Monday, April 24, 2017

Comments by Michael Rock

Showing 68 of 68 comments.

  • The reference to Tom Waits adds a dimension to my memory of Dr Nardo. Micky was steadfast. And even though he often mention his age I somehow felt he would be around forever. His voice was important and we will miss him.
    I was reading his blog through the Allen jones trial, and much of what he admires in jones can so easily be said of nardo himself. Anyone who assumed he would simply go along “picked the wrong man”.
    I believe that in the future people will look back at our time and wonder how so many could be so wrong about so much in mental health despite so much evidence. I’m sorry nardo didn’t get to see his position become mainstream. I’m sorry he didn’t get to see he was on the right side of history

  • Allen Francis saving normal?

    I used to joke that no one can earn a PhD without having a touch of OCD, but its not funny anymore. Running for president requires irrational self confidence and the ability to lie, manipulate, and fake sincerity. These are preliminary, fundamental job requirements.
    But in an age where every problem of thinking feeling and acting translates easily into a diagnosis, Francis cant find anything wrong with Trump?

    Thank you Dr Hickey
    Mike

  • Hi Richard
    Heroin was marketed as non habit forming version of opium. One hundred years later Xanax was marketed as a non addictive version of Valium. Some still argue benzodiazepines aren’t addictive, using a slippery definition of addiction. Even in journals the use of the word “abuse” is often used to infer that people dependent on benzodiazepines are not using them as prescribed. The public isn’t ready to adapt to a world that your family doctor has no idea if “Xanax is right for you”.
    I’ve seen the same thing with sleeping pills too.
    Mike

  • Hi Phil
    We did a segment on the Murphy Bill on anosognosiac podcast a few weeks ago. I had a hard time describing how alarming it is. It may be the very worst thing to happen to our outstandingly broken system since direct to consumer advertising. It is exactly, preposterously wrong on so many levels. Using the phrase “evidence based” is especially Orwellion.
    Over the past few years I’ve mostly had hope. There is more evidence (actual evidence) being published every month, and more people are willing to ask questions and challenge assumptions about “mental health treatment”. The Murphy bill is a devastating setback to hope.
    The only silver lining is that its certain to increase the number of bad outcomes, which may eventually force the public to rethink their faith in the cult of “mental health” experts. It will also be incredibly expensive, and drive more people to disability.
    The bill passed with overwhelming bipartisan support which is another breathtaking irony. (I wonder who the 2 dissenters were)
    One thing that hasn’t been discussed is the position of ordinary psychiatrists, and how this measure will put pressure on them to “err on the side of caution” in both medications and diagnosis. They may now feel obliged to medicate more aggressively then they already do. Even if they feel a person isn’t a danger to themselves or others.
    Once again you’ve articulated the issue precisely. I only wish your spotlight was shining on something more hopeful.
    Thank you
    Mike

  • Hi Sera. I can imagine the hard work and pure stubborn cussidness it must have taken to organize and execute this protest.
    I shook your hand a few years ago at the madinamerica film festival, and told you I appreciate your writing. Thank you again.
    Its amazing to me how easily people assume that treatment basically works, and that the problems with mental illness is not enough treatment. It follows that people who get treatment have better outcomes (disability, suicide, violence) then people who “slip through the cracks”. This assumption persists despite a great deal of evidence to the contrary.
    One example is how they use cases like Jesse Holmes and Adam Lanza as examples of the need for more treatment. Both of these young men, as well as most of the other recent spree shooters, had been exposed to treatment when they killed. And without any treatment at all-they killed no one. Its stunningly obvious. We don’t know what the drugs really do. But for some reason we assume that pumping people in crisis full of drugs will be helpful. In fact its irresponsible not to do this. There must be more to it than a lack of information.
    Mike

  • Hi Boans. I used to listen to Quadraphenia on my commute. Thank you.
    A couple years ago I noticed a psychiatrist carrying a copy of Anatomy of an Epidemic, and I asked to speak to him when he was finished with it. The copy I donated to our clinical library was “borrowed” and never returned, So he must have bought his own copy.
    My intention wasn’t to debate him or bust his chops, I was really just curious what he thought about it.
    We had a long conversation a couple weeks later. He said he didn’t disagree with the book, although he isn’t sure about some of the conclusions about meds being the only cause of the rise in disability. He was certain that none of the other psychiatrists in the network would disagree with the statistics, and that treatment often dosent work and sometimes makes things worse. He felt that this couldn’t be discussed openly until some one at the national level opened the discussion. He felt it had to be a “guild” statement.
    Mike

  • Tim Murphy has a summary of his “helping families in mental health crisis act” on his home page. In the first paragraph he names individuals who committed mass killings, and presents then as examples of the need for more medications and forced treatment. Included in his list is Jesse Holmes. As far as I can tell everyone on his list were in treatment and on meds when they acted. And none had a history of violence prior to being exposed to treatment.
    The bill passed with overwhelming bipartisan support. One part of the bill is to restrict funding for “anti psychiatric” groups

  • It seems like we all encounter the same defensive reaction and it is evidence resistant. Very frustrating. But in the face of all the harm its tragic and criminal.
    The “mental health” industry is insulated by the same lack of evidence they use to
    justify what they do. Specifically you can’t test for, or measure, or test against any of the diagnosis. Therefore whatever outcomes happen are “better” then what would have happened had we not pumped a person full of drugs.
    I think the one area they are completely exposed is informed consent. Once they have evidence they are forced to do some really fancy footwork to justify ignoring it.

  • This article seems to confirm the historical data we see in Anatomy of an Epidemic, as well as the WHO studies, Harrow, etc.
    Somehow the human race endured without treatment for tens of thousands of years. And although there has apparently always been “mental illness” with us, the number of individuals afflicted, and disabled by “mental illness” has never been higher then it is here and now. The suicide rate has never been higher then it is right now. And yet there has never a time and place in history in which treatment was more available and more widely used then in the united states in the last 70 years.
    I remember reading in psychology texts back before Prozac that depression was the “common cold of “mental illness” and usually resolved within a year with or without treatment.
    On thing the data doesn’t seem to address is: How many of the people who did get into treatment, still have their diagnosis a year later?

  • deeeo42
    I hadn’t thought of it but of course you are correct. ECT is obviously brain injury. I don’t have much experience with ECT, although memory loss is a common complaint in the people I’ve worked with who went through it.

    The people with TBI Im referring to are car accidents and strokes. There are several stroke survivors who had been on psych meds for extended periods of time prior to the stroke. I don’t think any had ECT, but Ill start asking the question just for my own information.
    Thank you
    Mike

  • I’ve had some recent contact with brain injury rehabilitation. Its very easy to chalk up some one’s reaction to brain injury as evidence of psychiatric diagnosis and pump them full of drugs. This makes the person’s capacity and baseline function even harder to assess. Meanwhile the person becomes more confused or more agitated, which leads to more drugs. People who are trying to recover from a stroke or TBI should be the last people we start indiscriminately pumping full of psychoactive agents (aside from children).

  • Hi Liz
    I’m not sure anyone remembers Dr Mark Foster, who was one of the first contributors to madinamerica. He was a young primary care physician in a clinic who read Robert Whitaker and started educating patients about psych meds. He posted periodically and described helping people to reduce their meds of get off them completely. He was fired for this. I’m not sure what became of him. He struck me as the kind of Dr anyone would want for their PCP. Sincere and genuinely concerned for the health of his patients.
    Mike

  • rasselas.redux
    I think you’ve uncovered a rather embarrassing mistake on my part. I was referring to Eleanor Longdon whose TED talk I would link if I could figure out how to add links in these comments. I’m not sure if Elizabeth Longdon is the same person, a twin sister, or if the internet simply confuses the two as often as I have. My search engine dosent seem to know either. Mike

  • Hi Richard
    I’ve been reading your articles here for years. I should have reached out to you after the whistle blower article was published, at least to send my regards. It was a very discouraging time.
    I am humbled by your encouragement but I completely disagree that my experience was harder then yours. As a senior clinician, with a public reputation earned over 22 years in the same organization, you had much more to loose then I ever did. I made noises about taking my complaints externally, but you actually did, several times. And you took a stand when it is especially bad times to be a whistle blower.
    I use the screen name Marcellas Shale, which you might recognize. We have commented on the same threads at times. I started using it back when I was concerned about backlash professionally, and its kind of a joke.
    Marcellas Shale is the geologic formation they are fracking in my area. It appears to be destroying our water supply, (although its hard to find reliable facts). We even had an earthquake, unheard of in these parts, which has been associated with fracking.
    I attended meetings about fracking when the movie “Gaslands” came out, and got active in the local politics.
    I live where the Molly Maquires were hanged in the early days of labor unions. The coal companies took the coal and went bankrupt when it came time to clean up the toxic waste they left. So the people around here should know better then to trust corporations.
    But our guy lost to the candidate who promised to charge no taxes on the gas industry, (who donated gobs of cash to help him win). I sent a letter to the winner, a guy named Doyle Heffley, and told him how sad I am to realize that our representatives no longer work for the people.
    Heffley responded with a form letter asking me for a donation.
    Perhaps its always been this way, but it certainly seems like something is very wrong at the top. Way above psychiatry and the pharmaceutical industry. Somewhere above even the FDA, NIMH, EPA, and all of the other government bodies whose singular task is to protect the public from exactly the kind of naked institutional corruption we see right in front of us. I think Whistle blowers are ignored and prosecuted because they are drawing our attention to something we already know, but have collectively decided to ignore.
    We all drink to the Mollys here on St Patricks day and pretend to remember what they sacrificed so that we could have organized labor, a middle class, and an American century. They remind me that the system can change. It has corrected itself in the past. I hope old timers like you and me are around to see it when it happens again.
    Frankly I don’t hold out much hope for any of the candidates in the current election cycle.
    I apologize for the long ramble, but I wanted you to know that I consider what what you did was for all of us, and that there are people out there who get that.
    I certainly will be more active on madinamerica.
    Mike

  • I worked briefly for a locked facility for juveniles several years ago that was pretty bad. Not as bad as what the nurse illustrates, but a similar culture. It was dehumanizing for everyone involved. We would spend an hour in group getting the kids to open up, but as soon as they showed an emotion, the medical people would sedate them, sometimes against their will. They brought me in to reduce restraints just after a kid died being restrained.
    Im happy to report we did reduce restraints by 70% in the 6 months I worked there, but the culture proved intractable and I quit. the only time I walked off without notice. I still remember the smell of the place and the futility.
    The facility I just left was nowhere near that bad. Patients did have the right to refuse meds, and this was generally respected, although there was a great deal of pressure put on people to comply voluntarily. They did away with restraints years ago and seclusion is very rare, although it does happen.
    Mike

  • Hi Oldhead
    I know you from reading your comments on madinamerica. I’m a fan. Hopefully the podcast will contribute to the anti-psychiatry movement. I began listening to podcasts a few years ago, and couldn’t find any willing to present a skeptical view of mental health treatment. The popular ones, like “Mental Illness Happy Hour” celebrate diagnosis while promoting a great deal of misinformation and complaining about stigma. There are a dozen great podcasts on skepticism, but they seem dismissive of questioning psychiatry. I find Steve Novella particularly disappointing.
    Every week I read stories in mass media that relate to mental illness, but they are rarely analyzed from a critical point of view.
    A common theme in the comment threads here is that we are preaching to the choir, and we need to expand our audience. I’ve noticed a significant increase in the number of people who comment on articles in the mainstream media who are willing to challenge the conventional narrative. I find this encouraging. However the stunning approval of the Murphy Bill last week reveals how far we have to go. Providing more money and more power to psychiatrists is outrageous. Hopefully expanding the message to a new media will reach a few more people. We should have the next episode released Monday. I hope you check it out.
    Mike

  • That is indeed my photo, and I was not stoned. I must have a resting stoned face because I’ve heard this before. Useful at social events but not during traffic stops.
    We are actively looking for Skype interviews for the podcast, and you can arrange this through the anosognosiac.com website.
    You definitely can help us by giving us a 5 star rating on Itunes and liking us on Facebook. No money required.
    Mike

  • Hi Liz
    After reading Anatomy of an Epidemic I wrote to Mr Whitaker and told him I intended to buy the book and donate it to our clinical library. He was kind enough to write me back and wish me luck. I saw him speak in Philadelphia and had the privilege of introducing myself at the Mad In America film festival a few years back. I found him to be genuinely warm, thoughtful, and approachable.
    There is a phrase in my area about professionals who are “Whitaker aware”. When I heard this the first time I realized we will eventually win.
    There are many hero’s in our movement.
    Laura Delano was one of the first people to tell her story here. By now we can see her story is all too common, but she had the guts to challenge what she had come to believe about herself without the benefit of a movement. She was a trailblazer for countless others.
    During the really bad days I reached out to Corrina West, and she immediately contacted me to offer support, encouragement and suggestions. I once read a comment about her that she is “incapable of not helping some one in need”. I think its true.
    I am in awe of Dr Phil Hickey, who contributes here and also has his own blog behaviorismandmentalhealth.com. in part because we share a clinical orientation and in part because he is fearless and incredibly articulate. He has a true gift of sorting through the logical quicksand and exposing the rot.
    David Oaks, who I also had the privilege of meeting in Philadelphia, will probably go down in history as the father of this movement. If you don’t know about it already; look up the hunger strike he organized. I imagine the courage he must have had years before the internet allowed us to organize and share our stories. I saw him speak once after his injury on a video feed, and his humor and warmth came through to everyone in the room. I wish him well.
    Mike

  • Hi Pauline
    I’m sorry this happened to you too.
    I read your comments this morning, but I was busy today working on the podcast so put off writing until now. I found myself chewing on your objecting to people “not doing their jobs properly”. I assume what you meant was something overt or even bureaucratic, such as psychiatrists signing off on nurse practitioners assessments without seeing the patient themselves, and that sort of thing. But of course there is an entirely different level of corruption and misbehavior at work in both of our stories. Its systemic.
    Years ago, when I was still working in residential treatment I was a supervisor in a group home for young adults who had aged out of the juvenile system. Out mission was to teach them lifeskills and transition them to independence. However, everything the company did undermined the clients independence. I got frustrated explaining over and over again to my bosses, and watching the clients become even more dependent on the system. I got no where except dreadfully burned out.
    One day I was complaining to my Dad and describing what I saw. I told him “they just don’t understand”. He corrected me. “No Mike. YOU don’t understand”. and he was right. I was stuck on the embraced mission, and overlooking the real mission. Actions speak louder then words. As a behaviorist, I should know better.
    I also wanted to point out that even the professionals have no expectation that treatment will actually work. The diagnosis allows us to be categorized and disregarded. Treatment would have made no difference in people listening, no matter how “effective” it could possibly have been.
    I hadn’t thought about “gaslighting” until I read the comments here but its such an apt description. Think of all the people it has worked on. It makes me feel a little more kindly to the people who haven’t found our community yet.

  • Back when I was starting out the psychotherapy industry was in crisis, and we aligned ourselves with the new medical paradigm in order to survive. We embraced or at least colluded with dsm III and the shift to biology. It’s hard to get reimbursed without those codes and few could afford to pay out of pocket.

  • Milgram and Rosenhan should be required reading for everyone working in mental health. If critical thinking can be defined as questioning assumptions and asking questions, its obvious why those habits are institutionally discouraged.
    There was a strange dissonance where I worked: Med compliance was always perceived as a huge problem, and the reason people came back over and over. But it was actually not a common compliant. Most people reported taking the meds as prescribed. It was fairly uncommon that some one came in reporting that they stopped taking meds and symptoms came back. I pointed this out occasionally by showing the actual numbers, but the facts did little to change the narrative.
    Mike

  • Hi liberalminority
    I read your earlier comment and started to respond, but decided its too broad a topic. I agree completely that Disability due to mental health has more to do with economics and quality of life then actual incapacity for most people. I think finding purpose and meaning to life is a basic human need. For many people I worked with, receiving disability became as much of a trap as being stuck working at walmart. Being paid to be incompetent has an effect on identity too. We touch on these themes on the podcast but obviously have much more to say about it. Its a sensitive subject. Im sure to offend everyone trying to open up a real conversation.
    Mike

  • Thank you for listening. We are upgrading our equipment and figuring out a formula, any suggestions are appreciated. We are not natural media people so the learning curve is sharp. I hope you keep listening.
    I forgot you arent living in the u.s. The Murphy Bill isnt an issue for you. It also wont be needed in Australia because of the sensible gun laws down under.

  • Hi Boans
    I read your comments on countless articles. So I feel like I know you.
    Sounds like you have a case of Anosognosia my friend. A rather bad one I’m afraid. I hope you check out the podcast.
    You describe the absurdity so well. I hope you can laugh about now, or soon. Wouldn’t it be satisfying on some level to know that the people on the other side of the table totally understood reality and were pretending not to? If they had to acknowledge that theirs is the delusion?
    I want to acknowledge an important difference in our experience: I could leave at will. I may have felt trapped in my situation but every day I swiped a badge and the doors opened. I had the option to call in sick every morning. I can only imagine the skin crawling horror of being confined and at the mercy of actual delusional people.
    Another really important point that hasn’t come up is the Murphy bill, and how this might effect people in our situations in the future. It’s like two groups of delusional people having competing parties and trying to drown out the others music by turning the crazy volume up and up

  • Hi Victoria
    I was writing a comment to Rae when your comment was published. You said a mouthful in your last sentence:
    “It’s convenient for parents to have their child labeled with a diagnosis, it takes them off the hook for bad parenting…”
    Psychological defenses (ie rationalization, denial, and so on) work best when they are subconscious and automatic. They function to protect habits from change.
    I can use myself as an example. Being a father is the most important role in my life. If I were confronted with evidence that would reveal me to be deficient in this role, it would require me to reconfigure and reassess all kinds of things I want to be true about myself. It would threaten a cornerstone of my identity, not just to myself, but to my neighbors, friends, family, etc. A diagnosis, as you say, would indeed be convenient. I might even be able to define myself as a victim in the narrative. And Id be sensitive to different interpretations and defensive when something gets too close. So on the one hand Id be decrying the horrors of mental illness while simultaneously dismissive of any other explanation for my child’s behavior, or even suggestions that my kid isn’t mentally ill at all. It shouldn’t be difficult for even a novice therapist to recognize cognitive dissonance. But I’m not likely to respond well to this perception. The therapist, being human, is subject to the same, subconscious drives as everyone else. I might complain about him and take my kid to some one who “gets mental illness”. And all he must do to keep my business and win my approve is validate, validate, validate. Id certainly feel better when I left his office, and likely to be a repeat customer. The therapists job is to agree that the kid’s “illness” is the problem. Validation may sound like a harmless, kindly thing to do, but it can be insidious. If you want to find real life examples of my little story, attend any NAMI meeting.
    Consider a thought experiment: Imagine that your mother, instead of you, has been attending the same therapist you are now. The therapist hasn’t met you and has only heard your mother’s side of the story of your family. Would your therapist focus on getting your mom to realize what a horrible parent she was? Or would she simply find some one else to blame? Who would be the villain of the story now? Your grandmother? you?

  • Hi Rae. I agree therapy does not have to be harmful. What you describe is horrifying, and I’m glad you found some people in the profession who saw your strengths and your potential and at least tried to intervene. I don’t know if you are familiar with “Munchhausen syndrome by proxy”, but I’m curious of your take on it.
    You might have had more people on your side then you knew about, since most clinicians will automatically, although discreetly, examine the parents role in “dysfunctional” children. Unfortunately since the parents write the check, they are the customer. If the parents don’t like what they hear, they can take their business to some one else. This sounds a lot like what happened to you, if I read between the lines correctly.
    I hope you know that no one can tell you who you are suppose to be. No one is more qualified to figure out who you are, or what you are capable of, then you. I hope you learned to take a close look at the lives of anyone who judges you “dysfunctional”.
    I turned 51 this year. I’ve lived and worked in different parts of the country for many different organizations. I’ve spent my entire adult life around mental health professionals. I’ve worked with them. I supervised them. I’ve had them over for cookouts. So I’ve had a good look at their personal lives. One thing I can say is that, as a group, outside the office, they don’t seem any more mentally healthy or stable then any other friends or family I’ve known well. Their kids aren’t happier or better adjusted or “functional”, then anyone else. Another thing I can tell you is that they very often don’t practice what they preach. They often don’t live by the same standards or practice the coping skills, or take responsibility for their own “dysfunction”, that they are quick to define in others. This makes them human beings of course. Just like you and me.

  • The very worst part of this whole mess is what we are doing to kids. You can assume that some, if not most of the professionals you are dealing with are pretending not to know whats really going on.
    It might be helpful to approach a member of the treatment team privately, ask to speak freely and off the record, and ask questions. Its quite possible that they will level with you, especially if they are parents and feel they can trust you.
    Its often pointed out that psychology and psychiatry have always needed to apologize for what they did to the previous generation. 50 years ago lobotomies were not off the table. I wonder how the next generation will judge our silence now.

  • Hi Erin
    You raise some very good points. The EAP sessions were not helpful, but its really not a fair example because of the situation that sent me for counseling and the relationship EAP had with my employers. Neither of us could be completely candid. I knew the therapist professionally and she knew about my conflict with my employers, who paid her.
    I have been in therapy several times over the years, and I have found it very helpful when I needed a sounding board, or to clarify my values on a decision that was troubling me. I like therapy to be time limited and goal oriented. So I dont attend indefinitely. I think too many people dont realize they have become dependent on therapists.
    On the other hand marriage counseling was unhelpful to the point of harmful. We went to three different therapists over 4 years. All highly recommended. Im sure its works for some people. Just like medications probably work for some people. I dont have statistics, but I bet divorce is the most common outcome of marriage counseling.
    I also agree that mental health professionals aren’t generally profiteers. As you say, there are much better ways to make money then social work. People get into this work to help people. I was referring to the corruption that happens when profits are prioritized, typically at the corporate level, over the instinct to do the right thing for a client. Its when these forces are given the power to dictate what is the most important consideration that the problems begin. We see it with money in politics and steroids in baseball.
    Its really good to hear that not everyone has been compromised. I love what you wrote about “expectation to recover”. Spot on. Low expectations are much more harmful then high expectations. Ive heard about a program in Chicago that works with bipolar teenagers who embrace the same ethics.
    I want to say also that I was able to hang in as long as I did because I was protected by the clients who rated me highly on follow up surveys. I wasn’t suppose to promote high expectations for recovery in our clients, but I did anyway. The message was overwhelmingly popular with the people who passed through. I like to think I was helpful to people.
    Mike

  • Thank you for reading this and taking the time to comment.
    During the worst of it I sincerely did start to question my sanity. The point that really hit home was the question “how could you be the only one who questions this?”.
    It was you people, this growing community, that got me through. I am not alone. I am far from the only one who sees whats happening and speaks up. And for what its worth You are not alone. Although I don’t comment often, I read the articles and the comments every day. So I hear your voices too.
    I wrote this essay when I was angry. It was originally intended to be a snarky written reply to one of the counseling supervision meetings I attended. I decided not to use it, and it sat in a file until I ran into an ex co worker a few months ago. By then she found herself marginalized as I had been, and so she told me about the secret meetings they had to speculate on my diagnosis. She apologized for her part in it. I didn’t realize that the process had gotten that far. I was angry again.
    Its all very much like a witch hunt, or rooting out communists. The tactics are the same, its really only the labels that change. When some one refuses to conform to a point of view that is critical to maintaining a power structure, they must be isolated. I worked in mental health, so my problem must be mental illness. If I worked for a church, Id have demons. We are easy to pick off when we are alone.
    Please check out our podcast “anosognosiac”. You can find us on Itunes or on our website, anosognosiac.com Comment, like us on facebook. But especially consider allowing us to interview you via skype for the podcast. There are others out there who need to know they aren’t alone.
    Again. Please know that I am very grateful.

  • I saw Dr Francis speak at the Madinamerica film festival a few years back. I give him credit for coming and speaking to an audience obviously opposed to his position and his record. He very openly declares over medication and over diagnosis as problems, but immediately pivots to the idea that there are people who “really” need these meds but aren’t getting them. He pointed to the number of mentally ill prisoners as evidence for this. He apparently believes that the only people who “really” need meds are the few of us left who aren’t taking them.
    It seems to me that DSM IV was his opportunity to define who “really” need meds. We see how that turned out. If Dr Francis has some secret new diagnostic tool up his sleeve he should let the rest of us in on it.

  • Last winter Lieberman was complaining that the New York Times has something against psychiatry because of another Op Ed.

    If it turns out that Bryce Williams was not involved in some form of treatment prior to the shootings, he will be the exception. Most of these shooters didnt act out until after they were involved in treatment. Its stunning and disheartening to read the comments.

  • My first assumption is that binge eating disorder is simply the first new epidemic prompted by DSM 5. Does anyone know how many of the binge eating disorder committee have financial ties to Shire pharmaceuticals?

  • I have never heard of it (some one lodging a complaint against a psychiatrist with the AMA). It seems like if we take psychiatrists at their word, that they are “real Doctors” then the AMA would be the over riding organization. Probably a silly question on my part.
    Some one Else’s comment (above) fits what I observed working in the field. It was not uncommon for a primary care physician to dump people on us (in a psychiatric clinic) after the patient had become addicted to something the PCP started them on.
    Another silly question is this: wouldn’t the medical insurance companies (in the US) have great data on the number of people who deteriorated after beginning mental health treatment? The insurance companies pay for the office visits, therapists, and the pills, and would have data on the long term outcomes of treatment for each doctor in their network. They see the big picture better then other shareholders. I’ve always wondered why they don’t object more vigorously to obviously bad care since they have to pay for it.
    Personally I suspect the change will happen through through lawsuits. Much like the tobacco companies blinding the public through denial, eventually some one will win a lawsuit, possibly involving “informed consent” or conflict of interest, and then the flood gates will open. The Psychiatrists I know are terrified of lawyers. I cant believe they still get away with telling people they have a chemical imbalance. That alone should be malpractice.
    The clinic I worked at was a disability factory.

  • Is there a correlation between Risperidone and prison population? This is what a 5 minute fact check reveals. Risperidone was released in 1994. the prison population was roughly 600,000 in the United States.
    Between 1994 and 2014, Risperidone, (as well as the other atypicals) increase in sales to become among the most widely prescribed drugs in the United States. At the same time the prison rate increased to 1,600,000.

  • Lieberman’s recent defensive reaction to the recent New York Times article was in stark contrast to reality. He does beg a diagnosis, but since Im boycotting DSM 5, Ill refrain. Clearly anosognosia is part of the problem.
    On the other hand “narratives” can be easily examined. Lieberman is seizing a position I call “two kinds of special” . He declares himself a “hero” but embraces the posture of “victim”. Its a neat trick because in either case (hero or victim) he is entitled to exceptions from normal social expectations. (By repeating words like “stigma” he can justify misrepresenting facts. It becomes ok to mislead people or even lie because his cause is noble and his intentions above reproach.)
    If he was my client Id help him understand that the only real difference between a hero and a victim is that the victim defines himself by whatever happened, while a hero defines himself by how he responds to whatever happened.

  • Thank You Alesandra and welcome to MIA. It is encouraging to have more prominent critics presenting these (obvious) facts to the public. The problems are systemic in medicine, but are especially obvious in psychiatry. I agree that the consumers can affect change in terms of demand, and that individuals must accept responsibility for their own health. Simply raising awareness has not reduced demand so far. Im curious about your view on direct to consumer advertising.
    Michael Rock

  • Another concise article Dr Hickey. Your counterpoints are like precision bombs. Its pointless to argue with Psychiatry, and only slightly more productive to preach to the Choir here. How do we take our arguments to the mainstream? I cringe when I read Huffington Post. Deep in the comments section there is usually a psychiatrist reassuring the faithful that its “a chemical imbalance” only they can see, and only other special, enlightened, people can understand. Its all very predictable, so ought to be easy to counter?

  • I am familiar with the tactics of Mr Early, his anonymous mother and even her son. They are predictable defensive reactions, intended to dismiss unacceptable facts or evidence, and preserve the status quo. We had better get used to them if we intend our movement to succeed. Applause to Cannotsay, Discover and recover, and many others for keeping the discussion honest, without taking the bait to become emotional. The facts of this debate are very clearly on our side, and it isn’t difficult to calmly, but persistently stick to them.
    As I wrote I am familiar with this tactic: My disciplinary “counseling sessions” have always been in response to a “concerned patient, or family member” who is upset by my suggestions that recovery is possible, the diagnosis is far from scientific, or that dependence on meds is not always absolute. In short; I am either “not letting me accept my illness enough”, or “saying something bad about the meds”. In my “final written warning” a young man, taking 4 different addictive medications, threatened to dump his pills down the drain, because I said “you need to do more then take pills and sit in therapy to get better”. (I can only assure you I said this very gently, and the young man was not upset after I said it, although it was clearly not what he wanted to hear.
    The young man threatened to drop out of treatment unless my heresy was admonished. The young man was reassured that he is obviously dependent on meds and therapy, and wont be expected to do anything to recover, aside from take pills and sit in therapy. He stayed 34 days and went back inpatient after the medical folks tried to wean him off Ativan. (he was quickly put back on the Ativan).
    Both the young man and myself are surrounded by people whose faith obscures critical thinking. All the young man had to do was to recite a reluctance to believe: “I hate taking pills”, to provoke this validation. Faith in his incompetence relieves him of expectations to change.
    It could be the same for the young man in the story, the one from NAMI. If whatever version of “sanity” his dependence on meds provided him was preferable to the anguish of “insanity”, he wouldn’t require leverage to ingest them daily in the first place. It reads like a classic power struggle to me, but perhaps Im just cynical. Also it is the fundamental compulsion of the enabler to externalize responsibility of the person being enabled. This is why her interpretation of “tough love’ Is so rigid and black and white. Kicking the son out was obviously much harder for her then it was for the young man to endure 48 hours outside. Not to mention all the attention he receives..
    So for all the drama of Bob’s message, all the talk of “blood” on hands, the only actual harm was done by the status quo, which was probably quickly restored.
    Frankly I am rooting for that young man, as I am for the young man who set in motion the end of my career. Possibly they will find us here someday.

  • Thank you Mathew.
    I think this is an important and timely refinement. It will encourage me to stay and comment more often. My reluctance to comment on discussions I felt strongly about, such as Jill Litrell’s “Talk Therapy Can Harm Too”, is sometimes motivated from concern that I would hurt feelings.
    I strongly agreed with her(including her responses to comments), and thought her brave for declaring her position.
    I think its noteworthy to the discussion here that Jill and I would likely completely disagree about the question of causation. she is a self declared biologist, and I am a self declared, (and quite stubborn) behaviorist. Opposite ends of the”nature versus nurture” argument.
    I think an important step in our movement is to seek out more public discussion through mainstream media. A good example of this was in response to Dr Leiberman’s essay in Scientific American. The reaction was more powerful because of the number of commenters who did not agree and expressed their opinions reasonably. This spoke volumes.
    I hope that more of us will wade into the waters of public disagreement, rather then restrict ourselves only to the safety and comfort of reassurance and agreement here.

  • Hi Sera. Thank you for so eloquently describing the resistance many of us encounter in our naïve attempts to try to change the system, while working within it. I think it speaks of our hopeful nature and sincere intentions. As I’ve written before I do not expect to survive in the field long enough to see it happen myself, which gives me a certain freedom.
    The despair and discouragement you describe comes to me when I catch a glimpse of the impossibility of our task. It sucks the wind out of me sometimes. The vast industry of disability.
    I honestly try not to look at it. which is also an act of Faith and Denial.

    I recognize many of the reactions and arguments you get. The blowback from clinicians and other stakeholders. I think it is denial: a very simple, very primitive defensive reaction. (as a general rule, the more rigid and primitive the defense, the more desperate the person/group is to not acknowledge the truth). Denial (and faith) protect against awareness. This is what Kuhn suggests will happen just prior to a paradigm revolution.
    It is pointless to argue matters of faith with evidence, and I’ve tried to stop arguing with clinical people who are actively not listening, or are personally offended by my honest opinion about a case they are working on. This is especially true when they are in numbers, and will only validate each other. It is their numbers that discourage me the most. It seems I am always alone when it really counts.

    It helps to not take their defensiveness personally, although I certainly get stuck there myself from time to time. It also helps to focus on the people you are able to reach. I bet there are always plenty of these around you (Sera) everyday.

    Another tactic I recognize is shifting the attention away from the uncomfortable facts, and onto some peripheral issue, such as your wardrobe, shoes, or the way your message makes them feel. If some one is defensive (or angry or uncomfortable) –it must be because you are doing something wrong. They might even promise to understand you if you only can change “the way you say it”. (they wont)

    Gandhi said:
    first they ignore you
    then they ridicule you
    then they attack you
    then you win

  • Ive been to therapy several different times over the years, always insisting on brief, specific, time limited objectives. I personally found that therapists oriented towards validation, insight, support, and catharsis always left me feeling upbeat when I left the office, immediately after my session, but were not very helpful in terms of actual change. And the reverse was also true: therapists who were more like coaches left me feeling immediately unsettled, but less stuck long term.
    All these preferences are narratives. Defenses function to protect habits from change.
    The last supportive/ insight based therapist I will ever go to was a marriage counselor. Im divorced now.

  • This was my comment; i hope it keeps with the dignified tone you encourage:
    I urge any adherent of scientific method to examine more closely Dr. Lieberman’s assertions in his article of May 20, 2013.
    Despite his exuberance for the new DSM 5, there remains no blood test or brain scan for any diagnosis of mood, thought, or personality disorder. There is no objective measure for severity of illness. There is no way to prove a person does not have a mental illness.
    We continue to have no “meaningful scientific understanding” of diagnosis, cause, or treatment. None of this has changed in DSM 5.. Psychiatry remains faith based medicine.
    Remember that even today, there is no general agreement on “recovery” (i.e. does recovery mean staying on the meds or learning to not need the meds anymore?) There is no definition of “Normal”.
    I find Dr. Lieberman’s dismissive and misleading remarks of DSM 5 critics alarming. How does he respond to Robert Whitakers Anatomy of an Epidemic? Has he read and fact checked the book? How does industry thinking explain the rise in disability rates for people who are in treatment?
    Thomas Insel, the Director of The National Institute of Mental Health, released a statement last month calling the DSM 5 “invalid”, and that people with mental illness “deserve better”. A week later, he and Dr. Lieberman issued a joint statement, calling DSM 5 the “Gold Standard” in modern Psychiatry.
    Possibly all of Insel’s statements are true: The Gold standard in psychiatry is invalid, and people deserve better.
    Where does Dr. Lieberman draw the line between psychiatry’s “checkered past” and this new age of enlightenment? Where is his evidence that the medications are actually safe and effective? That diagnosis (old or new) is reliable and valid, and that treatment leads to better outcomes?
    From my experience, (25 years leading group psychotherapy inside and outside the medical model) Better outcomes in mental health result from encouraging people to have faith in their strengths rather than their (entirely hypothetical) limitations. Even very sick people can recover, or become less chronically ill, when they are connected in some way to other people, (a social group) and engage in some form of structured occupation (work, school, volunteerism). These things help people find purpose and meaning in life. Any of these things can be done on or off the meds. (Although the side effects are problematic).
    Dr. Lieberman doesn’t seem to realize that the antipsychiatry movement is largely populated by former patients and their family members. In other words; people who are intimately familiar with mental illness. Their experience of “stigma” is no academic abstraction, at some point they accepted their illness and took the meds.
    The true stigma of mental illness is low expectations for recovery.

  • I have to agree: Martyr is the right word, but it stings a little. I certainly hope I’m not coming across as whining. These have all been choices I’ve made, and I accept responsibility for the consequences. Of course I can’t know what these consequences will be. Of course I’m scared. But these choices are a deliberate action toward becoming the kind of person I want to be. Possibly it will be the thing I am remembered for.
    Part of this is a question of personality and preference. Perhaps it’s my Irish ancestry. If I were sitting in a rocking chair at 80 years old, looking back on my life, I wouldn’t be proud to be someone who was always flexible, always bent in the wind. I would be proud to be someone who took a stand at times, and lived my life in the service of others.
    I have to disagree: the cause does need more “martyrs”. Imagine any important cultural shift that didn’t have martyrs. Think of Rosa Parks and Remember The Alamo! Martyrs inspire. They don’t always get destroyed either. Perhaps if enough of us stand firm together they wont be able to fix on any one individual. There is safety in numbers.
    Naturally I’d rather the martyr is someone else, but I couldn’t find any volunteers.
    I think the group of people who need to stop being martyred at the people who still accept their illness and take the meds. Far too many people have suffered in those ranks.
    I believe in our cause. But I believe our energy and efforts have been ineffective trying to argue science and evidence in “faith based” medicine. Our mistake is to think of the authorities as scientists, or people who rigorously embrace the scientific method. You simply can’t argue matters of faith and denial using facts. It is a waste of breath. (As evidenced by every war fought over religion).
    My understanding is that I have no legal recourse for wrongful termination. In Pennsylvania the employer, especially the large, campaign donating corporations, are morally, ethically, and legally allowed to decide who makes a good therapist and what a therapist must think, say, and feel.
    Thinking outside the box: Possibly my girlfriend and I could sue each other for sexual harassment, (since she works at the same hospital in another department), but one look at the two of us together and I wouldn’t see a dime. Plus I might need her to support me soon.
    I had in mind something more along the lines of JefferyC.
    I suspect we might find an exposed flank using the legal system. When I was going through a divorce a few years ago it was helpful to develop a legal mindset. To think like a lawyer. It seems to me that the standard logic applied in clinical settings would be very difficult to justify to a jury. Especially when funding and reimbursement is added, and how these influence treatment decisions. I fantasize about getting some of these people on the stand and try to explain to a jury incredible psychobabble (such as “stages of change” or how med compliance leads to better outcomes) and how this justifies prescribing three different addictive medications to a young man with an identified substance abuse problem . (This actually, recently happened). Cap this testimony off with the fact that this young man was that month’s best paying customer, and end the case. A decent lawyer with an interest in the subject would eviscerate him.
    Marcellas would say more about this. Michael should wait.

  • I am very touched by your comments. Also humbled. You probably dont realize Ive read so many of your comments on MadInAmerica I feel as though I know you. You dont know that you’ve made a difference in my life. A wonderful irony is Faith Ryhan “applauding my courage” when I was too afraid to introduce myself to her in Philadelphia last May!
    In truth what motivates me today are the people I didnt speak up for more stidently over the past few years. It is much too late for me to advocate for these people. All I can do now is tell their stories. For example: The very worst part of this whole mess is what we are doing to the adolescents right down the hall from my office. I work with adults, and so I can convince myself not to look too long or hard at the kids. I see the parents come in for visiting hours sometimes and I see the fear in their eyes. They have a sick child with a mysterious illness and feel powerless. I am a Dad and I know the look and the terror behind it. These people are vulnerable to a reassuring authority figure with a quick fix. The last thing they want to do is ask questions.

  • Changing personal identity requires adapting to different, unfamiliar expectations, social roles, occupations, ect. Even when the current identity results in great suffering, change is difficult. Many people will refuse to hear that they can be free, and will defend against it, especially at first. They will deny it.
    Most people I speak to who have “recovered” in the way you did (ie, by realizing that there never was anything wrong or damaged in the first place) feel really angry a few years later. One woman told me she had assumed that her providers had only her best interests at heart, that this was a fundimental agreement in therapy. She was very hurt to realize that her doctors and therapist were actually “assuming the worst” about her. She was in treatment over 15 years!

  • Hi Corinna. I was going to write one more comment as Marcellas, but my username has already changed. Thank you for all your support this past year.
    “just trying to make my piece of the pie work, and I need your help”
    I am not a Christian, but please assume from me the same kindly respect for your faith as you do for mine.
    Ive consulted my Gods on your behalf, and they tell me that the game isnt over yet for you. They say It isnt time to assess the results yet (or change your direction abruptly). They want me to suggest you think more of the whole pie you are in, rather then only your piece in it. (I think they mean you need more partners, or partners with different skill sets).
    They also want to say something peppy and encouraging, like “the experiences you had this year will pave the way for successful grants in the future”. (I hate when the gods try to be peppy, it never works).
    I will aslo ask my Gods every night this week for numbers (5 and a powerball). If we hit-your grant writing days are over.
    My thoughts are with you

  • I was emboldened by Reading Anatomy of an Epidemic, and inspired to speak out by the many contributers here, especially Dr Keys, Dr Foster, and Corinna West. After Im fired I will be even more outspoken. Over the past 10 years Ive developed an alternative to the current system (using CBT, DBT, and Positive psychology) which I am currently using at the hospital. They wont allow me to test for outcomes, and insist on containing the ideas that recovery is possible.

  • The legal system might offer a proper forum for the national discussion we are trying to provoke. The arguments to support the current paradigm are hard to expose within the medical model, precisely because the diagnosis cant be tested for or against. Possibly if we look at the assumptions through a different lens (ie, legal) it can reveal the corruption. It also allows people who have been harmed to act toward restitutions. Of course the financial incentives are just as present in the legal system as psychiatry and counseling. I work in a large hospital network in Eastern PA and it seems very obvious that the people who attend treatment longer, and have the most access to care are much more likely to end up on disability. We make more money on people who dont get better, and the only outcomes we measure are financial (attendance, staff to client ratios, etc). We try not to consider how many we help wind up disabled within a few years. We ignore completely the people who get better and stop taking pills. There is no profit in it.
    Im outspoken and will be fired pretty soon for telling people that recovery is possible. Im angry about what is happening, especially to the adolescents. Most of my co workers, will conceed that they see the same things I do, but feel like they cant say anything because they need the jobs.

  • Perhaps I a only a cycnical old behaviorist, and cant help but look for reinforcements. But I think It takes a buyer to sell and vice versa. No matter what a person, (or even a dog or cat) does over and over, the habit must function in some way. Something is relieved by doing it. With personality disorders it is usally a combination of “attention, control, revenge, or to display inadequacy”.
    Always a touchy subject, especially to those who “accept their illness”