Svava, Great story and very courageous of you to speak out about all you experienced. It is also good to see that people from far away, without English as their first language, are finding MIA and speaking up. I hope you’ll write here again.
Great story and very courageous of you to speak out about all you experienced. It is also good to see that people from far away, without English as their first language, are finding MIA and speaking up. I hope you’ll write here again.
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…
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.
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.
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.
Great writing here; it’s fantastic to see your voice speaking so clearly and authentically about this difficult experience and what you can learned from it that can help other traumatized people, well done.
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.
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.
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.
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.
Nice article Sascha, thanks. Some very interesting thoughts and impressions you had. I posted a link on the ISPS listserv.
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:
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
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.
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.”
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.
Well, apparently not everyone shares your opinion.
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…
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.
How about “Exercise Reduces Depressive Feelings” – because the last time I checked, major depression was not a valid disease entity.
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:
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.
Why are antipsychotics used in nursing homes anyway? That would seem to be the first question…
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.
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.
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.
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.
I agree, “it” isn’t a thing. I will make this point in future writing.
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.
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.”
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.
In other news, plants grow taller when they get more sunlight
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 –
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.
“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”:
I have also summarized these phases for less-disturbed people here:
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.
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 🙂
I should say the correlations between discrimination / abuse / neglect and severe distress are so strong as to look like virtual causes. That is how this type of quasi-experimental research actually works.
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.
Elizabeth, How could you know that “no one was suffering with serious mental problems” around the year 1650 AD?
Let’s give some citations for our “facts”, please…
I thought Hoffer had been exposed as a fraud? Can anyone else comment on this.
See here for citations – https://en.wikipedia.org/wiki/Abram_Hoffer#Controversy
It seems even Thomas Szasz thought he was a quack.
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.
Great article. Thanks for having courage to post your thoughts about your own treatment and about professionals here. Hope you will write more on this topic.
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:
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 , 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 , and the Director of the USA’s National Institute of Mental Health , 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 . 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 . 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” (, 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…”
Joanne, why do you think people presume that “mental disorder” is a useful term conceptually? Why not consider that distress of varying degrees and understandable and expectable reactions/adaptations to varying degrees of stress, rather than abnormal responses or aberrations from “normality”?
Thanks Bob; this was a very interesting and engrossing investigative-journalism style read.
Excellent article Niall. Love how you tell it is like it is.
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.
Nice to see another perspective here – thanks for having courage to read alternative narratives about what causes some people’s distress.
Wow great ideas Kjetil
Nice work Eric – good to hear about this. Thanks for putting in lots of time and effort.
Excellent as usual, Phil.
I would add one more practical suggestion: http://www.meetup.com can be used to relatively cheaply create a group in your town or city dedicated to exposing and criticizing psychiatric concepts and supporting people in finding alternate sources of help.
For example here is the new Pittsburgh Antipsychiatry Meetup – https://www.meetup.com/Pittsburgh-Antipsychiatry-Meetup/
Great article David; thanks for your honesty.
How about, any century now?
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.
We’re still waiting for you to post your first actual citation or even a single piece of evidence supporting any of your claims…
Where is the evidence for the strong biological component as causal for schizophrenia?
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.
Well done Robert great news!
Very well written Daniel. Thanks for spreading the word about psychiatry. And good to see you on here.
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.
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:
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.
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.
A sad story worth sharing – thanks for writing it so clearly and well Suzanne.
Excellent article James… good to see a the case laid out cogently and clearly like this, about what is really going on behind the scenes with the drug prescribing epidemic.
Calling it “involuntary psychiatric care” is a misnomer, due to the use of the word “care”.
What bothers me the most is that psychiatrists not only forcibly give drugs, but also mislead families and clients that these drugs are “medications” treating specific “illnesses” (e.g. schizophrenia / bipolar), even when no biomarkers exist for these supposedly discrete pathologies, and there is no clear evidence that severe distress caused by biology/genes primarily. So forced treatment can become a pathway along which people get led into becoming a chronic patient / a believer in the brain disease model.
Psychiatrists should present their pills honestly as tranquilizers / numbing agents, which are exerting generalized effects without specifically treating any “illness”. They should admit how little is known about psychiatric diagnosis and that diagnosis lacks validity and has poor reliability.
And of course they should not force people to take drugs, let alone misleadingly frame these drugs as medications treating a brain disease.
Seclusions / restraint is another issue. I remain open to the idea that if someone is violent and about to harm another person, they should be forcibly restrained or secluded for at least a limited time. But as Oldhead wrote, this is a matter of violence and a legal response to it, not the province of psychiatry and its invalid diagnoses and questionable treatments, the latter of which should always involve choice as to whether a person wants to accept them or not.
You said at the end what I was thinking from the very beginning of your article:
So much more could be offered.
Psychiatric involuntary commitment is a relatively minor issue when set against the backdrop of so little resources being available to help seriously distressed people in the USA outside of drugs. In terms of job training, affordable housing, individual therapy, family therapy, etc, the availability of these psychosocial resources – which in many cases could prevent the need to even consider committing someone – is sorely deficient by an order of magnitude (10x) or maybe even two orders of magnitude (100x).
Involuntary commitment also makes only a small difference because it typically means locking someone up for only a few days or weeks. Not everyone is harmed, but many are harmed by being started on too many drugs and being traumatized by the force used. For those who are not harmed, like the woman who appreciated her experience, they might be kept safe, but a few days or weeks are usually not enough to address all the life circumstances that may be contributing to serious distress.
And lastly, this part was also important,
“When one is raised, so to speak, in a world in which these problems (paranoia, heightened disorganization of thought and behavior, marked elevations of mood and energy) are known to be illnesses, then the examination of the problem starts, in my view, midway down a road. The questions asked have to do with how to best treat the illness over the person’s objection. If, however, one starts from a premise of uncertainty — accepting that these are complex situations whose cause and etiology are unknown — then one might be more cautious about jumping into framing the problem as one of access to treatment.”
I continue to be amazed to see psychiatrists writing about serious distress as if it were a brain disease, even in the lack of any objective evidence/biomarkers of biogenetic causation. It seems like this is the hallmark of thinking for most in the field: Assume your conclusions.
I guess when you need to frame problems as illnesses to make your living and feel justified in prescribing drugs, that is what you do. But to me it is unethical and an example of living an unexamined professional life.
Let’s be straight here: calling someone’s words “egotistical” and “machismo” is making it personal, rather than discussing the issues. Again, let’s discuss the issues at hand rather than making assumptions about each other.
And I said, “it would be powerful” if more people spoke out publicly… and that … “In some cases it is indeed too risky, due to threats like job loss, repercussions from the system or from family, and so on.”
So at the beginning I explicitly acknowledged that there are some situations where it’s not possible or desirable to speak publicly; that dosen’t sound like pressuring people to me.
AntiP, I agree. Relative to your points about journalists, if I lived in certain countries or settings I would not write online publicly or under a real name. But living where I do, being in the US and not currently involved with the psychiatric system, I feel it’s a calculated, worthwhile risk.
Oldhead, there’s no need to respond in such a negative way.
Many authors on this forum with experience of grave harm from psychiatric treatment have decided to publish and comment under their real names, such as myself, Tina Minkowitz, Rai Waddingham, Sera Davidow, Caleb Chafe, Laura Delano, Chaya Grossberg, Corinna West, Rufus May, and others.
I’ve been free of psychiatric treatments for a long time, fortunately.
Absolutely, people’s opinions are just as valid if they are made under a pseudonym or under their real name.
You don’t know what I experienced or did not experience in the system, so should not assume what I know or don’t know. Hint: it was pretty vicious. You also don’t know the specifics of my personal or financial situation.
The part where I spoke about courage was intended to say that sometimes, people choose to make difficult decisions that feel risky at the time, such as the choice to speak out publicly against psychiatric treatment. To do that takes some guts, but it may also have benefits such as showing that it’s possible to talk about difficult experiences in the psychiatric system with less fear and/or less shame. And it may inspire others.
To not do it, is equally an option and sometimes a wise and necessary one, as you wrote. You interpreted my comment as criticizing other people generally, but I did not intend that, as can be seen in how I answered other people.
I hope you will appreciate that I responded to your comment without making negative assumptions about your own motivations or impugning you personally.
Kindredspirit, thanks for sharing this story… sorry to hear about the incredibly irresponsible therapist and what that put you through.
Again, I think people should do whatever they feel necessary to stay safe.
Having said this, many people, including many authors of MIA articles here like Olga Runciman, Eleanor Longden, Caleb Chafe, myself etc, eventually reach a point where they feel free enough emotionally and financially to speak up publicly about their experiences. I think this is a positive thing, because there should be no shame in having receive invalid psychiatric diagnoses, having taken drugs (however one thinks about drugs), having been harmed by treatments which one didn’t want, etc. And so I hope more people will do this.
Cat, it is difficult to admit these things publicly, but I think there is nothing wrong with making mistakes and having been hurt when we didn’t know better. It’s nothing to be ashamed of. I also took psych drugs, was afraid of the idea of incurable mental illnesses, etc, at one time in the past. It’s ok… sometimes we make mistakes, and now we know better.
Having said this you should do whatever you think is best. I like your posts and think your online consciousness-raising is very valuable. I also like the humor in some of your posts as that is very therapeutic when people are seeking relief from a system as oppressive as mainstream psychiatric treatment… so well done.
Rachel, I hope you will become freer soon and more able to speak up as you wish.
I only considered speaking up publicly once I had moved away from my family to live independently, stopped taking all psych drugs, became established and secure financially. There is a certain base level of resources and self-sufficiency that is needed to limit that risk that comes with speaking out publicly about such difficult issues as psychiatric diagnoses and treatments one has been through.
I think if more people here would speak up about injustice using their real names with actual photos, it would be powerful… as do people like myself and Frank Blankenship and Tina Minkowitz. If so many people are commenting under pseudonyms, it speaks about how afraid many of us are to be seen and say what we have to say publicly.
In some cases it is indeed too risky, due to threats like job loss, repercussions from the system or from family, and so on. In other cases, the fear is mostly a perception, and if a person starts speaking up under their real name, nothing that bad will happen. The latter has been my experience. So, let this be a challenge to others to come out from the shadows if they feel they can, and if they have the guts to do so.
What is dishonest is that no mention of the Big Pharma funding is to be found on the site… or maybe I didn’t look hard enough to find it. But sites need to be honest and list where they are getting their money from:
Nothing there about pharma funding. Maybe the money spigot hasn’t been turned on yet, but if and when it does (is it already on?) there should be full disclosures.
And the CEO’s response totally ignores the content of what was said to him about the reasons for leaving. It’s not very genuine, to me.
But how could this be the case?!
There are no conflicts of interest in psychiatry… only confluences of interest 😉
Great article, Danny. Thanks for coming in here. I have gone through similar experiences to you in questioning and moving away from mainstream views.
I have done a lot of questioning of the “illness like any other” model myself. I find people are often threatened by it being questioned, and also cannot imagine that what they have been told about the causes of their distress might be so mistaken (i.e. it’s embarrassing and disturbing to even consider how far off the mark the explanations many people are given about, for example, schizophrenia, are).
Please check out a few resources that are not drug-company funded and which question mainstream diagnoses:
Drop the Disorder – https://www.facebook.com/groups/1182483948461309/
ISPS and its forum – http://isps-us.org/ and groups.yahoo.com/neo/groups/isps
ISEPP and its forum – http://psychintegrity.org/ and https://groups.yahoo.com/neo/groups/psychintegrity/info
Questioning the disease model and talking about difficult experiences is the norm on these forums… as it is here.
Occasionally I try to talk to mainstream online psych forums in a way that questions the medical model, and often it has very mixed results; for example here – https://forums.psychcentral.com/schizophrenia-psychosis/466042-interview-psychologist-lloyd-ross-treating-schizophrophrenia.html
But I was encouraged because when I shared these views around the internet recently, only one forum out of many banned me, and that is a forum that is committed to telling people they have a brain disease and have to take drugs.
I think people are hungry to hear other more hopeful views than the brain disease and have to take drugs one.
There is a way of thinking about serious distress that goes from, roughly…
– a “younger”, more developmentally early, less mature way of thinking and feeling, sometimes called presymbiotic phase, and which involves seeing things as all-good or all-bad, and confusing what is oneself and what is other people
– through various phases up to an older, more mature, more integrated/ambivalent way of processing relationships and situations (called individuation / separate sense of oneself and other)
I think there is some reality to these continua in how people experience their relationships and lives, very generally speaking. Mahler, Stern, Schore, and others who’ve seriously studied mothers and children and what helps children grow up to be fulfilled adults, have done good studies of these ways of relating and not pathologized the problems as much.
The question is what to call these experiences, and how talking about it can not be destructive to label or discuss common experiences.
This is a great post – nice to see a broad 30,000 foot view of options that can help with emotional distress. The key point I took away from this is that drugs are just one option among many, not the centerpiece of treatment necessarily – and this should include experiences that get labeled “schizophrenia” and “bipolar”, in my view. From reading most mainstream material, you would think drugs should be 70-80% of the treatment for serious distress… whereas really, they should probably at most be 10-20% (or sometimes 0%) of an integrative approach that addresses what can help a person in many spheres and on many levels.
One criticism – DBT may have more short-term research due to its branding, but it’s not necessarily better in any way over the long term for people labeled “borderline” (a meaningless, vague label anyway) than other approaches. A lot of survivors hate DBT because of its concretization of labels and its directive, simplistic approach. So I don’t think you should put it out there as the primary approach for a vague label like this. Here are a couple of ways to rethink this issue:
– Intensive Long-Term Therapy can have really good results for trauma that gets labeled “borderline” – https://bpdtransformation.wordpress.com/2015/02/13/22-proof-that-borderlines-are-motivated-for-psychotherapy-and-can-fully-recover/ – no DBT study has these kind of long-term results over years, that I’m aware of.
– BPD should be abolished as a label and replaced by a more continuum-based, non-stigmatizing way of describing serious distress: https://bpdtransformation.wordpress.com/2015/06/26/26-why-bpd-should-be-abolished-and-what-should-replace-it/
These links above are from my personal site about part of my traumatic experience.
Borderline Personality is not a thing people have, just a flawed label for experience people may have at one time and become free from later. These labels are a conundrum and most of the studies on them are, admittedly, biased in various ways by the observer’s input.
The problem is that that the word “merit” makes it sounds as if the word “schizophrenia” is something that people deserve or earn… almost as if the label schizophrenia were valid or accurate, and as if such a label was worthwhile. In reality, two people can “merit” this label while having no experiences in common. It is largely arbitrary and subjective. Not to mention extremely harmful given the assumptions attached to this outdated word.
These labels are just so problematic.
Yes Sandra, I urge you to reconsider the language, “those who merit the diagnosis of schizophrenia”.
Nobody merits or deserves such an invalid, outmoded, harmful, misleading label.
“I wonder what leads Robin Murray to acknowledge his mistakes when others seem to hunker down.”
Well Sandra, as Upton Sinclair said in the early 20th century, “It is difficult to get a man to understand that ‘schizophrenia’ is not an illness and that antipsychotic tranquilizers are not ‘medications’, when his salary depends upon his not understanding these facts.”
Or is that a misquote? I’m joking… but perhaps once they come to the end of their career, it becomes a bit easier to acknowledge mistakes.
From an outsider perspective like mine, it seems obvious that it would be much easier to admit one’s mistakes once one’s living has been made and one’s retirement has been funded, as in Murray’s case (given that he’s in his mid 70s). It’s still good of him to admit to mistakes, but less impressive – and perhaps from another perspective less foolish and risky – than for a younger man. In his case, speaking out involves primarily humility, which is a good thing, but not risk. But for younger psychiatrists, speaking out could involve being unable to pay their mortgage, not being able to send their kids to school, not being able to fund their retirement, etc… who would take those risks?
Regarding this, “The idea that antipsychotic drugs treat a specific pathological process inherent to all who merit the diagnosis of schizophrenia simply makes no sense. And yet these compounds seem fairly consistently to reduce the intensity of voices and lessen the intrusiveness of unusual thoughts.”
This is where I think it would be helpful to simply name most of these compounds as tranquilizers or deadeners. People will not do that, perhaps because they don’t want to face the reality that we are silencing our fellow humans en masse by loading them up with numbing agents that block their ability to think and feel… treating them, in some cases, almost like non-human animals or cattle. It’s not a very attractive picture. The euphemism that we are giving them “medications for schizophrenia” protects the self-esteem of professionals and prevents us from facing how inadequately such people are really being treated.
More broadly, the need to frame antipsychotic drugs as “medications” treating an specific disease process, and the need to overfocus on biology, must be traced directly back to the profit motive for both psychiatrists and their benefactors, the drug companies. I discussed these factors in my essay last year:
“This bio-genetic focus is understandable when one considers that primarily bio-genetic explanations of psychosis have numerous “advantages” for the psychiatric profession, in that they:
1) Support the illusion that psychiatrists are treating well-defined brain diseases in their privileged role as medical doctors;
2) Justify the use of tranquilizers, euphemistically named “medications,” to treat the supposed illness;
3) Protect psychiatrists and allied mental health workers from having to get to know psychotic people intimately as individuals, a process which often involves encountering uncomfortably large amounts of confusion, terror, rage, and despair;
4) Allow for shorter sessions and more profit per hour worked – it is much easier and more lucrative to give someone a pill after a 15-minute evaluation, than to sit and talk to them for an hour;
5) Allegedly protect parents from being “blamed” for contributing to their child’s psychosis despite the fact that biological models actually encourage prognostic pessimism, and obscure the obviously uncomfortable fact that not all, but many parents of psychotic individuals have abused and neglected their children, as pointed to by the studies connecting trauma and psychosis”
Lastly, Sandra, you might be interested to check out how George Soros picked stocks in his early career. He studied the thinking processes you describe and tried to interrupt his own processes of easily assuming which stocks were best by reading many contrary views – i.e. constantly challenging himself by reading both the supporters and critics of ideas about different companies. In this way he stopped himself from becoming too enchanted with any one view. I read about this in an interview, but I don’t have the link.
Another good book on a related subject is Future Babble, in which cautious thinkers who think along ranges or continuums are more accurate in making predictions than more certain thinkers who try to make precise prognostications.
Hi Fiachra, thank you, I do not have personal experience of this phenomenon but don’t doubt it is possible from reading the experiences of others who were withdrawn abruptly from drugs and then experienced sudden recurrence of their distress. Disturbingly, leading American psychiatrists during the 1980s and 1990s actually proved that such experiences are possible, via conducting unethical experiments in which they suddenly withdrew patients from their drugs cold turkey.
Hi BCharris, thanks for commenting. I think Lloyd is actually open to the idea that other causes of severe distress exist and that in some cases they could be directly physical or caused by adverse substances one ingests, as you felt yours to be. Severe distress can be caused in a variety of ways… among the ways that come to mind that are known to be heavily associated with the “symptoms of schizophrenia” (i.e. delusions, hallucinations, voice-hearing, paranoia, withdrawal) are…
– prolonged torture
– prolonged isolation
– taking various illegal drugs
– heavy use of cannabis
– unbearably painful surgical procedures
– other hallucinogenic substances like you describe
– various adverse social experiences like sexual abuse, extreme neglect, physical abuse, bullying, severe poverty and hunger
I think Lloyd is just focused on trauma because that is primarily what he worked with. It doesn’t he excludes other possible etiologies. Also, I would have to support Lloyd and say that the research seems to suggest that traumas of various kinds are some of the most common experiences raising the risk of getting one of these diagnoses… this does not mean, however ,that traumas are present in every case or are causal in a given case.
Hi Liz, thanks. When I reviewed the text of Lloyd’s talk I sensed some of it would be controversial. But I’m glad some people like it despite the somewhat blunt parts. In knowing him a bit personally, I like how Lloyd is reallyhonest and will always tell you what he thinks in a very straightforward way. He says that’s how people from New Jersey are in general. I don’t know whether that is true or not 🙂
I would imagine that people who work with or stay with Lloyd tend to be those who are more willing to talk about traumas and discuss troubling feelings around their experience in the world. So it’s possible that Lloyd’s views could partly reflect the type of work he does best, and the people that tend to gravitate toward and stay with him as clients. That would only be natural – all of us have preconceived ideas / schemas / internal object relations based on our unique experiences… these affect how how we represent the external world, and inevitably affect our worldviews by causing us to attract some things and repel or be unaware of other things.
Thank you for commenting.
In hearing from various parents and family members I have been forced to reconsider what I thought before about trauma and psychosis… I once thought some form of trauma was the cause of severe distress in almost all cases. Now I see that it’s more complicated. It’s by no means primarily the parent that causes what gets labeled as “schizophrenia”, of course (although in some cases, abusive parents are a large negative influence, unfortunately, although they should not be blamed since the parents themselves are often subject to secondary adverse psychosocial factors).
But more than this, in some cases we simply do not know why someone becomes delusional, withdrawn, paranoid, or hallucinates. It may be partly due to some fragility in their personality which makes them susceptible to stress – although I would say that this is never the ultimate cause… it’s always some interaction between the environment and the organism that leads to the expression of severe distress. However we always divine what that interaction is or how it works. It is hard to follow the causal chain from proximate causes to ultimate causes. Perhaps biology, the way the mind and the brain it depends on interact with the environment, and the way a distressed person conceptualizes the world, are simply too complex to untangle precisely in some circumstances.
Happily, I think what you say is quite true – healing human relationships can help even if we do not understand the ultimate or even proximate causes in toto of serious distress. Luckily, human beings are primed to respond well – although it may take some time – to things like safe environments, having enough money, genuine interest on the part of another, a non-intrusive other who listens and waits, being in nature, exercise, and so on. So even with a severely distressed person where causes of distress are not apparent, there are many ways to help.
I am glad to hear your son is doing better.
I do not think psychosis is a disease. It’s just a vague label for severe distress which can have any number of disparate causes. I only use it reluctantly… because I want outsiders, who do not know other ways of thinking about problems in feeling / functioning, to find such a piece in the first place. The terms I use in my own mind are things like “serious distress”, “soul emergency”, “pre-symbiotic ways of relating”, “regressed mental states”, “being in terror” and so on. More relational, experiential and soul-focused.
When it comes to Lloyd and his uses of these words, I obviously did not tell him what to say. I believe that when Lloyd was trained in the 60s/70s, that “schizophrenia” was commonly used in training psychologists how to think about and communicate about severe distress. That is probably still the case, so Lloyd is simply using the words that he was originally taught by his teachers to think about delusions and hallucinations. But, you can see in how he speaks about it that Lloyd doesn’t really believe in any underlying illness in a person who is diagnosed as being supposedly schizophrenic.
I am glad you enjoyed reading some of Lloyd’s thoughts. I like how Lloyd is very direct in what he says. Since he was always someone with a private practice, he doesn’t have a boss or company controlling him and so can be forthright with his opinions.
Hi CatNight, thanks for checking in. I don’t know this Aeuspcalian authority concept and would be interested to read more if you have references.
I agree, it can be easy for things to go wrong when attempting to help a severely distressed person… for example, if the therapist is inexperienced, or if they have serious doubt about whether successful therapy is possible, or if they are poorly trained… or, if the family of the client is unsupportive or abusive, or if there is not enough money to do therapy long enough or frequently enough for what an individual wants or needs. Any one of these things alone could negatively influence or derail a psychotherapy relationship. On the other hand, many good treatments do happen, and few of them are reported or ever known due to confidentiality. What we hear about in terms of good (and perhaps bad) treatment must be the tip of a huge iceberg. Although, good and bad experiences in therapy are also relative, and therapies can (and I would argue almost always do) contain both aspects.
When you say “giving power” to a professional, I would refer to this as being dependent upon someone who is in a more powerful, quasi-parental role. I think this can be helpful or harmful. In a positive sense, being dependent on a person who is genuinely committed to your best interest, and is loving, can be very helpful. This is what happens in normal childhood development – the young child depends on the parent emotionally for support. In a successful therapy of severe distress / psychosis, this process is crucial (it’s called a “therapeutic symbiosis” in the Mahlerian, or Searlesian terminology). On the other hand, if such dependence goes on too long it can be harmful. Or if the client becomes trusting but then the therapist makes serious mistakes and betrays that trust, that can be very harmful.
These possibilities for better or worse do not say anything inevitably or essentially negative about psychotherapy, in my view. Psychotherapies are a variety of human relationship. And human relationships have innumerable variations and no two are alike.