Comments by Matt Stevenson

Showing 341 of 341 comments.

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

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

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

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

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

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

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

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

    I also shared a somewhat similar story a long time ago on one of my blogs, here –

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  • 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.

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

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

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

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

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  • Sera,
    Great article; I enjoyed reading it!

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

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

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

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

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

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  • 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…

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  • 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.

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

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

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

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

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

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

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

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  • 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.

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

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  • 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.

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

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  • 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:

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  • Phil,

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

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

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

    “FDA Approves Despondex for the Annoyingly Cheerful

    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.

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

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

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  • 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!

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  • “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.

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  • 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.”

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

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

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

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  • 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…

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  • Joanna,

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

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

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

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

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  • Hi Miriam,
    I responded to this article on the ISPS forum ( 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.

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  • 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.

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  • This is a great article.

    And like I said here –

    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.

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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.

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  • 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: . 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:

    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:

    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:

    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.

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  • 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.

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  • 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.

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  • 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.”

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  • edchilde,
    Great comment. Do you know about ISPS? (
    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 –

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  • 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.

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  • Dr. Epperson,


    “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.

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  • 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 🙂

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  • 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.

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  • 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.

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  • 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:

    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…”

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  • 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.

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  • 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.

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  • 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.

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  • 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.”

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  • 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?

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  • 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”…

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  • 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.

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  • Noel,
    The Soteria project ( 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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 –

    ISPS and its forum – and

    ISEPP and its forum – and

    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 –

    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.

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  • 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.

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  • 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” – – 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:

    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.

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  • 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.

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  • “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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • Bruce, America generally has a very individualistic ethos, where being vulnerable, needing help, being gentle and soft, are seen as weakness. It is a shame because many American individuals are not like this privately, but a collective sort of societal psychosis operates where we feel that talking about trauma, vulnerability, fear etc is forbidden as it is a sign of failure or weakness. In fact nothing could be further from the truth – being open, vulnerable, and dependent are signs of strength – and time-limited dependence (on others for emotional help) can be a crucial thing in recovery from many extreme states.

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  • Madmom, I agree with this. In large part NAMI functions as a mechanism of group denial of adverse psychosocial factors, and a promoting factor for drug company sales. Their biogenetically-focused ideas tend to soothe feelings of guilt/blame and assist denial in non-diagnosed family members, while resulting in emotional alienation and reinforcement of inability to function for “mentally ill” family members.

    I am going to come out with an interview with Lloyd Ross, a therapist with some strong opinions on NAMI, hopefully later next week on MIA.

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  • Hi Bruce,
    Great article. The current treatment of people labeled schizophrenic in America today could be seen as a slow-motion euthanizing of this population in a silent emotional sense – they are chronically tranquilized with heavy, long-term use of drugs, which is one factor resulting in a massive group of terrified people living at home in relatives’ basements unable to work or study. The less fortunate of these – the ones supposedly “missing out” on antipsychotic drug treatment – are those on the streets, in prison, in halfway houses etc. They are also unable to function for the most part. Most of these people are quite deadened emotionally, and of course they are also dying much younger in physical years of life.

    One critique Bruce, of this:

    “The key to a community truly assisting people experiencing altered and extreme emotional states is for that community to believe that these states have meaning and value for the community.”

    Firstly yes, it may have meaning that people are in extreme states – in the sense of revealing what is deficient or harmful in the social sphere that has caused harm to a suffering individual. On the other hand, those states in themselves many times do not really have much value – many such people are simply in an emotional hell of terror, rage, and despair. Far from being valuable, this sort of emotional state is something to escape from as quickly as possible. I am speaking from experience here, and also from talking to many others and reading hundreds of treatment accounts of people in extreme states. There are also more mystical and religious type-psychotic experiences, but those are not the majority from what I can discern. Truly debilitating extreme states that result in a person being unable to function at all are not really that valuable or positive in and of themselves. I find that certain professional authors who may not have direct lived experience tend to generalize and romanticize about these states of mind.

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  • Ok, we will have to differ on whether race is always a relevant issue. In some situations, it is not. Few things are always or never.

    Also, poverty is extremely important and may be a large part of the cause of how minorities are portrayed – relative income inequality and poverty are actually the top two factors correlating with receiving serious mental health diagnoses, according to the John Read research. I would argue it is a root factor that accounts for much, perhaps most of the discrimination and social problems that minority people face more frequently than white people. Money and what comes with it – security, housing, jobs, etc – are like oxygen in our capitalist society, unfortunately.

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  • Good blog, Sera…. I particularly agreed with this part:

    “Because it’s precisely these out of whack ratios that lead the general public to believe they know what these diagnoses mean, and to assume that all people with such labels are some sort of monolith. Because even though they know they’re watching fiction, those fictionalized representations are basically all they’ve ever seen.”

    There is the persistent myth that labels like “DID” or “bipolar” are explanations in themselves for behavior or thoughts/feelings, not merely descriptions. To me it is a most damaging delusion… or perhaps, what is most damaging is the underlying ideas attached to the label, which tend to include otherness, strangeness, inscrutability, incurability, chronicity, biogenetic causes, etc.

    Only one point of disagreement, about this:

    “However, until the ratio of people labeled with a psychiatric diagnosis who are represented as ‘good’ verses those represented as inherently bad or broken matches the ratio of ‘good’ verses ‘bad’ for… say, undiagnosed, heterosexual, white males … then it’s just flatly unacceptable.”

    Not sure why there’s the need to bring race into this piece, which was quite good without it. Obviously, people with a psychiatric diagnosis are never going to be represented exactly the same as a dominant social group, at least as long as diagnosis persists. And since there is more poverty and trauma experienced by many, not all black or Hispanic people, there’s going to be more emotional problems on average among them and thus more representations of social struggle (correlated with psychiatric diagnoses). But that’s not innately a value judgment nor is there any causal connection between someone’s literal skin color and a psychiatric label (although those connections are inappropriately made)… things are never going to be exactly equal or just, so if we expect that they will then we’re going to be chronically disappointed.

    But yes, having said this it would definitely be great if experiences of suffering related to trauma were presented with much more insight, sensitivity and compassion.

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  • David,

    Thanks for this review.

    For me the most important part was this,

    “Most of the beneficial effects Kramer describes can be reframed in terms of an emotional blunting, or the numbing of all emotions, not simply the bad ones. Just like people on an SSRI will nearly universally report genital numbing within 30 minutes of taking their first SSRI—if they’re asked—people will also report some degree of emotional numbing—if asked. They don’t necessarily feel better; they simply feel less.”

    It does sound decidedly less romantic when you unmask “antidepressants” as what they really are – crude emotional numbing agents, not medications treating an illness. And it exposes that psychiatrists are not functioning as doctors treating a well-defined illness.

    In that regard David, the only thing I could have suggested to add to your well-written review was a note about how “depression” is not a unitary illness, but a vaguely described syndrome – people feel depressed to greater or lesser degrees for loads of different reasons. The language used around treating this “illness” is completely misleading.

    And lastly David, if you can have the insight that psychiatric drugs are blunt instruments that often do harm, perhaps at some point you can discuss the same for ECT.

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  • Yes Richard.

    Another interesting factor is that the exponential rise of connectivity via the internet in the past 10-15 years has enabled critics of the existing system to spread their ideas more.

    Before 2000, almost all discussion about “schizophrenia” was dominated by academics writing in journals and books, with critics unable to spread their ideas as counters or alternatives widely or effectively. Critics are still fragmented but now they are more visible and can find each other more easily. Whereas before most of the connectivity and organizing belonged to those who held the traditional reins of power, i.e. ability to publish and speak in journals and university settings.

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  • Terry, Great response and critique of Murray’s “bonafides” thank you.

    This is the exact same arguments I make against people like Murray within the ISPS group. I argue that their work should not be respected or taken seriously since for the most part they do not know or work with real people, in the sense of getting to know them intimately and helping them recover. What they do is much easier – sit in the halls of academia making up poorly-evidenced biological and genetic theories about “schizophrenia”.

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  • Kermit,
    It is important that Murray said what he did. And I like your comment.
    On the other hand, skepticism of his intent is warranted too. He only came out like this once he was near the end of his career and the reputational / financial risk was presumably less due to having already had his career and made his money. That takes far less guts than it would have to do it much earlier.
    In this way, it’s similar to Allen Frances, who made loads of cash by promoting pills for antipsychotic drug companies and profiting from DSM 4, and then turned around and became a critic once he had his wagons loaded down with bags of cash. You have to wonder how genuine it is. Although I think Frances is a worse, more clearly hypocritical case than Robin Murray. Robin Murray’s admission is also important because it will affect current mid- and early- career psychiatrists and associated workers.

    The person with the most guts would leave thei field during their career, or speak out from within the field at professional risk to themselves during their career. But I haven’t seen anyone do that yet, except for perhaps one or two professional MIA writers who left the field to practice differently or work elsewhere. These latter deserve more credit than Murray, IMO, who via his biological reductionism over 30 plus years did great harm in my judgment.

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  • Yeah that is just BS from Robin Murray. You have to wonder if this guy is aware of the Open Dialogue’s 3 studies in which about 75% of the people never used antipsychotics even initially, and most recovered to become functional. And the WHO studies where many, many people in lower income places who couldn’t even access the drugs still were able to improve and become quite functional with prolonged communtiy/social support. What kind of echo chamber must Murray be in to not be aware of or to deny these things and cling to drugs being necessary for all.

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  • Shook,

    IN your part 5 you made an argument for short-term use of tranquilizers.

    However, it’s important to point out that strong evidence supporting use of long-term drugging for improving outcomes beyond 1 year is lacking. This was discussed in Sohler’s study here:

    So the scale might or might not be weighted against tranquilizing over the short-term (if one defines “effectiveness” as making a person more compliant and less able to feel rage and terror), but long term there is much more doubt.

    Importantly, we want to clarify that antipsychotics drugs are basically tranquilizers that limit the ability to sense and feel disturbing thoughts/feelings. They are not medications treating a specific disease. With this in mind, it’s more clear why their long-term use does not promote a return to functioning and relating well in many very severely distressed people, since drugging cannot address the environmental and psychological factors underlying chronic long-lasting terror, rage, and distrust.

    It’s also important to note that intensive psychotherapy has had a lot of success with people labeled “schizophrenic” that is underreported, and that this can be achieved in many cases without the use of drugs.

    Reviewing 37 studies of psychotherapy for people diagnosed as “schizophrenic”, William Gottdiener said,

    “There is a long-standing controversy about the use of conjoint medication in the psychotherapy of people with schizophrenia. For many years psychotherapists were reluctant to employ antipsychotic medication as an adjunct to psychotherapy because they thought it would disturb the therapeutic process. However, since at least the 1960s most therapists that treat people with schizophrenia have used antipsychotic medication in conjunction with psychotherapy. Most therapists think it is indispensable. However, between 40% and 75% of patients do not take their medication (Perkins, 1999) and there are many for whom medications fail to work (see above Hegarty et al., 1994). For these patients and for therapists who choose to offer treatment with little or no adjunctive medication, it would be important to know if such treatments work…

    It is surprising that the proportion of patients that were likely to improve without conjoint medication, is similar to the proportion of patients that were likely to improve with a combination of individual psychotherapy and antipsychotic medication. This finding is contrary to most therapists’ clinical expectations. The finding that individual psychotherapy can be effective without medication is not new (see Karon & VandenBos, 1981). However, it is important because it suggests that individual psychotherapy alone might be a viable treatment option for some patients who do not improve from treatment with antipsychotic medications, for some patients who refuse to take medications, or for patients who are treated by therapists that choose to use little or no adjunctive medication.”

    To me, as someone who once took these drugs and discontinued them against my psychiatrist’s advice, this finding that improvement can occur without the drugs is not at all surprising. And given that up to three-quarters of people choose to stop taking their drugs, it certainly merits more research into non-drug treatments for those psychotic people who do not want to use the drugs long-term, which is probably most.

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  • It’s a bit strange to hear Robin Murray say this,

    “Murray states that he expects the concept of ‘schizophrenia’ as a discrete disorder to become obsolete, just like “dropsy.”

    And then for him to speak the whole rest of the article as if schizophrenia were still a bonafide, carved at the joints, separable “disorder”. The severe end of the spectrum of extreme distressed (traditionally labeled “schizophrenia”) should not be called a singular term at all. There is one “it” there. For some people severely distressing experience is temporal and short-lived, for others medium and for others much more severe and long-term. Much depends on how the environment responds to the distress.

    On another listserv, I wrote about this issue of “Murray’s mea culpa” in this way:

    I thought some people might like to see British psychiatrist Robin Murray’s reflections on his regrets from a career in psychiatry, especially the part quoted below:

    “I Ignored Social Factors for 20 Years” – Robin Murray

    Quote: “So almost by accident, I got into epidemiology, and then was confronted by the evidence that one of the most con-sistent epidemiological findings in the United Kingdom is the high incidence of schizophrenia in the African-Caribbean population. Having excluded genetic and other biological causes, we were forced to look at the role of social factors such as migration, social isolation, and discrimination.19

    It is odd that it took me until the mid-1990s to take social factors seriously as component causes of schizophrenia because when I trained in the 1970s, social psychiatry was predominant at the Institute. Indeed, one of the first researchers that I worked for was Jim Birley who, together with George Brown, had demonstrated the importance of adverse life events in schizophrenia.20

    However, by 1990 the predominant view, including my own, posited that schizo-phrenia was a brain disease influenced by aberrations in developmental genes20 and early environmental insults.21,22Social psychiatrists, including our local experts such as Paul Bebbington and Julian Leff, confined themselves to say-ing that social factors contributed to relapse. Indeed even as late as 1998, we took a sociologist, Rosemary Mallet, to the winter workshop on schizophrenia in Switzerland. Unfortunately, she was miserable because she didn’t ski, and apart from her own poster, there was no mention of social factors in the whole conference!

    In the last 2 decades, it has become obvious that child abuse, urbanization, migration, and adverse life events con-tribute to the etiology of schizophrenia and other psycho-ses. This has been a big shift for me! Indeed about 5 years ago, after I had given a lecture on the subject of social factors in schizophrenia, one listener stood up and said “Professor Murray, I last heard you talk abut social factors in schizophrenia in 1982. Then you were against them, now you are for them.” The audience fell about laughing! I splut-tered that one must change one’s mind if the data change. However, the truth was that my preconceptions had made me blind to the influence of the social environment.

    I never had a proper epidemiology training—but a suc-cession of younger fellows in my group spent a year at the London School of Hygiene and Tropical Medicine. There theylearnt how to use epidemiological techniques to exam-ine risk factors for psychosis, whether they were social or biological. So, for example, Peter Jones and Mary Cannon were interested childhood hazards be they infection or abuse, David Castle and Nori Takei studied effects of urbanization, Jane Boydell and Craig Morgan researched migration and ethnic minority status, while later Marta Di Forti examined the effects of cannabis.

    Jim Van Os in particular taught me, and then European psychiatrists as a whole, that it’s oversimplistic to regard schizophrenia as just a brain disease. Asthma may be a lung disease but it is one which can be precipitated by environmental toxins (eg, pollution) and allergens. Just as the lungs process air, so the brain processes external stimuli; consequently, its healthy function can be harmed by noxious factors in the social environment such as childhood abuse or adverse life events.”


    Haha what a concept that last sentence is! Too bad it took decades to realize this idea, which seems not to have crossed the Atlantic yet. Apparently, leading American psychiatrists still don’t understand this concept.

    To me people like Sir Robin still sound like aliens studying humans a if they were another species, failing to appreciate the subjective, lived experience of those they write about. The people they write about sound like automatons or machines, without agency or volition.

    Lastly one has to wonder if Murray has ever done intensive psychotherapy with real clients, or if he is just sitting in a university classroom “studying” people from afar.

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  • I highly doubt that reliable brain activation patterns will ever be found for any fabricated DSM disorder.

    If brain reliable differences are found associated with particular labels, in my view they should be primarily differences of degree or intensity corresponding to the way multiple linked brain structures respond to greater or lesser amounts of stress.

    They would not likely be differences of kind (as opposed to degree) – i.e. not differences of kind or differences in location of brain-part activation correlating to one “disorder” over another. In this vein, one would expect those labeled “schizophrenic” to have more severe expressions of certain brain responses associated with stress than those labeled “anxious” or “obsessive” for example. But the brain regions activated in people given more “severe” labels would probably be many of the same parts to varying degrees as those observed in less severe labels, and simply be more severe expressions of the same phenomena. And the labels themselves would explain nothing, just like knowing which brain regions activate would explain nothing at all about how to talk to, understand and help a person at an interpersonal level.

    Within the next 10-15 years, it can be predicted that the NIMH’s current RDOC (Research Domain Criteria) search for brain activation patterns correlating to DSM disorders will fail to produce reliable results. The question then is what will happen. Probably some new doomed scheme of biological categorization will be invented, with more requests for ongoing funding. The goal, as always, will be to “Extend and Pretend” – to maintain the status quo in terms of funneling money to biological researchers and to Big Pharma companies. The other goal will be continuing to sell as many drugs as possible via misleading psychiatrists and clients into believing that the drugs are highly effective, and to keep enough people believing that psychiatric drugs are “medications” targeting specific “illnesses”.

    Here is a link to an Allan Schore piece on trauma and brain activation, which explains how stress early in life produces common brain responses across a range of supposed psychiatric diagnoses. Reading this, it’s obvious that brain studies will never produce reliable results for individual illusory psychiatric disorders. People are too individual to fit a label and, paraxodically there are too many commonalities in the ways in which people’s brains respond to stress both less and more severe for distressing experience to fit neatly into different supposed disorders. The current biological research is about profit and social control, not about understanding or helping.

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  • This is a fascinating article, thanks.

    Although, I think the ideal solution for many people is to never take psychiatric drugs, or to stop taking psychiatric drugs entirely if possible. Working out difficult feelings and thoughts interpersonally and in terms of what resources in the environment help was always better, in my experience.

    Regarding this,

    “The argument that violence is caused by an underlying psychiatric disorder has been proven wrong…”

    This is misleading because there are no discrete psychiatric disorders that are the cause of anything (as Insel, Frances et al admitted, these categorizations of distress lack validity and are mere descriptions of clusters of behaviors, not well-defined illnesses). Distress and decisions to take action based on distress arises from complicated interactions between a person and their environment over time. No one “gets” or “has” a “psychiatric disorder” called things like “schizophrenia” or “bipolar” that then “causes” them to be violent. This whole way of thinking is so hard to understand; one might assume it comes from doctors who do relatively little intensive psychotherapeutic work with clients and thus do not understand that saying that “psychiatric disorders cause things” makes no sense.

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  • Phil,

    I liked the following poetic, image-filled section,

    “And so the tentacles of psychiatric destruction, disempowerment, and, ultimately, despair, are spread to all parts and segments of our society, and people of all ages and all walks of life are shoveled indiscriminately into the insatiable maw of psychiatric dependency and premature death.”

    This sounds like something I would write.

    And no, psychiatric practitioners will never voluntarily curtail a scheme that is so profitable – and so easy, when many of one’s victims are so vulnerable and do not know any better.

    In the movie The Dark Knight, there’s a scene where Batman and his advisor Alfred Pennyworth discuss the nature of the villainous Joker:

    Alfred says: “Alfred: With respect, Master Wayne, perhaps this is a man that you don’t fully understand, either. A long time ago, I was in Burma. My friends and I were working for the local government. They were trying to buy the loyalty of tribal leaders by bribing them with precious stones. But their caravans were being raided in a forest north of Rangoon by a bandit. So we went looking for the stones. But in six months, we never met anyone who traded with him. One day, I saw a child playing with a ruby the size of a tangerine. The bandit had been throwing them away.

    Bruce: So why steal them?

    Alfred: Well, because he thought it was good sport. Because some men aren’t looking for anything logical, like money. They can’t be bought, bullied, reasoned, or negotiated with. Some men just want to watch the world burn.”

    Most psychiatric practitioners are not truly evil or demented like this. But they are absolutely addicted to the drug-like experience of getting large amounts of money, status, power and prestige that comes with giving psychiatric “treatments” to supposedly “vulnerable” patients.

    Those who think that psychiatrists will voluntarily change and stop harming people fail to understand their motivations, in a similar way to how the Dark Knight initially misread the Joker.

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  • Hi Margaret,

    It is good to see more people speaking up about having undergone very difficult extreme states and overcoming them in a variety of ways. I assume you have seen some of the many other accounts of such experience on this site, perhaps including my own.

    I think there is nothing to be ashamed of in revealing that one was once paranoid or delusional – it can happen to anyone under enough stress – nor anything to be ashamed of in revealing that a psychiatrist once labeled one “schizophrenic”. As Rosenhan once demonstrated, the darkly funny thing is that almost anyone who goes to a psych hospital and reports hearing critical voices can get a diagnosis of “schizophrenia”. That doesn’t mean that all such people are unable to function and handle their feelings – as is someone experiencing a genuinely incapacitating extreme states of mind – but it does illustrate what I am going to discuss below.

    Reading your piece, I was reminded several times how arbitrary and invalid the label of “schizophrenia” is – how there is not a valid illness called schizophrenia delineated by any biomarkers outside of a psychiatrist’s subjective judgment. From the psychoanalytic viewpoint that I use to look at these problems, extreme states represent an early emotional development state in which terror, rage, and despair result in regression to a childlike state of mind. Usually such a transition can be correlated to specific stressors such as abuse, divorce, job loss, neglect, financial stressors, etc. The terror usually results in a regression to a state of self and other fusion, in which a person cannot really tell emotionally what thoughts/feelings are their own and which thoughts/feeling belong to other people. Thus their own fear and suspicion gets projected into other people having malevolent intentions, as for example in the paranoid fears you once had about your coworkers.

    But the notion that such a regression can be concretized as “schizophrenia” and pegged at “6 months’ duration of psychotic ‘symptoms’” (in a psychiatrist’s subjective judgment) is just bullshit. These experiences vary greatly from individual to individual, plus there’s no sharp cut-off point along the continuum at which one becomes “schizophrenic” or “non-schizophrenic”. Richard Bentall explained this well in his book “Madnes Explained”, in which he discussed how the paranoia, terror, and suspicion that people who get labeled “schizophrenic” experience is not different only in degree, not kind, from lesser experiences of the same things that any of us can and do experience under stress.

    There is not one distinct class of people that “have schizophrenia” and another majority group that don’t carry the “schizophrenia genes”. The mistaken assumptions around all of these issues – which relate to the non-validity and poor reliability of almost all psychiatric diagnosis – explains how psychiatrists deluded themselves over the last several decades into believing that a discrete “schizophrenia” existed (as opposed to a continuum of extreme states varying in severity and without a clear division from less severe distress). Psychiatrists also made the mistake of believing that extreme states are primarily caused by faulty genes, rather than being caused primarily by environmental stress interacting with the brain/epigenome in a dynamic interpenetrating fashion.

    And of course, the notion that “schizophrenia is a lifelong, incurable disease”, is one of the most pathetic, stupid, harmful, and blatantly false (in multiple ways) things research psychiatrists have ever said, an outmoded delusion on psychiatrists’ part that needs to be consigned to the trash heap of history.

    Regarding this, “I was now coping with the fact that I had been diagnosed schizophrenic — and that proved to be more difficult to recover from.”

    Yes, this is one of the most insidious, harmful things that psychiatrists do – tell people that they have a lifelong brain disease and will not be able to fully recover. The terror and pessimism created by such false prophecies can be devastating and even lead to suicide. And many people do not dare believe at first that the psychiatrist is simply spouting bullshit and that the notion that there is a lifelong incurable illness called schizophrenia is, quite simply, an untruth.

    Regarding this, “Well, I believe any schizophrenic on medication is a walking time bomb, because any day they could stop taking their medication — secretly, out of desperation — and all those repressed emotions and thoughts could come exploding out in uncontrollable fury with unpredictable timing.”

    I couldn’t have said it better – the ugly truth is that antipsychotic “medications” are not bonafide medications treating any well-defined illness entity in any way – a far cry from insulin for diabetes. They are nothing more than heavy, numbing tranquilizers that dull down the ability to feel the terror, rage, and confusion that are so overwhelming when one is in an extreme state of mind. This numbing and quieting of the person is what is called “effectiveness” and “response” in reviews of the drugs, pathetic and short-sighted as that conceptualization is. Meanwhile, absolutely nothing is done by the drugs to enable the person to develop more ability to handle their emotions and to face and work on the life problems and stressors that may have led them to break down. On the contrary, the ability to think clearly and to process emotions is progressively eroded by the neuroleptics with long term use.

    Not being on antipsychotic drugs after a diagnosis of schizophrenia to me is something to be proud of. It is a sign of insight, willingness to take an intelligent risk, ability to think for oneself, and often-times the ability to realize that one’s psychiatrist does not know what they are talking about. More than once on this forum I have recounted how tapering off antipsychotics against my psychiatrist’s wishes was a decision I am proud of and never regretted, and would do again.

    Well done again for sharing your story Margaret.

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  • Nice list, Susan. I always appreciate the passion you bring to these articles.

    I assume you may have also noticed come studies have coming out recently that show that peers are very effective in helping with emotional problems in other, poorer countries, such as with feelings of depression in India. Countries like India could be a place for peers to gain a stronger, quicker foothold than in the USA, given that psychiatric treatments are fewer and less entrenched at the start in developing nations.

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  • Phil,

    Did you know that new neuro-imaging breakthroughs have been made that allow the diagnosis of ADHD to be precisely made via having children wear brain-wave measuring helmets that track the intensity and degree of inattention down to the millisecond?

    Gotcha… they haven’t!

    You’re right; these arbitrary criteria show why what I usually say is true: Every psychiatric diagnosis is a misdiagnosis. Because no psychiatric diagnosis has explanatory power, and psychiatric diagnosis is always lacking in validity.

    Diagnosis is indeed the Achilles heel of psychiatry, and thus should be a target for critics to hammer away at indefinitely for years to come, just as soldiers would attack the weakest part of a castle wall repeatedly in order to bring the structure to the point at which the whole edifice collapses.

    The current RDOC (Research Domain Criteria I think?) of the NIMH is another diversion tactic by mainstream psychiatry: having failed to establish the validity of current DSM disorders, they have made an empty promise that future brain circuits will be identified that are causal to “mental disorders” and which will uncover a valid biological basis for the DSM disorders. This attempt is almost certainly doomed to fail.

    Perhaps this might be a good subject for a future article, Phil – getting out ahead of NIMH and their Research Domain Criteria, and predicting how future neuro-imaging research will inevitably fail to identify replicable biomarkers for “mental disorders”. It will look all the more convincing if critics can predict the failures ahead.

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  • Ok. You might consider having a brief “further reading” or “references” section at the end, citing authors such as Whitaker, Breggin, Moncrieff, Kirk, Bentall, Watters, etc, and sites such as MadinAmerica. That would only need to be on screen for a very short time. Many among the public will not know these resources exist.

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  • Hi Steve,

    Here are my “live-blogged” notes made in a Word file as I was watching your excellent video:

    provide clickable links during the relevant section for references to the NIMH leaders’ statements and the British Psychological Society’s critique. Or provide brief on-screen references to books / articles / talks. I was thinking where is the backup for this claim? Many people may not wait to see references if they are coming at end of video.

    “cultural acceptance of medical model?” – questionable that most of the public accept this unquestioningly. John Read’s research shows it is not widely accepted by the public. In most countries the public favors the social welfare model, not the medical model, already. See his Youtube videos.

    May want to give more references / links on screen showing how biological / medical model framings lead to more pessimism, fear, and distancing. See my article, “Rejecting the Medications for Schizophrenia Narrative.”

    Not sure if it’s accurate to say that Freud considered psychoses a medical problem. I thought he didn’t know how to effectively treat psychoses and didn’t spend much time writing about this area. Could be mistaken. But no references for your statement given.

    You could expand on the notion “Validity is about truth of DSM” by clarifying that the question is whether DSM labels refer to discrete, “carved at the joints” entities which exist in the external world.

    “two different diagnoses from two different clinicians” – references for this? True but would be good to see data, if only brief links to articles / books. See Noel Hunter’s articles for good examples of how this can be done.

    “Manual with terrible reliability” – true but where is reference for this? Can you show the charts of how reliability has even decreased over time? See 1BoringOldMan blog for these pics.
    “Increase criticism of DSM” – can you give a few quotes from prominent critics? Both recently and in 80s/90s.

    I like Brian Koehler’s (of ISPS) quote, “The human genome did not evolve to reify DSM diagnoses.”
    – Where does it say that only clinicians can understand DSM diagnoses? I didn’t know this was in the DSM. On the other hand I haven’t read it nor would I waste my time doing so.
    “The DSM 5 totally lacks validity” – gives the quotes from Insel, Hyman, Kupfer, Frances right here. Best attacks come from the other side’s own words.

    “erroneously implies discrete boundaries” – yes, crucial criticism, and it is a deal breaker. Cannot have reliable valid categories given relativistic continua of distress which actually don’t break up into discrete concrete entities.

    Ignores harmful effect of stigmatizing – again where is reference or source for this? What studies suggest this is the case? True but give people link to read or research…
    EuroAmerican focus? Yes. Maybe mention Ethan Watters here.

    Strong vested interests – yes. I wrote about this provocatively in my article, noting how the disease model underlies psychiatrists’ supposed superiority and greater knowledge to other mental health professionals.
    18 billion in neuroleptic sales? Yes, but would be good to provide a link here in my opinion evidencing this stat.
    Perhaps give examples of how much some psychiatrists and researchers were paid to promote drugs and diagnoses. Perhaps link to website DocsforDollars etc.

    Parents being defensive about abuse. Yes, but provide support for this contention as it is contentious. Perhaps reference ACE study or John Read’s research on trauma and psychosis.

    Harmful to treat emotional suffering as a medical problem. Yes!!! But where is link to this evidence.
    Worsens outcomes? Yes, at least you mentioned Whitaker here. Also mention many references given by Sami Timimi and John Read in their online talks on Youtube.

    Agree with you not to criticize or try to write off psychiatric drugs but to promote informed consent and respect people’s right to choose to use these drugs if they think they help.

    Allen Frances was a major taker of money from drug companies, then turned around to criticize the newer DSM editors once he’d made millions of dollars from the older DSM and from drug companies. Maybe note this?

    – “flagrant coercive practices” banned by Human Rights – can you give a quote from the UN writing about this?

    Question – what type of cameria / recording software did you use?
    what type of editing program did you use to do the on-screen text and images?
    Wondering because I’m interested in producing videos myself about other mental health issues.

    Hope this is useful Steve. Take what you like and leave the rest.

    I really liked your video and think it’s a great first step. Basically I recommend to give more references, links, and further reading to defend the talk against assertions that it’s unevidenced, unsupported or nonspecific.

    Steve if you didn’t yet please join this group –

    I posted a link to your article there.

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  • Very well-written paper, Paul.

    I had not even heard of Ruby Wax before. To my knowledge her popularity has not reached America. However I don’t watch TV, so my ignorance could be my own disconnection from popular media.

    I don’t think it’s difficult to disagree with biological reductionism. I regularly do so in all sorts of public settings. For instance, at a meetup event recently, I directed refuted the idea that “schizophrenics” always have to take drugs. People were shocked; I didn’t care.

    I am not sure why you stooped to this part:

    “Opponents of the social determinants school would argue that such treatment would only be triggering peoples’ underlying susceptibility to mental disorders. To which I would reply: someone, or something, still needs to pull the trigger.”

    It appeared that you agreed that there is a “trigger” to supposed vulnerability; I think this is problematic. The human genome did not evolve to reify DSM or ICD diagnoses. The most we can speculate is that some people might be genetically more or less resistant to stress, with the way they react to it being highly individualized, not more or less resistant to to invalid creations of the white-coat people. The research on genetics and mental labels has produced nothing of note. Besides, once a person is born, their epigenome and biology is constantly being modified by interaction with the environment in an interpenetrating process. Genetic vulnerability to stress is not some static thing that stays the same throughout life.

    Paul, You might consider Mary Boyle’s thinking on “vulnerability-stress” theory:

    Quote: “Who or what is protected from scrutiny by vulnerability?
    In the case of vulnerability-stress theory, thefocus of scrutiny has been the ‘vulnerable’ indi- vidual – whatever else they’re protected from,it’s not our scrutiny. This focus is made to seemreasonable partly through word order: the the-ory is stated as ‘vulnerability-stress’ with the im-plication that vulnerability comes first, is morebasic, so that it seems reasonable to focus on theperson to identify the nature of this vulnerability and perhaps to put it right. Even when vulnera-bility is used more generally, the focus is stillmainly on the vulnerable person, a focus whichseems reasonable at least partly because of psy-chology’s and psychiatry’s claims to have discov-ered many negative individual attributes –low-self-esteem, cognitive deficits, mental disor-ders etc, which not only seem to explain the vul-nerability but make it easy for us to accept vulnerability as yet another attribute – a state-ment about a person – rather than a relationalstatement about what happens between people. Vulnerability exposes only one side of this rela-tionship, while protecting the other fromscrutiny. We can see this relational aspect clearly if we take statements about individual vulnera-bility and ‘translate’ them into statements aboutrelationships. On the left side of Table 1 are state-ments of a sort easily found in the media and pro-fessional literature, apparently about individuals,or social groups, and which suggest that our focusshould be on these people or groups – how toprotect them, make them more resilient, and soon. But if these statements are translated intorelational statements (with the two referencedexceptions, not found in the media or literature)

    then a very different picture emerges in which twopoints are worth noting. First, that the reasonable-seeming focus of our scrutiny and potential actionis changed from the vulnerable individual to those who seem to be damaging them. Second, in every case, the people or groups who do not appear inthe statements about vulnerability, are in various ways more powerful than their counterparts whodo. The disturbing conclusion is that the idea of vulnerability runs the risk of systematically pro-tecting from scrutiny the potentially damagingactivities of relatively more powerful socialgroups. Since vulnerability is usually named inothers by those in positions of relative power, itis perhaps not surprising that they should wishto protect their privacy. But we should not un-derestimate how helpful psychology and psychi-atry have been to this process, with their persistent focus on the individual and their pro- vision of an extensive range of negative charac-teristics both to explain vulnerability and tofoster its acceptance as an individual attribute.”

    Source: page 27 of this download –

    Lastly, it is amazing that people continue to believe the trope about 25% of the population “having mental disorders”. As I like to say, according to psychiatrists here in America 80 million people have clearly diagnosable psychiatric diseases and 240 million are completely normal. When you frame it like that, it’s obviously bullshit. No one is immune from the problems of living, and those problems are matters of degree without clear cutoff points along a continuum.

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  • Where is this strong evidence, oldhead? Perhaps you can tell us where the strong evidence that these changes are irreversible is, in the paper…

    The only supposedly irreversible syndrome I’m aware of is tardive dyskinesia, and this syndrome only occurs in a small minority of all people that take antipsychotics for some time.

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  • Eve,

    I’m curious why your mentor, Andrew Weil, has the following on his website in reference to “schizophrenia”:

    “What are the causes of schizophrenia? The cause of schizophrenia is unknown. However, scientists focus on the interrelationship between a genetic predisposition for the disease working with environmental pressures to ultimately manifest symptoms in susceptible individuals. Knowing that medications work on the neurochemical level to treat schizophrenia, it is certain that problems with brain chemistry, including the neurotransmitters dopamine and glutamate, contribute a key role. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia as compared to those who don’t have the disease. While researchers aren’t certain about the significance of these changes or the interaction with these particular neurotransmitters, it still supports the theory that schizophrenia is indeed an abnormal condition of the brain.”

    Is he really that ignorant, or simply intellectually lazy, or is it something else?

    For one thing, it is not at all certain that dopamine plays a key role in causing, rather than correlating, with severe distress labeled “schizophrenia”. To spread this misinformation as Weil does is harmful and unethical. The “diagnosis” itself is subjective and uncertain – two people can “have” the condition who have nothing in common. But no one would ever know that from reading Weil’s site.

    It’s important for people to know that contrary to Weil’s assetion that “the cause is unknown”, we know a great deal about what causes extreme states – including that trauma and isolation are often central contributors… we also know that there are no “medications” to directly treat what is a vague non-medical syndrome, and that distress labeled schizophrenia can be alternately understood as a normal reaction to abnormal circumstances. Here’s more:

    John Read of ISPS speaking about “Who is Right about the Causes of Psychosis – Psychiatrists or their Patients?” –

    Noel Hunter from ISEPP writing about misleading research (as presented by Weil and others) on “schizophrenia”:

    My discussion of the history of “schizophrenia” and the relevance of trauma –

    Really annoys me to see these untruths put out there as fact, over and over.

    At least there’s a difference between an online forum like this where one can speak out freely, and a university environment or psychiatric conference, the latter being places where questioning the validity of schizophrenia would be sacrilege. Not here.

    I will also contact Dr. Weil myself directly.

    From looking at Weil’s website, it looks like he’s a guy who makes a major effort to promote and make money out of his name/brand. Too bad he didn’t put nearly as much effort into checking the validity of the information he puts on his website about “schizophrenia”.

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  • Thanks Eve.

    Looking forward to hearing much more from you.

    Of course agree with everything you are sharing in this article. Would like to hear about everything written above in more detail, including case examples of the people one sees in such a shortened way, and more information about how seeing someone for such short timeframes works on a month to month basis.

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  • Yay Bob! Thanks for the update.

    Good to see that Olga Runciman and Eric Maisel will be involved in getting content.

    If you need additional fundraising support / funds (similar to last year’s fundraiser) don’t hesitate to reach out to people here.

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  • Amazing:

    “Dr. Gordon’s research has also analyzed neural activity in mice who supposedly carry mutations “of relevance to psychiatric disease… the lab studied genetic models of “these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis… A gigantic leap is then made: that his research “has direct relevance to schizophrenia, anxiety disorders, and depression.”

    What a joke! It’s the tried-and-true NIMH formula: You assume the existence of a valid illness called schizophrenia, and then you look at cute white mice and speculate what they might tell you about the disease in humans. What bullshit!!!

    Even when leading NIMH officials and past DSM heads said that these categories (“generalized anxiety disorder, major depression, schizophrenia”) lack validity and usefulness for research, they just go back to doing the same thing. It’s the definition of insanity: doing the same thing over and over again and hoping for a different outcome. That is what research psychiatrists do.

    I have to wonder how research psychiatrists keep coming up with this stuff. You would think they were trying to be funny on purpose. But the amazing thing is they don’t even do it on purpose. That is the biggest incongruity: research psychiatrists are dead serious about their diagnostic labels and really want to be looked up to as prestigious researchers, and they don’t even realize what ineffective and out of touch they appear to people looking at severe distress from other perspectives outside the field.

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  • Hi Martin,

    You obviously think deeply about these things – that must help you in figuring out ways to understand and help your clients. It might also make you a good MIA author – consider that!

    Regarding New Zealand, perhaps you saw Paris Williams’ critique of the psychiatric system there (he lives there too as you may know):

    I agree there are a lot of good insights and ways to understand and help people that have come out of, and still come out of the field of psychology. I differ from some other MIA commenters in having that position in agreements with yours.

    My favorite field-area of psychology is the developmental object-relations psychoanalytic area. You may know the authors like Freud, Jung, Klein, Fairbairn, Sullivan, Kernberg, Rinsley, Masterson, Adler, Searles, Volkan, Boyer, Grotstein, etc. There’s a rich tradition there of doing really good work to help people with all kinds of trauma. And the conceptual models they have of early developmental states (a psychological alternative to the disease model of “schizophrenia” etc) is really good in my opinion.

    The British Psychological Society is doing good stuff. If you like the critiques of these authors, you might also like the critiques of the system of American psychiatrists Jonathan Shedler and Barry Duncan. You can find a lot of their papers on Google. Duncan wrote a good book called “The Heroic Client”. And Shedler has some great criticism of CBT and the flaws in “evidence based” therapy on his website –

    Also see re: Duncan –

    I agree with you – if a treatment works to help someone in their experience, it doesn’t matter that much what method arrived at it.

    I would say that psychological research is not as reliable as people think. I encourage you to check out the whole of Smedslund’s essay “Why Psychology Cannot Be An Empirical Science.” If you cannot find it email me and I have a copy (bpdtransformation (at) gmail (dot) com). I also think Brian Nosek’s work about how psychology has not replicated a high proportion of experiements is instructive.

    Martin one more thing you really might like – Paris Williams has a 25 page paper he hasn’t published yet about the positivistic (mechanistic/Newtonian) approach to psychology versus the relational / subjective-qualitative approach to psychology. He would probably share it with you if you emailed him. He is at pariswilliamsphd (at) gmail (dot) com.

    Martin if you like discussing these things also consider joining – a lot of these discussions are going on there on the listserv – Maybe you are already a member.

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  • Hi amnesia,
    I also read your comments – and thank you for coming in. I just didn’t get back right away because your comments came after the article was first posted.

    Anyway, I wish you the best with your husband and particularly liked this part of what you said:

    “Drugs don’t heal people. People heal people. I hope soon to be able to support people having exceptional experiences and extreme states.”

    I agree with this idea and hope you will be able to help other people heal soon.

    Thank you for coming in.

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  • Nomadic, I think many people would agree that severe distress and suffering is something to be healed and get better from – maybe not “recovery”, which is somewhat of a medicalized colonized word, but certainly healing or wellbeing after suffering.

    Indeed, the way through ordeals is forwards. I think Buhner talked about a lot of ways to achieve that in the article. Your statements about “healing” being attempts to avoid and deny by moving backwards are rather vague and nonspecific, and without knowing what you had in mind it’s hard to say more.

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  • Martin,

    This is an excellent comment and some of the most deeply thoughtful musings I have seen in an MIA comment; well done.

    Let me respond to a few things you said that I found interesting.

    I think you are correct that, “This suggests that increased emotional or sensory sensitivity, particularly in relation to human interaction, develops mainly as a result of experience.

    I would suggest this increased sensitivity to negative stimuli is paired with a decreased sensitivity or receptiveness to positive / “good” stimuli, or toward trustworthy relationships. You might like my article here that explains the Fairbairnian approach as to why traumatized people tend to not notice or internalize good stimuli, but to have a heightened attunement to anything “bad”:

    You are probably correct that this strategy is evolutionarily adaptive, at least at first. However, it then becomes a problem in later life as we know.

    I agree that that invented categories of neuro-atypical and neurotypical do not represent divisions in reality, being more like symbolic ideas. I also saw a conflict between that idea and Stephen’s insistence on the other hand that there is no such thing as “normal”. It shows how sometimes we can think in different compartments in our minds in conflicting ways that wouldn’t make sense if we compared them directly.

    The trauma does matter, of course. The trauma is important on its own and its severity and nature directly affects how we think about it. I agree, the actual events – and whatever resilience we have beforehand to help us process the actual events – are more important than whatever we may tell ourselves later.

    Also agree that Western culture is not all bad. I have been reading some contrarian books recently which are relevant to this issue, by Matt Ridley (the Rational Optimist) and Peter Diamandis (Abundance) which talk about the benefits of technological development in capitalistic democracies. I read these as a counterbalance to the constant pessimism about development and technology which seems to permeate our society. I think these optimistic books have good points. Life now is much easier and less filled with suffering in many ways than for people who lived to an average 35 years old at most and had no medical care or leisure time centuries ago.

    The US is a particularly bad example of mismanagement of healthcare dollars and faulty narratives about the nature of emotional suffering. It has a bizarre inversion where many of the most distressed people are subject to the worst treatments (far too many drugs, no therapy), whereas in poorer cultures such people are given more social-emotional support, are less stigmatized, and are not overdrugged. The harms of unrestrained capitalism and economic inequality show up clearly in how American corporations and wealthy people exploit and mistreat “the mentally ill”.

    I like Jordan Peterson’s work and how honest and forthright he is. I watched his Youtube videos. I hope Canada doesn’t start legislating what people have to say about other’s first names. I would never do that.

    I think this statement, “the entire therapeutic process, in nearly every instance, is to make them fit in whether through use of drugs or not’ by Buhner is pretty accurate. At least in America. There is really no interest in listening to people labeled bipolar or schizophrenic here, and every interest in shutting them up as quickly as possible with drugs. Your point about the family though is correct – many families want something different and better. And they are starting to become aware that the “brain disease having to be drugged” narrative is unscientific and limited.

    Regarding a critique of the scientific method you might like this:

    The problem with Western science as applied to psychology it that it has run into the ground in its failure to establish valid diagnoses and its failure to realize that its categories are subjective, not objective. As Holzman discusses.

    The scientific method when it comes to psychiatry and psychology is a sham. They are not real sciences. I’m going to repeat here a quote you may have seen me make elsewhere, from Jan Smedslund, about why “Psychology Cannot Be An Empirical Science”:

    ““The main conclusion to be drawn from irreversibility is that 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.” (from “Why Psychology Cannot be an Empirical Science”)

    I think this is so important to appreciate; the difference between real experiments and a lot of the quasi-experimental trash based on invented diagnoses that research psychiatrists put out. As John Read said, any real field of medicine would dismiss such disjunctive diagnoses in a heartbeat. As the NIMH already has. Only problem is, no real diagnoses are coming to psychiatry anytime soon – or probably ever.

    Ok, I see now you think the same as me – psychiatry is not a real science but a perversion of science. Indeed.

    And I agree, appearing humble is not everything. If one is good at what one does, why be inhibited about that, say it with a touch of confidence or even playful swagger. That’s how I am with what I do and say. As Conor McGregor said, “It’s hard to be humble when you’re the best.”

    Thanks again for your careful thoughts.

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  • Lisa, the logical problem in your statement:

    “(they have) scans that show abnormalities in the brain with disorders and these are real…”

    is that the existence of the “disorders” is presumed a priori, and how to define “abnormal” depends entirely on the opinion of the doctor. Different feelings, thoughts, and behaviors always correlate to changed brain chemistry. Indeed our brain is constantly changing its chemistry as we respond to the environment for better or worse. But that does not make our brain’s responses to adverse psychosocial factors an illness caused by biogenetic factors.

    By psychiatric logic, if you took a brain scan of a person taking a piano lesson that they did not enjoy and felt upset about, and their brain chemistry changed (which it inevitably would), that would be evidence of Piano Playing Disorder. The problem is that the notion of Piano Playing Disorder would be an invention or projection from the mind of the psychiatrist, not something real in the (admittedly) altered biochemistry of the person taking the piano lesson.

    As to this: “these fMRIs can show certain abnormalities of brain function and there are certain characteristics with each different illness.”

    The problem with this is that the “illnesses” and judgments of “abnormality” are creations of men sitting around a table, not anything reliably identified by blood or brain scans. The doctors view the brain scans first, then decide arbitrarily what is “normal” or “abnormal”. There’s nothing scientific about it.

    And Lisa, consider what the leading American psychiatrists say about the validity of these “disorders”:

    In 2013, discussing psychiatric diagnosis, the psychiatrist and former National Institute of Mental Health director Steven Hyman stated:

    “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.” (emphasis mine)

    Hyman went on to call the DSM model of diagnosis, which includes labels like “schizophrenia,” “Totally wrong… an absolute scientific nightmare.”

    Hyman’s successor at NIMH, psychiatrist Thomas Insel, followed up this criticism by saying:

    “At best, [the DSM is] a dictionary, creating a set of labels and defining each. 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.” (emphasis mine)

    David Kupfer, the DSM 5 chair, while trying to defend the new DSM, admitted that the discovery of biomarkers for supposed illnesses like schizophrenia remains “(D)isappointingly distant… unable to serve us in the here and now.”

    And former DSM-IV head Allen Frances went so far as saying, “There is no definition of a mental disorder. It’s bullshit… these concepts are virtually impossible to define precisely.”

    What other field of medicine talks like this about its own labels?

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  • Frank, of course I did not mean disappear literally or stop doing business. I meant stop engaging Phil in arguments within that they are bound to eventually be exposed as lacking evidence and data.

    And their arguments were indeed weak and unevidenced – they did not even cite specific studies to support their claims, counter to what you say – but nevertheless Phil broke them down comprehensively above. Nonsubstantial arguments are indeed a “problem” for psychiatry in terms of making sense and having logical, well-thought out models of human suffering and what to do about it, just not a problem in terms of continuing to deny criticism and keep doing what they do.

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  • Phil,
    Thanks for taking time to break this down.

    We can assume now that Carolina healthcare partners will disappear, since they will presumably not have any real counterarguments to your breakdown of the myths that “schizophrenia” is a valid illness caused by biogenetic malfunctions, etc. And they won’t want to embarrass themselves further.

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  • Sandy,
    Well-written article; your heart and compassion comes through in this. These are some of the most important things to heal people, regardless of our orientation.

    I was just reading an online book you might like, that gave me some new insights into why the brain disease model did not pan out and lead to cures:

    It looks like the faulty unscientific assumptions made early on in the process of researching the diagnoses doomed the research effort.

    Regarding hospitalization as an “answer”, I find it puzzling when people say these things too. To me, the only “answer” found in confining someone for a few days or weeks is that they might be physically safe for at least that long (but maybe less safe after). From my experience, little therapeutic engagement occurs in hospital settings, although your hospital could be different. And there is no “disease” being medicated, just severe terror, confusion, rage, and despair being tranquilized to a temporarily tolerable level – a process which cannot address the developmental/identity issues and lack of social supports which often underlie the distress. And then the social factors and emotional issues causing problems are obscured by the imposition of the unsupported brain disease narrative, leaving the person and their network less able to innovate, think for themselves, and have hope. This is just speaking generally about American psychiatric hospitals by the way, not about you in particular.

    You might also share with your cohorts the apparent results of gradually increasing medicalization and drugging of severe distress (“schizophrenia”) over the last few decades: gradually decreasing rates of functional recovery, as discussed in Jaaskelainen’s meta-analysis where it was admitted “We are not getting better at getting our patients better” –

    The bad news, from the biological/genetic perspective, is that no genetic breakthroughs, nor any new breakthrough drugs, are likely coming to change this dismal picture.

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  • Jonathan,
    I did a quick search too and I don’t find it. It could be a misquote or misattribution. Or Goethe could have some something similar but slightly different, and Buhner misremembered the wording. Anyway it looks like Goethe didn’t say exactly that quote. But I think it’s the idea that important, and Buhner was probably something to that effect that he read in Goethe. It’s the idea that seemingly strange things make sense or are normal when viewed in terms of what the person is responding too that we are initially unaware of.

    If you want, you could contact Stephen Buhner via email to ask him (his email is listed in on the site, I think, or I have it backchannel).

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  • Hi Oldhead, I basically agree with you. Although, my thinking is coming out of conceptualizing distress and problems as existing along continua of severity at different times. But absolutely, there are not valid discrete scientific categories such as schizophrenia, or bipolar, etc – although distressed people do tend to have some functional problems, and to express their suffering in some similar ways, partly because we face many similar developmental challenges in relating and functioning growing up. Still, maybe I am putting too much focus on the “waves” of these continuums, even though I no longer really see them as particles, to use a physical metaphor.

    When I was saying that negative experiences strongly correlate with trauma and deprivation, I was thinking of John Read’s studies about the importance of trauma/neglect in contributing to distress actually. These are common causal factors in many people’s experience of struggle. But yes there are other causes too.

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  • Hi Francesca,

    It is courageous of you to speak out in this way, well done!

    First let me recognize what is surely one of the great quotes of the year here on MIA:

    “I think it’s also fair to say that objectivity is not psychiatry’s strong suit.”

    Haha! The understatement of the year.

    I was wondering while reading if you have the ability in the long term to move to a different Canadian county with a less oppressive system. I read about another Canadian psychiatric survivor, a woman – can’t remember her name – who escaped involuntary treatment in British Columbia by moving to Quebec or Ontario. Maybe you know who I mean.

    One thing I found curious was that you seem to both question and believe in the validity of discrete categories such as “bipolar” and “schizophrenia”. In my way of thinking, these labels denote continua of suffering which are non-discrete (i.e. have no sharp boundaries at the lower and upper edges of each continuum), and thus not valid when considered as discrete conditions. Moreover, emotional suffering is not accurately termed as “illness” – because as you again accurately noted, no biological or genetic cause of such suffering has ever been uncovered.

    You can see here, using this image, I explained the psychodynamic model of labels such as “bipolar”, “schizophrenia”, “borderline”, which you might find interesting:

    Further, I wish to suggest to you a few possible reframings of language; you may or may not find these useful, as they are just my opinion:

    “I have an episodic, sometimes debilitating, serious mental illness” – if I said something similar about my own experiences, I would have said, “I periodically experienced severe distress affecting my ability to function”, excising the use of “illness”. This is less medical.

    “medication” – I would call these tranquilizers or drugs. Since there is no biological illness process with the type of problems being discussed (although there is altered biology due to distress), there is no medication to treat such supposed illness.

    “hospitalization” – I would call this confinement, because there is no medical problem being treated (unless the problems really are also medical).

    “disguise mental illness” – one could say, “hide the fact that I am distressed, confused, terrified, enraged, etc.”

    “Although anosognosia is indeed an actual phenomenon that occurs, for example, in stroke victims, there is no sound basis for believing it similarly occurs in most of the seriously mentally ill.” – this is problematic – anosognosia cannot even occur in people so-labeled, because they have no clearly defined illness. You said this in another part of the article. It is not a question of whether or not the people labeled agree with their psychiatrists, since the psychiatrists have not proven that a valid illness process exists. They have to do this first before anosognosia is possible.

    “bipolar disorder (my sole accurate diagnosis)” – I would question whether any psychiatric diagnosis is accurate or meaningful. One might at one time roughly approximate the behavioral/thinking/feeling description of a particular “diagnosis”, but then over time this may change and one may no longer fit the criteria even remotely. I think you have seen this through your long list of diagnoses (which I also had).

    Francesca, do not take my criticisms the wrong way – I say them out of comradeship with the parts of you that oppose the mainstream system, and to encourage you to think in a way even more counter to establishment psychiatrists and to the system. Which you are already doing.

    I liked your statement: “Despite this lack of objectivity, we are expected to take it on faith that a patient has this insurmountable neurological barrier to insight, rendering her incompetent to direct her own care. “

    It reminded me of when I wrote, “It is almost as if (establishment psychiatrists) believe that by simply asserting that schizophrenia is a valid, discrete illness over and over again in journals and textbooks, by starting each article with “schizophrenia is a chronic, severe brain disease,” that this magically makes it so.” (

    I agree with you that taking psychiatric drugs can sometimes be useful if it calms a person down. But we need to be honest that these are merely general tranquilizers (or sometimes stimulants), not specific medications taking any illness. Then people can make an informed choice.

    Keep on advocating as you are; you are doing a great job with raising these issues.

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  • Rossa,
    For sure you can always repost stuff like this if you want.
    I agree with and like this sentiment: “Recovery is to be expected if you keep your attention focused on it long enough.”
    When I was getting better I repeatedly promised myself and predicted that I would do certain things, like getting jobs, buying a house, finding a good therapist, stopping being afraid of certain diagnoses, etc. And over time I did all these things – I think it was partly because I believed I could do it and thus was more likely to take certain actions and adopt certain attitudes that led to those outcomes. The power of positive thinking.

    Am glad to hear your son has been and continues to make progress from where he started.

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  • Fiachra,
    Always good to hear from you and thanks for the comment.

    I agree, long timeframes are not always necessary for “recovery” (recovery being a vague term depending on one’s perspective and what a person wants). But I think that just as extreme states of mind occur along a continuum or spectrum of severity, so we can see that both the intensity (frequency) and duration of help needed to move a person to a desired better way of being is likely to vary – the time necessary being longer when the initial problems are more severe or when the help is not so high quality or is infrequent, and less long when the problems are not so bad to start with or the help is highly skilled/attuned and intensive. This is very general but you will probably see my point.

    The “no one person’s very special” comment entertained me, because I follow UFC (mixed martial arts) and saw Conor McGregor’s recent comment: “It’s hard to be humble when you’re the best.” –

    That made me laugh, because apparently Conor has not come to a Buddhist enlightenment yet. I admit that his quote also sounds like something I would have said when I was younger 🙂

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  • Hi Alex, thank you, and that is an interesting quote.

    Surprisingly, that is one of the few things I subjectively disagree with about what Buhner said. What I differ on is the supposed value of extreme states as generators of insight or “breakthroughs”. I see them primarily as negative experiences which communicate extremes of deprivation, unmet need, trauma, fear, etc (which is probably because that is how it was in my experience). In my opinion the positive version of these experiences would be better called something else to differentiate it, like mysticism, shamanism, enlightenment, spiritual awakening, etc. I know some people report having extreme states of mind that are positive or spiritual, however, and calling it psychosis, which again shows what a vague term psychosis is.

    Although to be balanced, this quote by Buhner is also ambivalent, and not in any way an unwavering endorsement of extreme experience – just a statement of one possible function of that experience.

    I agree that old systems are breaking apart, as shown with Brexit, Trump, etc.

    Alex, you might like this blog on the collapse of the political-economic status quo and how we can become more resilient despite it:

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  • Hi Liz,
    Thank you for checking in. When Paris shared Buhner’s article about healing “schizophrenia” on the ISPS listserv, I thought it was strange but also interesting. Then after reading it carefully, I saw he had some idea what he was talking about, and I thought it’s important to bring alternative approaches to severe distress like his into the public eye – partly because they are in themselves interesting, and partly as a counter to the tired, monolithic, uncreative focus on biogenetic approaches to severe distress coming from most mainstream institutions and professionals. Buhner’s views are the type that some people would dismiss as “o” or “unscientific”, but a lot of laypeople love his work and find great use in it.

    Regarding the length and depth, this is a bit unrelated, but a while ago I read this 8,000 word article on Aeon: “Omens – When we peer into the fog of the deep future what do we see: Human extinction or a future among the stars?” ( )

    And after reading that and greatly enjoying it (as astronomy and futurist thinking are among my biggest interests), I noted to myself, “Yes, there is still value in long, depth, careful explorations of complicated topics, even in this world we have now of 24 hour news sound-bytes and 40 character twitter messages.” So I decided to focus my reading and writing more on in-depth explorations of complicated topics, and to try to cater to people who want more than a “TL:DR” summary (Too-long, don’t read – the Reddit term for a summary that allows one to avoid really delving into a complicated topic). Hopefully this length of article succeeds in engaging some people and penetrating to a depth that a shorter article or a Twitter note wouldn’t.

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  • Also, as I have posted before, perhaps Carolina Healthcare Partners would like to consider the possible consequences of framing severe distress as a problem primarily caused by – rather than correlated with – biology and genetic expression:

    The problem with using primarily biological models of psychosis is not only that they are unevidenced, but that (not unlike antipsychotic drugs) such models can have serious “side effects.” These include:

    Harsher judgments from people who believe “the mentally ill” have biological brain diseases –

    More prognostic pessimism from both laypeople and professionals endorsing biological models –

    Increased stigma and less ability to regulate mood in those told they have a chemical imbalance –

    Less motivation to explore what one can do to change problems in those given “mental illness” labels –

    Worse outcomes for so-called “mental illnesses” compared to outcomes of physical diseases –

    Greater fear of people given mental diagnoses (and interestingly, as this talk shows, the majority of the public rejects psychiatry’s narratives about a primarily biogenetic cause of mental health problems in most countries outside the United States) – – and

    Please answer this, if you can, Carolina Healthcare Partners. And Phil Hickey.

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  • Regarding the Carolina Partners in Mental Healthcare comment, it’s important to keep in mind some factors when evaluating their opinion:

    1) Thomas Insel in fact admitted that the great weakness of current diagnoses including bipolar is their “lack of validity.” Other leading American psychiatrists have said similar things, including Allen Frances (“There is no definition of a mental disorder – it’s bullshit”), David Kupfer (“biomarkers for mental illnesses remain disappointingly distant), and Steven Hyman (“psychiatric diagnoses seem arbitrary and lack objective tests”).

    Biological factors may contribute to severe distress, and all severe distress is expressed in our brain chemistry, since the brain is an organ for processing and responding to the environment. That in no way means that labels like “bipolar” are valid when considered as discrete illness entities, especially when considered as discrete entities supposedly caused by malfunctioning brain chemistry or genes. There is no good evidence of a primarily biogenetic cause – rather than a biogenetic expression/correlation – of these problems. One wonders if the Carolina Healthcare commenters has studied epigenetics and has a clear understanding of the difference between correlation and causation.

    The following statement from the Carolina Healthcare Partners illustrates the weakness of their approach:

    “Mental illnesses have a long history of biological evidence. For example, researchers have demonstrated that people with depression have an overactive area of the brain, called Brodmann area 25. Szchizophrenia has been linked to specific genes, as PTSD and autism have been linked to specific brain abnormalities. Suicide has been linked to a decreased concentration of serotonin in the brain. OCD has been linked to increased
    activity in the basal ganglia region of the brain.”

    Firstly, none of these categories are well-established disease entities like Huntington’s or diabetes. So all of these statements are based on assuming a conclusion (that the applied labels are valid without biomarkers) in one sense. And the question is, biological evidence of what? Correlation is not causation. The cumulative effects of stress, whether psychosocial and/or biological, do not permit the assumption that discrete “illnesses” called major depression and “schizophrenia” exist as valid illness entities. That does not mean the distress is not real, of course. But in this statement, Carolina Healthcare Partners committed the classic psychiatric fallacy of assuming their conclusion – assuming in this case, that differences in brain chemistry of certain labeled people within a quasi experimental study proves the existence or validity of psychiatric disorders. Reality doesn’t work that way, guys…

    So, expressing the “foundation” of biological expression for serious distress is quite fine – if one doesn’t misinterpret foundation simplistically to mean cause – but imagining that discrete diagnoses can be made out of quasi-experimental studies of distressed people in different settings is quite another.

    Also, to refute another misconception from this comment, the vague concept “schizophrenia” has been linked to hundreds of genes, and getting this label is far more strongly linked to poverty, trauma, neglect, and abuse than to any gene, as discussed below. Perhaps the Carolina Healthcare Partners would like to address this?

    We have to remember that mental illness labels are just that – subjective labels given to a person, not illnesses they are known to have by any known biomarkers.

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  • Hi Cat, thanks for your comment – did you mean “Northern” exposure or “Other” Exposure? I understood though that you are saying that many people only hear the medicalized/psychiatric brain disease model of extreme states, and do not get input about alternative or non-traditional medicinal approaches to these problems. I agree.

    I believe Stephen Buhner has been on some mainstream TV shows about shamanism/herbal healing too; but I will have a look for it on Youtube later.

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  • Hi Sam,
    Thanks for sharing your successful experience helping your wife; it’s great to hear that.
    From experience I agree that dissociated self-states can be worked with and integrated via understanding how they relate to internal mental schemas of people both past and present. In my view powerful negative emotions and fears are often underlying the persistence of dissociation (and the defense of splitting that maintains it).

    I would like to clarify one thing: I think dissociation occurs along a continuum without a precise boundary at which it is a “disorder” or not. What matters is how much does it interfere with or impair a person doing what they want to do, or living in the way they want. Also, the neural underpinnings of dissociation are real in altered brain chemistry – and the ways of relating may appear “hard wired” or fixed – but that does not mean these ways of being are not modifiable via creation of new circuits and alteration of existing ones. And of course, such processes are not a lifelong or incurable disease.

    And as Stephen said, “the more you perceive in the meaning field you are embedded within, the more opportunity you have for protective action.”

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  • Shaun, Perhaps you are also aware that this organization from the article (This is my Brave) is funded largely by drug company money, specifically the maker of these two drugs:

    As noted on the right hand side of their website:

    To respond to the actual topic, people don’t “have” or not have “bipolar disorder”: people having feelings of mania and depression exist on continua with less moody, better functioning people/states of mind, and there is no clear cut-off point at which one has a disease, nor are these adverse experiences diseases. That is why no biomarkers for so-called bipolar disorder have been discovered, nor likely will they.

    From the object relations developmental viewpoint that I favor, bipolar states of mind represent a developmental arrest between more severe psychoses and what are called “borderline” states. But these experiences, which are often associated very strongly with adverse psychosocial factors, are not illnesses, nor are they necessarily lifelong or non-transformable, as we discuss over at ISPS (

    If a discrete disease process causing moody ups and downs were discovered, such a problem would become the domain of neurology, anyway, and psychiatry would not be needed.

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  • Thanks Will.

    I think the key takeaway from this study is this:

    “quality of life was far more determined by non-medication factors such as working, going to school, coping, and having social support than it was by whether or not someone was taking antipsychotics.”

    It is as I have argued before on this site: tranquilizers for pseudo-illnesses are not such a big deal. If there weren’t so much money to be made from drugging people up, we wouldn’t even be talking about the pills for non-illnesses so much.

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  • Shawn,
    This is true – many of these articles use mainstream medicalized terms out of necessity; i.e. because the authors feel they cannot get published or be accepted in mainstream journals (a prerequisite for advancing a research psychology career) without using terms such as “mental illness”, “schizophrenia”, “symptoms” etc. It is a difficult chicken or egg thing. Speaking to some of these authors myself backchannel, they would actually prefer to use the terms “human suffering”, “extreme states of mind”, “distress”, etc, but these would not be accepted as scientific, so they can’t get started using those…

    You might like to check out the group ISPS – – on which these debates go on. People can get a free 3-month trial to our messaging listserv ( and there are some interesting discussions and resources about alternative ways of understanding people commonly labeled “bipolar” and “schizophrenic”. Please come check it out. That goes for anyone else reading this too.

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  • Oldhead,

    While you may not like posters like Shawn or shook (who I disagree with quite a bit also), do you not think we can discuss heated issues with them in a respectful tone? I think both you and I would like more people to be involved in the discussion here at MIA. But by responding to them as if they were idiots or little children who should automatically see things your way, you are not promoting a healthy dialogue.

    Please remember some of the things we’re meant to abide by on the Posting Guidelines (I’m saying this not as a moderator, just as a participant pointing out that they’re there):

    “Keep comments civil. This includes refraining from posting personal attacks, threats, sarcasm, spamming, hyperbole, misrepresentations of oneself or others (including strawman arguments), illegal material, profanity, hate speech, disparaging assertions about a person’s character, discrimination based on a person’s identity or occupation, and calls for violence against any people. We ask for good faith and the benefit of the doubt in our effort to allow anybody who wants to join the dialogue to do so without fear of abuse. Please respond to and criticize ideas, not character.

    Honor differing viewpoints. This website intentionally brings together individuals with varying backgrounds and values. We believe civil, inclusive dialogue to be crucial to finding solutions to our current paradigm of mental health care.

    We are a shame-free zone. Language that primarily exists to disparage, shame, dismiss, taunt, bait, exclude, or otherwise diminish another person is not allowed on Mad In America.

    We are a certainty-free zone. Benefit of the doubt will be given in all cases. Commenters are asked to refrain from assuming or inferring anything about another person’s position. Errors of omission or misuse of terms are always assumed to be made in good faith. A person’s choice not to acknowledge or respond to specific arguments will not be assumed to be malicious, or a sign of a character flaw, or otherwise held against them.”

    Oldhead I think we can do better regarding some of the above. I recognize that I myself have in the past done some of these things, and I’m trying to do better also.


    To Shawn, while I disagree with some of your positions, I respect that you have generally argued in good faith about contentious topics and not stooped to personal attacks. I hope you will not take being attacked by a few commenters the wrong way and choose not to return to the site. A few people are not representative of everyone.

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  • Ok thanks Shaun, that is a fair response, and I appreciate your taking the time to write this, and appreciate the sentiments you said.

    I am quite aware that full recovery from “severe mental illness” – what I would call presymbiotic or symbiotic psychotic states – is not currently a practically attainable goal for many people due to lack of finances, lack of supportive friends and family, lack of depth intensive therapy, lack of job and housing resources, lack of hope, and so on. But I view this as a matter of a relative lack of resources and support, not a lack of potential for recovery in people given a certain label.

    These social and systemic deficits of resources are larger cultural problems particularly here in our individualistic culture as you said. But at the same time I think it is good to be careful not to make essentialist, deterministic statements about simplistic labels like “schizophrenia” or “bipolar” and how people given that label will do, since these tend to reduce agency and hope and encourage undue pessimism.

    And as you must know, there is more than enough pessimism out there about labels like borderline, bipolar, and schizophrenic. Severely distressed people have enough challenges without us telling them they can’t achieve whatever their goals are…

    Shaun, you might also be interested to read my favorite quote from Smedslund about why the outcomes in one or even a few quasi-experimental study of human beings should not be used as a basis for predictions; I think you’ll understand it:

    “Why Psychology Cannot Be An Empirical Science”:

    “The main conclusion to be drawn from irreversibility is that 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.” End quote…

    So it’s my position that you can’t really make valid statements about what certain labels of “patients” mechanistically do in general, but instead should speak about what people can do in certain settings, with certain resources, with certain therapists, over particular timeframes etc… whirls in particular streams at particular points of the river.

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  • Shaun,
    It seems like you didn’t look closely at the resources I posted.

    So here are a few more, from a broader group-level study perspective. These links show that with sufficient resources, and outside of the mainstream psychiatric system, the potential for full recovery from severe distress can be quite good. Unfortunately, and this probably illustrates why you have the beliefs you do, Shawn, adequate resources to help people are something we often lack here in America, and awareness of alternative approaches by American mental health professionals such as yourself is (obviously) quite limited. But that ignorance doesn’t permit us to make generalized statements about the potential for full recovery from “major mental illness”, as if we had any power to predict how they will do. Ok here are my studies:

    The Empirical Evidence about Recovery: Many People with (Serious) Mental Health Problems Recover – – This looks at recovery rates of major depression and schizophrenia to show that both full recovery and/or major improvement are surprisingly common.

    Revisiting the Developed versus Developing Country Distinction in Course and Outcome of Schizophrenia –

    This shows how a large proportion, sometimes more than half, of people labeled schizophrenic in developing nations recovered fully. In developed nations the proportion was smaller but still significant, much more than “rare”. Shawn, if you look at the recovery rates in India and Nigeria, it should give you pause about the statements you made.

    Open Dialogue five year study – – This showed how five years down the road, about 75% of initially psychotic people were symptom free and functioning well under the Open Dialogue approach.

    The Vermont Study – – about half of the people in this study had no significant level of distress and functioned fine, long after being diagnosed with “schizophrenia”.

    Empirical Correction of Seven Myths about Schizophrenia –

    And Bruce Levine says, “I have spent time with hundreds of treatment reform activists who were once diagnosed with schizophrenia but who have recovered without medication, and my experience is that they consider themselves lucky to have had family and/or friend support for their choice to resist psychiatric authorities. They tell me that overwhelming anxiety is often a trigger for relapse, and having family or friends with confidence in the possibility of recovery and in their treatment choices is a great anxiety reducer.”

    Source –

    So Shawn, just because you have lower expectations for people with a certain label, doesn’t mean others have to set their sights accordingly. Here again I’ve shown you up with actual data, whereas all you’ve put out is opinion.

    If you want to provide some data to counter mine – to support your point that the type of stories I’ve linked to the first post, and the broader study data I’ve linked in this post are rare, impossible, mistaken – please be my guest.

    Otherwise, you’ll just look like you’re holding onto outdated pessimistic beliefs. Anyone can say anything on the internet; we have to back our statements up with more than opinion.

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  • Jo,
    As a rabid critic of the biomedical model and psychiatric diagnosis, I could not agree more with this and so I joined your group.

    Via my own writing about “borderline disorders” and “schizophrenia”, I have received hundreds of emails about this issue, and not all but the large majority are people who are scared that they have a lifelong incurable disease that won’t allow them to work, have good relationships, and find fulfillment in life.

    Holding the beliefs I do about these problems representing emotional developmental arrests – i.e. primarily failures of ongoing emotional support, love, and security – I can present a more hopeful open-ended model of suffering to them. However, many, many people never hear or find an alternative to the model that your brain is broken and you need to take drugs indefinitely. But people keep searching online for more hopeful viewpoints, and many of them do find their way through to alternatives.

    If you want to add a couple more stories / resource lists to the group, please check these out:

    I am in Washington DC – you know, the place where old guys sit in boardrooms and make up DSM disorders.

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  • Shaun,

    I’m starting this comment in a new thread here, because your idea about there being “no cure” for “severe mental illness” is wrong on a number of levels and needs to be called out.

    I hope other commenters will check out the links below and see why they don’t have to give Shaun’s pronouncement the time of day.


    Regarding this,”With a wide range of treatments and behavior changes, people can stabilize their symptoms. But there is no cure, that is for sure. Not one science has figured out yet anyway.”

    Don’t be so sure my friend.

    It seems like you don’t know much about how to cure bipolar or schizophrenic conditions.

    Let me share a few stories with you:

    My story:

    Caleb’s story:

    Lois’ story:

    Daniel’s story:

    Eleanor’s story:

    “Rethinking Madness”; Six case studies here:

    “Treating the Untreatable – Healing in the Realms of Madness”; 13 case studies:

    “Weathering the Storms – Psychotherapy for Psychosis”; 12 case studies:

    So much for the “no cure” idea, huh Shawn? If you actually read these you’ll see there’s a lot you don’t know about how to intervene and transform with what are called bipolar and schizophrenic states. It takes a lot of work and time, but it’s doable.

    I advise you not to think you can tell everyone whether or not their experience can be “cured”… such a position is rather hypocritical, given how you were earlier advising other commenters not to make hasty assumptions about psychiatric drugs. And as you’ll see in the link, I’m not someone making assertions without having lived the experience and done the research. I have recovered from distress that others labeled as “serious mental illness.” And I believe it can be cured because I lived that experience.

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  • Shaun,

    Regarding this,”With a wide range of treatments and behavior changes, people can stabilize their symptoms. But there is no cure, that is for sure. Not one science has figured out yet anyway.”

    Don’t be so sure my friend.

    It seems like you don’t know much about how to cure bipolar or schizophrenic conditions.

    Let me share a few stories with you:

    My story:

    Caleb’s story:

    Lois’ story:

    Daniel’s story:

    Eleanor’s story:

    “Rethinking Madness”; Six case studies here:

    “Treating the Untreatable – Healing in the Realms of Madness”; 13 case studies:

    “Weathering the Storms – Psychotherapy for Psychosis”; 12 case studies:

    So much for the “no cure” idea, huh Shawn? If you actually read these you’ll see there’s a lot you don’t know about how to intervene and transform with what are called bipolar and schizophrenic states. It takes a lot of work and time, but it’s doable.

    I advise you not to think you can tell everyone whether or not their experience can be “cured”… such a position is rather hypocritical, given how you were earlier advising other commenters not to make hasty assumptions about psychiatric drugs. And as you’ll see in the link, I’m not someone making assertions without having lived the experience and done the research. I have recovered from distress that others labeled as “serious mental illness.” And I believe it can be cured because I lived that experience.

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  • Shawn,
    Mental illness alone does not do anything. It is just a label given to subjectively observed behaviors, thoughts and feelings.

    What does kill people are the cumulative effects of adverse social and psychological experiences (which affect biology and genes), as well as some direct biological factors (such as toxins or drugs). Calling these adverse factors and their sequelae in terms of human suffering “illness” doesn’t really explain much, nor is it a good metaphor.

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  • Shawn,
    To give one example of where the “mental illness” notion fails, being in a state of chronic terror and rage – a frequent precursor to having paranoid thoughts and delusions – is not an “illness”, but is a state of experiencing usually resulting from years of adverse stressful experiences, in which the brain / epigenome is profoundly affected by experiences of fear, horror, deprivation, frustration, etc. Here on MIA many people have discussed these connections carefully, including the ACE (Adverse Childhood Experiences study).

    Being in extreme mental states is not usually explained well as an “illness”, as with diabetes which relates simply to lack of insulin.

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  • Aurora and Shawn,

    I think we need to be honest that psychiatric drugs are not targeted entities treating an illness called “bipolar”, but are instead tranquilizing, depressing, or upping substances that have a generalized effect upon neurotransmitters. They may still help people by numbing them for shorter or longer time-frames, but what they do not do is treat any life-long brain disease, contrary to what psychiatrists say about so-called bipolar and schizophrenia.

    Regarding the reasons why certain people reject the validity of labels such as “bipolar”, and think of psychiatric drugs as general tranquilizers rather than as medications treating a specific disease process, please consider the views of the leading American psychiatrists of recent years about DSM diagnoses including bipolar…

    In 2013, discussing psychiatric diagnosis, the psychiatrist and former National Institute of Mental Health director Steven Hyman stated:

    “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.”

    Hyman went on to call the DSM model of diagnosis, which includes labels like “schizophrenia,” “Totally wrong… an absolute scientific nightmare.”

    Hyman’s successor at NIMH, psychiatrist Thomas Insel, followed up this criticism by saying:

    “At best, [the DSM is] a dictionary, creating a set of labels and defining each. 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.” (emphasis mine)

    David Kupfer, the DSM 5 chair, while trying to defend the new DSM, admitted that the discovery of biomarkers for supposed illnesses like schizophrenia remains “(D)isappointingly distant… unable to serve us in the here and now.”

    And former DSM-IV head Allen Frances went so far as saying, “There is no definition of a mental disorder. It’s bullshit… these concepts are virtually impossible to define precisely.”

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  • Thanks for taking the time to come up with this Noel.

    It is strange how time and again, the notion that “your borderline disorder” or “your bipolar illness” is causing distress keeps popping up. I have repeatedly stated this to people – a psychiatric label is not a direct cause of anything (distress is usually a derivative of other complex causes). A psych label is simply a label for an experience. Exactly what you said.

    I think these factors you listed are very powerful:

    “Biological explanations of disease that are separate from one’s life circumstances have many positive aspects. For instance, they allow for a sense of validation for one’s pain and suffering, they decrease the sense of moral inferiority, and, in the words of Carrie Fisher, they “explain away my behavior.”

    Other factors would be that the biological decontextualized narrative supports the framing of drugs as a solution to “treating” the problem, and that the biological narrative supports the notion that psychiatrists have some mystical medical expertise about life problems that other psychological professionals don’t.

    Don’t forget that an $18 billion annual industry – antipsychotic drug sales – is riding on the perpetuation of myths that bipolar disorder is a well-defined disease entity that can be effectively treated by drugs.

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  • Aurora,

    You are apparently one of the relatively rare people who continues to take drugs faithfully for that many years. Most people labeled with bipolar seem to discontinue the drugs relatively quickly, probably in part due to the side effects and the disempowering narrative about “treating one’s brain disease”:

    Of course, this particular article makes the mistake of saying, “Knowing you have to take ‘medication’ for the rest of your life is a hard pill to swallow.”

    Luckily it’s not a pill one has to swallow at all, because many people can get better from severe distress without long term use of drugs.

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  • Aurora, in your case drugs could have been and apparently were very useful. However, individual anecdotes are not a substitute for data from quasi-experimental studies of large numbers of people across a range of settings and timeframes.

    The facts remain that long-term compliance with these brain-dampening drugs is quite poor, that the adverse side effects are often severe, and that on balance these drugs encourage pessimism and a lack of agency via indoctrinating people into believing they have a brain-based illness called “bipolar” that is out of their control.

    I wrote about this topic below, and it’s quite relevant to “bipolar” and drugs, since drugs are one of the prime agents used by many psychiatrists to convince clients that their distress represents a biologically-based illness:
    The problem with using primarily biological models of psychosis is not only that they are unevidenced, but that (not unlike antipsychotic drugs) such models can have serious “side effects.” These include:

    Harsher judgments from people who believe “the mentally ill” have biological brain diseases –

    More prognostic pessimism from both laypeople and professionals endorsing biological models –

    Increased stigma and less ability to regulate mood in those told they have a chemical imbalance –

    Less motivation to explore what one can do to change problems in those given “mental illness” labels –

    Worse outcomes for so-called “mental illnesses” compared to outcomes of physical diseases –

    Greater fear of people given mental diagnoses (and interestingly, as this talk shows, the majority of the public rejects psychiatry’s narratives about a primarily biogenetic cause of mental health problems in most countries outside the United States) – – and

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  • Where is the data supporting that there is an enormously heightened risk of death without drugs, i hate wellness?

    Tragically, about 10% of people – more or less depending on the study – eventually suicide who are also labeled bipolar (unlike diabetes bipolar is not a discrete or scientifically valid disease condition, so how and by whom the label is applied also matters tremendously, but that’s another issue).

    Even if 0% of people suicided who were on drugs for supposed bipolar – something that is obviously not true – the difference between 0% and 10% would still be small compared to the 90% of people who suffer greatly and never suicide either on or off drugs (and let’s not kid ourselves that there are many, many, many people who don’t take their prescribed drugs reliably, or stop completely due to the side effects).

    So in other words, you are probably blowing the protective effects of drugs out of proportion, and you didn’t present any data regarding mortality to stand on in the first place. If you want make a real argument, please come up with a range of studies showing that drugs significantly reduce mortality in people given this arbitrary label “bipolar”. I don’t think you have this data.

    And let’s be clear – these drugs are tranquizilers, not medications. Antipsychotic drugs damping down people’s feelings are not medications treating any coherent illness entity. No wonder they are used for so many disparate problems apart from “bipolar” (if that even makes sense…), given their generalized nonspecific damping effects on the ability to feel and think.

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  • Hi All,

    I encourage others, both professionals and laypeople, to post comments on the following mainstream article about Carrie Fisher’s bipolar being supposed caused by a “chemical imbalance”:

    Somehow the chemical imbalance myth causing bipolar got revived here, and then the author (a psychiatrist) suggested that childhood trauma has nothing to do with bipolar disorder.

    I posted the following public comment )recopied) below, with some research from Noel Hunter:

    Anyone can make a comment on the article via a Yahoo account, Google account, or Facebook account.



    “As someone who was once in a psychotic state but recovered, I find it sad to see that Carrie Fisher, one of my favorite actresses, bought into the “chemical imbalance” myth. It’s also regrettable to see Sally Satel deny that childhood stress can be one factor (among many) raising the risk for becoming distressed in a way that gets labeled as bipolar. Recent research that I cover in the article below shows that childhood trauma and later trauma are some of the biggest risk factors correlated with receiving a label of bipolar and schizophrenia.

    I wrote below about my own struggle with psychotic states, and how I took a different path than Carrie to recover, in my article “Rejecting the Medications for Schizophrenia Narrative”:

    I share this as an example that there is no one size fits all; and people do not have to accept the disempowering narrative that they have a lifelong brain disease and must take drugs. Some of us who were (formerly) severely mentally ill find another way that works better for us.

    By the way, here’s a sample of the research (which applies equally to bipolar), that Satel denied when discussing the causes of such distress:

    “In the model of severe psychosis I favor, adverse environmental experiences are frequently (although not always) involved in leading to psychotic breakdowns. In support of this position, a number of psychologists and psychiatrists, such as John Read, Colin Ross, and Richard Bentall, have done research showing a powerful link between being labeled “schizophrenic” and having experienced physical, emotional, and sexual abuse.

    An article by Noel Hunter reviews this research and provides references to the literature:
    “Read et al. concluded in 2005 that child abuse is a causal factor in “schizophrenia.” Read et al., after identifying similarities in the brains of traumatized children and adults who were diagnosed with schizophrenia, demonstrated the neurodevelopmental pathways through which childhood adversity may cause psychosis. In 2004, Janssen et al. established a strong dose-response relationship between childhood abuse and psychosis after following 4045 individuals from the general population for two years. Bentall et al. also found a dose-response relationship between childhood abuse and psychosis (meaning that the greater number of adverse experiences and/or the higher the severity, the greater the risk), wherein those who had a high-severity of childhood abuse were 48.4 times more likely to develop psychosis as an adult. When specificity and dose-response relationships are demonstrated, a causal relationship is strongly probable. In fact, Bentall et al. stated that “experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.” And, lastly, in the same month as the Sekar study was released (January 2016), so too was a nationwide cohort study out of Denmark and Sweden which found that experiencing the death of a first-degree relative before 18 years of age, especially from suicide or accident, resulted in a 39% increased risk of being diagnosed with schizophrenia.”

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  • Haha that is true Jarett – if diagnoses were also worth anything I’d also have a lot of cash. On the other hand as we both know it is not really a laughing matter to be given one of these “serious mental illness” diagnoses.

    Regarding Borderline Personality Disorder, please read my story about recovering from problems associated with that label –

    Btw I checked out your personal Wix and see you are helping other people be more encouraged – well done! It is very rewarding to help people.

    You might also be interested to check out groups such as ISEPP (, which includes some psychiatric survivors. About early psychosis, you might like ISPS (, as well as my article rejecting the validity of schizophrenia:

    Sorry for trumpeting myself here. I want to encourage you that there are quite a few other psych survivors speaking out publicly about the ways they found to get better deeply and holistically (as opposed to “I’ve got a lifelong brain disease and have to take my meds to manage it”), and in so doing encouraging others. It took me a long time to get to the point of speaking out publicly, due to fear of stigma, job loss, etc. But I’m glad I did it and commend you on doing the same.

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  • Hi Jarett,

    Well done on speaking out about all this publicly; that takes a lot of courage. And glad to hear you are feeling better now; you surely deserve that.

    Beyond the drugging, another aspect of your story stood out to me – the misleading effects of being diagnosed with so many different labels. Like so many people it sounds like you were brainwashed to believe your distressing experience represented “disorders you had”, rather than primarily understandable reactions to your own complicated individual experiences over time. When one doesn’t know any better and has professionals in white coats telling one that one’s distress is caused by one’s “bipolar” or by one’s “major depression”, the inversion of cause and effect that appears so frequently in psychiatric logic, and its divorce from the context of a person’s life, may not be immediately apparent.

    In other words psychiatrists brainwash many people into believing that “the disorders” magically cause the distress in isolation, rather than interaction between the individual and the environment over time leading to distress. Thus the decontextualists (i.e. the psychiatrists) make it more difficult to think of distress as logical and understandable responses to what has happened in one’s life, and more difficult to believe one can take action to change one’s circumstances for the better.

    It’s good to hear you were able to start thinking for yourself more and trust your own sense of the right path to take. That is what so many psychiatrists do not allow, by paternalistically labeling suffering and pressuring people into numbing “treatments”, rather than by listening to them and giving them real choices.

    I felt this section below provided a good example of how what psychiatrists tell people often warps their minds:

    “I was blown away. I cried, I laughed, I raged, I found hope again. I’ve always suggested to past doctors that I may have PTSD, but they would only scoff, get irritated and hand me the DSM IV, which clearly stated that I needed to have suffered a near fatal event in order to have PTSD. Where was my Vietnam? Where was my car crash? No, to them I was just looking for attention, and they’d follow that by telling me to let them do their job. However, in 2013 an updated DSM5 included Childhood Post-Traumatic Disorder or Complex PTSD, so maybe I should have been doing their job after all?”

    There is no recognition by the professionals that these “disorders” lack validity and do not truly exist as discrete entities. In the black and white world of psychiatry, subjectively-observed disjunctive criteria are enough to “have” or “not have” a supposed disorder, and thus to spin the bottle for this or that pill, with barely any regard for the social context or life story of the person involved. It is truly amazing to see how little understanding some psychiatrists have that distress occurs along a continuum/spectrum with adverse social experiences being one of the major contributors to most reports of distress – and this applies not just to “PTSD” (another artificially delineated and questionable concept, as if PTSD were clearly separable from other DSM diagnoses), but also to more severe distress often (mis)labeled as bipolar.

    Ultimately psychiatrists fail to realize that our complex human genomes did not evolve to reify or confirm fabricated DSM diagnoses, which are simply labels made up by old white men sitting in boardrooms.

    If you haven’t heard of him, you might also like the writing of Colin Ross – – such as his book the Trauma Model, A Solution to the Problem of Comorbidity. It explains why separate psychiatric disorders do not really exist as 0s or 1s that has one either has or doesn’t have, but that emotional-social problems and biological correlates are matters of degree over time.

    Lastly you might also like this article by John Read on the future or lack thereof of psychiatry, if you haven’t already seen it:

    Thank you again for speaking out Jarett; we need more people like you doing that.

    p.s. While I focused on the weaknesses of diagnosis – one of my favorite topics – I did hear the immense suffering caused by the drugging. I was on over 10 drugs myself, although I didn’t have as difficult a time coming off. And my father was on many different psych drugs and was harmed by both them and ECT. So yes, the side effects (and psychological effects) of these drugs can be very nasty, and lead one further and further away from being able to do the things that can really lead to wellbeing. Again glad you are working past that. Once one has some momentum, is getting off drugs, and no longer believes the lie that one has lifelong brain disorders, getting well is not impossibly difficult.

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  • Stuart,

    There are no “actual rates” of “mental illness” to measure; as subjectively judged distress based on spoken words, actions, and thought cannot be reliably measured in the way that one can measure, for example, the number of pounds of copper shipped through Los Angeles in a given year, or the number of sheep on a farm in Iowa in April 2016.

    Of course, people’s distress – including very severe, long-term distress that gets labeled “schizophrenia” or “bipolar” – are real experiences, and these experiences are reflected in altered brain chemistry and epigenetics over time. But that does make these experiences illnesses, any more than it would be evidence of an illness if one’s brain chemistry changed in significant ways after taking a course of piano lessons, being held hostage by terrorists for months, losing a beloved spouse in a traffic accident, falling in love, or losing a job and becoming depressed. Inevitably, one’s brain chemistry would change profoundly in individualized ways through all of these experiences, and three out of the five might lead to a (spurious) diagnosis of “mental illness”.

    Dr. Pies is in a Scylla and Charybdis position. If rates of (non)-illnesses have increased, then clinicians are “over-diagnosing” the people who come in to see them, and drugging is not making a big difference in reducing the number of people who supposedly fit a diagnostic category.

    If rates of non-illnesses have not increased, as Pies asserts, then the continually increasing drugging of these people evidences a number of problems, most especially that the drugs do not work to improve long-term functional outcomes of distressed people.

    In Dr. Pies’ fantasy world, “schizophrenia” is a chronic, long-term disorder that requires indefinite druging, but that’s not the world everyone lives in, including people such as myself who once experienced psychosis but found alternative ways out.

    It’s hard to tell what is really going on in the smoke and mirrors world of psychiatric statistics.

    But ab initio, the whole problem comes back to the lack of valid diagnoses in psychiatry and the lack of any biological treatment that can directly target a non-illness, let alone make a substantial long-term difference in the direction of most people’s lives.

    To repeat, there is no knowable rate of “mental illness” – just how many treatment providers have given however many people a subjective label at a certain time. Pies talks around this problem, speaking about labels like “schizophrenia” as if they represented well-delineated concepts, but well-informed members of the public can now see through the charade.

    Severe distress is real and the depth of distress in people’s lives may vary significantly due to a whole range of factors, but this doesn’t mean we should pretend that there are neatly reified mental illnesses out there that people “have”. Things are not going to get any easier for Pies, because there are no valid diagnoses coming to psychiatry anytime soon.

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  • Ekaterina,
    Well done for speaking out with your own truth. I find when you have a deeply felt confidence in what you’re saying based on your lived experience, it doesn’t matter if other people criticize or try to invalidate you. Keep exploring and speaking up the way you have been.

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  • Merete, great article, credit to you for speaking up.

    Regarding the idea that treating people experiencing psychotic states of mind without drugs is “unscientific” (a strange thing to say given that “schizophrenia” is a disjunctive unscientific diagnosis, and since there is no scientific support for using tranquilizers beyond one year), do they not know about William Gottdiener’s research on this issue (or the Open Dialogue results)?

    Check it out here –

    This piece, the biggest meta-analysis of psychotherapy for extreme states (covering 2,600 plus people, in 37 separate studies of therapy averaging 20 months’ duration) came to the following conclusions from Gottdiener:

    “There is a long-standing controversy about the use of conjoint medication in the psychotherapy of people with schizophrenia. For many years psychotherapists were reluctant to employ antipsychotic medication as an adjunct to psychotherapy because they thought it would disturb the therapeutic process. However, since at least the 1960s most therapists that treat people with schizophrenia have used antipsychotic medication in conjunction with psychotherapy. Most therapists think it is indispensable. However, between 40% and 75% of patients do not take their medication (Perkins, 1999) and there are many for whom medications fail to work (see above Hegarty et al., 1994). For these patients and for therapists who choose to offer treatment with little or no adjunctive medication, it would be important to know if such treatments work.

    When antipsychotic medication was used with individual psychotherapy the mean effect size was r = .31 (95% CI + .19 to .42). When antipsychotic medications were not administered with individual psychotherapy the mean effect size was also r = .31 (95% CI + .12 to .48). The corrected effect size and BESD results for psychotherapy with medication and without medication was the same. The corrected effect size was r = .36 and the BESD results showed that improvement rate increased from 35% to 66%.”

    “It is surprising that the proportion of patients that were likely to improve without conjoint medication, is similar to the proportion of patients that were likely to improve with a combination of individual psychotherapy and antipsychotic medication. This finding is contrary to most therapists’ clinical expectations. The finding that individual psychotherapy can be effective without medication is not new (see Karon & VandenBos, 1981). However, it is important because it suggests that individual psychotherapy alone might be a viable treatment option for some patients who do not improve from treatment with antipsychotic medications, for some patients who refuse to take medications, or for patients who are treated by therapists that choose to use little or no adjunctive medication.”

    You might also like to see this piece where I wrote about non-drug approaches to extreme distress –

    There are a lot of these accounts of full recovery from extreme states without drugs out there; psychiatrists just seem to be unaware of them, perhaps because non-drug focused approaches challenge their status as authorities and interrupt their Pharma funding.

    Also Merete, you might find these ideas from a comment posted on another forum useful, about how to create counter-narratives to psychiatric views:
    There are many avenues through which laypeople with lived experience can write and speak about their ideas and get published – for example, via self-published Amazon Kindle books, using blogs self-made on WordPress, Wix or Weebly, via Mad in America, Counterpunch, Truthout, or Asylum Magazine; via creating a Youtube channel, or via Facebook groups. These can all be done essentially for free or for a few dollars/pounds a month.

    With the advent of these freely available online social media outlets, there are far fewer barriers to non-professionals spreading alternative views. So I encourage you to write about your views, as the proportion of writing about extreme states coming from people with lived experience needs to increase.

    Such actions disrupt the story promulgated by mainstream psychiatric researchers and Pharma-funded institutions of there being a biogenetically-based brain disease called schizophrenia needing drugging in every case – a false narrative that is already under assault, and which will come under increasing pressure as counter-information to the mainstream views about “schizophrenia” becomes more widely available.

    Please get more people in Norway to speak up; you are right we don’t have another survivor to lose.

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  • Olga,
    Terrible to read this.

    Are there any alternative newspapers and/or online blogs in the Danish language in which you can publish this story, along with naming the psychiatrists and institutions involved in perpetrating this abuse? The Danish public needs to hear about what these psychiatrists are doing, and they need to be named. If there are no consequences and no light shone on the situation, they will not change their behavior.

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  • I think this is the point Noel stated most needing to be emphasized:

    “It cannot be ignored that individuals in emotional distress are, indeed, more likely to become aggressive; rather, what needs to be highlighted is that there is no “illness” causing the behavior but rather reactions to things like poverty, oppression, abuse, and other trauma and that these factors need to be the focus of any efforts to decrease violence in our society not further oppressing, abusing, and traumatizing people.”

    It’s pretty obvious – people who are terrified and enraged, and are frequently in poverty and in difficult interpersonal situations without enough soothing, loving support from others – these people are more likely to lash out violently simply due to the stresses they are under. They are also the people most frequently labeled as borderline, bipolar, schizophrenic – meaningless words that basically distract attention from the fact that people so-labeled are often under immense life stress and have been very upset, often for a prolonged time!

    The illusion is that there is any illness called bipolar or schizophrenia causing these individuals to become violent. People’s brain chemistry changes all the time, including when they are under extreme stress, so there are biological correlates to aggressive feelings and acts, such as increased release of brain chemicals like cortisol. For balance it should also be noted that there are biological correlations with positive, loving feelings and acts, matching the release of brain chemicals like oxytocin.

    The myth is that there is some genetically or biologically-caused illness causing undesirable (or desirable) behavior and corresponding altered biochemistry.

    Another myth is that there is a separate class of people labeled bipolar or schizophrenic who cannot recover to become normal. Most likely, the wealthy, male white people giving the labels to the younger, more diverse, less wealthy “mentally ill” would themselves be getting labeled “mentally ill” at a much higher rate if they had been born into poverty, had poor parenting, and been subject to stress and trauma of all kinds. The labeling professionals have no special genes protecting them from becoming psychotic under sufficient stress.

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  • Sera, I thought this part was particularly on target:

    “You insistently point to how things aren’t working, and then declare with all the apparent confidence in the world that what is needed is more of the same. Person’s taking their psychiatric drugs, but they aren’t working? More drugs for them! Psychiatric hospitalization hasn’t fixed anything? Send them back!

    What precisely do you think is going on in these hospitals that you lament do not have enough beds available or enough laxity in their policies for all the forced commitment you would like? It’s not Disney World in there. I can tell you that much. No magic is happening. It’s just more psychiatric drugs and incarceration until people are released into the same damn situations from whence they came.”

    This is the primary illusion the mainstream media spreads: that psychiatric diagnoses are valid and that if only more people were taken off the streets, drugged and confined, that things would be better.

    And there is continually the illusion that slapping some invalid label like bipolar or schizophrenia on a person explains what has caused that person to be so distressed, hopeless, nonfunctional, or enraged. Newsflash: it doesn’t. It is tired, tendentious, and stupid. Stop labeling people.

    To me the following paternalistic, force-focused statements from the Globe article showed the true colors of the system they were discussing:

    “They (the mental health system of San Antonio) want people in crisis to submit to help, and to see police as partners in making that happen…

    They’ve done what many Bay State advocates dream of, and one thing those advocates resist: taking decisions on treatment and medication out of the hands of the most severely ill.”

    And how did San Antonio do that? (Primarily) by taking $6 million dollars from AstraZeneca.

    There are a few good intentions to the Globe article and even a few good parts to the San Antonio system – these things are never all bad. Just a shame the few good potentials are so contaminated by the disease model and so heavily framed in terms of those who dispense treatment and enact social control – all based on the myth that mysterious mental illnesses are causing life problems, and the idea that everyone has to be on a drug right away.

    And too bad they didn’t cover Open Dialogue or intensive psychotherapy of extreme states without drugs; to me those are better solutions.


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  • Well done – this is a well-written, incisive, and carefully referenced article that hits all the high points about what is wrong and harmful in the 21st Century Cures act. Thank you for helping to get the word out to more people about what our government and elected representatives are doing.

    As usual in the USA, the money and benefits of legislation go to the corporations and the wealthy, while increasingly more young and vulnerable people are added to the “get your daily meds” line. It’s important to speak up respectfully – but firmly and clearly – about these inequities and not to allow oneself to be hushed by agents of the status quo.

    Your article notes how people with lived experience and their families often feel quite different about what constitutes a helpful intervention or attitude compared to politicians or mainstream professionals. I find this too – in speaking to young people and their family members, opinions about psychosis and the mental health system that are upsetting to Mds and PhDs are not upsetting to those with lived experience and their families. Experiencing this emboldens and encourages me.

    Thank you again; I wish more people were speaking out the way you do.

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  • Bonnie,
    It’s very heartening to hear about this type of event; well done!

    Regarding the slow processes of activism which are so crucial to laying the ground for sea changes, earthworms are not the only metaphor drawn from natural processes.

    Another good one is earthquakes – underground pressure has to build up via geological processes over decades or centuries, before the potential energy stored suddenly erupts in a major repositioning of the earth’s surface.

    Additionally, one can do an experiment illustrating such processes: Build a sandcastle on the beach. Then fill a bucket with dry, fine sand. Hold the bucket above the sandcastle and slowly pour a thin line of grains onto one corner of the sandcastle. For a few minutes, a small block of new grains will build up and the main sandcastle structure will not move.

    But then, suddenly, without warning, the weight of all the small grains will pass a tipping point and the entire sandcastle will fall down and settle into a new arrangement totally unlike the old one. This example is analogous to activism against psychiatry over long periods – for most of that time, very little may appear to be happening as the slow drip, drip, drip of ideas and actions (a living version of the sand grains dropping onto the psychiatric sand castle) gradually affects one person at a time. But eventually a tipping point is reached and collectively more people begin to become aware and ask for change. This pressure can then threaten the whole sandcastle and house of cards that is psychiatry. That is what we can see happening at events like your Toronto talk.

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  • Hi Cindy,

    What a heart-breaking story – difficult to even comment on. I will only say that the long-term confinement by the “hospital” is completely inappropriate to what happened and what caused this incident, and is motivated out of fear and misunderstanding by the public and lawmakers.

    One more thing – the Fundme page might get more donations if it told Marci’s story in some moderate level of detail in the description box. That’s what the most successful campaigns on GoFundMe do. And the donation page might benefit from a photo of Marci’s living daughters, along with a mention of how and why they need their mother, to inspire support. The current description on that page doesn’t really tell you much about why people should donate or what is the problem. I also think GoFundMe is a site which gets more visitors so you might consider doing a campaign there too, or instead of.

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  • Will,

    This is a great article, thank you!

    As someone who went through a similarly depersonalizing experience of hospitalization / prisonization, and being labeled with a severe psychiatric illnesses, I related very much to everything you said.

    I have a term (I don’t know if someone else used it first) that I use for the attitude of the people who don’t approach your experience in a dual, meaning-making way – I call it “pre-relational” or “pre-relativistic”. This is how I talk to people now about the way in which most psychiatrists view the experience of people labeled as having so-called “schizophrenia”. The key question, as David Garfield said to me once, is whether they see a person or an illness.

    I did want to critique one part:

    “We can also assume, and this is crucial, that the capacity for psychosis must confer some evolutionary advantage and fitness for the species as a whole. Without this advantage and fitness it would defy what we know about the nature and meaning of all aspects of humans as a species in the context of evolutionary biology. It simply does not add up to what we know about evolution to simply consider psychosis as a failure, limit, obstacle, or breakdown of the organism. If it were, it would have disappeared from the evolution of the human mind as a species, rather than what we see — that psychosis consistently appears as a feature of human capacity in all cultures at all times.”

    I don’t believe this is crucial or necessary, and I think it is illogical. The relation of extreme experiences to trauma, stress, poverty, neglect, abuse, suggests that they are attempts at adaptation or attempts to survive the unthinkable. One could say they are adaptive if they allow one to survive extremely adverse experience. I guess you may have a point there – they may be adaptive in their function or intent. Is that what you mean?

    Hmm, now I am thinking about it a bit different.

    I guess I just wish to say that extreme states which represent severe distress and inability to function are not in themselves really beneficial or adaptive (except as a form of temporary survival) – but are rather attempts to survive and get back to a more harmonious, related way of being in the world. So we don’t really want people to go crazy, but we can see that primitive psychological defenses may have adaptive, survival-enhancing qualities, at least at first…. I know there are extreme states which represent transcendence and reaching another spiritual level, but if they do not fundamentally impair a person’s ability to function and relate, I would differentiate them from the experiences being discussed here.

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  • Chaya; this is a great article; I really enjoyed it. You are so right about the importance of speaking to people face to face versus texting and facebooking. Real relating is where it’s at.

    Your article reminded me of something I read recently, Survival Plus by Charles Hugh Smith. Do you know him?

    Here’s an excerpt from Smith about the current state of our economy and healthcare system, with a word on psychiatric drugs from an outsider:

    (From “Survival Plus”)
    A great clash between what we are told is unfolding and what is actually unfolding lies just ahead.
    The status quo “Powers That Be” and its mainstream media repeatedly insist that:

    We have abundant cheap energy for a long time to come; Peak Oil is decades away. We have plenty of time for technological wonders to arise and replace petroleum. The Social Security and Medicare entitlements promised to all Americans, though totalling some $50 trillion in excess of projected tax revenues, will be paid; all that is needed are modest policy adjustments. The current financial meltdown was unexpected and could not have been foreseen; it is a temporary “bad patch” which has already been fixed by government intervention and modest policy/regulatory adjustments. Environmental issues such as the stripping of the world’s fisheries, dead zones in the Chesapeake Bay, dwindling fresh water acquifers, etc. can all be fixed with modest policy adjustments. The consumerist culture which has evolved over the past 60 years is a natural and highly successful perfection of capitalism, prosperity and American values; Americans are the happiest, most prosperous people on the planet.The fast-growing epidemic of obesity and related chronic diseases in the U.S. are puzzling and worrisome, but we have the finest healthcare system in the world.

    Yet all of the above is demonstrably false.

    In reality, the decline of abundant cheap oil (oil under pressure in supergiant fields) has already begun. The iron laws of demographics dictate the promised entitlements cannot be paid and that Medicare is only a few short years away from insolvency. The current financial meltdown was not only easily predictable, it was inevitable, as the consequences of systemic fraud, deception, embezzlement, misrepresentation, collusion, debauchery of credit, exponential expansions of risk, debt and speculative leverage could not be held off forever.

    The devolution of American culture and values to a one-dimensional “consumerism is the highest good in the land” was not natural, and rather than produce the perfection of capitalism, it has produced the perfection of crony capitalism, monopoly capital and an ever-expanding State beholden to an Elite which owns or controls the vast majority of the productive assets, financial wealth, income and lawmaking machinery of the U.S.

    Rather than being the happiest people on the planet, Americans are visibly unhappy, anxious, depressed, distracted and all too often heavily sedated with powerful psychotropic medications.

    This is not to question the positive contributions made by psychiatric medications to those suffering from psychiatric disorders; but we should question the idea that tens of millions of our citizenry (including children) are suffering from serious psychiatric disorders. We should wonder if the overzealous dispensation of such drugs masks cultural rather than psychiatric disorders, and an unspoken desire to “treat” these cultural disorders in a relatively low-cost fashion by numbing the patients’ awareness of their own alienation, anxiety and unhappiness.


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  • Phil,

    Thanks for this article. I like the 10-point list.

    It’s interesting to think that if she read this, the author of the article being reviewed (Dr. Gold) would probably only be able to respond by denying, minimizing, and avoiding many of your points. The motivations for such responses are obvious – the first is financial. One would not want to give up a career path one has already embarked upon that would lead to an income of somewhere between $200,000-300,000 a year, or more, at Stanford University where this psychiatrist works. The second motivation would be status-based; once one starts developing a professional identity, it becomes a part of one’s self-esteem and has to be protected, even if the scientific underpinnings of one’s profession are very weak.

    And perhaps another motivator is that a form of “treatment” which uses drugging, coercion, and “illness management” for distress is easier and less disturbing for the professional than to explore possible social causes like trauma, neglect, and poverty, and to encounter the terror, rage, and despair that can accompany these experiences.

    I actually wrote an email to the author (Gold) sharing my story of recovery outside the system, and my response to my own hospitalization. And I referred her to ISPS (, a group which has alternative primarily non-medical approaches for people in extreme states, and which includes some psychiatrists.

    I do this type of outreach often; professionals rarely respond, which is probably understandable given that my views are a direct threat to their model of diagnosis, understanding distress, and treatment.

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  • Selena, You should write a new article about your experience, and also updating people on Reid, and try to get Mad in America to publish it. That will bring the issue current on MIA and get more signers. Otherwise very few people will see this due to this being an old article you commented on.

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  • Ok, Victoria I hope you will get more involved here. We need more people to speak out who have alternative views on serious distress and how to help people experiencing it. Maybe you can write an article about your success one day.

    Remember that your psychiatrist should work for you, not the other way around. If they aren’t doing a good job, hopefully you can eventually switch to another psychiatrist or work with another type of helper. In my case, I eventually decided to taper off antipsychotics secretly, alone. It was a risky decision but it worked. I am not recommending this or not recommending it; you have to do your own research and make your decision.

    If you ever need support feel free to email me at mstevenson2010 (at) outlook (dot) com

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  • Victoria, you are totally right to stand up for yourself in this way. Surely, from reading this site and other sources you are now aware that psychiatric drugs are not medications treating a specific disease, but general tranquilizers (for the most part) dimming the central nervous system and limiting the ability to think and feel.

    The brain disease model is indeed complete bullshit. It artificially separates the dynamic, interpenetrating way in which brain and environment interact and affect each other all the time. There is no evidence that chemical imbalances or faulty genes cause any sort of discrete psychiatric disorder at all on their own. The way psychiatrists attempt to talk about this fails at the start, partly because they lack valid discrete categories to use in discussing adverse experiences.

    So yes there is nothing genetically or “brain chemically” wrong with you in any sort of disease or pathological way (if there were it would be a real brain disease!). You are as human and as entitled to feel well as anyone else – and with sufficient support and accurate information about your problems, you’re as capable over time of feeling well genetically and biochemically as anyone else, too! Don’t believe their lies, and believe that you can come to feel better, alive, and fulfilled.

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  • Ron,
    Yes, you are right, as long as we can use the word blame without making simplistic moral judgments – i.e. studying who is responsible / causally involved, rather than painting people as malicious evildoers – it can be ok. The problem is partly as you say that people tend to misinterpret or overly negatively interpret the feelings behind the term “blaming.”

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  • Hi Ron,

    Thanks for this article.

    While going through I’m doing some commentary of my own on the sections you picked out:

    “Psychosis is nobody’s fault. People do not cause it.”

    On the one hand this statement is pretty vague, because psychosis is not one unitary thing with a single cause. On the other hand, the research on trauma, neglect, and abuse makes it so clear that negative interpersonal interactions raise the risk for getting labeled psychotic. As John Read said, child abuse can be – but is not always – a causal factor in psychotic breakdowns. And when it is involved, parental abuse of children is only one factor, and then not even necessarily the most important one.

    This Navigate manual seems to be based on the old idea that covertly inserting the disease model into severely distressed people’s minds will reduce stigma. But then over the long term, the cost is that the (usually present) interpersonal contributors to one’s problems are not explored or understood. Then, due to the disease model, distancing/fear/misunderstanding between the supposed helpers and the person with extreme states results, along with chronic drugging which blocks motivation and the ability to feel.

    Ron, rather than wondering about rapists/abusers, why don’t you wonder whether Big Pharma is funding some of the institutions supporting the professors involved in this Navigate program? These companies would be the ones who have the interest in seeing extreme states as a biological problem unrelated to what happens socially.

    Ron, I think this part of what you wrote is a problem:

    “But placing blame where it belongs is the way we make sense of things, it’s how we learn to get in control of what we are doing and where we are going. “

    Identifying a parent as a causal agent in contributing to distress is not the same as blaming. There is no need to “blame”, since that word sounds like a negative personal judgment. Instead of blaming, we can perceive deeper and understand. Most parents who abuse do so out of their own emotional immaturity, from lack of knowledge about how to parent, out of poverty, and especially from their own traumatic issues that got passed down from their own parents (the grandparents). So there are reasons why they do what they do; we shouldn’t blame in the judgmental sense since that doesn’t benefit us, but should identify their behavior as problematic in as neutral-objective a way as possible, and then seek to find alternative ways forward.

    I see you may have been attempting to use the word “blame” in a neutral sense. However, with the way most people understand that word, this will be difficult.

    Navigate also assumes that visiting a psychiatrist and getting drugs for every breakdown that gets labeled as psychotic is necessary; something that is simply not true. But to be aware that well-trained therapists can work effective with regressed people without any involvement of psychiatrists or drugs is somewhat of an existential threat to psychiatrists and to the NIMH. But it is an awareness that we need to share. In fact, I have recently been talking to several parents about these non-medical options for their children labeled with “serious mental illness.”

    What I do when talking to families is in fact the opposite of Navigate; based on my lived experience as someone labeled with extreme states in the past, I “delegitimize the psychiatric disorder” – I explain how extreme states are not lifelong biogenetically-caused illnesses, and how reversible and modifiable such distress is. I reject the term “symptoms” (of an “illness”). I refer the parents to authors like Jay Joseph, Paris Williams, and Bruce Levine, who can explain better than me how flawed the illness model in the Navigate manual is. And I have more credibility than most mental health professionals, because I actually experienced these conditions and recovered from them. I am also more genuinely hopeful than these professionals.

    As for this statement, ““According to the stress-vulnerability model, psychiatric illnesses have a biological basis.”

    What a misleading statement that is! No wonder people do not trust our governmental institutions. Changes in brain chemistry and epigenetics (usually, not always) correlating to stressful experiences are not illnesses simplistically caused by biology. Postulating a model of a “biologically-based (i.e. caused) illness” without evidence is unethical, and the authors of the manual should be ashamed (although perhaps they are simply ignorant).

    As usual, psychiatric professionals seems to feel they can just put out an unevidenced theory about psychosis that appears to reduce blame, that fits in with the current climate of focusing on biological explanations. They seem to think that by repeating these unevidenced statements about biological basis, symptoms, illness, etc loudly enough people will believe them. But I think more people are stopping believing and questioning mental health professionals’ explanations of “schizophrenia” and “bipolar”. I recently had a mother of a young person with psychosis ask me whether she should read Kim Mueser’s book, and I told her not to, because I know that he puts out unevidenced bullshit like in the Navigate manual.

    As Ron rightly and courageously said, “One way of challenging this distortion is to simply ask to see the research that shows that there is in fact a type of human being invulnerable to getting psychosis.  Of course there isn’t…”

    As for this: “Scientists believe that the symptoms are caused by a chemical imbalance in the brain.” (p. 101).  And “Medications reduce biological vulnerability by helping to correct the chemical imbalance in the brain.” (p. 102).”

    This is the very apogee or zenith of ignorance in American psychiatry. In a just world, this would be cause to fire all the leading workers at the NIMH that wrote this document. It is propaganda that is doing real harm in terms of reducing hope and promoting long-term dependence on unproven neuroleptics drugs. It is indeed “blatant fraud”, as Ron said.

    And then they said this: “perhaps” as many as 20% might go on to live “relatively symptom free lives” (p. 6) and the possibility that “a small minority of persons with first episode psychosis (perhaps 10-20%) can live successfully even off medication.” (p. 114).”

    This shows how very ignorant these people are about effective transformative appraoches to curing psychosis. They should read Gaetano Benedetti, Ira Steinman, David Garfield, Murray Jackson, Vamik Volkan, Paris Williams, Gustav Schulman, the Open Dialogue Approaches, and other ISPS authors to try to get a sense of how very much they are missing. Who is gonna be encouraged by the numbers above?

    On the other hand, you can’t fail when you set your goals so low 🙂 (i.e. when you only think 10 or 20% of people can fully recover, you might just achieve that, even if you use the outdated and harmful disease model of “schizophrenia”).

    A lot of the distortions above, which seems so offensive and obviously wrong to us with lived experience, simply has to be ascribed to ignorance on the part of these professionals. It is still incredible to see it, and to imagine the alien (from our perspective) professional environment they must live in.

    I also think the professionals who are spreading this misinformation via the Navigate manual should be named:

    Shirley Glynn, a professor at UCLA
    Cori Cather, a professor at Harvard Medical School,
    Susan Gingerich, a social worker and winner of a NAMI book award
    Jennifer Gottlieb, a psychologist affiliated Boston University
    Piper Meyer, a psychologist affiliated the University of Minnesota
    Kim Mueser, a psychologist at Boston University
    David L. Penn, a professor of psychology at the University of North Carolina

    It is amazing to see people who have been in the field for 20 or 30 or more years, as some of these people above have, but then still have the reductionist and inadvertently pessimistic attitudes that they do. It just goes to show how great the power of biological simplistic explanations for extreme states is. And how little understanding there is of what intensive psychotherapeutic approaches can do to change outcomes for severely distressed people.

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  • Sera,
    I cannot really respond regarding Facebook posts that I cannot see. If you want to post a link to a Facebook group here, that might help. However I understand it may be a private group.

    I took a look on your Facebook profile and I see mostly white people criticizing the white people on these comments, so it must be another page.

    I guess at this point; if we can’t dialogue with these people from the mysterious group, it’s a dead end – if they think we’re unwelcoming (without having ever talked to us, I should add), and we don’t know how to contact them – then there is no way of interacting or changing the perceptions. Thus things will remain a closed system, as Fairbairn would say. That is unfortunate.

    Again, I will say that I will talk to anyone who wants to talk.

    And I do not know how Earl feels, because he has not commented here.

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  • AA – I know this is true. Racism by police is real and it’s really bad. On the other hand, I think most police try to do a decent, fair job most of the time. We hear constantly in the media about the unfortunate (but significant) minority who are discriminating against and mistreating minorities. I think sometimes this makes things seem even worse than the are, i.e. how the media constantly focuses on what is wrong and not what’s right. However the problem is still real.

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  • AA,
    If you find that link I would be interested in seeing it.

    The police shootings are very bad; one can’t help but be aware of them.

    Nevertheless, I think even more important than police violence (which I view as an effect, not cause) is the extreme poverty and lack of economic opportunity that affects so many African-Americans. I think these economic factors, primarily lack of good education and good jobs, are the biggest underlying drivers of crime (which leads many young African-American men into confrontations with police). Without addressing these economic factors substantially, I do not see how simple changes in attitude on the part of white people will significantly impact the social problems facing minorities. Of course they are all interwound, because discriminatory attitudes from whites do affect the educational and economic opportunities of minorities. It is complicated.

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  • Richard,
    I was trying to make a polemical point about free speech, to say that there are a range of ways of looking at these issues.
    No, I will not take on the job this time of going into detail about which part of each quote is “correct” or not.
    But, thank you for your sincere engagement and your genuine goodwill about all these issues, I really appreciate it.

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  • Iden,
    Your and Earl’s voices are totally valid. You have a legal and personal right to speak out and I am glad you do.

    I also wish more non-white authors and commenters would write on MIA. Allow me to say that there is no one forcibly stopping black or other non-white people from authoring more articles on MIA. Many commenters, as well as MIA staff, have encouraged them to do so – and a few have. Let me say here that I as a white person welcome more black people and those of other races to comment on the site and to author articles. I have the sense, however, that people from non-white backgrounds tend to expect negative reactions from people outside their ethnic background (sometimes understandably, but sometimes mistakenly), and that this expectation then can become a problem that blocks connection or correction of negative expectations. So the question then is how to address these issues. I know that was what the blog talked about, but I disagree with the directive, prescriptive way of offering solutions in the blog.

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  • Hi Richard,
    Thank you. Racism is so obviously very real and harmful, and unconscious racist bias results in overlabeling of non-whites with (invalid) illness labels, which are really forms of social control and distancing. The distancing keeps white “normal” people comfortably apart from non-whites who are believed to have a brain disease, and to come from a totally different economic and social background. I do see these things; but also think it’s very hard to quantify how much of these dynamic constantly-changing processes are due to race and how much due to other factors. It’s possible on the group level that poverty might be more important when it comes to who gets labeled; I don’t have the precise numbers to back that up, however. I think this is probably true, though, from reading John Read’s research about factors contributing to getting a severe mental illness label.

    I have a different perspective on being politically correct; I think political correctness has gone too far. We shall have to disagree a bit on that.

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  • Richard,
    It was the attempt by the authors to silence people from using the slavery analogy, and to do so by privileging their view of race relations above others that led me to respond as strongly as I did. Obviously, the very mixed response to this article has demonstrated that they do not have a unique claim to truth or rightness when it comes to the slavery/race/psychiatry conundrum.

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  • To play the devil’s advocate, as well as to highlight that critics of social justice advocates make their own valid points, I’d like to share a few conservative articles I read recently. On RealClearPolitics, I read articles from both left and right-wing writers. Here are some of the right-wing ones which are relevant to the issues of identity politics and black-white relations raised above:

    Quote: “After the Dallas shooting, Rohini Sethi, an incoming senior and the University of Houston’s vice president of the Student Government association, took to her Facebook to express her disgust after the Dallas shootings. “Forget #BlackLivesMatter,” she allegedly wrote. “More like AllLivesMatter.”
    The reaction was swift. The president of the University of Houston student body both publicly denounced her actions and suspended her…. Black Lives Matter did not simply wish to censure her speech; they threatened her. Public humiliation, shaming someone in authority who does not agree with what you say is more than abusing your position of power to curtail free speech. It’s potentially destroying someone’s life and future.”

    Quote: “Two out of three black people prefer the term “all lives matter” to “black lives matter,” according to a Rasmussen poll released Thursday. Only 31 percent of black people surveyed said that the statement “black lives matter” most closely comports to their own beliefs, compared to 64 percent who chose “all lives matter.” (The Rasmussen poll surveyed 1,000 respondents from Aug. 17-18 and has a 3-point margin of error.)

    Former Maryland Governor Martin O’Malley drew criticism for telling a group of Black Lives Matter protestors that “all lives matter” at an event in New Hampshire last month. O’Malley has since apologized for the claim. “That was a mistake on my part and I meant no disrespect,” O’Malley said. “I did not mean to be insensitive in any way or communicate that I did not understand the tremendous passion, commitment and feeling and depth of feeling that all of us should be attaching to this issue.” GOP primary front-runner Donald Trump called O’Malley a “little, weak, pathetic baby” for apologizing.”

    Quote: “The media, which lean overwhelmingly left, and the political fraternity, with its own leftist component, don’t fool around much with narratives that contradict left-wing (aka “progressive”) essentials. Among these essentials: the conviction that American whites, having racked up a record of racial oppression, are due for a comeuppance. On such terms, a dead white cop, shot by an inner-city (or in the Harris County case, a suburban) black man isn’t half so interesting a story as an inner-city black man shot by a white cop.”

    Quote: “When the phrase “all lives matter” is seen as derogatory, the person holding that view is seriously in need of a course correction. The idea behind the position seems to be that because of victim privilege, only black people have the right to say their lives matter. Everyone else stands on a different moral plane, so that saying that their lives also matter is an affront to the priority that the victim-race must maintain…What about people who see the phrase “black lives matter” as excluding them, as if their non-black lives don’t matter? Do they have moral standing in Shep Smith’s universe? I suspect not, because such people are not anointed with the sacred status of victims.”


    I certainly don’t agree with everything in these articles. But they make points showing that any given African-American writer may not necessarily speak for most black people (a point Oldhead also made), that Black Lives Matter advocates threaten police and try to restrict the free speech of those who disagree, that whites will not respond well to being relentlessly guilt-tripped and having reparative behavior prescribed, and that overfocusing on how one is oppressed and victimized may backfire.

    These ideas are mostly politically incorrect, but hopefully MIA will allow them to stay here as an example that we still have free speech in this country. On a lot of other internet blogs, a contrary comment like this would be deleted immediately even if stemming from sincere disagreement. We’ll see if this happens here.

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  • Hi Richard,
    I like your comment.
    I think you misunderstand or are unaware of how I view the term “politically incorrect.” I (usually) view it as a compliment. I say politically incorrect things about psychiatric diagnoses, drugs, the mental health system, etc, all the time. To me saying politically incorrect things is a strength; I try to express the things that, for example, many therapists, psychiatrists, university professors, could never have the courage to say about psychiatric diagnosis or extreme suffering.

    Also, what is politically correct or incorrect is heavily based on perception and subject to influence, such as Big Pharma money. For example, the politically correct thing to say about someone who has delusions and hallucinations and can’t function is that they have a psychotic illness and need indefinite medication. But that is bullshit.

    In this article, the moralizing, prescriptive, paternalistic tone, e.g. the four exhortations for what white people should do, was a problem, as was pointed out by multiple commenters now. Whether or not it’s “right” is kind of beside the point; instructions to one race as to what to do in relation to another is unlikely to be practical in terms of working to change minds and behavior.

    The term “white-splaining” in particular is unlikely to be listened to or responded to at all by most white-people. This term smacks of what you talked about Richard – the assumption that one’s own view is right based on identity politics, i.e that one’s position as part of a particular race or class is the right one or the only valid viewpoint. So it is counterproductive for black people to use this “white-splaining” term, as it is for Sera to do so – at least counterproductive if they want change, rather than just feeling vindicated.

    You are correct that racism occurs very frequently in the psychiatric system as in the criminal justice system (where it is arguably even worse, IMO). I do not deny this at all. However, I do not see where I said that poverty was the central thing.

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  • Sera,
    I did look, but obviously didn’t understand it in the way you wanted me to. But then, I have sincere differences of opinion with you and Iden.

    If we’re going to make this a popularity contest, Sera – an ill-advised idea, I fear – then I’ll note that quite a number of commenters have criticized the overfocus on race and the excessive sensitivity on the part of yourself and fellow authors that is running through the article and discussion. As well as disagreeing with many of the article’s main points about slavery.

    To other commenters, feel speak to me directly. No need to hide behind backchannel emails. I don’t want to have to wait for a statistical analysis from Sera about her rather unscientific sample of criticisms (as obviously, those who agree with her and disagree with me will write to her) to find out what you think 🙂

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  • Iden, good to see another MIA writer is only about 30 minutes away from me (I’m in Vienna/Fairfax area, west of the river). Maybe we will get to meet one day at one of these conferences.

    Thanks for your comment. There is a lot of segregation in DC (and parts of NOVA too, for sure) by income. I don’t like to see that.

    And if you ever want to come to one of our meetups email me and I’ll be happy to share info – I’m at bpdtransformation (at) gmail (dot) com

    You might be interested to know the folks in my meetup groups have largely no knowledge about my being a psychiatric survivor, writing on MIA and other forums, etc. The Meetups just aren’t about that. And I think they would be surprised if they found out. Probably a few of them will, eventually. But I have nothing to be ashamed about…

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  • Twist, you are right; southeast DC is still like a ghetto, full of drugs, crime, and poverty, and it is a terrible thing. I have been there a few times; just walking down the street as a white person one feels afraid.

    You are probably right they aren’t bringing their concerns to me; I may not have the life experience to understand their concerns.

    Then again, these meetups that I do are not about race. They are social groups for people in their 20s and 30s, of any and all races, to make new friends and have fun. And we do have fun.

    In NOVA – a huge metro area – there’s a big range of backgrounds, at least in the areas I am in. It may be only 11% black, but that represents hundreds of thousands of black people. It’s also a very large proportion of people from Hispanic backgrounds and different Asian backgrounds.

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  • Sera,
    I didn’t say exactly what you said. I am noting that if there isn’t a perceived win-win situation for white people in changing their behavior (which would benefit both them and other races, not just other races), they will probably not.

    After all, if the majority of white people were going to change their perceptions and actions around race purely out of the goodness of their hearts, why wouldn’t they have already done it?

    Many voters in the recent election who voted for Trump view race relations as a zero-sum game: If accommodations are made for blacks, many whites feel, whites lose out, for example with jobs or with affirmative action. Whites by and large don’t want that, and they don’t like the moralizing, prescriptive, thou-shalt-feel guilty message that’s contained within this article, and will IMO be unlikely to result in change.

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  • Sera,
    Ok we will just have to disagree.

    The politically incorrect point I was trying to make at the end of the last comment was that that there is a lack of incentive for people of a certain group (in this case whites) to focus more attention on the experience of another (in this case blacks). Most human behavior, in my view (which may be cynical) is motivated primarily by self-interest, and as a white person I don’t see what there is to gain by following the four directives issued in your article. IFewpeople are altruistic purely for altruism’s sake. I’m wondering what the payoff or benefit is for white people and for all people invested in changing the psychiatric system (and yes, both/all need to benefit otherwise they won’t be motivated to act) if we police our speech as was suggested. Not clear that it would make a significant difference.

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  • Iden,
    This may not come over well, but we can always by offended by what people say – somewhere, some time, there’s always someone saying something very insulting and hurtful.

    As I shared in an earlier comment, people on other forums have been telling me to commit suicide, that I’m still crazy and didn’t get better, and so on. It doesn’t bother me, because I know it’s bullshit. I don’t take it seriously, because it’s pitiable and stems from lack of information and fear. I just keep on improving my life and living well, and I don’t listen to the haters. If I listened to them and wrote articles telling them how they should talk, they would probably reject or ignore it, and I would feel like I had wasted my energy.

    So I wonder why if people of a given race think that what people of another race is saying is ridiculous, why they try to hard to get them to change how they speak, rather than ignoring them and focusing on improving their own lives. From experience I know it’s not that easy, and some people are not in a position to discount or counter the effects. But trying to get people to speak a certain way is never really going to work, because we cannot control what others say. Like I was saying to Sera, we can’t legislate speech, and trying to force people to think or act a certain way is unlikely to result in success in my view, because people hate being controlled and told what to do.

    And really, when I speak about psychiatric slavery, the intent does matter. I never intend to denigrate or reduce the impact of actual legal slavery on others. People of other races can spend energy getting upset by what I said (although I never had them in mind in the first place), or they can ignore it and focus on bettering their one situations. When I refer to psychiatric slavery, I am speaking about how one’s mind is enslaved by numbing drugs for years, and how one’s entire identity and ability to live is compromised by the imposition of the psychiatric illness identity. These experiences to me resulted in unfreedom, i.e. enslavement by the disease model. And they were very, very severe for me. I’m not comparing them to any one else or even thinking about race… and like I said, I don’t worry about offending everyone out there who might be offended. I can’t do that, and I don’t have to.

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  • Sera, we cannot legislate speech, only make suggestions that others are free to endorse or ignore.

    For your part, you seem *super* invested in focusing on race, when the bigger issues in psychiatric oppression IMO are denial of adverse social factors, medicalization of experiences, coercion, paternalism of psychiatric professionals, etc. Racism is a significant issue, but to me, as to apparently some other commenters, it’s not a key or the central issue in defining or resisting psychiatric mistreatment.

    You might examine why people like me, and other commenters, remain emotionally unaffected by your article and will continue to use the term psychiatric slavery even after reading all of its points.

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  • Sera,

    I’d also like to note that there are broader ways to look at the intersection of slavery and race throughout history.

    For example:

    Quote: “Modern slavery is a multibillion-dollar industry with estimates of up to $35 billion generated annually. The United Nations estimates that roughly 27 to 30 million individuals are currently caught in the slave trade industry.[8] India has the most slaves of any country, at roughly 18.4 million.[9] China is second with 3.4 million slaves, followed by Pakistan (2.1 million), Bangladesh (1.5 million), and Uzbekistan (1.2 million). By percentages of the population living in slavery, North Korea tops with 4.4% (about 1.1 million people out of 25 million), followed by Uzbekistan (4% of its population), Cambodia (1.6%), India, (1.4%) and Qatar (1.4%).[7]”

    So let’s reframe this statement from the article: “it feels completely disingenuous for proponents of this analogy (that slavery isn’t primarily linked to black history) to offer up vague dictionary references or historical citations of slavery in Greece and Rome as first defense.”

    Not so disingenuous, if there are millions of Asian and other non-black slaves today. It’s not just a few ancient Romans or Greeks. It’s not only historical but also present-day; slavery then and now, on a global level is not only black but multi-racial.

    And there are dozens of examples of historical slavery all over the world, for example:

    Quote: “A new study suggests that a million or more European Christians were enslaved by Muslims in North Africa between 1530 and 1780 – a far greater number than had ever been estimated before…One of the things that both the public and many scholars have tended to take as given is that slavery was always racial in nature – that only blacks have been slaves. But that is not true,” Davis said. “We cannot think of slavery as something that only white people did to black people.”

    Even is this number is a large over-estimate, and “only” a few hundred thousand white people were enslaved by Muslims in the 16th to 18th centuries… it does suggest that black people do not have a global monopoly on use of the word “slavery.”

    I encourage others readers to read with skepticism and to research and counter-research the claims of an article such as this. It’s easy to make generalizations based on a Google search from an American computer, but it may not tell the whole story.

    Since psychiatric oppression is by no means limited to America, I don’t think psychiatric slavery as a term has to be called into question by the legalized slavery perpetrated in America in relation to African-Americans (who were the main objects of it in the USA). Globally, slavery has harmed many races. As does psychiatric oppression/slavery.

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  • My response to selected parts of this article:

    Quote: “In an analysis for the British Journal of Psychiatry, experts in the UK question the evidence for the common practice of prescribing antipsychotics long-term after a single episode of psychosis. They suggest that psychiatrists consider the severe side effects and slowly reduce patients to the lowest dose that prevents the return of distressing symptoms.”

    I agree with this, except to say that voices, delusions, hallucinations, and withdrawal are not “symptoms” of any illness, but are primarily understandable responses to loneliness, stress, trauma, neglect, poverty, etc, and to the terror/rage/confusion generated by these experiences. One cannot discuss these issues very realistically, in my opinion, as long as people’s lived experiences are being overwritten with the meaningless word “symptoms.”

    Courageously (for a psychiatric journal), the researchers says,

    “The researchers write that “long-term ‘maintenance’ treatment with antipsychotics is based on hope rather than evidence. Going further, they cite studies (including Harrow and Wunderink) that show that a significant percentage of patients with psychosis can successfully withdraw from antipsychotic medication “without detriment in the long-term.” ”

    Based on hope rather than evidence, indeed. An interesting later section proceeded:

    Quote: “the researchers ask, “What is the wise psychiatrist to do faced with the concerns we have reviewed?” They suggest the following:

    “He or she will treat acute psychosis with the minimum necessary dose of antipsychotics, employing weight sparing antipsychotics wherever possible; dopamine partial agonists have this property and may also be less likely to induce dopamine supersensitivity. Following recovery, the psychiatrist should work with each patient to decrease the dose to the lowest level compatible with freedom from troublesome psychotic symptoms; in a minority of patients, this level will be zero.”

    Firstly, the wise psychiatrist would understand that there is no valid biogenetic illness entity called schizophrenia, and that alternations in brain chemistry and epigenetics due to adverse experiences are reversible, as well as that one cannot predict what proportion of a vaguely-labeled group of people will or will not need tranquilizers for what length of time in what circumstances.

    Secondly, the assumption that drugs are necessary as a front-line treatment is a mistake. The researchers should have stated that it is often possible to help acutely psychotic people with no drugs at all, but using instead an intensive psychotherapeutic approach, as did the Open Dialogue researchers and psychiatrist-psychologists such as Boyer, Volkan, Karon, Rosenfeld, etc. Then again, such an honest statement could not be published in today’s psychiatric journals.

    The researchers make the assumption that most “patients” – not that the people involved have any clearly delineated disease that doctors are treating – will need to stay on some low level of drugging indefinitely. This is also mistaken, as outcomes in poor countries such as India (in the WHO) and in intensive interventions such as Open Dialogue (in Finland) have shown that most psychotic people can get better and not use or get off drugs long-term.

    The article finally notes:

    Quote: “They emphasize that such an approach (using less drugs) can only be accomplished if there is greater access to and reliance on non-pharmacologic treatments, like psychotherapy. They call on psychiatrists to begin a campaign to make sure that their patients have access to alternative treatments.”

    Yep. Sounds like they should go to:

    In my view they could have also noted that seeing a psychiatrist is not necessary to effectively intervene with psychotic states. Non-medical therapists can do curative transformative work without the necessity for psychiatrists nor drugging for many, perhaps most cases. In poorer countries the support of family and community can be enough.

    Lastly, here is the list of conflicts of interest for the authors of this article, which included Jim Van Os, who (surprisingly to me) apparently has his fingers in the cookie jar of Big Pharma:

    R.M.M. and J.v.O. have received honoraria from Bristol-Myers Squibb, Janssen, Lilly, Roche, Servier and Lundbeck for lectures, and M.D.F. has received honoraria from Janssen and Lundbeck. O.H. has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Astra-Zeneca, Autifony, Bristol-Myers Squibb, Eli Lilly, Heptares, Janssen, Lundbeck, Leyden Delta, Otsuka, Servier, Sunovion, Rand and Roche.

    With a list of conflicts of interest that long, you have to be impressed they would speak as honestly as they did.

    Hi Justin – hope you will pay attention to the medical language in reviewing this article, and try to gradually shift to more human-sounding words. Still, nice report.

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  • Hi Iden, thanks for your restrained, curious comment.

    I am living in a pretty wealthy zip code (outside of Washington DC) but it’s also one full of a broad mix of ethnic backgrounds. I think the people at my meetup social events are largely college-educated (often with masters degrees or more), relatively economically secure, well-read and informed people. And they are people who have been to colleges (and now work situations) where they see a big mix and range of ethnicities and backgrounds. So I think they get to interact with a range of races and backgrounds and that this interpenetration helps them to be open to and not judge people of diverse backgrounds.

    I notice when I go to meetups that I still have judgments about people of other races – for example, when I met a young black man at a recent meetup at a restaurant, I spontaneously had the idea in my mind that he was probably relatively uneducated, which turned out to be wrong (while it was probably true of a few of the white people there). As I shared in the comment from Sera, I had a racist influence within my family that contributes to me having these biases or assumptions. But there’s a difference between having a bias/assumption and what you do with it. And, I think that getting exposure to people of other races (sorry, that sounds kind of bad) in a variety of situations really helps to break down barriers and lessen racism. We have that here in Northern Virginia. But I think in a lot of other cities, racial segregation remains to a greater degree, and so racist assumptions (and actions) have less chance to be broken down. I’d be interested to hear your thoughts on this.

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  • Sera,
    I have no reason to think my opinions are less or more equal or valuable than opinions of people of any other race.

    I try to treat everyone of every race fairly, but I don’t accept being made to feel guilty for what my ancestors did, or the idea that I or other whites need to “atone” or give special accommodation to another group. Having said that whites of course should not discriminate.

    There’s a problem when you come out with an article and try to tell people four things they need to do in relation to another race. It’s not gonna work, since people don’t like being prescribed what to do. It comes across as moralizing and paternalistic. Again it might feel good, but it’s unlikely to change minds and hearts.

    I’ll be very open and honest about my background, since I believe in the healing potential of that. I come from a family of privileged white people with one of our members being overtly racist toward blacks and Hispanics. But I resisted that, and although I still occasionally hear their voice in my mind telling me unspeakable things about people of other races, I respond to it by trying to be open-minded toward people of all races and not judge them. I think I largely succeed in this.

    It’s hard but I think we should take a look at the racial reasons why 47% of the country voted for Trump – in my view it is partly because they are threatened by ethnic-demographic change away from the white majority. But IMO a moralizing, prescriptive, guilt-inducing approach to white people in terms of telling them how they should relate to black people will not work. It will just create more resistance in whites to openness to other races. The Puritanical-prescriptive-guilt-laden approach was probably a large part of why uneducated whites participated in the numbers needed to get Trump through the electoral college.

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  • Hi All,

    I’m going to disagree with some points of this well-intended article, which at some times unfortunately come across as thought-policing:

    Firstly, any person of any race can be enslaved; African-Americans do not have a monopoly on this most unfortunate experience throughout human history. Today in small parts of Asia and the Middle East, non-black people are still enslaved. Historically, many, many peoples of different ethnic backgrounds have been enslaved – from smaller Hispanic tribes conquered by the Azctec and Incas, to European peoples forced into labor or battle by the Romans, to a variety of East and South-East Asian groups throughout history. Let’s get a broader perspective – simply because the majority of historical slavery in America has been of black people – a very unfortunate fact – does not mean that we cannot discuss the experience of slavery in relation to psychiatry (psychiatric slavery extending far beyond America) without being insensitive (which is a matter of opinion, anyway).

    Furthermore, there are significant parallels between being deceived about the nature of one’s distress and put on drugs for life (rendering one unable to work and love), and being enslaved in more overt and visible ways. In this country, we fortunately have free speech, so I am free to continue to point this link out. You all are also free to interpret the term “psychiatric slavery” in a discriminatory way, but your analysis here obviously didn’t convince me of the rightness of your point.

    Lastly, no matter what we say, we’re going to upset some people. I don’t worry constantly about who will be upset by everything I say. I believe our culture has swung way too far in the direction of being careful about saying every little thing, to the point that we now have “protection zones” where upsetting things can’t be said on college campuses. This is a country of free speech; let’s remember that.

    Also, the higher diagnosis rates of non-illnesses among black and Latin people is likely primarily due to social factors more frequent in those groups, especially poverty and lack of economic opportunity. Their getting these labels is not caused directly by their skin color in a simplistic cause-effect way. Although bias by white people “over-diagnosing” (if one can overdiagnose an invalid psychiatric non-illness) is also likely involved.

    Re: The part arguing, “Stop arguing with Black and other people of color when they tell you to stop.”

    Sarah and Iden, human psychology being what it is, you must know that ordering people to do some general thing in relation to a certain race is unlikely to work. No one likes being told what to do. And postulating a general rule about what white people should do in relation to black people is unrealistic and simplistic. Sometimes white people’s positions are going to be right (or right to a degree), and sometimes they’re going to be wrong (or wrong to a degree). And vice versa. Generalized rules for how to interact in unique, quickly-evolving interpersonal situations are unlikely to be useful in my opinion. I’m sure it feels good to you to write this in a moralistic way; it will probably just do nothing to effect those who read it..

    Notice, I don’t say that people shouldn’t find things offensive. White, black, yellow, brown people can react to me however they want, as long as it’s physically non-violent. For example, people online have even recently been telling me I should kill myself, that I was misdiagnosed and never had a severe mental illness, that I’m still crazy and delusional, and stuff like that. It doesn’t bother me because I am immune to that bullshit. Although of course I don’t appreciate those sentiments, dumb people (my opinion) also have a right to say them.

    But I also have a right to say what I want, and the authors of this article cannot tell me what I should do in conversations with people of other races. That is what free speech is about.

    A bit about my current background – I interact with black and Latin people all the time in my meetups, and for the most part these issues never come up. I just treat people as people, trying to engage with them in a positive way regardless of their skin color. Then again, I don’t move in the circles anymore of the “mental health” system and its oppressions. I left that in the dust long ago. And to be honest, I escaped what I will call psychiatric slavery largely because I had enough money, and because I knew that psychiatric diagnoses were frauds and that there was a better way.

    I imagine you may try to claim that my comments vindicate your criticisms of what white people do, but if you claim that; you will simply be ignoring the validity of my concerns in the same way you accuse others of denying the importance of many of your key points.

    So, I will continue to use the analogy of psychiatric slavery; this article makes no impact on me in that regard. And I will continue to help extremely distressed people in the ways I do, which many of them report finding very helpful/hopeful… there is no one size fits all for how to advocate and relate.

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  • Hi Judy,

    My sincere condolences too. I saw your display at the ISPS Boston meeting and already knew about Dan.

    No matter how many times I read it, it’s shocking to hear versions of the following coming from mental health professionals:

    ““Dan, you are bipolar. You have a chemical imbalance and need to take medication for the rest of your life, and these are the symptoms. Do you understand?” Every time, Dan’s response was documented: “I’m not bipolar, I’m just different.”

    For a “professional” to be able to say that, to have the degree of ignorance and lack of understanding of frequent experiential causes of extreme distress, is profound and beyond words. I almost feel as if saying such a thing should be a crime, given the outcomes it leads to and the emotional state of terror and despair it puts a vulnerable person into.

    My story almost ended permanently as well at the hands of this type of treatment by the system. With a little less luck I could be dead too. It’s disturbing to think that there is no real help available at the psychiatric hospital and you are essentially on your own – when you get really distressed in our society, survival becomes a zero sum game. Too often the professionals are not on your side, but are instead adversaries who attempt to impose misleading conceptualizations of extreme distress on to you.

    I still remember the psychologist at the mental hospital who would loudly pronounce to us (young people gathered in a group therapy room), “Bipolar disorder is a biologically-based mood disorder. You can’t cure it but you can manage its symptoms.” I mean who the hell wants to hear that? Now I know it was all a lie, although one the professionals didn’t even know was a lie. Mind-bending.

    Like you described well about many of those who get better, “They escaped the trenches of our medical model of psychiatry, and learned how to integrate their voices and other unusual experiences into their lives in a meaningful way. This approach focuses on holistic recovery rather than symptom treatment.” I had to abandon the notions of “symptoms”, “illness”, and so on before I really became hopeful and started to feel calm, secure, ok and then alive again.

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  • No, I didn’t say there was a grand racist scheme against minorities, that would be your projection.

    I’m actually employed full time, off all psych drugs, not symptomatic in any significantly impairing way, socially active..

    If you have real arguments, make them – and if you have courage, do it under your real name like I do.

    If you don’t have real arguments, just continue with the personal insults. It only makes what you say look weak.

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  • Hi Noel,

    Thanks for this post.

    Both “actual” prisons and mental prisons (“hospitals”) represent lock-ups where a disproportionate number of the inmates are poor Latinos and blacks and the majority of the guards are middle-class whites.

    One can imagine going back in time to see black slaves watched over by white masters in the fields of Louisiana or Georgia in 1850, and then switch to an image of black young people being drugged and confined in 2016 at any American mental “hospital”. There are many commonalities in terms of racial and economic oppression.

    The minorities in the 1800s produced profit for their masters by unpaid physical work (this economic oppressions happens today to a lesser degree, via the uncomfortable reality that Hispanic and black people commonly work for extremely low non-livable wages cleaning the houses, tending the gardens, and care-taking the kids of white professionals). And today another racket has arisen: psychiatric hospitals, where large numbers of helpless minorities are diagnosed with fictitious diseases which allow white-controlled corporations, served by their agents the psychiatrists, to sell tranquilizing pills of extremely questionable value, the costs of which bilk taxpayers and associated government programs out of billions of dollars.

    Mental hospitals can be understood as neo-plantations for Big Pharma corporations – they are starting points for the corporations and their psychiatrist-minions to implant the seeds of the delusion into vulnerable people that they have illnesses and need to take drugs. Mental hospital environments result in slavery both physiologically – to long-term drugging for illusory “illnesses” – and even more importantly, psychologically – mental enslavement by the myth that one has a brain disease and needs to take a “medication”.

    If one uses the analogy of the 1850s South, the slave drivers at a modern day psychiatric hospital, who are never seen on site, are the corporations and their leading executive officers, almost always white men. The foremen are the psychiatrists who implement the brain disease / drugging program of the corporations.

    And the slaves are the drugged lemmings who shuffle along the drab hallways at 9 am and 9 pm to receive their “medications”, starting what is often a lifelong career as profit-producing machines for the corporation. And yes, far too many of them are Latinos and blacks, politically incorrect as it is to say that.

    And Noel, relative to the mention of poverty and economic inequality, you might find this article – “The Engine of Inequality: Privilege” – interesting –

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  • Rai,

    Thanks for this article,

    It is disturbing, albeit unsurprising, to see the range of euphemisms deployed by agents of the status quo to legitimize their pathetically ineffective and non-insightful ways of dealing with severe distress.

    When I was reading your article, it was necessary to reframe a few things:

    “a range of treatments… the cornerstone is medication”

    There is no “medication” for invalid mental illness diagnoses; there are only drugs / neuroleptics which exert a generalized numbing effect on thinking/feeling, as I wrote in my recent article here (

    Further, these “treatments” do not in fact treat any disease process directly. It is incredible the lack of insight shown by mental health workers who are unaware or must avoid these realities. To be fair to them, they are caught in a system that has great power over them and the “patients” – another euphemism.

    “There’s been a breakthrough. He’s been able to diagnose… Bipolar Disorder.”

    Sadly, no. So-called “bipolar disorder” is not a valid label and certainly not a term that explains much if anything about what has happened to a person, nor what is likely to be helpful. All the problems recently discussed on MIA in terms of nonvalidity and nonreliability of the “schizophrenia” label also apply to so-called “bipolar”.

    Hannah’s hopeful response to this apparent “breakthrough” is sad – the group-level reality is that outcomes for severely distressed people have not improved in response to biopsychiatry and its “medications” over the last 50 years. This was demonstrated in the Jaaskelainen meta-analysis discussed on here earlier.

    Diagnosis is indeed a Trojan horse for many – great description on your part Rai. Over time, many people give up more and more of their soul to the illusion that they “have an illness” that will limit their ability to work, relate, and live.

    The irony is that someone who believes they “have an illness” and is “treating them with medications” is in a certain sense delusional, as many psychiatric survivors know….

    “the very root of where suffering lies…. in our brains”

    Root suggests cause – this is where psychiatrists are so profoundly mistaken. Suffering comes primarily out of our brain / epigenetic / mind’s interactions with the environment over long periods, and via the narratives we build up based on social experiences. Psychiatry has to date produced no evidence of brain processes or genes alone causing anything, as has been repeated ad nauseum.

    “One’s (psychiatric) condition becoming critical” – this way of thinking is misleading. Psychiatric diseases are not an original cause of anything. What happens in one’s life, both positive and negative experiences, and how they impact on one’s mind/brain and one’s identity, and how one responds / what resources one has available to respond, are all important to look at….

    It is funny to see that psychiatrists do sometime have rays of honestly and openness, through the clouds of seeing people as having “illness”. I often think, in listening to them, that they are are as “ill” as their “patients”, as deluded as they claim their clients to be, in some sense – in terms of blindly believing the empty, baseless biological model of “mental illness” against all evidence. In not understanding the primary causes of why brain biology / (epi)genetics change over time…

    The ECT part was sad. The long-term outcomes from ECT are very poor as has also been reviewed here ad nauseum. People only seem better briefly because they have been shocked out of their minds!

    “These nasty illnesses… the unfortunate people who have to live through them” – this represents the apogee of delusions among psychiatrists who simply cannot see people as people affected primarily by their circumstances as experience. Is there a name for this disorder? (that the psychiatrist has?)

    One should also look for whether any pharmaceutical companies funded the psychiatrists profiled, the movie makers, or anyone else helping to produce the film along the way. The chances are that they did.

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  • Hi Sandra,

    It’s good to see this work ongoing.

    Re: labels, you may see I was also criticized in a recent article for use of these terms. There are other words, but they are often more cumbersome, and no simple label does justice to the great variety of problems, strengths, and expressions of distress that are seen among different people.

    Still, I think it’s good to shift away from the term “mentally ill”, as it really is a misnomer. People are distressed, have problems in a variety of ways, people suffer, but people don’t “have” discrete mental illnesses. The Newtonian, linear, concretized, all-or-nothing way of speaking about human suffering that modern psychiatry uses has run its course in terms of usefulness, if it ever had any.

    For people with “psychotic” diagnoses, that term can be replaced by “extreme states” or “organizing states” (organizing referring to trying to find some coherent way to order confusing, overwhelming experience). For people labeled as “having” depression, I think we should stop using terms like “have” depression or “have a depressive disorder”, and just say people are feeling depressed at a particular time, usually for understandable reasons… understandable responses to reality challenges are not “disorders”, nor does one “have” a mental illness in the way one has the flu.

    We need terms that show that people are people, that human beings have souls. Modern psychiatric treatment – 15 minute dia-drug psychiatry – mostly evidences no soul. Young medical trainees know it is not a respected field, and they largely do not want to join the field (versus other truly medical specialties).

    I have recently been making the case that one should consider NOT going to a psychiatrist when one is severely distressed, because psychiatrists have little to offer that other sources of help do not. At the same time psychiatrists come with many more risks related to misuse of drugs and misleading communications about the nature of distress, and thus many psychiatrists are a threat to recovery. In the longer term, I would like to see psychiatry mostly “retired” as a profession, because I expect that outcomes would improve and distress would be medicalized much less.

    At the least, one should have a choice, and a psychiatrist should not be automatically involved in treating an extreme state, nor in treating feelings of depression, etc… if the suffering individual and their family does not want that. It should be about choice as your article implied. And psychiatrists should not be placed above other mental health workers in the hierarchy of authority of who-gets-to-treat, because they do not deserve such placement. They have neither the scientific basis nor the effectiveness of better outcomes to justify such a privileged position.

    I may have a bias because psychiatric treatment led directly to the death of my stepfather, led my biological father to lose his capacity to work and to lose his memory, and almost killed me. With these “treatment results”, who wouldn’t be biased against the field… without psychiatric treatments, things could have been much easier for me, my dad could still work and remember, and my stepdad could still be alive.

    I took a look at the Excellence Board – – and it seems it is still mostly made up of PhDs and MDs. While I like many of these people, I have to wonder how far reform can go if MDs and PhDs are leading the reform effort. I suspect not very far. I encourage the board to consider electing more non-professionals, more people like Gio.

    Let me suggest one other area of research to have in mind for the future: long-term psychotherapy (2-5 years) of extreme states (commonly labeled “schizophrenia”). Gaetano Benedetti (in “Psychotherapy of Schizophrenia”), Roberta Siani (Self Psychology for Psychosis in Martindale’s “Psychosis – Effective Psychotherapeutic Approaches”), Barbro Sandin (in Cullberg and Sjostrom’s papers), Bertram Karon (in his own “Psychotherapy of Schizophrenia”) have each done pilot studies of multiple-times-per-week recovery-oriented therapy for extreme states lasting 2-5 years. Their outcomes were mostly very good, and if widely known would probably show a hopeful alternative – i.e. that getting only psychotherapeutic help, or psychotherapy with limited or low drug use, could be a viable pathway for many very severely distressed people. Also, the savings to the economy from decades of disability use reduced could be very great if such help were more available.

    This idea is similar but not the same as Open Dialogue – it focuses on 1-on-1 depth therapy, of the kind therapists like Steinman were talking about at the Boston conference. While Open Dialogue can help many, not every person has a family to be involved, nor does everyone want a family or system-oriented approach. And so 1-on-1 intensive therapy of extreme states should be another alternative (and already is, if one knows where to look).

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  • This was my critique of the Rosenbaum NEJM article on another forum. It’s a bit harsh on psychiatrists, but writing like this, they surely deserve some stern criticism:

    I’m going to quote here some parts of an article which exemplifies why psychiatrists are so poorly regarded relative to other medical doctors.

    The certainty of being correct about “severe mental illness”, sense of looking down from a cool Olympian height on “patients”, and lack of understanding of the subjectivity recovery is all there.

    It is no wonder that people are turning against such white, wealthy elites, as exemplified by recent events such as Brexit and Trump’s election, when so many experts such as this (white, wealthy) psychiatrist think they can impose their view about who is right on common people and their families.

    And this is from the New England Journal of Medicine – a supposedly prestigious medical journal.

    I am going to critique selected parts below.


    Quote: “Despite their conflicting messages, both stories reflect the pervasiveness and fallout of undertreatment. Approximately one quarter of homeless people in the United States have serious mental illness — a category comprising diseases such as schizophrenia, bipolar disorder, and major depression that cause substantial impairment.2 Most are not receiving regular psychiatric treatment, but undertreatment isn’t limited to the homeless. Of 9.8 million U.S. adults with serious mental illness, an estimated 40% receive no treatment in any given year.3 Those who get care often face protracted delays: the average lag between onset and treatment of major depressive disorder, for instance, is 8 years.”

    – The usual illusion operates that if only more treatment were available, outcomes would be significantly better. Those leading the system such as this psychiatrist cannot consider that their attitudes and treatments might be causing more harm than good. It’s tragic to see statements that show how removed psychiatry as a profession is from seeing its patients as human beings with subjectivity: “one quarter of homeless people… have serious mental illness”… “diseases such as schizophrenia… that cause impairment”…. “undertreatment”… “onset of major depressive disorder”…. as if giving someone a label explains what is causing “impairment”, as if these disjunctive entities actually existed as valid disease entities, as if one quarter of people had a disease and the other three-quarters don’t, as if undertreatment were the main problem, and so on. It really is like Alice through the Looking Glass.

    Quote: “Beyond homelessness, the clear consequences of undertreatment include fractured relationships, joblessness, victimization, substance abuse, incarceration, and early death. The causes of undertreatment, however, are less obvious. We tend to focus on structural problems, which are objective and often quantifiable. But the structural impediments to care can’t be addressed without reconciling the conflicting ideals underlying them.”

    There it is again – the idea that the “care” (is that the right word?) that psychiatrists have to offer should be given automatically and indeed forced, as if it is the only option. And the notion that undertreatment by the system leads to all sorts of bad outcomes, without any evidence offered as support of this statement. And by care, let’s be clear that they mean drugging, confinement, and then being monitored in the community while on drugs. Meanwhile, intensive psychotherapy or family therapy without drugs is not considered, despite the evidence for it in Gottdiener and Open Dialogue .

    Quote: “But early, consistent treatment requires stable community environments and available psychiatrists.”

    One cannot deal effectively with reality when illusions like this persist – such as the notion that available psychiatrists are necessary for consistent, adequate “treatment”.

    Psychiatrists have nothing to offer that other mental health professionals and peers do not.

    As I explained in my MIA article, there is no biological disease entity to treat with people labeled “schizophrenic”, despite all the colorful pictures of brain differences in those labeled which may be primarily explained by adverse psychosocial factors. Psychiatrists are not required to treat problems which do not have primarily biogenetic causes, but are instead most likely caused primarily by adverse social experiences and stress of all kinds.

    Quote: “One is that the side effects of antipsychosis medications may be unacceptable.
    Although these medications are “clearly effective,”8 and many patients who are unable to take one drug fare better on another, we do need better drugs.”

    The psychiatrist neglects to say, conveniently, that there is no evidence base for use of these drugs beyond one year, while citing a single quasi-experimental study as support of their contention. And effective at doing what? Any tranquilizer will be “effective” at quieting someone down and reducing their distress temporarily. That doesn’t mean it is treating an illness, let alone addressing the personality problems and primitive defenses that underlie their longer-term emoptional issues. And better drugs are not coming, since Pharma companies have seen the writing on the wall and are starting to lessen their investment in new psychiatric drugs.

    “Quote: But many of the most severely ill people never even seek treatment — the majority of them because they don’t believe they have a problem that needs treating.9 Because this self-perception makes them unlikely to identify themselves to researchers trying to understand their motivations, it’s difficult to quantify the contribution to undertreatment of such anosognosia”

    This idea represents the zenith of hubris in the psychiatric profession – the notion that by assigning “anosognosia” as a label to people who disagree with their approach, that this justifies the use and effectiveness of psychiatric treatment. As Auntie Psychiatry explained in pictures:

    “Quote: No matter how advanced mental illness is, however, without treatment, social unraveling seems inevitable.”

    Does 1 plus 1 equal 3 because I say so? What a bunch of bullcrap!! This made me laugh out loud this morning.

    Quote: “In the 1970s, Alan Stone, a psychiatrist and Harvard law professor, conceived the “thank-you theory of paternalistic intervention,” arguing that when someone with serious mental illness declined treatment, need ought to trump liberty if, once psychiatrically stabilized, the person was likely to be grateful for the intervention.”

    The “Thank you theory of paternalistic intervention” – another example of why so many in the general public do not trust psychiatrists.

    Quote: “Because language shapes our perceptions of the world, the insistence that we call people with serious mental illness not “patients” but “survivors,” “clients,” or “consumers” perpetuates underappreciation of their needs. “Survivor,” as Torrey notes, implies “survival of a traumatic event, specifically in this case involuntary treatment.” Words such as “client” and “consumer” emphasize that people with mental illness should participate in decision making15 — ignoring the impaired insight that may render that impossible.”

    How true that is – language shapes our perceptions of the world. “Underappreciation of their needs”, meaning what we, the psychiatrists, think they need (and force on them). Meanwhile, back in the reality that most non-professionals live in, it is in fact scientifically incorrect to call a person with “schizophrenia” a “patient”, since no serious scientist or doctor would ever do that, knowing that a disjunctive, unreliable label such as “schizophrenia” is not a valid illness category, and that psychoses occur with great variability along different continua and dimensions.

    Quote: “The risk arises when “recovery” becomes antagonistic to psychiatry. Although the message that everyone can recover may empower people with mental illness, it is simultaneously a subtle rebuke of psychiatrists, who are perceived as having acted solely out of self-interest in insisting that people with serious mental illness have a lifelong need for psychiatric care. But that belief flips causality: psychiatrists are no more responsible for the chronic needs often associated with schizophrenia, for instance, than medical doctors are for those associated with HIV. If a revolution is needed, surely it lies in more support, not less.”

    Recovery can and should be antagonistic to psychiatry, at least the psychiatry we have now. The public, including especially former people who escaped the system such as myself, can and should oppose psychiatry at every turn. It is not a subtle rebuke to psychiatrists, but a rebuke outlined in bright neon letters.

    As for “chronic needs associated with schizophrenia”, psychiatrists apparently continue to evidence no insight as to how their treatment and their reductionist attitudes about “illness” create the poor outcomes which then lead them to think that “schizophrenia” is a chronic disease. Talk about anosognosia in professionals…

    Quote: “Some recovery advocates use the vague ideals of the movement to sidestep scientific rigor. Regarding the absence of recovery-oriented commentary in scientific journals, for instance, psychologist and advocate Patricia Deegan, who was diagnosed with schizophrenia in her teens, writes, “Although the phenomenon will not fit neatly into natural scientific paradigms, those of us who have been disabled know that recovery is real because we have lived it. Such reasoning stifles dissent (who can argue with someone’s “lived experience”?) while justifying a lack of evidentiary standards. ”19

    It is amusing to hear a psychiatrist talk about scientific rigor, when their leading figures in the NIMH and APA such as Insel, Kupfer, Hyman, and Frances admitted that their diagnoses have no clothes in the past few years. And if psychiatrists wonder whether “scientific rigor” is effective in promoting recovery, they should look at the state of their profession, its fading respectability, and the woeful rates of recovery among people they have treated.

    Quote: “Questions about the role of treatment in recovery have been reinforced . . . by studies suggesting that some people with long-term use of antipsychotic medications do less well over time than those who are not on long-term medications”20 — an observation that’s as confounded by severity of illness as a conclusion that cancer chemotherapy is harmful because patients who receive more of it die sooner.

    The psychiatrist here predictably twists the Wunderink and Harrow data to fit their preconceived theory.

    Quote: “Another argument that questions the role of formal treatment derives from a 1988 review that suggests that people with schizophrenia in developing countries have better outcomes than those in Western societies.21 But the review acknowledges its methodologic limitations, including non-Western definitions of schizophrenia that may include more benign disorders.”

    And they do the same with the Hopper and Sartorius data, even when the re-analysis of that data came to the same conclusions.

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  • Caleb,

    Great story – well done for having courage to share; every story like this adds up to influence society as a whole in a positive direction.

    I resonated with this part,

    “When I received my diagnosis of schizophrenia, I thought about the consequences of living with this illness long-term versus committing suicide, and how either choice would affect my friends and family. After long deliberation, I decided that I would try to make it for “as long I could hold on for.””

    This is where things could have got really bad and pushed you into suicide or chronicity (not being able to function long term) if you hadn’t had a recovery-oriented doctor. As it was, you were already very scared by the prospect of having an incurable lifelong severe disease (“schizophrenia”), as you expressed in the article.

    To me, along with excessive drugging, this is where the system does so much harm – by brainwashing individuals into believing they “have schizophrenia” and must lower their expectations for relationships, work, and being fulfilled. The negative expectations the system creates are a profound obstacle and in many cases more of a barrier to recovery than whatever was going on first in the person’s life.

    Even if they recover, mainstream mental health workers often tell you you will be “managing your illness” and “in remission”. And that is just bullshit – people really can get better and “no longer have schizophrenia”, to use the crude, reductionistic language.

    I have quite a similar story to you, breaking down as a young person, going through extreme states, being on loads of drugs, but then finding support and a way to recover so that now I work full time and have good relationships and am off drugs. As you say it is very hard work, but totally worth it in the long run – definitely much better than ending up as a burned out, nonfunctional husk in the psychiatric system.

    Lastly Caleb, I have one shameless advertising plug – if you don’t know the ISPS group please check it out – – and consider joining its Yahoo groups email listserv.

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  • Corinna,

    Regarding this, “The effects of trauma are important: increased suicide, substance use, mental health labels, physical health issues, more domestic violence, more incest, etc. These all happen at the same rates in rich neighborhoods as in poor neighborhoods (according to Missouri BRFSS data, and there is similar screening data in all states),”

    The link you gave to the BRFSS data does not even list most of these trauma categories… it says nothing about incest or suicide, for example. So, linking this as a data source for comparing rich and poor neighborhoods does not prove anything about the notion of certain traumatic events having the same frequency in poor or rich neighborhoods (something that sounds rather unlikely…). You also said there was “similar screening data” in all states, but provided no references.

    Can you clear this up?

    On the other hand, I agree that ACE score is subjective and does not properly take into account the degree or ongoing length of the trauma, nor how the individual responds to or copes with it. Any individual ACE score could be very misleading in terms of what it says or doesn’t say about the severity of an individual’s trauma and their ability to respond. An ACE score is like a two-dimensional measurement in a four-dimensional world (the fourth dimension being time…)

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  • Sa, to me the word “psychotic” is only descriptive, not a judgment. I realize other people see it differently.

    To me “psychotic” describes an early emotional phase where negative interpersonal experience has predominated over positive interpersonal experience, resulting in profound lack of trust, inability to function, chronic terror, and (sometimes) use of delusions and hallucinations to handle the overwhelming fear. I think of it as describing the early region in this diagram:

    To me it is potentially temporary – because with help one can move out of that emotional developmental stage. But the word psychotic does not inevitably denote an illness.

    However, because there are better words available like “extreme states” or “organizing experience”, that appear to be less harmful, I can change my usage and not use psychotic, or at least refer to it much less going forward. I will try to do that now.

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  • Nomadic,
    This comment, in my opinion, is all-or-nothing and does not reflect the reality that many people choose to go to therapy of their will and many find great help from it. Nor does it reflect what Paris was discussing quite clearly – i.e., that “the problem” and “the solution” (rather vague terms as these are) often lie in our interpersonal experiences, i.e. with things outside our own head.

    As I’ve shared in many other comments, there is much research, for example in the books of Barry Duncan and his collaborators (e.g. The Heroic Client) which shows that people are better off functionally and emotionally if they have access to therapy, rather than if they do not.

    You appear to be saying that people are on average worse off if they seek therapy. But you provide no data in support of this assertion. Since extraordinary claims require extraordinary proof, please provide that data if you would like this idea to be taken seriously…

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  • Someoneelse, the psychiatric industry will only get out of the business of medicalizing the experiential when enough of the public become powerfully aware of how hollow and harmful their diagnoses and treatments are… that is the reason that I had in mind behind doing more of these interviews, because every time people speak out with alternative views to the disease model, it affects gradually more minds. At some point, hopefully a tipping point will be reached where a larger mass of people no longer accept the myths that psychiatrists spread about schizophrenia being a predominantly genetically-influenced disease, and both seek and demand alternative approaches to extreme distress.

    People like Paris and myself can set an example by having recovered from extreme states without long-term use of drugs and without accepting that we had a brain disease, and by speaking out about our views. And we do.

    I think iatrogenic damage from drugging is one possible pathway to having a severe emotional breakdown. However I think it is mistaken to speak as if iatrogenic damage is the main or primary cause of severe problems in living that get mislabeled brain diseases such as “bipolar” or “schizophrenia”. The research that Paris was talking about appears to show, to the contrary, that it is adverse life experience, stress, isolation, fear, trauma… negative environmental experiences of all kinds – which in turn affect brain chemistry and (epi)genetics – that leads to these type of problems most often, at least initially. Having said this, in many cases iatrogenic damage from drugging can worsen and exacerbate the existing problems derived from experience. Even leading psychiatrists like Andreasen now admit the physical problems caused by long term tranquilizer (i.e. neuroleptic drug) use, including brain shrinkage, tardive dyskinesia, obesity and so on.

    Anyway thank you for commenting and for your passion in holding the psychiatric cartel to account.

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  • Hi Truth,
    I think the concept of “blaming” mothers is simplistic – as you have suggested previously, there are many factors that can impact parents, and most parents are doing the absolute best they can given the resources they have available. But in my opinion we should also not shy away from appreciating how crucial a secure, loving relationship with a parent is – and that the lack of such a relationship in different degrees and ways, or its being shattered by trauma of some kind, is a factor significantly raising the risk (different than “causing) for a serious emotional breakdown. Again, I see this as positive, because it highlights how modifiable and reversible serious emotional problems potentially are. If such problems are not primarily based on faulty genes or chemical imbalances, but are primarily caused by a lack of getting one’s needs met in the environment in a variety of ways (Doesn’t that sound less blaming?), then repair and healing of such conditions is more possible.

    Another good theorist on how to work with severely troubled people and their family was Donald Rinsley. Did you know this work? He was a therapist at the Menninger Institute in Topeka, KS. He worked with many severely troubled adolescents and their families. I liked his book, “Treatment of the Severely Disturbed Adolescent”, and learned much from the object-relations theory in it that helped me to understand extreme states.

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  • I agree, BetterLife. I was once incarcerated at a “recovery center” where the head of the center would call the clients in the morning and evening by loudly shouting “Meds, Meds, Meds, come take your meds!”, and the (already heavily drugged) clients would file in one by one like so many sheep or cattle. Apart from that we were barely talked to and left to our own devices for most of the day. It’s sad to think about that time.

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  • Alex,
    I meant generally that some people are not spiritual, or are less spiritual, while others are spiritual or are more spiritual. For example I am an agnostic / borderline atheist who does not believe in a higher power. But I consider myself a humanist and do feel I have a sense of self…. I was trying to say that other people also vary along these dimensions. Maybe I was not seeing the gradations or subtleties of meaning within the word “spiritual” clearly enough.

    Oldhead, words are just words. I am trying to say that what we do with them and how we use them, what we assume about their meaning, is what matters the most. Attaching fraudulent concepts / meanings / assumptions to the term “schizophrenia” is what has made it so harmful as you have been saying. The term “extreme states” or “severe distress” would be examples of sounds / words that have not become twisted as badly like “schizophrenia” has.

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  • Richard,
    I did read this blog, the Santa Claus one. I just didn’t get into the debate myself due to being busy with work that week.

    “Extreme states” is a good enough term for me, if a bit less pithy than “psychosis”. And I prefer “wellbeing” or “fulfillment” to “mental health.”

    “Schizophrenia” is indeed an Achilles heel of the psychiatric establishment – it is such a vulnerable, disjunctive, vague term… when one tries to assert as research psychiatrists do that there is a unitary disease called “schizophrenia” that gets passed down primarily via the genes. They know how weak this idea is – or at least some of them must – but by denying to themselves how fragile – really nonexistent – the science backing the disease model of “schizophrenia” is, and by convincing the public that as doctors they know what they are doing – as well as via the inability of most oppressed people in extreme states to speak up – in all these ways the leaders of the medical model try to control the dialogue and define reality in a way that keeps them in power. However, their way of defining and treating people is obviously completely unacceptable, and enough is enough…

    Richard, my way of understanding “schizophrenia” goes back to early psychoanalytic concepts, if you know the writers like Donald Rinsley, James Masterson, Gerald Adler, Otto Kernberg, Harold Searles, Bryce Boyer, Vamik Volkan and before them early psychoanalytic theorists like Klein and Fairbairn. They worked a lot with very regressed people in intensive therapy and, via doing some very effective work (in terms of progression to emotional wellbeing) with people in extreme states, and offering a coherent model (in my view) of how these extreme states derived largely from adverse social experiences, they convinced me that their models were on the right track, via their writing.

    I also had direct lived experience of adverse social experiences causing extreme states, so of course it was not too hard for me to be convinced. But what I like about the psychoanalytic approach to psychosis of these particular writers is that it is very hopeful – it views extreme states as reversible and curable – and also, it imbues these states with relational meaning and value. That is what is so unattractive and outright harmful about the mainstream psychiatric approach to “schizophrenia” – it destroys hope, and it is meaningless.

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  • Oldhead,

    I am glad we had this discussion; what you say does gradually affect my views, as hopefully my and Paris’ views are useful to you. It takes a lot of time to change one’s core ideas and paradigms – it’s taken me years to think the way I do, after all. I think it’s good to approach people with the idea that no matter how different their viewpoints are than one’s own, there is a reason they think that way and they may not want to give it up wholesale right away. I have found this in talking to people who believe there is an incurable brain disease called schizophrenia; telling them they are wrong bluntly is threatening and tends to make them withdraw. But interacting with them in a way that makes them question their beliefs a little bit, and provides a hopeful alternative, rather than saying “You’re totally wrong!” or “Your view is bullshit” can be helpful. And sometimes some of their views are right too, about aspects of what they’ve been through, of course…

    “Schizophrenia” being a disease term is very negative and harmful, but it’s made even worse by the degree of negativity that professionals attach to it. It’s not like saying you have the flu, and you can fully recover and not have it anymore. Somehow mental health professionals get this delusional idea that people get a disease called schizophrenia, and then are doomed to live with it for life and never be cured. That’s the worst thing they do, in my opinion, is not only give the disease label but also, often unintentionally and due to lack of awareness of other approaches apart from the biological model, attach extremely pessimistic self-fulfilling prophecies to it. Doing that is just so harmful.

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  • Alex,
    Good to hear about all this progress you made. I like to think of what is necessary for escaping the psychiatric system as analogous to what is necessary to have a rocket escape the atmosphere of a planet – you need sufficient velocity and support (fuel) in a particular direction to escape the gravitational pull of the planet / psychiatric system… but then once you achieve whatever it is, i.e. 25,000 mph or enough psychosocial support outside the system, the “gravity” of the planet or psychiatric system loses most of its power over you and you enter a “new world”.

    And that’s cool that you were in San Francisco. I’ve been there, and Paris worked and studied there for some years. Also, Ira Steinman, the ISPS member who recently published an article on here, “Curing Schizophrenia through Intensive Psychotherapy” (there’s that dreaded word again!) lives and works in San Francisco now. I remember the great stories in his book about how he saved clients who were on their way to the Golden Gate Bridge for really bad reasons.

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  • Stephen,

    Thank you for this study; it makes sense to me generally. There is a whole line of attachments theorists who emphasize the crucial nature of attachments to parents and others in the early environment, going back to Margaret Mahler and John Bowlby, and forward to Daniel Stern and others like Allan Schore and Peter Fonagy. Their work is important; but later experience is also very important (after early childhood, involving extra- and post-parental experiences within schools, with peers, love relationships etc).

    Paris also said to me backchannel the following; and I think it is ok to quote him here:

    Paris: “For those who question the links between ACEs (Adverse Childhood Experiences) and the later onset of psychosis, you may also want to direct them to my “Madness and the Family” guidebook – – or article (and of course John Read’s articles on these topics).”

    Stephen, what you’re saying about the lack of a good fit between parent and child is also an interesting and troubling possibility. I think this is also true and is another dimension that builds resilence against or otherwise vulnerability toward breaking down in a way that may get labeled as “mentally ill”. People’s personalities are so complex, and we all know when we have a good empathic fit or “match” with another person, although it’s hard to define why exactly this may be in each case. But if a parent and child do not match well temperamentally, this may be very problematic because of the simple fact that a child is usually very dependent on and spends so much time with a parent during their early years.

    You are right, I don’t think parenting is the only or necessarily the primary cause of development of extreme states, although it certainly can be and is in a fair number of cases. Although, this is hard to measure – how do you precisely measure the effect of better or less helpful parenting? – it’s not like measuring the weight of platinum or tracking the speed of a physical object. As I think Paris would support me on, the principles of relativity and chaotic/unpredictable non-linear systems come into play when looking at how parenting may dynamically interact with the child and with other factors in the child’s environment. I think this complexity gets lost when people get threatened by the idea that parents are going to be “blamed”, and thus we need to say that “schizophrenia is not caused by bad parenting”… even though, ironically, there is no one single schizophrenia disease to be caused by bad parenting.

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  • Richard,

    What words, or what way of speaking, can we use to describe delusions, hallucinations, withdrawal, anomalous thinking, nonfunctionality at a particular time, if not “schizophrenia” and “psychotic”?

    By the way, I think psychotic is a much less medical word than schizophrenic, but that probably doesn’t matter because it obviously seems medical and more importantly offensive to some people.

    In any case I’m happy to change my language if there are better ways of speaking about severely distressing experience available. Part of the reason I still sometimes use them is just out of habit – I’ve had professionals use these words with me for many years, and read many books where they are use.

    One alternative way forward is just speaking directly about distressing experience – that can work well, although it can be cumbersome and long. Another way is to find new labels, such as “extreme states” or “emergency of the self”. Although, one must be careful lest those words become contaminated or co-opted by those in power.

    I think it is not so much the word itself, but more assumptions underlying it, and how it is used, that become so harmful. As I was saying to Bonnie below, millions upon millions of usages of the word “schizophrenic” in interpersonal interactions between mental health workers and people adjudged to be chronic, hopeless, other, etc is the foundation on which the mighty stigma and harm of the word “schizophrenic” have developed.

    So it is what we do with the word, and what the power structure does with the word. I even wonder if the word “schizophrenic” or “psychotic” could be taken back and destigmatized, but that is probably impossible at this point. I agree a new way of speaking and/or new terms are probably better. How about “extreme states” or “self emergency” or “personal crisis”? (I think some people are not spiritual)

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  • Bonnie,

    Can you share what words you would use for, or how you would talk about if you didn’t use specific single words, experiences that involve a person being delusional, withdrawn, nonfunctional, hallucinating, and so on? Would you just talk about specific experiences in a person’s life history?

    With “schizophrenia” – a word I also regard as illegitimate, but sometimes reluctantly use because of wondering how most mainstream people will find what I write otherwise – what has been so harmful, I think, are negative assumptions underlying and attached to the word, e.g. chronicity, pessimism, otherness, hopelessness, biological nature, reductionism. These come from how those in power think and act, millions of repetitions of which build meaning and stigma in to a word, not from the particular word itself.

    Or do you have better words for extreme experiences Bonnie? If so share…

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  • Truth,

    Thank you; I find this debate interesting so will respond. First, I posted a link to this interview on another forum ( and you can see that some commenters there responded negatively to it – without reading it fully, they mistakenly assumed that Paris believed that all psychosis is caused by bad parenting:

    This forum is one dominated primarily by the disease model, and so I think that some commenters there are threatened by the idea that a large contributor – not the prime cause – of extreme states could be parenting and/or peers.

    You are right to call for balance – over time I have come to see how varied are the possible causes of extreme states. Not only how varied, but the way in which extreme states develop in a person is non-linear and complex (and can never be precisely known as in physical sciences) and almost always involve multiple interpenetrating causes, of which less than optimal parenting might or might not be involved to a lesser or greater degree, and if it is involved, it would not be the only factor.

    I think the massive changes in (often isolating) technology in recent decades, the lesser availability of working mothers, greater societal expectations on children to grow up and perform early, and many similar factors, have probably created stresses that raise the chances of breaking down as you say.

    It also would not make sense to say “parenting difficulties are THE primary cause in children”… because each case is individual, extreme states are not one well-defined entity, and the degree of influence of more or less effective parenting in a given group may not generalize to another group. In this regard, it gives me a chance to quote my favorite social researcher’s criticism of psychological research, which I interpret as a call to be cautious about making categorical generalized statements:

    “The main conclusion to be drawn from irreversibility is that 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.”

    (Smedslund, 2015, “Why Psychology Cannot Be An Empirical Science”)

    So in other words, even if parents contributed a lot to to the problems of one individual or one small group, that might not generalize to a different person or group… or the entire culture of parenting might change over time. The possibilities are endless and as you say Truth it is best to not jump to conclusions.

    Lastly, before I make this longer than Paris’ actual interview (!), I want to I relate to what you said about Paris – some years ago, he was briefly a mentor to me too and an encourager during a difficult period.

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  • Hi Alex,

    I related personally to a lot of what you beautifully shared here, in particular:

    “Their fears, worries, and delusions became my fears, worries, and delusions, until I was ultimately able to separate from their world view and come into my own, based solely on my experience and not on anyone else’s.”

    This reminded me of what I’ve understood happens in extreme states from my reading of psychoanalytic approaches and more importantly from lived experience; the person who becomes terrified and overwhelmed fuses or merges their view with other people and cannot differentiate what are their perceptions from what are others’ perceptions. In another sense, they cannot sense the separateness of other people emotionally.

    This brought to mind Harold Searles, a great therapist of regressed states (and speaking in an age when the word “schizophrenia” had less stigma), who said something like, “The schizophrenic patient sees reality first through the eyes of mother, then through the very different eyes of father, then through the eyes of others, but finds no single, secure view of reality to form a solid bedrock sense of self…”

    “Persecution” would be a good word for what I also felt in relation to certain “severe mental illness” labels – or more importantly, the assumptions of chronicity and incurability that lay behind them. That is the most harmful thing. Again I like the psychodynamic perspective – in my view, the person’s vulnerable self is the “object” of the all-bad internal representations of what the person thinks that mental health workers think. Read that again… in other words, the person internalizes the scary attitudes of mental health workers and psychiatrists (“I have an incurable brain disease”… “I will always need drugs”… “I cannot fully recover”… “My brain is defective”)… these “introjects” or schemas of what the person thinks those around them think then constantly replay in the person’s mind… these replayings create terror and despair. I believe this phenomenon accounts for a large part of the poorer outcomes in Western nations for extreme states, relative to what they could be and relative to poorer countries where professionals and the disease model have less negative influence.

    Anyway Alex, thank you again for commenting… and let me personally appeal to you and say that it would be great if you could write a few articles for MIA about your escape from the system, as you sound like you have much wisdom and have a good position now to look back on what happened to you.

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  • Thanks Bruce. I just said to Paris backchannel that this interview is so in depth and lengthy that it may not get many reads / comments, but also suggested we shouldn’t judge that metric necessarily as the measure of success. With a longer, more involved piece being put out in today’s short-attention-span digital age, you’re always going to have relatively less readers compared to sensationalist shorter articles. But I think for those who do grapple with Paris’ thinking more, the rewards may be greater than reading a shorter “hit piece” on psychiatry. And hopefully Paris’ hopeful attitude really helps some people that we never hear from – in that regard the view count on these pieces is usually at least one, sometimes two, orders of magnitude greater than the comments.

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  • Fiachra, thank you for your comment and support now and in the past. Losing a complete life to psychiatry is one of the worst things in the world, but being delusional / hallucinatory / chronically confused and despairing can also be a nightmarish experience if one gets stuck in such a state and cannot find a way out – it can be unbearably painful in itself and lead to many lost opportunities in work, love, and living. So I wouldn’t put severe experiences of extreme states that much further down the continuum of suffering, necessarily, compared to getting buried by the mental health system. But certainly, I think (and you probably agree with me I’d guess) that involvement with the mainstream mental health services often makes experiences of extreme states worse.

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  • Oldhead,

    From my perspective it would be nice if you could engage with the content of this article in a positive as well as negative way, as there’s a lot positive in what Paris has shared, and I am not the main focus of this piece, nor did I instruct Paris in any way as to how to respond… Of course what you do is up to you. However there are no requirements for how to engage with me, other than limitations you put on yourself. And you can blanch as much as you want.

    As you know, I do not see the term “psychotic” as being hate speech; my viewpoint is different than yours. Just because I do not agree does not make my view wrong or bad.

    I do agree with you that “schizophrenia” is a more harmful term, and more of an invalid catch-all category. However, experiences of delusions, hallucinations, chronic terror/rage/despair, withdrawal from meaningful relationships, and inability to function in any way are real. These experiences do impact and harm the person experiencing them and the people around them.

    Perhaps it is better to simply speak about specific experiences in a specific context, but from my personal experience and talking to other people who received “severe mental illness” labels, there are commonalities in how people respond to distressing life experiences in terms of being terrified and angry, having confusing or even delusional thinking patterns, having difficulty with working/studying and/or forming intimate relationships, and so on. So to speak generally about very severe difficulties is problematic, but it is also not necessarily without any loose correlates in the common experiences of a given group of people, nor intended as hate speech.

    I realize we may have to disagree on this; I am ok with that. Perhaps Paris will answer your comment below.

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  • Hi Rasselas, I don’t know if I understand your question / comment? It seems like the syntax doesn’t make complete sense.

    I can say that I view “schizophrenia” as a vague, poorly-defined term the meaning and ramifications of which changes depending on who is using the term and in what context they are using it. I think it is better, ideally, to speak about specific experiences leading to particular feelings, behaviors, and thoughts. This is however not such an easy process as applying one blanket label, thus the allure of the often meaningless word “schizophrenia.”

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  • Borut, no I don’t agree with this idea that there is one real biology of madness and that that real biology may be only or primarily triggered by “natural hallucinogens” in people’s brains. I think psychotic states are caused by many different interpenetrating factors and that many of these factors are social and environmental experiences which affect biology. I wrote about these psychosocial factors, including citing John Read’s research, in my article on “Rejecting the Medications for Schizophrenia Narrative” that I believe you read.

    We should also be clear again that “schizophrenia” is a label people are given, not one unitary illness people have or do not have, and psychotic states exist on a continuum of degree and constantly change in response to internal and external influences.

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  • Peter,

    Finding causality in these studies is very difficult because in studies of human beings there are so many interpenetrating causal factors operating, with non-linear feedbacks and unseen causes of causes working in the background. Still, it’s interesting to see that the drugs may be exerting some overall malignant effect on increasing suicidality.

    One can only see such a phenomenon operating at a group level, although I have some personal experience at an individual level – my stepfather hung himself in his hospital room while on a strong dose of antipsychotics. Any single case like this is correlation (when it comes to the possible effect of drugs), although it’s also a human person and a tragedy. This experience brought home to me the truth of what you say – you can’t watch someone every minute. My stepdad was in the part of the ward where the nurse watches you every 15 minutes – and that didn’t stop him from hanging himself due to severe agitation and despair.

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  • Bruce,

    I like this article very much.

    However, it seems likely that “people with serious mental illness” dying 25 years younger is not so clear-cut – what are the chances it would come down to that nice round number? As you know, “serious mental illness” is not one discrete entity, but a label given based on subjectively assessed behaviors, rather than anything clearly identifiable like diabetes. One has to wonder at studies saying people die “14 to 32 years younger” (which is it, and why such a wide range?).

    Still, it is almost certainly true that many, many people who are in terror, delusional, and nonfunctional are dying far too young. You are quite right about that point, although the 25 number may not be so clearcut.

    I also agree that treatable medical conditions are the proximate cause, not the ultimate cause of death in many cases of people labeled “severely mentally ill”. Most likely the actual chain of causality is much more complex than simply a physical illness, involving being in constant terror and rage, having a lack of supportive loving relationships, the need to smoke cigarettes and take drugs to compensate for powerful negative affects and lack of love, lack of money which is hugely psychologically stressful, the effect of stigma and being ostracized, lack of meaningful work and community engagement, and the effects of constantly being on harmful antipsychotic drugs. These and other factors must interact to put tremendous stress on the body and raise the chances of developing diabetes, cancer, and other diseases. So it is not simply that untreated physical diseases are the cause of people dying young in the cases of those labeled seriously mentally ill. That is like saying “schizophrenia causes X”… it doesn’t do anything. We need to look deeper at the social context. Treating the physical diseases might not even work very well, if the social factors and the drugging which have probably led to the physical breakdowns were not addressed.

    I have to question this part:

    “The key to a community truly helping people experiencing altered and extreme emotional states is for that community to believe that these states have meaning and value for the community. Once a society diseases and pathologizes these states as mere “illness” and “defect” without meaning or value, those people experiencing these states are seen as burdens on society.”

    There may not be much value at all in being terrified, paranoid and nonfunctional, Bruce… speaking from experience. Not every person who becomes psychotic is some hyperenlightened, ultra-spiritual variety of being. Some people are just suffering from horrific inner persection and overwhelming negative emotions and want to get out of that states. In these cases, the psychotic state itself is not meaningful or helpful to anyone, neither the sufferer nor the community. But he community can still respond by providing empathic listening, psychotherapy or similar interventions, and meaningful activities to draw the person out of the horrific psychotic state and help them develop emotionally. But this process is different from viewing that psychotic state itself as having a significant positive aspect; it may not do in some cases. Let’s be aware of this range.

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  • Nathan,
    Psychotherapy is not like a pill that comes off an assembly line – the individual and constantly changing human relationships that are psychotherapy are much less able to be generalized about.

    With intensive psychotherapy of psychosis, yes, it certainly can be harmful, as can any human relationships with a more (or less) troubled person. Intense rage and terror are usually underlying psychotic mental states, and if these are not processed safely then their emergence can be harmful or even deadly. Also, some therapists presume they know exactly what is wrong with the client and impose their view of how to fix things on the person, rather than listening to and collaborating with them. This can also be harmful.

    However, there are many, many good therapists out there who understand how psychotic states form developmentally, are very patient and emphathic, and who do good, honest work with many people.

    As for evidence, here is a large meta-analysis of psychotherapy with 2,600 people labeled schizophrenic – – which states:

    “Our findings indicate that individual psychotherapy is associated with improved functioning in the majority of patients diagnosed with schizophrenia who receive it. We found that all forms of individual psychotherapy (psychodynamic, cognitive-behavioral, and non-psychodynamic supportive) were associated with an improvement in functioning for people diagnosed with schizophrenia, but that the largest improvement rates were associated with psychodynamic and cognitive-behavioral therapies… Individual psychotherapy is associated with improvement in functioning in people diagnosed with schizophrenia in the overall meta-analysis and in each moderator analysis of the data.”

    We can always argue about which data is valid or not; but perhaps if you think therapy is harmful, you can produce data proving that it harms most people, i.e. is more harmful on aggregate than not. And just saying that some person’s analysis is poor and that they are overstating outcomes – without links to references and a well-reasoned explanation supporting this notion – is not convincing.

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  • Moni,
    Well done for finding your own way and not accepting wholesale the disease model conceptualizations of psychiatry. It’s hard to do that in a world where it seems like the majority of people and institutions are forcing the “you have a brain disease” model down your throat. I had the same struggle. But for me, as I found alternatives that worked, I became ever more sure that “schizophrenia” and “bipolar” experiences were not incurable brain disorders, not chemical imbalances, but were understandable, human, and heal-able problems.

    It’s cool that you had athletic success that gave you some confidence that you could beat this. Do you know Stephen “Wonderboy” Thompson, the MMA fighter and karate black belt? I really like him.

    I myself was an advanced tennis player even before I began to have severe emotional problems, and being in and around the game, even during some of the worst times, really helped me to get better.

    Breathwork to help with emotional issues has a long history too; I wonder if you know about it. Wilhelm Reich (Character Analysis) and Alexander Lowen (Bioenergetics) are too of the early writers who analyzed muscular blocks and constrictions of breathing in different types of serious emotional problems.

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  • Ira,

    It’s so great to see this being published online for everyone to read! And good to see you using more modern technology to spread your knowledge 🙂

    This paragraph below illustrates for me what’s so important about your approach and the psychodynamic approach in general:

    “Such a psychodynamic approach runs counter to the general run-of-the-mill excessive prescription of medications, but gives the patient a chance to make sense of his psychosis and achieve lasting healing and sometimes CURE. Such was the fortunate outcome with Lois. And such is the possible outcome of an Intensive Psychotherapy of schizophrenia with many other patients.”

    Your type of approach provides some hope and a sense of meaning via understanding scary, inscrutable “psychotic symptoms” as potentially meaningful and transformable. As you note in your book Treating the Untreatable – – many severely disturbed people have been in terror for years or decades due to lack of hope and not having a way of making sense of their experience.

    Hope is like oxygen for people in extreme states and their families – too many such people are literally dying or nonfunctional because they are delusional / hallucinating / withdrawn etc, but they don’t have the hope that comes from an empathic, committed partner who believes their experience has meaning and that they can recover.

    I expect that you may soon be hearing in these comments from others who think that therapy is universally harmful and unnecessary. I will preempt such comments by noting that psycho-therapeutic relationships are as varied and individual as human relationships, which is what they essentially are. Generalized statements about psychotherapy and what it does or does not do outside of a particular context are meaningless. However, large-scale studies of long-term psychotherapy by Falk Leichsenring, Paul Knekt, Barry Duncan, appear to show that – on average, and in about 80% of cases but not in all cases – people are emotionally and functionally better off when they engage in long-term psychotherapy than when they do not.

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  • Hi Noel,
    In a sense we could say there is no true insanity, because anomalous responses that get labeled psychotic almost always make sense if we understand the individual’s experience in context. As you said, most people who go crazy have very good contextual, experiential reasons to be having extreme fears, delusions, to be withdrawn, and so on. So insanity is a logical response to specific experiences at specific times. Or perhaps we can say it would be insane to not go insane when faced with extreme stress.

    It is disturbing to realize that events and people in the world can be capricious, uncontrollable, cruel, senseless. I think this is a reason why many people believe in God and religion, as a way of softening this awareness. I read one writer (New York analyst Jeffrey Seinfeld) who described psychotic states as “the death of God (the good other)” and the experience of “darkness on the face of the deep.” Hope is crucial – and to sense good intent, gentleness, and love in another, similar to how a young child does with its mother in symbiosis, is what heals extreme states, in my experience.

    It is also bizarre to see researchers looking at the level of specific cells and neural networks to try to understand extreme experience. To me one might as well try to translate an ancient language by looking at the molecular composition of the stone table it is written on. As John Read said, it is darkly humorous to think we can now identify the part of one’s brain that makes one disagree with one’s psychiatrist? I am glad I still have that part and that it didn’t get lobotomized!

    Lastly, I would add that with the advent of the internet, it can become harder to sense how the “other” is emotionally, and easier to misinterpret their online postings. So, let us each try to hold on to uncertainty and openness, before judging others we communicate with online merely from what they say in certain forums.

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  • Anyone who has gone through different experiences has different brain chemistry. Brain scans prove nothing about a discrete illness called ADHD existing let alone one in which people can never come to concentrate. Indeed, what happens with these brain scans is that research psychiatrists presume a priori that certain individuals “have ADHD”, and then they scans their brains and compared them to “normals'” brain scans, and take the (inevitable) average differences as proof of an illness existing. But this is simply circular logic – average differences in brain chemistry at one point in time between two quasi-experimental groups do not prove anything about an illness called ADHD. As oldhead suggested, one must wonder where you got these ideas…

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  • Well done Phil – it is indeed stunning and distasteful to see the ignorance and presumptuousness of a phrase such as the following:

    “One thing is certain, though: There is no cure for ADHD. Someone with the disorder might learn to adapt to it, perhaps with the help of medication, but patients young and old are generally told that they will deal with their abnormal brains for the rest of their lives.”

    Few people can believe that the person writing such a phrase is essentially delusional – i.e. that Schwarz has no understanding of how or why problems with attentiveness and focus do not in any way constitute a discrete illness, let alone incurable ones… and that many children could think with more logic and nuance than Schwarz.

    As you wrote very cogently,

    ‘Under the guise of medical care, they routinely rob people of their sense of competence, their dignity, and in many cases, their lives. They have radically undermined the concept of success-through-disciplined-effort, and have ensnared millions of people worldwide in their ever-expanding web of drug-induced dependency and self-doubt. They are not the thoughtful and expert codifiers of genuine illnesses, as Mr. Schwarz contends. Rather, they are drug-pushing charlatans and hoaxsters who have systematically and deliberately deceived their clients and the general public to enhance their own prestige and their incomes.”

    This is a great description of what psychiatrists do in general; and really applicable to almost any of their pseudo-diagnoses.

    Thank you for continuing to sound the alarm against this nonsense.

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  • Jill,
    There is no “the cause” of psychosis – there is “a cause” (for an individual in a particular situation) or many different causes when looked at from the 30,000 foot view.

    Inflammation itself can mean a variety of different things, refer to different parts of the body, vary in degree over time, and be caused by a multitude of different prior causes. So overfocusing on inflammation as if it is one unitary thing is as unlikely to lead to clarity as focusing on “depression” or “schizophrenia” as if these were unitary illnesses. Inflammation (of what?) is more likely just a follow-on of other earlier causes, just as varying dopamine levels in the brain is not a first cause (of schizophrenia or anything else). I’m surprised this is not more obvious to you.

    Furthermore, depression and anxiety are syndromes, not discrete diseases.

    I agree with oldhead about the circular thinking and correlation-causation confusion in your comment.

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  • Terry,
    Thank you for your excellent article. It is indeed stunning when one examines and understands how little science underlies the diagnostic categories and treatments employed by most psychiatrists. “House of cards” describes the situation perfectly.

    A few years ago under a pseudonym I wrote an article echoing many of your themes and exposing the lack of science behind one of psychiatry’s primary “severe” diagnoses, Borderline Personality Disorder:

    I called it the Science of Lies, after Szasz. It is an apt term for this field, although many psychiatrists do not actually know or intend to mislead and harm, contrary to how it sometimes appears to those of us who get drugged or coerced.

    One must wonder how many more influential people and groups need to become more aware of the spurious nature of psychiatric diagnosis and treatment in order for more profound change to happen, for a tipping point to be reached. The last few years have not been good for psychiatry in terms of its public image, although treatment in many areas continues largely unchanged.

    This makes me think of the law of the vital few, aka the Pareto Principle:

    Anyway, good article and well done for writing this.

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  • Stephen,
    Great article and great choice of pictures.

    The first picture with the bed (if it can be called that) was powerful for me, bringing back memories. I immediately thought that if Franz Kafka were writing today, he would locate some scenes from stories like the Metamorphosis or the Trial in a modern psychiatric hospital. The setting would fit in perfectly to his narrative of alienation, discouragement, senselessness, and the presence of callous, capricious authorities.

    The second chart, mainly in what it omits, lays bare the failure that is the American mental health system. It’s stunning that so many potentially positive or mixed (good and bad) words are missing from the categories “affect” and “thought process”. Words like “curious”, “hopeful”, “determined”, “reflective”, “warm”, “engaging”, “planning”, have no place here. And for thought process, the only “positive” category is “clear” – as if a healthy person should be like an automaton or drone who feels very little strongly, and just functions mechanically in a socially-approved way.

    Great pictures to describe a profession that has lost its soul.

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  • Bradford,
    Yes I have read Whitaker’s book, although from your response, I wonder how carefully you read my comment. To me and others, it’s pretty clear that making a claim based on single quasi-experimental studies about what neuroleptics do generally is misleading and may confuse correlation with causation. This doesn’t mean I don’t believe that the drugs are often very harmful – of course I do. I have taken them myself and so have other members of my family who have been very harmed by them.

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  • Hi Jim, It is not at all that simple. In the Open Dialogue approach it is not simply that neuroleptics are avoided whenever possible, but also that substantial recovery-oriented family, vocational, and other social support is provided for a long period. These latter factors, and the philosophy behind them, may be crucial to achieving the 80% recovery rate. Therefore, creating a title suggesting that neuroleptics are the one or primary causal factor in reducing recovery from 80 to 5% is misleading – it would be better to admit that there is significant uncertainty and lack of knowledge about these causal (vs correlational) factors. To me this is more intellectually honest given what we know and especially what do not know.

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  • Fiachra, the title of the article is pretty clearly about antipsychiatric drugs doing harm – – and the title’s wording also suggests neuroleptic drugs as the proximate cause of recovery being reduced from 80 to 5%, which is misleading.

    Yes, there is also good news, i.e. that recovery rates could be much higher. But that was not the substance of what I was discussing here.

    I support Jim Gottstein and his mission personally. I just wonder if the way this article is written will be viewed as credible by a broader audience…

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  • Jim,
    I think it is not so simple and easy to say that “neuroleptics reduce the recovery rate of psychotic people from 80% to 5%”. This statement is simplistic and ignores many potential confounding factors in each study, along with minimizing other possible causal factors in each of the two outcome scenarios. Such a statement might sound good if one is against psychiatric treatment – as I mostly am too – but the question is, it your assertion any more valid or founded in clear logic and science than a lot of what the other side says?

    For example, in the Open Dialogue results, psychotic people are given intensive family-oriented social support, often combined with individual psychotherapy, for months at a time. This social support is probably crucial to the good outcomes in many of the 80% who recover there – it’s not only the lack of neuroleptics alone that account for the good outcomes, and the drugs’ absence could be partly or wholly correlational too. So to say that “neuroleptics reduce recovery from 80% to 5%” fails to take into account the complexity of the causal factors beneath the surface. Psychotic people in the 80% good outcome group also live in a relatively less individualistic northern culture (Lapland in Finland).

    Meanwhile, it is not clear what level of psychotherapeutic social support the people in the Harrow study experienced. I remember that it was not clearly reported in the Harrow studies how much and what kind of social supports were available – a typical omission in a study by psychiatrists who mistakenly believe that a person suffers from a brain disease that operates partly or wholly independently of social context. But, generalizing to how most American psychotic people are treated, we can guess that very little intensive individual or family psychotherapy was available in Chicago. If this is true, then again the groups in Finland and Chicago are not comparable, and the statement that neuroleptics reduce recovery from 80% to 5% is simplistic and misleading.

    I say these things as someone who is absolutely against the disease model, mostly against psychiatric drugging, etc. In opposing these things, I think we need to speak carefully and have a careful understanding of causal versus correlational factors in interpreting people’s outcomes in variable settings. And, I would question whether your presentation of neuroleptics in this case demonstrates a careful understanding of the issues. The statement “neuroleptics reduce recovery from 80% to 5%” makes it sounds, to the uninformed reader, as if neuroleptics alone or at least primarily are responsible for reducing recovery rate in this way, and this is certainly misleading.

    Lastly, I think it is well to consider that generalizing from one or even a few quasi-experimental psychological studies (such as Open Dialogue or the Chicago study) is fraught with difficulties and unlikely to provide a reliable guide as to what will happen in other settings. I would like to quote here the Scandinavian psychologist Jan Smedslund, who cautioned that psychological studies in one setting do not provide nearly the certainty about external reality that many people believe they do:

    ““The main conclusion to be drawn from irreversibility is that 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.” (from “Why Psychology Cannot be an Empirical Science”)

    I believe this analysis is correct, i.e. that studies such as the Chicago study and the Open Dialogue studies should be viewed “as yielding possibly useful knowledge in limited domains for a limited time”. We like to think that these results are generalizable to psychotic people in other places, but due to the unpredictability and complexity of human functioning, perhaps we should be more careful in making overgeneralized statements. Secondly, I encourage you to be more careful in presenting possibly correlational factors (such as drugs) as causal ones, since your credibility is not enhanced by confounding the two. Again, I say this as someone who supports the Open Dialogue approach and is against most drugging.

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  • Good to hear about Spanish-speaking people having a forum to learn about and discuss alternative approaches to severe distress.

    Although, I wondered if the title for such an initiative shouldn’t be something like, “Mad in the Hispanic World” (or a shorter term, if you have one, for Spanish speaking countries), rather than “Mad In America Spanish”. We do have a lot of Spanish-speaking people here, but the majority of Spanish speakers globally live in their own countries across Central America, South America, Spain, and a few other places.

    I don’t speak Spanish; otherwise I would offer to translate my “Rejecting the Medications for Schizophrenia” articles into your language – I feel like the critical voices of authors like John Read, Thomas Szasz, Richard Bentall, and others might be interesting for Spanish speakers to learn about who are not familiar with alternative approaches to psychosis.

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  • Hi Tabita,
    I very much agree that having more people speak out about alternative approaches to and understandings of serious distress publicly is important. That is why I did it myself, and have encouraged other commenters to do so as well. Although I had some ability to protect myself, I was still quite scared that bad things professionally or personally might result if I spoke up publicly. But so far, nothing bad has happened at all – and more importantly some people I talked to are quite encouraged and helped by speaking to me and sharing their own experience in response.
    The lack of anything bad happenig makes me realize that for the most part other people care less about us than we think, and also how inconceivably vast the internet is… but we can still influence some people than sharing our stories.
    What I feel would be great would be if many thousands or tens of thousands more people would speak up about how the disease model, the ignoring of social factors, the vast over-reliance on and misrepresentation of drugging, etc, is causing real and very personal harm. That number of voices might start to be heard more widely and then Joe Everyman would think more seriously that there might be something very wrong in the messages they are hearing from the drug companies and those funded and influenced by the drug companies, such as many psychiatrists and NAMI representatives.

    And well done for your passionate and clearly written article.

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  • Hi Greg, I really enjoyed your article – very well written!

    I found out many of the same things you did after being labeled with various psychotic and other diagnoses. Most psychiatrists and mental health workers do not understand that difference – and differences resulting from adverse experiences and life challenges, in particular – are not something to be necessarily fixed, to be numbed, to be viewed as deviancy or illness.

    I also agree with you that recovery is not an apropos word. It’s pretty obvious why it is not – it presumes that a person was “normal”, then fell ill with some psychiatric disease, then needs to recover from that. It imposes the medical-disease model onto subjective human experience, a square peg in a round hole. People do not work so simply or in as black and white a way.

    Glad to see you are working in the peer field, and good luck to you in changing the culture in the system where you work and will work.

    Also, in case you don’t know about it, you might be interested in the group ISPS, which has a conference in Boston soon (

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  • Thank you for your excellent article and cogent analysis of the games people play, Bonnie. It is so true that when faced directly with clear anti-psychiatric arguments and with refusal to back down, psychiary supporters’ houses of cards tend to fold, and often very quickly.

    As a person working outside the mental health field in a totally different field of work, and as someone who’s now not only partly self-employed but also backstopped by family money, I feel relatively secure to criticize psychiatric practices publicly under my real name – as I am now doing through my articles on this site and my writing elsewhere.

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  • Jonny,
    The current psychiatric approach of diagnose the illness, drug the supposed symptoms, and maintain on drugs indefinitely is indeed flawed and even antithetical to healing. As many observers have stated, the poor average outcomes of service users and the public’s low opinion of psychiatry is the fate of a profession that has allowed itself to be largely taken over by the drug companies and by the need to be perceived as medical professionals. Speaking generally, what the service user wants or needs in a social context barely registers in the current psychiatric system.

    I am glad you are considering alternative approaches, and it is brave of you to publish here while working in a profession which is afraid to consider non-medical approaches to severe distress.

    I also had a suicidal father who got trapped in the psychiatric system and received loads of drugs and ECT. Know how difficult that is – and sorry that you lost your father.

    I agree with Richard above that the terms “mental illness” and “severe mental illness” are problematic. If we do not know that behaviors, thoughts and feelings that are getting labeled are caused by malfunctioning neurotransmitters or faulty genes, nor that the labels that psychiatry uses are valid and discrete entities, it would be best not to refer to people’s problems as medicalized illnesses. It is not necessary to use these words to sound “scientific” or be accepted. It isn’t impressive to us – the people who have gotten better by rejecting the language and treatments of the current system. We need new words, such as “extreme states” or “severely distressed”.

    Here in America, once upon a time in the 1960s and 1970s we had some hospitals that treated severely troubled young people in a way somewhat similar to Open Dialogue. Psychoanalytic psychiatrists like James Masterson and Donald Rinsley ran psychiatric centers where young people could live for extended periods, receive intensive psychotherapy, and the family could also be involved in family therapy, with drugs being only used for short terms or not at all. Masterson wrote about this approach in his “Trilogy of the Borderline Adolescent”, including the book “The Test of Time”, available on Amazon still I think. Like Open Dialogue, his approach also had much, much more success than the current drug-and-forget approach.

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  • Borut, I have lived in your part of the world, actually, in Eastern Europe, for several years.

    I don’t think I’m frightening people! And having a boss doesn’t mean one can’t think freely… and I work in a field completely unrelated to the mental health field, so what I do in my day job has nothing to do with that. Although, some of the children I work with can get a little bit crazy. But they are children…

    I am not sure if I understand everything else you said, but thank you for commetning!

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  • Fiachra, I think the experiences that get labeled schizophrenic are very real – delusions, hallucinations, overwhelming terror, feeling paranoid, not being able to work or go to school, etc. Of course, the people who go through those experiences have brains and genes that are responding to and changing with those experiences. That does not mean they have a disease that is caused by the correlating changes in brain chemistry and epigenetic expression. This is the primary mistake of biological psychiatrists – to confuse correlation with causation when studying what get called psychotic experiences. .

    One needs to dig deeper and clarify what exact experiences are being talked about, and how do social experience and biogenetic responses to that experience interact, and what is causative versus correlational.

    The model of a single illness caused by faulty genes makes no sense when you are faced with complex human beings having their own history that relates to how the are feeling and functioning now. The biological model of “schizophrenia” is obsolete and outmoded.

    From my reading, I knew early on that many, many people had fully recovered from experiences that are labeled schizophrenic. So even though I went through very difficult times, I always had some measure of hope. Many people do not have this unfortunately at the time they are told they have a chronic brain disease requiring drugging.

    Again I am glad to hear that you got better. I suspect it is not CBT (as in your case) or psychoanalytic approaches (as in mine) that were the most curative factor in helping us get better, but rather being able to understand our experiences in a way that made sense historically, and being able to form a better trusting relationship with someone who really thought we could improve our situation.

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  • Oldhead, I agree that extreme states, whatever we call them, are often understandable reactions to a toxic culture. However, it is not only the culture, but also abuse and neglect within particular families that can lead to breakdowns, as in my case.

    Regarding these admittedly problematic labels, I tried to explain in my first reply that in my opinion there are some commonalities between people who become severely distressed and how they do so – as indeed there are things in common in terms of what we all need emotionally to become mature and fulfilled growing up, especially in terms of supportive human relationships – and that this informs my understanding of these loose labels. But it seems like my approach did not make sense to you.

    Regarding the way you started the comment (“Where to start, where to start…”) I respectfully suggest that you consider finding a way of expressing your disagreement that presumes a bit less surely that you are right and the other is wrong. People are unlikely to be moved by what you say if you start out by talking to them as if they’re an ignorant person or a child who just doesn’t get it, which is how the tone of your messages comes over to me, whether that is intended or not. Your view is not always right, not does your response to this article represent the response of most of the other commenters. My approach may not be your cup of tea, but again that doesn’t mean it’s not helpful for some people.

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  • Fiachra,
    I am glad you survived and got better. I also like Daniel Fisher and his advocacy.

    As I said with the first article, you have a great story and might consider telling it publicly if you can do some safely at some point.

    Yes, it is hard to overestimate the (harmful) effects of drug company sponsoring of the primary mode of “treatment” for extreme states. At this point, most research psychiatrists have no idea what they are studying when they set out to find people labeled “schizophrenic” to test drugs or psychosocial interventions. They really think they are studying a disease primarily caused by unfortunate genes or dopamine. They know nothing of the work of Jay Joseph or the many other authors named in the first article who have rejected the biogenetic model. Their research cannot make a big positive difference since it does not think that people can fully recover, and does not communicate hope and respect for the individual.

    The massive profits from the drugs have devastated the professionals’ ability to understand psychotic states holistically and in depth and to be truly helpful, speaking generally (it varies, there are some good professionals). As they say, the love of money is the root of all evil…

    And yes at this point, university professors and mainstream psychiatrists are mostly too afraid to speak out against the prevailing model of treatment, lest they be ostracized and/or lose their jobs. Even within groups dedicated to reform and change of treatment for psychosis, such as ISPS, most professionals are still too afraid or simply don’t have the motivation or energy or time to speak up about what they believe, which is sad. That is why people who are less afraid such as myself – and many others, because I cannot do much alone – need to speak up.

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  • Hi Borut, thanks for commenting. I think people stuck in mental institutions are often victim to many forces like poverty, discrimination, lack of family support, lack of job training and skills, fear of authority figures like psychiatrists who seem powerful, etc. It’s very risky to speak out from that sort of position.

    But nevertheless, more people from all walks of life are speaking out against psychiatric treatment and pseudo-diagnosis. Many of them are on MIA and similar forums. More people are becoming aware of how harmful and ineffective mainstream “treatments” are and demanding something different. I hope you will be able to do this too!

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  • Frank,
    Thanks for your well-considered words. I totally agree – the right to refuse treatment should be an option. Especially, especially when antipsychotic drugs have so many near-term and long-term potentially harmful and even deadly side effects – and when the entity they “treat” is so poorly defined compared to conditions in real fields of medicine (this explaining how antipsychotics are now being used in nursing homes, foster care, and so on, to numb almost any variety of undesirable behavior). But in principle and based on human rights also, absolutely.

    I’m pleased that my father was recently able to discontinue antipsychotic drugs after over a decade of being on a very high dosage. I spoke to him about all the long-term risks and he eventually came to the decision to self-taper down, which his psychiatrists wouldn’t have done unless he proposed it. The drugs have done a lot of damage to him already, but I think now his chance of developing physical problems in his later years will be less.

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  • Sa, I like the idea of the two continuums – social/environmental stresses, often relational in nature, and physical toxins/impingements of various kinds that are also stressors.

    The Open Dialogue model of not pre-supposing cause is a good one. I have traditionally been biased toward the psychodynamic model of social stresses, especially the family’s influence, on making a person break down. This is partly because my own parents caused a lot of stress for our family by being emotionally unavailable and in one parent’s case being physically abusive. But now in dialoguing with more people I see that the range of possible causes of extreme states is greater than I previously thought.

    It used to disturb me how psychiatric research articles about “schizophrenia” would often start by proclaiming, “Schizophrenia is a highly heritable chronic brain disease.” Now it’s humorous for me to read this total untruth, but it isn’t humorous at all when one is scared and feel’s one’s existence is under threat. Hopeless, deterministic falsehoods like this are the reason why people who get labeled “schizophrenic” often become suicidal right after being given the label.

    And in their very certainty about the nature of psychotic states, many psychiatrists render themselves (and sometimes others) totally unable to learn from inquiring into what might be going on in an individuals’ life story, and unable to learn anything beyond their narrow biogenetic model.

    I hope your loved one is doing better and wishing you the best in helping them.

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  • Alex,
    You may know that when people are isolated for long periods without sensory stimuli (as in hostages or prisoners of war being held in isolation), they almost always develop the “symptoms” of so-called schizophrenia after a few weeks or at most months. So, it shows that any one given sufficient stress can break down and go crazy.

    I agree that the potential for this type of breakdown, one that seems anomalous or extreme to others, is contained in every person given enough stress. But it actually makes sense given the stresses such people usually experience. It does not mean such people have a chronic brain disease.

    By thinking of it as something caused by unlucky genes or neurotransmitters, as separate from social experience, I think psychiatrists and researchers are able to shield themselves from the awareness of and perhaps the fear of the possibility that they themselves could go insane if they were subjected to the same stresses that people labeled schizophrenic go through (stresses which are usually not even asked about or acknowledged when the “crazy” ones are “treated” in mental hospitals).

    In his book, Treating the Untreatable, Ira Steinman talked about how many of his craziest clients had been to any number of psychiatrists and therapists, with no one asking them what had happened to them or what meaning they attributed to hearing voices or having strange beliefs, but instead just drugging them on the basis of the disease model. When one starts to be curious about the meaning of these things, one can start to understand the individual as a person and not a meaningless disease.

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  • Hi Viiu,
    Thank you for engaging with this again. It is strange to me, as someone who experienced extreme states and was involuntarily committed to a mental institution and so on, to see that doctors for the most part are so oblivious toward or in denial of the effect of adverse social experiences on making someone crazy. It seems obvious… human relationships, especially with parents early in life, are crucial in helping us become emotionally well and able to have good relationships with our fellow human beings.

    So the lack of these relationships, and/or actively harmful social experiences, can drive us crazy. But somehow psychiatrists, under pressure from Big Pharma and from some families, enter this mindset where they feel they need to create an artificial separation between “severe mental illness” (i.e. inexplicable “symptoms” caused by faulty genes or brain chemistry gone bad) and other life problems. When in reality, the difference between more or less severe suffering is not fundamentally one of kind, but of degree… in my view.

    Also, a lot of it comes down to fear of the powerful negative emotions in people being labeled as psychotic. It’s much easier to just drug them. Engaging with them and feeling what they are feeling is hard work and can be quite scary and alien for someone who has no lived experience of extreme states.

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  • Hi Steve, thanks for your support. I agree, people do not want to look at the links between trauma and behaviors that get labeled “schizophrenia.” I have already been hearing from a few psychiatrists that people who experience trauma and got labeled schizophrenic must have been “misdiagnosed.” It is a bit amusing now, but it’s not for those who have their experience denied, nor does it make sense conceptually.
    And yes I intended this article to be very direct and to pull no punches when making these links. The natural tendency we seem to have in our society is to avoid talking directly about what environmental factors might be contributing to extreme states. There is also a large ignorance about the fact that psychotherapy and other psychosocial approaches can really be transformative; someone can not just “manage an illness” but really get well.

    I like the picture of the baby in your profile! Cute.

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  • Oldhead,
    No need to be afraid. I don’t think of myself as an alternative psychologist. But I did use what I learned long ago about how trauma and neglect contribute to being terrified, withdrawn, being unable to distinguish between what is me and what is someone else, hearing a critical voice and having a lot of rage (that would be a good definition of “psychosis”, right there, according to my experience). What I did and how I understood my suffering worked for me and my life is very good right now.

    If we never use conceptual/continuum-based labels even loosely, it becomes hard to communicate about anything. The fact is, there are some commonalities that emerge when people are abused, neglected, traumatized, or just have trouble making friends and being close to their caregivers for any number of reasons. Such people tend to withdraw, to experience increasing fear, to feel enraged at the lack of love, and in extreme cases, to develop alternative inner worlds which may include hearing voices or seeing things that are not there, as a way to remain related or connected to something inside rather than outside. These states which are based on emotional responses to what goes on around us are real – calling them loosely “psychosis” is not meant to be stigmatizing or medical, and never has been in the way I understood that word since I was a teenager.

    Apparently my experience is quite different from yours in how I understood that word. That does not mean my view is wrong.

    I would gently suggest that you consider more what you might have in common with me and others, rather than what is unpalatable about their views, because many of your comments start with discounting or arguing against the other person’s version of reality if it does not fit exactly with your viewpoints. And it is hard to have a real dialogue or to learn from each other in that way.

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  • Hi Knowledge,
    Thanks for your comment and I am with you all the way on what you said. Regarding difficulty identifying family contribution to extreme distress, I think Paris Williams and Ron Unger had good articles on MIA and on their websites about how to acknowledge problematic family problems which contribute to (not simply cause) extreme states. I view this as empowering, if done right, because by facing and looking at how being emotionally unavailable, or being mean to another family member for any number of reasons, and seeing how these patterns can reinforce their distress, it allows one to have insight and to actually change things for the better. The biogenetic model by contrast is disempowering since it is static and noncontextual. There is not much you can do, in other words, if someone’s problems are mostly caused by bad genes or misfiring neurons. But in reality, there is much we can do to change psychotic states both from how we work on ourselves (if we experience extreme states) and how we treat others.

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  • Katinka, well done on your recovery from this experience, your well-written essay and the excellent video, the last of which is particularly powerful. To be totally honest, I had somewhat doubted these stories of pills having these sudden extreme effects on people, since it seemed unbelievable on superficial observation. But now, having read your story and manyother stories, I have come around to taking these reports seriously. The possibility of such adverse reactions is indeed a real threat, and it’s very scary because it seems like there may often be no way of predicting whom might be affected or when.

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  • Jim, It’s good to see you continuing this work. I hope over time that you will (and perhaps already have) inspired a number of other lawyers to take on these cases of opposing forced treatment. We need many such lawyers; some in every state who are more knowledgeable about the nature and harms of (forced) drugging and ECT, and who can speak up for the voiceless.

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  • Cat, thanks for commenting. I had a quick look at the description of this book online and it looks interesting. It makes sense that this phenomenon of profiting from mischaracterizing the nature of complex human distress would not be confined to our own time period only.

    I like how you talk about the “denizens of the devil” suppressing the truth. That is a very mythic description. It is interesting that people experiencing extreme states often get delusions of the devil or of persecuting demons. Often, these images are symbolic of abuse, trauma, or cumulative stress the person has suffered through. The meaning in these hallucinations is also a good demonstration of why the biogenetic model is so false – if psychosis were simply a meaningless breakdown of brain chemistry or genetic processes, then the resulting delusions or hallucinations would have no meaningful content and would be simply random sounds, colors, mismatched sensory data etc.

    And speaking of psychotherapy of psychosis, your comment segues to my favorite quote from Fairbairn, when he said the following regarding the need to work through traumatic and “demonic” internalized experiences:

    “. . .the psychotherapist is the true successor to the exorcist. His business is not to pronounce the forgiveness of sins, but to cast out devils” W.R.D. Fairbairn

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  • Alex, thank you for your response and your commitment to speaking out so often about the importance of a humanistic, validating response to emotional suffering.

    What you say about mental health workers projecting their “delusion” about having-a-brain-disease onto clients is true in my experience too. The consequences of this phenomenon, which has probably not been studied since to do so would threaten the system, are quite severe in my opinion. Believing in the biogenetic model renders mental health workers unable to see their clients holistically as individuals, and often makes them lose real hope that the person can get well. It becomes a self-fulfilling prophecy, because when dealing with a person who is very scared, untrusting, and withdrawn, one will usually worsen those traits and promote pessimism by relating to them as if they had a chronic brain disease. That is what the research about the harms of the biogenetic approach linked above is clearly saying.

    This is a large part of the vicious cycle in the mainstream mental health system that leads to such poor outcomes – pessimistic, reductionistic beliefs combining with lack of resources, with ignorance and fear, with overdrugging and so on. It is no wonder so many families do not know where to turn for effective help. But yes, that is why alternatives are so important, and there are several good ones already available.

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  • Ron, thanks for your support and for your own voice speaking out clearly in relation to “schizophrenia.” In the face of a society that, in my view, fundamentally misunderstands psychotic people as having a chronic brain disease, we need not just one or two, but many hundreds or even thousands of people speaking out about alternative approaches to extreme states. By continuing to speak up regularly we can encourage many others who are now silent to emerge from the shadows.

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  • Michael,

    This is such an excellent article. I like to think of myself as a tough guy with a hard edge, but couldn’t help being moved when I read this.

    Regarding this section, “We’ve all been with a friend or loved one and realized that we both have stopped talking, and that a sweet and sometimes even profound silence emerges between us.
    How precious that can be.”

    This reminds me of descriptions from the great therapist of people in extreme states, Harold Searles, wrote when he talked about how a “therapeutic symbiotic” relationship with a formerly psychotic person could involve pleasurably experiences of simply being comfortably together, with no need to do or say anything to the other person. He felt this “emotional oneness” existed frequently in the childhood of healthy young children and their parents, but rarely or never in the childhoods of those who went on to be labeled borderline or psychotic. Having felt this being with another myself in a therapy I did, if it can be reached this experience tends to soothe and provide a great confidence and security to the formerly psychotic person, and to greatly reduce the effect of remaining rage/terror/confusion.

    It occurs to me that this “healing silence” must very rarely occur in mainstream mental health settings between psychiatrists and their clients. Under the disease model, the focus is all on doing something to fix, control, or reduce the symptoms of the person in front of you. There is no understanding of the need to be with another person – and no awareness that if you can reach beyond the antidependent defenses and be with the regressed person for long enough, this may lead such a person to be cured of their psychotic “disease”.

    And mental health workers usually do not realize how intuitive and perceptive even the most regressed people are – they tend to have very long emotional antenna due to all the difficult experiences they’ve been through. In my experience, they sense quickly whether others are labeling or objectifying them as a “person with a lifelong illness to be managed”, or conversely, whether they have a genuine interest in them as a person and think they can fully recover.

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  • Gary,
    This is an excellent, cogently-written article.

    The powers sustaining the present psychiatric system in terms of the massive profit motive, the allure of simplistic explanations of distress, the ability to deflect “blame” from people around suffering individuals, support of the illusion that psychiatrists are doctors treating brain diseases… are truly formidable.

    I like in particular the idea of creating incentives for change via cost savings compared to business as usual. I think this – i.e. money – is one of the most powerful weapons that can be wielded by would-be reformers. Saving money by using far less drugs, releasing unnecessary psychiatrists, closing enormously expensive and ineffective psychic prisons are all attractive ideas to cash-strapped governments who already want to cut mental health budgets. Meanwhile, promoting cost-effective options like peer support institutions and programs led by professionals without medical training seem like no-brainers.

    I would add that spreading the knowledge about how the psychiatric system does harm contained in this and many other articles to families of emotionally distressed people could be very important. Many family members of people caught in the system are themselves functional and not ensnared in it personally; thus they are more able to immediately demand change.

    Lastly, two criticisms: 1) I agree with an earlier commented who noted that “misdemeanors” is a euphemism, and a bad one. As Peter Gotzsche said, the behavior of drugs companies and their agents has much in common with organized crime. And organized crime takes things a little bit, and sometimes a lot, beyond misdemeanors.

    Secondly, you used the term “medications.” In my recent article, “Rejecting the Medications for Schizophrenia Narrative”, I explained why this is a misnomer as no physical disease process is being treated by such chemical compounds. Thus “medication”, a word generally understood to mean a substance treating a disease caused by biological or genetic malfunction, is an inappropriate word to describe generally psychoactive substances that do not treat valid medical diagnoses…. and such terminology supports the status quo. If you want to do something easy to bolster your current advocacy efforts, consider substituting the word “drug” or “neuroleptic” (for antipsychotics) for the term “meidcation.”

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  • Linda Lee,
    Good to see you on here my blogging friend!

    That is so impressive to see how you married, had kids and to read about what all your kids are doing now. Although your story is not scientific evidence, it’s a powerful anecdote. It shows that “schizophrenia” is on one level just a label, that psychotic experience is modifiable depending on the environment, and that “schizophrenia” is not a disease that gets genetically transferred down generations condemning one’s offspring to a bad life.

    It is sometimes necessary to take one’s “treatment” into one’s own hands when it turns out that doctors do not know what they are doing with helping psychotic people, which in this country is far too often.

    In my case, I unilaterally decided at one point that I was going to stop taking antipsychotics, and did so without telling my psychiatrist. So I self-tapered myself off, a process requiring some continued deception unfortunately. In psychiatry this would be evidence of having “anosognosia” (a brain-based inability to agree with your psychiatrist!) and “noncompliance”.

    But it worked out fine, and I have never taken the drugs again. And now I live independently and work and am doing fine. We are the people who don’t show up in the follow-up studies of being given severe mental illness labels, because we drop out of the system.

    Courtenay Harding, the researcher, once told me about the dozens of young men who had called in to report their experience when she had done a radio show about “severe mental illness.” Many of these had been labeled “schizophrenic” and committed in their teens or 20s, but they got out, left the system, and went on to have normal lives while never telling anyone about their experiences because of the fear of being judged for having been so labeled. Many of these people are out there.

    I am sad to say that I have already been hearing it from people both in relation to the “schizophrenia” and “borderline” labels who say that I couldn’t have “had these disorders” because people don’t get better from them. It doesn’t bother me one bit because I know they are wrong, in multiple ways – both in terms of misunderstanding these labels as permanent illnesses, and being ignorant of the huge number of narrative accounts by severely distressed people who have gotten well. It is kind of morbidly funny if you don’t take it seriously. But it is also harmful and very discouraging to others.

    Good to hear from you.

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  • Oldhead,
    That is ok, you have a right to label the word “psychotic” however you want.

    I agree with you that there should be less reliance on “experts” when discussing controversial topics. Maybe I do that too much, but at least I do not give too much credence to what the experts within research/biologically-focused psychiatry said. If I had given them much more credence, and not sought alternative ways of coping with my most difficult periods, I might well be nonfunctional, homeless, imprisoned or dead right now.

    However… I have never considered the word “psychotic” to be a disease term. To me it is a vague descriptive word which describes a way of experiencing considered by one observer to be out of touch with what many or most people consider to be consensus reality. Of course how to define the latter is contentious. I would add that what people experience when they are extremely distressed, terrified, nonfunctional etc always makes sense and has reasons for why it transpires in the way it does. So in a sense, there is no “craziness” and “psychotic” people are having logical, understandable reactions to what most people would describe as crazy-making environments or interpersonal situations. Someone would be crazy not to react as they do when faced with overwhelming stresses or experiences that don’t make sense…

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  • Hi Mohiuddin,

    Thanks for discussing some of your theoretical concerns; I find this type of discussion very interesting.

    I have a few critiques though:

    1) I would say that the Type 1 / Type 2 psychosis separation is artificial and overly concrete.

    Human experience is too complex and variable to reliably separate people into these two groups; these are ideas that exist in our minds about psychotic people, not what those people actually are at a given time. Your categories are what psychiatrists have long labeled “acute” and “chronic” “schizophrenia”; however I never gave these designations much weight. In much psychiatry writing I read, the idea existed that once a person had been functioning in some way that a psychiatrist labeled as “crazy” for at least two years, then they suddenly became “chronic” whereas before they had been acute. But it doesn’t make sense to me to divide what is a complex continuum or spectrum into these two concrete categories.

    But the question remains, as I like to humorously ask, why is the cutoff point not two years, four months, 18 days, 9 hours, 36 minutes, and 11 seconds, rather than two years exactly? This question just shows how arbitrary and subjective these divisions of labeling other people, based on lengths of time we think they have some behavioral label, are.

    Also, many of the people you worked with have probably been drugged very heavily for very long periods. This can cause major harm to their ability to think clearly, and may result in many of the thinking problems / inability to function that you are seeing in your “chronic” group.

    2) I think that analyzing the past may or may not be counter-productive; it depends. In the long cases studies in Murray Jackson’s Weathering the Storms, and in Ira Steinman’s Treating the Untreatable, and in Harold Searles’ Collected Papers on Schizophrenia and Related Subjects, these psychoanalytic psychiatrists described clients who were severely psychotic for many, many years – as long in many cases as the people you are describing – and yet, if they met frequently enough with a therapist for a long enough period, they were able to gain meaningful insight into how their past experiences and relationships influenced their current problems. They were eventually, after much struggle, able to internalize therapeutic experiences related to talking about their past, despite starting in a “chronic” or “out-of-contact” (Searles’ word for the clients you are describing) position. So, it depends on the individual and on the resources that are available. I do not think we should seek to make generalizations or find absolute laws based on arbitrary labels like “Type 2 Psychosis”, because the complexity and unpredictability of human nature is likely to mean that these rules do not apply when the conditions/resources available in any given case changes.

    3) I also disagree that past analysis negates the need to explore and stimulate the ego strengths of these people. It is not all or nothing; one does not preclude the other. If a trusting relationship is established, and if a previously psychotic person is less overwhelmed by constant confusion/terror/rage, then one can both explore past experiences and support the healthy aspects of personality that remain. And, I would say that either one of these processes could even support the other, depending on the context and timing.
    It sounds like I disagree with you on a lot. I think this is misleading though; as I know we share the same concern for having psychotic people understood as people with potential, with their own stories and individuality, who deserve understanding, respect, and love.

    I also agree strongly that many psychotic people already have insights into their psychological conditions and their history. But like you say, one has to talk to psychotic people and listen carefully to what they say to learn about this, something that is difficult when one presumes they have a brain disease probably caused by faulty genes/misfiring brain chemistry, and that their utterances are thus unlikely to be meaningful.
    I will be there in Boston; am sorry we cannot meet then, but I’ll try to look out for Charlie and his presentation.

    I appreciate all your thoughts; I also feel as if I’m learning from the feedbacks you and others have given me on all these issues related to how to understand psychotic states and support people who go through them.

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  • Someone Else,
    Thank you for your comment – and well done on escaping the mistreatment you faced and making a better future for your child.

    It is important to clarify that child abuse is one possible stressor that is involved in many, but certainly not all (not even close to all) cases of when people become psychotic.

    Mainstream psychiatric criticisms have commonly distorted the dialogue by claiming, simplistically, that people such as myself believe that “schizophrenia is caused by child abuse”, thus creating a straw man that has little relation to how many critics of the psychiatric system actually think. In fact, not only is child abuse not implicated in many psychotic breakdowns, but there is not even one singular schizophrenia to be caused by childhood abuse, so the situation is more complicated than it is made to appear by such claims.

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  • Hi Guys,
    Thank you for your support. Yes, I have previously used the other name to comment on others’ work and to write about “borderline” states, something I also experienced.

    I am glad that you will now know I have not disappeared, but have switched into using my real name. I have always liked all of your three’s comments on here.

    I agree with Oldhead that there is no reason online commenters have to user their given name, and that there is value in anonymity and innate value in the content of one’s message. However, there is also value and power in speaking out under one’s real name and being seen. This can also lead to advocating and speaking in more public offline settings. I hope to do some of this eventually.

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  • Hi Frank, I was also a prisoner in such environments, and these people are certainly not my idea of heroes either. That is why I often think of psych hospitals as “psych prisons” and the healthcare system as the “sickcare system” in my own mind at least.
    When I speak to troubled people, I usually encourage them to think about how they can avoid entanglement in the system/”hospitalization” and get help via alternative means, including using their own strengths/resources/ability to think critically and research, plus family support and psychotherapy (and yes I do think it can be very helpful, but the fit has to be good).

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  • Alex, thank you for your comment. I certainly agree that addressing/acknowledging (in the first place) abuse and trauma would be a very important step in addressing the causes of not all, but many psychotic states as well as less severe problems in functioning/feeling. Obviously, one cannot really deal with things one does not look at or is not willing to talk about. You would think that as a society we would have learned that by now!

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  • Chris,
    Thanks for these astute comments. You are quite right about this. Because psychiatrists have failed to identify clear biological/genetic causal pathways behind people’s distress, they are forced into vague unfalsifiable statements like “dopamine may play a role in schizophrenia” as a way of supporting and falsely legitimizing the disease model. In this way they try to walk a tightrope where they carefully and deftly give as much credence as they can to a brain disease model which is actually a hypothesis, and not even a theory (e.g. the idea that serotonin plays a role in “causing” depression, with the idea of cause being only implied, not even said directly, as a way of trying to guard against quite valid criticism that there is no real science behind any of these speculations). You see what I am saying.

    And yes, they imply that the drugs may remedy whatever it is that the serotonin or dopamine “plays a role in”, but they don’t dare say it directly, because they simply don’t have the evidence that these brain chemicals are causing (rather than expressing) the distress… not to mention the lack of validity of the diagnoses.

    Thanks again for your support Chris. I have read your MIA articles from past years and enjoyed them.

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  • Mohiuddin,

    It is good to see you on here. First, I must congratulate you on your incredible command of large words which is impressive for someone using a second language!

    And more importantly, thanks for your kind comments.

    I agree particularly with your point that generalized studies about what drugs or therapy do at a group level tend to get applied without consideration for individual situations, and that this can be harmful.

    Additionally, you are correct that people often tend to get scared by behaviors that don’t fit social norms, and then they reach for simplistic labels like “schizophrenia”, which create the illusion that they know what is going on with that person (i.e. they have a brain disease causing these behaviors/experiences), and they reach for easy “treatments” i.e. drugging. Meanwhile, the meaning of the psychotic experiences and the possible causes, which often lie in experiences in the individual’s past life, and lost and not explored.

    Thank you for eloquently pointing out these difficult realities. I think what you said fits quite well with Ken Blatt’ s (from the ISPS listserv) recent essay on Mad In America about the challenges of keeping a relational/depth/individualized approach going when faced with the challenges of risk-aversion, overdrugging, belief in concrete diagnoses as destiny, insurance pressures, and so on, within the context of an American psychiatric hospital.

    Again my friend good to see you on here. Now you just have to encourage Tyler to post on here too. You know what I mean 🙂

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  • Hi Ron,
    Thank you for your supportive comment. We have spoken at least once before I think, and it is good to hear from you again – I feel mutual respect for your book and disclosing your struggle to “be”. I agree with you that courage/taking risks is an important part of establishing one’s identity, both in general and in opposition to the psychiatric system.

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  • Hi AskforCor,
    Thanks so much for sharing your experience with your son. My parents were also very worried about me when I was going through difficult experiences like this some years ago, and would often isolate myself.
    I think psychotherapy can be very, very helpful for psychotic states if the person wants it and if they are able to form a good empathic bond with the therapist – something which can take a long time, i.e. years in some cases.

    You might be interested to check out the narrative accounts of such psychotherapy in two books, Treating the Untreatable by Ira Steinman and Weathering the Storms by Murray Jackson. You will see that such treatment is much more in depth than the “CBT for psychosis” 6 or 12 week courses of therapy that are often discussed as the psychotherapeutic treatment of choice for “schizophrenia” today. They involve being with the person for long periods, tolerating uncertainty, containing negative feelings of terror/confusion/rage, gradually understanding through the relationship what are the reason why the person is so isolated and untrusting and withdrawn, and developing trust so that the broken connections with the outside world can be repaired or established for the first time.

    Also, it is not necessarily trauma and abuse that causes psychotic experiences/withdrawal. It can be stress of any kind, isolation, fear for any number of reasons. The potential causes are many and they all interact with each other. But I think there is always a set of reasons and a story behind why people are withdrawn and psychotic at a given time. Such experiences are not a meaningless brain disease.

    Am also glad to hear your son has your support; your simple physical presence may mean more to him than you realize. Keep hope and you may be surprised at what can happen in the long term.

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  • Hi Nomadic,
    I want people to know they can do their own research, access helpful resources outside of / possibly replacing (for their case) the use of psychiatric resources, and come to their own understanding of what is called “schizophrenia” and other “mental illnesses”, as well as make their own choices about how to deal with these experiences, which may or may not include using a psychiatrist’s help.

    This approach is obviously threatening to the psychiatric approach, which is that anyone given some arbitrary label is in need of “treatment” including (usually) drugging.

    No, I do not support the idea of no cooperation with psychiatrists/psychotherapy/recovery. I used to believe this (about psychiatrists), but there are some good understanding psychiatrists who can think critically and they are worth talking to. Also, there are many good psychotherapists who do not endorse the disease model and only use it when they have to for insurance. Many, many of these.

    And as for recovery, it depends on how one understands that word. I do not really think recovery is the right word for getting better from whatever problem, because it implies simplistically that one was well or “normal”, then fell ill with some disease, and then needs medicalized “treatment” to get better. In other words “recovery” is a covert word of the disease/medical model. But sometimes when used generally, I think “recovery” is not such a bad word.

    I would say that good psychotherapists can provide empathic understanding, respect, and love – of a kind – and that within the boundaries of the relationship this can be very helpful. Of course, this may not happen in many cases, but psychotherapeutic relationships are just human relationships and so they vary greatly and generalization are kind of meaningless.

    But I am with you in being opposed in general to the disease model, and especially being opposed to the common psychiatric practice of imposing meaning/what people should do to “treat” their problems onto anybody in distress, rather than listening to them and respecting their viewpoint and desires.

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  • Hi Fred,
    Thanks for your comment. I personally do not think things in society are this bad, or at least do not have to be, but it depends on one’s individual experience of course. There is a lot of corruption and it can be easy to see our society as Orwellian or Kafkaesque, but nevertheless, I would say many people are able to live fulfilling lives and resist these influences. There is some interesting research on this by Ed Diener, who researches what factors c0ntribute to or detract from wellbeing in different countries.

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  • Hi again Rasselas,
    I would not give antipsychotics to a rabid dog either 🙂
    But I think for limited periods, with informed consent, including acknowledging that they are (for most forms of antipsychotic) a very strong tranquilizer that can have a lot of tradeoffs/severe side effects, that there could be a place to use them at least briefly.
    However, it is interesting that many of the people advocating even the short-term use of these drugs have never tried them themselves.
    I look forward to discussing this with you again.

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  • Hi Rasselas,
    Thanks! I like those shades. Leonardo DiCaprio wore similar aviator-style shades in the movie The Aviator and since then I liked that kind.

    I like your comments. You are right that psychotic experience, as you imply, may not necessarily be something to be overcome. I would say it is something to be overcome to the degree it is preventing you from doing things you want to do, such as being able to have satisfying relationships with other people, or earn an income or work etc. But, as seen in the Hearing Voices Movement, some people do not feel their voices or vision are “bad”, or want to get rid of them. Some of them experiences their voices as helpful. So good point. Actually, myself for a brief time I had one “good” voice, a helper… but most of them were bad and the overall experience was one I did not want.

    I think there can be a way out of madness, or a way to change how you understand and relate to the experience. In many of the cases studies in the books I linked to in the article, e.g. Searles/Boyer/Volkan/Steinman etc, there are stories of how people changed their way of relating to others and to their own psychotic experiences and forged a very different, often much more satisfying way of being.

    You are right, there are always stresses and traumas in life and none of us escapes them. But it is a matter of degree of trauma, as well as how much support around them and resilience the individual has. In many cases of psychosis, the traumas or environmental stresses in the person’s life has been overwhelming and this causes a breakdown.

    But in the article it did say that traumatic events are not always the cause of breakdowns/psychotic experiences/inability to function. They are just often associated. There is no one single cause.

    Lastly, I would say that ability to feel/function well, perceive reality relatively accurately, do what you want etc, i.e. what many people consider “sanity”, derives not from trauma mainly but from having enough supportive human relationships and security during childhood and early adulthood. This is my opinion based one experience mainly but also from reading authors like Mahler, Fairbairn, and others who studied children and what they need to become emotionally well adults.

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  • Hi Oldhead, I think you and I have actually discussed this before 🙂 You will know what I mean, but keep it between us.

    Anyway, you may know what I am going to say. Psychotic to my mind refers to a spectrum of experiences that are considered anomalous or not in touch with reality, at least as most people judge reality. But, I see that from your perspective this could be construed as a judgment or label of behavior/thinking that is not so different from “schizophrenia.” But to my mind, the word “psychotic” is less medical and does not denote a singular disease entity, and does not have covert implications of being caused by biological or genetic malfunction. So, it is a vaguer, more descriptive word less laden with negative or pessimistic implications.

    I think people who experience severe/chronic states that get labeled psychotic, and which make them not able to have satisfying relationships or to function in society, are terrified/enraged/hopeless/very lonely a lot of the time. So, underneath what gets labeled psychotic states is often a whole lot of emotional pain and often a history of isolation/stress/neglect or abuse. But, it depends, this isn’t true of every individual.

    In reality is is very difficult to describe many of these extreme experiences using words, because people’s experiences are so different and individual. So, the word “psychotic” is best used lightly, and not considered to be applicable necessarily to an individual.

    You can 9f course share your understanding of these words again if you want, since I’m not sure I’m remembering it right.

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  • Hi Ace,
    Thank you for your support. As I’ve responded to others, I encourage you to speak out publicly to the degree that you safely can, in terms of sharing your experiences and your individual way of understanding voice-hearing. Your understanding would probably be quite different than mainstream psychiatry’s, and would encourage other laypeople that they can think for themselves and not uncritically accept the disease model, top-down, one size fits all, “schizophrenia”/other reductionistic labels way of understanding these experiences.

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  • Richard,
    Thanks this means a lot coming from you. I have read many of your articles and comments and am not surprised we agree on many things, as we think remarkably similarly about psychiatric diagnoses, drugs, and the mental health system.

    In Vamik Volkan’s book, The Infantile Psychotic Self, he described how severe psychosis can be understood as a “best possible solution” – as maladaptive as psychotic coping mechanisms may seem – to a truly intolerable environmental/interpersonal situation. Specifically, in severe psychotic states, there is usually overwhelming terror, rage, despair, and the inability to trust others in depth, and this toxic brew of emotions fragments the psyche and results in the use of defenses such as fusion/splitting/projection. But yes, to relate it to the parallel you drew to how to conceptualize addiction, psychotic states can be understood meaningfully as coping mechanisms (or as outcomes of failure to cope in more adaptive ways with life challenges).

    And yes, “schizophrenia” is the “sacred symbol” of psychiatry, as Thomas Szasz wrote, and is also in a way an Achilles heel of the field, given that so little actual research and evidence support the existence of any unitary disease entity named “schizophrenia.”

    I agree also that there is no reason to have to pander to the mainstream by calling drugs “medications” and psychotic experiences “schizophrenia”. I thank you for bringing this to my attention in your earlier articles, as it was actually you specifically who got me to change my thinking about “medications” 🙂 No need to answer that, but I think you’ll understand what I’m saying.

    I do intend to be back with future articles, and look forward to interfacing with you again and to hopefully reading more articles from you.

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  • Boans,
    I think it is hard for people to believe that the narrative about a “schizophrenia” brain disease requiring drugs and (sometimes) coercion is as flawed, harmful and mistaken as it is. This is especially the case when such a narrative is supported, in seemingly democratic nations, by doctors, governmental institutions, hospitals, police, etc.

    Coercive psychiatric practices comes to seem normal and acceptable when it becomes “business as usual” over many years and it integrated into the profit model of healthcare professionals and government institutions. In this way it grows organically, like a voracious weed that winds its tendrils around those who fall through the cracks… who do not have the normal/supportive enough family experience and resources to keep them out of the psychiatric system.

    This sad state of affairs does not really speak to psychiatrists / mental health workers / police being evil or “bad” for the most part. Rather, it speaks to deep levels of corruption, ignorance, distortion, inequality, poverty, and greed, these factors operating at a systemic level to encourage the abuses and disease model distortions like “schizophrenia” that paper over and give a veneer of legitimacy to what is really going on.

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  • Yes, the worst periods of terror / nonfunctionality were pretty terrible. I am going to write in the second part of this series how I am not totally against drugs and think they can be useful at least for limited periods. But of course, I do not agree that antipsychotic tranquilizing agents are “medications” needed indefinitely to treat an “illness.” Also, it’s important to repeat that antipsychotic drugs do nothing to address the experiential, relational and stress-related issues causing psychotic states: in my view these will resurface once the drugs are withdrawn, having remained dormant/suppressed while strong drugs are given.

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  • Hi Fiachra, I agree that the crisis right before or leading to the psychotic breakdown is usually the result of a long process of many traumas / deficits / stresses / conflicts / isolated periods. The psychotic experiences such as paranoia, terror, delusions etc could be viewed as the outcome of failure to cope or get enough support to overcome earlier traumas/challenges. I see this model which gives significant weight to past adverse experiences as more meaningful and hopeful.

    I have read many of your comments at MIA, like your viewpoints very much, and encourage you to write publicly about your recovery if you can do so safely, as many people would benefit from hearing your story.

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  • Hi Boans,
    Thank you for your comment. Despite what a controversial comparison it is that you make, there are some loose parallels between the misrepresentation of the nature of emotional suffering promoted by our psychiatric institutions, on the one hand, and the many misrepresentations about reality made by authoritarian leaders and their government on the other.

    You are right that many people have come to believe falsehoods such as “schizophrenia is a chronic brain disease”. But it’s time for that to change. I believe that hopeful alternatives for helping people, new and understandable models of human suffering, and stories of success are our best tools for changing hearts and minds.

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  • Yes, it is important to keep hope that there is a better life outside of the system – and there is, more than it is possible to imagine and hope for when one is stuck in the system, as I remember.

    I think this article below speaks particularly well to the importance of defining wellbeing outside the established psychiatric terminology; please check it out!

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  • Dorothy,
    It is very nice to hear from someone else diagnosed who recovered and has a good story… one I hope to hear more of! I agree with you, the word “schizophrenia” has less and less meaning for me as time goes by.

    I also agree so much with your point that “gentle kindness” is a crucial ingredient in helping recover from extreme psychotic states. Although it is important to note that when psychotic people are terrified, confused, enraged, and hopeless, it can be very difficult for them to trust others and internalize that gentle kindness, as the resistance to forming a positive relationship can be very strong.

    Unfortunately, as we know too well, the establishment mental health system via its coercive, labeling, and risk-averse nature tends to make it even harder to reach the vulnerable core of a psychotic person. I am glad you found somebody that could reach you in that way.

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  • Nomadic, I would not agree that this is a general rule, i.e. that therapists by nature turn sufferer’s problems back on themselves.

    The therapist I worked productively worked certainly did not do this – rather, despite some challenges we had a very positive relationship, one that allowed me to eventually feel loved and esteemed as an individual in a way that was crucial for recovering from my extreme states.

    So while I think it is certainly possible that the position of power/authority vested in the therapist can be abused, and that this is something to be cautious of, it is not inevitable. Therapeutic relationships are essentially human relationships, and so there a great variety and complexity between different therapeutic dyads, making generalizations about what therapists do difficult or meaningless, in my opinion.

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  • Hi Nomadic,
    Thank you for your comment. I agree that “we”, if you mean people who are committed to moving our societal approach to severe emotional suffering toward more humane and helpful model, are weak in legal and political action.

    We unfortunately do not have access to the huge amounts of money and (bought) political power that corporations pushing the disease model of “schizophrenia” and other serious problems have.

    However, what we do have is the power of our own voices. That is why I decided to critique the existing approach to “schizophrenia” and recount my psychotic experience under my own name. This entails some level of risk given that I now work and know many people in my “normal” life outside the mental health system, who don’t know this part of my story but may now discover it. But I hope that as more people speak out directly about their dissatifaction with the existing psychiatric system, that it will create a snowball effect building more public awareness about alternatives as the inconsistencies, lack of effectiveness, and serious harms of the current mental sickcare system are exposed.

    But as I have said in this article, it’s important to highglight that there is nothing shameful or “bad” about having gone through extreme states. In sharing our experience directly we can reduce stigma in a real sense (not false, “accepting one has a disease” sense), and hopefully open the minds of others to alternatives.

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