valid criticism).

  • Harper – I share your views about the important role of trauma/life adversity in the emergence of mental health problems, and also the destructive effects of shame. Also – as described in my article – I recognise the challenge of overcoming obstacles like public inertia and vested interests, but I suppose I’m a tad more optimistic about the potential to overcome these formidable barriers.

  • Barbara – Your interest in my article is appreciated. I’m glad you concur with the idea of investing much more in the 3rd sector/charitable sector. I do, however, harbour mixed feelings about the mental and physical health having integrated provision. In one way this idea makes sense (our psychological wellbeing impacts on physical health and vise versa). On the other hand I believe there are dangers in viewing our approach to each as similar – the ‘illness like any other’ approach to mental health problems is unhelpful in a range of ways (e.g. increasing stigma, encouraging the assumption that biological deficits are the primary causes, increasing passivity, reducing hope etc.)

  • Oldhead – As I stated in an earlier response, I’m not convinced (but open to persuasion). Are there any examples of a different political/economic systems where human suffering is minimised?
    I’m not a political scientist and admit to ignorance in this domain. Are there any references you could recommend to me that illustrate how a radically different political system would markedly reduce the factors that we know contribute towards human suffering and overwhelm i.e. power differentials, victimisation, intra-family abuse; poverty, homelessness, discrimination etc.?

  • Richard – Thank you for your interesting and detailed response.
    I accept your point about the term ‘misdemeanours’; it does indeed understate the seriousness of drug-company behaviours.

    I’m less convinced about idea that the total rejection of capitalism is the central and essential prerequisite for radical change in the way we respond to human suffering. I suspect competitiveness and significant power imbalances would emerge in any political system, but I’m open to being convinced otherwise.

  • David – thanks for reading and taking the time to comment.
    And I agree with your comment that the mental health industry is largely immune to ‘strategies’ and internally generated attempts at reform. Here in the UK, our National Health Service – the main provider of mental health services – is stubbornly resistant to any attempt to change the way it does things; hence the ‘illness like any other’ approach persists.

  • Steve – I think you say it all in this comment. I couldn’t agree more. We’ve been hearing biological psychiatrists claim to be on the brink of a great discovery for over 60 years but, as you rightly point out, it’s not going t happen because they’re looking in the wrong places.

  • Eric – I like the term ‘mental health helper’. Unlike a couple of the other people who have commented on this thread, I have no problem with the term ‘mental’ (I believe medical terms like ‘treatment’, ‘illness’, ‘disorder’ ‘symptoms’ are much more unhelpful). As for ‘mental’ – although, of course the term can be used pejoratively – to me it simply signifies someone’s inner experience.

  • Boans – I was referring to non-drug approaches when I made that comment.
    There are documented accounts, however, of how some researchers (usually those opposed to bio-medical treatments) who have ingested antipsychotic medication so as to gain first-hand experience of what it feels like.

  • Ourviolentchild – Thanks for the positive feedback.
    Although the comparison with midwifery is not ideal, I think it does illustrate some of the relative advantages/disadvantages of formal vs informal helpers.

    Interestingly, when you ask people who have worked with mental health services what was the most helpful aspect of the whole experience they will commonly highlight something that professionals would probably see as peripheral or of no significance: e.g. the psychiatric nurse who agreed to speak with me under the tree in my garden when I wouldn’t let her into my house; when the psychologist shared a personal story about his own family’s woes. It’s as if the most beneficial bits occur when the professional steps outside of his or her professional role.

  • Jackdaniels – I think you raise an interesting point. As mentioned in my post, one of the advantages of a professional is the regulation and expected standards, and the power to stop someone practising if they deviate from the minimum level of competence/conduct. I do wonder, though, whether it is possible to get the best of both worlds (at least within core mental health provision – by which in the UK I mean inpatient and community mental health services) by having a means of weeding out the bad apples while not suffocating everyone else with pointless bureaucracy and regulation. Maybe leadership is the key here?

  • Steve – I agree with the suggestion that all professionals should be interviewed/grilled by peers and service users prior to appointment. And any process that nurtures enhanced personal awareness has got to be a good thing. Also, as a therapist, I believe it is important to have experience of being on the receiving end of the very approach you offer to others.

    As to the question of whether education/training has a role, I believe it does, especially with regards to supporting/maintaining the desired culture and values. I accept that its not the only way of supporting an enabling culture, but I do think it can play a part in countering the tendency to drift to the culture of lowest energy. Also, I believe that good quality leadership has a major role here.

    Thanks for reading and commenting.

  • Harper West – Your approach sounds an appropriate one, and overlaps a good deal with my own in the days when I routinely offered psychological therapy. And as described in my post, I don’t believe we should scrap all mental health professionals, but rather develop a different type of core support with other interventions for people to opt in to (including psychotherapy).

  • Frank – The topic of non-consensual ‘treatment’ opens up many other issues – misuse of power, how Mental Health legislation is a form of legalised discrimination, psychiatry’s warped approach to/ inflation of risk. I don’t think I ‘carefully avoided’ it, it is just that it is a specialist topic in its own right that could be the focus of another post. Also, in the UK (and I assume in the USA too) the large majority of people receiving core psychiatric services are not under section yet still seek the help of (or, at least, consent to receiving input from) mental health professionals.

  • Madmom – So sorry to hear about your extended ordeal around the involuntary treatment of your daughter – I can’t even begin to imagine how difficult that experience must have been for you all. Clearly, in this case a non-professional/socially supportive approach would have been much more helpful and appropriate.

  • BPD Transformation – Thank you for your considered response.
    There is not much that I’d argue with, and many areas of agreement. You’re right about the benefits of less medicalised language when describing these support staff, the disadvantages of trying to do psychological work in bio-medical settings (most of my therapy provision took place in Community Mental Health Team settings), the central importance of the relationships, the potential of Open Dialogue, and the stifling effect of pervasive risk aversion.

    On the other hand, I’d take some convincing about the general superiority of psychoanalytic approaches with psychosis ‘borderline’ problems (although I can’t claim expertise in these approaches). My sense is that the appropriateness/effectiveness will vary from person to person, some engaging well with the richness of abstract constructs to explain one’s inner experiences, while others lean more, for example, towards more transparent/pragmatic approaches like trauma-focus cognitive- behavioural approaches.

    Thanks again for sharing your ideas.

  • Many of my anti-psychiatry colleagues in the UK would agree with you about the contribution of class and the various types of discrimination. Some would go as far as to suggest that we’ll never achieve radical improvement in the way we respond to human suffering while we inhabit a capitalist system. Speaking personally, I’m not convinced that abuse of power and damaging inequalities would not occur under alternative political systems, but perhaps I’m opening up another (huge) issue there!

  • Rooster – It is interesting to read about the variation in degree of bio-medical thinking across the different services. And I think you’ve raised a central point around the idea of staff feeling under threat (including that related to status & money) and how this makes them less receptive to change/alternative approaches.

    I appreciate your thoughtful comments and feedback.

  • Gerard – the dubious reactive- endogenous distinction is also one that I’ve heard many times.
    And yes, I think you’re right about the doctors having no idea about how the drugs work (although, after saying this, I’d have a bit more respect for them if they openly admitted that the drugs they are prescribing will produce abnormal brain states, rather than clinging to the myth that they are somehow restoring balance).

  • bcharris – Fair point – the drug companies have a lot to answer for. But I’d also argue that the psychiatry profession has got a huge amount to lose should society’s responses to human misery and suffering change from a primarily medical one to a primarily social one. For a start, psychiatry would not be able to maintain its position around the top table of medical specialists – with implications for status, power, salary etc.

  • Yes, Steve, I agree that it is perplexing how so many people can buy into the bio-medical approach to human suffering. But then again, I guess it’s a seductively simplistic explanation that discourages people from thinking more widely about the ills within society, as well as getting politicians off the hook – they can just say that people are reacting in challenging/unexpected ways simply because they have some assumed aberration in their brains. And then, of course, we have the vested interests of biological psychiatry and drug companies (plus the power of advertising).

  • But the psychiatric profession is built on the premise that mental health problems are primarily caused by biochemical or anatomical abnormalities in the brain – take this away from them, and the whole profession cannot justify its place at the top table of the medical sciences (alongside orthopaedics, gynaecology, coronary care etc.). So I’d suggest that – although you are of course correct about how these genuine biological disturbances in other parts of the body can produce mental health problems – these conditions (general paresis, thyroid disease etc.) are outside of psychiatry’s remit.

  • Steve – I could have usefully included the ‘is this depression situational or clinical’ in my list, or other similarly dubious distinctions like reactive/endogenous. I believe it to be all a part of biological psychiatry’s desperate efforts to retain the upper hand, by claiming that severe/’proper’ mental disorders require medical expertise to cure them.

  • Nomadic – I think you make a relevant point about the degree to which we challenge these unhelpful comments when we hear them.

    When I worked in the psychiatric system I often discussed with like-minded colleagues about challenging the nonsense as and when we witnessed it. It was generally felt that it was not feasible to challenge each and every time as we would be doing it multiple times each day and would soon be viewed – given our impotent position in a place where bio-medical ideas dominated – as troublemakers with extreme views. As such we’d be ostracised and lose any small influence we had gained. Typically, therefore, we’d all choose our battles, confronting some of the unhelpful utterances, while biting our tongues when we witnessed others.

    The issue you raise is one worthy of further discussion – in fact it might be a useful theme of a future blogpost. Thanks for taking the time to comment.