Thursday, November 23, 2017

Comments by Matt Stevenson

Showing 100 of 366 comments. Show all.

  • Hi Phil,
    Thanks for taking the time to do this.

    The take-home piece for me was:
    “Against the full range of the HDRS-17 spectrum, the differences between the drug and placebo groups at week 6 are clearly trivial.”

    This is what I expected from when I began reading your article. When you have a forty point scale, and the difference between taking a drug or a sugar pill might (or not) at most be a point or two over several weeks, does it really even matter which one you are taking or not taking? (well, it can, due to other antidepressant adverse effects, but that’s another story).

    The big picture is that what is going on or not going on in people’s lives / social environments is so much more important when it comes to affecting their mood than whether they are taking a “real” antidepressant or not. But to acknowledge that could lead to the loss of billions of dollars in profits.

    Of course, the real unacknowledged goal of these pieces is to promote the self-interest of both the authors and the drug companies, which are much the same…

  • Eric,
    Great essay; very well-written and incisive.

    I would add to what you said that the effect of much psychiatric treatment today is most unfortunately similar – over a much longer timeframe – to what the Germans did much more quickly in the 1940s. In other words, modern day psychiatric treatment – comprised primarily of indefinite tranquilization with all its long-term effects, and telling someone they have an incurable disease and should not expect recovery – often largely prevents people from living a meaningful and enjoyable life, and leads to early death via all manner of physical and psychological adverse events. Thus, it often takes a few decades to gradually exert the same effect on the “patient” which the Nazis did in only seconds in the gas chambers. It is horrible to think about this, and about how much distortion, denial, avoidance, and self-deception goes into maintaining the myths about “schizophrenia” that many in the field hold.

  • Hi Ivy,
    This is such a great story. I read it a few days ago and meant to commend you on your bravery for speaking out so clearly and incisively. It is so healthy to share negative experiences like this without shame or guilt – many people unfortunately are made to feel they should hide having ever been involved with the MH system; but speaking out about it like you are can be healing and releasing. I also agree with all your perceptions about the very unfortunate abuses and lack of acknowledgment of harms that go on within the system. So much of it is out of the control of even the people who work within these hospitals… “they know not what they do” as it says somewhere in the Bible.

    I also shared a somewhat similar story a long time ago on one of my blogs, here – https://bpdtransformation.wordpress.com/2015/02/04/21-the-nightmare-of-psychiatric-hospitalization-in-america/

  • This is a brilliant article, although it is partly because so much of what is obvious is not obvious to psychiatric researchers.

    I think about the same concepts as the author in saying that biochemistry is the conduit, expression, or vessel through which our experience in life expresses itself. In this way, there is no more sense in saying that the alterations in brain chemicals while taking an enjoyable piano lesson are a disease, than saying that feeling depressed after one’s mother dies is a disease. Feelings and their neurobiological correlates simply are what they are, and they involve the environment and the organism interacting dynamically.

    Psychiatry barely recognizes the influence of the environment, especially with “severe mental illness”, and thus its practitioners are largely helpless to help such people, since they see a disease rather than a person to be understood. Meanwhile, the real goals are achieved: get the cash flowing in via quick pill prescriptions, appear to be a doctor treating a medical disease, and retain patients for life since chemical suppression does not solve real life issues, at least not usually.

  • Phil,
    Good to hear your voice on here again.
    Of course I agree with everything you are saying here, no surprise.

    I was sad to read a psychiatric article last month (on another forum) by another group of psychiatrists arguing that even considering that “schizophrenia” could be treated without neuroleptics would be “unethical”, because it would be to deprive “patients” of “the only known evidence-based treatment for their illness”. It is scary to think about the massive distortion and self-delusion on so many levels that goes into making a statement like that – the lack of knowledge about what the “efficacy” and relapse trials of the drugs really show, the ignorance of the data about long-term effects of cognition, tardive dyskinesia, parkinsonism, brain atrophy, the lack of any understanding that severe terror and distress are not “treated” by antipsychotics, but people are merely numbed to what they are experiencing. Such psychiatrists are truly lost in a maze of self-confirming, but delusional perceptions about the people they are supposedly treating. The sad thing is, they are not actually bad people, and they could do much better, if they had accurate information about the nature of severe distress and the serious harms of neuroleptics.

    I agree with others here that critical psychiatry can be a useful forum for reaching the general public who are not ready for stronger messages. Also, not all psychiatrists are totally close-minded, and some are beginning to become more aware that there may be serious problems associated with long-term use of the drugs, as well as that environmental stress and trauma are much more heavily involved with what gets labeled psychosis than many used to think. Some of these people can and do care and can do good things in terms of raising awareness. So, it is not that psychiatrists are always harmful, although inadvertently many of them are.

    Phil, drink of the fountain of youth so that you can be here a while longer.

  • Sera,
    Great article; I enjoyed reading it!

    The penetration of drug money and associated medical model terminology into NAMI is so complete and deep that it’s hard for many inside the organization to know what has happened to them… it’s like, how does a fish know it is swimming in water? It is all it’s every known. From such a fish’s perspective, there is no sense or memory that things could be radically different; for example, that a mental health organization could be independent and could act as an ethical check on the excessive drugging pushed by the corporations. Instead, it’s all about “confluence of interest” (to use the unforgettable term used by a psychiatrist whose name I forgot, but who tried to rationalize drug money “conflicts of interest” as confluence as interest, to Marcia Angell’s disgust).

    The bottom line is what you said: Nami and drug money go together like:
    – a zebra and its stripes
    – a cheetah and its spots
    – a fish and water
    – a Somalian pirate and a rubber dinghy

    There is no way for Nami to change, because its growth and function has been entirely predicated on ingesting poison – i.e. drug money with the implicit expectations that drugs and the disease model be promoted. To let go of this poisonous attachment, Nami would have to radically shrink and scale back its services. Those running the organization prefer self-delusion and maintaining the status quo.

    In this regard, the process of trying to oppose Nami and the disease model reminds me of my favorite quote from Macchiavelli:

    “It must be considered that there is nothing more difficult to carry out nor more doubtful of success nor more dangerous to handle than to initiate a new order of things; for the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from the incredulity of mankind who does not truly believe in anything new until they actually have experience of it.”

  • I also find the picture of the white psychiatrist in the lab coat at the top of article fascinating and disturbing. So evocative, saying so much with no words. The white male who defines pathology and wields the power to define others, pointing with his little Powerpoint stick at the version of “reality” that he projects onto the minds of the vulnerable and distressed, presumably…

  • Bob, another thought I had:

    It seems like the psychiatrists are unaware, or forget, that citing a single or even a few quasi-experimental studies about human subjects is not good evidence for anything. As you implied, what is needed is a range of many studies of different kinds that intersect to give the same message. There is a book I recently read, “Brain Storm: The Flaws in the Science of Sex Differences”, where author Rebecca Jordan-Young says,

    “Unlike true experiments, where the controlled circumstances of the research can give strong evidence about cause and effect relationships from even a single study, quasi experiments become convincing only when multiple studies, related in specific ways, all point to the same conclusions. Neither individual studies nor even a small set of replications can ever be decisive. Nor can the results of even a vast number of quasi experiments simply be evaluated in an “additive” fashion. Rather, because all the studies are quasi experiments, the overall credibility of the theory depends on how well the studies fit together…. Because quasi experiments derive their strength from their relationships with other studies, a reasonable evaluation must consider all – and only – the studies that examine the same hypothesized (relationships).”

    There are so many possible confounds to any single quasi-experimental study that one absolutely must have a range of related studies to say anything convincing. In this regard, it is revealing to see how the psychiatrists unscientifically cling to the Chinese study, as if they hoped to convince an ignorant public that one single quasi-experimental study is proof of anything. What is shocking is how little evidence they really have of any long-term benefits of antipsychotics. It truly is a house of cards.

  • Bob,
    This is a fantastic post – measured, detailed, incisive. Thank you.

    It is truly amazing the degree that Lieberman et al have to distort, avoid, deny, spin, and massage the data of numerous studies in order to deny that there may be significant harm coming from long-term antipsychotic use.

    I couldn’t help imagining a fragile house of cards when reading this piece. The long-term use of antipsychotics is extremely fragile, in terms of being totally without a scientific basis of efficacy.

    Another metaphor for neurotoxins that came to mind was of a real estate salesman who shows people a perfect looking house – what the visitors don’t see is that the salesman has concealed massive cracks in the foundation, hides the fact that the appliances are non-functional, doesn’t talk about the fact that the floors are rotting away just beneath the surface, and generally minimizes any concern while presenting the few surface “good” elements.

    This is why I call neurotoxins when presented as “antipsychotic medications” “simulacrums” – this term means that they give the surface appearance of being effective and genuine, but are in fact shams that are insidiously harmful for most in the long term.

    This weekend I watched the disturbing movie Alien: Covenant, which I imagine some here may have seen. In this movie there is a traitorous character, the android David, who gives every evidence of being a friend and protector to visitors newly arrived on a dangerous planet (perhaps a metaphor for newly psychotic patients). His real plans become evident later, when he sacrifices the humans in horrific experiments designed to breed aliens using the human as literal breeding vessels.

    I could not help but think that neurotoxin drug treatments work like this: they are presented as something benign and “good”, but over the years they more often than not eat the person away from the inside, literally and metaphorically colonizing their mind and body. Their real aim is eventually revealed (to some who research outside the psychiatric narrative) as making profits for the drug companies and sustaining the status of the professionals. An important difference is that most psychiatric professionals are not really aware of the true long-term effects of the drugs in many cases; the cognitive dissonance would be too much. David, on the other hand, is quite aware of what he is doing, and thus is a chillingly evil and ruthless character.

  • Hi, Well written article and you should feel very proud for having the courage to stand up for yourself and speak so clearly and strongly. I’ve shared a link to your piece in other forums. Although I cannot be there in person for the court date, I wish you the best and hope you have others around you there supporting you.

  • Kurt,
    Thanks for this interesting article. I hope you won’t take criticisms of your ideas too hard. To me, you appear to have particular ways of thinking about helping someone as “treatment”, of interventions as “brands” of therapy, that might be (unintentionally) offputting to many people here who are heavily against mainstream psychological ideas and practices. However, I wish more people would comment on how you included interesting facts, insights, and ideas about suicidality, even if you operate with a framework of thinking different from one’s own. I think we should not judge people so quickly for what they say or how they say it, and understand first. When we judge someone, we do not learn.

  • Bob, thanks for all your have done to set up and continue MIA. It is such a great resource.

    Although I don’t agree with allowing authors to shut down comments – in fact, I strongly disagree – I also think it’s not the end of the world if a few articles are “uncommentable.” Those articles will probably just get less attention. I fully expect as you said that most authors will still allow comments. Also, if you see potential value in the idea, maybe there is something potentially beneficial to it that I couldn’t see. As the founder of the site, I think we supporters should support you to experiment with things, even if we disagree. At worst, it can be tried and if it has serious adverse effects, then it could be reversed or modified in various ways.

  • Hi Richard,
    I just saw this; I don’t feel embarrassed at all. Martin made a number of insightful points; I did not agree with everything he said, but thought some of it was quite valuable. By assuming I agree with certain things he said (when you couldn’t know all that I actually agreed or disagreed with), you might be making a mistake.
    Fortunately, I am not too easily upset now by people disagreeing or criticizing me, so your comment doesn’t disturb me.
    As to my own comment, I was just emphasizing my own position on the importance of free speech and being able to give opinions, even when they are upsetting and controversial. I hope we can agree on that. In general I always really like your comments and your passion, btw.

  • The comments here from Martin are excellent.

    I especially agree with this section: “I have also noted that many of the staff at MIA are young and have spent considerable length of times at the types of liberal-leftist, echo chamber universities I described above. Are you trying to bring this type of ‘enlightened’, politically correct and safe environment to MIA? Are you projecting your experiences of these environments onto this community?”

    As some here know, I am a staunch supporter of free speech, and think MIA’s existing moderated comments sections are valuable and fine as they are, and should not become “optional” depending on the whim of the author.

    Allowing professionals to speak but not be spoken to will not be without consequences – such a decision will result in a loss of credibility for Mad in America in the eyes of many of its supporters, a loss in credibility for those authors who choose to block commenting, and a lack of feedback and learning potential for these authors about both positive and negative aspects of their writing.

    In a way, such a decision will make certain Mad in America articles come to resemble liberal university “safe spaces” in the way Martin describes – and, ironically, may make this aspect of the future MIA similar to what occurs in some closeted professional institutions, where certain party lines cannot be questioned or discussed (in those cases because people are scared of losing their jobs, in the MIA-of-the-future, because the MIA editors have allowed people to speak but not hear feedback).

    The reality is, there are no real undisturbed safe spaces that last for any length of time, and trying to artificially create a pristine, uncriticized environment always results in unforeseen adverse consequences occurring elsewhere in response, just as it does at liberal universities. In this regard, some readers might be interested to see this article which gives an example of one possible “endpoint” of illogical censoring, one which we can only hope that MIA never stoops to:

    http://www.nationalreview.com/article/447419/rebecca-tuvel-controversy-campus-radicals-free-speech-social-justice

  • Phil,

    I love the tone of your posts; it often makes me smile and laugh.

    It’s all just too logical – what happens in our lives can make us depressed, and who gets depressed versus who doesn’t (when encountering “the same” stresses) can be understood via looking at the presence or absence of protective factors external to the precipitating stress, which raise or lower the threshold for these stressful events causing feelings of severe depression. Who would have thought…

    Coincidentally Phil, and slightly unrelated to this article, I recently found out that this country has an excess of exuberant people, and this excess needs to be controlled. Behold:

    “FDA Approves Despondex for the Annoyingly Cheerful

    http://www.theonion.com/video/fda-approves-depressant-drug-for-the-annoyingly-ch-14310

    Excerpts: “Dr. Alman Wei calls the drug, “A huge step forward in the battle against exuberance. If you’re in a good mood every so often, that’s normal. This is for those who have a persistent positive outlook on life.”

    But not everyone is convinced that Despondex is the cure-all for perkiness. In this week’s Time Magazine, Michael Pelosik of UCLA argues that many patients get similar results from natural remedies, something as simple as a a diet of corn syrup and white bread and a total lack of exercise.

    But Dr. Wei disagrees. “We have to erase the stigma attached with getting chirpy people real medical help. I mean, do you know what it’s like to be around these people? It’s pretty fucking annoying.”
    —————

    Thus, Phil, both depression and exuberance must be controlled via chemical means, so that all of us can achieve our destiny: to be functional, but unfeeling and deadened automatons who mechanically go about the business of producing profit for the corporations.

  • Daniel,
    This is a great article; thank you. You write very well.

    I agree that conforming and doing what society expects in terms of “recovering from pathology” is a path to failure. I often tell people how if I had done what psychiatrists and other mental health workers told me to do, I might well be dead or nonfunctional today. Finding what works for you based on your unique experience is the way.

  • This is a great comment. I’ve sometimes been guilty of making negative assumptions and attacking people who I don’t know personally in the past, and it shuts down dialogue and doesn’t advance goals in the long term. It’s a case of short-term feelgood attacks but long-term failure to grow one’s support network and advance one’s goals. So I think Jim is making a great comment here in calling for giving people the benefit of the doubt, being curious and trying to understand where someone is coming from before judging or attacking them, and so on. Well done Jim!

  • “Although the authors do not mention it, substantial evidence suggests that alternative treatments for those problems might be exercise and dietary changes—which have been consistently shown to improve depressive symptoms, regardless of body fat and sex.”

    I was just going to say this – how about “diet and exercise” as an alternative approach for morbidly obese people? Losing weight is likely to make depressed and obese people feel much better about themselves than taking a pill with its side effects.

    Then there’s all the factors in our society that have led us to go from a civilization where almost no one was obese 100 years ago, to a country today where 35 percent or more of people are obese and can barely get around. All the issues like processed sugar and corn syrup in every other food, massive portion sizes at restaurants, technology and smartphones keeping us sedentary, lack of opportunities for exercise, not getting outdoors and so on. These are the real causes of obesity, and the hardest ones to tackle.

  • These researchers are discovering what Smedslund said in “Why Psychology Cannot be an Empirical Science”:

    “Empirical research in psychology… can only be seen as mapping temporarily stable statistical tendencies at the aggregate level. These mappings must be evaluated on pragmatic grounds, i.e. as yielding possibly useful knowledge in limited domains for a limited time…The regularity that is nevertheless observed cannot be taken to reflect permanent laws, but only temporarily stable feedback-loops. These are like whirls in a stream which are stable only as long as the total flow of water does not vary and the stones on the bottom maintain their positions… The findings in psychological journals may superficially appear to be of the same order as those reported in physics or chemistry and, hence, psychology may superficially look like an empirical and accumulative science. The conditional and transient nature of psychological findings is rarely acknowledged, perhaps because the publication and preservation of empirical findings will then appear unjustified since they cannot be taken to be useful in the future. The scarcity of attempted replications also allows psychologists to avoid thinking about this problem.”

  • Joanna,
    Good to hear back from you; I really like and support your incisive critical writing in general.
    Language about distress is so powerful in shaping feelings and perceptions – we just had a discussion about this in ISPS. There is the necessity to use what may in some ways be euphemistic misleading terms in order to alert laypeople or others within one’s profession to one’s article, as you said. However, if it goes on too long and new ideas are not later introduced which question dogmatic assumptions based on euphemisms, it can lead to reinforcing misleading, stigmatizing terminology.

    It’s a difficult conundrum. I also criticized Bob Whitaker for it at one time in the past, and he responded in a similar way to you. But I think he is also very aware of problems with the common use of terms like “schizophrenia”, “antipsychotic”, “medication”, “illness” etc, and uses them with increasing awareness and more lightly over time. To most psychiatrists, however, I think the use of these terms is not “light” at all, but a key identity piece and means of maintaining social control and perceived knowledge/authority in the eyes of consumers.

    With me, it’s a bit more of a personal thing, because I don’t like to have my (past) experience and others’ experience of severe distress labeled as illness or disease when it is in fact uniquely personal, subjective, and transformable.

  • Also Joanna, I’m wondering why you don’t write, “tranquilizers or neuroleptics can be useful, and the benefits of tranquilizing people can sometimes outweigt the disadvantages”

    or, “While I would not dispute the usefulness of tranquilizing or numbing people for the treatment of acute distress”…

    It doesn’t sound quite so medical or “good”, then, does it?

    Euphemisms do have their place too, don’t they…

  • Joanna,

    The evidence we have from John Read (Models of Madness) and others writing about trauma, poverty, neglect and so on shows that “psychosis” is most often not an “illness” one is “at risk of”, but the individual’s understandable responses of terror, rage, confusion and despair to adverse experiences and deprivations in life. It is these feelings, primarily, that generates the “symptoms” of psychosis and the resulting incapacity of social and work function. Thus giving tranquilizers – and that is what they are, not medications – to severely distressed persons cannot possibly address the life problems leading to such breakdowns over the long term, except to make a person progressively less able to feel their thoughts and feelings, and progressively less able to respond flexibly and adaptively to life’s challenges.

    I think your article is great, except it uses a lot of medicalized language that is inappropriate to what is simply severe human suffering.

    The Goff article can be viewed as a positive thing: It shows that Lieberman et al are sufficiently threatened by antipsychiatric and critical psychiatric criticism to have to start speaking out against it preemptively and aggressively. These authors sense that the cash train that is antipsychotic drug treatment – all 18 billion dollars a year of it – is going to become increasingly vulnerable to derailment as the evidence about how ineffective and nonmedical tranquilizers really are is revealed to a wider and wider swath of the public. Such changes in awareness, and the growing realization that profound distressed labeled “schizophrenia” does not constitute a lifelong, incurable brain disease- these also undermine the medical identity of these authors and their claim to be doctors treating diseases of the brain. Their incomes and status may greatly diminish if their most cherished “illness”, “schizophrenia”, and its supposed treatment, “antipsychotic treatment”, are revealed as what they really are. In this regard, “schizophrenia” and “antipsychotic medications” should become a prime target for antipsychiatrists and critical psychiatrists, being the Achilles heel of psychiatry as they are.

    Your article make many great points, but it could go even further. Rather than saying, “Psychiatrists need to support people to evaluate the pros and cons of antipsychotic treatment for themselves and to keep doing this as they progress through the journey with their condition.” It could say many people do not need psychiatrists period; non-medical therapists and friends/family are more than enough for many psychotic people to get well, just as they are/were in poor countries today and in the past, as evidenced by the World Health Organization’s studies in Agra, Columbia, Mauritus, Nigeria etc.

  • Hi Miriam,
    I responded to this article on the ISPS forum (www.isps-us.org) with a rant about how deadening symptoms over the short term has nothing to do with improving long-term functionality and quality of life. Similar to what Steve McCrea said. I thought you might like to see:

    ———-

    it’s worth pointing out that the main reason Jeff Lieberman is spinning the data like this is to maintain his (illusory) status as a doctor treating brain diseases, and to keep the cash coming in from the drug companies for his research. And when one defines what the “benefits” of antipsychotic drugs really are – keeping people quiet and dulling their feelings to the point they don’t bother themselves or anyone else – it all ends up looking pretty pathetic and awkward.

    I can’t resist mentioning here that in his recent TIPS paper, Jan Olav et al quoted Bola and Leucht as having proved “the undeniable efficacy of antipsychotics”. But again: the efficacy in doing what? The answer is keeping people quiet, compliant and tranquilized for a short period, and has nothing to do with understanding the patients’ experience or what they might want socially or vocationally in the longer term.

    As to the question of whether antipsychotic drugs make most people more functional in the long-term and help them to develop loving, trusting relationships… well, I think we can answer that based on our own experiences. Ironically, Jan Olav’s study answered that, too, because 10 years down the road more than 70% of the TIPS study’s patients in Norway were still drugged up and barely functional. So much for “undeniable efficacy”.

    While I know some people don’t like these blunt discussions, I think the worse attitude is when we cannot have an honest discussion about what drugs are actually doing (treating a disease process versus tranquilizing). Such a discussion, while painful and awkward for those giving the treatment, should include looking directly at the drugs’ impact on the brain, and how taking them is linked with functional and social outcomes (or not) in the long term… Again, the current discussions around “medications treating symptoms” have little or nothing to do with what is good for patients, and everything to do with the need to prop up the drug industry and maintain professionals in their privileged social positions. It’s really pretty embarrassing when you strip away the fake euphemistic language and look at what is actually going on. No wonder people in the field don’t want to talk about it openly. I’d be ashamed too, and I wouldn’t want to talk about it if my professional status and my ability to pay my mortgage and car payment depending on not upsetting the apple cart.

    This morning, I was driving near a private mental hospital here in DC, and was thinking the best thing that could happen in the short term for our mental health system here in Washington DC would be if all the mental hospitals burned to the ground. Because at least then for a year or two, until the facilities were rebuilt, patients would be spared from being locked up all day in a drugged-up haze, and the professionals would be spared from babysitting patients while doing absolutely nothing to understand their life situation… which to be fair is really not their fault either, because no one has taught them how to build a relationship with seriously distressed people, or even that doing so is possible.

    It is truly amazing the degree to which the disease model and drug-first treatment ruins professionals’ ability to engage and understand clients as people. In Washington DC, at this point, the “mental health treatment” at our DC public and private hospitals (I’ve seen the inside of both) has deteriorated to such a point that there can be no redemption, resurrection, or fixing of the system toward person-centered treatment at all. The voracious weeds of profit-seeking and group-self-delusion have so thoroughly choked the life out of mental health treatment here in DC that there is going to be no turning it around, probably not for decades or ever. That’s why it would be better to simply burn down our hospitals and give people a break, especially considering that most patients, and many professionals (some of whom I’ve talked to) hate being at these institutions. At least then it would be a year or two until the rent-seeking corporations rebuild the mental prisons so they can take in more poor people to drug.

    Ok, time to get back to real life.

  • No, psychosis is not a homogenous experience with homogeneous risks. Severe distress varies along a continuum from the most regressed, presymbiotic, disorganized, terrified and nonfunctional cases at a given time, up to more related, symbiotic, functional, cases where the anxiety can be managed. The diagram in this article shows why psychosis is not one unitary thing:

    https://bpdtransformation.wordpress.com/2015/03/19/23-the-borderline-narcissistic-continuum-a-better-approach-to-understanding-diagnosis/

    And again, to drug a person at any point along this continuum is not to treat a disease, but simply to numb that individual to their experience.

  • This is a great article.

    And like I said here – https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/

    I think we need to make it clear that these antipsychotic drugs are in no way medications targeting any specific disease process. They are simply general tranquilizers which dull the ability to think and feel (both good and bad things) in the same way that a tranquilizer does to any animal, such as the cattle and sheep that similar compounds are often used on. Their mode of action is no rarified or medical than that. So, for some people being tranquilized and having one’s fear and rage reduced to a tolerable level can be a desired thing, at least temporarily. For others, they make it hard to deal with problems in living, and/or have horrific side effects. What these drugs in no way to is treat a disease called bipolar or schizophrenia. Let’s be clear about that.

  • Nice letter, Bob.

    Although, I believe Oldhead is correct that ADHD is not a real disease to begin with, and that arbitrarily assuming that some people “have it” based only on having several out of a checklist of subjectively judged behaviors is very problematic.

  • Hi Lynne,
    This was an interesting article.

    I would view personal feelings about medications more in terms of expectancy and placebo effects, and less in terms of spirituality – but that is partly because I am agnostic and spirituality is not very important for me personally.

    I certainly think that how the person conceives of medication itself, and what they expect that it will do, is extremely powerful psychologically, often more powerful than the drug itself (this certainly seems to be the case for antidepressants, the effects of which are up to 80% a placebo and not a “real” drug effect, in terms of reducing distress, according to Kirsch).

    Another powerful dynamic is whether person believes the drug is “treating an illness” (i.e. whether they fit the pill into the framework of the disease model) or whether the person sees the drug as exerting a generalized damping effect on their mind/ability to feel, but not as treating any biogenetic disease. I suspect that the latter is less common than the former, given the way that psychiatrists and drug companies routinely mislead people to believe that their problems in living are brain diseases. Thus, and strangely, one could posit that many people think in a somewhat delusional way about medication – i.e. believing it to be treating a biogenetic disease they have (e.g. correcting a chemical imbalance)… rather than perceiving accurately that it is simply a nonspecific chemical compound inhibiting their general ability to feel and think as lucidly.

    I believe one could also say some similar things about spirituality and religiosity (i.e. that they are delusions), since I believe that these beliefs are basically denials of the fact that we are as far as we know alone in the universe (without a known God), that there is not necessarily meaning or order or intent in the universe, and that there may not be anything at all after death. Although, they are often adaptive delusions, since one feels safer and less afraid of death and meaninglessness by believing in God or being spiritual.

    After writing this, I realize that it is depressing not to be spiritual; however, I do not view deluding oneself with unevidenced beliefs as something to be proud of and thus it is difficult for me to be spiritual, even though I love nature and other people. This reminds me that depressed people often perceive the world more realistically than those who are more well emotionally.

    Anyway, I have digressed but thank you for stimulating my thinking with your article.

  • Robert,

    This article is really good stuff. I will probably share it on the ISPS listserv if no one else does.

    I will add a few points to yours:

    Regarding your paragraph critiquing diagnosis, I’d say that, at the least, severe distress (schizophrenia-schizoaffective-bipolar-borderline etc) should be reconceptualized as a long overlapping continuum of related states, not as discrete “disorders”. It makes no sense to pretend that problems that vary along spectrums, that are individualized and constantly responding to the environment, are discrete “disorders”. To do that would be like a modern-day scientist pretending the sun still revolves around the Earth… really, it’s amazing how reductionist some psychiatrists and mental health workers are about diagnosis. Diagnosis is not really valid, anyway, but at least dimensions or continuums of different experiences are a more realistic way of describing how people vary in their suffering at different points in time.

    Jim Van Os writes well about this new dimensional/continuum model of psychosis: https://www.sciencedaily.com/releases/2016/02/160203090208.htm . I would say that Psychosis Spectrum Syndrome should replace schizophrenia, at the least, as a precursor to hopefullly abolishing pathologizing words for human suffering which should be the ideal goal. These are human processes, not illnesses.

    Your points about “medications” are well-taken. However, you don’t go far enough. You should ask that professionals acknowledge that these are general tranquilizers or neuroleptics, not medications treating any identified illness process. You may recall I have written about this: https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/

    If we can’t have an honest discussion about what we are doing to people – and this includes being honest about the nature of the action of these drugs on the brain – how can we be effective in understanding and helping?… after all, if psychiatry were a truly scientific, empirical enterprise, then all new long-term prescribing of antipsychotic drugs would immediately be curtailed, since there is no evidence base for prescribing these drugs beyond one year when considering their side effects and lack of any demonstrated restorative effect on work and social functioning. The only reason not to do so, of course, is profit – cash for drug companies, income for psychiatrists, and status for psychiatrists who want to be perceived (illegitimately) as doctors treating bonafide medical illness. This is another very difficult issue that needs to be openly discussed. Psychiatrists do not have any special expertise vis-a-vis psychosis that other mental health workers do not, unfortunately, given the lack of validity around diagnosis and the lack of any bonafide medication that treats any identifiable illness process relative to psychosis. The sooner this can be accepted and psychiatrists can be demoted from leading treatment teams, the better, as John Read said: https://www.madinamerica.com/2016/03/in-search-of-an-evidence-based-role-for-psychiatry-2/

    The World Health Organization research in which people in developing nations without drugs did much better should also be discussed openly, alongside Harrow, Wunderink, and the other studies Whitaker reviews.

    And yes, absolutely trauma, poverty, discrimination, neglect, abuse should all be discussed as possible but not inevitable causes of psychosis, including in people labeled “schizophrenic”. Again, if one cannot openly discuss what is going on, how can people be understood and helped effectively. American mental health workers’ understanding of trauma as a factor in many cases of psychosis lags decades behind the research being done by John Read, Richard Bentall and others. For starters, professionals could be given copies of John Read’s book, Models of Madness, which would serve as an eye opener: https://www.amazon.com/Models-Madness-Psychological-Schizophrenia-International/dp/1583919066/

    To conclude, and to end on an unfortunately pessimistic note, Mary Newton’s comment is correct – most American early episode psychosis programs have nothing to do with Open Dialogue, and are merely disease model, drug-distribution, “illness management”, brain-washing programs which do little to enable any depth understanding of what is going on to cause distress in the young person and their family, but do much to indoctrinate young people into believing they have a brain disease and need to be on drugs for long periods. Even Oregon, which is relatively progressive, bases its programs upon a disease model (which EASA is, no doubt about it) and most states are much more committed to a disease and drug-everyone approach than Oregon. Thus, most American FEP programs serve the needs of drug companies and psychiatrists far more than they serve the needs of patients and families, and Robert’s optimism is premature in my judgement. I hope that this can gradually change. Having said this, I very much doubt such change will come from inside the profession of psychiatry / public mental health treatment.

  • Hi Gordon,
    Nice essay – it’s good to see some older psychiatrists challenge the new delusions in the profession.

    I see you trained at the Menninger. Did you ever meet Donald Rinsley? I thought he was one of the best writers and therapists coming out of there.

  • Nice article Sera. Regarding this paragraph:

    ““More detailed knowledge of clinical interventions will be needed so that peer specialists know when and how to support individuals in treatment. For example, Hendry explained, research has shown that when an individual is receiving DBT for a personality disorder, peers must have enough knowledge about the phases of DBT to avoid “getting in the way.” This can occur when the individual’s therapist “withdraws,” leaving the individual “alone” to face challenging situations as a means of developing essential distress tolerance and emotional regulation skills. Peers who recognize the phases of DBT treatment can adapt their interactions with the individual in ways to support the therapeutic goal.” – Same guy, same month/year, different document (‘A single National Standard for Peer Specialist Certification‘, also July, 2016)”

    It’s hard to overstate how flawed this virtual word salad is, given that serious problems in thinking/feeling don’t break down validly into discrete “personality disorders”, that such labels are extremely stigmatizing, and that all the “efficacy” of DBT is based on is short term trials of getting people to tamp down their thoughts and feelings in a medicalized way… and there are other approaches to severe distress that may work better and in a less stigmatizing, medicalized way than DBT.

  • Mr. Corrigan,
    Excellent analysis of the study you’ve done, and a great model for someone like me learning how to critique psychiatric studies of other things such as “schizophrenia.”

    My thought from the beginning of reading your article was that, in a sense, almost everything you discussed was more than was necessary, because the diagnosis of ADHD is made based on subjective judgment, without biomarkers, and thus lacks validity. The sequence is that these researchers label people with ADHD based on vague criteria – and THEN seek to look for differences between these kids and others arbitrarily labeled “normal” – rather than FIRST identifying a clearly observable disease process and going from there. It is the same thing as usual in psychiatry – circular logic and assuming one’s conclusions.

    You did eventually get to that point:
    “For this study, it is explained and understood that there is one group that has ADHD, and a control group that does not. But given that there is no biological marker that can be used to make this diagnosis, how was this distinction made?”

    But in my opinion one could have begun the analysis by undermining their whole study on this basis alone. Still, the other critiques are useful, so thanks.

  • Aimee,
    Excellent article; thanks for pointing out what is happening in non-euphemistic language.

    Recently, on another forum, I made a related comment about the state of psychiatric treatment and their conceptualization of distress:

    “If we step back a great deal further and look at this state of affairs from a 30,000 foot view, what psychiatrists – and to be fair many other mental health workers and members of the public – are doing is to apply a Newtonian, mechanistic, linear, Krapelinean viewpoint to a dynamic, constantly-changing interpersonal world that is more quantum-like, relativistic, unpredictable, and relational. In so doing they perceive very little about the lived experience and potential of the people they label, and by degrees their minds become frozen, in terms of being unable to see the distressed human beings before them as a person with potential rather than an illness to be managed.

    I believe that the mechanistic, Newtonian, Krapelinean approach to understanding human behavior is so powerful, and so deeply toxic, that it often ruins the minds of many mental health workers to the point that they are wholly unable to see severely distressed people as their fellow human beings, with the potential to become just as well as any of us. These professionals become instead unwitting agents of a corporate assembly line which produces innumerable drugged invalids year after year. They are like fish swimming in a mechanistic ocean, the toxic water of which obscures the human potential of those they treat to varying degrees, and leads them to inadvertently choke the life out of those they diagnose and drug for far too long. It’s pretty horrific to think about, but I think everyone here knows there is some truth to these words, especially those of us who have almost died because of this approach.”

  • Michael,
    Thanks for this article; hope is the most potent Rx, far more powerful in the long term than any antipsychotic, antidepressant or so on. It was interesting to hear the story about the combat nurse and the veterans you treated; shows the parallels between caring for physical wounds and caring for the soul.

  • edchilde,
    Great comment. Do you know about ISPS? (www.isps.org)
    You might be interested with your background.
    I’m also curious to ask you something… if you see this message please get in touch, I’m at bpdtransformation (at) gmail (dot) com. I’ve written quite a lot about psychosis, e.g. here –

    https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/

    https://www.madinamerica.com/2016/10/rejecting-medications-for-schizophrenia-narrative-part-2/

  • Julie,
    This is a great story; thanks for sharing. I really have nothing to add; what you say about the power of human connection and love being curative, and by implication the drugs/diagnoses/”treatments” often becoming deceptive, harmful diversions or impediments to following that path, is so true.

  • Dr. Epperson,

    This:

    “A growing body of research and practice is showing that the most effective, humane and mutually transformative way to help someone deal with unusual beliefs and experiences is not to deny, argue, institutionalize or drug them out of their perceived reality. Rather, it is to invite the person to talk about their beliefs and experiences, and actively listen without judging them or trying to modify their beliefs. Find out about their reality, and then look for ways to help them cope more effectively with things as they perceive them.”

    was the basis of Harold Searles’ approach to helping severely distressed delusional people at Chestnut Lodge in the 1950s/60s/70s… he said that unless the therapist could enter the regressed / severely distressed person’s worldview, and see things through their eyes rather than imposing their own viewpoints on that person, that a therapeutic relationship would not develop between the two.

    Searles wrote about this in books like “Collected Papers on Schizophrenia and Related Subjects”… in papers like, “Four Phases of Patient-Therapist Interaction in Psychotherapy of Chronic Schizophrenia”:

    https://www.amazon.com/Collected-Schizophrenia-Related-Subjects-Maresfield/dp/0946439303/

    I have also summarized these phases for less-disturbed people here:

    https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

    The most developmentally early of these phases, and the one in which it is most important not to impinge if internalization of a potentially helping outsider is to occur, is the “out of contact” phase.

  • Emmeline,
    Perhaps I was mistaken about that. It seemed like a few sentences had been softened the second time I read the article. But maybe it was all a “delusion” on my part.

    No doubt, if I did imagine these changes, the delusions could be attributed it to some undiagnosed and untreated DSM disorder that I still have. If only I could find the right pill for them 🙂

  • A lot of truth to what you say, Dee. However, the last time I looked on Amazon Whitaker’s book (Anatomy) had a much greater number of both total reviews and favorable reviews to Frances and Biederman’s books… take a look:

    Whitaker – https://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452425/

    Frances – https://www.amazon.com/Saving-Normal-Out-Control-Medicalization/dp/0062229265/

    Biederman – https://www.amazon.com/Adhd-Across-Lifespan-Evidence-Based-Understanding/dp/B000G0IPJM/

    Perhaps awareness is more widespread among the general public than we think. After all, John Read’s research shows that the public in most countries already disagree, on the whole, with psychiatrists on what are the predominant causes of distress (i.e. psychosocial versus biogenetic)

  • No, neglect and abuse can be and often are primarily emotional / relational; there is no inevitable correlate there with not eating good food.

    With poverty, there may be a link with poor nutrition, on average. But the psychological stress of being poor and unable to pay your next bill is something completely separate… and we don’t have as much data on poor nutrition causing emotional distress as we do, for example, about abuse and neglect causing it via the ACE studies and those cited in Models of Madness (John Read).

    Experiences of discrimination is clearly often a cause (in group studies) of severe emotional distress, as cited in the two sources above.

    Human problems are complicated and we can’t narrow it to one factor, I think we can agree. I am totally open to nutrition being important, by the way. I just don’t think we should go telling most people it’s the main cause of their distress, unless we somehow know that in a particular case. The research I’ve read in Read / ACE makes it pretty clear that traumatic experiences in the world and in relationships are often enough, alone or primarily, to cause emotional breakdowns. We are relating, experiencing creatures, not just bodies that eat food.

  • Richard and others have already said it, but yes, to posit that nutritional deficiencies are the causes of most problems in living is at best misguided and incomplete, and at worst a major distraction from other factors which cause distress, such as abuse, neglect, trauma, poverty, discrimination etc. The ACE study is quite clear about how these factors are linked to severe distress in adulthood, as are dozens of studies of serious distress by John Read and others.

    I think the essay above has now been modified and softened a little bit, but it’s still a pretty extreme position. That’s not to say at all that good nutrition isn’t very important and can’t in some cases be a large cause of distress. But it’s just one piece, and in many cases a small piece, of what contributes to distress in the general population. Overfocusing on some cases where nutrition is very important isn’t a justification for positing that nutrition is the sole or primary cause of distress of everyone in our society, as the original version of this article incredibly did.

    A thought example might be instructive: consider if someone had been confined in a supermax prison isolation cell for two years and was experiencing depression, hallucinations, and severe anxiety. One could replace their crappy prison food with the best organic nutrition available, delivered three times a day, but leave them otherwise totally isolated without any human contact for 23 hours a day. Does anyone seriously believe such a person would “recover” emotionally if they continued to live in that environment, despite having great food? Let’s get real here. Human relationships, meaningful work/activities, feeling part of one’s community, a connection to nature, exercise, creativity, and many other environmental factors are at least as important, and collectively often much more important, than simple nutrition. To overfocus on one factor is not doing us a service in the big picture.

  • Hi Jcotphoto,
    I’m honestly sorry about these difficulties; your son deserves a much better life.

    What I did to recover is told at the beginning of this piece:

    https://www.madinamerica.com/2016/09/rejecting-the-medications-for-schizophrenia-narrative-a-survivors-response-to-pies-and-whitaker/

    I also review a number of more hopeful alternatives at the end of this article:

    https://www.madinamerica.com/2016/10/rejecting-medications-for-schizophrenia-narrative-part-2/

    We also have a LOT of links to hopeful programs, approaches, and ideas for psychosis in the ISPS Learning Resources page here:

    http://isps.org/index.php/learning-resources/learning-resources

    I hope some of these ideas in the Learning Resources page are useful.

  • Madmother, thanks for commenting.
    I think the whole approach to psychiatric publishing which emphasizes numbers, statistics, measurements, labels, rather than qualitative exploration and experience is such a problem. There are many things that can never be learned from a number or label as opposed to having an experience or listening. But in the mechanistic empirical positivist approach to psychology, which reduces the mind to a disconnected thing to be studied in isolation, taking single quasi-experimental time points as if they were meaningful predictors about future people, the appreciation for experience and the subjectivity and unpredictibility of human beings is lost. Yes, even John Read and the Psychosis journal are subject to these pressures. I think their writing is better than most psychiatric journals – not that that is a great compliment – and think some of the pieces are genuinely good. Many of the individual authors contributing pieces to Psychosis are further pressured by their universities or supervisors to write in a quantitative, reductionist way. They could do much better. But I often think also they don’t even know what they are missing. I only have the view I do because I’m an outsider who self-studied these things and is not in academia nor a professional.
    Well done for fighting the system and protecting your family; I hope you succeeded.

  • Julie, perhaps you mistook my reference of ISPS for ISEPP? ISPS is the group The International Society for Psychological and Social Approaches to Psychosis… ISEPP is the International Society for Ethical Psychology and Psychiatry. I only discussed ISPS.

    I understand from experience your idea that professionals and experts can be very harmful. I do think that most of those in ISEPP are not that way, however, from my personal experience.

  • Steve, JR is not making a recommendation pro or con; he is just considering the question: “whether or not to soften our criticisms of psychiatry in the hope of reaching those psychiatrists whose minds are not totally closed. But doing so rests on the assumption that change can come from within the profession. For the last few decades examples of that are few and far between…. Therefore in the article below, published last month in the open access journal Future Science, we pull no punches.”

    From that quote, you can see he is actually doubtful about the usefulness of softening the criticism, and he then proceeds to very directly criticize in a multitude of ways.

  • That is an excellent distinction you make. I had not thought of that; thank you for bringing it up Mik. I will keep this in mind for the future.

    As usual, it is not so simple as there being either “those who are worse” and get into the system, and “milder cases” who don’t. As human beings, we are subject to nonlinear, complex, unpredictable inputs and feedbacks all the time. As you mention, one of the possible factors (out of thousands) is iatrogenic harm by the system. It is probably even true that some milder, less troubled cases (at the beginning) become “chronic psychotics” due to prolonged mistreatment and overdrugging by the psychiatric system. Whereas, other, more initially troubled people may get lucky and not get stuck in the system for very long, and find their way gradually toward wellbeing via other means.

    Thank you for reminding me how complicated it is and for highlighting how the system can do massive harm, a point that understandably does not come up in professionals’ narratives of what happens for suffering people, given the cognitive dissonance it would cause if acknowledged.

  • There are seriously distressed people who would recover with nothing more than community (i.e. human) resources, definitely. This happens over time in developing nations, as developed in the World Health Organization report on severely troubled people.

    Soteria and Diabasis are other related examples of that approach, of non professional supportive-general-social intervention proving helpful.

  • Mik, glad you found your own way out of the system. I have a similar story of rejecting professional advice and finding what worked for me.

    Treatment which is next to worthless in terms of producing better living and wellbeing is allowed to persist because it is extremely profitable (via drugging and hospitalizations) to select groups of professionals and corporations, and because it satisfies needs for social control of people society finds disturbing.

    Regarding the idea that those who recover are “lost to follow up”, this is what Slade and Longden were saying in their critique of the Jaaskelainen study that formed the centerpiece for the pessimistic statistics which Johannessen et al quoted in their introduction:

    “Sampling strategy, a.k.a. exposure bias — Jääskeläinen primarily took her sample of “schizophrenics” from studies of people entering hospital settings or in regular contact with services. As Slade states, “many people live with psychosis-like experiences outside of mental health services. Their ability to self-manage without attracting the attention of services indicates a lower level of severity and a higher rate of recovery. This means that people with less severe difficulties are systematically less likely to be present in the samples included in the Jääskeläinen review.””

    Courtenay Harding calls this “the clinician’s illusion”.

  • Hi Feelin,
    I think some people do realize this, but few within the system.
    Yes, of course, psychaitric professionals’ incomes and the business of mental hospitals are sustained by continual indefinite prescribing of drugs via psychiatric appointments, hospitalizations of distressed people, and so on. If people get better and come off drugs the money dries up.
    And then there’s the problem that when people do get well, they often turn around and say that their recovery had little to do with the drugs or with “managing an illness”, and much to do with addressing the real problems in their life and with rejecting psychiatry’s biogenetic ideology. Psychiatry highlights the few supposedly recovered people that believe in “illness management”, but John Read’s research shows that most of the public reject the notion that distress is primarily biological or genetic in origin.

    And I agree that Pete Earley is a sad case of someone who swallowed psychiatry’s disease model hook, line, and sinker, probably to the profound detriment of his own son.

  • Hi Feelin,
    I also have a Bachelors in English; good to see some English majors on here. But I also have a PhD from the School of Hard Knocks, like many of us do. I like to say that this latter degree is worth more than any degree in psychiatry or psychology.

    Regarding delusions, I have recently been considering that the entire operations of many mental hospitals could be considered to be a mass delusion – if one considers how far out of touch with reality are the professionals within in terms of believing (without evidence) that severely distressed people have biogenetic diseases, that tranquilizing drugs are “medications treating diseases”, and so on. It really is like an Alice in Wonder Land zone within psych hospitals when you think about it. But what treatment is there for the professionals?

  • Mik,
    Well done on getting out of the system, and glad you had some education and personal skills to help you.
    This is such a common and unfortunate thing – professionals trained in the disease model perceive only illness, and not the actual person sitting in front of them in their social context. They not only perceive distressed people in this way, but make it a reality for many people via their pathologizing and their ineffective “treatments”.

  • Hi Fiachra, thank you for commenting as always.

    I agree that these terms are so problematic. “Illness”, to me, is a lazy term used by people who are not able to, or don’t care to, understand what a person has experienced that has led them to be distressed.

    I also agree that psychosis is misleading and harmful word – in recent months I have warmed to oldhead’s criticism of my use of this term. I still use it sometimes because otherwise it’s hard to talk to people who don’t know any other terminology. But, I like much better the terms, “severe distress”, “soul emergency”… and just terms describing experiences like having strange ideas, seeing things, being terrified or paranoid, or whatever. People don’t “have psychosis”; they experience actual thoughts and feelings.

    Lastly I agree that neuroleptic is a better term than antipsychotic. Robert Whitaker uses the term neuroleptic well, although he also sometimes (and mistakenly in my view) uses the term “medication”, although he says he does it to communicate with professionals on their terms. Here is some background on the term neuroleptic that I found interesting:

    Neuroleptic: “a term coined to refer to the effects on cognition and behavior of the original antipsychotic agents, which produced a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients caused a reduction in confusion and agitation and normalization of psychomotor activity.”

    http://medical-dictionary.thefreedictionary.com/neuroleptic

    The definition also says that newer antipsychotics don’t produce these effects; however, I would say based on experience that they do. That assertion seems to me to be the old myth that newer generation antipsychotic drugs produce much better outcomes with less side effects than older drugs – in other words, a lie.

  • Hi Even, thanks for commenting. I think that “emotional pain-killers” is a great description of the function of antipsychotic drugs. It is in this way even clearer than tranquilizer or neuroleptic. Although, I think tranquilizers is also a pretty clear word saying that they dull people down generally, rather than treating any disease. But, best to be clear! I will remember this idea in the future.

  • J, thank you for your comment, although I actually disagree with some of what you are saying – although not with the spirit of it.
    First, I do not consider ISPS an organization of psychiatry. Many people within it are truly curious and progressive, and want deeply to understand and help distressed people, and do very good work. ISPS could actually be considered a fertile place for non-mainstream ideas to reach professionals. And ISPS contains a number of service users and family members who are very critical of mainstream psychiatric ideas. I think the article above is not a good representation of ISPS as a whole, at all.
    Also, I don’t believe psychiatry – if it were a person, which it isn’t – does not want people to recover. I think most people within the system simply are so lacking in understanding the flaws of the mechanistic, biogenetic paradigm of human distress; they simply do not know what they do not know. I do not attribute to most people a negative intent, although I see how people could feel that (and might be right in at least some cases depending on their experience).

  • Hi Steve,
    Thanks for your comment; I basically agree with what you are saying. ISPS does use some medicalized terminology, and the wing within the group that does it the most becomes seriously problematic in terms of reframing human distress as illness; the critiqued article is a good example of the type of terminology they use and the harmful assumptions it can lead to.
    When you speak about what John Read is advocating, what are you saying that he supports? I was not sure how to interpret those sentences. Generally, I like John Read’s critiques of psychiatry very much.

    I also agree that psychiatry as a medical profession should be afforded no credibility in addressing psychosis; their position on a supposedly biogenetic nature cause of psychosis is fundamentally mistaken; and precludes effective understanding and intervention with severely distressed individuals. The Johannessen article was not nearly as bad as many psychiatric articles in this regard; nevertheless, they still used far too much medical model and managed to come out with pretty pessimistic assumptions about the group as a whole.

  • Fiachra, I do not think we can say that delusional, paranoid, hallucinating, non-functional, or terrified people were “well to begin with”. Such people are usually in quite severe and profound experiential distress – although distress is not equivalent to disease or lifelong illness.

    But, perhaps you meant that here is really nothing “wrong with them” – but much wrong with what they have been through, whether it is trauma, neglect, abuse, discrimination, poverty, or some other combination of psychosocial stressors leading to a breakdown. If you meant this, I totally agree.

  • Franks for your comment, one I am genuinely very sympathetic toward. I agree that a fully recovered person has their own independent life and support system and does not require those in continued contact with “services”. And agree that the way to full recovery usually involves cessation and termination of “service use”.

    I also totally agree that if a bunch of professionals think the best they can do is 9-21% recovery, why would anyone go to see them? No one in their right mind would want someone so ineffective and pessimistic, with such low standards and so little hope for their “patients”. That’s why I often suggest to distressed people to think very carefully before visiting a mental health professional, and to ask them tough questions if they do. And that’s why I found it so disturbing to read the critiqued article purporting to be “the truth” or “the way it is” for people with whatever problems are described as first-episode psychosis.

    For me, learning to critique and reject the opinions of “experts” was crucial to getting better. I think the writer Paula Caplan, for example in her book They Say You’re Crazy – How the World’s Most Powerful Psychiatrists Decide Who’s Normal – https://www.amazon.com/They-Say-Youre-Crazy-Psychiatrists/dp/0201488329 – does a pretty good job laying out similar ideas.

  • Hi Richard,

    Thank you for your passionate comment and your generally impassioned and excellent comments. Let me say I hope to see another article from you soon.

    I totally agree with what you said here:

    “I am not suggesting that personal attacks or cheap sarcasm and snide remarks are the way to go here. But let’s face facts here, there is a serious clash of world outlooks (based in a class society) that have devastating consequences on the daily lives of millions of human beings… We don’t have time to be all “sweet” and “sensitive” about these life and death questions.”

    I remember that the late Pat Risser wrote an article called “Where’s the Outrage?” – https://www.madinamerica.com/2015/11/wheres-the-outrage/ – which evidenced similar attitudes to the need for urgency in seeking deep change as you do.

    I totally agree with this. Polite, gentlemanly critiques are far too easily dismissed by the powers that be as “well-meaning, but uninformed”. I believe that stronger confrontations which not only do battle with data, but also fundamentally challenge the whole ideology and the assumption base (of which terminology is a large part) are needed.

    I am not even sure if I would call Johannessen’s article Critical Psychiatry, by the way. To come out and say that only 9-21% of “first episode psychosis” people will recover – in denial of more effective approaches, and ignorant of the fact that quasi-experimental research and the limitations of psychological researchers do not allow to state such an idea as if it were a fact or universal law – to say this is astounding, with its implications that up to 91% of people may mechanistically fail to recover. And it is potentially harmful both to professionals and any unfortunate service users or family members that may read it. That is why I spent 4 hours yesterday writing this article, in time I could have been spending with my family or doing something else fun. Because someone has to say something, and they have to say it loudly.

    One personal admission – the first version of the article above (mine) was even more confrontational and direct, because I feel quite strongly about how the ideas in Johannessen et al’s piece may cause harm. The version above is the “lite” version that Emmeline helped me write. But I think it is still more than clear and direct enough.

  • Hi John, thanks for commenting. In ISPS, there is a split between some who are trying to move more fully away from the medical/disease model, a group in which I include myself (although I know some here would still critique me for not doing so enough), and others who continue to use mostly medicalized language and treatments but do so under the guise of being progressive and gradually changing the system. This article represented in some ways a critique of that latter element within ISPS. In perspective, I think it is hard for people who have grown up working in psychiatric hospitals and received medical education (to become psychiatrists) to know how others may perceive their use of medicalized terminology and assumptions, sort of like how it is hard for a fish to know it is swimming through water.

    The journal the Johannessen et al article was published in is not actually an ISPS journal; it’s another journal which is more traditionally psychiatric. However, it is disturbing to me that one of the ISPS Executive Committee members is involved in publishing a recent article using some medicalized terminology and promoting such a pessimistic, limited viewpoint about the potential recovery rate for “first episode psychosis”, invalid, vague term as that is.

    The ISPS Journal, Psychosis, is published by MIA Author (and ISPS member) John Read and others: http://www.tandfonline.com/toc/rpsy20/current

    Although this latter journal still uses some medical terminology, I think it does a much better job of focusing on psychological and social ways to help people and on being more hopeful. I recommend people to check the Psychosis Journal out.

  • Dr. Ragins,
    When you speak to young people about psychiatric diagnoses, do you let them know that psychiatric diagnosis is utterly lacking in validity, has no explanatory value, and has worsened in reliability over time?
    When you discuss “medications”, do you openly speak about how psychiatric drugs are not fundamentally different from other generally psychoactive substances such as marijuana, cocaine, heroin, and other street stimulants, downers, and uppers… and that these compounds do not in any way constitute medications treating a specific “illness”?
    And when you use the term “mental illness”, do you really believe this is a valid way to talk about your fellow distressed human beings?

    In my view, here is a better view of the profession to present to your students, from John Read:

    https://www.madinamerica.com/2016/03/in-search-of-an-evidence-based-role-for-psychiatry-2/

    Starting Quote: “While psychiatrists everywhere are doing their best to help people, their profession is in crisis. Psychiatry is struggling to defend itself from multiple sources of critique, and to reassert its future role. One possibility that is taboo for any profession to consider, however, is that it has little or no useful role. That possibility must be contemplated by others. An evidence based approach to evaluating what good psychiatry contributes to mental health services in the 21st century leads to some challenging conclusions.

    Psychiatry’s crisis is evidenced in many ways. Most blatant is the international outpouring of criticism at the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [1], its latest attempt to categorize human distress into discrete psychiatric ‘disorders’. The fact that the attack on the poor science involved was led by the editor of the fourth edition [2], and the Director of the USA’s National Institute of Mental Health [3], was embarrassing.

    It seems psychiatry is now held in low regard by other medical disciplines. Medical students in numerous countries are uninterested in psychiatry as a career, seeing it as unscientific and ineffective [4]. In one study only 4–7% of UK medical students identified psychiatry as a ‘probable/definite’ career choice, partly because of its poor empirical basis [4]. In a recent survey over 1000 nonpsychiatric medical faculty members, at universities in 15 countries, “did not view psychiatry as an exciting, rapidly expanding, intellectually challenging or evidence-based branch of medicine” ([5], page 24). A total of 90% believed that ‘Most psychiatrists are not good role models for medical students’. The most negative opinions were expressed by neurologists, pediatricians, radiologists and surgeons…”

  • I do want to support what another commenter said about the lack of validity for the label “bipolar disorder” – let alone generational or hereditary bipolar. The human genome did not evolve to reify or transmit invalid DSM diagnoses.

    MIA author Jay Joseph has some excellent essays about why twin studies and other gene investigations do NOT support a genetic basis for schizophrenia, bipolar, or other related “illnesses”/severe behavioral-emotional problems.

    https://www.madinamerica.com/author/jjoseph/

  • Emily,
    Great job! This is a fantastic story. I have read your story in more detail on the Jewish Currents site and was impressed with how you spoke out from the first time I read.
    I totally agree that speaking out and being an example that people who’ve been traumatized by the system can come to to tell their story, privately at first… is so valuable and needed. Well done.

  • Ok, again you made an assertion, “The bodily system of the central nervous system is CASUAL, but the endocrine system can be contributing component to schizophrenia as well.” – but you give no data, no links to studies, no evidence or explanation for these opinions.

    Why should people believe you if you cannot back up your assertions?

    And perhaps you meant “causal”, not casual.

  • pathayes,

    If you have actual data beyond opinion which explains how misfiring nerves cause schizophrenia, please present it here. I think most readers know that that data doesn’t exist, which is one reason why the diagnosis of schizophrenia lacks validity – being a label under which two people can have no symptoms in common, but still receive the same “diagnosis.”

  • pathayes, you haven’t made any actual arguments nor presented any evidence with your comment.

    Of course we all have a nervous system.

    And yes, our brain chemistry changes constantly in relation to the environment.

    You said the nervous system is “a reason” – for what? Perhaps for your idea that “mental illness” has a biological component? If so you need to clarify that and explain how the nervous system can cause mental illness. You didn’t do that.

    What you haven’t presented is any evidence that changes in brain chemistry are the cause of distress, rather than the expression or correlation of interaction between organism and environment.

    Meanwhile, I presented admissions from leading American psychiatrists that DSM disorders lack validity, have no established biomarkers, and that there is not clear evidence of biogenetic causation for these problems. But you didn’t seem to acknowledge or respond to that… isn’t it more powerful when the leading people within the profession admit that lack of evidence?

  • Or rather than a fool disagreeing, perhaps former NIMH directors Steven Hyman:

    “The underlying science remains immature…The molecular and cellular underpinnings of psychiatric disorders remain unknown… psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials.”

    and Thomas Insel:

    “The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

    … offer a different view on the biological side of mental health challenges.

    The fact remains that while all of our experiences are expressed in biology and epigenetics, there are no biomarkers for any DSM disorder, nor any evidence that changes in brain chemistry or epigenetics are causal for – rather than correlated with – behavioral and emotional problems that get labeled as mental illnesses.

    Perhaps you can define more clearly what you mean by “a biological component”…

  • The level of deception and misleading intra-group reassurance within the psychiatric establishment is startling and stunning… or perhaps not so much when we think back to how staunchly tobacco execs resisted acknowledging the harms of their immensely profitable product decades ago. Profit over people.

  • Hi Oldhead,
    Thanks for your comment. While it may not correlate with my being right, I have felt from my reading about people experiencing delusions / hallucinations / withdrawal etc (experiences that get these severe labels) that there are commonalities (at the group level) in terms of the people having experiencing a lot of neglect and/or abuse, when I read their stories either in the first-person or from the third-person view of someone relating to them. And then there are some commonalities in how seriously distressed people react – they have trouble with making trusting relationships, trouble with functioning independently in a confident manner, trouble dealing with high levels of terror/rage, etc. It would be strange to me if there weren’t some commonalities, since people do have common tasks to deal with in growing up and navigating the world and relationships, and since as human beings we tend to react to threatening things by, perhaps obviously, becoming afraid and upset.

    Do you think that’s incorrect?

    I see your view too. People are very variable and applying any of these labels to an individual doesn’t mean much at all.

  • Noel,
    The Soteria project (https://www.power2u.org/downloads/SoteriaMosher1999.pdf) is quite similar in how it was run to the 388 Project which still runs in Quebec, Canada:

    https://www.youtube.com/watch?v=mmqT-4W4Cvg&t=24s

    http://gifric.com/388.htm

    I did not realize this link before for some reason prior to read your article. 388 has had, and still has, results similar to Soteria for French-speaking Canadian people experiencing psychosis.

  • Noel,
    Good to see more deep thinking from you… it had been a while.
    I’m always impressed by how you cite a range of interesting sources, and keep finding new ones. It reminds me of someone I know 🙂

    Now, being a bit more humble, I do really like this essay.
    I’m becoming a bit more open to the idea that the suffering aspect of psychosis itself could be transformative, which is difficult for me to see because it was not my experience. However, the fact that things are rarely all-bad suggest that it’s quite possible that some adaptive or possibly useful results may come from a psychotic crisis. It’s like the Chinese word for crisis, meaning opportunity.

    I still remain of the opinion that the most important thing for healing is genuinely supportive, close relationships which support the psychological self and gradually allow it to be freed from the negative thinking/feeling/behaving it is caught up in. But such a statement can only be made very generally, because psychosis or schizophrenia are very vague words and the nature of people’s problems varies a lot from person to person. Still, I like to think about the developmental continuum in which all-bad internalized experience (partially based on neglect – almost always some neglect or lack of needs met – and then sometimes also based on added trauma or abuse) is key to understanding the disturbing thoughts/feelings and behaviors that get labeled psychosis.

    Of course as you rightly point out, psychiatry mostly does not understand, or will not acknowledge the factors pointed out in the sentence above. Thus it is important to keep pointing it out – and to point out a range of ways of looking at the problem, as you do in this case by exploring other cultures and how they understand unusual experiences differently, as well as psychedelic drug use.

    Thanks for this great article.