Tuesday, August 20, 2019

Comments by shaun f

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  • Excellent article. More and more of my clients are looking to get off pills, because I think they understand that it’s not helping them achieve their goals and in some cases doing much harm to them physically and mentally. Hopefully, society can find a way through all this toxicity, but to be honest I don’t see that happening until capitalism as we know it ceases to exist. Capitalists seek to exploit “opportunities” to make a profit, damned the consequences. Exponential growth is harmful and unsustainable in most cases, like in your cancer example. The system is broken but I’m unsure humans have found a system which doesn’t exploit the land, animals, or people to sustain itself.

  • Ramesh,

    How do you explain an overall reduction in violent crime in the last quarter century at the same time there has been on ongoing increase in psych drugs prescriptions? Furthermore, there has been a significant decrease in the amount of impatient hospital beds during this time. I agree with you that psychiatric abuse occurs, and should be stopped; however, it’s a stretch to say that hospitals and doctors are “deliberately” harming and torturing people. They actually believe they are doing good on the whole. This issue is of course very debatable. Modern-day treatment is a mixed bag of results. Most people who come through the MH system are content with their care, otherwise I have to imagine so many of them wouldn’t voluntarily stay coming to group/individual counseling or seeing their doctors. It’s not exactly like there is a large movement against psychiatry. Actually, it’s a small number of people who have spoken out. The vast majority of folks are content with the system as it currently stands. So until the people who voluntarily choose to participate in the system stop and demand reform/changes, the status quo will remain.

  • “DT” is Donald Trump, our womanizing, misogynistic POTUS. I’m sorry but Cosby, R. Kelly, Weinstein, et al. deserve every bit of criticism and judgement for raping and sexually assaulting/harassing women. We can’t blame the system for people acting like giant turds. At some people are responsible for their actions. Certainly, men in power have ample opportunity to abuse their status, and unfortunately many do. Trump is a rich ahole who thinks he should be able to do whatever he wants regardless of how it impacts others. This is a personal attitude of his, and all the men I mentioned above fall into this category as well. There are hundreds of female actresses who have been assaulted, abused, or harassed by male producers, actors, agents, and directors. We see sports stars like Woods do similar things. Did the system make Matt Laurer harass co-workers and cheat on his wife? No.

    The truth is that men can and are violent, no matter what system they are in. We abuse both men and women. We men need to learn to control our violent and sexual impulses and respect others. We can never justify rape or other sexual violence. We too often act like animals and don’t use our prefrontal cortex nearly enough.

  • Steve,

    “It is also important to keep in mind that while women can be abusive, emotionally and sometimes even physically, men are supported and protected by social structures and gender role expectations in ways women are not.”

    Not necessarily the case these days. I’ve seen women have their parental rights taken away and given to men for what seemed to be gender bias in the opposite direction. Also, now when the cops are called for a DV situation, it is often the case that men are at higher risk of being arrested, even when they are innocent. There is a belief by many that “women are always the victim” in such situations, which is clearly not the case. Yes, men do have social advantages, but they are shrinking by the year (for the better). 50 years ago DV against women was basically enabled by the system (much like drunk driving), but thankfully today that has changed. Any abuser should be held accountable.

    Typically, in the MH system, however, it is the survivor who is “treated” and “diagnosed”/pathologized for their distress from the abuse. The abuser is the one that needs to change, but usually they don’t see their role as being problematic (which is why they don’t seek treatment unless forced to by the courts). It is the trauma survivor who has to find a way to cope with all the madness.

  • “Some men thrive on abusing their partner and manipulating the effect of that abuse to further disempower her by crazifying her reaction in what becomes a vicious cycle of abuse and often an inability to leave because of credible threats to the woman or her children.”

    Some women do this to men as well. It isn’t common but does occur for sure. I have an aunt in my family who emotionally abuses my uncle. It’s a mess and my uncle feels pretty trapped in the dysfunctional situation.

  • Screen time, like all the other factors mentioned in the article, clearly plays a role in human development and well-being. I do agree anecdotally that bullying and early drug use are very detrimental to children and teenagers. It seems that everything in our environment plays a role in our health and development. I’d suggest that if a kid is on the computer, smart phone, or TV most of the day, then they will likely develop some problems from it, such as social anxiety, low self-esteem, etc. Much of this depend on how the caregivers respond to the child; I know of many parents who use this technology as a de factor babysitter. From an attachment perspective, children are more likely to develop anxious and avoidant styles of bonding later in life if they don’t get regular, consistent, and predictable responses from their caregivers/parents. This is probably one of the top factors in healthy development. Screen time may just play a role in all of this but likely isn’t the most significant factor.

  • I do hope that the anti-psychiatry message is more widely heard and understood. Unfortunately, MIA and other such groups in America are on the fringe. The vast majority of people still believe “mental illness” is a valid construct and thus that diagnosing and “treatment” are logical conclusions. I don’t see this changing anytime soon, especially with powerful interests involved to maintain the status quo, like Big Pharma and the APA. It sure seems that for radical reform/abolishment to take place we need more than 2,500 views of articles like this one. Millions of people need to be exposed to the downsides of traditional “treatment”. Honestly, I’ve tried to educate my clients about such problems like diagnosis not being scientific and pills being potentially dangerous, and most of them say, “Well, I still want to see the doctor”. If the people coming to my clinic don’t seem to mind the status quo, it’s very doubtful there will be any significant revolt anytime soon. We can debate these issues online all we want, but it doesn’t change the system. We do need a large camp of people to come together for any substantial change to occur given the pervasiveness of diagnosis and “treatment” with pills. While it isn’t hopeless, I give us a better chance to land on Mars by 2025 than I see psychiatry removed from the system. I guess anything is possible since we did (maybe?) land on the moon.

  • Sam,
    Thanks for your kind words. You clearly understand my process, and your effort at empathy is greatly appreciated! If you read my posts from 1-2 years ago I think I’ve come a long way in understanding how “treatment” is problematic and why some people see abolishing the MH system is the only reasonable answer (as a side note, I prefer reform where we would reduce prescribing by 95% or more and provide a lot more therapy instead–without diagnosing or (mis)labeling people).

    My sense is that I get flak from some on MIA because I still work in the system which has harmed many of the posters here (and because I don’t support abolishment). While traditional outpatient treatment clinics can and are helpful sometimes, they can create devastation in peoples’ lives. Our doctors don’t have to personally face the consequences of their prescribing practices. Therapists don’t have the feel the negative emotions they evoke in sessions. It is our clients who face these realities in lives. I’ve been personally very frustrated at our doctors when they minimize the harm which we are clearly doing with “side effects” from pills. I think many counselors are oblivious to the reality that therapy can do more harm than good as well. In my therapy I aim to be like Carl Rogers–warm, compassionate, good listener, shows care and concern, and try to leave my ego at the door. It’s amazing how people feel better just knowing that someone cares about them and tries to really understand them without judgement.

    Of final note, I’ll add that I don’t believe I was contradicting myself in the post Oldhead commented on. I was saying that while on the one hand conceptualizing “mental illness” as a metaphor makes sense to me, we still cannot say without certainty that “mental illness” doesn’t exist (kind of like arguing if God exists or not). We do know that the brain develops illnesses, but we don’t know why or if issues like depression or mania have genetic/biological causes. I suspect that some people are genetically vulnerable to certain distressed states like depression; however, what seems to unlock most peoples’ “symptoms” is the environment–namely, trauma of various sorts. Humans are mysterious and probably always will be to some degree. I do think there are genetic/biological differences which may account for why some people experience problematic behaviors or emotional states. I mean, the Ted Bundy’s of the world sure seem different on a fundamental level than the Dali Lama’s (or the rest of humanity).

    Thanks again.

  • Kindred,

    You are right, and I appreciate the nudge! I have altered how I talk with clients about their distress already. I normalize their experiences and point out that it would be crazy not to feel distress after dealing with traumatic events. I do encourage them to seriously consider alternatives to pills. I educate them that we require a diagnosis which is not scientific. I do a lot of things that other clinicians don’t do. But I could do more, including the way I conceptualize “symptoms”. I do what I can to not make the situation worse for my clients.

  • Thank you for you for writing this important article. As a LPC I’ve heard usually good things about NAMI from others in various MH systems. Most professionals I’ve heard talk about NAMI don’t say anything critical. They assume that speakers bureaus, education, and outreach are all worthy activities because it can decrease stigma and increase engagement in treatment. Not until reading MIA did I realize the harm done by groups like NAMI. I have assumed that they do good work, but of course that is the convenient narrative for paid helpers to believe (especially when we’ve been indoctrinated by the culture of “mental health treatment”). I was a victim to being “educated” about only one point of view, the disease model. Every place I have worked uses DSM codes to bill, and even that was never presented as a potential problem for the people we supposedly care about, our clients. There’s a lack of critical thinking in medicine and MH systems. We all go after the money and disregard the harm which is being perpetrated by the system, such as forced hospitalizations and drugging. NAMI has no issue with continuing the status quo because it works for them. This is the same with psychiatry, APA, DSM, MH centers, and Big Pharma. Nearly everyone is getting wealthy (well, NAMI employees don’t get paid much or are volunteers) off the suffering of others, but they convince themselves they are compassionate and doing good work. Cognitive dissonance is strong amongst these groups.

  • Kindred, I get your point. Using the term “symptoms” refers to a “pathology”. Because most people who do experience terrible “symptoms”/distressed states, however, they aren’t particularly bothered with the term “symptom.” Certainly, I understand that getting away from any medical language is preferable. It’s semantics, and definitely people on MIA pay close attention to these words, which are too often used as weapons by family and so-called professionals.

    I am so accustomed to using medical terminology because that is the system I work in and have been in when I worked at a hospital.

  • Oldhead,

    Our interactions have generally felt difficult and unproductive. So yes it is probably best we stop commenting on what each other has to say. We come from different points of view, and like I have said before, both have valid points to offer. It is frustrating that we can’t focus more attention on what we agree upon (like forced “treatment” and the DSM). But so be it. This is the internet, where communication is often challenging.

  • Oldhead,

    It’s pretty interesting that you accuse me of lecturing others while you do the same to me. I’d suggest we work on finding common ground rather than trying ways to one up the other person. It would be more productive.

    Most people who experience distressing states take no issue calling their experiences “symptoms.” It is a small minority who do. Calling hypervigilence a “symptom” of trauma doesn’t necessarily have to be pathologizing. It’s a real experience which causes real suffering.

  • Well said, kindred. I don’t disagree with any of this. You are right that the scientific method needs to be utilized in determining actual diseases. Western medicine has a lot of faults, one being that assumptions are too often made by so-called experts without knowing the root cause of the symptoms. We often look at the surface level stuff rather than digging in to find the real answers, and in some cases I’d posit it’s likely impossible to know what is the actual cause of someone’s symptoms.

  • Steve,

    I have never said that mental illness, as defined by the DSM, can be scientifically delineated. We simply don’t know if distressed states, like hallucinations or mania, can be attributed to parts of the brain which have gone haywire. This is why you are right that the term “mental illness” is more a metaphor than a reality (that science has been able to prove, anyway). We cannot say with certainty, however, that “mental illness” doesn’t exist either.

    We do have enough data to know that the brain, like all organs, can develop various illnesses, such is the case with dementia, MS, Parkinson’s, Huntington’s, epilepsy, and ALS. . It stands to reason that the brain is vulnerable to various kinds of diseases (and foreign bodies, like tumors), which can and do impact human behavior, thought, and emotion. Someone who has suffered with depression their entire lives will tell you that it sure feels like a curse (e.g., disease) that they cannot shake.

  • Hi Sam,

    Thanks for your empathy! I do take lots of flak but it’s ok.

    I agree with you that dissociation is on a spectrum, like every other human experience. I call your wife’s situation “extreme” because she meets DSM criteria for DID, which is very rare. While all of us disassociate to some degree, the vast majority of us, including trauma survivors, never develop alters. And you are right that there are very severe cases where people never are able to do real healing.

    I’m glad to hear that your wife had you to support her. When people are going through difficult experiences, one thing I know for sure is that they need huge amounts of support and love.

    Have a great weekend!

  • Hi Sam,
    I think there are many valid ways of conceptualizing these complex issues. I see disassociation as a natural response to trauma. What you say makes a lot of sense from how you experienced your wife’s disassociation. I think disassociation becomes very unmanageable when people don’t have the tools to ground themselves to their core self/the moment. When people are regularly “not here” in the present, life can become quite difficult. The trauma is the reason people go there but it can and does happen in everyday life without one trying to.

    I myself do it more than I would like. I recall starting to disassociate in school a lot. It was probably because my father was an alcoholic and my parents weren’t showing much happiness. I sometimes disassociate in the worst times, like when I’m co-facilitating a group at work! I also disassociate frequently when doing mundane actives or even while driving!

    I couldn’t imagine how difficult it would be to support someone with severe disassociation.

  • Steve,

    Your definition of the mind are basically boiled down to the choices we make, like being courageous, and feelings, like regret. All of these experiences/thoughts/beliefs/feelings can be tied to various parts of the brain which we do understand to some degree. Again, your distinction between the brain and mind seems completely arbitrary and lacking any real differentiation.

    I do believe in science, which is why I’m more and more skeptical of psychiatry which lacks hard data. Psychiatry is about treating symptoms with pills which they have no way of knowing are helping or hurting anyone, and certainly know that they aren’t treating the root cause (usually, trauma, or some form of brain trauma like a TBI).

    Regarding the DSM, I have said repeatedly that we’d be better off burning the document and not using it. It is arbitrary in it’s distinguishing various “disorders” without ever having to prove that they actually exist (within the person). I hate having to use the DSM, and look forward to the day in the future where we don’t have to label people in order to support them.

    The concept of “mental illness” has been around for thousands of years, long before people where shoved full of pills. Clearly, people do experience distressing states, some of which never improve (with and without any form of help), and we can call it “mental illness” or “distressed states” but basically we are talking about the same experience/problem, e.g., hearing distressing command hallucinations. We can focus on semantics all we want but it doesn’t change that fact that millions of people around the world experience various distressing symptoms that they desperately want relief from.

  • Rachel,

    It totally sucks to be victimized by “medicine”. It’s unacceptable that thousands are harmed by doctors ever year in the name of “helping”. This is also why I want to stay as far away from hospitals as possible, since there are 100,000 deaths a year due to mistakes by doctors and nurses. And nearly everyone is better off not being on pills.

    I would agree with you that studying the brain should be left up to neurology and not psychiatry, because clearly the latter isn’t doing much when it comes to brain scans and the like. They treat symptoms and that’s about it.

  • Steve,

    All information ultimately goes back to the brain to be processed. Our CNS connects to nerves, and the spine, which all lead back to to the brain.

    The distinction between the mind and brain seems arbitrary and can’t be distinguished by science (yet, anyway).

    As far as I can tell therapy is focused on helping the brain to learn new things, process trauma memories, develop new neural connections, and so forth. When people learn over time that they do have some control I think it changes the brain. But I have no way of verifying this. Like I said earlier, we have a long way to go to understand what is going on in the human brain when change (or trauma) does occur. And why some people are seemingly more resilient than others. So many questions and few answers.

  • Well said, Sam. A point of clarification. Disassociation is a normal reaction to unhealthy and scary events. The problem arises, like with nearly all coping reactions, is that the helpful reaction becomes burdensome and gets in the way of living a full life. Disassociation keeps someone mentally protected when experiencing harm. But in adulthood that same person who continues to subconsciously disassociate will not feel so protected from this defense mechanism that was helpful in childhood. Substance use is another example. Initially, people often find illegal drugs and alcohol to be a relief, but in the long-term, they usually experience bad consequences to their health, finances, and relationships.

    Dissassociation isn’t the real damage to the brain…it is trauma and will always be trauma. The interesting thing is that we all react differently to trauma.

  • Richard,

    I don’t really disagree with anything you are saying. I think there are many causes of human suffering. I can tell you, however, that we do know brain development is directly linked to early childhood experiences. We know that if an infant is locked in a dark room for a period of time they will lose the ability to see. We know that if children aren’t provided a reliable and supportive home environment, that they will likely struggle with boundary setting and relationships, as well as a host of other issues. We know that children disassociate when they are regularly exposed to trauma, and frequently these people as adults will involuntarily disassociate. I could go on and on. The point is that the brain (e.g., self-esteem, self-image, decision making, problem solving) is damaged in some people, to no fault of their own, and they do want some form of resolution/healing. I would venture to say that the brain does need healing under such circumstances.

    For those who say other organs are involved, I would point out that none of our other organs are designed to think or feel. They are there for a specific purpose, like clearing out toxins or moving blood around our bodies.

    “Have you forgotten that we live in a society filled with injustice, trauma, discrimination, and multiple forms of violence, including poverty?”

    Our brains no doubt are damaged by these social and human problems.

  • Rachel,

    You bring up a good point. The system can induce symptoms in people, which is why drug treatment is like throwing darts and can be very dangerous. Iatrogenic consequences are all too common because we don’t really understand how individuals will respond to various pills.

    There are many people who come to my clinic, however, who experienced manic states prior to ever getting on any pills.

    I don’t hear any of our doctors saying that their pills “cure” anyone. They are quit open to the fact they are trying to treat the symptoms and not the root cause of anything. There are no cures provided in psychiatry or most other forms of Western medicine, unfortunately.

  • Steve,

    Can you say you know what is going on in the brain when someone is experiencing distressing voices or can’t sleep for days on end? Or dementia? The simple answer is no. My own theory is that the structure of the brain is damaged or altered when individuals experience trauma. Also, clearly genes play a large role.

    Do I think that pills will likely ever cure the symptoms mentioned in the DSM? No. What will likely lead to lasting healing is when we provide support and care for everyone, make sure their basic needs are met, help people heal through creating meaning and purpose in their lives, and so on. Chronic poverty is one top reasons people suffer with various symptoms; however, for some people they just can’t shut off their symptoms, even after they have attained all the things I’ve mentioned. We simply don’t have all the answers. So I think anyone who says definitively that “Mental illness doesn’t exist” is just as wrong as those who say there is a chemical imbalance in the brain which leads to symptoms. We don’t have enough information one way or another yet (although many on this site would disagree). What we do know is that people suffer from a variety of states and they seek answers and solutions from so-called experts who too often create more harm than good.

  • Stephen, I agree with your analysis. Our current system does not support the needs of all of its individuals. We have an inept system.

    Steve, I would slightly disagree. I think with severe, distressing symptoms, a cure of sorts is necessary to alleviate suffering. Severe mania, for instance, can be life threatening. We don’t understand all the mechanisms of the brain, as it’s the most complicated organ in the body. It drives all human behavior and emotions. The problem is that the medical model is throwing darts without really knowing what they are doing to people in the long run (they should have a good idea by now, but people do respond differently to “treatment”). This is the travesty to me. We shouldn’t experiment on people. That is inhumane. It’s amazing to me how many people, however, willingly/wantingly participate. I strongly suggest to people all the time to reconsider getting on pills, but they say to me that they are wanting any chance to feel better and are willing to take the risks.

    Richard, my point is that we simply don’t know what is going on with the brain, so we can’t cure the distress that people are coming into MH clinics want treated. Medicine can rarely cure anything. It does treat symptoms, like cancer, pretty well, but it hasn’t been able to cure cancer, diabetes, or hearing voices. By the way, regarding voices, most people I talk with who are voice hearers would much rather have this symptom eliminated, or cured. They don’t love hearing, “You should kill yourself”, “You are a loser”, etc. It’s upsetting.

  • Steve,
    Very true. “Professionals”, including myself, are invested in continuing to get a paycheck, and most of us are afraid to rock the boat because we have bills to pay. We’ve spent years in college attaining graduate degrees and student loan debt and feel compelled to stay in jobs which are possibly doing significant harm. We tell ourselves that the harm which the system creates is small compared to all the good we do. The cognitive dissonance is very uncomfortable, particularly in fields which are supposed to be helping others. We don’t want to believe that our interventions are hurting people. We think we are good people doing good things in the world. Of course, metabolic syndrome, TD, stigma, forced hospitalization, and coercion don’t fit into that narrative of being “good, helpful” clinicians.

  • One difficulty with OD is that many families (in the US) aren’t in (healthy) contact with people experiencing extreme states. In many cases the family is the cause of the distress in the first place. Lapland is a very small and homogeneous place, and I would also imagine that there is a greater sense of community and connection there than in places like the US. Clearly more research is needed. I think the OC perspective makes a lot of practical sense because it’s systemic and holistic.

  • John,
    What would you hope to attain by having regular dialogue with Dr. Breggin (or anyone else online)? Most of us are strangers online. I’m not sure this is the best option to attain support to be honest. I think he would agree with you that the system is messed up (e.g., the DSM) and that people like yourself have been harmed by the “treatment” you received. Do you have a therapist, church, or another avenue to attain support?

  • Well said, Sam. Crisis can be an opportunity to bring about growth and change. Belief systems we hold are very powerful and can get in our way of being more effective. Ego defense mechanism, such as cognitive dissonance, are natural ways for humans to cope with distress. Unfortunately, they can get in our way of moving forward!

  • Steve,
    True. Certainly something to consider. I think many of my colleagues are scared to push back because it feels like David v. Goliath. The entire system is structured around the idea that SPMI is a valid concept and “should be treated.” We clearly need a revolution, but the powers that be won’t go away easily. I feel daunted fighting against Big Pharma, APA, and psychiatry in general. The power differential is huge.

  • Madmom, I sure hope you are wrong but clearly the medical model still dominates “treatment” in hospitals and clinics. Any system where psychiatry is at the top of the chain the DSM labeling will be used because of billing. The truth is that many professionals would rather not use the labeling but the system requires it. I do agree that if we don’t fall in line we will get fired. Big pharma and the APA have gone to great lengths to develop a system which is focused on diagnosing and prescribing. Private practice therapists do have more liberty and rarely espouse the SPMI perspective or agenda. I do work in community mental health but plan to make my way out in the next year. I am tired of the overdrugging and pathologizing we do. Many of my colleagues feel similarly. I think we too often follow the status quo because it’s easier than making our own path. Maybe some of my ideas about clinicians being progressive like myself is wishful thinking? I sure hope not but you are probably right. I think all doctors and other “helpers” should be required to read the articles on MIA to better understand the perspective of people who have been harmed by this dysfunctional system. Thanks for sharing your thoughts.

  • “Who is this “we,” guy? Speak for yourself please. (Are you also part of the “we” that’s occupying Iraq, Afghanistan and Syria?) And if you’ve adopted a crazy lifestyle why are you counseling others? Do you consider being a “middle class” American (I think you left out white) “normal”? So many questions…”

    Our world is mad because of problems like the military industrial complex, rampant consumerism, corporate welfare, overprescription of all forms of drugs, plastics in our oceans, conspicuous consumption, and corrupt governments. Humans are certainly the cause of the most recent spike in global warming, and yet we’ve done very little about it. We are slowly killing our planet (eroding the conditions were we can thrive), which is quite stupid. So yes there is quite a lot that is mad about the world at large and America in particular.

    Certainly psychiatry contributes to this “madness”, but so do a host of other powerful players in the world. We probably need a massive revolution around the world if we have any hope to stop this madness. I just don’t see it happening because most people are either comfortable enough or feel powerless to change these powerful institutions. Oh, and humans are inherently imperfect, so we screw things up all the time. As we have seen in the Middle East in the last decade, revolution doesn’t guarantee a better system. Maybe you just a new dictator or a wolf in sheep’s clothing.

  • A lack of love–e.g., physical, emotional, and sexual abuse–is why most people seek “mental health treatment” in the first place. Love (healthy attachment) is what all humans need to feel “ok” with themselves. Without love, we have nothing.

  • I and most of my colleagues (people trained after 2000) have been taught to focus on the emotion behind the voices. Of course, there are some clinicians who will poorly handle this area. Former clients who post on MIA have had horrid experiences with doctors and therapists, which is why there are here to begin with. For all the thousands of people who are generally content with their “treatment”, they have no need to go to MIA.

    I’ll also add that groups like HVN are a wonderful resource for people to go talk about their voices without influence from the medical model. I wish there were more chapters in the US.

  • Most therapists and social workers would never “argue” with their clients who experience hallucinations or delusions. We are taught to be empathetic and work to understand our client’s experiences from their unique point of view. I do think psychiatry more often than not assumes there is a biological basis for these “symptoms” that the medical model “should” address; however, it’s important to separate out the other fields who were not indoctrinated in the medical model. I can’t recall once in the last decade that I told a client that their delusions are flatly wrong and need meds to correct them. That would be contrary to my values and training as a therapist. If I don’t respect my client’s perspectives and value them as equal human beings, I have no business being in my field.

  • Frank, good points. The reality is that our world is mad. From a middle class (“normal”) American perspective, we are crazy for adopting the lifestyle of materialism and hedonism. We suffer greatly as a result. We live isolated from our communities, and we spend our free time too often numbing out on screens. We over consume food and alcohol, which is why over half the country is overweight or obese. We are unhappy as a whole because material goods will never fill our souls. What is deemed “normal” isn’t always healthy. It was once “normal” to consider slavery acceptable. It’s now “normal” that we as a western society see nothing wrong with drugging up trauma survivors (or just regular “normal” people who have jobs). Madness is such a subjective subject because it’s socially constructed.

  • Steve,
    Thoughtful post. I would disagree that the system is “rotten to it’s core.” I think it’s very flawed but can be reformed. If we stopped pathologizing and drugging, and instead focused more attention on providing emotional support, the system would be much more effective. The problem as I see it is the medical model dominates the conversation and practitioners just comply with the demands from such a system.

    About half the clients I work with have full time jobs, and most who don’t either have serious medical issues or are caregivers. While some clients are harmed by our services, I’d have to think that if we were that bad, people on the whole would get worse and not better. But that is not what I’ve seen over the last decade. Obviously the harm done by pills is unacceptable and wrong, but that doesn’t mean that other aspects of the “care” people receive isn’t helpful to them in their daily lives. I’d have to think if the system was really rotten to it’s core, none of our clients would be able to work because we’d be harming them so much that this would be impossible. The system is messed up and needs changing, that is for sure.

  • Well said. I totally see how toxic individualism damages all of us. It’s very tempting to blame the individual for “all their problems”. This is one of the reasons why the DSM is very flawed, because it essentially says that the person is what is “dysfunctional” when in reality they are responding normally to very difficult and traumatic circumstances, e.g., depression.

  • Rachel,
    It is also possible that your friend’s son had other reasons for refusing to let her see the grandchildren. While it’s tempting to blame MH centers for all kinds of social and familial problems, there are many other variables which affect peoples’ choices. It’s possible your friend appeared unstable to her son, or unpredictable. Who knows?

  • Oldhead, many people do like coming to MH centers. I have clients who take three bus rides and two hours just to come see me for a 30 minute appointment. While you clearly don’t want any part of this system, there are others who feel that their “treatment” is in their best interest.

    I also try to encourage my clients to look at ways to reduce their meds or get off them completely, but guess what, most of them are reluctant to do so because they find some benefit from it. Also, most of them seem to care very little what DSM diagnosis they’ve been given. I tell them the possible negative effects of the diagnosis, such as stigma and being denied life insurance, but I usually get nothing more than a yawn from them on this front.

    I believe in reform and you believe in abolishment. We both have valid points.

  • Good point, Rachel. Sunk cost fallacy is relevant in many areas of life–jobs, relationships, and psychiatry. I would tend to agree that when people invest a lot of time and effort into their “treatment”, it is hard for them to accept that it has been a waste, harmful to their health, and so on. Also, often people seen in MH centers don’t attribute any positive changes to themselves but rather to their “treatment”. They think that without this “lovely” treatment things would fall apart. I think that many people do see benefit in coming to the MH centers, however, because of social connection. They make friends in groups, connect with therapists, and so on. One problem in America is that we are isolated, lonely, and disconnected. This is a natural consequence of our individualistic culture and the way we live (e.g., living far away from family), and thus MH centers fill a void to help support people who are suffering. While MH centers do some good in this regard, we do badly by our clients when we drug them up with neurotoxins and pathologize them with the DSM.

  • Well, the problem is we don’t have a viable system which would not somehow get manipulated by the powerful monied interests. Socialism in European countries is the best system currently that tries to consider everyone’s needs, but it has yet to be duplicated in large, heterogeneous countries like the US.

  • Well, said, Kindredspirit. Humans have yet to find the ideal social, political, and economic system which supports the needs of the common people and to protect vulnerable individuals from actual harm. In modern life people are treated as disposable commodities who only matter when the 1% can profit off them (employees) or use them for some other benefit (e.g, our troops). Once we are no longer considered useful (e.g., the elderly), we are discarded and devalued. “Mental health clients” will be used by the system until the system is radically changed or clients walk out. The rub here is that many clients come to mental health centers to seek other resources, such as housing or help attaining public assistance benefits. So many basic needs for the poor are now requiring a doctor’s attestation that the person is “disabled” and thus eligible for affordable housing, transportation, student loan dismissal, and the like. The system is founded on the idea that a doctor can verify that someone is “disabled” and thus determine that the person cannot work. This is very flawed for so many reasons. So while some people are truly distressed by their symptoms, many are also distressed by poverty– the lack of access to basic needs and not feeling safe. We need to get away from linking the two. If someone is poor, they SHOULD have all their basic needs covered, especially in such as relatively wealthy country like America. Unfortunately, we know that many wealthy people hoard their resources and don’t want to pay more taxes to support everyone’s needs. Until everyone pays their fair share, we will continue to find ways to limit “entitlements” to basic needs. The poor will then be forced into finding “treatment” providers who will say they have a disability which makes them eligible for various resources. Additionally, psychiatrists typically will not meet with their clients on an ongoing basis unless pills are prescribed, so this set up coerces people to take neurotoxins when they really don’t want to be on pills in the first place. Screwed up system.

  • Rachel, I have not read that book on evil. I do find it to be a useful concept to help describe certain adult behavior. I would venture to guess that nobody would call a baby evil, because it has yet to develop a conscience. What scares me is that some people seem to lack empathy or a conscience (I believe due to neurological conditions we don’t understand, probably often the result of childhood trauma). These people sometimes become serial killers and dictators. They also become doctors, CEOs, lawyers, and politicians! No doubt evil behaviors exist, such as the case during the Holocaust and Hitler.

    Basically evil is “Antisocial Personality Disorder in the DSM; people diagnosed with APD usually have done some horrid stuff to others in their lifetimes and don’t show remorse. They seem to lack the basic understanding of why what they do is wrong in the first place. I have met a small number of people who present like this, and they give me the chills!

  • From what I’ve seen anecdotally, trauma seems highly linked to fibromyalgia diagnosed individuals. It is my belief that the body will show various signs of distress anywhere from 10-25 years after childhood trauma. It appears that people who have experienced ongoing trauma in childhood are particularly prone to experiencing various physical pain and discomfort that cannot be accounted for elsewhere. Trauma also seems linked to autoimmune disorders.

    I believe most doctors don’t like diagnosing fibromyalgia because it gives patients few answers. Personally, I think it’s just the body’s way of processing traumatic material.

    I agree with you that the entire system is problematic. When capitalistic forces drive a system, we know that it will rarely benefit all of us.

  • Kindredspirit,
    Yes, it is absolutely terrible. Modern medicine should not be doing more harm than good, but clearly they are falling way short of their supposed ethos. I think that treating mental distress really needs to be out of the realm of psychiatry. So many medical problems are caused by “treatment”. Also, many medical problems are missed by doctors and falsely labeled as “mental illness.” It is very angering. Thank you for sharing your story which is very worth telling.

  • I agree Oldhead that it can go both ways. I see it here at my center where others (usually family or the court system) are pushing my clients to “get help”. Often the real distressing problem is in the family system or larger society, with issues like poverty, intergenerational trauma, and the justice system.

  • Kindredspirit,

    Your story is all too common in the medical model of “care”. Doctors in my experience are lacking emotional intelligence. They are also in denial that they do harm to people they supposedly are trying to help. I think that medical school needs to do a better job encouraging non-empathetic doctors into parts of medicine that don’t require a good bedside manner to be effective. Doctors, in my experience, are also an arrogant lot. They rarely admit serious mistakes. They place blame onto their patients when things don’t improve or worsen. They create addicts with their prescription practices. While there are some very thoughtful doctors out there, the norm is still to over-pathologize, under-empathize, judge, and to over-prescribe.

  • “This is important, because a non-diagnostic, non-pathologising, scientific alternative is not only already available, it is actually part of the World Health Organisation’s existing system… we can make the change today!”

    It would be wonderful to move in this direction. In my work it’s clear that socio-economic conditions and intergenerational trauma are key elements in individuals mental health picture. It’s likely that most human suffering (in the form of symptoms described in the DSM) are a direct result of living in acute and chronic states of stress, which includes social isolation, poverty, living in unsafe neighborhoods, facing discrimination by the police, and the like.

  • I totally agree, Bradford. The system is backwards. Clients aren’t brought into the process of how “treatment” is provided in any meaningful way. There are superficial committees that “consumers” can join, but they have no power and limited influence over how the larger system works in these roles. I did intern at a small MH center where they have a 50/50 client/professional board leadership setup. This is rare in the US, however.

  • Anyone who has been paying attention knows that Trump scapegoats immigrants for our social problems. https://www.theatlantic.com/politics/archive/2017/03/trump-scapegoats-unauthorized-immigrants-for-crime/518238/

    We also know that he doesn’t care about the well being of marginalized groups (or really anybody else not named Trump). DACA is a perfect target for him. Many white Americans (PS, I’m a white privileged male) are fearful that their power and reign over American society is waning, so marginalizing this minority group is a way to take back their feelings of being in control over society. It’s just a matter of time before we can’t stop the inevitable, when white people are the minority. Building a wall also won’t prevent this from happening. Fear mongering never goes out of style with authoritarian leaders.

  • Steve,
    It’s becoming a running joke with my coworkers that I’m the “anti-pills and anti-diagnosing” therapist here. They often roll their eyes at me when I say something about the systemic BS that is happening to our clients.

    I am talking to my clients about getting off pills, and I expect that I won’t be liked by the doctors or managers real soon. It’s interesting how much people believe in the medical model without much evidence for it’s support, yet we delude ourselves with “evidenced-based practices”. We think we are being rational and sane in our “treatment” of clients, but who ever thinks that they are doing harm to other people for a profit? The more I question the systems I work in, the more uncomfortable I’ve become with the status quo. Clearly our “treatment” works well for some clients, BUT do the benefits weigh out the risks? I know of people who have gained 50 pounds in six months on mood stabilizers. I know of people who have developed diabetes, became zombies, developed addictions because of the pills they were prescribed, and so forth. There appears to lack critical thinking about what harm is being done by these so-called “medications” and other things we subject clients to.

  • The prison system can certainly be improved. Just look at other parts of the world inmates are treated with more respect and dignity. https://www.businessinsider.com.au/vera-institute-european-american-prison-report-2014-5

    One could argue the MH system would be signficantly improved if we removed drugging and forced “treatment.” I know you want the MH system to be abolished (for understandable reasons), but many of us think there are better alternatives which wouldn’t require such drastic measures. Everyday as a therapist I hear from clients who say they are grateful for “the system”. The system works for some and not for others.

  • “Humans are not machines whose software needs an occasional chemical adjustment. The roots of human suffering are often located in traumatic personal histories of abandonment and neglect, larger social forces such as poverty, racism and misogyny, and thwarted existential needs. With their wildly disproportionate access to and flagrant manipulation of the media (as illustrated by the recent Facebook debacle), corporations have ushered in a global culture which concentrates wealth and power in a handful of individuals, leaving the rest of us struggling to secure basic amenities such as affordable health care and housing. Significantly, the corporations enjoying the greatest success today are those that alienate us from our own human nature; tech companies that seduce us to replace lived experiences with virtual ones, and pharmaceutical giants whose drugs alter our personalities and blunt our emotions. Increasingly, deep human experiences are replaced by shallow commodified ones; Facebook ‘friends’ replace realtime relationships, and the curated selfie is more valued than authentic self-expression.”

    Well said. Couldn’t agree more. Thanks for the article!

  • In my experience most psychologists aren’t interest much in “social justice”. The only helping profession within the mental health realm I know of who have emphasized “social justice” are social workers. The rest of us rarely deal with the macro issues that social workers tackle. The psychologists who I’ve interacted with over the years are heavily trained in the medical model dogma of diagnosing and patghologizng. They typically don’t address the systemic problems in society in any meaningful way. But hey they can interpret ink blot tests for you! So there’s something I guess.

  • Steve,
    Going old school with your BF Skinner reference!

    PS your posts are showing up out of order on MIA. I get an email notification but then it shows up before other posts have been made on MIA. It’s a little confusing in the order of posts. Let me know if that doesn’t make sense! Maybe it’s based on time zone? See the times on these few last posts.

  • Oh, boy. This must explain why people were so scared of Hillary being president!

    If we really lived in a nanny state I assume we wouldn’t have millions of people who are homeless and tens of millions who are very poor. We clearly don’t provide “care” to those who need housing, basic healthcare, and substance abuse treatment.

  • You are right that our modern computer/phone technology is highly addictive. My point is that it’s designed this way for profit not social control. People make lots of money off of this technology, and frankly many of it’s users are happy to spend our money on it. Certainly many people become addicted to anything which increases dopamine. I think that we do have a choice as adults as to how we use it. My phone doesn’t control me! I do have trepidation when it comes to children using it, because their brains are still developing. It’s a huge industry which is why Apple, Microsoft, et all, are worth so much. We as consumers do have a choice. We can’t blame companies for all of our problems. We do need to take some personal responsibility in this situation. If there wasn’t a demand, there would be no supply!

  • JanCarol,
    Yes, it is a slippery slope. We have a POTUS who is an authoritarian and attacks anyone who he perceives is against him. Not good.

    Regarding social media use, cell phones are ultimately a choice in terms of how we use them. The government certainly isn’t forcing anyone to use “smart phones” if we don’t want to. Frankly, most of what goes on with social media and smart phones is just about advertising and selling products. It’s not about controlling us but maybe keeping us numbed out to some degree. The truth is that if we woke up we would see that the economic system is heavily benefiting a relatively small group of people at the expense of the rest of us. That is what we should be concerned with IMO.

    I’d suggest using a different word to describe the situation than “totalitarianism”. If we describe the current state of affairs as the same as true totalitarian regimes, then we watering down the real thing, like North Korea. That place is nothing like Australia or the US.

  • ““The Russians” had ZERO affect on the election.”

    Did you complete an investigation into the matter? How many Russians have been indicted by Mueller? 12. They did hack the DNC at the very least, which was an attempt to discredit her.

    I was a Bernie supporter and see no evidence that the DNC “screwed him over”. They clearly favored Hillary, but that is how politics goes. Bernie was a long shot to get the nomination because of his leftist views.

    We need to look no further than the Kavenaugh hearings to see which party is still much worse. The Republicans didn’t give the Democrats time to read over the thousands of pages on K before the hearings began. It’s a sham. The Republicans in Congress just want their guy in no matter how corrupt the process is. Sad.

  • I think this article make some important points on this subject:http://nymag.com/daily/intelligencer/2018/09/john-mccain-memorial-vietnam-war-hero-pow-hanoi-funeral-patriotism.html

    The truth is that the military industrial complex is driving American politicians to go to war. Money is made when we are at war after all! The Halliburtons and Lockeed Martins of the world make bank while everyday people suffer and die in these conflicts. Our system has been corrupted, and probably always will be corrupted, by monied interests. This is why all forms of big business thrive and have amazing balance sheets while the average worker is not much better off, or worse than, they were 30 years ago. The fact that our laws now consider corporations to be “persons” is just one example of how far we’ve devolved. I agree that both dems and repubs are to blame for this mess. We can’t expect the decision makers to hold themselves accountable. It’s human nature to be self-interested. I do see dems as the lesser of two evils, but frankly both sides are corrupt. We need to have publicly financed elections so politicians can no longer be bought off by corporate interests. We also need to get rid of super pacs.

    Regarding Vietnam, we had no business being there, just as we have no business in Afghanistan. And for the record Trump has pushed for continued military activity around the world and increasing the military budget, so if you think he’s not pro-war, you are kidding yourself.

  • I agree Oldhead that both parties maintain the status quo in most ways. Neither one is particularly radical. They do stand for different values, such as gay marriage vs. marriage for heterosexuals only, environmental protections vs. most things go to make a buck, abortion vs. banning abortion, etc. We do elect our officials, so on some level we are still a democracy. We aren’t Russia after all, where there is only president (I mean, dictator, who will have his opponents murdered) indefinitely. The fact is that in America regular people can and do run for and win political office. Obama wasn’t particularly economically privileged, but he is smart, intelligent, goal oriented, and has clear leadership abilities. In the US his presidency was possible, but in most other places around the globe he would never had a chance to get to that level of politics. I miss him everyday. He is a good man, much like McCain, and now we have a man child running the free world. God help us all. Obama was truly inspirational. Trump only inspires me to throw up into my toilet.

  • Oldhead, this is false. Corporate news isn’t necessarily “fake” news. It’s only inconvenient for people like Trump who can’t admit their fallibility. Most news reported on CNN, MSNBC, and Fox is factual. But some people can’t handle the truth. Fake implies completely made up, which is hogwash when it comes to mainstream news. Of course it’s biased, but that doesn’t mean it’s not true, at least to some reasonable degree.

  • Oldhead,

    Chiropractors are potentially dangerous. I know one person who had a stroke after receiving subluxation on her neck. It’s a pseudo-science that is mainly a business venture to make lots of money (many similar comparisons to psychiatry if you ask me).

    https://edzardernst.com/2013/10/twenty-things-most-chiropractors-wont-tell-you/

    I went to a chiro once who told me that diabetes and other chronic conditions are the result of spinal misalignment. I walked out of the door after I heard his trash. Granted some people like you do report benefit, and that’s excellent. If you believe it is helpful, that is good for you. But I do think the public is misinformed about this “medical specialty”.

  • How many journalists and political opponents has Putin have murdered?

    Sure Putin is smarter and more strategic than Trump, but that doesn’t make him a moral leader. He’s sure good at getting positive attention for Russia through the Olympics and World Cup in order to try and legitimize his corrupt ways.

    For the record you have bashed Democrats, calling them the greatest threat to democracy. So pot, kettle.

  • Stephen,
    It’s a real head scratcher. The Reagan supporters in the 1980s would be very confused by what is happening today. Seems to me that until Trump came along, Russia was not viewed positively by the American public. Certainly, one would think that Russia’s meddling in our election would concern most American people. The fact that Putin murder’s his political opponents and journalists should be reason enough to be weary of Russia. I would say that Trump’s base is highly emotional and rarely has much logic for their support of the man. I mean, how did anyone think a billionaire who has always cared about himself first would somehow change his ways and prioritize the middle class and poor? Not gonna happen. His base will not be economically better off in the next decade, and somehow they’ll blame the democrats. Certainly Trump has made that case anytime anything hasn’t gone his way. “It was the Democrats fault!!!!!”

  • Well said, Richard. I do think it’s important to also distinguish from social and economic conservatives. The former is concerned with things such as abortion and gay marriage, whereas the latter group is most interested in lower taxes, increased profit margins, deregulation, and reducing the size of the government (but usually still support military spending). At the end of the day most conservatives believe in the capitalist system, and thus it would be difficult for them to support abolishing psychiatry and limiting big pharma from attaining their profits.

  • Let’s be clear, I doubt many folks are coming to therapy primarily because of their anxieties about Trump. I have yet to see it. In the first six months of his presidency, many of my clients expressed concern and worry that Trump will harm them in some way. But they had other anxieties which were more pressing, like basic survival of paying their rent or being homeless.

  • Nobody in the mental health world is seriously treating TAD as a real thing (It’s not in the DSM yet!). People get anxious about a number of things which are scary, and no surprise that marginalized people in particular are worried how Trump will make their lives more difficult given his rhetoric and unpredictable behavior. Trump is scary and dangerous, so we have all the reasons to feel concerned for our future. People willingly seek out counseling to talk about any number of reasonable anxieties they face in life. Trump is just one of many reasons to worry about the state of the world.

  • Well, Trump lies like his job depends on it. He doesn’t like it when anything critical is said about him. That is why he falsely proclaims this information is “fake’. This is dangerous behavior.

    “The Democratic Party is the biggest enemy of democracy…”

    Next you’ll tell me that Trump is the second coming of Jesus! Frankly, there are many enemies of democracy, none of which you listed. It really has little to do with party affiliation. The real enemies are super pacs, big business, Russia, and people like Trump who reduce peoples’ faith in our government and system in general. When people stop believing in our government, they will stop voting and participating, which will allow very powerful, wealthy interests to further take hold of our system.

    Sure seems like the Trump administration is following a certain Putin-esk playbook: https://washingtonmonthly.com/2017/01/31/the-12-early-warning-signs-of-fascism/

    Just remember what Trump said about the election if it doesn’t go the Republican’s way. What a lovely guy. https://www.theguardian.com/us-news/2018/aug/28/donald-trump-midterms-private-meeting-church-antifa

  • Sam,
    You are correct that all sides of this feel some level of distress. There is a reason that both Bernie and Donald had large audiences and support, because the middle class and poor are hurting in this country and have been for quite some time. Part of the problem, however, is that all criticisms of Trump are basically ignored by his base. It doesn’t matter what Trump says or does, and they look the other way. So the truth doesn’t really matter to them. They believe what they want to believe and ignore the realities which should be smacking them in the face. Trump is dangerous because he’s an authoritarian and a bully. There is no convincing his supporters that this is true. There is very little which is redeemable about Trump, and until people on the Right acknowledge this, we aren’t getting anywhere as a country. The man panders to his audience and lies with reckless abandon. Stephen is right, Trump is a malignant narcissist. Trump will turn on anyone, except maybe his closest family members, if he perceives they’ve wronged him. If people have wonderful things to say about Trump, he’s their buddy. Just look at how Trump treated McCain.

    The author probably should have left out the name calling. But when the shoe fits. By the way, most centrists these days don’t support Trump, either. They don’t need to be convinced that he’s unfit to be president. There is ample evidence which the middle of this country actually pays attention to.

  • Richard,
    I’m just not sure what the viable alternative to capitalism is? I mean, most of the industrialized world is capitalist to one degree or another. Humans have yet to perfect any system which avoids exploitation of land and people.

    Regulation doesn’t have to be a sham if the regulators are righteous, but far too often politicians are corrupted by the system. In America, for instance, we now treat corporations as people. We have super pacs which wield immense power. The rich run things. The rest of us fight for the scraps. The current system is unsustainable, but I just don’t see what we could realistically replace it with.

  • Richard,
    Conservatives value deregulation because it helps them make more profits. I think there are many examples of regulation which has protected the environment and people. The creation of the EPA helped to eventually clean up the polluted waters in America. Regulation also helps prevent consumers from being exploited by creditors. The concept of regulation isn’t a sham, but when industries are deregulated, everyday citizens usually suffer in the long rung.

  • Sam,
    He’s right in his characterization of Trump. Some people will not like this reality, but the facts certainly indicate that Trump is a narcissistic egomanic who makes too many (dangerous) impulsive decisions. If someone needs to defend the size of their manhood in a national debate, we should immediately disqualify the person from political office! Of course there is no DSM category for TAD, so it’s not really being patholigized. But it is a real phenomenon. Many of my clients over the last 18 months have expressed significant levels of distress with this man being in office. He does impact all of our lives, after all!

  • Lawrence,

    I was talking about regulation in general. There are many good examples of how regulation has protected consumers; for instance, requiring that cigarette packages have a warning label has probably helped to reduce tobacco use over time (as well as rising the costs through taxation). When it comes to MH treatment, regulation has done very little to protect consumers. The FDA has failed, as well as state boards.

  • Frank,
    NO, I never said any abuse is “ok.” Wwhen it comes to psych drugs, the FDA and state licensing boards are there to help “regulate” the industry, and many would argue they are doing a poor job of it. Many people do get excessively drugged by their doctors. I see it all too often. I understand why people think psychiatry is a sham; PCPs, however, are also largely responsible for their prescribing practices. They are the ones who often start people into the world of benzos, SSRI’s, opioids, etc.

  • Regulation isn’t a sham. We need regulation to prevent excessive abuses within the system, like monopolies and sub-prime loans. Of course regulation will be controlled by those in power; this is the case all around the globe. We need regulation that protects the poor and middle class, but unfortunately this isn’t a priority for the 1%.

  • Oldhead,
    Conservatives want to reduce government spending in general (although clearly they don’t practice this belief when it comes to benefiting themselves), which is why they don’t support spending for “mental health treatment.” Many of them, do, however, believe that mental illness is a legitimate concern. They just don’t love the idea of universal healthcare. There are plenty of conservative veterans who believe in PTSD.

  • Oldhead,

    “The primary clash in the AP movement is between anti-psychiatry survivors and “mental health” professionals, regardless of ideology. And currently the so-called “left” is probably more supportive of psychiatry than the “right.””

    What evidence supports that the left is more supportive of psychiatry?

  • Medicare expansion has been a godsend in my state, which has benefited the working poor the most. That is what my clients tell me anyway. They say they went years without getting therapy because they didn’t have coverage. They tell me they are grateful for the ability to see a therapist. I think when it comes to psych drugs, yes clearly this is increasing healthcare costs in the US. I would love to see national healthcare in the US, because people could then, in theory, get preventative medical care which would reduce suffering and long-term costs (and thus could treat real medical issues). That would be lovely.

  • Capitalism is exploitive in practice. This is why regulation is necessary. Humans have yet to find a balance where everyone wins. There always seems to be “losers” (in any system) in reality. I think income disparities will only grow as the human populace increases. About 1 billion of the world’s population still doesn’t have access to clean drinking water!

  • I’d say that psychiatry is currently problematic because it assumes there is a biological component to mental suffering and “symptoms” without any proof. We simply don’t know if there will be any real science to back up psychiatric belief systems. “Belief” is the operative word here. I am still open to the idea that there are possibly differences in the brain or DNA which lead some people to experience excessive distress, BUT until the day comes that science has proven this, we should continue to challenge psychiatry’s continued assumptions about “mental illness” as a valid concept. If psychiatry would go back to it’s roots of psychotherapy, I think more people would benefit. Maybe we should leave concerns with the brain to neurology?

  • Slaying,
    I think you inserted “socialist” with “capitalist” by mistake. Remember it is capitalists who put their aim at making the most amount of money they can, often without thinking or caring about the long terms risks. Just ask all the rich investors who buy drugs and then jack up the prices. Remember Martin Shkreli? Lovely capitalist human right there. Or the 2008 housing bubble which was driven by greedy lenders and deregulation.

  • Thank you Nancy for adding your thoughts to the conversation. You articulately pointed out why I think mindfulness can be useful.

    Steve, the clients who volunteer for the DBT programs at my clinic are never told “you need to do your mindfulness.” While I’m sure this message gets conveyed elsewhere, it is ridiculous to demand anyone do anything. It is certainly counter-therapeutic and doesn’t actually increase the likelihood that the “skill” will be practiced more regularly. The truth is that for mindfulness to be effective for anyone, they probably need to practice this for years if not decades. DBT superficially addresses mindfulness in the sense that coming to a group once a week isn’t likely going to lead to substantial change for the individual in this regard.

  • Steve, CAN is the operative word here. Doctors CAN be held liable, too, but it rarely happens.

    Streetphotobeing, there are some similarities between drug pushing docs and beer pushing bartenders. The difference, however, is that doctors study, take an oath to do no harm, and they state that pills are “medicine”. While bartenders may joke that their liquor is medicine, we all know this isn’t true.

  • Out,
    Thanks for your response. I guess we can agree to disagree. The way mindfulness is practiced and taught in the West seems to be secular, so I’m not sure what faith it’s directly connected to?

    And can you clarify what problems arise from mindfulness? I am serious about wanting to understand where you are coming from. The main downside I’ve seen to mindfulness for people is that it requires such a shift in how one relates to oneself and the world, and this is very challenging. Many clients tell me that they are uncomfortable with the idea of taking a nonjudgemental stance towards themselves, as they have been taught for their entire lives that they are worthless. So these messages have been internalized. We also tend to judge certain emotional states as good or bad, and mindfulness is difficult because it teaches something radically different–that emotions are neither good nor bad. They are just temporary states of feeling.

  • And let’s not forget that deinstitutionalization occurred in the during this same period when psych drugs started becoming available in the 1950s-60s. All these folks who had been traumatized and institutionalized were drugged up “so they could live independently” (or were homeless).

    Humans have a desire for short-term fixes (e.g., feel better now), and I think doctors and big pharma exploited this reality in our brains. Nobody really enjoys feeling any emotional pain, and luckily for us these drugs numb us or change our emotional state, so we like them (sometimes)! Once someone is physiologically hooked, they are dependent on the system to maintain that status quo. Doctors, one could argue, are no different than bar keepers, liquor store owners, or local corner drug dealers. But they have the law on their side.

  • Out,

    Mindfulness is not some sort of doctrine or dogma. Mindfulness is one of the least controversial concepts in the mental health world. Albeit it is difficult to practice, it has immense value to the human psyche and daily life. In one form or another it has been practiced for thousands of years by humans. I hope one day it will be taught to every human on the planet. Our world is the opposite of mindful much of the time, with constant distraction, judgement, attempts at multitasking (which rarely work), and the like.

    Do you think math or science is unfairly “imposed” on students? Should that not be the case? Maybe we should let kids play on the jungle gym all day? Heck, I would have loved that as a child. I didn’t want to learn anything at the time, but I’m glad adults imposed learning into my life. Mindfulness is just one more form of learning. Especially considering the insidious nature of technology in our lives, mindfulness becomes evermore important. Both kids and adults are less happy because of social media and it’s impact on feeling “not good enough”. Mindfulness can help people, all people, to practice letting go of our judgments towards self, just notice them actually, and to be in contact with our inner world and the present moment.

  • Thank you for sharing your insights. PVT is integral to my use of EMDR with clients. Many of us are in a constant state of increased arousal due to trauma. I personally think mindfulness is one tool that people can use to tap into their parasympathetic nervous system, which is key for social engagement and increasing positive emotions.

  • There are different types of judgement. Many people are their own worst critics, making negative comments about themselves that aren’t really based in fact. The negative judgments I’m talking about are distorted and usually messages people received in childhood. You are right that some judgments are fair and based on the facts, but I would say that this isn’t the same thing as saying “I’m stupid”, “I’m unworthy”, “I’m a bad person because I’ve made mistakes”, “I’m unloveable”. These judgements are detrimental to one’s one view of self and make it very likely that the person will suffer more.

  • Out,
    I do try and practice it. I find that it is easy for me, as well for many others, to be judgmental of ourselves (often based on what we experienced in childhood). I’m no expert on the subject, but I know it’s value. It’s not about telling people they are wrong, but rather encouraging a nonjudgemental stance. If we can’t agree that is a good thing to work towards, then I don’t see how any common ground can be found.

    What was my knee-jerk response, exactly? I have no idea why you think my comments were patronizing, but maybe we are in a PC world here on MIA where we cannot express disagreement, otherwise we risk being called “patronizing” or “gaslighting” (I’ve seen this elsewhere on the site)? I do find it strange that anyone would find mindfulness offensive. You clearly see value in it for yourself, so why protest so much? I don’t get it.

  • If you find it wonderful, not sure why you would protest? Like I’ve said before, mindfulness isn’t pathologizing. It’s a life skill. Being mindful of one’s thoughts and feelings is just as integral to life as any other subject taught in school. It’s pure hyperbole if anyone is suggesting that people are being forced to practice mindfulness and being punished for not practicing it. Where is this happening? DBT is the only modality in counseling (and community MH centers) which heavily focuses on mindfulness, and only a small minority of clients attend these classes (voluntarily, mind you).

    What is more oppressive is the current education system in America, which focuses on standardized testing and removing many “electives” like art and music.

    Mindfulness isn’t about telling people what to think. Mindfulness is encouraging self-compassion and non-judgement of self. If that is controversial, then we are really screwed. You might as well protest math, science, art, and gym being taught in schools if you think mindfulness is problematic.

  • I’m not sure how encouraging non-judgement of self and focus on the present is problematic or dangerous. Seems to me that in order to be successful and/or content adults we need to be mindful. If we aren’t in the present, we can’t enjoy what is happening right in front of us! Like a beautiful ocean, reading inspiring poetry, or spending quality time with loved ones.

  • Steve,
    I agree that the DSM is social construction. My point is that many clients don’t view “mental illness” as an invalid construct. Mental illness as a scientific concept is yet to be proven. I tell my clients these days that there is no evidence to support the labels; nevertheless, many of them still conclude that the description is helpful and makes sense of their experience.

  • Correlation and causation are two different concepts. Maybe DFW’s mental makeup or personality lead to his suicide? Should we blame his domestic abuse on psych drugs or ECT? Maybe he was just an abusive, egomaniacal, controlling jerk towards women because he felt entitled to have what he wanted? We will never know these answers, but no doubt people will focus on “the facts” that fit their worldview. Maybe he couldn’t accept that he couldn’t be a brilliant writer all the time because he was a perfectionist? It’s all speculation.

  • I have to laugh at some of the criticisms of mindfulness. Mindfulness is about trying to adopt a nonjudgemental attitude towards self. To notice our thoughts, notice being distracted, redirect our focus onto the present moment, and to try and do one thing at a time. Our current world doesn’t support mindfulness, as we have constant distractions in modern life. It’s a nonpathologizing view of the human experience. The fact that anyone would get offended by such concepts is to me quite confusing. All children should be taught to practice mindfulness, as it helps someone develop self compassion and focus to be present in one’s life. Not sure how this is controversial.

  • Sam,

    Thank you for taking the time to share your story. I can’t imagine how difficult it is to support someone like you do who experiences severe disassociation.

    I do think it’s important to recognize, like you said, that we all experience some level of disassociation. I certainly did some of this in my childhood, sometimes out of boredom in school, other times due to by home life dealing with an alcoholic parent. Disassociation can keep us “sane” in a world which is often crazy. The problem is that for some people they lose control the ability to bring themselves back to the present moment with their core self. I do believe we all have parts, and these parts come out at different times for different reasons. When we are under duress, it is more likely that whatever MH symptoms we are likely to experience will come out in an effort to cope. I, for example, deal with anxiety, and when I’m under more stress I tend to excessively worry about things out of my control or worry about my own decision making. Luckily when my anxiety flares up I’m still usually able to function, but I know not everyone is in this same category.

    I do think you make an important point, too, that many people who suffer from various maladies, like dissociation or chronic suicidal thoughts, never have been in the system. I have met many clients over the years who have suffered for decades without asking for any professional help. Clearly the cause of their suffering was not and never will be psychiatry, therapy, or psych drugs.

    I believe that childhood trauma is the number one cause of human suffering, and the consequences of such treatment in childhood is why people feel disturbed and ask for professional help in the first place. No doubt the mental health system is problematic, as MIA as clearly elucidated. I am disturbed by the excessive use of psych drugs, and I also know that it does provide real relief for some people. I feel torn about the way we “help” in the modern world. I see why people are critical of the system. I also think, however, that the system is not the root cause of most of life’s problems.

    For people who have been stuck in the system for decades, nevertheless, they are likely to be victimized by the horrid “side effects” psych drugs create. These folks are justified in their anger at the system. I have met such people my my work and here on MIA, and am angered myself when I see ambivalent responses from supposed helpers. These providers seem to just accept that the pros outweigh the cons of such “treatment”, but what is key here is they don’t have to live with the consequences of whatever chemical compounds their clients are ingesting. Psychiatrists will never get TD, akathesia, metabolic syndrome, or diabetes from prescribing pills. No, it’s their “patients” who do.

    I wish you well, too.

  • Truth,

    We really don’t know what killed DFW. All those factors you mentioned probably did contribute to his early death, but we just don’t know. Like the article states, there are many reasons people die by suicide. It’s difficult to know for sure but we can make reasonable theories that his “treatment” played a large role in his behaviors. Clearly ECT and psych drugs did not help him to “feel better”.

  • DFK,
    Well said. Fully agree. The culture of competition at all costs is toxic because it falsely sets up perfectionist attitudes which crush the human spirit. None of us us perfect. Very few people “are the best” at anything. If aren’t “successful” in life, we are also blamed for “not working hard enough” or whatever. It’s probably one reason Americans, and Westerners in general, aren’t terribly happy, despite our relative wealthy to developing countries.

  • Oldhead,

    People have the right to conclude whatever they wish about their treatment in the MH system. If they feel or think it is helpful, that is what matters to them. You may not agree with their conclusions, but that might be more to do with your experience than theirs.

  • Fred,

    I know how service user feels/thinks because I listen to them. I have talked with hundreds of such folks, most of whom say positive or neutral things about their treatment. I have read little turtles comments for quite some time, and it is clear where they stand. While you think “mental illness” is “mythical”, service users like little turtle and others clearly disagree. They have said so in their posts.

    I agree with your concerns and criticisms of diagnosing and the DSM. I plan to get out of the MH system because I’m sick of being required to use these non-scientific labels on people. The main benefit to diagnosing is that the service becomes billable. But of course the client doesn’t benefit from this!

  • Alex,

    Thanks for the comment. My comment was more of just saying hi and hope all things are good in your world. I use smiley faces to try and convey friendliness. This is exactly what I meant when I said that online communication is rife with challenges and people can easily be misunderstood in their messaging. It is helpful to me when people are clear about their concerns or wanting clarification. If I don’t know what the issue is, I can’t address it.

  • Alex,

    Well I guess the confusion is mutual, as in this most recent thread. I’m not sure how we started with you thanking me for expressing my feelings and then it quickly moved into you expressing a feeling of vague confusion (without any clarification about what, exactly, is confusing). It’s a head scratcher. Now you are claiming that I’m “triggered” by this feeling you are having. If some online acquaintance feels confused by me, there could be so many reasons for this. All I asked for was clarification which you haven’t provided. Honestly, peoples’ emotions change all the time, and “confusion” is more a cognitive concept to me than a feeling like love or anger.

    Truth be told as I am processing your feedback, I feel annoyed. If you want to get down to feelings, there you have it. After all this back and forth I still have no clarity on what you have felt confused by.

    Be well.

  • Alex,

    It’s pretty easy to get confused by others over the internet. The truth is that most communication is nonverbal anyway, which is totally missed here. I really don’t have anything else to add. I’ll continue doing my thing, as you will continue to do yours. Have a good afternoon.

  • Alex,
    I can’t speak to your subjective emotional experience of my posts. If there is something that seems confusing, giving me some concrete examples may help me understand where you are coming from and maybe I can clarify.

    I will tell you that I have some ambivalence because I see merit to the various perspectives on the MH system. I think people have good reasons for how they feel, such as LittleTurtle with liking their psychiatrist and believing in the concept of “mental illness.” I can also see why other posters feel that the system needs to be abolished. I am still trying to figure out exactly where I stand in all of this. I am not anti-psychiatry per se but also have become dismayed by the practices psychiatry endorses. All I can say is it’s a journey and I don’t expect to have it all figured out anytime soon, if ever.

  • Alex,

    “I have to say, Shaun, after all the dialoguing we’ve done on and offline over the last few weeks, I honestly don’t know in the slightest from where you are coming. You confuse me, and I do wonder why it is I’m feeling this from you?”

    I don’t know what you are talking about. Can you clarify with examples?

  • Fred,
    You make a lot of good points. All I’m saying is that there are plenty of “service users” who feel similarly to Littleturtle in their experience. That is a fact, whether anyone here on MIA likes it or not.

    I’m definitely not a fan of psychiatry these days; I see little value in what they do with overdiagnosisng and overprescribing. However, it does remain that many folks do believe in the “mental illness” paradigm and find it helpful in addressing their concerns.

    My guess is that the doctor does believe in mental illness but thinks it’s over diagnosed. I’m guessing they think that there is clinical mania, for instance. I, for one, have seen the damaging effects on peoples’ lives who have experienced this level of distress.

    I frankly have no idea if mental illness is real or not; I have yet to see hard evidence to support the diagnostic categories.

  • Oldhead,

    Most people in outpatient treatment are there because they choose to be there. Versus involuntarily inpatient which one would have to go to court to fight to get out of. Of course there are exceptions where people are on a short-term cert on an outpatient basis, and they’d have to also go to court to get off the cert. I don’t support certs, as I think they are ineffective and we shouldn’t forcing anyone to take psych drugs they don’t want to be on.

    I’m curious, it seems that by your response you think they are not that different. Can you say more?

  • Littleturtle,
    Thank you for providing your experience with your doctor. You are not alone in your experience “with the system.” Certainly, many people do find relief working with their doctors. I’m glad to hear that you are one of them! Your doctor seems open-minded and moderate in his beliefs, which I wish was the case for all doctors! I also like that your doc shows their human side. We need helpers to do more of this IMO.

  • Well said.

    “If a client transforms, its because they transformed themselves.” I agree completely that if someone makes changes in his/her life the kudos goes to the person who did the hard work to get there, not the therapist.””

    Very true. I can take little credit or blame for how my clients’ lives turn out. I mean I only see them about 1-3 hours a month!

    Also, if a client struggles, it isn’t necessarily because the client is “resistant”, “non-med compliant”, “personality disordered”, or “difficult”. It could also be because the systems they find themselves in are the problem. For many years I struggled as a counselor with the concept that poor outcomes are a matter of life. I worked with folks who are homeless, and it was difficult to see them struggle so much to survive. I got angry at hospitals for discharging these folks to the streets when they were still medically compromised. The various systems, not these individuals, are at fault. Social Security doesn’t get people benefits who need them quick enough. The local housing authority is inadequately resourced. Affordable housing is wholly under supported. Access to quality healthcare, like dental and vision, is usually lacking. And so forth…

  • Jancarol,

    You make good points.

    ““I have to function, so I’d better see a professional who will ensure that I do.” That’s the bootstraps, and it’s actually the “easier” path based on our societal norms.”

    Let’s be clear, though, that I as a professional don’t have the power to “ensure” that people function. All I have the power to do is listen, validate their feelings, provide encouragement, and provide potential resources in the community to help the person get their basic needs met.

    When I say voluntary treatment, all I mean is that the person ultimately decides to walk through our doors without being forceably coerced into doing so. They could not come, and possibly deal with other life consequences as a result. I don’t control that as a counselor. If someone says they are here willingly, I take that at face value. If they say they want to work on X, then I can be here to walk on that journey with them. If they say I want to be closed from treatment, I will close them.

    In life it’s near impossible to say any behavior is 100% voluntary, since we are products of our environments and we are conditioned to behave in certain ways by our families, communities, law, etc.

    I would just note that there is a huge difference between involuntary commitment at a hospital vs. outpatient clinic.

  • Oldhead,
    “Maybe because only a foolish or erratically self-promoting person would presume to answer such a general question, as the answer will be different for each person experiencing such anxiety.”

    No, I never said that there is one answer the question I proposed. But the fact remains that if someone is suffering from severe anxiety or something else very disturbing, they may want or need assistance in coping with this real pain. That is the point. I frankly don’t care where people get help and support, but it is clear that many folks need this outside of their friend or family groups, because what they get from these circles is often unhelpful or completely minimizing or damaging. Most of my clients come to me because they don’t get what they need from other areas of their lives.

  • Thanks Catnight. I only rely on DSM categories because my current job requires me to do so. I don’t buy into the DSM, and I tell my clients such these days. I hope we can one day get away from all these labels, because I don’t see how they help and often cause more harm than good.

  • True, Oldhead. Very few people work within the system with the intent of challenging the status quo. Stephen does stand out, and should be commended. I am doing this now in small ways and I see how nearly impossible the task is. I talk to my boss and I just want to scream sometimes. I see why people like yourself feel the way you do. I hear comments like, “This client has X diagnosis, so you should try to get them to see the doctor because they should be on an antipsychotic.” There is a certain narrative that is created with diagnosing, and quickly “professionals” like my boss think they know what is best and the right treatment for the client. In this regard no doubt there is a tremendous amount of ignorance, hubris, assumption, and arrogance in determining what the appropriate treatment should be. I do see why people think this kind of treatment is overrated and actually dangerous. My clients who get off psych drugs often look and feel better, but I’m pretty sure my boss wouldn’t understand why this is the case. They are clearly indoctrinated in a profound way.

  • “My job not being talking to child molestation domestic violence victims, it is not an issue with me.” But you say that they need to learn to deal with their anxiety. So how would you suggest that someone deal with their anxiety who went through something like this? I doubt you’ll give me an answer because it seems you aren’t offering any solutions for chronic, debilitating anxiety. But it sure seems like you have concluded that it’s the suffering individual’s fault for not figuring out how to quell their anxiety. What does “put it into perspective” even mean? Well I tell you this is one thing we offer in therapy, but I get the sense you are against this treatment as well.

  • Steve,

    “Ironically, with the current diagnostic system, the psychopathic killer is the one who is considered the MOST normal, as s/he doesn’t have any reaction to killing and watching people be killed.” No, that is funny. If they don’t feel empathy for others and get some sick enjoyment over watching people suffer or die, then they probably meet the criteria for Antisocial PD which is considered the most difficult to treat because we haven’t found a way to cure people from being cold and heartless.

    “Additionally, those who don’t meet the criteria for PTSD are given the message that they have “successfully handled the transition” back to civilian life, and the damage that has been done isn’t validated or brought to light, because, after all, to talk about this stuff is to admit that you are “disordered” and “need professional help.””

    Well just because they don’t meet criteria for PTSD it doesn’t mean they don’t have other challenges coming back from war, like depression or addiction to alcohol. Also, while I don’t know for sure, I doubt providers are exactly using the language as you describe. When someone has very bothersome symptoms, such as those associated with PTSD, they do FEEL disordered because they aren’t functioning like they once did. They are damaged and injured by trauma. Of course the situation is what caused these symptoms, but nonetheless it is the individual who is needing the help to heal. I know myself and many of my colleagues don’t see people we see as “disordered” but rather “disturbed” by their experiences and symptoms. I would be surprised if the VA is shaming people for having these symptoms which meet DSM criteria. But hey I could be wrong.

  • Stephen,
    I am in full agreement that our troops are traumatized by the horrors of war. My point is that most of them still do not meet criteria based on the DSM for the diagnosis of PTSD. I believe many of them meet criteria for other diagnoses, such as addiction, depression, generalized or social anxiety, agoraphobia, and so forth. The truth is that depending on how war vets are treated after their duty plays a large role in how well they function afterwards. WWII vets were heralded as heroes, given jobs, started families, etc., and we saw very few of them become homeless and hopeless like many of the more recent war vets.

    Vietnam vets, on the other hand, were called baby killers and spat on when they returned because the public sentiment was strongly apposed to the (stupid) war. Events like the Mai Lai Massacre didn’t help the public’s image or trust in the troops, but I believe most troops were not intentionally killing innocents. Regardless, Vietnam vets weren’t treated by American society like the vets that served before them. Even look now at how John McCain is treated in some circles by supposed patriots.

    And of course the VA falls way short of supporting troops once they’ve been harmed by war. We value troops when they are healthy and serving, but when they are sick and retired we discard them. Reminds me of how we treat the elderly.

  • Frank,

    “people need to learn to put their anxiety in perspective so that it isn’t debilitating.”

    Yeah, and how do you propose they actually do this?

    I wonder how you would talk to a childhood molestation/DV survivor. “You know, Sally, really you just need to put all this fear you have in perspective. You aren’t being molested any longer, and your husband isn’t beating you anymore, so you are safe now. Got it. Quit worrying and move on with life.”

    Frank people have real reasons to be scared or to continue to have persistent anxiety or depression, and sometimes that fear gets to the point they no longer are able to work, have friendships, socialize, pay bills, take regular baths, etc.

    You’ve made it clear that the MH system isn’t for you, and you seem to indicate that you have found other ways of dealing with distress that don’t involve the system. Great! Now, others can find their own path that works for them. I have no interest in recruiting people into the system that don’t want to be in it.

    I myself won’t be in it much longer, either, as I am frustrated with the bureaucracy, focus of quantity over quality, lack of time I get with my clients, being required to use the DSM, psych drug focus, and so forth.

  • Steve, you make good points. I don’t see any objective way for the MH system to gauge how effective it is. All I know is what people tell me and what I see happening around me. The reality is that people do ask for and want treatment because they are suffering. I think we help some people lessen their suffering, but there are also plenty of people who drop out of treatment or don’t show or report any noticeable improvements. The truth is that the MH system cannot remove childhood or adult trauma, which I think is at the root of why people come see us to begin with. We can help treat it through treatments like EMDR and TREM. I do know that pills won’t do it.

  • Frank,
    One, most conventional treatment is voluntary. Two, anxiety is on a spectrum, some of which is very mild and some of which is quite debilitating. I think if you’d talk with some of my clients you would see that this is the case. I don’t believe in “mental illness.” I believe that mental distress is real and damaging in peoples’ lives. That is all. It’s great that you don’t want traditional “treatment” for yourself, but it doesn’t mean that everyone else feels the same way.

  • Steve,
    I’ve yet to see this in practice. Most peer support folks I’ve met are doing the job of a quasi-case worker, such as taking clients to doctor appointments, talking to them, meeting with them in the community, riding the bus together, etc. I think a lot of this depends on the setting and treatment program goals. The truth is that there aren’t that many peer support jobs out there. They are still a small minority of the total number of employed folks in the MH system.

  • Steve,
    “Shaun, I don’t buy into this idea that either you accept a diagnosis or you are somehow telling people to pull themselves up by their bootstraps. I’m guessing Frank’s answer would be to find support among your friends and associates, though of course, I could be wrong, and Frank is capable of answering for himself.”

    I’m not making this argument. Frank made a comment which I was responding to. During this conversation Frank has made no clear argument for alternatives to conventional MH treatment for people who are suffering from distress. I find this line of thinking all too often on MIA, where people say “abolish the system” but offer few ideas as viable alternatives. Frank is also dismissing the reality that PTSD symptoms and other symptomatic profiles do cause real distress and disability in peoples’ lives. This is a fact whether people want to believe it or not. Psychiatry is not the primary cause of most people’s suffering. I get that some people think conventional MH treatment doesn’t help and makes things worse, but the reality remains that the vast majority of people keep coming voluntarily and ask for services.

  • Frank, not all anxiety is created equal. Some anxiety is pathological when it creates profound disability. Just ask anyone who is agoraphobic or who has severe obsessive thoughts and compulsive behaviors. But I’m sure you think those aren’t real problems, right?

  • Catnight, well said. I think basically all human distress is trauma-related. The way that trauma manifests, however, is different from person to person. The fact is that most people will never develop full PTSD symptoms. Other may develop depression or anxiety or addiction or……I will tell you that the clients whom I see who have severe PTSD tend to deal with the same set of symptoms for years if not decades. While change occurs all the time, for some people this process is a very slow and painful one.

  • Frank, so what should people suffering from PTSD symptoms do? I guess from your perspective they should just stop making excuses and pull themselves up from the bootstraps since they have a fake illness? You clearly don’t agree with the current system, which is fine. But what is your alternative for these folks who are clearly suffering?

  • Frank,
    These days the vast majority of mental health treatment is outpatient and voluntary. What I am talking about is this type of treatment. I’m not selling involuntary, forced inpatient treatment. I, like many others, support people’s choice to attain voluntary treatment if they feel they need it. that is all. And truth be told I don’t need to sell it at all. My clinic has a wait list of 1-2 months to get an intake, so we have an ample supply of people who want the support.

  • Frank,
    All humans are trauma survivors because we are alive and experience terrible loss, scary events, etc. The point is that some of us bounce back more easily than others do. We don’t know why that is, but clearly there is a phenomenon where some people don’t develop chronic and debilitating symptoms and others do. It’s not exactly like people choose to have nightmares or flashbacks and others don’t.

    It’s frankly BS to assert that some people “don’t want to bounce back.” Some people don’t know how to. What you might be referencing is learned helplessness, which also comes from childhood trauma and the MH system which can foster this belief within some people. Clearly many folks feel dis empowered, and any good therapy will help to address this issue.

    Regarding peer support, these are folks who have benefited from “treatment” genuinely believe that it’s helpful. I’ve seen many clients get much better and want to help others do the same. I see nothing wrong with this. While the MH system didn’t work for you, it works for plenty of others. If the system were really that bad as you say, then one would think there would be more of a public outcry. It’s a small minority of people who have been really injured by the system who are wanting the system to be abolished. But the truth is that the vast majority of people find some usefulness in seeing therapists and doctors.

  • Frank,
    I see all of these labels as various responses to trauma. The issue is that some of the symptoms people experience are horrid and not fun, which is why they seek professional help in the first place. If you think PTSD is “an excuse”, then clearly you haven’t experienced it yourself or have known anyone who has. Your tone sounds judgmental, as if someone would choose to suffer like that! By the way, the whole point of psychotherapy for trauma is to help someone empower themselves and create meaning and purpose in their lives after the trauma. It isn’t intended to enable clients to make “excuses” for why they are “sick.” A good trauma therapist will validate the pain, help the person to retell their story if needed, and to assist the client in seeking out meaning and purpose in life again. Judith Herman’s book Trauma and Recovery does a good job describing the process. As a final note, very few people in the MH system stay in treatment their entire lives. That is a small minority.

  • Stephen,
    I agree with you that folks with PTSD dx shouldn’t be placed on strong psychotropics. We do tend to try and “put a lid” on many symptoms with drugs, and too often it doesn’t help and can make things worse.

    While I agree that in the short-term people who display PTSD symptoms are having a normal reaction to a scary event(s), if the symptoms persist and cause the person loss of being able to function in everyday living, then it goes beyond what is normal IMO. When someone is disabled by chronic and persistent night terrors, panic attacks, excessive fear, intrusive memories, extreme avoidance, etc. it is not simply a “normal” response for these to continue. Most people who come back from war, for instance, do not meet criteria for PTSD. Only a minority do, just as a minority of people will experience more long-term symptoms described in the DSM. If PTSD were “normal”, then most people should be expected to develop these symptoms after a traumatic event. But that doesn’t happen.

    While I’m cognizant and concerned with labels, I find the PTSD diagnosis to be very accurate and fitting for people who experience these symptoms. When we say something is “wrong” with someone with PTSD, that isn’t exactly the case. PTSD is simply describing the functional impairment the person is experiencing. Clearly they aren’t functioning like others do without the symptoms. I think we can agree that is true.

  • Frank,
    How does PTSD lead to name calling? It’s a description of someone who is suffering from trauma with very specific symptoms of avoidance, changes in mood/cognition, intrusive thoughts, etc. The truth is that PTSD sufferers are in distress and looking for solutions to feel better. Stating someone has PTSD isn’t slanderous. Actually, the PTSD label is one that most folks perceive as being least stigmatizing, unlike Borderline PD, Bipolar, and Schizophrenia.

  • The problem with psych meds, like many other legal and illegal drugs, is it numbs people out. I guess most humans like that feeling at least occasionally, because life is hard. Unfortunately, people who get stuck on these meds for a lifetime usually don’t function better in the world. I would rather see psych meds used in the short-term, like less than 6 months, but that rarely happens. Docs have no problem prescribing meds that they think is helping the client in some way, as long as they don’t think the person is abusing them or getting high. There is so much wrong with this way of doing things, but that is how they are trained.

  • Rachel,
    The basic skills any good counselor possess does not come from good schooling. I think they either have empathy and compassion or they don’t. We have master’s programs because it legitimizes the field and state boards require it. But frankly there are many excellent healers and listeners out in the world who have no formal education in this area. In my graduate school we learned stuff that most of us will never use in our careers, like psychological testing and career guidance.

    Any good helper will empower and remind the person that they aren’t defined by any label (and that the label is BS). A good helper will listen and not give advice (mostly). A good helper will work to instill hope rather than hopelessness.

  • By the way, my brother has not been hospitalized or made any similar comments in years. I think he realized that he probably needed to take care of himself differently. So while it was unnecessary to take him to the hospital, he learned from this experience and is taking better care of himself.

  • What is the viable alternative in dealing with people who are an imminent danger to themselves or others? I guess we should jail those who are making threats towards others (even though they haven’t committed a crime yet) and just let suicidal people kill themselves?

  • I think my example points to why welfare checks happen. People should not send or say things that they don’t want used against them later. My brother made a choice to send that email, and he faced the natural consequences of that choice based on the current standards of the society he lives in. He’s no dummy. He knew his doctor had a legal and most would argue an ethical obligation to act on this information.

  • Well, technically people have these rights. I agree that accessing them is a challenge at times. No doubt people get traumatized by these interactions, but at this point I don’t see any viable alternatives that currently exist in society when someone is a danger to themselves or others. Obviously when hospitals are denying these rights, they should be held accountable.

  • Why do you think doctors, social workers, and therapists ask for welfare checks? It is because they have good reason to be concerned for the person’s safety. My brother emailed his PCP that he was suicidal, and so the doc reasonably followed up and the police came to our home. It was quite an ordeal. By the time the cops finally talked to my brother, he was feeling better, but they were so concerned about the content of the email that they brought him to the hospital to be evaluated (he was released later that night). If people don’t want to have welfare checks done on them, they probably shouldn’t say and do things which they know professionals will be concerned about. As a professional I’ve very rarely asked the police to do these checks, and when I have it is because the person has made threats to harm themselves, others, or I have good reason to believe that they aren’t in the state to take care of themselves at that moment (like not showering for a month or not eating).

  • Out,
    People do have alternatives. Online and in person support groups (Lifering, AA, ACA, HVN, Smart Recovery, Grief groups with numerous orgs, etc), churches, meet up groups, and so forth. The reality is that many systems have bought into a certain model of treatment and the DSM. Nearly every public resource–housing, income, food stamps, etc–requires a disability dx to be eligible. Poor people are trapped more so than the rest of us who are wealthier because we don’t require a certain DSM label to get our basic needs met. Clearly the system needs reformed, and I would say that if someone wants help and support, there are many ways to attain it. Psychiatry doesn’t really have a monopoly. Most people get their psych meds from GPs and not psychiatrists. People want relief which is why they (usually) go to doctors in the first place. It doesn’t mean that doctors are necessarily the best equipped to help, but that is what society has deemed appropriate for the time being.

  • Steve,

    “But once enforced “treatment” comes into play, there is literally no legal limit to how long they can continue to force you to comply, except for getting the AOT order renewed annually. There is no “maximum sentence.”

    Well, clients have the legal right to challenge a cert. I was on a jury where a guy challenged his cert and he won. Also, it is very rare for anyone to be held on a cert for longer than 6 months. This only happens if someone is deemed to be imminently dangerous to self or others, or gravely disabled. If someone is in the position of being on a cert, they would be wise to deny any SI or HI. If they can’t take care of themselves, well that is a different matter altogether.

  • Oldhead, the vast majority of people seeking help from psychiatry are there willingly. They are telling docs, therapists, and social workers that they are suffering. If they didn’t endorse the various DSM symptoms, then they would not receive any DSM diagnoses.

    There is very strict criteria that anyone can be held against their will. The law is clear about grave disability or imminent threat to self or others. That is it. Most people in the system have a choice to stay or leave, and guess what, most of them stay because they see some benefit to it for themselves.

  • Steve,
    While the diseases the DSM describes cannot be verified scientifically, the distressing symptoms people experience can certainly be treated. That is what we actually treat, not some arbitrary diagnostic category.

    Regarding Mirandizing, I think people should be fully informed that what they say can be used against them. If someone is expressing imminent SI or HI, they should be informed beforehand that clinicians cannot legally ignore this information. Most people would be better off with involuntary situations to either remain quiet or to tell the hospital staff what they want to hear. Most of my savvy clients know exactly what to say to appease hospitals so they can get out.

  • Boans,
    No, I am talking about people who are literally violent or threatening violence towards innocents.

    Your personal example is one where the doctor had an unfounded opinion of you. That isn’t justified. What I am saying, however, is that when we have evidence that someone IS violent or imminently treating violence, that intervention is justified, such as being held against one’s will. I have no qualms with this.

  • There’s a lot that can be done about the profit motive when it comes to healthcare. The problem is that big business buys off politicians who could (and should) change the system. We could stop allowing people who worked for big pharma to also work for the FDA. Also, physicians could be taught or retaught to only prescribe when it is a severe case. We have people being overdiagnosed and over medicated which is costly not only to human lives but to the entire system. Doctors have a responsibility to not give what their patients demand but to prescribe what is clinically appropriate. One issue now is that patient satisfaction scores are tied to employment for doctors, so doctors are much more likely to make the person happy with a script rather than do the right thing and stop prescribing so much. Medical schools and patient advocacy groups could stop taking big pharma money as well, but that would require finding a spine and standing up to the man. The question is who has the courage to stand up to the status quo?

  • Vanilla,
    In America we value capitalism at any cost. And the cost is high. Most people are ill informed about the real risks associated with psych and medical drugs. It’s not like consumers can easily find all the studies done on these drugs. There is so much superficial information available on the internet it is hard to actually find good information for the average person who doesn’t have hours to devote to such an endeavor. Doctors, not patients, should be who big pharma is “educating” on new drug therapies. I also think there needs to be a body who monitors this so that doctors get all the relevant information to them, not just the info that will make the pill look like a good option. Consumers usually have no clue about how all of this works, so why should we be marketed to? We are because it sells more pills, plain and simple. Big pharma wouldn’t do it if it wasn’t profitable.

    https://www.theguardian.com/media/2002/oct/23/advertising.marketingandpr

  • Vanilla,
    You make some good points. The problem with direct marketing is that it vastly increases the changes that pills will be prescribed. In other parts of the world which don’t have this direct marketing in place, people aren’t clamoring to see their doctors for the next new exciting drug to try. Americans take drugs in huge numbers and I believe most of this has to do with big pharma influence, including this marketing. Marketing works. They show healthy looking and attractive people doing fun things! Who doesn’t want that for themselves?

    Your latter point is an important one. I think that many people take pills for the reason you state. It is a way to help us get by in life. The reality is that no pill will take away someone’s trauma, which I think is as the heart of why people feel clinically depressed, anxious, and the like. If we don’t deal with the root cause, the symptoms will persist. Once drugs are stopped, the symptoms are often more worse than before treatment began. Also, we have to be real that “med adherence” is a real problem, so even getting people to take pills daily is very difficult. These pills help some people and harm many others because, in part, it teaches them to be passive. While this is a survival strategy it has poor outcomes in the long run.

  • Vanilla,

    “The thing is, you have hundreds of thousands, probably millions of people convinced that the drugs are an option worth considering.” The US is one of the prime consumers of drugs because we have direct to consumer marketing and insurance companies willingly cover pills. This is a farce and should be outlawed (marketing) but big pharma is buddy buddy with Congress and the FDA. Also, taking a pill is easier than doing other kinds of work to make ourselves feel better.

    “3 – where does the obligation to provide information on the drugs stop, and the responsibility of the consumer to investigate begin?” Good questions. It is our responsibility as consumers to educate ourselves as much as possible. Unfortunately, people trust others in positions of authority, so they believe what they are being sold without asking enough questions. We all should learn to be more skeptical. The last housing/mortgage crisis wouldn’t have happened if people A). did not buy a house they couldn’t afford, B) refused ARM loans, C) did their own number crunching to see if they really could handle the increase in payments, D) if lenders weren’t willing to give money to anyone with a pulse, E) if lenders did not receive bonuses for providing bogus loans, etc. The whole point of this is that if there weren’t people demanding home loans and if lenders were more judicious with handing out loans, there would have been no crisis. There is a similar phenomenon happening with MH care in the US. People want to feel better and find the quickest solution to meet this goal. And some find it in the form of pills.

  • Steve,

    “I would certainly want some legal advice before being put in the hands of someone who can lock me up or force me to take “meds” for the rest of my life.” I’ve never met anyone who has been forced to take pills for their entire lives. Most “mental health patients” can stop taking meds at will and often do.

  • I’m happy to hear you found a support system that worked for you. I’ve talked with many clients who’ve received no help from family, friends, or peer support (like AA), which is why they have come to the MH center. Too often they tell me that they are judged or misunderstood by others in their lives. In my work as a therapist I try and do exactly what your support system does, which is the listen, understand, and provide a safe place to process.

  • True, Vanilla. Humans have always used substances to change how the feel. I do think informed consent is something that is problematic because people implicitly trust doctors to do no harm to them. People have been conditioned to believe in doctors because they are a medical authority. What people fail to realize is that doctors are clearly fallible, and they have no real way of knowing what is going to help or hurt their patients. Many people accept that they are guinea pigs being experimented upon, and I think they should have that choice to try psych drugs if they think it is what they need. I think all providers, however, need to do a better job of informing clients of what the potential risks are.

  • Rasselus,
    I do agree with you that some people need to be temporarily restrained because they are a danger to others. There are people in the world who are a menace to innocents. This is where psychiatry has some value to society. The problem is that they are overmedicating and over treating, which is an abuse of power that posters on MIA have experienced personally and professionally. I think doctors have abused their influence and have strongly bought into psych drugs as an answer to human distress. They have also believed that hospitalizing people is helpful, which is usually not the case; in fact, most people find it to be further traumatizing and dehumanizing. Doctors probably mean well but the end result of their actions is too often harm rather than good. Furthermore, they promote the idea that mental illness is a scientifically validated, which clearly isn’t the case. Survivors from psychiatry have real reasons to be angry, including the horrid “side effects” from “treatment.” As a side note, people who are true psychopaths rarely seek out “help”, because they don’t see their motives, actions, or desires to be a problem. As a therapist I’ve rarely interacted with such people unless they are referred by the legal system.

  • Out, exposure therapy is one of the best know ways to help people cope with severe anxiety, which is what complex PTSD is. Avoidance is the hallmark of anxiety (in addition to intrusive worries), and until the avoidance is addressed, the anxiety will likely stick around and cause the person additional and worsening suffering. People with phobias, for instance do well when the go through the full exposure protocols. Also, EMDR for trauma is an exposure-based treatment which has shown positive results for many trauma survivors.

  • Rachel,
    Yes, we all should be angry by the “treatment” you received. Isn’t it strange that often people feel better once getting away from “treatment”? So many of my clients tell me that they have felt “drugged up” and “out of it” on these legal drugs that the docs prescribe. I don’t understand why these supposedly educated and smart doctors keep harming people but convincing themselves it’s “medicine”? Maybe, money? I’m sure some of them really think it helps, but it is just a pure rationalization I guess. I’m glad you got to a better place in your life away from the system.

  • Housing First is an excellent model but it is terribly underfunded. And Rachel is correct that many subsidized housing properties are terribly run and infested with bed bugs and other problems. In my community we are building one or two new subsidized properties a year, but this is wholly inadequate. We need 100x this many built but you know poor people aren’t an important political constituency.

  • They don’t just “need drugs”, but they also need housing, transportation, income, etc., most of which are dependent upon a “mental health diagnosis” and “treatment.” Without either of these latter two, most people will not qualify for SSA, DHA, Human Services, mass transit, or other basic needs (if they are poor). Secondary gain, or basic needs, is why many people seek out and/or “demand” psychiatric diagnoses.

  • Well said, Helen. It is clear that we need an evolution in how society treats those who have different experiences from what is (arbitrarily) deemed “normal”. It seems to me that there aren’t clear answers, either, because we live in complex societies which can cause distress on multiple levels–families, schools, churches, government institutions, mental health facilities–can and do create additional stress and trauma in peoples’ lives. I do believe we should get away from the medicalization of mental distress for all the reason’s MIA has articulately pointed out over the years. Burning all DSMs and stopping the practice of prescribing pills to everyone for just about anything would be a huge step forward.

  • Chris,
    Haha. This is also why it’s a bad idea to shop on Amazon after two drinks. Impulse buying is so easy to do with a click of a button! No worries.

    You make some very valid points. Modern society is oppressive on many levels. Additionally, since the twentieth century people started living significantly longer, and many of us, particularly in the West, had more time to think and ponder existential issues than in the past when we were hunter gatherers. Our mind makes us uniquely susceptible to overthinking and being too much in our heads (meaning, it’s hard to be mindful and be in the present moment). Humans are complicated and we’ve created complicated systems and technologies as a result, much of which has unintended results.

    Regarding society, one challenge I believe we face is that often people have nobody safe to turn to when in distress. Church used to be a source of community connection and support, but fewer of us are practicing, and those who are can become subject to abuse themselves (e.g., recent Catholic church cover up and molestation scandal). It also doesn’t help when young people are scared into submission with some religion which threatens them with hell and damnation if they don’t do as they are told, e.g., not be gay.

    Dysfunctional families/intergenerational trauma (eg., severe abuse, molestation, invalidation) are often the reason I see my clients in the first place. It would be wonderful if my clients, or anybody, felt they could lean on their families when they need love, support, and non-judgement. But to be frank in my experience personally and professionally, it is rare to find such a situation. Usually when people try to be honest about how they feel with family and friends, they are told they are “crazy”, “lying”, “wrong”, “have a drink”, or experience some other invalidation, which just adds further pain to the situation. Most people don’t act like counselors are trained to do (act like Carl Rogers). Most of our family and friends have preconceived notions of who we should be or how we should act. I as a counselor don’t have such agendas (other than to help the person move in a direction that feels right to them). I listen to them, validate their pain, and normalize their humanity without ridicule or placing blame onto them. This is what most of us want from our loved ones, but too often we get the opposite messages and thus feel worse about ourselves. Furthermore, there is so much history between family members, and thus people can quickly become defensive, blaming, shaming, and so on. I would never tell most of my family members how I really feel. I would either get no empathy and/or they would tell me “to get over it.” These are the messages that too many of us get from “loved” ones.

    One message I try to get across to my clients is that it is not they who are sick but rather the culture and environment which is toxic. I explain this is a good explanation for why they feel bad, why the struggle, etc., because they aren’t well supported by their communities, families, etc. My sense is that most of them still blame themselves, because this is the message they have received for virtually their entire lives.

    Regarding developing countries, it is like these individuals live on a different planet. I think 40% of the world doesn’t have access to clean water on a consistent basis. There are countries in Africa where life expectancy is around 40 years. When you are in this kind of environment, survival is always at the forefront of your mind. For most of us in developed countries, where we live in individualistic cultures that support a narcissistic attitude towards self, this is ripe for anxiety and depression. We have social media which continues to send us messages that we are inadequate, not attractive enough, not wealthy enough, not fun enough, not smart enough, etc. We have a lot of time to sit and ruminate, both about the past (which often causes feelings of depression) and the future (which causes feelings of angst and worry). If we haven’t figured out how to use our free time, it can literally drive us mad! And the 24 hour news cycle does nothing positive for our psyche, as it is distorted and superficial.

    All humans are self-interested, and you are right that this self-interest can keep corrupt and toxic environments afloat (e.g., Nazi Germany). I believe that I’m doing my part to help people tap into their inner strength and to help them see their gifts. I view my job as instilling some form of hope. I don’t believe this as some radical change for the world, but for the individuals who see benefit in this work, it can be life changing. I have worked with clients who after years of being in abusive relationships, eventually left and found more contentment in life (and safety!). I have worked with others who have gone back to school, started new friendships, stopped abusing drugs and alcohol, become more assertive, etc. I cannot possibly take credit for their hard work and efforts, but I do believe I played a small role in some of these positive changes that they made happen in their lives. These aren’t trivial changes, either. When clients who have experienced significant life trauma come to therapy, progress is usually going to be slow. But those who stick it out for a period of time begin to shift their view of themselves and thus their confidence to empower themselves to make changes that will better their lives in one way or another. I try and be careful not to make folks feel dependent on me, as I emphasize personal choice, responsibility, and freedom when doing therapy. I don’t tell them they are weak or need someone else to prop them up. I simply reflect what I see in them that they may not easily validate or notice was is within themselves. I hardly believe that this type of perspective is supporting the status quo. If I were truly supporting the status quo, I would be much more of a “company man” and telling people that it is they who are sick not the system.

  • Chris,

    Communities, friends, and family don’t want to hear about people’s trauma in general. Most of my clients also don’t want to burden their loved ones. Frankly when my clients have told their family about the trauma they experienced, particularly sexual abuse, it was not taken seriously or minimized, which created further harm and traumatization. I have little faith that my clients will be able to find adequate replacements for therapy if they had to find support elsewhere.

    Regarding what is considered “abnormal”, much of it has to do with the distress that the symptoms cause someone. This is usually when people seek treatment because they are unable to work, hold down relationships, or have other hardships due to their symptoms. There are plenty of people who hear voices, for example, but aren’t disturbed by the experience. These folks rarely seek out treatment.

    Almost exclusively I work from a Rogerian framework. I figure if I can emulate UPR, genuineness, and empathy, that is probably the best I can offer anybody. I try to keep it simple and most clients seem to respond well to this. I have a handful of clients whom I currently do EMDR with; I am still learning quite a bit about EMDR and it’s usefulness (or not). I know my training got EMDR for his PTSD and found it immensely beneficial, so he got trained himself and believes very much in it. I’m definitely not there yet when it comes to fully believing in EMDR. I think it probably does help some people, but I’m particularly skeptical that it can help almost any condition under the sun like some proclaim. I think it’s best for single event traumas like car accidents. We shall see over time.

  • Chris,
    You did not bother to ask me the context of what I was saying about EMDR. You don’t seem particularly interested in learning about my experiences with it, which is your prerogative. You allude to psychiatric “creep” even though psychiatry has nothing to do with EMDR.

    I don’t believe that therapy is the end all and be all for all human suffering. I think it helps some people feel better. That is about it. And of course it can do more harm than good.

  • I agree with much of what you just said, Chris. Our culture/economy is detrimental to well being on many levels. We probably also need to get away from “evidenced based practices” for the most part with therapy because in my experience it isn’t what clients want or find beneficial. I think therapy can help some people figure out how to make sense of this crazy world that works for them. Short-term treatment is en vogue because this is what payers will cover and everyone thinks doing the EBP’s will lead to good outcomes for most people. I think if you are dealing with minor issues, then yes. But for complex trauma survivors, short term interventions like SFBT and CBT rarely work.

    You threw in EMDR. I don’t see that as a short-term fix for most situations. More like 6-12 months for the people who have multiple serious traumas. The nice thing about EMDR is that it’s non-pathologizing and reduces the client’s “need” for psych drugs or long-term treatment. As an EMDR practitioner, I can say that I’ve seen people quickly start feeling better about their trauma and/or themselves after doing as little as one session with a light bar. I think EMDR out of all the interventions I’ve learned is the most promising for delivering on it’s promises of long-term symptom relief.

  • I totally agree with both of you, Steve and Chris. More and more I am seeing the MH system the same way. I will add that therapy still has value to those who need compassionate and empathetic people in their lives. In the West in particular we are isolated and not supported by our communities like other parts of the world. My clients tell me that they cannot tell other people in their life what they’ve told me because they will be judged, blamed, further stigmatized, etc. The best work I can do is to let my clients know that their story matters and that they deserve compassion rather than self-blame and judgement. I do agree that there is a certain dependency on the system that too often takes place, and that many clients do not give themselves credit for their hard work to feel better (I’d say much of this belief derives from childhood trauma and invalidation).

    Profound trauma often leads to a weak belief in self, believing that one is unworthy, inept, a fraud, and so on. These core beliefs are tough to shake for any of us. Due to my own childhood trauma, despite what others have told me about myself and my own accomplishments, I still struggle with some of these beliefs that there’s something “wrong” with me. I’m not sure if anything will “fix” this feeling I have about myself. I’ve seen some great therapists but still struggle with self-confidence and worth. I know that nothing is a panacea for human suffering.

    Thanks for all the great dialogue. I am glad to know I’m not alone in my challenges.

  • Alex,

    Thank you for taking the time to read my posts and for sharing your perspectives. I do greatly appreciate it. Your comments around awakening to me is similar to mindfulness/meditation practice. It’s a journey not a destination! There are so many opposing forces in the world and nature, and without one, we would not appreciate the other.

    I would certainly be up for communicating more. I don’t have a website since I’m not in private practice (yet). I’ll reach out to you through Steve. Have a great Sunday!

  • Alex,
    I also should mention that I’ve been on psych drugs before. I was put on them after my dad died when I was 24. I was grieving and my doctor suggested meds to help with anxiety (I was doing checking behaviors with locks and the oven). Looking back on it, I was not myself because I was upset and grieving. The problem as I see it is the medical model immediately thinks to medicate understandable human responses to life circumstances. I took myself off the pills after about 9 months because I felt I had processed much of my grief, but as a result I had heart palpitations for a couple days which freaked me out and was very uncomfortable. This is just a drop in the bucket to what people on psych drugs experience with TD, akathisia, and metabolic syndrome.

    I don’t recall my doc telling me about such things to worry about. I’m glad I didn’t get stuck on pills because from what I know about longterm risks and talking with my clients, it can be terrible trying to get off these pills. One of the main interventions docs are trained to provide is pills, and because of this they keep doing what they know, despite the harms to their patients. I think med schools need major reform, but you know until big pharma isn’t so influential, this is unlikely to change, which is highly upsetting.

    I have experienced social anxiety much of my life (12-35), ever since I was bullied as a kid (and my parents had what I perceive is a loveless marriage, which I got to see first hand, and my father was addicted to alcohol from when I was about 12 until he died), and in my twenties it was particularly uncomfortable, as I would get anxious and feel the need to escape the situation. This luckily has mostly resolved in my 30s, but for a period I was highly avoidant of anything which caused me extreme comfort socially. It was terrible. I can see why pills or other drugs would be an escape for people who feel so uncomfortable in their own skin. I still struggle with self-confidence issues and feeling ok being me. When clients tell me they appreciate my kindness and tell me I’ve helped them, my immediate (internal) response is to not believe them! I know from personal experience that trauma is at the heart of human suffering, which is why I don’t support pathologizing people simply because they have feelings or behaviors which are perceived to be “abnormal”. What the hell is normal anyway?

    One final note I’ll make is that the reason I still believe in my work is because so many of my clients feel judged, alone, with nobody else they can talk to about how they feel in their day to day lives; I hear it often from my clients that they look forward to talking to me because I listen, don’t judge, and validate their pain. I don’t try to change them, convince them that they are “ill”, or any of that BS. I normalize their pain and point out that it would be unhealthy not to have the responses they have to dysfunction and trauma. I deeply care about those folks who I work with; they are truly amazing, and I hope for all of them that they will feel that way about themselves one day. I feel it is a privilege, as they tell me things they haven’t told anyone else. This is why I think therapy can be very helpful, if done carefully and thoughtfully. I think we all deserve such treatment. I hate to see my clients drugged up, because more often than not they say they don’t feel very human when in this state. While I think a small minority of people do get better with psychiatry, the majority don’t.

  • Alex,
    I am more than happy to hear new information and perspectives that differ from mine, which is why I’m on MIA to begin with. If I just wanted to hear more of what I’ve heard for 15 years, I’d go to the APA and FDA for all of my information.

    You keep saying I’m projecting. What I am saying is that the fact that the MH system is starting to embrace non-pathologizing treatments for trauma is a step in the right direction. I agree with many of your criticisms about the MH system. The truth is that all large systems seek to keep themselves in power. We are all self-interested, and some of us are particularly greedy and short-sighted.

    Regarding psychotherapy, I also agree with you that it has the potential to harm clients. It also has the potential to make the client very uncomfortable because it’s asking them to challenge their beliefs, feel their emotions, consider changing the status quo if it isn’t working for them, and so on. All of these challenges are threatening and difficult to most individuals, as change is stressful. The other side is that some clients have become dependent on the system because they haven’t developed a strong internal locus of control. They believe they need others to take care of them, and no doubt the MH system has played a role in creating this dependency. One thing that has changed in the MH world is the idea of an “episode of care”. In other words, we don’t tell clients we expect them to be in treatment for life. Instead, we tell them we expect it to be temporary. Again, I think this is an improvement from the past where people were “stuck” in the system forever.

    I will also point out that clients keep demanding our services. If there wasn’t a demand, there would be no supply. We have people waiting 1-2 months to get into our center, so we aren’t dragging people kicking and screaming into treatment. They can also leave at any time, and we’ve made that clear in the informed consent. We also tell them that they do not have to see a doctor if they don’t want to. Personal choice is emphasized. This I find is respectful of the person.

    Take care.

  • Alex,
    I should be have been clearer. What it seems you are saying is that the system is getting worse. I am giving you an example of how the system is offering a non-pathologizing treatment option, which seems like an improvement. Do you not think this is an improvement from psych drugs? My point is the system itself is making EMDR even an option for clients, which is a massive improvement over psych drugs and CBT. People much higher than me support using EMDR, as they do with DBT because they believe it helps people empower themselves.

    What information am I missing? You imply that I’m ignorant of something. It seems to me you might feel this way because I haven’t concluded like you have that the system needs to be abolished. I will say I find this goal to be completely unrealistic. I don’t see big pharma and psychiatry giving up their profits or influence. I do hope that over time more people will be exposed to what MIA is talking about. We all should be critical of everything. Once the masses are on the same page, we will see substantial change. Until then, I will do my best to advocate for change that I believe in, as I know you’ll do the same. We should all speak our truth. I know mine is constantly evolving these days. Take care and thanks for the spirited conversation.

  • So Alex you seriously think that changes like offering EMDR is a sign that the system is getting worse? Please, I don’t get that logic at all. It makes me think you don’t understand EMDR or it’s philosophy. EMDR won’t “save the system”, but again I think it’s a step in the right direction towards nonpathologizing and compassionate care which doesn’t require drugs. It will actually mean that more people will quickly move through treatment and move on with their lives.

    There are also thousands of testimonials of people who say the system has helped them immensely. Everyone has opinions about whether it has been good, bad, indifferent, etc. I tend to fall on the side that we’ve done some good but also a lot of harm. This is why I believe we should abolish the DSM and stop over drugging the population. This is quite a radial perspective for someone who is currently in the system. It isn’t “my” system but the system a lot of people have influenced over decades. I do not like many aspects of the current state of affairs, which is why I’m changing my practices in a lot of ways, starting with informed consent. I am also advocating with my colleagues to do the same and be more transparent about the downsides of treatment with their clients.

  • Hi Alex,

    Yes, certainly we see this from different perspectives, although we agree in many respects, too!

    “because you seem to insist that the system/field can be reformed, and I’m saying it is beyond repair and doing way more harm than good, in any respect, way beyond the issues of DSM and psych drugs.”

    I’ll just point out that if the DSM and drugs weren’t in the picture, there is no way we’d be in this mess with iatrogenic effects, dehumanization, and pathologizing human suffering.

    The system in some ways is changing for the better. At my center 30-40 therapists have been trained to provide EDMR over the last few years. EMDR trainers have explicitly told us that the whole point of this treatment is to end treatment as quickly as possible, including titrating pills as appropriate. This is a paradigm shift from the idea of “lifelong patients” in community MH centers. This is a good thing.

  • I agree with you, Alex, that there are many paths to healing.

    There are thousands of social workers and counselors who don’t subscribe to the medical model, however, and I think many of them do good work with their clients. The issue is the medically-dominated systems. These systems view the person treated as “ill” and needing “treatment” with “psych drugs.” This is the core of the problem. We need a paradigm shift away from seeing individuals as fragile, incompetent, and sick. People are resilient, strong, and survivors. That is the message people need to hear. We all have fragile parts of ourselves, and these fragile parts need to be recognized and validated, not drugged up.

  • Digital media use is a problem for both kiddos and adults. The people who make this technology know it’s highly addictive. This is comparable to Big Pharma, because they know once someone starts regularly using (the technology, pills), it becomes very difficult to get off of and away from it. It’s capitalism at it’s finest….exploit people to make a profit! What’s scary to me is that most people who use “smart” phones (this is an ironic name) will develop some level of dependency on the technology, meaning they will feel anxious if they don’t have access to it, will crave using it, may develop irritable moods if denied access, and so forth. We are creating a mass of humanity in the developed world of people who have attention spans of gnats.

  • Any technology which encourages a short attention span will become problematic. We live in a world which is overstimulating. The internet is now designed with the idea that many people will quickly jump from one thing to another in short order. “Smart” phones are making us stupider and decreasing our ability to be mindful and sit with ourselves. This isn’t a good development at all. We are causing people more distress through technology.

  • CBT is superficial. That is the real problem with it. The larger truth is that for any treatment to be helpful, it probably needs to address the person’s trauma history. Mental health treatment isn’t necessarily the problem. The system this treatment is provided is more likely the issue. Community mental health centers are set up to focus on quantity rather than quality treatment. A good therapist will do almost nothing more than listen and validate. Some modalities like EMDR also have promise because they are nonpathologizing.

  • This article is pretty useless. Correlation also doesn’t equate to causation.

    “Examples of family strain that emerged as a result of treatment included a spouse who was distressed after his wife became less attentive and took more time for herself after being in therapy and a client who felt guilt and sadness after choosing to distance herself from a parent.”

    Um, this sounds like people making healthy choices for themselves. I’m assuming that in both cases there might have been good reasons for these individuals to make these choices to focus on their own needs and well being.

    Therapy isn’t some panacea for human suffering. It is one way some people can find relief from suffering but by no means is it a perfect solution. CBT in particular is very limited and doesn’t help people feel understood or validated. We all experience “cognitive distortions”, and to me this isn’t the root cause of most human suffering (trauma, especially in early childhood).

  • Sera,

    Thanks for your reply.

    “1. Why is it true? What about hospital *actually* helped the person? And what did they need to ignore/avoid/not be impacted by that was negative in order to achieve that positive?”

    I would say that some people report that the structured environment of the hospital helped them to change their temporary, distressed emotional state. Generally most people who benefit are the ones who are there voluntarily. I think that “forced treatment” usually is ineffective and too often traumatic. And when I say “beneficial”, I am talking about the person who feels heard by the professional, feels that they have other options than to do something destructive, feel more rational and less impulsive, and so forth.

    I would love to see society have other options in these cases which don’t have a high potential for traumatization. When it comes to forced treatments, the vast majority of my clients tell me that the treatment was unhelpful. This is why I do everything I can to avoid sending someone to the hospital who would be involuntarily going.

  • Richard,
    I did read your blog and you make a strong case for abolition. I would argue that people deserve the right to access current mental health care, BUT that they deserve to be fully informed of any and all negative effects from the “treatments” before ever starting. They should be fully informed that there is no scientific support for the DSM categories, that psych drugs often do more harm than good, that they deserve to have any and all of their questions answered, that they can choose to not engage in the system, and so forth. I do think that people should be able to voluntarily receive treatment like ECT and EMDR, so long as they understand all the risks. One concern I have about the MH system at the moment is it too often fails to fully inform clients before treatment starts what the real risks are. This to me is immoral and unethical to say the least. I have been paying much more attention recently to what I say in my informed consent at intakes, so clients know that they do have choices and that the MH system as it stands is not a scientific endeavor. I tell people that they are walking experiments with psych drugs. This convinces many of them not to see a psychiatrist at my facility, and I feel this is progress.

    I agree that “forced” treatment, like ICs, need to end. To me it’s apparent that this kind of “treatment” rarely works and is often dehumanizing and creates a sense of learned helplessness.

    Going back to what I said earlier I think that people who are voluntarily receiving treatment as usually the ones who tell me that it’s helped in some way–they feel less depressed, more motivated, more able to function in daily life, etc.

    Ultimately I think people benefit the most when they feel heard, understood, validated, and cared about as an equal human being. That is what I strive for everyday in my work. And hospitals are not the place to receive this kind of care.

    Thanks for the dialogue.

  • Thank you, Sera for your response and recommendations. Very helpful. I certainly provide informed consent to start off treatment, so anyone who feels acute homicidal or suicidal thoughts or intentions knows what my legal limits are related to confidentiality and contacting the authorities. I have been talking to my colleagues more about these kind of concerns, and I’ve been encouraged by their agreement and support. Hopefully we all can be a part of helping to change this system for the better.

  • Richard,
    Thanks for your reply. There’s a couple points I’d like to make. One, I think that it’s unrealistic to ask clinicians to not follow the law. We have invested time, money, and energy into getting education and training to do what we do. If we start breaking the law, as you suggest, we risk losing what we’ve worked to attain. Second, there are people who will do better after being sent to the hospital. I can’t say how many exactly, because that would require some complicated study. But I know that some people feel it helps. The problem is that we don’t have alternatives to hospitalization, which is of course traumatizing to some folks and makes things worse. Many folks in my area who are hospitalized are actually there voluntarily, because they don’t feel safe in their homes, or because they are seeking 3 meals and a bed (homeless folks), or because they feel they need some additional support.

    “Ironically, if that person DID take their life after getting out of a forced hospitalization (that you initiated by your actions) you would suffer absolutely NO professional or legal consequences. Instead, you would only be praised and consoled by other professionals, who ALL want to self justify and reaffirm the workings of an oppressive system that they knowingly AND unknowingly continue to “enable” with “mandated reporting.”’

    You are correct except that professionals don’t believe that it’s an “oppressive system”. Most people in the system, both clients and staff, believe that it’s a helpful system overall. There is an important role of mandated reporting, because we should protect vulnerable individuals in our communities. If a child or elder is being abused, we can’t just sit by and let this slide.

    I will say that my clients tell me that overall hospitalization wasn’t helpful. I think this is because it feels dehumanizing and is humiliating. We need other options, that I’m certain of.

  • Thanks for the reply Sera. Regarding clinicians influence on docs, I think it depends on the setting and the situation. Most doctors I’ve interacted with, both in outpatient and inpatient settings, seem to listen to me but make their own determination. When I’ve sent a client to the hospital I’ve never seen the doctor defer to my opinion. I’ve actually felt more dismissed by them rather than felt they seriously cared what I had to say. But maybe my experience is an outlier? I venture to guess that for clinicians who work in hospitals this is probably a very different situation. Nearly 100% of the MH holds I’ve initiated have led to the person being seen in the ER and released within 10 hours.

  • Ken,

    I forgot to mention that yes only MDs in hospitals in my state (and I think most others) can decide to keep someone for a 72 hour hold or longer. As someone with an MA in counseling, my only ability is to initiate the process. In most cases I see ER’s will quickly discharge the person back to the community (probably because it isn’t a money maker for hospitals to have inpatient stays for “mental health patients.”) However, the folks with the good insurance coverage are more likely to get unnecessary “services” IMO. We should take the profit motive out of healthcare, but that is a completely different thread.

  • Hi Ken,

    Thank you for the reply. This is helpful. I like your approach of joining with the person. I do agree with the premise that covering one’s anxieties through focusing on liability is common and unhelpful to the person who is suffering. There are examples where professionals have been blamed when they have not warned people of threats or been assumed to be ignoring potential danger signs (I think of the Aurora, CO, shooting where his treatment team was assumed to have missed something). CYA is common in the medical community, and I do feel this is often why we are doing risk assessments and Columbia screens all the time.

  • Steve,
    Your kids were lucky to have parents who were very invested in fitting the situation to their needs. Unfortunately, there are millions of kids who don’t have the same opportunity, and thus they struggle in the school environment which does not cater to their needs. Also, I’d venture to guess that the bulk of these kids are growing up in difficult households/communities, so of course trauma plays a role. The “identified patient” should not be the child.

    Because I’ve only worked with adults, I feel most comfortable in stating that ADHD symptomology seems like a legitimate construct for some people. One problem is that virtually everyone performs better on stimulants because of increased focus and concentration it provides. I think people can learn to cope in ways which are effective for them in adulthood, and that providing stimulants does more harm than good for those who struggle with these symptoms. I have had clients who get addicted to their stimulants and get quite depressed and lethargic off of them.

    If the world was set up to work for people with ADHD symptoms, there would not be a problem. Unfortunately, we live in an often inflexible and overstimulating environment which expects people to “act a certain way” otherwise they are deemed “a problem”, hence the appeal of psych drugs. Ironically in America we value conformity despite our ideal of individual freedom and personal choice.

  • Stephen,
    I agree that more money needs to go into providing basic needs. I would also postulate that some people (kids and adults) have a combination of: a tremendously difficult time staying focused, feel like they have an inner restlessness causing them to be fidgety, being easily distracted, experience impulsive behaviors, often have trouble waiting their turn, also have a tendency to get hyper focused on one thing and ignore everything else around them.

    I suspect that some of this is neurological, but frankly we don’t know why some act this way and others don’t. In many cases people with this group of symptoms are very successful adults; I work with many of them in my office! The problem is that for some people this set of symptoms causes functional difficulties with work, relationships, school/learning, finances, etc., which can cause significant distress. I think schools should be structured differently to enable kids with these differences to learn in a manner which suits them, not the other way around.

  • Sera,

    Thank you for sharing this moving and courageous story. I do have a question for you. As a therapist myself who works in a state with laws requiring me to send someone to the hospital who is “imminently” reporting a plan, intent, and means to end their own life or someone else’s, how would you advise me to navigate these situations? If I do not send someone to the hospital to endorses imminent intent, I am subject to losing my license, job, and ability to work in the mental health system (or as an independent therapist). I rarely send clients to the hospital as it is, maybe 2-3 a year, and they have all been voluntary. Over the last decade I’ve maybe sent one person to the hospital who did not want to go, and as I recall they were seen and released from the local ED.

    Personally, I think the way you interacted with David is most respectful and honoring of that person’s experiences. Clearly forced hospitalization is rarely appreciated or beneficial to the person who is experiencing it. Quite the contrary, it too often is traumatic, dehumanizing, and increases risk of suicide. I find the entire system in this regard to be inadequate and unjustifiable.

    I do think a person should have the right to end their life if they reasonable deem this to be the best option for them to end their suffering (I don’t, however, when it comes to homicide, which I think is a reasonable position). This is not a position the system takes. I have also seen many people temporarily feel suicidal or homicidal but quickly change their minds after having a few hours or days to think it through. The system intends to create a situation where an upset person can be “safe” until they are more “rational” (e.g., don’t plan to end their lives or someone else’s), but the reality is that hospitals do a poor job of making anyone in distress feel heard, cared about, and respected.

  • Steve,
    I do see how this could play out where I work as well. I feel that my social worker and counselor cohorts are often in agreement with my positions on pills and diagnosis. Unfortunately, I can’t have these conversations much with docs or management. They just have bought into the system and are most “yes men”. Large agencies like mine feel like the military–with values placed on order, chain of command, following directives from above whether you agree with them or not, debate on serious issues not encouraged, doctor being the center of care, etc. The way large entitles operate tend to diminish and dehumanize the worker and therefore the people we serve as well. There isn’t meaningful discourse happening between management, staff, and clients. The management tells the staff what to do, and then we do it whether it is helpful or not to the client. If we don’t do X, we get punished or threatened. I can see why people like you, Steve, got out of the system.

    I will most likely be out, in part because I’m going rogue by highly encouraging my clients to/inform them: A. end treatment, B. reconsider taking pills, C. get off pills ASAP D. tell them their diagnosis isn’t scientifically valid E. point out how they are being coerced into treatment. I feel this has been freeing, and I’ve been glad to see that some of my clients have made significant and meaningful steps to make changes in their care. I saw someone recently who weened off Risperidone after our conversation, and they were thanking me for pointing out that their family was a likely contributor to them taking pills (as well as other factors), and that they feel much better off these pills. That made my day. I felt like that was real progress for this person. It of course also makes me angry (at big pharma, doctors, etc) that people actually feel better off most pills. The system is set up on a bed of lies and mistruths, and since people are taught at a young age that “mental illness” is a chronic condition which “needs treatment” to get better, people coming in for services have been indoctrinated for a long time that “treatment” makes one feel better. They’ve also been taught to think that they are the problem (their brain) rather than environmental circumstances. Big pharma can’t make money, or hasn’t figured out to, on treating toxic environments.

  • Out,
    Totally agree. Ironically, dehumanization is common in the medical field. Stigma is also real. I would be afraid to tell my boss that I struggle with anxiety, for example, because that might be perceived that I can’t handle my job.

  • I think doctors are at a higher risk because they are often perfectionists and ultra competitive. Inevitably, when they can’t “fix” people they try to help, they feel like a failure. I also think that depression is quite high in this group. They are very intelligent academically, but often socially and personally they struggle.

  • I think the reason we call it mania is because it’s easier than saying: increased goal directed behavior, impulsivity, increased energy, talkativeness, grandiosity, decreased need for sleep, and irritable moods. Of course context matters when people are feeling depressive, manic, hearing voices, and so forth. Certainly, depression or mania “can be the problem”, but usually there are other circumstances which are leading to the person’s feelings or behaviors. My point is that mania by itself, the collection of symptoms mentioned above, can and is very destructive in peoples’ lives, because they do things they normally wouldn’t do during these periods of increased energy and impulsivity. Any good clinician will find out the context to the person’s life of why they are symptomatic. However, that is not always clear to find a cause.

  • I apparently wasn’t clear. I’ve seen people’s lives turned upside down because of unresolved mania–like losing jobs, relationships. housing, money, health, etc., because their symptoms were out of control. This is not about medicalizing anything. This kind of mania is dangerous for the individuals who experience it. I don’t see how what I’ve said is paternalistic? If someone literally is falling apart, I think it’s unethical for society to do nothing about it. People need support in such circumstances. They need to know that people care about them, are worried about their safety, etc. I don’t believe pills should be the first treatment, but certainly there are plenty of people I’ve met with who said that Lithium was a lifesaver for them because they were able to regain control of their minds, their actions, their self care, and so forth.

  • Thanks for the response, Alex. The truth is that the internet will always be a place of conflict and disagreement. I prefer face-to-face interaction much more because it fosters more understanding and appreciation for context. There will always be differences of opinion about what is best and what needs to change in society. The world is not black-and-white, and because of this it causes us all some level of anxiety in terms of understanding and acceptance of it’s complexities. You are right that arguing on the internet rarely solves anything, and too often subjects ourselves to more anxiety and upset.

    To be frank, Alex, I don’t think posting on MIA is going to change much. I think the best way for all of us to change the system is by advocating for change at the levels of power that can actually make a systemic difference. We do need to reeducate the world when it comes to “mental illness”, as clearly people have been told lies. Unfortunately, MIA isn’t in the mainstream, and so very few people even hear the messages about real concern for the status quo. I don’t know what the answer is, other than focusing on ourselves and our choices and advocating for systemic change (beyond posting on an internet forum). I, for instance, can stop working in a system which I think is very flawed. That won’t change how the system works, but I will at least know that I am following my own ethics. Be well.

  • Stephen, I agree that the bulk of quality therapists go into private practice. The worst ones are in state hospitals from what I can tell. Hospitals can be pretty dehumanizing, and rarely do people feel better after experienced “the treatment.”

    I do expect to be in private practice in the next year or so, because like so many others, I have ethical concerns about how the system operates. I know for certain that we don’t need to diagnose in order to help (aka, listen and validate emotional pain). I also know that having a caseload of 80 clients is insane and doesn’t allow for clients to be seen nearly as frequently as ideal so they can move on with life sooner. In my view nearly all treatments should be short-term, but unfortunately people do get stuck in the current model being told they need lifelong treatment, like someone with diabetes (I tell my clients to think of treatment as short-term and that they don’t have a discernible illness like a bone fracture or cancer).

  • Alex,
    Not surprisingly you didn’t respond to my points about EMDR. I think that is because EMDR contradicts your general perspective of the MH system as being abusive. EMDR is non-pathologizing and quite compassionate. I do wonder why nobody on MIA has posted a blog about it? Strange, don’t you think?

    You are fine to think of me as an “enabler”. You aren’t in the room with me and my clients, nor do I think you have ever visited my MH center (in Colorado), so continue to generalize the entire system without having any direct experience with what I am doing NOW.

    I understand that plenty of people feel harmed by the system and that the system has failed them. I also understand that the folks on MIA are only one segment of people who have been in the system. There are tens of thousands of people who also feel helped by the system, so how do you reconcile this?

    I don’t believe the MH system has entirely failed everyone. I think that we live in a toxic world of capitalism which views everyone as expendable. The problem is much larger than any one system. SSA, Congress, Housing Authorities, Big Business, Legal system, and so forth are all contributors to human suffering.

    The reality is that many clients come in to see me because of early childhood events in their lives. They also come in because of other unmet needs, like housing or income. They do not feel it is the MH system which is the main culprit in their lives. MIA posters have had particularly bad experiences in the MH system, but it’s distorted to think that their experiences reflect everyone’s experience in the system.

  • I think it’s unfair to say “most of the community MH centers have not real desire to actually help…” Sounds like this is your experience with ONE MH center, so again it’s unfair to generalize to ALL centers. My MH center works with people to find jobs, apply for SSA benefits if they want to, go back to school, attain permanent housing, attain basic needs like clothing, furniture, and food, and so forth. Clients choose here if they see a doctor. They choose if they take pills or not. I think everyone should have these choices so they can decide what is right for them. Also, the MH center you describe is more of a pill factory, sounds like how PCPs operate, not how MH centers run in my state. In my state every MH center has more therapists and social workers than prescribers. Also, in my state psychiatrists are too busy to deal with MH courts. There are very few people who are actually court ordered for treatment here. Most short-term certs are dropped after folks leave the hospital after a week. Twenty years ago the landscape looked a lot different. I know of clients who spent years hospitalized for things like basic depression, because unfortunately insurance companies willingly paid for such “treatment”. This to me is unjustifiable and unethical treatment.

  • Good points. I would just add that for someone to be considered clinically manic, their symptoms need to be causing significant distress or impairment in social, occupational, relationships, financial areas of functioning. Mania isn’t unacceptable per se, but rather can cause additional trauma in the person’s life, which is why it has clinical significance. It’s isn’t just some benign experience, like having a dream or temporarily feeling sad. Unresolved mania can lead to hallucinations, starvation, homelessness, attaining STDs, and other horrible maladies. I think this goes beyond just a simple inconvenience.

  • Well said, Richard. I like your conceptualization of mania, it’s purpose for the individual to cope with intense emotional pain/depression, and how it can become very problematic way of being in the world. I do also see it as an avoidance strategy, and a manner to feel better about life in general, albeit temporarily.

  • I disagree. Mania is legitimate concept because it creates all kinds of havoc for those who experience it. Someone who isn’t sleeping for multiple days in a row (drug free), experiencing distressing racing thoughts, engaging in dangerous impulsivity (like having random, unprotected sex with multiple partners), experiencing unrealistic grandiosity (thinking they are god-like), is a real phenomenon. I’ve met with people who feel and behave in this way, and it never ends well. While mania isn’t something we have a test for, it sure seems like a real concept for those (adults) who have experienced these symptoms.

  • Well said. Dysfunctional homes create all kinds of trauma that functional ones never will (this is on a continuum, of course). I’m not sure if there’s direct sexism, but it’s the female that is patholigized in this article, so I see why you feel that way. I also don’t think the first example of Billy fits with “mania”, because to be manic someone needs have multiple days of decreased need for sleep, racing thoughts, dangerous impulsivity, unrealistic grandiosity, and so on. If someone can pull off such an event, they aren’t manic. They are a passionate enthusiast!

  • Alex,
    We don’t live in a world which embraces different experiences like “psychosis”. We are too often pushed in a direction of conformity.

    Most of the people I see who fit this experience of psychosis are folks who are hearing derogatory voices, fear that the government is harassing them, thinking their house is bugged, and so forth. These folks are disturbed by their experiences and it’s been difficult for them or myself to see how it is “transformative” in any sense. Unless you consider terror transformative.

    I’m glad to hear that you admit you are generalizing. I get that your experiences fit a certain perspective, but it doesn’t mean that the field on the whole fits your experience. I have also experienced some of what you have as a client and a therapist, and I can say my experiences have been mixed. In general I find that independent practitioners are more likely to treat their clients without having to pathologize their experiences.

    I will also note that my agency, the largest in my state, has spent at least $100,000 to train and supervise clinicians on EMDR. This treatment is specifically designed to end treatment as soon as possible. The EMDR model is nonpathologizing. This goes against what people on MIA generally think of community MH settings. We are aiming to end care sooner rather than later, because we recognize that when people stay in the system forever, they often don’t improve and sometimes get worse. EMDR therapists work with doctors to ensure that medication dosing is lowered and tritration occurs as EMDR begins to show signs of improving client well being and symptom profile. The end goal is the get the client off any psychotropics. MIA should celebrate such models and see this as true progress. However, I’ve yet to see an EMDR related article on this site. I’ve searched for one in the archives and can’t find anything. This doesn’t surprise me, since the bent on MIA is against most mainstream treatments. That is unfortunate because it does provide real relief to folks who suffer from various forms of trauma.

  • Alex, I’ll also mention that I notice quite a bit of over-generalizations made here on MIA when it comes to psychotherapy. There are so many different types of therapists with varied modalities. To say that ” (all) therapists are trained…” is simply ignoring the fact that all therapists are trained differently. There are therapy programs which focus on somatic work, career guidance, Gestalt, etc. Also, most therapists I know don’t take insurance and thus don’t diagnose. I think the majority of therapists whom people are talking about on MIA as unhelpful or abusive are those who work under psychiatrists in the medical model. Therapists in general aren’t trained with a heavy medical focus. In fact, for most of us there is only one “abnormal psychology” class we take in undergraduate or graduate school. We don’t see our clients as inherently ill or disordered but rather resilient and creative.

  • I would encourage you to read up on Internal Family Systems by Schwartz. This model posits that we are all multiple selves, comprises of various parts and a “core self”. A person’s maladaptive states (e.g., self harm) are consequences of the loss of harmony in, and polarization of the internal self-system (such as when early childhood trauma occurs). Anyway, there’s a lot more but the point is that this view of the world isn’t pathologizing or “othering”. While therapy doesn’t work for some people, it surely helps others. I think for the people on this site unfortunately they’ve experienced the worse the system has to offer. There are many great therapists out there.

  • Fiachra,
    I’m curious what you think of someone who experiences delusions? I have worked with clients who seem to have a disconnection from reality (which is the basic definition of psychosis), and I have had no problems connecting to them based on their emotional state, like fear or anger. Using the term “psychosis” is no different than talking about depression or anxiety. To me it is simply a temporary emotional/sensory/cognitive experience (although many of those whom I work with would say it feels more permanent, like ongoing hopelessness or suicidal thoughts) People I work with who experience symptoms of psychosis aren’t permanently in this state, which is why I object to schizophrenia as a diagnosis, for instance. Also, we have no scientific way to measure these experiences.

  • “Overall, these findings demonstrate that “providers in the public mental health system typically interact with clients in multiple, multifaceted ways, struggle to meet overwhelming human needs (and degrees of socioeconomic disadvantage) and navigate complex moral and ethical challenges, all under the auspices of a heavily bureaucratized and underresourced service system.”’

    This sums up the challenges quite well. A large number of clients who are seen by community mental health agencies are significantly under-resourced and thus have many unmet basic human needs which they are attempting to get met through multiple bureaucratic government and nonprofit systems.

  • Steve,
    “The replacement will only be better if those who replace it have different intentions in designing the new system.”

    There’s a proverb, “The road to hell is paved with good intentions.” https://fee.org/articles/3-policies-with-good-intentions-and-tragic-results/

    “But there is no way that change happens until/unless the reality of the current system is thoroughly exposed and discredited.”

    I do agree with you. I just wish the audience was larger, and hopefully continuing to shed light on these injustices will move us closer to real change. Also, in my estimation much of the problem lies in that the majority of people are still content enough to engage in the current system.

  • Steve,
    I don’t disagree with anything you said. Systems, like people, are flawed. I just don’t see much of a viable alternative. Systems of power have existed in all civilizations since the beginning of time. Systems keep themselves going because people are all self-interested, from top to bottom. Of course the people running the system are benefiting the most. Just look at Congress, most of these folks end up much wealthier by the end of their time in “public service”. Then they go into lobbying or some corporate enterprise to enrich themselves further.

    I often hear on MIA that the system should be abolished, but how does anyone really think this will happen when the cards are stacked against change for “the people”? The DSM and psychiatry are very powerful. Obviously, people working in these systems can get out or advocate for change, but unless everyone does this, the system will perpetuate itself or just morph into some other dysfunctional, unjust system. Change too often happens at a snails pace, unless of course we look at ADHD or childhood bipolar diagnoses…these developments have happened quite rapidly because of the powerful interests involved! The people on MIA and elsewhere don’t have the financial influence to impact the world the same way big pharma does. That is the sad and frankly depressing reality to me. The world runs by monied interests. Capitalism, like frankly all economic systems, are heavily flawed and predatory. I have yet see a system which doesn’t screw over a large group of humans. No wonder why people think, “What is the point?” I ask myself this all the time these days. I feel dejected. Corruption is everywhere, and people continue to suffer. There is genocide happening right now in Africa, yet who is outraged? People are being drugged out of their minds in the West, yet who really cares? As you can see I feel a bit dejected and pessimistic at the moment because from what I can tell the masses are being constantly distracted while the 1% who run the world do as they please, sailing in their yachts, vacationing in the Alps, going to 5 star restaurants, being chummy with “world leaders”, buying $200,000 cars, and the like. The rest of us are just trying to pay rent and survive day to day.

    I would love to see unjust systems be abolished, and it seems to me that the replacement won’t necessary be any better because inevitably the powerful in society will find a way to benefit the most.

  • Hi Alex,

    I certainly respect your decision to take a break from the dialogue. I have appreciated your openness and willingness to talk with me.

    Regarding systems in general, I see both good and bad. I can tell you that one reason I continue to believe that the system is worth saving is that people get their needs met through these various systems (housing, healthcare, food, clothing, shelter, jobs, education, human connection, etc).

    Also, I know that many clients come to see me because I am literally the only person they believe they can honestly share with how they really feel. Many of them feel judged or minimized by family and friends. Some have told their parents about being sexually abused and the parents denied it happened. Or they say they are depressed and their loved one asks, “Have you taken your pills?” Or they tell their friend they are anxious, and the friend offers them a beer. I could go on and on with examples of people in my clients’ lives responding in ways which are more harmful than helpful.

    They tell me therapy is a safe place where they can be honest and vulnerable.. There is definitely value in “therapy” for this very reason. There are millions of Americans who feel totally isolated and lonely, and if they can find some solace by coming to see me, feel a little less lonely/more hope, then to me it’s worth it. The system I work in is far from perfect, however I believe the human connection piece is very important–letting people know that their story matters, their suffering matters, their lives matter, their dignity matters, their basic needs matter, their existence matters. Too many of my clients have received the exact opposite message most of their lives from parents, teachers, students in school, and so forth. Chronic poverty, limited economic options, drug addiction to substances like heroin and meth–all of these issues and more my clients have had to learn to cope with. Many of these folks cannot find other options. Some go to church, but it’s not like they can easily open up about their trauma to people there. The way society currently functions American’s are pretty unhappy and lonely because too many of us are suffering in silence. This is why forums like MIA are important, as it’s one avenue for individuals who have suffered to connect with and support each other. I think this is why people go to groups like AA, too, to tell their stories and develop real human connection.

    Please don’t feel like you need to respond to all of this, but I felt it was important to shed light on my own experience and why I think the therapy I do is important to support my community in need.

    Be well and take care.

  • Hi Alex,

    “I was around when CIT training started, and it has notable problems which only reinforce the stigma, discrimination, and marginalization.

    You’re talking about the system changing (or improving) the system, and that ain’t gonna happen, it’s not logical. That which is the problem is not going to create the solution.”

    I guess we have a difference of opinion here. In my experience the police have had no training in understand mental health or addiction related behaviors/symptoms, and they would get more punitive with people more quickly. They seem to be a bit more compassionate and understanding now since being CIT trained, but I understand why not everyone would see it this way. Traditional training for cops had very little mention of these topics in the past. I think it’s progress. Cops aren’t going away, so to me it’s better at least for them to notice the signs of developmental delays, autism, TBI, PTSD, cerebral palsy, etc.

    Systems do evolve and change over time. I do believe in reform, and I understand why some think it’s not possible. At one time in America women couldn’t vote and black individuals were considered property. Clearly the system has improved in some areas, and this was done over time within the three branches of government.

    “People who have experienced severe trauma since an early age have patterns and cycles to break. Healing happens in layers, and it’s up to a person’s process how they heal and by what means. Some can be extremely efficient but still have layer upon layer, depending on the history.”

    You are right, and therapy is only one possible way people can move towards healing and empowerment. I do understand that folks who are in therapy too long are prone to feel dependent upon it and maintain a weak internal locus of control. It is best, I agree, for the short-term. EMDR, for instance, can be extremely short and produce excellent results. I wish my clients had access to all the forms of healing so they could actually make a choice. Unfortunately, Medicaid covers very little else besides mainstream services.

    “I felt my cause was a lost one at one point, I’ve talked about my almost successful attempt to take my own life. I had good reason to believe it was hopeless, it all stacked up like this thanks to the messages I received from the system. I was in it hard core at that time. It’s why I call it “terrifying.”

    BUT, I was wrong, thank goodness, and I found my way, and then my power. I speak about it only to give hope to others. At one point, I had told a friend that I needed a miracle to get through the mess I was going through. Well, they occurred. I’m here, and I’m thriving. ‘Nuff said.”

    It is encouraging to hear stories like yours. I am glad you found your way through all of this. It is my hope that every trauma survivor can find their path to healing.

  • Alex,
    Thank you for sharing your story. Given the other similar stories I have heard from others, yours sadly doesn’t surprise me. All of these human created systems are abusive and manipulative on some level. History is ridden with examples of abuse. I’m not sure what the answer is, other than for each of us to focus on our own truth, advocate for what we believe in, and try to avoid re-traumatization if at all possible.

    For the course I my career I’ve worked directly with hundreds of people impacted by the legal system. They too often tell me of being railroaded by the system in one way or another. Too many are set up to fail. More recently I have been encouraged by probation departments being more flexible and understanding, but the progress has been slow. More police officers are being CIT trained, which is needed so they have a better understanding and appreciation for people who are in distressed states.

    ‘“Clients” need to be short term, and for a specific purpose, not to take over and control their lives. Of course they need to be in charge of their own care. You work for them, not the other way around”

    I agree that if this is what the client wants, it should be short-term. And what I have seen is that people who have experienced severe trauma since an early age need more time to heal. I am encouraged by EMDR as a treatment for trauma, because it helps the brain and body heal itself through bilateral stimulation. I don’t want lifetime clients. I don’t want any client feeling dependent on me.

    Unfortunately our culture supports active passivity and learned helplessness. I wish everyone felt empowered to change their lives for the better. Many feel like lost causes.

  • Thank you for sharing your story, Kerstin. You are brave, determined, and will no doubt help others in a very meaningful way because of your own knowledge and wisdom. I believe basically all “mental health symptoms” are the natural result of personal traumas. It’s scary to experience these symptoms, and it’s important to find the right supports for each person to properly heal. We all have the capacity for healing, and clearly the current model of psychiatry isn’t the answer.

  • The legal/”justice” system works the same way. To many marginalized people, the lawyers, judges, cops, parole/probation, and prison system are all in cahoots to support and enable each others’ bad behaviors. Someone without money in the system has very little chance at attaining real justice; a parallel to this is the “mental health system,” where rich people can pay out of pocket for services and thus do not need to be stigmatized with a psychiatric label to receive treatment. They also have the easier ability to sue doctors and others who they feel have treated them badly.

    Power and authority, more often than not, is corrupt, dehumanizes and marginalizes those whom are seen as “criminals”, “mentally ill”, “thugs”, “poor”, “immigrants”–basically, anyone perceived as “the other”. This is why it is very important that the people have an equal say in how things are run and how people are held accountable. I would suggest that we have citizen boards to review police brutality cases, for example. This is also why it is so important to involve clients in their care on a equal footing, meaning they should have an active role in how the care is provided, and to be able to have access to information which would make the system more accountable for the treatment outcomes.

  • I have had extensive conversations with this client about the lack of validity of the DSM and the problems with pills. I think it would be most fruitful to ask the client what they think of their understanding of their experience is and what it means to them, which we have already started to do.

    May I ask, if you were in my client’s position here, what would be helpful from the therapist? I am more than open to suggestions. I think an open dialogue is important.

    If a client asks to see their chart, I personally have no qualms showing them. My agency, no doubt, is anxious about such things because they worry the client will misunderstand what is there. I find this to be insulting and patronizing. I guess they don’t want to have to defend what is there.

  • Lavendersage,
    This doctor is temporary and won’t be seeing the client on an ongoing basis (luckily). I find, however, that this doc’s attitude is often prevailing within the MH world, that “professionals” know what is best and the client just needs to “accept reality” as the “professional” thinks is accurate. There are so many problems with this line of thinking, and I think it goes back to this false belief that doctors (and therapists) have some magical insights that their clients lack, as if we are superior at clarifying human suffering and what it all means. We are very fallible and clients should follow their own truth, not one propped up by the MH establishment. I agree with you that transparency is very important to building trust. I think many clients are confused about what is up from down because they’ve been steamrolled by the system, given too many pills with too many assorted diagnoses.

    Steetphotobeing,
    I asked her why she thinks the person “lacks insight”. I am awaiting a response. The hubris coming from so-called “professionals” is angering. I really do wonder how this doc knows what is going on in my client’s brain and body? I think it’s called magical thinking.

    Rachel777,
    I can’t agree with you more! Too many of my clients tell me they feel cognitively and emotionally blunted on psych drugs (I’ve recently started asking them different questions that get at the heart of this, and their answers would be of no surprise to anyone here on MIA), and so what do their doctors do with this? Change or add pills! Very few doctors I know really work to reduce or eliminate psych drugs, in part because this is sadly the only intervention they learned in med school. So if $200k in student loan debt only gets you the ability to prescribe dangerous pills, I think that money could be spent more wisely, like creating programs based on mutual support and compassion. Unfortunately, many docs don’t have the temperament to sit with others’ who are in emotional pain.

    I think my clients, and all human beings, just want to be known, understood, validated, and respected. When people receive this kind of “treatment”, strangely they usually feel better. I wish doctors would take more of this approach than the “let’s throw 5 to 10 pills down your throat and see what happens!”

  • “The potential for a psychotic disorder diagnosis to worsen distress is supported by studies that examine the beliefs of friends, family members, and providers. Individuals diagnosed with psychotic disorders are believed to be less capable of making decisions, “unpredictable,” “hard to talk to,” and “dangerous.” These beliefs are endorsed by the general public as well as by people close to those who received the diagnosis.”

    I find that the diagnoses of bipolar and borderline personal disorder also cause the community at large, family, friends, etc., to believe that the person is deficient and “needs their meds” to function in society. The stigma of a mental health label now is also a scapegoat for mass shooters and other violent offenders. Diagnoses clearly do more harm than good.

    I recently received an email from a doctor who says that our mutual client is “lacking insight.” I assume that is because this client has not accepted they are ill as the doctor thinks they are. I am sick of “professionals” believing they know what their clients’ truths are, as if they can magically jump into the person’s body and know what is really going on.

  • Julie,

    Like I said in my initial comment, clients whom I work with tell me they have been in more clinically focused groups. It’s clear many others experience something very different elsewhere. I do hear from my clients that they rarely see their doctor in inpatient settings, which is ridiculous. Your experience doesn’t surprise me. Doctors within the impatient settings are not so interested in hearing out their “patients.” Clearly the status quo isn’t supportive nor helpful. This does need to change.

  • Oldhead, I’d love you to identify how I have “vociferously defended forced incarceration and ‘”treatment.”‘ I’ll wait to see the damning evidence. All I have said is that I do believe it is sometimes necessary to complete a mental health hold, like when a client says they plan, intent, and means to kill themselves or others. I have no legal choice. Does that mean I always agree with the law or the current options for dealing with the situation? No. Please get off my back. Seems to me you want to convince others that I’m some fraud or something. You are just proving my point that you seek to attack people who disagree with you rather than searching for some productive dialogue. I doubt you’d ever say anything like this about Amy Hoopes, who is making a similar argument.

  • Steve, I hear what you are saying. I’m dismayed at the astronomical diagnosing and drugging of children because “they are different” than what is expected of them (compliance with teachers and other adults). In this sense adults are trying to quell children into behaving in ways which are more controllable. Given that our brains aren’t fully developed neurologically until our mid-20s, any drug treatments should be of very last resort kids and young adults. Thanks for taking the time to explain your thoughts.

  • Oldhead, it is clear to me that you are most interested in making sarcastic remarks than having an actual conversation with me. That is unfortunate but it is what it is. Look at the conversations I’ve had with Chris and Alex to see the difference. But this is the internet after all, so I gotta keep my expectations realistic. I wouldn’t want to have one of those nasty cognitive distortions!

    It is frustrating to see youcherry pick my posts without looking at the entirety of my comments. That is probably asking too much I guess. If you read everything I’ve said, I would think we have a lot in common in terms our beliefs about the system. I do notice that you usually only comment on my posts if you have something negative to say. Just an observation.

    Finally, I’ll point out that I seem to be a target here whereas the author of the original story made similar comments around the system and hardly got the same scorn I’ve received. Strange, don’t you think? Well, it is the internet, so there’s that.

    Have a good day. And I sincerely hope we can have more productive conversations in the future.

  • Hi Alex,
    Have you ever written for MIA before? If not, I think you should. Your message is an important one of self-empowerment.

    and thank you for taking the time to have a dialogue with me. I have been frustrated on MIA with some conversations because to me they sometimes lack the quality of mutual respect and empathy (it can feel like a boxing match at times).

    I am doing my best to grow, and frankly it’s uncomfortable because I feel I’m in no man’s land. I’m not radical enough to be accepted by some in MIA (e.g., abolish the system, psychiatry is evil), nor am I accepted by the establishment mental health system (e.g., psych drugs help more than a harm, diagnosing is benign, forced treatment is often helpful, etc). I’m trying to find a balance to it all.

    I am also trying to find my truth again, because what I was taught by the system, doctors, managers, etc., was a very biased view of “mental illness.” I am scared that I have harmed people by using my “authority” as a mental health provider to encourage clients to see doctors who prescribe them toxic substances. I know I have done good, too, by creating a safe, non-judgmental environment for my clients to talk about their lives, their pain, their traumas. I hope the good has outweighed the bad, but it’s so subjective, so who knows?

    Moving forward I do plan to tap into my power and do my best to “be the change I wish to seek in the world.” Hopefully that will lead to some good things.

    Thanks again for the encouragement and sharing your own personal insights and growth. Your story encourages me.

  • Alex,

    I can’t disagree with anything you said. The reality is that our inner world is the only part of life we really have any control over. We can choose to go against the status quo to one degree or another. My point, however, is there are very powerful, coercive forces in the various systems which we all interact that do impact our choices to a certain extent (e.g., capitalism, corrupted government leadership). We live in a toxic world with inept leaders, and of course this will have an impact on all of us.

    I, like you, try and live by my own values and ideals, which is why I’m doing the work I am doing to begin with. Take care.

  • Steve, the percentage of clients who go to an ED and become inpatient is very low, as there are fewer and fewer inpatient beds even open anymore. The push continues to be for outpatient treatment because it’s cheaper. I’d love if there were more Soteria Houses available. Tell me, how many are open in the US? Until there are multiple Soteria House’s open in every major city, the main option is going to the hospital.

  • Oldhead,

    Imminent: About to happen.

    If someone says they have a gun and are going to kill Aunt Sally, I do talk to them. But if they don’t agree to give up the gun and talk about why they want to harm their relative, I have no choice but to call an ambulance and take them to the hospital. People shouldn’t tell their healthcare workers they have a plan and intent to kill self or others unless they want to go to the hospital (and we inform people before they become clients of this legal obligation in our mandatory disclosures). This is how it works. I wish there were other options for sending people to, but that is the current system.

  • Oldhead, you missed my point. These people who take these pills report to me that they believe they help them function better, as evidenced by keeping full-time, professional jobs, maintaining their relationships with others, etc.

  • Steve, regarding your question, I didn’t create the law. I am expected to follow the law. I don’t know why everything was set up like it is regarding acute psychiatric concerns.

    “Why can’t we simply create a space where people who are dangerous can be safe until they’re no longer dangerous?”

    We already have this, which is being at an ED (most people who are sent for a hold don’t get hospitalized) or inpatient hospitalization. We don’t have other alternatives because that is how the whole of society has chosen to deal with imminent safety issues. I agree that other options should be considered.

  • Julie,

    “Shaun, Who decides who is dangerous and who isn’t?”

    Well, in general it works like this: A client tells me they have a plan, intent, and means to imminently harm themselves or someone else, and they cannot agree not to act on these thoughts or intentions, I decide that they need to go to an ER to be further evaluated. This is a legal requirement. Of course this system can be misused, but the bottom line is that if someone is saying that they can’t guarantee they won’t harm themselves or others, then professionals cannot ignore this. We are legally and ethically compelled to act on this. We also have a duty to warn if a client is saying they plan to kill someone. I don’t enjoy getting involved in this stuff, but it’s a reality of being a professional. Since I’m licensed, if someone says these things, I cannot just look the other way. Also, if someone cannot do activities of daily living, they will qualify for being gravely disabled and will be placed on a hold because they aren’t taking care of themselves.

    You are right that people are usually temporarily in these states. The problem is that I cannot read the future, so I have no clue how long it will last. I talk with my clients every week about their suicidal thoughts. That isn’t the issue. Sometimes people will act impulsively if they are in a very vulnerable state, and this is why we have the laws that we do.

  • Oldhead, what are you asking? Big pharma corrupted medicine in America. Before direct-to-consumer marketing was legal, we did not have an epidemic of prescribing practices. I think it was 1987 where the tide changed with Prozac and direct marketing. Since then Big Pharma has done a great job of being the most profitable industry in the world.

    I do not believe there is a “political function of these medications” as you say. You realize that there are tens of millions of highly functioning people on these meds. Many of my friends and other professionals I know are on sleep aids, SSRIs, mood stabilizers, and the like. Literally all walks of life are medicated, which is a larger social problem–we’ve been conditioned to believe that a pill is a answer to our woes. People aren’t magically happier on these pills; however, most are relatively functional. I do suspect most would be better off if they got off the meds, but that is another discussion.

    The US economy would quickly collapse if the government’s goal was to directly harm a large number of the populace. Also, they’re pretty stupid if this is the goal, since metabolic syndrome is expensive to treat in the meantime.

  • Oldhead, as is typical, you ignore my question. Do you know what EMDR is about? It has nothing to do with psych drugs. It doesn’t require any diagnosing.

    Regarding psych drugs, yes I think there is a small number of people who benefit from them. I, for instance, know that helping people avoid seizures and DTs from alcohol withdrawal that short-term benzodiazepine use is indicated. The problem with psych drugs is they are being prescribed for long-term use, which we need to avoid. I also think doctors need to be a lot more judicious with their prescribing practices. They are too liberal with handing out antipsychotics, mood stabilizers, stimulants, and SSRIs.

  • Oldhead, my clients tell me they are most disturbed by the trauma’s they experienced in childhood, such as sexual assault, invalidation, growing up in drug addicted homes, living in group homes, and neglect, just to name a few. While some do note that psychiatry hasn’t always helped them, and in some cases they believe have harmed them, they do not believe this is at the heart of their issues in life. I provide EMDR, which is a non-pathologizing, compassionate, treatment to address the core issues of trauma. I will not apologize for providing such interventions which reduce human suffering and decrease the need for psychotropics. Do you know much about EMDR? I would love to have an actual conversation about it, as it can quickly reduce negative emotional states for trauma survivors.

  • Oldhead, you might be correct, but until big pharma is no longer the significant driver of care, I don’t see much changing. They simply have too much power and influence. Our political, economic, government, and legal systems have been corrupted by the ultra wealthy.

  • Oldhead, you clearly see no utility in the current system, and as a result think it should be abandoned in its entirety. I think it should be considerably reformed so that the whole person is treated and fully respected. More pills clearly isn’t the answer.

    Please remember that reasonable people can disagree with each other and still find common ground. Nobody has talked to me. And to be clear I’m more antidiagnosing and antipills than I’ve ever been in my career. I just told my boss this week that I think it is not our place to push clients to see doctors unless the client asks for this service. I’ve been using my influence as a therapist to help people better understand the problems with pills as well. I see that as progress.

  • Lavendarsage,
    Thank you for mentioning Soteria House. I have never heard of it before. I will definitely look into it, as it sounds like an interesting model of care from my brief Googling so far. I think we need to continue to look outside the box for solutions.

  • Oldhead,
    I’m pragmatic. I do believe that reform is more realistic than abolition. Also, I think that inpatient hospitalization is necessary for some people, like those who are temporarily homicidal, suicidal, or gravely disabled. I do have a question for you, Oldhead, which is what would you do with people who are clearly dangerous or unable to care for their basic needs? I think impatient treatment is necessary for some, because over the course of my career I’ve seen too many people in an altered state of distress who need a safe, structured environment to stabilize and move on with life. We don’t need to create lifetime “patients” in the process just because we have inpatient treatment.

  • Plebtocracy,
    I’m not a big CBT fan, but I do see it’s limited utility. I’m more a fan of Carl Roger’s humanist perspective on therapy and tend to focus my work with clients based on his teachings. No doubt the medical model has infected therapy models of care, but it doesn’t have to be that way. We need to work to change that.

  • Stephen,
    If you were to redesign the inpatient model, what would you do differently? I think that more than anything people need to feel safe, understood, and respected as equal human beings. While there are probably some instances with drug therapies are indicated, I think we are doing much more harm than good, especially in inpatient settings. Primary care is also a part of the problem because they overprescribe as well and don’t give adequate informed consent.

  • Hi Amy,
    I would certainly be interested in reading anything on the lack of psychotherapy in inpatient hospitals. From talking to my clients who have been in these places, they get generic group therapy which they find unhelpful. I suggested to my boss (we work in an outpatient community MH setting) that maybe clients would feel better in inpatient settings if they were just listened to and validated; I also expressed my dismay that too many of my clients have been overdiagnosed and overmedicated in these facilities, and he did not seem to be nearly as concerned about these problems as I am. But he’s worked in the system for decades and is clearly a believer of the medical model.

    I am pissed off that “professionals” dismiss and minimize client experiences. Seems to me it’s often ineffective or harmful, so maybe we should try something novel like talking to people about their lives?

    I was also highly encouraged by my agency to use “motivational interviewing” get get clients to reconsider seeing a doctor about pills when they are considered high risk for re-hospitalization. My thought is that if a client doesn’t want to see a doctor, they shouldn’t be pushed in that direction. But hey I believe in client autonomy, which is clearly not as popular as MH systems like to pretend to care about.

  • Alex,

    I agree with you, and I’m sorry to hear that many therapists, social workers, and doctors abuse or misuse their “authority” in the situation in ways which are damaging to their clients. Societies and organizations naturally create hierarchies, and over time they tend to take on a life of their own. People fall into line or they get punished (eg., fired from a job, getting kicked out of a program, etc). I do prefer the term responsibility over power.

    Regarding mandated reporters, I’m not sure how else this can be handled. I mean, we are there to inform the authorities that innocent people are (potentially) being hurt. If children or the elderly are being abused, something needs to be done about it both from a moral and legal perspective. You can come up with another phrase, but the basic principle of ensuring that people who know about abuse report it is very important in order to (hopefully) stop the abuse or neglect from continuing.

    There will always be “inherent imbalance” in human relationships, say with kids and their parents, but it doesn’t mean that it’s inherently unjust or abusive.

    In regards to the MH system, I would love one day for clients to have equal say as to what is happening in their care. There are a couple models out there of shared leadership, but they are all too rare. I interned at one place where the boards were equal number of clients to staff/professionals, and I think this should be the standard everywhere.

    Regards

  • Amy,

    Thank you for sharing your story. This is a similar story I hear from my clients who have found themselves to be in the unlucky position of being hospitalized. Pills and more pills with a lack of informed consent. I hear from too many of my clients as well that they recall seeing the doctor very little while in the hospital, even though this is the person who supposedly is there to make an informed medical decision about these powerful drugs. I usually hear from my clients that the feel worse after being discharged. What is the point of doing this to people if we make the situation worse? Oh, yeah, I forgot, money.

  • Julie,
    As far as I know, all states have laws against doctors/therapists having sex with their clients. There is so much room to abuse people that it should be outlawed. I think my my state you can only initiate a relationship with a prior client after 5 years. I have mixed feelings about this.

    I would say it’s unfair and inaccurate to state that “most therapists are either abusive or incompetent.” We’d need to do some kind of study or some data collection to determine the actual numbers of therapists who fit into either category. Obviously, as folks on MIA have stated, many of their experiences in the MH system have been abusive and poor, which is totally unacceptable. MIA posters have had particular bad experiences, however it is a jump in logic to say that this is transferable across the board. I know many wonderful therapists, some of whom I’ve seen myself, and they have been supportive, helpful, and caring. Doctors, on the other hand, I can’t say the same thing (some have been good, but many are too blinded by the medical model). I think there’s a big difference in inpatient settings vs. outpatient private practice. I continue to hear horror stories about the former but not the latter.

  • Alex,

    Thanks for the response.

    “What is not clear to me is when a therapist considers himself/herself to have some kind of authority over a client. Why is that? To me, that is a counter-transference because a client has their own agency, pure and simple.”

    Most therapists I know don’t try and prop themselves up as an authority, per se, but the law and the nature of the relationship dictates this to some degree. Therapists are mandated reporters of suspected child and elder abuse and neglect, and we also have a legal obligation to place someone on a hold if we deem them to be of imminent risk to self or others or gravely disabled. We also have the power to sign off on paperwork for benefits and housing. So we do have power given to us by the law and the system we are in. I’d prefer to be on equal footing with my clients, and I do my best to remind them that they are in fact the authority in their lives.

  • Rachel,

    My clients feel better as they lower or get off the pills, too. What a shocker!

    It continues to be my view that psychiatrists are indoctrinated by their training and by big pharma. They are amazingly brilliant yet stupid at the same time. Why they don’t listen to their clients more when they say the pills are’t helpful or are harmful is beyond me.

  • Oldhead,
    Can I ask this: If real abuse is the existence of power, how do we overcome this? It seems to me that any powerful entity will abuse it’s power because it has the ability to do so. Power corrupts in my experience. I was watching a youtube video with the lead singer of the Smashing Pumpkins and he was talking about the music industry’s abuse of artists. This seems to happen to one degree or another in all big businesses, including mental health.

    I agree with your second point completely. The “consumer” term is ridiculous. My agency has gotten away from it, preferring “person served.”

  • Someone Else,
    “And today’s psychiatric holocaust is a holocaust primarily against child abuse victims, our society’s weakest members.”

    Actually, child abuse survivors is the term I prefer to use, because this group of people in my experience are some of the most resilient on the planet. It takes much strength to cope with childhood abuse and trauma. They are vulnerable but not weak. The problem is that like most people, they trust that doctors know what is best for them. This is a fallacy. Doctors are human and are often guessing at how they can help. They are throwing darts, and often these darts make the situation worse. Actually, doctors have been indoctrinated by their schooling and their culture of drugging, so they are being duped by the powerful players (eg., big pharma). They’ve been taught to believe that pills are better than no pills, and they usually WANT to help. Unfortunately, the pills too often don’t. They don’t have the right training or tools to really help. They also, too often, minimize the problems their clients face with pills and other life circumstances. They can come off as cold and uncaring at times. They are also stressed out by a dysfunctional model and expectations. They don’t have enough time with their clients to actually listen and validate emotional pain. They are rushed, which is why they go to what they know, which is prescribing. It’s a dysfunctional, hurtful cycle on both ends.

  • Alex, I take no offense at your commentary and critique of your experience with therapy. There are too many lousy therapists out there, just as there are many lousy electricians, dentists, politicians, etc. Most therapists find themselves in this field for a reason, and if we haven’t done our own work, countertransference (or just plainly inappropriate behavior) is definitely going to become a problem in treatment (or supervision). Any good therapist will recognize their own stuff and deal with it appropriately, like be in therapy themselves.

    I have seen multiple therapists for myself in the last two decades, and I had mixed experiences. Most were good who weren’t directly involved with a larger system like Kaiser. Clinicians in private practice tend to be more creative and flexible in my experience because they can feel more free to do the work that resonates best for them. They aren’t stressed about stupid treatment plans or case notes!

    I try to be a “guy who gets it”, but I know I have to keep pushing myself, learning new perspectives (like here on MIA!), get outside my comfort zone in this vast MH system, etc.

    “If a male client is being inappropriately sexual with a female therapist, then no, of course she shouldn’t shame him, but she should protect herself, and perhaps suggest a referral? Wouldn’t that be the right message to send, more honest and direct, not to mention self-caring?”

    Good question. I find that when talking to my female colleagues, some of them get uncomfortable with any conversation about how their clients may find them physically attractive. I think that instead of immediately referring when the therapist is uncomfortable, maybe exploring the issue more with the client would be fruitful? If they are being bold with their therapist about how they feel, this behavior may also be displaying itself elsewhere in their lives, causing other problems, like social isolation. Also, this is a grey area. One therapist may have a high tolerance for this kind of behavior from clients; I, for instance, have male clients flirt with me on occasion, and it doesn’t bother me at all (I’m heterosexual). Other male therapists may feel differently about it, especially if they have different beliefs about what it means to be gay or bisexual. They may inadvertently shame the client if they are reactive to the situation because of their own biases.

    I would never suggest a therapist put themselves in harms way. There is a big difference between a client saying I have “cute shoes on” versus “I want to have sex with you.” The truth is that most clients are just trying to connect to their therapist in one way or another, and sometimes they overstep in that process. It doesn’t mean the client should be punished but rather it can be used as a learning moment around social appropriateness. If we just had more conversations, much of the tension around transference/countertransferrence could be resolved without being an impediment in the therapeutic relationship.

    Your therapist and director stories are clear examples of these “professionals” stepping over the line. Someone with authority needs to be very careful how they wield their power. Both therapists and directors have a responsibility to share their feelings about those they are working with very carefully and judicially. These people should have been in their own therapy to deal with their issues rather than project their stuff onto others.

  • Alex, I find it interesting how uncomfortable some clinical staff are with strong emotional states (especially doctors!), like anger and feelings of attraction from their clients. Many of my female colleagues will basically shame their male clients who make sexual comments. It seems we all have some defenses against feeling uncomfortable, but it isn’t helpful if therapists and doctors can’t sit in the same room with someone who is expressing a genuine emotion. It also doesn’t mean we should tolerate verbal abuse, and this is very subjective what constitutes abuse in the clinical environment. If a client is acting threatening, obviously we need to address it. But if a client isn’t able to share their real feelings, they probably won’t benefit from counseling and we are wasting our time.

  • Oldhead, it does matter what their misconceptions are, because their beliefs drive their actions to treat suffering people in a certain manner. The whole system is based on this general belief about illness and treatment. We have a long way to go before we truly see a system that isn’t dominated by the bio mentality. I think we need a bonfire with all DSMs. They are worthless.

    I do think training programs need to change. If they don’t, young professionals will continue to move in a similar direction as prior generations of treatment providers.

    You are right that clients don’t need to solve the problem. The issue is that they lack the power within the system–FDA, medical schools, MH centers, etc–to directly change it. Hopefully professionals will wake up to the reality of the situation.

  • From NAMI’s website: “A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits and basic brain structure may play a role, too.”

    It seems they are taking on a biopsychosocial model approach. But it is clear they still heavily buy into the “bio” part because they promote the idea that the DSM labels are discernible and reliable diagnostic categories. They have an entire sections on their site about diagnoses and the typical drugs which are prescribed to treat said conditions.

  • Alex,

    Thank you for sharing your story. I do believe that you are correct. Getting away from toxic environments is key to being healthy, and addressing our “inner landscape” is integral to healing.

    I agree with you about the “professional bullying” piece as well. Clearly this is dangerous and very toxic to people swept up by the system.

    One challenge I see is that many providers within the system genuinely believe in the model of mental illness, and thus they think that anti-stigma campaigns are important so that people get the help they need. They genuinely believe in the interventions, such as SSRIs and antipsychotics, and tend to view “side effects” of treatment as minor compared to their perceived benefits to their patients. They’ve (and really we’ve) been indoctrinated by the medical model of mental health, and thus think that treatment is usually necessary for people to “recover.” Clinical staff also too often mindlessly do what they are told because “it’s the best we’ve got” and “we have to bill to keep our doors open.” When I have brought up concerns to my boss around the lack of validity to what we are doing, I’m viewed as being a threat to the agency and told that we use “evidenced-based practices”.

    We should be thinking critically of what we are doing everyday, because innocent people are being harmed because of what we are doing. The agency tries to amplify the positives, like X number of people got jobs or housing because of our help,” and yet they never advertise the dark side of the industry, like “X number of clients now have diabetes and heart disease due to our prescribing practices.” It’s all distorted and one sided.

  • Alex,

    What you say really resonates with me. Thanks for adding your thoughts.

    One thing I’ll add on the stigma debate, is that society and families also stigmatize people who are “different”. This happened long before psychiatry was about pills and before the DSM had a stranglehold on society. People who were called “crazy” were locked up for years in asylums 200 years ago. Humans are scared of what they don’t understand, and thus we can be quite reactive and punitive in our responses to those whom we don’t understand or see as being “abnormal.” Human history of responding to people who are different than what is considered “normal” is horrific: http://www.inquiriesjournal.com/articles/1673/the-history-of-mental-illness-from-skull-drills-to-happy-pills

    People demonize and bully others all the time, starting in grade school. We make others feel “less than” ourselves as a defense mechanism against our own vulnerabilities and insecurities. Humans are very flawed, and you are right that we ought to start with ourselves to be the change we seek in the world.

  • Steve,

    “I have always been a strong advocate for eliminating the DSM entirely, because I find the labels to be worse than the drugs, for the reasons asserted above, and other reasons.”

    I would disagree with your latter point. The drugs directly cause early death and disability. Diagnoses like PTSD can actually help a veteran, for instance, to get the necessary support to cope with their trauma. I think the problem with the DSM is how it is used and not the diagnosis in and of itself. Because DSM diagnoses are used as justification for drug treatment and, that I see as the main problem.

    If clinicians were to say that the way they feel is clearly the result of trauma, like I do, then we can quickly de-stigmatize the “diagnosis”, because their reaction is completely “normal” under such circumstances, although it is causing them significant problems in daily living. And the reality is that many people coming in for services know that their symptoms, like nightmares and flashbacks, are causing them difficulties in daily functioning. They know something isn’t right, and they want relief. Ideally the system would provide non-invasive supports that would be purely voluntary, like EMDR. That is what I’d like to see happen anyway.

    I do agree that too often diagnoses harm people, making them feel dependent on the system to keep them going because they have “a mental illness that needs a lifetime of treatment to maintain stability.”

  • “They lump sins/bad behaviors with harmless eccentricities and emotional trauma.”

    Good point, Rachel. I think psychiatry doesn’t appreciate the vast uniqueness within the human condition, and just because someone doesn’t fit the boring stereotype of “normal”, it doesn’t mean that they have a “disorder” that needs treated with drugs. I think we all should be most concerned with those who are harmful, like the Ted Bundy’s of the world (and doctors who knowingly harm their clients). If psychiatry could stop those people (antisocial lunatics) from doing heinous acts, that would be admirable. I don’t see that happening, however.

  • Julie,
    Stories like yours need to be told. Clearly, there is an abuse of power in the mental health world; clinical folks, especially doctors, too often see themselves as the expert and minimize anything negative their clients have to say about their treatment. I am sure this is the case with drug effects, where very frequently a client is just given another pill to deal with another problem rather than trying to remove the problem (pill) from the equation. A lot of doctors I’ve met are well meaning but they have big egos and don’t have the lived experience of their clients to empathize with the real suffering that is taking place.

    One doctor I know states (and documents) that many of his clients have a “fragile personality structure”; this speaks volumes about how he views his clients as being broken at their core. This is the sort of BS that we all should be angry about. Frankly, I see my clients as both fragile and resilient, like I see all people. We all have different parts of ourselves, and if doctors only see the “weak” or “fragile” sides of their clients, they can’t expect many of these individuals to ever “recover”. Of course their interventions will usually never help someone recover from trauma, but rather to stay dependent on a system which too often fails to empower the people who are supposedly being served.

  • It’s clear that many drug manufacturers don’t care about patient health: https://www.cbsnews.com/news/boston-scientific-gynecological-mesh-the-medical-device-that-has-100000-women-suing/

    Why would they continue to manufacture products which either are known to cause harm or which effects aren’t really known on the human bod? Money I guess. I watched the 60 Minutes episode on Boston Scientific’s mesh product, and there’s corruption everyone, including the FDA which seem to be co-conspirators.

  • The concept of confidentiality in groups is meant to encourage members to keep personal things shared in group by others inside the room, to not share that knowledge of others’ experiences with outsiders. Members can always share their own experience outside of group, but the point is to make members feel safe so that what they say in group doesn’t get said by other members outside of group. Of course this gets broken at times because people talk.

  • Thanks Rachel. No worries. I should have been more thoughtful before I posted anything from Jaffe. Honestly I wasn’t aware of all his beliefs until after I posted his article. I think I was being ignorant and I look forward to continuing to learn on MIA and elsewhere on alternative perspectives on the MH system and drugs. I used to think it was all so benign because that was what the medical model thought me, but clearly I was taught wrong. Be well.

  • Oldhead, thanks for reaching out. I don’t take what was said on MIA personally, or I try not to anyway! You are passionate about your beliefs and experiences, and you shouldn’t change that simply because some people may take offense. Your “tough love” of sorts has helped me to challenge my own beliefs about “mental illness” and the effects of “treatment.”

    I just read Michael’s article, and what is so scary is I can relate to it so easily! Michael correctly points out, “There are no lab tests of any kind for any DSM diagnosis. The diagnosis is subjective. The diagnosis can’t be tested for, measured for severity, or tested against. The current system lacks validity and reliability. Everyone inside the system seems to acknowledge this, but simultaneously insist on treating a diagnosis as sacred.” These sentences perfectly sum up the current paradigm and political viewpoints within the MH community. What’s funny is that we are displaying the same “cognitive errors” we try and help redirect with our clients. Clearly people at the highest levels within these systems know on some level that what we are doing is a farce, yet the continue supporting it because they enjoy the benefits of their privilege, and they can feel good that they are “helping people recover” despite knowing the horrible effects from their supported treatments of pills. I do wonder how many of my colleagues and bosses are truly delusional. I think they could easily meet criteria in the DSM. So much cognitive dissonance.

    I do plan to present my concerns to my team at a supervision next month about the reliability and validity of the DSM. I also plan to ask them to read some critiques of the DSM from NIMH. Many of my coworkers, I suspect, will generally agree with the criticisms, but many will fear for the jobs and will maintain the status quo. Many of them tell me that tell their clients that the diagnosis they give, like mood disorder unspecified, is just a collection of symptoms which label’s their suffering. While this is slightly better than saying, “You have a disorder called Bipolar because you are manic”, neither are scientifically validated. There is power in truth, even if those around us don’t see it the same way. I do plan to ask my colleagues to think critically of what we are all agreeing to and subjecting onto our clients, and I’ll report back on how it goes. I would love to see a revolt, but this moment I would be content with some critical thinking and challenging the status quo.

    Thanks again and be well.

  • Oldhead, what I see now can’t be unseen. When I hear my manager talk about the importance of treatment plans now, I just want to throw up (I used to just roll my eyes). NONE of the people I see come to see me because they want to do paperwork so we can bill for the service. I’m still unsure how I can quantify human suffering anyway. Such a stupid system we’ve set up. Most providers are unhappy because we are stuck on our computers for hours a day instead of actually talking to our fellow human beings. Finally, I’ll add that most of my clients want to be heard and known, and they feel as though their doctors care about little else than throwing more drugs at them. If the doctors would just listen rather than prescribe, we’d be so much better off. Zoloft with a side of sexual dysfunction and insomnia or validation of your pain….I wonder which option is better?

  • Steve,
    I think it’s ultimately positive that I feel uncomfortable and angry right now. It tells me there is a problem that needs my attention. I have a feeling I won’t be in my job much longer given that I’ve been telling the people I serve that they’re likely being harmed more than helped on the drugs their doctors give them and that the labels we slap onto them are totally unscientific and stigmatizing. My agency may see this as a hostile act!

  • Lavendersage,
    Thank you for the kind words and the virtual hug! I do love hugs. Maybe I can recommend to all our doctors to prescribe hugs instead of pills? I’m betting there’d be fewer “adverse” results.

    I think I’ve been in denial about the realities of modern “mental healthcare” in western countries. I wanted to believe that we were doing more good than harm, but reality is starting to smack me in the face more and more. Everyday I see evidence of the harm that is doing to people who are mainly seeking to reduce their suffering, get their basic needs met, and to be understood by others. The individuals whom I’ve had the privileged to work with have been told by society that they are disordered, ill, and need treatment in order to be ok. That is BS. Every aspect of society is impacted by the paradigm which we currently find ourselves in, where we see the root of the problem as being with the individual rather than considering the dysfunctional and traumatizing world we all live in as the main cause of the suffering. Be well.

  • Oldhead, yeah I agree. The more I open my eyes to what is happening around me, the harder it is to ignore the ugly truths. Just today I heard another horror story from someone who spent time in prison and was drugged up on 10 pills at a time, describing walking around “like a zombie who couldn’t think clearly.” WTF? The doctors kept throwing pills at this person and it only made them feel terrible and sick. I don’t know how these “professionals” sleep at night knowing they are killing and harming people by treating them like this? I guess having a nice car and house make it all worth it? This kind of “treatment” of innocent people needs to stop immediately.

  • You are right. I’ve heard that message loud and clear from my org that money keeps our programs open, and thus we need to do everything we can, even if it’s ethically dubious, to bring in revenue (Our budget is $100 million a year, so you’d think we’d be ok if we didn’t look under every rock for state money). Ironically, our doctors and pharmacy is losing money for the agency, so maybe we should just drop them both and do case management and therapy? I doubt they’d see it my way for some reason….

  • Steve,

    This comment resonates with me today: “Clients’ voices threaten those in power, because those in power know at some level that they are emperors without clothing.” I asked my manager in our team meeting recently if ALL clients are regularly surveyed to get their opinions on how our services are effecting them. I was told some clients are randomly asked to fill out a survey (with a $5 or $10 gift card given to them upon completion, which may sway the results since the clients are essentially bribed to tell us how they feel); I asked how the agency uses such important feedback, and she did not know. This is very telling of how the system works.

    The people who run my agency and most others really care what clients think of their treatment, otherwise we’d make a substantial and meaningful effort to hear all of their voices and change our system based on their feedback and needs. But instead the agency is making sure it hears from the staff, which again speaks to institutional priorities. My organization should frankly care most about client satisfaction, because supposedly our mission is to help people “recover”. If we really gave a crap about how clients’ lives are impacted by our “treatments”, we’d do a much better job trying to hear from them. But no, our agency talks about how they care about employee “well being” and “client recovery” all the while not changing how the system works for the client. I doubt they want to hear the feedback that clients feel like guinea pigs in some experimental lab, because they have to KNOW this is the truth.

    I can see why many don’t believe reform is possible. The power structure is too hierarchical and patriarchal. I feel a bit dejected at the moment. This is BS.

  • We should all RAISE our voices in such scenarios. One of the problems with psychiatry is that is does minimize and dismiss too many of the valid concerns clients have about experiences. Many of my clients, too many, tell me that despite saying to their doctors that they don’t feel any better with pills, or feel worse, more pills keep being offered as a solution. This is certainly reason to be upset and frustrated by a broken system. Docs don’t live the life of any of their “patients”, yet they think they know what is best because they have a degree and privilege.

  • Steve,

    Here’s an illustration of how dysfunctional our current model is: The state I live in created a financial incentive for my organization (and others) to attain more funds for a specific payer type (I believe, folks with Medicaid). The state says if we see the client four times in 45 days, then we become eligible for about half a million dollars if we meet this standard with a certain percentage of people who the state says are eligible. These clients are not being picked for needing (or wanting) more assistance because of their actual needs or acuity, but because of their insurance type. This is unethical treatment IMO.

    Many of these clients are doing well and don’t want to come in weekly, but we are still encouraged to get them in so we can get the extra funds. This is just one of many examples of how these systems aren’t working for the clients’ best interests; but rather the state can say they care about mental health treatment and about making sure we are seeing people in a timely fashion, and my organization can say that they are being financially prudent and cares about providing engaging services to new clients. These narratives are partially true at best, and the problem is that clients are treated as pawns in the system rather than as unique individuals with unique needs and goals.

  • Steve,

    Good points. The current MH system is seriously flawed because it is all driven by the medical model of the DSM and pills. I recently received a survey from my employer, and I told them that the one thing I’d love to see them work towards is a paradigm shift away from diagnosing and “med monitoring” to one which focused on social justice and providing support (e.g., long-term therapy) to those who are suffering (from trauma). We don’t need a diagnosis to provide help. I think that is one of the biggest misconceptions people have, like somehow a diagnosis is going to tell us anything about anybody. I’ve probably met 500 people with a depression diagnosis, for instance, and unsurprisingly, none of them are the same! We can’t put people in neat boxes and treat human emotional suffering like we do a broken bone. All humans are trauma survivors, and we ought to be treated with dignity and respect.

    “Worse yet, many therapists now take on the role of medication compliance monitors, pressuring and manipulating clients toward “accepting their diagnosis” and “cooperating with treatment.” There are definitely exceptions out there, but they are exceptions, especially in the world of involuntary clients. I’m sure it’s easier to find a quality therapist for those who have money, but no insult intended to you or your clinic, for poorer and more powerless people, therapy often varies from ineffective to downright dangerous, in my observation.”

    Over the last month in particular I’ve paid more attention in my work and the messages with implicitly and explicitly tell our clients. You are right. We have phrases like, “med noncompliance”, “treatment noncompliance”, etc., which of course means that the “ill” person isn’t listening to us “wise doctors/therapists/social workers” about what is best for them. Most psychiatrists get annoyed when their clients aren’t taking pills as they are prescribed, but since these pills often aren’t helping or making the situation worse (hello metabolic syndrome), can we blame them for being ambivalent? While my organization does provide services that aren’t following the medical model, like horticulture therapy, we are existing in a sick system which forces unscientific labels to be slapped upon people who then are told they have a disorder and “could benefit from” pills that “may” help their symptoms, although we have no way of measuring the change over time in their brains of neurotransmitters and such. We continue to experiment on people with drugs, which isn’t much better than some of the “treatments” of the past: http://mentalfloss.com/article/31489/10-mind-boggling-psychiatric-treatments

    Take care.

  • Chris,
    I would love for mental health care to get away from short-term treatments. I think they are usually superficial at best. They help people better who have very clear and generally simple goals, such as wanting to be more assertive with co-workers.

    I also agree that if adequate resources aren’t in place, we can’t expect people to “get better”, whatever that looks like. If someone is dealing with chronic poverty and violence, for instance, my 30 minute visits every couple of weeks won’t change that situation. This is why I believe in universal basic income, quality healthcare, and housing for all. If all of our basic needs are met, like being safe, I think we have a better chance at addressing issues that long-term therapy can assist with. Take care.

  • Thanks for the reply, Chris.

    Reading the beginning of this post reminds me of the show 13 Reasons Why. Many people criticize the show, but I do think it highlights your point that people are suffering in numerous ways that aren’t evident to everyone. These issues are no doubt complicated and multifaceted.

    “surely this is not much different to offering drugs to people drugs that might subdue, suppress or make you less bothered about things previously bothering”

    I would argue that therapy is different because the process is supposed to help people better understand themselves, how the world impacts them, make positive changes in their lives, foster compassion towards the self, healing from trauma and loss, cope with a toxic world, and so forth. It’s about personal development, and in no way do I see this as similar to drug therapies.

    Peace.

  • Chris,
    Well said. I don’t disagree with the philosophy of what you presented around free will. My main point is that we as individuals, despite everything you just said, still have a responsibility for our own behavior and how we treat others. If I continue to road rage, for instance, I need to ask myself why do I continue to act this way. If I want to buy a gun and shoot innocents, I need to ask why is this justifiable? We do need to acknowledge the system, and work to change it as well. And we as individuals can’t blame society for our own bad behaviors.

  • Well said, Frank. The more I’m listening to my clients’ experience with psych drugs, the more I see the obvious harm that is being done to them. TD, akathisia, diabetes, metabolic syndrome seem to be minimized by psychiatry, as though clients should just be grateful they hear fewer voices or whatever. I can’t tell you how many clients express dismay once they start gaining weight on these pills. We put too much trust into doctors.

  • Chris,
    Yesterday was a tragic example of when “refusing to accept reality” turns to violence. A gunman opened fire at a the Capital Gazette and killed five innocent people because he had a grudge against the paper for a story that was written about him years ago. Las Vegas is just one more tragic example of rage going awry, and 9/11, etc. We as individuals have a responsibility for our own acts, and we have responsibility to help each other. This doesn’t mean that we shouldn’t fight against unjust systems, but if we don’t start with our own behaviors, I don’t see how any society can be stable. No matter how angry we are, we need to know that lashing out at innocents is never the answer. Just because my boss writes me up, it doesn’t mean I have the right to kick the dog or punch my wife. My boss and the system he could be working for could be complete shit, but then it’s up to me to do something about it, like get another job. We can blame systems for all the ills in the world, but what is that going to change? Which individuals are actually responsible? There are so many people involved for keeping toxic systems going (self-interest). Radical change at a global–even local–level is very difficult to attain and maintain. Getting any kind of consensus from a large group is near impossible, such as the case with global warming, abortion, gun control, education policies, and war. The last election in the US is a shining example of the culture wars, polar opposite positions, hate, and so forth.

  • Alex, well said. I would say that we can learn to “wake up” with the assistance of others. I do believe, for example, that MIA has helped me to shift my thinking in ways that would have seemed impossible to me a decade ago. I do challenge the DSM and “medication management” in ways I wouldn’t have done in the past.

  • Chris,

    Ideally the individual decides what needs to be accepted. I think of situations where my clients are on probation and choose not to follow the requirements, like take random UAs, because they disagree with the system. They refuse to accept the reality of the situation, and then they face the consequences of being sent to jail or having probation extended. They may suffer more because they do not comply with the law. They don’t have to agree with the reality, and I would say accepting the situation as it is rather than as they think it SHOULD be goes a long way in being more effective to get the desired outcome (e.g., off paper).

    I agree with you that the broader society/systems scapegoats individuals, which is why you see these anger management, et al. classes. It’s easy to blame the individual for their anger rather than look at what could be contributing to it (like disrespect from an institution).

    Emotions give us useful information; however, they aren’t necessary rational, either. Rage, for example, quickly turns into danger for self and others. Rarely does a situation actually call for it. And love, for example, binds people together; however, if I love an abusive person, I often stay in a toxic relationship which hurts me.

    No doubt there is collusion going on within these various systems. The DSM is a perfect example of this. The reach that the DSM has in society is astounding, but to whose benefit? I would it benefits big pharma, APA, and psychiatry.

  • Hi Alex,

    Thanks for the question. What I tend to see often with clients is that they tell me they don’t believe they have the ability to leave or deserve a better situation. They also say that they also don’t have any other good options, which is frankly true when you live in poverty and you don’t have a social safety net. Many of my clients make choices with their safety because they are trying to get other basic needs met, like food and shelter.

    The DV cycle is a very nasty one. Many DV survivors know on some level that they don’t deserve to be mistreated, but they defend the other person because “I love him/her”. Love is often a justification for staying. Also, abusers are well adept at manipulation, so survivors genuinely believe that they “deserve” the poor treatment, and they hold onto the brief “good times,” hoping they’ll have more positive experiences with the person. Many abusers know that to keep their partner, they need to at least show some remorse and say “I’ll never do that again”, even though many of them don’t have the wiliness or skills to do otherwise.

    I try to be patient with my clients in these situations. I can tell them “get the hell away from this abusive person!” but that doesn’t help. I sit with them and their struggles, and try and help them to see their own worthiness and deserving to be happy. We examine safety and I provide information for DV shelters and the like. I gently encourage them to consider how the relationship is impacting their health, their goals, their relationships, etc. This process can take a long while, and sometimes people never make it out of these scary relationships. Getting out of these relationships is one of the scariest and most difficult things anybody will do. Also, it is a very common dynamic. At one time or another most women end up with someone who is at least mildly abusive. While men tend to be the abusers, that is not always the case.

    Additionally, often people who find themselves in toxic adult relationships grew up in households with poor boundaries, so these individuals are also confused about what healthy love looks like. They sometimes think being hit shows you are loved, or being yelled at shows their partner cares. I’ve had other clients who get parentiefied at an early age, where as a pre-teen or younger they were in the role of taking care of siblings or even parents. This is very damaging to a child, because they need to know adults are in charge. And when the adults are out of control, lacking skills, clueless, it is very confusing to a child’s sense of safety and security.

    Then in adulthood these same people end up often in relationships where they are going to be abandoned (not have their needs met) either emotionally, physically, or both. I think Adult Children of Alcoholics literature does a good job of explaining this dynamic and how it causes toxicity in adult relationships. We ultimately have to love ourselves in order to be in a healthy relationship, and if we weren’t shown genuine, healthy love as children, this becomes a very difficult task. When don’t trust our decision-making, our choices, or our experiences being in relationships becomes very challenging.

    I think DV situations are another symptom of a larger social problem–because feel powerless, scared, hopeless, frustrated, and so on because of the toxic and difficult world we live in. Human systems are flawed, like capitalism and governments, and this trickles down to all of us in one way or another. We feel the stress and sometimes lash out at others due to feeling powerless. This is why perpetrators of DV need support as well, in order to break the cycle of violence and manipulation. They need to be taught that it’s wrong to treat people this way, and that there’s a better way to interact with others.

  • Hi Chris,

    Good points. Regarding radical acceptance, I think people have misconceptions of what it does and doesn’t ask us to do. I like Marsha Linnehan’s description and definitions; she says that what has to be accepted is reality as it is (the facts of the past, like my father’s alcoholism or that 9/11 happened), accept that we all have realistic limitations (there are things I cannot do), that everything has a cause (e.g., my grandparents (who had their own trauma) abused my parents which caused them to feel low-self esteem), and that life can still be worth living despite painful events. She also goes on to point out that rejecting reality doesn’t change it, and that acceptance and change go hand-in-hand, whereas rejecting reality doesn’t change it. Refusing to accept things as they are keeps us stuck in unhappiness, bitterness, anger, sadness, etc. She also says the path through hell is misery, and that by refusing to accept the misery that is part of climbing out of hell, we fall back in.

    Regarding your example of socio-economic injustice, the working class people accepted reality that they were being abused and they stood up for themselves. There are many famous cases of this in history, such as MLK Jr. for civil rights. If these people did not racially accept there is something seriously wrong in the world, they wouldn’t have acted. The interesting part of acceptance is that it frees us to act. Without acceptance, we reject reality and suffer more as a result. The truth does set us free, even if we don’t like what the truth is.

    The serenity prayer also comes to mind. I find that when humans focus on what we cannot change in life, and say how horrible it is, we get stuck and suffer. When we put our energies into what is possible, we feel empowered and uplifted. Therapy can be used to help the the individual and society. If the individual is suffering less and enjoying life more, they do impact those around them. Of course therapy is usually a slow process, and we don’t exactly know what will change in that system they are in. I can say that some of my long-term clients take a while to make important changes, like leaving toxic relationships (because of childhood trauma). This is still a worthwhile process to help someone to come to terms with their reality and to help them see the power they actually do have to make profound changes for their well being. I don’t see therapy helping to create world peace, for example, unless every man, woman, and child was provided this resource. And not only that, but that everyone’s basic needs were met. I doubt we’d have war if everyone was clothed, fed, treated with respect, housed, provided necessary medical care, and so forth. But we live in a world which is full of trauma, chaos (e.g., Syria), and poverty, because wealthy, corrupt interests rule the world. We have to keep fighting, and I think therapy is a tool to help empower individuals to improve their lives, families, and communities.

    I could certainly talk a lot about how I think capitalism is also apart of the larger problem, since so many people are unhappy be a slave to their employers. Most people in America need two incomes to pay their bills, and this puts immense stress on the family unit. Also, because employment is so closely tied with identity in America, people feel lower self-esteem when they are unemployed, underemployed, or “disabled.” Most of my clients want to work, but they also want meaningful jobs. We exploit people in capitalism just like we exploit resources. We use them until they no longer provide utility, then we discard them. Reminds me of how we treat the elderly. Toxic systems will never make humans feel healthy, even those in power, because deep down they are anxious about how long it will all last for them to benefit.

    Thanks for the thoughtful dialogue. Have a good weekend.

  • Steve and Rachel,

    I saw this article online and found it thought provoking: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060802/

    I plan to facilitate a conversation about the points made in the article and by MIA members to my team members. I think it brings up some very important critiques of the DSM. All I can say to both of you is that I’m trying to challenge myself, my views, my perceptions of these important matters.

    I feel as though I know very little at this point; after reconsidering everything I’ve been taught, both from my schooling, my clients, MIA, and my bosses, I have to consider the reality that the DSM is harmful and that pills don’t usually help and too often cause a host of terrible effects and withdrawal. I have been paying more attention to my clients commentary about their pills and what it does to them, and I can say for certain that many of them say they dislike how they feel on them and that they would prefer to be pill-free. Some still tell me they like them, but many do not. I’ve been advising my clients to seriously consider titrating and to consider other ways of trying to feel better. If I’m also honest with myself, I know that many, if not all, have my clients have been mislead about the chemical imbalance argument and that pills, like SSRIs, are relatively harmless. They clearly aren’t. I used to think they were, too, because that is what I heard from doctors. They seem most concerned these days with opioids, benzos, and stimulants, but the truth is they should be equally concerned about all the pills they prescribe given the short- and long-term effects. The medical model in mental health does seem to be on very shaky ground.

  • “Harmless kinds like “Aliens are talking through my TV set.”

    Well, most of the people I’ve seen seem quite disturbed and scared by the notion that anyone is talking to them through their TV set. They are also disturbed when they hear voices telling them they should die, kill others, that they are stupid, etc.

    “We also find this in “doctors” who ignore how sick and stupid long term druggings make those beneath them–deluding themselves into thinking it’s okay to live in segregated slums and die before 53.”

    I agree that too many doctors ignore or minimize the long-term implications of the “treatments” they prescribe. They don’t want to believe they are causing harm but as evidenced by the experiences from folks on this website and elsewhere, they certainly do harm innocents with unnecessary pills.

  • High ACE scores correlate with all kinds of poor outcomes in adulthood. Adverse childhood events and intergenerational trauma are real problems in society. And the human services/child welfare programs don’t usually make the situation better. None of my clients who have been through the foster care system came out without further trauma. You are right that we need to support parents rather than take away their kids, except in the most worst case scenarios of abuse and neglect. Being a parent is hard work under the best of circumstances, and a parent who has been through their own trauma is carrying wounds that do impact how they interact with all people. We need to support all trauma survivors and provide the tools necessary to help them heal and be directly involved in their children’s lives.

    My own mother, for instance, grew up in a household with a cold mother and under-involved father. She ended up with an autoimmune disease, feelings of low-self esteem and self-worth, and co-dependency in toxic relationships (my father was addicted to alcohol and died at age 51 due to complications from his drinking and poor diabetes management). Her ACE score is 4. I believe these childhood experiences heavily influenced her life choices in relationships and negatively impacted her health and view of herself. Inevitably our parents impact us, and at least lucky for me my mother tried to show my brother and I love and concern, which is the opposite of what she got as a child. Unfortunately, my father was drunk most nights when I was a teenager and often had bad seizures in the mornings because his blood sugars were low, so I also have those wounds to heal from. And I myself struggle at times with over consuming alcohol. I hope I don’t repeat the cycles of my family, but certainly this is a possibility. That is scary. Good luck to you, Kindredspirit.

  • I forgot to mention the idea of universal basic income and housing. If every man, woman, and child was guaranteed these resources, I am certain many people would not be seeking out a diagnosis. In order to receive many of these services in my area, one has to have a “disability”. We sign off on government documentation for housing, income, transportation, loan forgiveness, food stamps, and so forth, per our client’s request. All of these documents more or less have to state that the applicant has a diagnosis that prevents them from being employed or something similar. Many of our clients come to our center because they know we can help them in these areas. I understand why the system is set up this way, as the government does not want to provide basic, affordable services to people who can legitimately work. But it then does create a certain dependency on the system for those who think they cannot work because they’ve been told by doctors that they have various mental health disabilities. Because all humans have needs, we seek out whatever resources are at our disposal in order to meet these basic needs of survival. The net outcome of this flawed system is that people receive treatment they don’t want, need, or that makes them feel worse, get diagnoses that don’t help them, get stuck in a system they cannot get out of, and further a sense of helplessness. There are clients who get out of the system, but if I’m really honest with myself, they are in the minority and usually have other safety nets to utilize, like family support. I do believe community mental health does good things, and we are also a part of the problem.

  • Hi Chris,
    Thank you for the thoughtful dialogue and sharing of resources. Humans living in a toxic world will be impacted by the environment, and I see my role as a listener, validater, and to help them identify how to cope with what they cannot change. The truth is that virtually everything happening around the world is out of our hands, and this is where concepts such as radical acceptance are useful (and very difficult!) to practice. Ideally therapy helps to reduce suffering and increase a sense of autonomy and empowerment. Most of my clients have a low internal locus of control due to their traumatized childhoods and adulthoods, and I do think therapy can help to work to increase that sense of internal control. Regardless of how toxic our world is, we do all still have personality responsibility to ourselves and those around us. If we don’t take responsibility for ourselves, who else is going to do this? Who is going to shower, feed, and clothe me but myself? We all learn ways of coping, and some ways are more destructive than others. Using substances to numb out, for instance, is an example of this. No doubt we engage in addictive behaviors in individualistic countries because we are trying to soothe our pain of isolation.

    I do worry that with many of my interventions people are telling me what they think I want to hear. I try to tell them that I don’t care what the truth is, but that I prefer the truth. There will always be a power differential in the therapy setting, and I try to do my best to lessen this, but it will always be lurking no matter how I try to diffuse the situation.

    Regarding your CBT critique, I think CBT basically posits about the outside world that you cannot control it. CBT is about our own interpretations and reactions to events. I think we all engage in cognitive distortions to one degree or another, AND some people engage in them to such an extent that it creates roadblocks for them. Road rage is a common example I use. If we get angry every time we are driving, it isn’t the fault of all the other drivers that this is happening. Something is going on within me which is causing the additional suffering. I think we can say that our own reactions, just the like world around us, can be toxic.

    If we all can learn to be most effective at taking care of ourselves, we have a better chance of changing the world. My hope is that therapy can assist traumatized individuals in tapping into their own strengths, power, gifts, and internal resources so they can go out into the world and make it a better place.

    At the end of the day human connection is key. Human connection is why MIA exists. People sharing their stories, supporting each other, connecting to each others’ pain.

    I think therapy will always be necessary in the world we live in for all these reasons, and certainly EBP’s aren’t necessary in the work we do. I generally try to be like Carl Rogers if possible, showing my clients authenticity, unconditional personal regarding, and empathy. They at least deserve that.

    Take care and be well. Thanks for the dialogue.

  • Steve,
    “Additionally, you are assuming other clinics provide similar levels of respect to clients at yours, which you have no reason to assume.”

    I’m not at these facilities, so I have no idea. I do believe that many people have had bad experiences within the MH system, including my own. And I know that many people do have positive experiences.

    “It feels like you’re dismissing their complaints by saying things like “I do find it interesting that my clients’ experiences are minimized by MIA.” A subtle but pretty barbed comment attacking the entire community here, or at least suggesting that those who post here are, as I said, outliers or extremists.”

    What I’m trying to convey is that my personal experience working with clients doesn’t exactly fit the same narrative here on MIA. I don’t recall seeing commenters on MIA recognizing that it’s reasonable or even possible that many of my clients would have positive experiences in the MH system. When I talk on this subject, it seems ignored or minimized. That is all I’m saying.

    “I continue to note that you avoid commenting on the very critical question of whether you think depressed people all have something/the SAME thing wrong with them, regardless of external circumstances, and that they all need “treatment” of a similar sort (therapy and/or drugs).”

    NO, I do not think depressed people all have the same thing “wrong” with them. I simply don’t know what is going on in their brains and bodies. What I do know is that they are usually suffering from some sort of trauma, despair, or mental pain. I don’t believe SSRIs or SNRIs are the answer, which is the opposite of what most psychiatrists would think. Treatment should be geared towards the individual not towards the so-called diagnosis. Life experiences cause depression.

  • Heavens,

    Like I’ve said elsewhere on MIA, I have mixed feelings about being in community mental health. I probably won’t be there much longer, because I do have genuine reservations about continuing to diagnose based on an unscientific process. The DSM is not helpful or necessary for treatment. I don’t see how pathologizing individuals’ traumas makes sense or helps them to move forward in their lives.

  • Rachel, I don’t boast about my expertise. All I’m sharing is my experience and what my clients have told me. I don’t see myself as superior. I have also been a client of mental health services, where I have received mixed experiences. Again, perceptions on internet forums can be misleading and false.

    I do find it interesting that my clients’ experiences are minimized by MIA, but it does go against the grain here. Many of my clients tell me that without the MH center that they do not believe they’d have jobs, housing, and stability. That is the truth.

  • Oldhead, just as I figured. I guess I would think that if I’m making regularly “insulting” comments you could easily find examples to show me. Like I said before, if I have made hurtful comments, I am happy to rescind them and apologize.

    This kind of situation reminds me why internet conversations are too often pointless. I’m pretty sure we’d be interacting better if we were face-to-face because it would encourage more respectful dialogue. It is similar to political cultural wars that exist in America today. Us vs. them. Never goes well because people become defensive and stop listening.

  • Like I said, Steve, there are consequences for some clinicians who break the law. You are right that people are too often dismissed when they have a diagnosis, but this isn’t always the case. People in power always have an advantage in any system and any society. I never said it is fair or always just. But people do get grieved and there are serious consequences for some. That is all I’m saying.

    May I ask, what other options do people who are served in the system have other than to use the grievance system? I am seriously asking. If they feel wronged by their “helpers”, what other reasonable measures would you suggest? They frankly don’t have many other options, other than to sue for civil damages. And how many folks can afford an attorney?

  • I’d say all emotions FEEL real at the time, but that doesn’t mean that they are fitting the facts of the situation. The feeling of rage, for instance, could be distorted if someone gets violent with an innocent person. Domestic violence comes to mind. Anger about injustice, on the other hand, is appropriate and justified.

    I think mental distress is impacted by both the environment and existential realities of living. Hostile environments are triggering and scary, and questions like, what’s the meaning of life?; why am I hear?; and what is real? all can cause distress and confusion.

  • Heavens,
    Well I can say that many people who are grieved in my state are held accountable, such as losing licensure and even being arrested. I know this system is flawed, but people do have a voice. At the end of the day the system (e.g., government) gets to determine the outcome, but all of us should do our best to hold people accountable.

    I assume you are referencing Paula Caplan’s complaint to the APA around diagnosing/DSM? This complaint is different than what I’m referencing. State boards have nothing to do with the APA. They follow their own standards of care, such as that a clinician cannot sleep with their client or have a dual relationship. The APA clearly has a monetary interest in keeping the status quo, so of course they’d dismiss Caplan because then it would require them to admit the significance flaws of their DSM.

    I do like Caplan’s quote: “The ultimate aim is to get professionals and the public to stop assuming that what’s most needed is to know what the person’s diagnosis is. What’s most needed is to listen to what happened to the person and to find ways that help.” Amen to this.

  • Hi Chris,

    I think you make some important points here. Our world is very complex, and in toxic environments we can’t expect people to feel safe and healthy. Also, you are right that therapy has not drastically improved overall happiness or well being in this world. Therapy does not prevent social problems like poverty, discrimination, wealthy inequality, war, and government corruption.

    Short-term therapy is basically what HMOs love. They want to be able to pay as little as possible for treatment, which is why long-term therapy isn’t favored in many places. Very few clients I’ve ever met who want therapy prefer the 8-12 week model, but there are some who do, who want “tools” to work on very specific goals.

    And to be clear most evidenced-based therapy today hasn’t been around for 100 years. Only psychoanalytic has been around that long, and hardly anyone uses this modality anymore. Most of us who practice are eclectic–so we use a combination of person centered, CBT, DBT, EMDR, MI, existential, reality, trauma-informed, and so on, based on the individual who presents to us and what their goals are.

    Ultimately, therapy isn’t a panacea for the world’s problems. My hope is that it can help people to reduce their suffering, increase their sense of autonomy and peace, increase their belief in themselves, and to help heal from traumas.

    Finally, I will point out that therapy is utilized in countries which are more individualistic. Collectivist cultures support each other more and fewer people feel isolated. Whereas in the West, too many of us feel like we are a man on an island and have nobody to turn to. This to me is one of the big explanations for the despair people feel (and thus their symptoms of depression, anxiety, etc. are a manifestation of this experience); so many of my clients tell me that they have nobody but me who listens to them. This makes me understand why therapy is necessary in cultures like my own where people do not get enough support from their immediate community and neighbors. I know nobody on my block, for instance, except the people who live in my building. This is a a common problem in the US. And certain no drug is going to fix this sense of isolation and disconnection. I can see why suicide is common under such terrible circumstances. Most of us yearn to be understood and loved, and if we don’t have meaningful social connections, this is impossible.

  • Like I said earlier, I would appreciate you back up your claim that I’m insulting. I’ll be waiting. And by no means do I intend to insult anyone, and I sincerely apologize if I’m upset anyone who has been harmed by the system.

    If you think it’s insulting because I have said that many of my clients report improvement in the current system, that is just purely fact. Some people do actually find their symptoms subside and attain improved outcomes with current treatments. If you find that offensive, well I then I think you are hypocritically being dismissive of the very people you seek to protect.

  • Oldhead, it sounds like it’s really hard for you to hear differences of opinion. This is the internet, and not everyone agrees.

    I would also love to see your evidence in my posts that I’m insulting. Please, go for it. I’m happy to defend myself. If you look at the pattern of your posts towards me, it sure seems you are doing your best to simply make me go away because you don’t like what I’m saying.

  • Streetphotobeing, you are correct that encephalitis could be an explanation for psychosis, and should be ruled out if many of the symptoms are present. The difference in my example is that many of the people I describe are older, male, chronically homeless, and do not have many of the symptoms associated with this type of infection, like seizures. One of my greatest frustrations, however, is that medical providers do not rule out all the major explanations for symptoms. We should always do a full medical workup with blood labs and a physical before starting any medication, but this just doesn’t happen in Western medicine. We should be making sure someone doesn’t have a thyroid imbalance, for instance, when looking at depression.

    I will also add that attaining spinal fluid from someone is is presenting with psychosis in an outpatient treatment center is impossible. Many people experiencing psychosis would also not consent to such a procedure being done. This procedure would have to be done in a surgery center, which is not where most people with these symptoms would voluntarily go. There are some practical limitations doing full workups on individuals, and I’m not exactly sure what the answers are about this issue. Is there a blood test that can rule this out?

  • Oldhead, I only referenced that specific article on the critique of the book. I don’t agree with everything Jaffe has to say. Jaffe clearly does believe that mental illness is a real thing, whereas on this forum people believe otherwise. I see merits to both perspectives.

    I’ve worked with people who were suffering severe psychosis, so I have a hard time believing that mental illness doesn’t exist at all. I’ve seen people pissing themselves, thinking the TV is sending them special messages, thinking the government is listening to them through their phones, walking the streets at night talking to themselves, yelling at voices, thinking they are talking to celebrities, hearing voices to kill themselves or others, and so forth (most of these examples are people not on pills). I worked with the homeless population for a decade and saw them suffer immensely. So yeah forgive me if I don’t believe everything MIA has to say on the subject of mental health and what constitutes actual illness.

  • Steve,
    Well you and I agree on a couple things. We both feel that others have ignored central points we’ve made and feel we’ve wasted our time. I am relatively open minded, otherwise I wouldn’t be reading Mad in America. I am open to challenging my views, but you really don’t know me, so it’s easy to jump to conclusions.

    I have real reservations about the MH system as it stands now as I’ve made clear in other posts. I also, on the other hand, see how the system helps people in my community. Both CAN be true. I think that’s the problem I run into on both sides of this debate. I talk to some of my colleagues, and if I say anything challenging about how we operate (diagnose, prescribe, etc), I often receive responses which are defensive and sound like denial. I see the same phenomenon here, where I say anything positive about the system–like we help people find housing or that many of my clients say that they find real benefit from medications–and I also get snark. I feel like I can’t win with either group. I see validity in both points of view, which is a difficult position to be in. So be it I guess. I’m on my own journey as everyone else.

    I doubt I will be in the HMO/medical model-dominated system for much longer, because I do have serious concerns about continuing to work in a model which pathologizes and over-medicates. I think at this point the whole world is over-medicates rather than dealing with the root of most human suffering–trauma and dehumanization. I do my best to be compassionate and show care towards my clients, but nobody on here will ever see that unless they are in my office with me.

  • You are incorrect, Rachel. I don’t know who DJ is, but he certainly isn’t me. I am a therapist in a community mental health setting. Choose to believe it or not. You and many people on here are making plenty of false assumptions about me and my beliefs, but keep going if you wish. It is clearly some fun entertainment for you. Also, you are incorrect about affordable housing. There are some very nice buildings being built by nonprofits around the country. Maybe do some research on the subject if you want to learn more. And finally our center helps people to find gainful employment; we have a handful of vocational counselors who help people in getting meaningful jobs.

  • Chris,
    Thank you for sharing these resources. I will take a look.

    I do think therapy can help in innumerable ways, such as identifying possible changes in areas of their lives which we control. Ultimately, therapy is a powerful tool if focused productively and thoughtfully. I try to stick to Carl Rogers’ core tenants of therapy and throw in a few other ideas along the way. I fully believe it is the safe relationship in therapy that really matters, not what techniques are used. I don’t see CBT being harmful if done in a thoughtful manner, because it points out the connection between thoughts, feelings, and behavior. If our thoughts are distorted/exaggerated (they don’t fit the facts of the situation), such as when I say “He’s an idiot for cutting me off in traffic”, it may lead me to feel stronger negative emotions such as rage which for many can lead to unhelpful behaviors, like pulling out a gun and shooting someone (recently in my community and guy shot and killed multiple people after such an incident). Thinking errors are something we all struggle with, such as “I’m a loser” or “Things never work out for me.” These types of thoughts don’t usually fit the facts, but we believe them anyway. No doubt the environment impacts all of us, and if we live in a toxic world, we will feel badly at times. But the truth is we cannot fix these social problems in the therapy setting; we can only work on the piece in our lives that we have any control over. This is the point of any good therapy to help us see our contribution to our own suffering and to also get validation of our pain and struggles in a safe environment.

  • Steve, I don’t know what you are talking about? Just because I don’t say what you want me to say doesn’t mean I don’t have compassion. Re-read my posts and tell me again I don’t display compassion towards those harmed. I’ve repeatedly said that I deeply care for anyone who has not been treated with dignity and respect. I have also pointed out that many people I’ve seen over the last 15 years have improved and feel much better because of the treatments they’ve received and the support they attained in the community. That message isn’t a popular one on MIA. It seems that there’s an all-or-nothing mentality that I simply cannot get behind on either side. I definitely know of people who think pills are harmless, which is also ignorant. I see the points both sides make and fall somewhere in the middle. Sorry to frustrate you so deeply. I’ll probably stop posting here and just read the articles, because clearly these conversations are counterproductive. Have a good day.

  • Oldhead, clearly you haven’t read my posts clearly. I diagnose because I have no choice in the system I am in. The government, HMOs, doctors, and the law all support diagnosing. In fact, all the the western world supports diagnosing to one degree or another. If low income individuals are going to get services, they need a diagnosis to be enrolled. Plain and simple. I am not in a position of power to change how the whole world works.

    I don’t see a new thread at the bottom.

  • Steve,
    A diagnosis can be damaging to someone’s view of themselves. I hear clients say that they feel perpetually “screwed up”, which sometimes has to do with the diagnosis, and other times has to do with their childhood and adulthood traumas of people treating them without respect and making them feel unworthy, unsafe, unloveable, etc. I have had clients who say they feel relieved to have an answer to explain their symptoms and thus feel some relief. I would prefer, like I’ve said before, to never diagnose anyone. Everyone is right on MIA who say the DSM isn’t a scientific book and shouldn’t be treated as fact. Diagnosing is completely unnecessary when working with clients.

    I totally agree that context matters when it comes to treatment. I am responding to some people on MIA who do essentially equate drug therapy with CBT/DBT etc. While I understand you aren’t making that comparison, I have seen others do it in the past on this forum. Heavenstobetsy’s story is an example of where the system clearly fails and harms people. DV survivors should be treated with the upmost respect, which means first making sure they are safe and have the resources to get their basic needs met. Trauma treatment should always start with safety, then move on from there. Nobody should be coerced to start treatment they aren’t ready for. We need to be truly client centered, which in my view means fully listening to our clients and hearing their point of view and then set up treatment and support which is consistent with their needs and wishes.

  • HeavensToBetsy,

    You are right. You were not treated with dignity and respect, and it sure seems you weren’t listened to or given the help you felt was most appropriate for your situation. I would never suggest that CBT be the first treatment for a domestic violence survivor. That doesn’t make sense.

    The general point I have been trying to make is that DBT and CBT can have benefit to individuals who are in the position and need for it. CBT for example has years of research to back up its use and has been shown to be quite effective at treating certain issues like anxiety and depression.

    I am sorry to hear that you had such a poor experience with the system. I honestly feel we are doing better but nowhere near we need to be. The system does have problems and I hope one day it will get away from pathologizing all human suffering and instead meet the person where they are at without any threats, harm, or suffering being inflicted on the individual.

    I have probably been influenced more by the medical model than I want to believe. I would like to think I don’t pathologize my clients, but the reality is that I’m forced to in order to admit any client into our outpatient programs. If they don’t meet any criteria under the DSM, I have to refer elsewhere. But if they have Medicaid, the chances of finding anyone that will take them without a diagnosis is slim. The system is also unjust because a rich person doesn’t need a diagnosis to receive treatment–they can just pay out of pocket. The rest of us must be labeled as “sick” in order to receive help. This is flawed on many levels. I am more concerned with what has happened to my clients than diagnosing them, but I’m forced between a rock and a hard place when it comes to providing treatment in America. HMOs and governments are a big part of the problem, too, because they push the agenda of diagnosis and pills.

    I think that not enough of us who work in the field are questioning our role in keeping the status quo going. I do plan to talk more with my colleagues about my concerns, the same concerns that many MIA members articulate. Nobody should be harmed by the mental health system, but clearly this is happening all too often in one way or another.

  • Steve,

    We simply don’t know what is really going on in the brain. We have much to learn. We do know, however, where pain is felt in the brain (thalamus then cerebral cortex), where addiction impacts brain activity, and so on, so we know some things. I highly doubt that depression resides anywhere else than the brain, since no other organ is as complicated or connected to the CNS as the brain. People don’t hear voices, for instance, because their ankle is sore. In any case, I do believe that one day science will show why some people experience mental health symptoms and others don’t.

    I think it is completely inaccurate to compare psych drugs with DBT and CBT. They are nothing alike. One is empowering and the other encourages people to be passive. I understand that nobody will ever completely agree on what “treatments” are helpful. But for people so point out all the horrible effects of pills yet at the same time say how terrible basic therapy treatments are like DBT, I find it difficult to take at face value. DBT doesn’t inject anything into anybody’s CNS. DBT actually encourages people to find ways to empower themselves. I would say that it isn’t these treatments that are problem, but rather how these modalities were implemented or forced upon people. No treatment should be used to bully people or demean them. Any good clinician will be effective at helping individuals to empower themselves rather than traumatize them further. ‘

    And yes I’ve read the book. Did you see my post from the Huffington Post? I think it does a good job of summarizing my thoughts on the book.

  • Heavenstobetsy,

    I guess we can agree to disagree. DBT and CBT are used to treat any number of human suffering. I don’t think mindfulness, for example, requires a diagnosis to be helpful to someone. DBT encourages healthy self care (e.g, PLEASE skill), assertiveness to protect oneself from being used by others (DEARMAN), a deeper understanding of why our emotions exist and what use they are to us (emotion regulation), and working on learning to accept what we cannot change in life (radical acceptance). I don’t think these are abusive concepts; quite to the contrary, for those who wish to avoid pills and work on themselves, DBT and CBT are great alternatives, as they focus on individual autonomy and choice to change their lives through natural means.

  • Rachel, you are right that the chemical imbalance theory has yet to be proven, and may never be. You are also right that psych pills do cause damage, such as tardive dyskinesia and metabolic syndrome. Usually people who are on psych drugs also have fewer resources, such as regular access to a dentist. I found this to be the case with most of my clients. Also, many of them do not floss or brush regularly (heck, many people with resources fail to do this), so that also contributes. Meth users also don’t do regular dental hygiene since their focus is on getting more of their drug rather than on healthy self care. People do get apartments on SSI in my community, but waitlists are too long because there is an affordable housing shortage. No doubt people with “disabilities” are discriminated against, and we need to work on making sure that everyone is treated fairly when it comes to access to housing.

  • Heavenstobesty,
    There is a process for clients to grieve their mental health providers in my state. If someone thinks they’ve been harmed by their doctor, therapist, or social worker, they have the right and the ability to make a formal complaint with the licensing agency/board. An investigation takes place and people are often held accountable. Many clinicians get in trouble, for instance, because they have sexual relations with their clients. Anyone providing MH treatment ought to be held to a very high standard. If that isn’t happening, that is a failure of many systems which are supposed to be in existence to promote public safety.

    One reality that I’ve come to believe in is that the world is unjust because monied interests are usually corrupt on some level. Money buys influence which buys laws that are favorable to powerful interests. I do believe that big pharma is corrupt, and any entity which has too much power is dangerous. Pharmaceuticals are the most profitable business in the world, and certainly big pharma is spending billions in advertising and influencing prescribing practices in order to keep the status quo going. I do believe, however, based on my own interactions with clients, is that some folks see immense value in having these pills as a treatment option. They report fewer nightmares, better sleep, improved moods, decreased voices, etc., and I cannot discount their stories simply because I think pharmaceuticals are too often problematic. That would also be short-sighted and arrogant on my part to tell them that their experience is inaccurate.

  • Someone else, thank you for your reply. Next month I do plan to present these topics to my coworkers. I do think we all in the system need to think critically about what we are doing and who we are doing it for. I for one know that a client of mine doesn’t need a diagnosis in order to get help, but that is how the system is set up. The premise is that the DSM is “the Bible” and thus is correct and accurate. There is also an assumption that prescribed pills are better than no pills, which I’m starting to realize is also false. Many clinicians say that the DSM helps give us a common language to understand the clusters of symptoms, but I think this is also unnecessary. We do need serious reform in mental health care.

  • Heavenstobetsy, I do agree with some of what you say, here. I do think you describe an outlier example, but I could be wrong. Most of my clients are trauma survivors and haven’t experienced what you describe here. I will say that many trauma survivors are given drugs which do no good. I think proper treatments, like community support and EMDR are much preferable. My clients do talk to me about how they feel, and not surprisingly they get better over time because I think they are getting what they need–relationships with caring, safe individuals who validate their pain. Drugs will never remove someone’s trauma from their experience.

  • But why would you prefer to have a damaged heart over a damaged brain? Seems like you should want neither. But I guess coke and meth make someone feel high, so there’s a benefit there. SSRIs don’t give people that same feeling of pleasure that other drugs do, including benzos and opioids.

    I think meth and crack addicts may disagree with you. Many of them keep relapsing and many die.

    You are right that any drug is potentially deadly, including OTCs.

  • It doesn’t surprise me, Oldhead, that you didn’t answer my original question and diverted the conversation. I don’t feel threatened, I’m asking genuine questions. However, I don’t see us ever having productive conservations given your general responses, which is fine.

    I don’t see adderall takers losing teeth and becoming homeless as I do with meth users, but go ahead and compare them if you wish. Meth users don’t know what dose they are taking or what is in the drug. At least stimulant users know the dose.

  • Rachel, I am saddened that your experience was so terrible. I can say that many of my clients who are on psych drugs do work and have quality lives. The ones who struggle with instability the most have severe trauma histories and usually are in poverty. These risk factors are significant IMO. There are many variables which contribute to suffering, and over time my hope when working with clients is that they know they are safe in my presence and that I genuinely care about them as equal human beings.

  • Steve, this article sums up how I feel about the book. Some great points in Anatomy and others that are pretty weak:https://www.huffingtonpost.com/dj-jaffe/book-review-anatomy-of-an_b_1071163.html

    You are right that the world we live in promotes psych drugs. I don’t deny that. What I would say though is that clients who’ve been on these pills for years still see value in them. Many take them for a period of time and then stop, with mixed results. I encourage any of my clients who think the pills do more harm than good talk to their doctor about titrating off of them. I think that the pills too often get in the way of therapy, because some of them do numb people out to one degree or another. I agree with you that we should always challenge the status quo, as clearly we need to improve the system as it stands now. Deinstitutionalization was good and needed, but what replaced it is also inadequate and often unjust (e.g., jailing people, not offering sufficient resources and services, etc).

  • Oldhead, so you think the effects of coke and an SSRI are similar?

    Most folks I see who say their drugs improve their quality of life function better–eg, they keep jobs, have better relationships, seek higher education, etc–on psych drugs. Usually for illicit drug use that isn’t the case. I’ve never seen anyone on meth or crack doing well, whereas with mood stabilizers and SSRIs I’ve seen very functional people.

    I don’t feel triggered, Oldhead. I think your posts continue to make my point that you are trying to get me to react rather than try and have a civil conversation. I’m happy to discuss the merits of our different points of view in a respectful manner.

  • Steve, I’ve already explained my position on other posts on why I have felt hostility, so I won’t say anything more about that. I can say I do listen to people, and I also make up my own mind like everyone else does about what is right and wrong. Regarding my last post, my 99% estimation is simply based on people who aren’t court ordered to treatment (on a 3 or 6 month certification). You are right that informed consent is lacking, that drug advertising is misleading, that family/community coercion is a factor as well.

    The vast majority of people who come into our clinic WANT to see a doctor about various options, per what they tell me. And many of my clients tell me that they feel better on medications. If I am to respect client autonomy, then should we be so dismissive of people who actually think they feel better on psych drugs? I have had many clients tell me that without drugs like Lithium they would not be able to function in society. It think it would be inappropriate of me to tell them that it’t really in their best interest to be off a drug that they’ve been on for years that they tell me they want to stay on.

    From what I see today the MH system is making more efforts to support people in full recovery, meaning that they wouldn’t need our services for their entire lives. Again people are entitled to their opinions about the system, and I do find the system I work in is probably more progressive and forward thinking than others I guess. At the end of the day I do think we’d all be better off severely restricting drug-based therapy for mental health, as evidenced by the experiences by the MIA community and what has been documented as problematic effects of these drugs. I am disturbed by drug effects like metabolic syndrome. I am also disturbed because doctors continue to guess as to what might help someone feel better, which basically means they are doing experiments on people. I do tell my clients that it is “trial-and-error” and that they may not find any relief from such “treatment” and will probably have “side effects”. Many of them still want to see a doctor anyway. I am glad that more people are coming to our clinic just asking for therapy. I do wish I could provide weekly therapy to all my clients so we could adequately work on their traumas, but I guess some therapy is better than none as long as it’s provided in a thoughtful fashion.

  • Rachel777, I would disagree that the system keeps people helpless or dependent. Actually, we offer and provide services to assist individuals increasing their independence through vocational counseling, education specialists who help people connect with local colleges and training programs, teach people new skills with computers, cooking, budgeting, etc., assistance with attaining basic resources like housing, benefits, medical care, furniture, clothing, food bank, and so on. Most of my clients tell me that they greatly appreciate these opportunities, since they often cannot find these resources in the community. And one thing to keep in mind is over 99% of individuals who take pills at my center do so voluntarily. The only people who may not would be those on a certification from my states’ court system, and even then they can refuse and go back to court to fight the order. I do not think anyone should be forced to take pills that they don’t want to take. Also, many of my clients eventually opt to stop pills, in part because they believe they’ve received relief in other areas of their lives and don’t feel the need to keep taking them. I encourage all my clients to get off meds if they feel it is in their best interest. I am not in the position to tell people what they should be putting in their bodies, other than more fruits and veggies! lol I’ve also had clients who have gotten mad at me or their doctor because we felt it wouldn’t be in their interest to prescribe medications.

  • I do not consider the medical model of care “my industry.” I was trained to treat clients based on non-invasive treatments like EMDR, DBT, and CBT. LPC’s do not do drug-based therapy and never will. Social workers and therapists like myself prefer to help clients heal and increase their internal locus of control through natural means, such as psychotherapy. My co-workers and I would not cover up any child abuse. Keep in mind that our client interactions are confidential, and we cannot breach this privileged unless certain strict legal guidelines are met, such as suspicion of ongoing abuse. I do agree with you that a nation’s greatness is measured by how it treats it’s most vulnerable members, which is why I’ve spent the last 15 years of my life working with individuals who are homeless, low income, and trauma survivors, because I believe they deserve care and love to help them heal and move forward in life.

  • Well, clearly brains are implicated in human behavior. I don’t think hearing distressing voices, for instance, comes from our toes or elbows. We simply don’t know enough how the brain works and why some people experience “symptoms” that others don’t. There is still a lot to learn in that area, which is also why I’m increasingly uncomfortable with the system pumping people full of psych drugs when we don’t know these answers.

  • Oldhead, I don’t see mental health care going away anytime soon. I find much value in it from a therapy standpoint. Many of my clients have healed their emotional traumas through treatment. I don’t care for the DSM, as it’s clearly a very flawed document. Hopefully one day we have actual science to prove what is and isn’t a “mental disease”.

  • I agree with most of your criticisms of the system. We should not have to diagnose sufferers of trauma in order to provide treatment. Trauma survivors are given any number of DSM diagnoses, and these diagnoses also change over time because diagnosing is so subjective. Most of my clients have experienced multiple traumas in their lifetimes, and I know for myself I see this as the root of most, if not all, of my client’s “symptoms.” We do document specific traumas and, when appropriate, do report child abuse to the authorities based on what the law demands. I do not believe that “today’s “mental health system” was intentionally designed as a gigantic child abuse covering up system” as you say, but I agree that it needs seriously reformed. If we actually covered up abuse, we are liable to lose our licenses and face criminal charges. Anyone who is a mandated reporter has a duty to report suspicions of ongoing abuse or if an abuser is in a place of authority, such as a teacher or pastor. In many cases by the time I see a child abuse survivor the perpetrator has already been through the courts or the survivor does not want to pursue making a report to authorities.

    Regarding Trump he has no standing when it comes to treating people with respect. He happily told a reporter that he sexually assaults women because he’s rich. Trump isn’t someone who cares about respecting other people as evidenced by his outlandish behaviors and commentary on women, minorities, immigrants, Muslims, and so forth.

  • Oldhead, there you go again. Now you are calling me unprofessional simply because I happen to experience hostility on this website and actually say something about my experience. That is telling. I am not deflecting. It is clear you don’t see your role in creating hostile communications on this site. I’ve seen you make comments elsewhere here where you clearly are derailing conversations. I assume you get some amusement out of it, but it’s counterproductive. I’d be curious what your ultimate goals are. I mean, do you really want to see serious reform in the way mental healthcare is provided in this world? If so, I’d suggest you change your tactics. If not, then keep being antagonistic. If you seriously think I want to raise a literal army to fight big pharma, that is pretty funny. It’s called a metaphor.

  • Oldhead, you don’t know me, just as much as I don’t know you. I would hope you would understand that coalition building is important in creating lasting change, and frankly fringe groups rarely, if ever, get anywhere because they aren’t big enough (e.g., the Libertarian Party in the US). To fight Big Pharma will take an army, which is something that is missing from the anti-psychiatry movement.

    When you cherrypick my comments, you are ignoring many of the ideas which we actually have in common. This has too often been my experience interacting with people on this forum. It seems that I’m a target for hostility and frustration. I have no ill will towards you or anyone else who has been harmed by unjust systems. I believe everyone deserves dignity and respect. I also think that respect goes both ways, and if I feel I’m being disrespected by anybody, I’m not just going to sit quietly and say nothing. You can accuse me of anything you want, but just know that it’s your subjective opinion based on very little actual knowledge of me as a person.

  • There aren’t many therapists posting on this site for a reason. I’ve felt attacked on here multiple times because I don’t agree 100% with what is posted on here. If you alienate potential allies like myself, I believe changing the MH system will become even more unlikely. I never said anyone is ungrateful but rather shortsighted in their attacks. Your perspectives won’t be heard by the masses if you don’t change your attacking and dismissive tone. That I’m confident of.

  • Thank you, Gerard. I do try to do good work, but I do fear that the system most therapists find themselves in is tainted by the medical model and pills. We are told by our masters (payers, management) that brief therapy sessions are effective, even for people with complex trauma histories. This flies in the face of reality, and I struggle because I know that community mental health in America is the only viable treatment option for those who are low income. Everyone deserves access to quality care, and to care which does no harm and gives them adequate space and resources to heal. I doubt that any antidepressant, for instance, will help a trauma survivor heal from their emotional wounds. It may for some help them to come to therapy more often because they may have more energy, but it isn’t going to “fix” anyone. I believe that at the very least healing can take longer than it needs to because clients cannot come in as often as they wish for therapy. This is sad and frustrating.

  • Frank, you are correct. Drug advertising should be outlawed, as it is manipulative and misleading. But Big Pharma, like all big business, is very influential over groups like the FDA, AMA, and Congress, so they get away with it. If we could take money and influence out of the equation, that would make such a difference. The other problem is that doctors themselves have set up an expectation from their patients that they will continue to get these pills indefinitely and have told their patients that these drugs are necessary for proper functioning. Many people who come to my clinic get angry at their doctors because they are limiting access to certain drugs like benzos and stimulants. Many clients see these pills as necessary to their functioning. Big Pharma is too influential over this whole mess.

  • Gerard, no doubt people have been abused and traumatized by the system. People have also been abused by their family systems, criminal systems, school systems, religious systems, political systems, and just about any other system created by humans. As a species, we are highly flawed and thus we damage each other. I hope one day we can find away to stop traumatizing each other, but I fear that day is much too far away, if it ever comes.

    Regarding calling people “emotional”, I was only referencing Frank’s comment that I should get another job. The reality is he doesn’t know what I do or how I treat my clients. He clearly doesn’t know that I cherish my time with my clients, that I don’t define them by their diagnosis, that I ask what happened to them rather than what is wrong with them, that I respect them as autonomous, intelligent humans who simply have been traumatized by a toxic world.

  • When I’m told by some, Gerard, to “get a real job”, that is clearly emotional. I’m a therapist who works in a setting which some on this site wouldn’t support, but so be it. I don’t pretend to be an authority with my clients. Too bad you can’t ask them how I treat them and our work. It seems many on this site are hostile to people in my position because they’ve had poor experiences in the MH system, but I’m not responsible for your trauma. I think it’s called projection. If you want to alienate potential allies to your cause, you are always going to be a group with little power and influence over how the system works. Keep attacking people like me, and you’ll be talking to yourselves about how horrible the system is but nothing with change. Enjoy that.

  • I don’t know what get a real job means? Low income individuals in my community cannot access any other mental health treatment than what we offer at my facility. I know I am doing good work, so I don’t care what people like you think since you are responding based on strong emotions. Good luck in your journey.

  • I’m sorry to hear your experience is so negative. Unfortunately the mental health system has remained connected to the DSM. I hope one day that changes. You are right that relationships in everyday life are probably more meaningful than relationships with one’s therapists, but I wouldn’t discount therapeutic relationships, as I’ve seen many benefits for individuals within this framework. Therapy isn’t for everyone, but for those who engage in the relationship, I know real positive change does occur.

  • Unfortunately parents are also conditioned to blame their kids rather than looking at their contributions, such as poor boundaries, unhealthy communication patterns, inconsistent responses from parents, addiction, etc. Kids need a safe, consistent environment to develop in a healthy manner. Schools also label kids inappropriately. I was labeled incorrectly by my grade school until my mother advocated for me.

  • Hi Steve,

    I would argue that most of us professional therapists don’t adhere to the medical model much, as we aren’t trained to think in terms of disease. But the reality is most of us work within the medical model, which requires us to follow certain guidelines in order for our agencies to get paid so that we can provide therapy. Actually, I hear that psychiatry and our pharmacy in my clinic is losing money, so maybe there is hope that one day we would only focus on therapy that didn’t require us to label everyone we see. I cannot admit a client into our program without a DSM diagnosis; the only other option for folks is to see private therapists who don’t diagnose and charge $100 or more a session, which is unaffordable to most. I will say that even our doctors at my clinic will talk with clients about behavioral strategies to manage or cope with various symptoms, so I know most of them try to provide some form of counseling. However, when they only see their clients on average of once every 3 months for 30 minutes, this is difficult on everyone. It’s inadequate. I think you should come visit my clinic, which is the largest in the state, because here we do focus most of our work on talking and listening. Many of us more or less ignore the diagnostic label and focus on the individual’s concerns and needs. If they don’t want pills here, they don’t have to take them. I’ve encouraged more of my clients to consider other options besides pills, but for some of them, they see no other choice. The other reality of your example of the individual with depression is that when someone is very depressed, the very idea of doing things actively can seem pretty overwhelming and difficult due to lethargy, anhedonia, poor sleep, etc. Even though it isn’t popular on this site, I do believe that some people make real positive strides on antidepressants to help energize them into being more active in their lives. The other issue is that primary care docs, who often are inadequately trained in mental health treatment, are the docs prescribing mental health pills. They don’t have much time with their patients, and thus people don’t receive adequate follow up and informed consent.

  • This book was written 30 years ago when psychotherapy looked much different in America than it does today. Therapy is much more client-centered now than in the 80s. Psychiatrists rarely provided therapy today, whereas earlier on they were the primary therapist and prescriber for their clients. Today I view psychotherapy’s main problem being a lack of access to people who need it the most. We do have some excellent therapies for folks, such as EMDR, CBT, TREM, and ACT, but people who want an alternative to pills may have to wait too long and often cannot come to weekly individual therapy appointments without paying out of pocket.

  • It would also help, Steve, if the root of the problem would be addressed. For instance, many kids diagnosed with ADHD are simply bored and thus act out. If schooling was catered to individual needs, many kids would be able to successfully complete school without being disruptive. Also, if kids received adequate psychotherapy when there is emotional outbursts or behaviors present, that would be preferable over using stimulants. These kids’ brains are still developing and I have to wonder what harm is being done by giving them drugs at such early ages. I would further argue that many children are growing up in traumatic or stressful households, so if this issue isn’t addressed by communities and families, we will continue to see kids display emotional and behavioral problems in the school setting.

  • As a therapist in a community mental health setting, I completely agree. While CBT is an excellent treatment choice for certain issues, like panic disorder and generalized anxiety disorder, for it to be most effective, it has to be provided in a very structured, consistent manner, and frankly many therapists are unable to provide enough access to ensure that the full protocol is completed. I, for instance, do provide CBT to some of my clients, but at best I can usually only see them twice a month. For many client problems, intensive, consistent treatment provides the best opportunity for healing. Our mental health system is inadequate in terms of access, and because of this we see higher than necessary drop out rates and slower progress than is actually possible if providers did not have such high caseload sizes (I am expected to do two groups a week, two intakes, attend meetings/supervisions/trainings, and see 80 clients every two weeks or so). Unfortunately, insurance/payers dictate how most people receive therapy and mental health and substance abuse treatment, except for those who can afford to pay out of pocket, which is not the majority. Healthcare should be provided in a timely, affordable, and accessible manner, plain and simple.

  • AA,
    I’m not doing it to detract attention. I believe it is a valid point. Posters on MIA demonize psychiatry but the truth is that many types of medical treatments make people sicker. I think we still have a long way to go before we really understand how the human body works and why some people get x condition and others get y. We need more longitudinal studies. I do believe we are doing mini experiments on people when we give them psych drugs, and I am personally uncomfortable with much of this. I think humans have been experimenting on humans for many generations and med mgmt. is another iteration of this. 75 years ago we were doing lobotomies. Now we give people pills. The difference is I think more people are helped than harmed, but I can see how not everyone views it that way. I’ll also suggest that we ought to stop prescribing pills like they are candy. Doctors should not practice this way.

  • AA,

    So am I wrong that other medical treatments also have side effects? I don’t disagree with SEs being a problem. Actually, yesterday I gave a talk to my colleagues about many of the concerns that folks on MIA bring up, such as that there are no biomarkers for mental illness and that we have no ability to determine if any prescribed drug is going to benefit or harm a client. I just don’t believe throwing the baby out with the bathwater.

  • AA,

    My points are relevant but you can chose to ignore or minimize them if you wish. I am not condescending at all. I know that some people are very harmed by current medical treatments. What I find on MIA is that most of the posters are dismissive of the tens of thousands of people who find relief and benefit from current psych drugs.

    I have never said I have a monopoly on the truth. I don’t. But I also know that thousands of people are helped by the current system, something which gets readily dismissed here on MIA. The MH system and medical model are far from perfect, but it can and does help people recover and live meaningful lives. MH treatment, particularly with non-medical interventions, has been expanded over the years to include recreational activities, social activities, vocational and educational supports, and so forth. The goal is always to help people recover to the point they no longer feel they need us or government assistance if possible. Most of my clients want to work and we do everything we can to support this goal of total self-sufficiency.

  • Andy, the disability is present before psych drugs are started. Yes, some drugs make it worse, but we also need to look at other factors that produce stress in individuals’ lives, such as being sent to jail, homelessness, substance abuse, domestic violence, etc, all of which occur in higher numbers for people with diagnosed conditions than in the general population. There are many risk factors here. To blame it all on “psych drugs” is ignoring the obvious realities which also cause pain, suffering, and early death in some individuals.

    Someone pointed out that in developing countries mental health outcomes are different. Well, of course that is true. The whole society operates differently than ours. We know that people are a product of nature and nurture, so it is clear that environmental factors weigh heavily on outcomes. Why do you suppose the demand for illegal drugs like heroin and cocaine are so high in America, especially compared to developing countries? Some of these issues might explain why people with different emotional states than what is considered “normal” in America have poorer outcomes than in other parts of the world. People in America aren’t generally communal in their thinking, unless you are talking about smaller rural areas. We are generally individualistic and Darwinian. This, of course, leaves many people isolated, lonely, misunderstood, judged, etc., which we know negatively impact health outcomes.

  • AA, adverse effects occur with all kinds of medical treatments. Many people die from chemotherapy, for instance, but it is the best option for trying to treat cancer. Heart surgery, or most serious surgeries for that matter, sometimes lead to complications and/or death.

    You are correct that low motivation is associated with mental health conditions; however, we observe this phenomenon both for people on and off of psych drugs. I am in full agreement with you that some drugs like Zyprexa are problematic for people who gain weight, develop diabetes, etc., because this does lower life expectancy. We still have a long way to go to develop better treatments which produce no harm. I can say, however, that in my decade or so of experience I’ve seen most of my clients improve on psych drugs and the ones with very serious mental illness got worse when they did not receive these treatments. That is my experience and most of my clients would say that they would be worse off without these treatments. Sorry that goes against the grain here on MIA but it is my truth and the truth of thousands of others who attain treatment on a daily basis in America.

  • AntiP,

    You don’t know my experience and seem quite dismissive. I’ve worked in large and small agencies, all of which had peer mentors/specialists, and I never saw what you are talking about. I don’t doubt that this occurs, but in my experience professionally this hasn’t been the case in my home state.

    No doubt there are peers who see things through a narrow window, but frankly most of us do that to some degree. Regarding “brainwashing”, I guess it all depends on your definition. There are many people who I talk to regularly who have seen great benefit from traditional treatments such as psychotherapy and med management. They say it saved their lives. I find it sad that many on the MIA forum completely dismiss these people as being “brainwashed.” Medications, or psych drugs like they are called on MIA, can help to manage symptoms but they aren’t a cure. Most people I’ve interacted with, hundreds if not thousands by this point, agree with me that when used appropriately, meds can help (and they also agree that side effects are problematic).

    I’ll also add that most people won’t do a job unless they get paid. That is how it works. Also, many folks I know too often will offer their help for free but it ends up being an unhealthy dynamic. I don’t see peers getting greedy like you imply. Many of the folks I know who have done peer work actually like helping people, and if they can get paid for it sometimes, all the better. Most of these folks are low income and can use all the financial resources possible to live.

  • I agree, Stephen, that training is very important and often it is inadequate for peer roles. Certainly most of the peers I’ve met believe in the current model and generally support what it is doing because it worked for them. They, more than anybody in the system, are a source for social support and encouragement for individuals with mental health issues. Not all of them support psych drugs but many do. Use of peers are in my view are a step in the right direction but I can see how others don’t feel that way.

  • Catnight, we can help the families you mention via support, encouragement, and supporting political candidates who will support policies and laws which provide resources and financial support to the marginalized.

    I’ve noticed on MIA that many posters seem to fixate on psychiatry and psych drugs while ignoring other problematic, powerful forces at work in society. We cannot ignore clear truths, such as many families aren’t supported and feel stressed because of socioeconomic inequalities. We need to fight for all forms of justice.

  • Ourviolentchild,

    So do you deny that some parents/caregivers physically, emotionally, or sexually abuse their children? I do believe that people are generally doing the best they can with what they know, but often what they know is insufficient. In the case of child abuse and neglect, I fail to find any reasonable justification for it.

    I agree with you that it’s a complicated issue, and parents certainly aren’t totally to blame. Society as a whole needs to take a more holistic approach to examine the root causes of human suffering and to create lasting solutions which do no harm. We still have a long way to go for sure.

  • Oldhead, how exactly are peer-based services a bad thing? These professionals are available to help provide support to people who are often marginalized in society. Most of the peer mentors/specialists I’ve worked with have been helpful and supportive; the only concern I’ve had is that organizations often do not put enough thought into how to provide support and supervision to people in these roles. People with lived experience can be immensely beneficial to helping others heal.

  • Trauma of all kinds does account for child “misbehavior”/acting out. We can and should be clear that parents directly impact their children, both for good and for bad. We all had imperfect caregivers, and in some cases some very detrimental parenting which is highly abusive. To ignore this contributing factor is to turn a blind eye to abuse and neglect,t which is one of the primary causes of childhood suffering. No doubt big pharma is the blame but parents are the ones who are ultimately responsible for their children’s well being.

  • It is disheartening how often kiddos are given psych drugs instead of getting help dealing with the root causes of their behavior. Too often they are experiencing trauma of some kind, or at the very least changes or stress in their home life (e.g., parents divorcing). And too often parents are conditioned by the system to think that if their kiddo gets the right meds the problematic behaviors will be erased. The sad reality is that many parents are the cause of their children’s suffering but don’t feel compelled to do the hard work to look at themselves and their behaviors. Easier to blame biology rather than look at other possibilities.

  • “It is no wonder that in all countries where this has been studied, the increasing consumption of psychotropic drugs has been accompanied by an increasing number of disability pensions.”

    This is correlation not causation. Who is to say that the cause of increasing number of people filing for disability has to do with the problems in society at large, such as few job opportunities for people with disabilities, lack of a sense of community, unhealthy diet and lifestyle choices (pushed on society by big business), etc.?

  • So true, Julie. The burnt out ones shouldn’t be practicing or should take a break and get their shit figured out. The system we work in frankly supports efficiency over ethical practice.

    Generally the money in mental health is made by prescribing psychiatrists and some psychologists who do testing. I know many great clinicians who do make very little and often have the most demands placed on them. If we value quantity over quality, everybody loses.

    I can also say that the quality of supervision is generally lacking. Most managers are encouraged to focus on making sure we workers are doing our paperwork so we can bill, such as treatment plans and progress summaries. If I didn’t have to do another one of those damn forms again in my life, I would be a very happy person. Very few of us got into the field to do paperwork, but it is how we often spend our time.

    There is a newer trend in healthcare, which I’m sure you’ve seen, called concurrent documentation. Part of it is good in that the client gets to participate in writing the note from the visit (ideally, but this doesn’t happen when I go to PCPs). The downside, of course, is that it frankly takes time away from talking about what the clients actually wants to address. Very few of my clients tell me, “Yes, I would love it if we complete more forms today! That will help me feel better!”

    There’s more work to be done, that is for sure. Thanks. Peace.

  • Thank you Julie for continuing to share your experience. I have experienced what you are talking about, as clients tell me that they say stuff to me they’d never tell other people in their lives. I think the reasons for this are many. In some instances the individual is worried about the judgment they may face if they share some things with the people in their lives. Also, clients face serious consequences sharing real information with the people in their lives. There are many examples I can think of, such as being molested as a child. I have been told by many of my clients that family members dismissed, minimized, or blamed them for these kinds of events happening. I think one of the most damaging things a family can do is invalidate the pain of a child in that family (or adult). So in other words therapy is a safe place that is confidential (with a few obvious exceptions). I know of many people who did not share what they feel or experience with loved ones because of fear of rejection, humiliation, and further victimization. What it boils down to in this instance is a feeling of safety.

    When someone is psychological vulnerable there is a risk that they may latch onto a helper and in some ways stop helping themselves (they feel powerless, hopeless, etc). It can look like a co-dependent relationship of sorts, which is why therapists and other helpers need to do their own work (through supervision, self care, therapy) to ensure that their own needs are getting met by their clients.

    I also have the experience of being idealized by my clients as being some kind of perfect being. Of course I say very little of myself (to avoid making sessions about me), so they believe that I have it all figured out. I don’t have life figured out but many choose to believe this, partially because they want to believe that the person who is helping them is well adjusted and doesn’t have any serious issues in their lives (they want to believe I can help them, which I do believe I often can by being a caring person). When clients are letting down their guard, they put faith in the helper’s ability to be there for them. I think there is a point where clients aren’t being helped if therapy goes on too long without any results. Therapists are taught to terminate (and refer) counseling if we believe the person isn’t benefiting from our services.

  • Matt,
    Thanks for sharing this information. It isn’t surprising, albeit disappointing, that a drug company is funding an organization whose mission is to de-stigmatize mental illness. Obviously, it is their objective to encourage more people to take psych drugs. No doubt there is a financial motivation there. I also checked out the potential side effects of their drugs and if I were in the position of considering taking them, I would probably say no looking at the horrific things that can occur.

    Regarding your second part of the post, I do agree that symptoms/behaviors exist on a continuum. I don’t think we’ve yet developed a better way of describing and categorizing any set of symptoms. What I am most interested in as a therapist is helping people to cope with their symptoms in healthy ways. I don’t want to see any of them drugged up.

    I believe we still have a long way to go when it comes to understanding how the brain works and how to fix brain problems, like a person who has no ability to feel empathy. My hope is that neuroscience will be able to decipher and clarify these issues to prevent modern medicine from harming people by their treatments.

    I do think the field of psychiatry would be better off going into either neurology or psychotherapy. It is clear that most of these prescribed drugs have serious, concerning SEs that aren’t being alleviated anytime soon.

    I do have a question for you, Matt, as it is clear you put a lot of thought into your posts. How would you describe someone who presents as unable to feel empathy and enjoys hurting others? In my field we call it Antisocial Personality Disorder, or sociopathy. I believe that this, like all other human thought and behavior, derives from the brain. It is clear that something is abnormal about people who enjoy killing or harming others, feeling no guilt or remorse. I struggle with accepting that these type of people are like the rest of us, who are able to feel a wide range of emotions such as guilt and shame. Is it fair to say that these folks, who have structurally different brains, are mentally ill?http://psychcentral.com/news/2011/11/25/a-psychopaths-brain-is-different/31866.html

    Also, here’s some interesting info from MRI scans suggesting that schizophrenia is also a brain disease. They have studied folks who are on psych drugs and those who aren’t. http://www.schizophrenia.com/disease.htm#history

    Thanks again for the dialogue. These conversations are helpful to deepen my appreciation for the complexity of the human condition.

  • Julie, I am disappointed to say the least that your experience was so horrible. From your description, however, it sounds like you found some of these folks to be helpful to you, so that is something I guess. I do get frustrated by the high turnover in my field, which I think has many causes and many negative impacts on the people we serve. I think that when a client builds a good rapport and trust with a helper, and that helper departs, it can be very damaging and not fun to have to retell one’s story to another person. This happens even more frequently in the case management realm, as many of these folks are new to the field and don’t get good supervision. Also, documentation requirements are burdensome and take us away from clinical work.

  • Julie, to be clear no ethical therapist will assert that they can “cure” anyone. That isn’t the purpose of therapy.

    Can you tell me what the credentials of your therapists were? I can say that I’ve had the most luck with master’s level social workers and therapists. I’ve found that when psychiatrist, for instance, try to do therapy it is more problematic, in part because they are trained in the medical model and not from a holistic perspective.

    And no doubt abuse happens in my field (as it does in all others). For decades doctors and therapists abused patients by having sex with them and other terrible things. This is now against the law, starting in the 80s in America. That is a shameful and any “clinician” who engages in this kind of abuse deserves to be jailed.

    I will also state that therapy is unlike those other services you mention. Humans are much more complicated than a car or laying down asphalt. There are many factors which impact human beings–finances, personal relationships, access to resources, loss, etc. To expect a therapist to be able and “fix” all of these variables which are out of our control is completely impossible. I believe that healing can and does come from having trusting, caring relationships, but it isn’t a panacea for all of life’s problems. That would be pure hyperbole. Any therapist who tells you they can “cure” everything in your life is a quack and should not be practicing.

    Finally, I will say that I’ve had three therapists myself, all of whom have been respectful, compassionate, and insightful. I trust all of them. That really bums me out that others have had radically different, terrifying experiences.

  • No, therapy is an opportunity to heal. People also heal through spirituality, relationships, meditation, etc. Therapy is only one possible solution of many, or a nice adjunct to others.

    Again, my hope and goal is to NEVER, EVER harm anybody through the treatment I provide. Specifically, I provide Dialectical Behavioral Therapy, Person Centered Therapy, Solution Focused Therapy, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy. I have a harm reduction perspective, meaning that I believe in reducing the harm where possible (e.g., for a person who uses dirty needles when doing drugs, I would educate them about clean needle exchanges).

    I generally see people who are on Medicaid. We have an overabundance of people seeking services, usually with a waitlist of 1-2 months. Again, I’d happily do another job and eradicate the need for mental health services, but until we eliminate trauma from this world, healers of all kinds will be needed. We all need support. Life is hard, and traumatic events are inevitable.

  • Julie, thank you for your thoughtful post. I can see what you mean looking at therapy through a “dependency” lens. I will tell you that over the last couple of years my agency has gone away from thinking that clients would forever be in the system. Now, there is actual pressure to discharge clients who aren’t coming in regularly. Also, we do work on co-creating mid and long-term (ideally tangible) goals (e.g., six month treatment plans) with clients so we know when progress and goals have been achieved. I have no desire to have clients feel dependent on me, which is why I work to help clients identify a wide array of resources to help support them in creating a “life worth living.” I don’t have any interest in “managing” my clients…they are adults who are almost always able to manage their own decisions and relationships. I see therapy as temporary for nearly every person. There are the rare exceptions where people have been so traumatized in life that they probably need long-term therapy to help them heal. Now, therapy is by no means a cure all. I see it as providing a safe space for clients to explore their lived experiences, values, goals, wishes, emotions, etc. It works for some but not all.

    I do believe that many therapy interventions can be short-term, and successfully so. Many of my clients tell me they get benefit from therapy simply because they feel heard and understood. I do my best to avoid judging them, since I am not in their shoes and haven’t experienced what they have. That would be pure arrogance on my part to think I know what is best for anybody. Obviously, I do talk with my clients about lifestyle choices and things that objectively might make a difference in how they feel, but I always encourage them to explore for themselves what works and what resonates for them.

    Peace.

  • I am sorry to hear, humanbeing, that you were given poor advice by therapists. Frankly, we are trained these days to give as little advice as possible. Anyway, clients need to make up their minds what they want from life, and me telling them to do X or Z doesn’t help. It doesn’t do anybody any good to act in a paternalistic fashion.

    I am in total agreement that technology has further separated us in general. We are strangers amongst neighbors in most parts of the country. I know very few people who live on my street, for instance. I do agree that creating real community is possible, but it does take work. I interned at a very small community mental health clinic and found that the key to their success was building a sense of community which came from the clients and not directed by the staff so much. They have a “consumer” board which has equal power to a professional board of directors. They have a real say in their care and creating their community. In my estimation this is one of the best models out there. I wish all community health centers were small, because the larger any entity gets, the more it will get away from it’s original purpose and the less connected everyone will be who is involved. The agency I currently work for has about 700 employees, and there is no way we can know each other nor can we possibly get to know the thousands of people we serve.

  • Humanbeing, humans have always been somewhat “dysfunctional.” We are imperfect beings after all, and being flawed we too often don’t set up society in a way that serves everyone. I’d argue that all previous systems, except for some small outliers, were abusive, hierarchical, used slavery as a means of production, etc. Things weren’t exactly great for the common person before capitalism and industrialization, either. It is rare for any society to share and spread power equally amongst it’s members.

    Therapist is a pretty damn good substitute in my experience. Also, it is unrealistic to ask people to talk about their feelings of shame and experiences of trauma with loved ones or friends. It is too painful to expect these folks to hold onto our experiences for us. Therapy, in my estimation, can be immensely powerful, as I have seen and results firsthand. I am sorry to hear you haven’t had the same experience. That is a shame.

  • Humanbeing, no doubt you are right that one of the best ways to be well in the world is to be connected and having meaningful relationships with others.

    I am saddened you do not support the counseling field, however. I think that is a short sighted. Most of us do not believe in the medical model and we seek to understand and support our clients goals, wishes, etc. We are trained not to push people in any direction, unlike family and friends can often do (and psychiatrists), because they are usually more invested in certain outcomes. My only agenda as a therapist is to help the client “be well” on their own terms, whatever road that might take (so long as it is ethical and legal). Many of the people I have worked with over the years feel that everyone in their lives has let them down, and thus they have few, if any, sources of support whom they can lean on. Believe me many counselors and social workers don’t make much money. When I worked at a homeless agency I made $32,000 a year for two years with a master’s degree. In no way are we getting rich or are well off doing the work we do. Psychiatrists, on the other hand, who often spend less than 30 minutes every 3-4 months with their patients, on average make between $150-250k a year. Counselors do care about our client’s happiness and well being (as do many of the other helping professionals I’ve worked with), and the vast majority of us do not believe that our client’s brains aren’t broken or un-healable. To the contrary, we believe that every person has a unique set of skills, attributes, and general positive qualities. We believe in building from strengths rather than focusing on so-called deficits. Have you ever heard of Solution Focused Brief Therapy? That is a good example of therapy that can help a person focus on what works rather than what doesn’t. DBT is the same. I follow a Strength’s Model when working with clients.

    There is an obvious disdain for therapy from some posters here, and frankly I find that to be sad. I know for sure that most of my clients have been better off because they had access to care (I was better off too when I’ve seen a counselor–actually, I still am seeing one to deal with my stuff). And I want to reiterate that we do not force clients to take psych drugs. Many of my clients are “therapy only” in the system I work for, and frankly I think that is the better place to be for most of them to be. As a system we rush to “medicate” clients, but that to me should be the last resort and not the first treatment offered. Unfortunately, many people get placed on psych drugs by PCPs who know very little about mental health. I am baffled by these doctor’s lack of common sense when the sometimes prescribe benzos, opioiods, sleeping pills, antidepressants, etc., all to the same person! I find that doctors do harm every day, mostly unintentionally, because they are overworked, have little time to actually spend with their patients and get to know them (the average PCP visit in America is a whopping 6-7 minutes), prescribe drugs because that is one of their only interventions, and because many patients who come to clinics demand and expect their docs to give them pills. It’s a sad state of affairs and I think we can blame managed care and big pharma for much of the mess. Doctors used to do home visits, had the freedom to get to know their patients. Now their patients are just another number, so of course outcomes will worsen. I do expect life expectancy to decline given the current state of affairs with human health in general and the desecration of the environment.

    Peace.

  • The Emperor is Naked,
    Too bad the writer of the article you cited is anti-Semitic. I have Jewish relatives and I find this absolutely offensive. Not sure why he had to go there, because he does have good points to bring up otherwise. But bigotry and ad hoc attacks aren’t going to help his argument.

    Example: “And when one considers also the complete dominance of the American and British mass media and Hollywood by Jewry(3) and Jewish policy, the disturbingly disproportionate amount of power wielded by that spiritually bankrupt minority race over our minds in recent times becomes even more apparent. The inevitable result of the continual onslaught on our minds of content at best mundane, at worst perverse and almost always manipulative, is mental disorder and spiritual death, as slowly but surely, over the decades, we have traded the spiritual soundness and fortitude of our Christian forefathers and the Word of God for the spiritual emptiness and destitution of our anti-christian manipulators and a continual stream of professionally delivered lies, propaganda and depravity – especially in the English speaking world.”

    Real psychological testing, which psychiatrists rarely do or are trained for, are valid and reliable, but the the problem is that we rarely do complete testing (as we should) due to managed care restrictions. Most of the time patients are diagnosed in less than an hour of face-to-face time, which is completely unethical. I would suggest that anyone who is seen for mental health reasons get a full medical and mental health workup, e.g., neuropsych testing. http://www.apa.org/monitor/julaug01/psychassess.aspx

  • Stephen, that hospital is still around. We don’t have many inpatient beds life in Colorado. Pueblo is where most folks go and we still have a smaller facility open in Denver. I can’t speak to their practices, but my hope would be they don’t force feed meds (I fear, based on your experience, that they might).

    I wish more “patients” would sue or challenge these things in court. I was once on a jury where a man was challenging his cert. It was interesting. He obviously had delusional beliefs but I’m pretty sure I recall that we said he shouldn’t have to be forced into ongoing treatment he clearly didn’t want.

  • I am a firm believer that individuals are the expert in their lives, not professionals. The arrogance to believe that we as professionals knows what is best is patronizing and frustrating. This is one reason I try not to make any decisions for my clients, because they have to pick up the pieces if it doesn’t work like I think it will.

  • Stephen, thank you for sharing your experience. I agree with you that it is wrong to force anyone, hospitalized or not, to take prescriptions they don’t want to be on.

    I do believe the experience of inpatient vs. outpatient treatment is quite different. I would never work for a facility that forced anyone to do a treatment they don’t feel comfortable doing. The nurses, doctors, etc. will not have to deal with the ramifications of that treatment….it will be the person on the receiving end who might not get the desired outcome of the treatment and might very well be harmed in the process.

  • AA, Hi. Thanks for the article. I do agree with the general ideas mentioned and don’t tell my clients we know what causes their symptoms. I do repeatedly say that I believe TRAUMA is the number one cause of mental health symptoms and that they aren’t broken or at fault. I normalize that life is stressful, and particular life events can be very scary and difficult to cope with (e.g., loss of a child).

    I will say that my own theory is that much of the benefit people get from medications has to do with being cared for (relationship building) as an equal human being and the placebo effect. Do I think meds magically fix messed up chemicals in the brain? No. I think much more of the improvements we see in treatment has to do with environmental factors.

    We do neuropsych testing in my organization. It is tremendously beneficial and has helped us to properly diagnose certain conditions. I’ve been involved with situations where we thought a client had a mood disorder/personality disorder, but it was actually a form of dementia which accounted for the presenting symptoms. Mental health treatment still has a long way to go (we still rely on interviews as the primary way to diagnose, which has obvious problems in inter-rater reliability). I believe we ought to be ruling out any medical problems, such as hyperthyroidism, before prescribing psych drugs, because it is too often the case that some undiagnosed medical condition is causing the symptoms. Of course sleep apnea is another classic example of a medical problem which produces MH symptoms such as irritability and depression. Also, I think we should try therapy first before ever dispensing meds, but there aren’t enough social workers and counselors to do this and many “patients” wouldn’t be happy with that arrange either, at least until they got used to it.

    Regarding your question on meds, I will always advise clients to speak with our nurses, their doc, or pharmacist about any med concerns. I will also explore with clients who want to get off of meds what a safe approach would be (e.g., titration, talking with their doc before abruptly stopping meds which could produce some dangerous w/d symptoms). Our docs are good at helping clients wean off of meds if they want to. Again, like I’ve said repeatedly, we do not force people to be on meds they don’t want to. We believe in client choice and autonomy.

    I can tell you that I’ve seen the terrible things meds can do to a person, such as TD, akathesia, weight gain, diabetes, etc. No doubt doctors and clinics need to do a better job educating clients about psych meds SEs.

    And no doubt big pharma is the biggest culprit. They earn their billions by convincing us that drugs are the answer and that we have a medical problem, when sometimes at least we are simply experiencing life. Unfortunately our culture and thus many clients who come to our clinic DEMAND certain drugs and will be very angry if we don’t give them to them (particularly benzos and stimulants). It isn’t helpful when people feel their only option to get better is medication/drugs.

    I will say that in our culture of instant gratification, getting clients to be patient with the process of therapy is hard. I fear that many of my clients get frustrated when they don’t start feeling better very soon and thus will prematurely drop out of therapy because the results aren’t what they expected. Healing from trauma and general life can and usually does take time and isn’t easy. I commend anyone who has the courage to face their fears, demons, challenges head on. Many people in America also have been taught to believe that they are weak if they ask for help, so many people delay seeking help. Nobody wants to be considered “crazy” or “schizo”, but many people unfortunately believe these stereotypes around MH treatment.

    Thanks for reading.

  • Good job, Matt. Thanks for pointing out these issues. Unfortunately, you are being attacked for trying to keep the conversation respectful and reminding posters that there are certain rules we ought to be following, like basic respect. Rage rules the day here.

    It is clear that posters like you, me, Aurora, and shook are the target of aggression because we don’t fit into their all-or-nothing expectations and because we clearly say things which cause them to try and belittle and attack. I am amazed at the hostility towards people who don’t agree with a certain perspective.

    As someone said it seems that some folks might need to create a new site where they can rage to their hearts content, changing nothing about the way treatment is provided (since nobody with a differing opinion would be allowed to chime in). These posters seem to think anyone who disagrees with them must be colluding or are being disingenuous. I think it is reflected in the larger world that we live in that feels ever more polarized and angry. I think that is sad.

  • Humanbeing, so tell me this, didn’t you get meds from a pharmacist? When you pick up meds there is a sheet that goes with it which tells you more info about the med, including side effects to watch out for. I do agree that doctors should better inform their patients about SEs and the drugs they are prescribing.

  • As usual on this site, Stephen, my posts are being mischaracterized. I actually said in a recent post that I believe the “chemical imbalance” theory isn’t strongly supported by science yet. We do know that mental health issues derive from the brain, but actual science is limited in telling us what happens in peoples’ brains when the experience such symptoms as mania, voices, or depression. I do suspect it has to do with neurotransmitters, but as far as I know there is limited evidence to know what is happening inside the brain. One thing we certainly don’t know is why there are variations in the results of taking specific meds with patients. People clearly metabolize meds (and food) differently, so again we still have some learning to do about the human body.

    Like I’ve said before, I find that many psychiatrists are arrogant and unhelpful. I have seen it firsthand at my clinic. I don’t dismiss what people on here have said. And I also think it is irresponsible to argue that psych drugs should never be used, since they do make a huge difference for many of the people I work with. My family and friends take these kind of meds and they tell me the same thing. I wouldn’t support the use SSRIs, antipsychotics, stimulants, etc., for my clients, friends, and family (and myself) if I felt they were convincingly harmful. Sorry you don’t like that answer but that is where I stand. Just because you don’t like what I am saying it doesn’t mean I’m being disrespectful or condescending.

    I highly doubt you’ve read over all my posts, otherwise you would have seen some of my criticisms of psychiatry and also my empathy for people who have been harmed by the system. Like I’ve said, I don’t blame anyone who decides meds are for them. You should get to decide what treatments you receive, if any. I believe in autonomy and choice. I am sorry that many people on this website have been harmed. That is not what the field of medicine was meant to accomplish.

    Out of curiosity, can you at least admit that many people do find benefit from psych meds?

  • Oldhead, no I simply repeat what my clients with bipolar, depression, schizophrenia, ptsd, ocd, and add have told me about what they find helpful.You continue to be dismissive of this. I haven’t sucked up to Matt or Aurora. They have engaged in respectful dialogue. You, on the other hand, I have seen are aggressive, sarcastic, and dichotomous in your arguments. You aren’t improving anything for anyone. I hope god works out for you. He or she certainly hasn’t helped protect any of the clients I work with from trauma.

  • No you have it wrong. I very much enjoy “my clients.” They are amazing, talented, intelligent, funny, hard working, great people. I am no “shrink.” I am a therapist, very different. I don’t really buy into the “chemical imbalance” theory of mental illness. I think that was contrived by pharma companies.

  • I believe in dialectics, so I think both can be true. There are doctors who are helpful and those who are not. My expression of frustration today could be coming from the fact that I was thinking of specific doctor who treats his patients like stupid children. I don’t respect any nurse or doctor who treats their patients poorly. I imagine you can empathize with that. I try not to demonize psychiatry because I’ve seen that it benefits many but of course it isn’t perfect, and frankly in some cases does more harm than good (because people are flawed). I am angered anytime I hear a helping professional acting like a jackass. And systems support these people because they are so desperate for docs. I find that doctors are a mixed bag. They are usually highly intelligent but often frustrating to work with. I hear too often that my clients feel unheard and invalidated to some degree. That does need to change. They don’t always learn people skills in med school.

  • Thank you Matt for your thoughtful reply. I think many of the studies you cited used the terms I do. I will continue to challenge my own notions and understanding of mental health. I believe society has a long way to go before we are fully strengths based and optimistic about outcomes within marginalized groups. I find that humans too often have narrow views of others, which frankly harms us all. I was angered time and again when my clients, who happened to be homeless, were judged as being lazy or apathetic. They were traumatized people who deserve compassion and love. We all deserve that. It is easy to judge and much harder to show real compassion and understanding. Thank you again for being unemotional in your responses and looking to further a rational conversation on these issues. All too often on the internet people attack each other which doesn’t move humanity forward in any healthy direction. Keep up the fight.

  • Matt, I don’t hold onto outdated or pessimistic beliefs. I consider myself a realist. One thing I can say for certain is that every single person and their situation is unique, so I don’t stereotype my clients or assume they can’t improve and eliminate their symptoms. They can and do improve, both with and without meds. I just don’t believe that there is a “cure” that can show, definitely, that mental illness has a clear cause, clear resolution point, etc.

    I have found that the following are most effective to ease and improve the symptoms of SPMI: sense of community/belonging, acceptance, connection, sense of meaning, feeling loved, being cared for as an equal person who has the autonomy to make decisions for themselves. I view treatment through the lens of attachment–many people who come to MH clinics have not had caregivers who treated them well and often in very destructive ways. One of my roles as therapist is to provide a safe space and model “loving” behavior of acceptance, unconditional positive regard, and authenticity. I think relationships are most powerful healing forces and can also be some of the most destructive.

    I am convinced that medications cannot solve mental illness. At the best it can manage symptoms but it is dealing with the problem rather than the solution. Many people in these studies you cite who have good outcomes have more protective factors and fewer risk factors. This doesn’t surprise me. My clients who have done the best have more financial, intellectual, social, and interpersonal resources/skills. The ones who struggle the most tend to be more isolated, poorer economically, have more legal problems, etc…. They aren’t set up for success. We need a system which treats the whole person and currently we are only partially there. Maybe someday.

    No doubt outcomes with such diseases as schizophrenia are impacted by culture. It is clear that human development is influenced by a combination of genes and environment. I do believe that certain environments are more positively suited to help people who hear disturbing voices than others. Western society is stubbornly individualistic which produces more isolation, stigma, etc., than communities which place high value on communal values. I think it is true that communal cultures are better suited to help people with mental health symptoms. Finally, I want to be clear that I promote and believe in recovery. I am optimistic in my view that all humans are capable of quite a bit, much more than most of them believe is possible. Thanks for sharing the articles and resources. Certainly I need to continue to challenge my own beliefs. I teach that with my clients, and so I should do the same for myself.

  • Anonymous, yup my clients at times do complain about side effects from meds. I don’t pretend this doesn’t happen. I also know that forced treatment has and does occur (today only occasionally despite what people insist here); it was much more of a problem in the past.

    Princess Aurora isn’t a statistical anomaly in my experience. Again, like I’ve said repeatedly, the vast majority of my clients have told me similar things about their experience with treatment, which interestingly ignored by most on this site (because it doesn’t fit nicely into your narrative of the evils of modern treatment).

    Do you know why people with mental illness die early? Please point to data. Until then it is nothing more than conjecture. By the way, the same statistic is true for people who are chronically homeless, most of whom refuse legal prescribed pills (I worked with them for years). Many of these same folks struggle with addiction. You want to know who also does?….people with mental health issues. Also know what else they have in common? I’ll tell you. Often poor access to medical care, few financial resources, being stigmatized by the general public, frequent sense of isolation, lack of meaning and purpose. I could go on but you should get my point if you are listening. The truth is that both groups have major challenges and aren’t well treated by society. That is plenty reason for dying early.

  • “On the one hand, it (Cognitive behavioral therapy) does possess the danger that the “drugs” but with a different and unique set of side effects and long term effects, probably much less obtainable and measured.”

    It’s pretty hard to take you seriously, Rebel, making an absurd comment like this one. CBT, as I’m sure you know, focuses on the connection between thoughts, emotions, and actions. Specifically, it is focused on helping people to identify unhelpful thoughts and replace them with beliefs which are more beneficial; instead of thinking, “I can’t handle it if my boss doesn’t like my work”, a more helpful thought might be “I will not be destroyed if I am criticized by my boss. It might even make me better at my job!”. It’s basic premise, which is quite obvious, is that people’s thoughts about events, not events themselves, that can be quite disturbing. In any case, CBT has been around for a long time and is a gold standard for treating a whole host of issues. You obviously have disdain for therapy and psychiatry, which by the way are very different fields. Many therapists can and are helpful and the best part is that we don’t prescribe pills, so you should like that. Yes therapists can be harmful if incompetent, but so can cops, dentists, and lawyers.

  • You make no sense, Frank. I am referring to genes, you know the thing that makes us human and is unique to each person. It seems like many folks on here just want to focus on terminology being used as an avoidance strategy.

    So can we agree that nobody on this site knows what led to Fisher’s death? Other than a heart attack, which we don’t know what caused it.

  • Amen, Aurora. Exactly. We all have valid points of view and we are entitled to do what works for us as individuals. We also have the responsibility to do our own research about what treatments we receive. We can’t assume that our doctors will always educate in every possible way. We need to do some of that work ourselves.

    Of course this all assumes that we as individuals have choice in our treatment. Many people on this site are convinced that a large percentage of clients continue to be “forced” or “coerced” into taking meds they didn’t want to take. Aurora, I am sorry if that is the case for you, but for some reason I think nobody is twisting your arm to take meds. Correct me if I’m wrong…. 😉

    And regarding Fisher no doubt this site doesn’t have access to her medical records or genetic makeup to make a clear determination as to what killed her. We also don’t know if Fisher’s drug use played any part in weakening her heart muscles. We don’t know if her meds had any part to play in the story. To make assumptions about her would be pure hubris.

  • Old head, your experience obviously is different from mine. Out of curiosity, when were you in formal mental health treatment? I can tell you that it has changed over the years to be more focused on client empowerment and choice. That is the framework I use in my work and I see it in action every day at our clinic. My clients get jobs, get married, have kids, develop new friendships, etc., all the while choosing to remain in treatment. Now some of them choose to just see a therapist, and guess what? We support that! If they want to see an PNP or psych doc, they can do that too! They can also see a vocational counselor, education counselor, nutritionist, attend a social group, attend a DBT full program, all on their own accord if they want to and are appropriate for the service. My agency provides a wide range of services that go well beyond “drugging” people.

    I am sincerely upset that people like you, Rebel, AA, and others have been harmed by the MH system and psychiatry. That is wrong.

  • Stephen, I agree with you that in hospital settings what you describe happens. However, doctors don’t have this power in an outpatient setting. It is illegal for docs to force meds on anyone who doesn’t want them. And even people on certs can refuse meds and take the issue to court. I am in Colorado which isn’t a terribly progressive place for MH treatment, but we do follow the laws which are pretty clear. Again the vast majority of people receive treatment on an outpatient basis, where they chose the level of treatment they want. I am sure it doesn’t always work out this way across the US, but frankly the laws are pretty clear that we cannot just force treatment on everyone–they have to be deemed to be an immediate risk to self or others, or so disabled they aren’t taking care of their basic needs such as eating. Even when people are placed on holds they usually aren’t held for longer than 24 hours in Colorado. We have very few psych beds, and often they are filled by people who choose to stay voluntarily after the 72 hour hold is over. That has been the case time and time again with my clients.

    Amnesia, please educate me. How many people in the MH system are forced to take meds that they don’t want to or have no choice but to do ECT? What percentage of all people served falls into this boat? I’d really like to know. I have yet to see this happen in my near decade of experience and I’ve worked with hundreds of clients.

    AA, I agree that the Murphy Bill is concerning around the issue of family involvement in treatment. I find it a violation of confidentiality that family members could impose themselves on any of my clients who don’t want family member involvement. Seems a clear violation of client autonomy. There are plenty of good reasons my clients wouldn’t want their family members knowing about their diagnoses, treatment, appointments, etc. If the client wants their family to be involved, then great! But the other side here is that some family members are the cause of trauma for my clients, and how can the system protect clients from avoiding further abuse by allowing these family members to have access to confidential records? I find this disturbing.

  • With all due respect, “curing” major mental illness, the kind that is chronic and debilitating, is extremely rare (symptoms can and do change over time; schizophrenia, for example, tends to calm with aging). You can also find many stories of people on the internet who say they are no longer gay because of conversion therapy, but anyone who has any knowledge on the subject knows it is likely impossible to change what sex(es) one is attracted to. I have heard many peoples’ stories who don’t feel they have been cured but rather have developed tools and ways to cope so they are no longer disturbed by symptoms when they arise. I hope one day we will be able to truly cure all medical and mental health diseases, but until that day comes I believe the best we can realistically aim for is remission of symptoms, processing trauma, and developing a healthier sense of self esteem and self worth.

  • AA, No doubt doctors in general are quite arrogant and sometimes don’t listen or hear feedback too well. Some do but I have gotten along much better with NPs.

    Regarding Fisher’s death, we can speculate all we want about her demise, but the truth is we don’t know what killed her (what caused the heart attack) and may never will. She had many risk factors for early death which has been well documented.

  • I am aware of the book, Old head. One think I can say is that society has also changed in innumerable ways since Thorazine was introduced. Now people live farther away from their families of origin (people are more mobile than we’ve ever been in history), which of course means that more people are lonely, isolated, and often relying on strangers for finding support (e.g., therapy). Also, the rise in technology, while it has been beneficial to a certain degree, has also increased anxiety and depression, particularly social media. I believe that in the past, before psych meds, families and communities took care of people displaying symptoms. Today, we have alternatives. Also, today we have more awareness of mental illness, whereas in the past, at least at times, was highly stigmatized so people didn’t talk about it. We know more now than we ever have around mental health issues.

    I will say one positive development is we have a much better understanding and appreciation for the connection between trauma and mental health. I can say that the vast majority of my clients have had serious trauma, usually multiple incidents, in their childhoods and in many cases adulthoods. This is why society ought to devote more resources to prevention efforts. If we can prevent certain traumas, I no doubt believe that mental health symptoms would decrease or never show up at all.

    Humans are both fragile and resilient, and treatment ought to focus on further developing and harnessing peoples’ strengths. I do believe in strength’s based treatment philosophy, which is why I believe therapy can and is useful to clients who are willing and able to do the hard work. CBT, DBT, MI, ACT, EMDR have all shown to be very effective in helping people to heal and cope in more effective ways. The most important variable, however, in therapy is building solid rapport and the therapist showing compassion, unconditional positive regard, and authenticity. These variables can lead to healing. I believe that medications have enabled my clients to have the energy, focus, motivation, etc., to cope more effectively with their emotions and disturbing thoughts.

  • While in hospitals it is true that doctors have leverage and power, as far as I know in the US people are rarely forced to take meds they don’t want to be on. The laws in the US have changed considerably over the decades. In the past, during time of institutionalization, no doubt patients were forced meds. Today, the vast majority of clients are seen on an outpatient basis and they can chose to take meds or not. I work with 80 clients currently, and none of them is forced into taking meds. It just doesn’t happen here. And yes in extreme cases the courts can place a certification on an individual to receive treatment, but even then the client does have rights. I find that many people on this comment section are over exaggerating the current realities in the mental health system, particularly around “forced” or “coerced” treatment. Yes, professionals like myself offer ideas for treatment, but it is up to the individual to make the choice that best suits them.

  • Rebel, yes people have been injured by psychiatry, no doubt. On this site what I find is that reasonable responses from people like myself are often ignored or minimized. Just realize that prescribed drugs were never meant to “heal the spirit/soul.” I do believe that trauma is at the heart of what we call mental illness. I do believe that certain genes within humans become activated when trauma, especially repeated trauma, occur. I have heard and continue to hear horror stories around trauma. I have no doubt this is the likely cause of “symptoms.” If we could eradicate trauma, I believe the mental health field would have many fewer clients. Unfortunately trauma continues in it’s various forms. I do believe that people like yourself feel that the system has traumatized you. I don’t discount that. I understand your desire to tell your story, and it is valid in it’s own right. But so are others’ stories which differ from yours. You think meds are basically evil. Others don’t. You can continue to treat yourself as you see fit, but it doesn’t mean it is wrong for others to take meds from their docs because they find them helpful. There is nothing wrong with challenging the system. I agree with many of the critiques of the system, particularly around capitalism. I think capitalism often puts profit over people.

  • Feelindiscouraged: well, tell that to all my depressed clients who feel hopeless and chronically suicidal. I can tell you that if we stopped treating mental illness today the way we do we’d have a lot of dead people on our hands.

    And for those of you who think meds are for social control, I find that laughable in today’s outpatient mental health world. How many of you have spent time in a MH clinic in the last decade? I don’t see too many people walking around looking like zombies. They live full lives–have jobs, friends, exercise, etc. If social control looks like helping people to live more full and safe lives, I’m all for it.

  • Matt, call it what you will. It is clear that the behaviors, thoughts, and feelings derive from the mind/brain. If someone thinks that bugs are crawling all over their body, or thinks that it’s a great idea to drive across the country on a whim without their wallet, or runs down the street naked yelling the FBI is coming, or actively cuts their wrists and has had 20 hospitalizations for suicidal thoughts, etc….they are probably ill. Now granted some of these states are temporary but in my experience this symptoms linger for a long time. 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.

  • No doubt therapists and doctors have unresolved issues, but so does every other human being on the planet.

    Well me as a therapist I don’t have any interest in controlling anyone. If a client believes medications are helpful, I support their decision. If they don’t and want to do counseling only, I’m good with that, too. It is their life and they get to chose what they want it to be.

    It is simply wrong that we want to control people. Me and my colleagues simply want to help clients be safe and feel the best the can under the circumstances.

  • No, I have mentioned capitalism. I do think that big pharm.’s main goal is to make as much money as they can. Doctors are pretty much the same way. This is why people shouldn’t be paid extra to dispense meds. Docs should be paid the same regardless of medications being prescribed (I don’t know exactly how they always get reimbursed, but I know that med mgmt is profitable due to the demand.

  • AA, I do believe that yes this does happen. I have never seen it in my work, though. None of my clients have ever presented with increased SI/HI that seem anything to do with meds. Usually they talk about increased stressors, difficulties managing emotions, new trauma, etc. which is clearly impacting their moods and state of mind. Stress is a major factor that we cannot ignore.

  • Old head, and you are an anti-psychiatry zealot. Strange how Aurora never got a reasonable answer which has been my experience here as well. All the people in your boat just ignore the obvious facts that mental illness is real and we can’t just sweep certain conditions under the rug or give them yoga to cure their ills. Have you ever interacted with people who think the government is watching them, or that they think their clothes are burning them so they strip naked? I have directly worked with such people who are dangerous to themselves or others and have no sense of reality. Sorry to tell you but that is an illness in most peoples’ books.

  • Get over yourself Oldhead. Hard to believe that some people actually find themselves better off being on meds? Did you read when Aurora said she thinks she would be dead without meds? Why do you suppose she would say this? Maybe it is because it is her experience which you seem to want to reject for some strange reason. Again, if any of my clients or anyone in the general public finds benefit from psychotropics, who are you or I to say that they are wrong? That is their experience, not yours!

  • Thank you for writing this eloquent and thoughtful reply. Your story is very familiar to me in my work with people who suffer from symptoms like suicidal ideation. I think animal therapy is an area that the MH system could really invest more resources into. Most people are calmer and healthier around animals. Many of the clients I work with have an emotional support animal. Unfortunately due to trauma, many of my clients have a hard time trusting other people but they feel safe with animals.

    I am glad to hear that you at least had a good experience with a therapist. One thing I’ve found is often master’s level therapists are better at empathy and listening than doctors who offer the same service. Many doctors are book smart but often lack people skills. I was once told by a head psychiatrist that there is no proof that many of the clients we serve struggle emotionally with the holidays. They sometimes lack basic common sense…

    Happy new year to you! Stay safe riding those horses.

  • Old head, I was skiing today so I wasn’t at my computer all day. And regarding dispensing advice, I will only give general advice on the internet, like that patient should probably talk to their doctors or pharmacists about any concerns they have about SEs or their med treatment. I also will gladly say that many of my clients have found tremendous benefit from medication management. It has nothing to do with taking advantage of what Aurora says…she has a valid story worth sharing and I applaud her for openly talking about her health and experiences in the MH system. It must be hard to believe that there are so many of us who support our current treatments, because like others said, the treatments provided are the best doctors and scientists have come up with, and because they improve the quality of life of many folks, like Aurora, family members, and friends. My near decade of experience in mental health informs me of these things.

    Feeling discouraged: Is it so hard for you to believe that there is more than one of us who can defend the use of psychotropics?

  • I do appreciate your perspective, Aurora, as many folks on this site do tend to focus their rage on psych meds and don’t want to acknowledge that many benefit from the treatments psychiatrist provide.

    Because I am a therapist, I am curious if you’d share why talk therapy was useless to you? I wonder if you didn’t find a good fit? I am sorry to hear therapy didn’t help but what ultimately matters is you found something that did. I don’t believe that therapists can help everyone, and I want to learn what us therapists can do better to improve client experience.

  • Truth, mental illness is complicated. Many of my clients talk to me about their struggles. The “truth” is that life is stressful, difficult, and challenging for all human beings.

    Regarding meds, there aren’t any conclusive tests I’m aware of which clearly determine the cause of death is due to some medication a doc prescribed. Yes, companies sometimes settle with claimants to lower the expense of fighting cases. It is pragmatic but doesn’t necessarily mean they are “guilty”. This is complicated and there is still a lot we need to learn. Meds can be harmful and we should continue to challenge pharma companies to ensure accountability and transparency.

  • To all the posters who think they know what killed their friends, how do you know psych meds were the culprit? Did the autopsy indicate this was the reason? Or is it your own interpretation of the situation? Human bodies are complex and we often will never know why any individual passes away. I feel for anyone who has lost a friend or family member, as I have, but I find that on this site people are blaming psychiatry and med mgmt without having the full facts. Yes, prescribed drugs can and do kill people, but so does bad genes, poor lifestyle choices around diet and exercise, drug abuse, etc.

  • I work with many people like you, Princess Aurora, who live a more fulfilling life due to medications and other helpful treatments. I wish you continued success.

    To Truth I’d say this: school shooters have histories of being disturbed, usually that is the reason their parents brought them into treatment to begin with. To assume psych meds are at fault is a stretch to say the least. You are right that some of the SEs from meds are terrible as you mention, but most people don’t get them. If SSRIs were so horrible, for instance, we’d have a lot more violence in society than we do since they are heavily prescribed. But guess what? Violence is down statistically and has continued to go down since the 70s.

  • Rebel, I agree with you on many fronts regarding your comments about people taking psychotropic meds. I fully respect their decisions and I’m not the one impacted by taking meds–they are. Regarding my own experience with SSRIs, I know that withdrawal symptoms are real, as I experienced brief arrhythmia. I don’t see meds as completely safe but in some cases, as others have said on this website, meds do at least sometimes make peoples’ lives better. We are interested in the same things ultimately–we both agree that people shouldn’t be harmed by the medical community, that we want people to be respected and educated about their treatments, etc.

    I do think it is unfortunate that you dismiss statistics. They do tell us about how groups of people are impacted by various things and give us more knowledge, which is something we all should want. I do fully believe in both quantitative and qualitative data. One thing I can say is that we ought to be asking clients what they want from treatment and what they don’t like. As a Mh system we don’t do that near enough. That is wrong.

  • Rebel, I was unable to reply under your message so I’m doing it here.

    You can resent my comment if you want to, but it still doesn’t discount the fact that southerns eat more fried foods on average than in other parts of the country, which partially contributes to obesity there. Not a judgement. I love fried food myself but try to eat it infrequently in order to avoid high cholesterol and weight gain. Chicken and waffles is awesome! Also, I know that southerners are unique just like the rest of us. My point is statistically speaking, there is more obesity in the south of the US on average than other parts. That isn’t a judgement just a fact. Regarding exercise and weather, Colorado has some of the most fit people in the US despite harsh weather in the winter. We are outdoorsy in general and find ways to exercise in most weather conditions. However, we don’t have high humidity, which is pretty oppressive and makes exercising more difficult. That again is a fact and not a judgement against southerners. I will add that most of the poorer states are also southern, which effects access to a wide array of food options. Now I fully agree this is a national and worldwide problem around access to healthy foods. I think in the US, however, the south is an example of where a combination of facts adds to these health problems I have mentioned. I have enjoyed southerners in general when I have interacted with them (except the anti-LGBT and racist ones).

  • Well, in southern states people typically eat more fried foods than in other parts of the country. Also, because of the weather, fewer people exercise. I have visited southern states and know enough to look at statistics.

    Over the last 50 years Americans food consumption has risen and our activity levels have gone down. Just look at the size of McDonalds food over time to see a perfect example of how our expectations of what we can eat has changed. We spend too much time doing sedentary activities such as watching tv, playing video games, and typing on the internet like I’m doing right now. I can tell you that when I was in my twenties I was 40-50 lbs overweight for two simple reasons: I ate too many calories and didn’t consistently exercise. My blood pressure was high no doubt due to my poor lifestyle. While everyone’s bodies are slight different, this basic truth is generally consistent. I will gain weight if I’m not mindful of what I eat. It is pretty simple. I wasn’t on meds when I was overweight. It was simple biology. My body didn’t burn more calories than I was eating.

    I will also add that economics has something to do with this. Wealthier people have access to healthier foods and lifestyles (such as gyms), so they are less likely to be overweight. This is certainly the case if you look at wealth by state and rates of obesity. Now not always the case but often so. Poor people tend to eat more fast food and don’t tend to eat as many fruits and veggies. There are many food deserts in the country where people only have access to unhealthy foods.

    Again, it is simplistic to say that psych meds are main cause of all these health problems in the public. It is no doubt a contributing factor but there are many other likely causes that I’ve discussed.

  • Rebel,

    We also shouldn’t ignore the fact that Fisher also used cocaine and other drugs. Cocaine in particular can weaken the heart muscle. The truth is we don’t know, and may never know, what ultimately led to her heart issue. My guess it is a combination of trauma, stress, drug use (both legal and illegal), possible lifestyle issues (diet and exercise).

    Regarding sugar, most of us don’t consume it in it’s most natural form. Typical Coke beverages use high fructose corn syrup. There are real health impacts from excessive sugar intake:http://www.health.harvard.edu/blog/eating-too-much-added-sugar-increases-the-risk-of-dying-with-heart-disease-201402067021

    The bottom line is that adverse health outcomes have a mix of likely sources. One thing I can say is that much of the food we eat is genetically modified in some way and we are eating basically a lot of chemicals. If you look at the ingredients in many foods in our grocery stores, you won’t know what it is unless you are a chemist. The only area of most grocery stores which actually has healthy foods is on the perimeter. We should just ignore all the crap in the middle of the store because it is full of preservatives, additives, unneeded sugar and salt. All of this impacts human health. This is one reason why we do have an obesity epidemic in America. There is a reason why southern states in the US have extremely high rates of obesity–a combination of lack of exercise and poor diet. We also just eat too much for how sedentary most of us are.

  • Eye opening. Thank you for the article. This is something I need to think more about since I do encourage some of my clients (as a therapist) to seriously consider psychotropics as a treatment option. Since these meds increase risk factors for heart attack, stroke, metabolic syndrome, is it worth it?

  • Rebel,I get where you are coming from. I’d be angry, too, if I was lied to or harmed by something that was supposed to help me. Many people posting here are angry and I feel they are nit picking things I’ve written in order to justify their position. I am not here to defend psychotropics or doctors, but I think there is some obvious extremism being presented here which is false and dangerous. I do care about the truth and what I find sad is how many people posting totally dismiss my reality and the reality of my clients, who tell me regularly that their lives are forever better because of the mental health system. What would you say to these people who believe they are better off now because they have access to care? Please, I’d like to know.

    What I think honestly is that some folks on here don’t appreciate being challenged or questioned. I have no problems defending my positions but it seems that many folks on this forum just want to vent their anger against psychiatry without being able to either defend certain positions or simply ignore the reasonable positions I take. I am a pragmatist and I care about what works and what is helpful. I can tell you that it isn’t compassionate to let people with major mental health and medical issues to suffer. I think people deserve treatment, and sometimes that means it is involuntary. The reason for this is people who are really sick often don’t have the insight or understanding of what they are doing. I’ve talked with people who have clearly lost sense of reality and they don’t understand the consequences of their actions. It is immoral of society to just allow that to go on without intervention. Sorry to disappoint you that I don’t see psychiatry as the evil you do. And I won’t just shut up because you don’t like what I say. I believe in my convictions just as you do. This doesn’t have to be all or nothing but it seems to me that you only want to hear from people who 100% agree with your extreme positions. This is a public forum and I’m free to continue to comment. You’re welcome to ignore me.

  • Old head, many people would disagree with your assertions that psych meds have no proven benefit. I have seen it for myself, both personally and professionally. Many of my clients would vehemently disagree with you. You are so anti-meds that you ignore the fact that millions of people are appreciative they have the option to take SSRIs, mood stabilizers, antipsychotics, etc.

    What kind of threat am I making? The reality is that if you cannot have a productive conversation with allies, such as myself, who is sympathetic to your POV, what is the chance you’ll be able to persuade others who may more strongly disagree with your position. Again, using words like “evil” only continue to divide us. It’s unhelpful and isn’t persuasive to the vast majority of people who don’t hold your all-or-nothing positions on psychiatry and drug treatments.

    Finally I’ll note that because of modern medicine human’s life expectancy has basically doubled in the last 100 years. To denigrate a field which has clearly improved the human condition is pretty silly considering this fact. Yes, psychiatry has it’s problems, and nobody has claimed that it is infallible, certainly not me. Modern medications have enabled people to live longer on the whole and to help them stay more independent.

  • https://www.verywell.com/do-ssri-antidepressants-cause-violence-379805 There is a an association between violence and SSRIs but there is scant evidence of causality.

    There have been and are many doctors who inappropriately prescribe benzos, opioids, etc. The NFL doctors are a good example of this nonsense with pain management where the NFL bans pot but opioids, or legal heroin, is just fine. I don’t agree with this kind of treatment because it does do harm.

    I do know that people have been harmed by the medical system, legal system, etc., and that should not be tolerated. I am sorry to hear that you think my perspective is BS but hey you are entitled to your opinion of me. I certainly still have a lot to learn about humanity and what is best for each person, but again this is why I try to defer to my clients as the experts in their lives. I do not purport to know what is best for everyone. What I have shared is my experience and what my clients tell me. I think your perspectives are valid in their own right, and you also may want to respect that other “consumers” have had much better experiences in their treatment than you have. That is a shame that anyone has been harmed by people in positions of authority and so-called knowledge. I think we see abuses in every walk of life from people in positions of trust and power–parents, police, government, doctors, lawyers, judges, etc.

    I have certainly learned a few things from reading folks’ responses to what I have to say. I have learned that many of you are angry at the system, and rightfully so for being harmed in ways you felt you didn’t consent to. I have learned that people here don’t trust that doctors have their best interests in mind due to their bad experiences in the system. I have learned that you don’t trust medications.

    I can say I do everything I can to increase my client’s sense of autonomy and choice. I do not have to live with the consequences of their choices or treatment, so it isn’t my place to tell people what to do or to force them to do something against their will. That isn’t what I learned in school.

    If there is no common ground to be found, it will be difficult to achieve real progress and evolving healthcare to better serve the individual. We need a dialogue that is fair and reasonable, but calling people “evil” isn’t going to move dialogue forward. This kind of thing shuts down conversation. The truth is that powerful interests are invested in keeping the system the way it is, and it will be up to the rest of us to challenge the status quo. If you demonize people like myself who is an ally with your general cause, there is no hope for substantive change. I empathize with your anger and frustration, and I do believe in much of what you all believe. Be well.

  • Rebel, when docs say drugs aren’t addictive they are talking about developing tolerance to the drug, abuse potential (can it get me high?), etc. I sure hope they aren’t telling people there are no long term side effects, because if that is the case, it is cause for malpractice. And these people do not believe in medicine if they deny the reality. I can say none of the docs I’ve worked with would say such a stupid thing.

    One part of the problem is that psychiatry got away from talk therapy and focused itself almost entirely on medication management, especially once deinstitutionalization happened in the US. Other professions like social work and therapy took over that role of providing talk therapy. Many of the psychiatrists I know see anywhere from 200-500 patients, which I think is way too much. They need more time with them. I have heard some places in the US only give 15 minute appointments for psychiatry every 2-4 months. How is this ethical? I don’t think so. I do not support such treatment. Doctors used to be able to make house visits and spend significant time with their patients. Those days came and went with managed healthcare, which is a thorn in the side of anyone trying to do good work in the field of medicine. Doctors and patients should be collaborating and building strong, trust-filled relationships. That kind of thing improves outcomes because when people feel heard and understood that goes a long way.

    Of final note, I think it is harsh and judgmental to imply that many people in the medical field are evil. Very few people in this world are truly evil. I believe some appear this way because they are burnt out and overworked. This happens all across our country. Also, there is so much paperwork that we are expected to do, which further limits our ability to be present with our clients.

  • Where is the data that psychotropics cause violence? In my experience people are rarely violent because of prescribed meds. It might be a convenient excuse for someone charged with a violent crime….

    I agree that the FDAs approach is often poor with regard to med approvals. I don’t think the standards are strict enough, especially considering that there are few, if any, longitudinal studies done before drugs are approved to the masses.

    You assume I was on benzos but I wasn’t. I was on an SSRI for about 6 months after my father passed away. I generally think benzos are a terrible drug to give anyone with serious anxiety or depression, as it can encourage avoidance and numbing behaviors and exacerbate the symptoms in the long run. We wouldn’t give alcohol to people with anxiety but basically benzos are alcohol in powered form. The w/d symptoms are about the same and the effect the body in similar ways.

    With the genetic testing we aren’t comparing clients with their parents or children. The point is to figure out which medications are going to be best metabolized by the client. That is all. Some people are highly sensitive to meds while others need double the typical therapeutic dose to get the intended results. I get you don’t support it, but it actually helps the clients who want to be on meds because we improve outcomes.

  • You are right, I do mean well but I am not terribly idealistic as you claim. I am realistic. I do not think meds are the answer for everyone. Actually, I think we should cut down on their use by a lot. I think many people think meds are the only way they will “get better.” Many people only superficially engage in therapy because this does take more effort and is more psychologically uncomfortable than popping a pill. We are in a society of instant gratification, and therapy rarely provides this. I will also add that I believe meds aren’t the problem per se, but the way they are prescribed and often not taken consistently. Benzos, opioids, and methadone are examples of where unintended consequences occur.

    I am mad that the medical field is so money driven. The profit motive should not have any place in healthcare. I also believe that healthcare is a right and not a privilege. Many of my clients cannot get access to inpatient rehabs for addiction, for instance, because insurance companies won’t pay or will only cover 28 days. This is wrong. Most people with serious addictions need at least 3 months of rehab to have any shot of developing the coping skills necessary to cope with their cravings, urges, and stress.

    I also add that I believe in a holistic approach to those I work with; the mind, body, spirit, career, relationships, etc., all matter and should be taken serious. We do need to also offer other forms of treatment and make them readily available such as acupuncture, meditation, access to nutritionists, massage therapy, etc. Western medicine isn’t the end all, be all. There are other legitimate forms of treatment that ought to be offered to help alleviate suffering.

  • For whatever reason I was unable to the post above, so I’m doing it here.

    shaun f

    The drugs that are forced on people labeled as the “mentally ill” are not meds. They do not cure any disease and many times cause the very things that they are supposed to “cure”. They destroy peoples’ lives, especially if taken over the long term. They cause metabolic syndrome, diabetes, tardive dyskinesia and akathesia (sp). They shrink the fontal lobes of the brain, the very part of the brain that makes us who we are as individuals. They keep people from being in touch with their emotions and feelings and often make it impossible to hold down a job. There are a few people who seemed to be helped by the drugs but most people don’t seem to experience this. So, why do you think people don’t want to take these drugs? Have you ever taken any of them yourself?

    First, I have never heard a medical professional state that psychotropics “cure” mental health disorders. The medical field in general offers very few cures. Most of the time doctors only have interventions to target symptoms and hopefully put symptoms into remission. There are cures for things like broken bones, stab wounds, etc., but many human maladies have no cure and no ethical doctor or therapist would say they can cure depression, cancer, or addiction.

    I agree with you that some of the SEs from drugs are terrible, like the ones you mentioned. These drugs aren’t perfect and in some cases do more harm than good. I agree.

    Yes I have taken an antianxiety med for a period of time to help me function. It did help me to cope (I was also in counseling at that time). I did have some w/d sxs of heart palpitations because I stopped taking them abruptly and didn’t really understand how to taper myself off without developing that SE. It wasn’t pleasant and I was young and uneducated. One thing I would say is that it is also the responsibility of the patient/client to learn about what they are putting into their bodies. They can talk to pharmacists who can answer their questions. Doctors have a duty to educate people and too often fall short of that standard as well. They aren’t without blame.

    Regarding your comment about holding down employment, I have found the opposite is true. Those who aren’t medicated and have a severe and persistent mental illness are almost always unable to hold down steady employment because symptoms such as insomnia, anhedonia, fear of leaving the house, irritable moods, anxiety, hypervigilance, hallucinations, etc., get in the way of doing a job. Many of my clients do very well working and taking meds. I am sorry to hear that isn’t everyone’s experience but certainly most of my clines have been able to live a better life because of the various treatment offered to them. Objectively many of my clients feel better as a result of treatment. That is a fact.

  • Respectfully, I disagree. I have worked with hundreds of clients, most of whom say that drug treatments have helped them live more full lives. I myself have taken psychotropics for anxiety, and while I had some brief unpleasant withdrawal symptoms from it, I found it helpful at that point in my life (I was also seeing a therapist). Psychotropics aren’t evil. The way they are prescribed is often very problematic. In the short term medications can help a person tremendously, and in some cases long term medication management is necessary to keep some people safe. Have you ever talked to a person experiencing extreme mania or psychosis? They can and do very dangerous things at times (e.g., like drive across the county not remembering where they’ve been or what they did, or driving a car into other cars not realizing it was a problem). When people lose sense of reality or are feeling so hopeless that suicide seems like the only answer, these folks do need treatment.

    I do not believe medications are the only answer, as again I am a therapist who actually believes in talk therapy. I believe that the therapeutic relationship can be healing–taking a nonjudgmental stance, really listening to and validating the person’s emotions and experiences, helping them to explore what is meaningful to them, help them to fully explore their choices and how it impacts them, etc.

  • Certainly things in Colorado aren’t perfect, but luckily the state has invested money and resources into providing more supports. The way we treat homeless individuals, on the other hand, is a pure travesty.

    We do have consumer boards where the people we serve have voice. I think that needs to continue to grow because obviously the system isn’t set up with the client in mind like it ought to. We need to listen to the people we serve and really work to provide the services that they want. I have no desire to encourage medication management if that isn’t what the client wants or would find helpful. There is a reason I support such programs like Housing First, because I believe we need to meet people where they are at.

    I will say that many of my clients say that Medicaid expansion saved them because they were in no man’s land with insurance prior. Now I am able to see people who traditionally wouldn’t have access to therapy. That is a wonderful development and I believe makes a huge difference in these peoples’ quality of life.

  • Yes, people do receive informed consent. If they do not, it is against the law. Yes, they can refuse drugs and go to court if they feel their rights have been violated.

    I will also point out that people are rarely hospitalized for long periods of time anymore in America. The system just doesn’t want to pay for the treatment. They would rather see someone live in the community and go to an outpatient clinic because it is cheaper and in theory the client will have a better quality of life.

  • No, we do not engage in eugenics. What I was referencing is genetic testing for enzymes of drug metabolism, which has significant potential for improving the efficacy of drug treatment and reducing adverse drug reactions. This is about improving outcomes so we stop giving people medications which make them sicker. This is progress. I would encourage you to look into it further. It is about learning more about individuals before doctors give them medications which may not be metabolized favorably.

    I continue to learn about my field and can tell you we still have a long way to go. I would love to see a day when we provided treatments with no addiction potential, no adverse side effects, and in general no potential to harm. We aren’t there yet. I would say, however, that psychotherapy has much potential and should continue to be encouraged by our system. We have many great therapists who can and do help people on a daily basis, without producing side effects or withdrawal symptoms.

    I am not a huge proponent of the drug industry. I believe doctors are pressured to prescribe when most people just want to talk to a compassionate person who will really hear what they are saying. Doctors and many other helping professionals are overworked and have little time to actually spend with patients. That has to change. I am aware that the average face-to-face time PCPs have with their patients is 6-7 minutes. No wonder we have an opioid and benzo problem in America. There is no way doctors can possibly do everything they ought to be doing in such a limited timeframe.

  • Rebel, Colorado has crisis centers that people use daily. We aren’t sending everyone to an inpatient hospital who presents in a crisis. I guess you can say just about anyone could be coercive–a salesperson, lawyer, judge, cop, social worker, etc. This is a human issue. I can say that on an outpatient basis, we do not force clients to take meds.

  • Yeah we have a version called a 27-10. We can only put someone on a hold if they are considered an imminent danger to self, others, or gravely disabled (not eating, cleaning self, etc). Most people put on a hold aren’t actually in a hospital for more than 24 hours here. Look, like I’ve said before on this website, I am not always a huge fan of the DSM or meds. In at least some instances, in my experience, medications have been the difference between life and death for some clients. Maybe you should talk to some of them about their experience before you continue to demonize medications. They do make many peoples’ lives better so they don’t need to be I think that talk therapy can be very beneficial, but it can and often does take time. Many people aren’t willing or ready to place themselves in that position. That is up to them and not me.

  • Old head, yes I do. I know the law here and the general practice of doctors. We have no need to pressure clients to take meds they don’t want to take. We aren’t living their lives and if they don’t want to take something, we don’t make them. We offer our expertise and they decide. I would argue that families of our clients make more of an effort to coerce than we do (and the legal system). We don’t require people take meds to come to our clinic. Clients can choose what level of care they want. We are probably the largest clinic in the state and people come generally on a voluntary basis.

  • There is little to no coersion to take medications in Colorado. Most people receive treatment on a voluntary basis. What I find more is that people are reluctant to fully engage in therapy because it requires a lot more effort and challenges the status quo (most people are uncomfortable with change). I find that many clients would rather take a pill hoping it will change their life. We live in a culture of instant gratification and therapy rarely provides this. I agree that humans need love and compassion.

  • Julie,
    Disability, especially for mental health, is subjective and I hear that you are angry towards a system which you believe has failed you. And from the sounds of it, the system did victimize you as it does to others. I am saddened to hear that and I hope we can have substantial reform in order to minimize people being harmed by a system which is set up to help (I do believe it is a money making venture for pharma companies but that’s another conversation). Good luck to you.

  • Hey Frank, so what about hallucinations, delusions, catatonia, hypervigilence, anorexia, bulimia, OCD, suicidal thoughts? These symptoms are often detrimental to the human condition, causing unwanted suffering. Folks who experience it need relief, which can cme in many forms. These symptoms are just as serious as high blood pressure, obesity, and cancer.

  • Well humanbeing, I am not sure where you live, but here in Colorado people can chose a wide range of treatment, such as case management and group and individual psychotherapy (thank goodness for expanding Medicaid here). I would much prefer that clients get therapy first and go from there, but the system isn’t set up that way in many cases (in my MH center, therapy is the default form of treatment; sorry to hear that isn’t the case elsewhere). I have no interest forcing meds on people. Here, that is illegal anyway unless there is a court certification, and even then clients have the right to challenge it in court. Very few people in Colorado actually are in this position. Most people in the mental health system chose to be in it here. I do agree that more resources need to be spent on housing, healthcare, vocational assistance, etc. I think our society tends to focus on treating the symptom and not the cause of problems (this is also why many clients aren’t comfortable with therapy, because it does require vulnerability and challenging oneself). Pills treat symptoms and they aren’t a cure. We haven’t found a cure for most illnesses. And I have no interest in coercing people to do anything they don’t want to. I am interested in making sure that people with a illness are safe.

  • How is mental illness a myth? Suicidality, violent thoughts, hallucinations, delusions, mania, depression, agoraphobia, anorexia, nightmares, flashbacks, hypervigilence….these things aren’t real? Oh, please. These experiences are just as real as cancer, hypertension, or diabetes.

  • What do you mean a “hopeless case?” Seems like you are dismissing what I say without even attempting to answer my legitimate question. Do you think a person with a mental health condition who cannot take care of themselves should be just left to rot? It’s a serious question. At what point is it acceptance to ensure the safety of someone who cannot take care of themselves in a safe manner?

  • As a mental health professional in the US, I find your story and experience troubling and disturbing. Obviously, I believe that the system has failed people when they are treated like criminals who have their rights taken away due to an “illness”. I believe that client autonomy ought to be sacred; on the flip side, at one point in time does society have a moral obligation to step in and make choices for someone who is obviously ill? I worked for a homeless agency and felt that my community let many of my clients down by allowing them to suffer on the streets rather than hospitalize them until they are well enough to live safety in the community. Too often I saw that hospitals would quickly discharge these folks because they lacked the necessary beds or didn’t want to deal with their problems (often they were uninsured as well). Now in the US we lock up over 2 million Americans, often for non-violent and drug related crimes. It is estimated that 25-50% of inmates have a mental health condition. We have moved clients out of MH institutions and into jails. That is sad and immoral to me.

    I have a question. Should we allow someone to sleep outside naked in freezing conditions because it is “their choice”? At what point do the state or professionals need to step in and make decisions for a person who clearly is unable to do so (at that time). There is a balance here. Serious mental illness is real; I have seen the harm firsthand when people don’t get the treatment they clearly need. Now I agree that psychotropics can be very problematic, since each person is doing a mini experiment with drugs and most people have at least minor SEs. My clinic is now able to do genetic testing to determine what medications are likely to be best metabolized by the individual, and I think this is a step in the right direction. I get why many clients do not feel comfortable taking medications. This is an issue for both MH and physical health treatments. People simply don’t like to take daily meds.

  • Julie, I never said I don’t use diagnoses. I have to for my job and sometimes they are useful to treatment and for clients (provides relief). That has been my experience. I think your last comments are hyperbolic. I am talking from a clinical perspective. You were the one who was initially bashing therapists. You are entitled to your opinions, as am I. And yes many people use terms like “narcissist” in everyday language. When someone acts like one it can be a helpful descriptor. Again when I actually talk about my clients or to them I do not use judgmental language. I do agree that labels can be problematic, and obviously this topic touches home for you personally. I just think we all need to be aware of when we are engaging in black-and-white thinking and realize there are many perspectives and many shades of grey in these situations.

    Do you believe that most people are harmed by diagnosing them with a mental health condition? I think the harm comes when they don’t get the proper (compassionate and knowledgeable) care.

  • I think anyone who has been using the DSM for a while knows it is socially constructed and lacks the scientific rigor of other fields. Mental health treatment is very different from other forms of healthcare. We still have a long way to go. I do agree that the BPD dx can be stigmatizing and for some it is. However, I work with many individuals with this dx, and for them it has been a general relief. I teach them mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance skills from DBT, and I have found them to be helpful to clients who struggle with these various symptoms. I do believe our system tends to over diagnose and over prescribe. I am also in a system which requires us to diagnose clients in order to treat them. I would much rather treat the person from where they are at without labels, but sometimes labels are helpful.

    I disagree with you that BPD is “only a negative label.” While yes it can and is sometimes used that way as a judgment of the client, it is also a useful label to understand a complex set of symptoms. In my experience one challenge with BPD is that there is much carryover into MDD, BMD, PTSD, ADHD, and addiction. It is difficult to separate out all the different symptoms to understand one thing from another.

    I do not expect the clients with BPD to behave any certain way. I see a range of symptoms, from extremely mild to highly volatile. I think more and more clinicians are viewing mental health symptoms from a spectrum POV, which I think is helpful.

    I will also add that I have an aunt with BPD and she’s in no treatment and alienates everyone from her life, except my poor uncle who fears leaving her would cause her to either become violent towards herself or others. This women is so difficult to deal with that she was even banned from her father’s funeral by her family. I have pretty much tried to avoid her since she kicked me out of her home because she didn’t like how I described a rug in her living room. She is very erratic and I believe is alcoholic as well. She does deserve treatment, but she has to own up to her stuff and want to change to make anything better. She thinks it is everyone else’s fault.

    Regarding Mary’s hx, she had previously suicide attempts, so to place blame on Gunderson is a bit much for her SA. While I agree that any abusive person can influence someone to harm themselves, such in cases of DV, it is also just as possible that the person who is hurting has been hurting for quite some time. It is possible that Kennedy was emotionally abusive or at least neglectful of his wife and the family, which could very much been a trigger for her unhappiness. I wouldn’t be surprised if Kennedy is narcissistic and felt he could do whatever he wants. By some accounts he was the “fun dad” who placed the responsibility of raising the family on Mary’s shoulders much of the time. This I imagine was very stressful for Mary, knowing that her husband was cheating on her for much of their relationship.

  • Even though the original post has nothing to do with the article, I feel compelled to respond as a therapist myself. I have been a therapist for about 8 years, and I have also seen a few therapists myself since 2004, all of whom were excellent and skillful. I think it is unfair to scapegoat therapists for poor outcomes; the truth is that therapists are rarely responsible for our clients’ choices, but of course we can make a situation worse depending on how we treat our clients. In the case you cite, I understand that Kennedy was struggling with both addiction and clinical depression (and possibly BPD), so she was unfortunately in a higher risk category for suicide. I have read that Kennedy was worried she’d lose her children in the divorce (her husband was temporarily awarded custody of their 4 kids), which is a common concern of many parents in such situations; I believe she also had a history of DUIs, which again speaks to her instability. Her husband, from some accounts, also repeatedly cheated on her which further complicates matters. She obviously felt much pain and anguish at that point in her life before her suicide. I do also understand that she was involved with AA, which traditionally has not supported treating the whole person (e.g., depression), which I think is to many alcoholics’ detriment. I do agree that there are some bad therapists out there, and I am sorry to hear that you have had a string of bad luck yourself. I work with about 20 therapists in my clinic, all of whom I believe are ethical and empathetic. Therapy cannot guarantee ideal outcomes, unfortunately. Clients suicide even with the most ethical and competent treatment team involved. Some clients do not respond well to medication management either, which is of no fault of their own. We still have a lot to learn when it comes to the human brain and mental health treatment in general. Also, treatment compliance for both physical and mental health hovers around 50%, which further complicates clinical outcomes. Doctors, nurses, social workers, and therapists are not without blame, but the truth is that our system is also somewhat fragmented and at times dysfunctional.