Wednesday, April 26, 2017

Comments by Matt Stevenson

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  • Hi Lynne,
    This was an interesting article.

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

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

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

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

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

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

  • Robert,

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

    I will add a few points to yours:

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

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

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

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

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

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

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

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

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

  • Nice article Sera. Regarding this paragraph:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Dr. Epperson,

    This:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Hi Fiachra, thank you for commenting as always.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Hi Richard,

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

    I totally agree with what you said here:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    And perhaps you meant “causal”, not casual.

  • pathayes,

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

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

    Of course we all have a nervous system.

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

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

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

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

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

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

    and Thomas Insel:

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

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

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

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

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

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

    Do you think that’s incorrect?

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

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

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

    http://gifric.com/388.htm

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

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

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

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

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

    Thanks for this great article.

  • 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.

  • Sandra,
    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.

  • Oldhead,
    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:

    https://themighty.com/who-we-are/

    https://themighty.com/our-team/

    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.

  • 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.

  • Oldhead,
    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.

  • Craig,

    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.

  • “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.

  • Hi Rossa,

    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.

  • Hi Oldhead,
    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.

  • Thanks for commenting, Fiachra. What exactly were you referring to with what Robin Murray say about dopamine sensitivity? I remember this as the general idea that severely distressed people would get used to being on a certain dose of antipsychotic drugs, but then once withdrawn their brain chemistry would react badly to the sudden change in levels of dopamine and be unable to function “normally” again. Not sure if that is correct. I read about this in Whitaker’s books.

    Meanwhile, yes I agree that a diagnosis of “schizophrenia” (which could mean a wide range of things) is not such a big problem necessarily. Although it depends… extreme states of mind vary along a continuum and some instances can be quite severe and long-lasting. But it all depends on how bad the precipitating conditions have been, and as you said on what quality and quantity resources are available to help… I remember Ira Steinman saying, at the Boston ISPS conference, that “It’s not THAT hard.” (referring to understanding and helping delusional people). What I think he meant to say was that the strong pessimism commonly seen in our society about being able to meaningfully talk to and understand people who seem out of touch with reality is not warranted.

  • Hi Fiachra, thank you… I think it is not helpful to romanticize severe suffering. When a person cannot function, is in chronic terror, is full of rage most of the day, can’t have any degree of close relationship, and is full of anxiety to the point that their mind starts inventing imaginary relationships (often expressed in delusions or hallucinations)… there’s not really value in that to the community. The value is in getting help and getting out of that state, and back into relationships. I find people who have not been heavily involved in the mental health system, not on antipsychotic drugs and thus not aware of their effects, and never delusional or hallucinatory at all, tend to misunderstand the severity of some of these states. Or perhaps not be able to imagine them, since as you know it can just be so difficult.

    I would put mystical awareness / shamanism / communion with the universe into a different spectrum of experience. In this realm, ego boundaries and separation between self and other are weakened – and this is a commonality with extreme states of regression that are labeled “schizophrenia” and “psychosis.” But the difference is that in the mystical experience, the person has enough ego strength to maintain some level of functioning and effective relating or to return to it quickly once the experience is concluded. However, when you are talking about severe psychotic states that impair the ability to take even basic care of yourself, or to have any sort of meaningful relationship, that is a different animal.

  • What a great story with such insight – thank you.

    I also recovered from being in the mental health system, and now work in two great jobs completely divorced from the mental health field. I have recently made a decision to never try to work in mental health – a hope I once had – and I am relieved to have chosen to stay away from mental health.

    I believe that in America the field is so fundamentally corrupted by the biogenetic model and by misconceptions about the nature of suffering, and about the fundamental differences between “normals” and people given labels, that there is no point to such an endeavor. To me, the predominant US approach to the seriously mentally ill resembles a covertly-run slave-plantation (where patients produce funds for the drug companies, with the psychiatrists doing the go-between work). Another good metaphor for this system is T.S. Eliot’s Wasteland:

    I think we are in rats’ alley
    Where the dead men lost their bones.

    The dead man’s alley is that metaphorical place where the unforgiving rats have chewed and gnawed away the bones of a person’s few remaining internalized good relationships, leaving no hope for rapprochement or redemption. That’s what happens when you tell someone they have an incurable brain disease and have to be on drugs, far too often. And when there is not sufficient community or loving support to help a person believe they can become well – something far too infrequently available to those labeled “borderline”, “bipolar”, or “schizophrenic”, making the gap between how they actually do and how they could do (with skilled psychosocial support) a massive chasm.

    Fortunately, they are some glimmerings of hope in more recovery-oriented work, but I want no part of such a system… given how much work would have to be done to bring about significant change, and how unrewarding it would likely be along the way. Narratives like yours simply reinforce my conviction.

  • Hi Noel,
    Although it might sound strange to say given the subject matter, I enjoyed reading this article. I admire when people can write bluntly and honestly about their shortcomings and about difficult, visceral topics. I try to do this myself in terms of speaking openly about “bad” things I have done, recounting when I did not act in accord with societal expectations, when I did not feel guilty for what I did, etc.

    I like your description of the DSM as “the greatest piece of trash”. I’ll have to use that line at some point. It reminds me of my last cartoon with the midnight reading of the DSM by four of my favorite people 🙂 If I continued that cartoon I would have them using the DSM as kindling to warm their cold souls.

    The most interesting point you made was our fear of a world that is random, unpredictable, senseless, and potentially meaningless. I have often felt viscerally in touch with this aspect of existence. It is part of why I have my doubts about religion – I see religion as partly a clinging to the notion of an organized, logical, just world in which one can be “saved” for being “good”, and is in control of one’s destiny. Beneath this belief is often a fear of the randomness, emptiness, and uncaring nature of the universe. We only have each other… just off the Earth’s surface, and for millions of light years in any direction, there is no evidence of continued involvement of God, of an afterlife, or of any caring father figure that will protect us from an asteroid strike, gamma ray burst, or any smaller unpredictable and potentially deadly event in our personal lives. Sometimes, I spend my mornings debating with myself whether I am more severe danger from a potential car accident caused by an out-of-control Mack truck, or from an assassin hired by Big Pharma to bring a permanent stop to my online postings. However, I am probably grossly overestimating my influence in the latter scenario (no doubt the result of a DSM disorder!) so the greater danger is probably the truck.

    I believe it is adaptive to believe in religion because it reduces these fears and promotes peer bonding (I must sound like the Terminator here, if you remember the scenes where Arnold Schwarzenegger analyzed the function of human beliefs and relationships). But it is something I find it difficult to believe in with my knowledge of science and my experience of the dark sides of human nature.

  • Stephen – tragic, and well said. Expectations are so important. I suspect these negative prognoses are a big reason why outcomes for severely distressed people are worse in “developed” America than in poor countries. It’s such a tragic loss because with sufficient intensive psychosocial support, severely distressed people can do quite well over time and can have intimate relationships, careers, etc. It’s also a big negative economically to have people on disability for decades, which is ironic for a country that spends so much money researching the biological causes of “schizophrenia” to so little effect.