Sunday, February 25, 2018

Comments by Susan Rosenthal

Showing 27 of 27 comments.

  • I am concerned about the mental and physical health of everyone in the Middle East today. I cannot imagine the burden of living with so much insecurity and continual, immediate war. It must take a tremendous toll.

    People need safe spaces, and war destroys the sense of safety. This larger context cannot be ignored in the discussion of mental health.

    This is a healthy discussion that needs to happen respectfully.

  • Context is everything, and that is the problem with this article.

    As much as I support the expansion of the Soteria model, I strongly object to Israel being lauded as “an inspiration for the world” – for any reason.

    There is a growing international boycott campaign against Israel because of its racist and genocidal policies against the Palestinian people. To counter this boycott, Israel actively encourages international artists and intellectuals to promote Israel. This article does exactly that.

    There is no acknowledgment of the inhumane conditions in Gaza, the largest outdoor prison in the world, where two million people are systematically deprived of basic necessities required for mental and physical health.

    There is no acknowledgment of the fact that Israel could not exist without billions in military funding from the United States, money that could vastly improve mental and physical health in America.

    This article disappears the suffering of Palestinians and whitewashes their oppressors.

    You’ve landed on the wrong side of this one, Robert.

  • Thank you for your post. I have experienced everything you talked about, and it is tremendously disheartening.

    I came to the conclusion that many people who say they to want to hear ‘the other side’ actually don’t. They want to feel smug in their ‘open-mindedness,’ but they are threatened by any hint of real change.

    It’s called cooptation – they pretend that you have a place with them, but that place is only to make them look better than they are.

    I have become much more careful about when, where, and with whom I put myself on the line. I would rather organize with people who are truly open to hearing what I have to say than to bang my head against a wall in the hope that the politically deaf will grow a pair of ears.

  • The relationship between lower social status and sickness/mortality has been documented and redocumented since 1845: https://www.marxists.org/archive/marx/works/download/pdf/condition-working-class-england.pdf

    In 1936, Hans Selye explained how it happens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2038162/pdf/brmedj03603-0003.pdf

    The problem is not lack of knowledge or not enough science; the problem is that capitalism is invested in explaining all human maladies in biological, individual, blame-the-victim terms. If it did not do this, it would have to take responsibility for an immense amount of unnecessary suffering.

    This is a political problem, and it can only be solved politically.

  • Psychiatry is so woven into the fabric of capitalism that one cannot be abolished without abolishing the other. As I see it, this can only be done from the bottom up.

    When society goes into revolutionary crisis, every institution splits along class lines, with employers and managers on the one side and workers and service users on the other side. A great many will waffle in the middle, shifting back and forth as the struggle develops.

    As workers take collective control of their workplaces, they will change how the work is done, for their own benefit and for the benefit of those they serve. This will generate much discussion about what is needed, what is effective, and what should no longer be done. Everyone will be involved in this discussion, including service users.

    Out of this genuinely democratic process will develop systems of meeting people’s needs that are completely different from what we have today. And in the process of transforming society from the bottom up, human beings will also be transformed in ways we cannot imagine.

    Critics will say that this is an impossible pipe dream, but I think it is far more achievable than the impossible task of convincing the powers-that-be to abolish psychiatry.

  • Richard, I apologize for my delay in responding to the rest of your postings.

    I share and appreciate your optimism for revolutionary change. As you say, just because the first attempt to create socialism was defeated doesn’t mean that we should give up and accept the horribleness of capitalism. Thank you for that – it is most welcome at a time when so many people are pessimistic.

    There is much to consider in everyone’s comments, far more than can be clarified in a comments section. If anyone wants to communicate with me in more depth, feel free to contact me through my website: http://www.susanrosenthal.com/

  • I agree that psychiatry should be abolished, along with all of the oppressive institutions of class rule. The problem is in the practice.

    When we call for psychiatry to be abolished, who do we think will do the abolishing? The capitalist state will not do it. The only social force capable of abolishing psychiatry is the majority working class, and they can only do this in the process of transforming all of society.

    Of course, there are humane alternatives to psychiatry, but they will never become mainstream as long as capitalism needs psychiatry for social control.

    So the question of abolishing psychiatry must be put in context. Are we moralists and libertarians who want to replace psychiatry with individual solutions that only the fortunate few can access?

    Or are we revolutionary socialists who understand that abolishing psychiatry can be achieved only in the process of remaking society from the bottom up? To my mind, that is the only way we can end the horribly oppressive conditions that push people over the edge and the only way we can build a completely different society that provides what everyone needs to thrive.

  • Psychiatry is a state institution and so are hospitals. Both need to be reconstructed from the ground up in the process of remaking society to meet human needs. I don’t believe we will need psychiatry under socialism, however, we will always need ways to support people in distress.

    Because the revolutionary left has not been involved in the anti-psychiatry movement, it has left a vacuum for the libertarian right to dominate. This has to change if we hope to demolish a psychiatric system that profits from the misery that capitalism creates.

  • It’s true that libertarians and other right-wingers typically oppose psychiatry. They oppose all social services and supports, including those that most people need, like subsidized education, unemployment insurance, medicare, and child support.

    For those with lots of money, social supports don’t matter. But for the majority of ordinary people, they mean the difference between being able to manage and falling apart.

  • Thank you for this very important article. We need to pay a lot more attention to the role of racism in psychiatric oppression. It isn’t that long ago that we were called ‘a race of mental defectives.’ Race theory erases individuality by attributing negative, biologically-based characteristics to every member of a designated group.

    At the core of psychiatric oppression lies the racist claim that ‘mental illness’ is a biological defect, that a psychiatric label will tell you everything you need to know about a person, and that everyone who shares a label is the same. That is racism.

    If we acknowledge the racist core of psychiatric oppression, we could link with other groups and organizations fighting different forms of racism. Working together, we would have a greater ability to demolish the biomedical model that oppresses us all. Common cause for mutual benefit.

  • I apologize for the length of this comment. It’s a letter to the Canadian Medical Association Journal that I think adds something important to the discussion. Bottom line – we must trust people to make their own decisions, right or wrong. Anything else is disrespectful and opens the door to tyranny. Psychiatric survivors, more than anyone, know this to be true.

    Letter: Availability of medical assistance in dying can be therapeutic

    by Ian M. Ball, MD and Scott Anderson, MD

    The legalization of medical assistance in dying (MAiD) in Canada has created many logistical challenges for institutions and health care providers. In a country where diversity is not merely supported, but encouraged, it is not surprising that there are many outspoken critics of MAiD. One of us (I.M.B.) is the medical chair of our hospital MAiD committee; the other (S.A.) acts as a MAiD provider. Having been involved in over 30 referrals since June 2016, we have several important observations to make.

    The gratitude expressed to us by families and patients is staggering. A recurring theme is that patients’ moods are tremendously improved with the knowledge that MAiD gives them control over their disease. In some completed cases, symptoms were not controlled to an acceptable degree by aggressive palliative care. In some other cases, despite excellent symptom control with palliative care, patients desired control over the circumstances and timing of their deaths, and so chose MAiD. As per the law, all MAiD patients’ natural deaths were reasonably forseeable. For patients who received MAiD, being able to prepare for their deaths, assemble their families, and die in a comfortable, dignified manner, were the universally espoused virtues of MAiD.

    We have found that MAiD deaths provide a greater level of patient comfort than even the deaths from the withdrawal of life support in intensive care units. MAiD allows the use of intravenous medications in anesthetic doses, combined with neuromuscular blockade. At our institution, the procedure lasts only a few minutes, and avoids the dyspnea and increased work of breathing, which is so often associated with even the best palliative care or withdrawal of life support.

    Although we support palliative care and believe it to be the right experience for most individuals, we have witnessed cases where palliative care was insufficient to manage the degree of suffering, or where patients simply wanted to avoid perceived indignities and loss of control associated with their progressive diseases. It has impressed us tremendously that the availability of MAiD has improved the outlook of many patients who have not chosen the procedure. The knowledge that MAiD is an option, should symptoms become unbearable, is very reassuring for patients and their families.

  • I am much more optimistic. In my lifetime, I have seen radical and surprising change – the fall of the Berlin wall (which no one anticipated), the growing acceptance of gay marriage on the one hand and on the other hand the reversal of many rights won in the 1970s.

    Change is constant. Which way it goes depends on what we do.

    Discussion forums are excellent for promoting clarity; however, to create real change, clarity must be married with organization, the willingness of like-minded people to work together to do something constructive. If we work together, learn together, and act together, we can make big things happen.

    Get-together, meetings, and conferences are important for building activist networks, raising issues publicly, and planning how to reach more people more effectively.

    Isolation kills. At every level, personally, socially, societally, we go forward together, or not at all.

  • Thank you for sharing this, Helen. I can’t imagine working in such a traumatic and re-traumatizing environment.

    Your story is important not only because it exposes the immense cruelty of the system but also because it challenges the rigid separation between those who work in the psy-industry and those who are victimized by it.

    People who work in the industry are more similar than different from the people we ‘treat.’ We are more likely (than the general population) to be trauma survivors and to have been given psychiatric labels. Our experience of trauma is a major reason why we enter the field. This is a closely-guarded secret because workers who are ‘outed’ as having psychological difficulties can lose their careers.

    Chapter 3 of Psychiatry Interrogated describes two psy-workers who lost their jobs (one also lost her licence to practice nursing) on the false assumption that mental illness = mental incompetence. https://www.amazon.ca/Psychiatry-Interrogated-Institutional-Ethnography-Anthology/dp/3319424734/

    It’s important to challenge the mistaken idea that providers and users can never work together. The psychiatrists who abuse their power are not on our side, no question. However, most of us entered the field in order to help people, which gives us a common interest with those who seek help.

    We have a common enemy – a medical system that prioritizes controlling people over caring about them. When we don’t see that, when we let them turn us against each other, then we all suffer.

    I know many providers like yourself, I am one of them, and we are organizing for mutual support. Please contact me: [email protected]

  • I agree with you, Seth.

    Given the evidence, I don’t see how we can ethically recommend neuroleptics for anyone. Especially since there are so many alternatives, and more could be developed if there was a will to do so.

    If one must use a drug for acute psychological crisis, why not use short-acting opioids as an adjunct to social support? They are calming and induce a sense of well-being when people are frightened or in pain.

    As with post-surgical pain, withdrawal or dependence is not a problem after a few days of opioid use. But I cannot imagine the establishment going for that. Too much is invested in the way things are. And too little is invested in providing what people really need.

  • I am deeply indebted to you for opening my eyes to the medical disaster that is psychiatry.

    I have made Mad in America required reading for the MA-level course I teach, Social Dimensions of Psychotherapy, and I have requested that our graduate school invite you to speak at our 40th anniversary celebration in 2018.

    You ask the most important question at the end of this article. I believe that psychiatry has gained so much power that it will take a massive social rebellion, even greater than the one that challenged it in the 1960s-70s, to uproot it. I believe that the groundwork for that rebellion is being laid today and that you are an important part of that process.

    I thank you from the bottom of my heart for your courage and integrity in showing us what needs to change and for launching the frame of an organization (this website) that can take us forward.

  • As someone who has been on both sides of the patient/provider divide I can totally relate to your comments.

    Those of us who enter the medical industry are taught that the priority is patient well-being. We soon discover that the reality is something else – protection of the profession (cover your ass) and subservience to the hierarchy (mind your betters).

    Professional training takes people who truly care about others and teaches them that those ‘others’ are nothing like them. In dividing us from our patients, they divide us from our humanity, and they block our efforts to do anything else.

    Jeff Schmidt’s book, Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-battering System That Shapes Their Lives (https://www.amazon.com/Disciplined-Minds-Critical-Professionals-Soul-battering/dp/0742516857) explains that the role of professionals is to help manage capitalism, so professional schools weed out those who won’t go along. Those who slip through the cracks are ‘sidelined’ or ‘frozen out.’ I have been ostracized and threatened with the loss of my licence to practice for treating people humanely. That is the true meaning of insanity.

    Nevertheless, I am hopeful. Medical workers are under attack from the same system that attacks our patients. More of us are suffering burnout from impossible demands, suffocating red tape, micro-managed working conditions, etc.

    Patients and providers have a common enemy and a common interest in defeating that enemy.

    We cannot let them divide us. As you pointed out, we all lose when that happens.

  • Privatized reproduction lies at the root of many problems, including women’s oppression and the oppression of those who are seen as less productive.

    When the weight of caring falls on individuals, they cannot do it all, so caring becomes ‘control.’ In contrast, when caring is a shared social responsibility, there are more than enough resources to meet everyone’s needs.

    Diversity is a threat to class societies and an asset to egalitarian societies.

    In societies where human needs comes first (meaning everyone’s needs), there is more acceptance of, and support for, those who are different – for whatever reason.

  • I totally get your frustration and rage. However, your anger is misdirected.

    People to come to realizations in their own time in their own way.

    I admire Stephen for showing his vulnerability, for how far he has come, and for how much he is helping young people to stop blaming themselves for how they manage overwhelming emotions.

    When you are ready, I encourage you to watch the rest of the TED talk.
    I think you will find that his views and yours are not so different.

    We all internalize our pain – that is inevitable.
    And we all need support to work our way out of self-blame.

  • This statement,

    “the base for organizing within this movement will be among psychiatric survivors and their families…While of secondary importance, there IS definitely some value in attempting to win over and unite with dissident and open minded psychiatrists”

    leaves out the many working-class people who form the base of the psy-industry, the ones who do the grunt work.

    Most front-line psy-workers are also psychiatric survivors or are closely related to them. They are overworked and underpaid. They are expected to solve complex social problems while being denied any power to actually do that. This powerlessness defines them as workers and not as managers or directors of the industry. They direct their frustration against themselves and their clients, and rarely against their impossible situation.

    On the other hand, psy-workers are the base and foundation of a powerful industry. They have the collective power to challenge it and (most important) transform the system that requires it. We got a tiny glimpse of what is possible in the strike of mental health workers at Kaiser Permanente in California. http://www.beyondchron.org/when-workers-fight-nuhw-wins-battle-with-kaiser/

    Ultimately, the demand for better working conditions runs parallel to the demand for better life conditions for those we serve. ‘Better conditions’ means the right to choose what happens. Every psychiatric survivor has experienced that right being violated – the right to be safe, understood, accepted, and cared about.

    We can join forces. We can choose to over-ride the needs of the system in order to serve the needs of our clients and patients – as YOU communicate them to us. We can go forward together.

  • I am sorry that you have suffered such oppression.
    Other oppressed groups have organized in self-defense and, if anything is to change, we must too.
    The first step is telling the story, and I so admire your courage in doing that here.
    A Canadian psychologist told his story of self-harming behavior in a TED talk (The Skeletons in My Closet – https://youtu.be/G17iMOw0ar8) and also in an article in the Canadian Medical Association Journal (Cutting Through the Shame – http://www.cmaj.ca/content/188/17-18/1265.full.pdf+html)
    I wish you all the best.