Mad in America

Comments by Peter C. Dwyer

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• As Dr. Gotzsche said in the first chapter of this book, “If we want to reform psychiatry, we will first of all need to change the psychiatric narrative and part of that narrative is the semantics.”

  And as I wrote, in part, in response to that chapter: politicians and the advertising industry know that to control the words we associate with a topic, is to control what we think about it. Hence, U.S. conservative politicians call inheritance taxes “death taxes.”

  Our referring to emotional and mental problems as issues of “mental health” concedes to psychiatry precisely the “mental problems as medical illness” premise which it has failed to prove, and on which the edifice of modern psychiatry rests. The same is true of DSM-defined “disorders” – “schizophrenia,” “depression” etc.: ten years ago, Thomas Insel, then Director of NIMH, acknowledged that the DSM lacked validity. Because of this, he directed that NIMH-funded research not be based on DSM’s diagnostic framework.

  Our linguistic concessions to psychiatry are like arguing that the emperor has no clothes, while still referring to the emperor’s “outfit.” If he has no clothes, he HAS no “outfit.” Psychiatry HAS no “disorders,” “mental illnesses,” “schizophrenias.” When they claim to have those things, we just say, “Prove it.” And they can’t even come close. All they have is immense financial power and an overwhelming PR budget.

  It is hard to call out psychiatry without using the “mental health” and DSM buzz words. Psychiatry and PhARMA spend more on PR than on research. Because public awareness is so shaped by their PR, wholesale rejection of their terminology in articles such as Dr. Getzsche’s invites both media and the public to tune them out.

  But we need to start now, putting psychiatry’s buzz words in quotes, to consistently show that those buzz words don’t reflect reality, any more than “unicorns” are real. And we can write articles persistently calling attention to the increasing evidence that the “mental health” industry’s made-up language diverts public and scientific attention from real human mental/emotional problems, and the real things that can be done about them.

• Re: Dr. Gotzsche’s, “If we want to reform psychiatry, we will first of all need to change the psychiatric narrative and part of that narrative is the semantics.”

  Dr. Gotzsche is so right. Propagandists, politicians and the advertising industry have long known that to control the words people associate with a topic, is to control what people think about that topic. Hence, U.S. conservative politicians call inheritance taxes “death taxes”; a past U. S president called the desperate people trying to enter this country “rapists and murderers.”

  It is obvious that someone attempting to clarify why reasonable taxes on inherited wealth are sensible, would not call such taxes “death taxes.” To do so would be to concede the argument from the start. Similarly, attempting to realistically describe those trying to enter the country illegally, while still referring to them collectively as “rapists and murderers” is both contrary to reality and self-defeating.

  Yet we refer to emotional and mental problems under the associated rubrics of “mental health” and “mental illness.” This concedes to psychiatry precisely the “emotional/mental problems as medical illness” premise which it has failed to prove, and on which the edifice of modern psychiatry rests.

  What a gift this is to biological psychiatry. But we don’t stop there. We still refer to DSM-defined “disorders” – schizophrenia, depression etc. – despite the fact that ten years ago, Thomas Insel, then Director of NIMH, acknowledged that the DSM lacked validity. Dr. Insel’s mandate, that NIMH-funded research not be based on DSM’s diagnostic framework, is still in effect.

  These concessions to psychiatry are like arguing that the emperor has no clothes, while still referring to the wrinkles in his pants, the missing buttons on his shirt and his leaky rain coat.

  It is hard to call out psychiatry without using the “mental health” and DSM frameworks. Psychiatry and PhARMA spend more on PR than on research; wholesale rejection of their terminology in pieces such as Dr. Getzsche’s invites both media and the public to tune them out.

  Dr. Gotzsche makes a prudent start, calling “antidepressants,” “depression drugs.” But we need to start now, in separate articles, letters to the editors and public statements, to persistently call attention to the increasing evidence that the “mental health” industry uses made-up language to divert public and scientific attention from real human mental/emotional problems, and the real things that can be done about them.

• Well, I just read through my several posts, above, and found there were a number of times I should have used quotation marks and didn’t. You’re right – i would get on a roll and get sloppy.

• Bradford and Steve,

  I never use med or medication in conversation, including with social work “clients” or others struggling with mental/emotional issues. Instead, I either say drugs, or psych drugs.

  Writing here, where I address a variety of readers with varied beliefs, I use some “mental health” system words, not because I endorse them (I don’t), but to try to communicate effectively with as wide an audience as possible. As you can see from my entries above, I put these terms in quotes as short-hand for writing “so-called” in front of each term. I think in the context of my entries here, it is clear that my meaning is, in fact, “so-called” – indicating that I don’t accept these terms as valid.

  Bradford correctly pointed out that I didn’t make clear that med was one of these psychiatry-system words which should be challenged. I agree with Bradford that I made a mistake, and as I prefer using med rather than drug in this kind of writing, I will correct my mistake by putting it in quotes – “med.”

  I appreciate you both, Steve and Bradford, for your ideas and your passion for what MIA stands for. Steve – check it out – you yourself used med a couple of times in this thread too, but your meaning comes through strong and clear.

  Pete

• Bradford – Good point. I try to be careful to put quotes around all of the phony psych language, because it’s really about people being people, and that’s the best way to talk about it. No dx’s, etc – we live, we feel, we think, we love, we strive; we need to care about and show ourselves to, depend on and support each other far more than our cultures permit. I will remember to say “meds.”

• I agree. The MIA site carries several recent reports that conclude imaging for psychiatric purposes is misleading and, well, pretty useless. I would add, worse than useless, because imaging is often used to lend the sheen of science to psychiatry’s biology-based paradigm.

  Among the problems with imaging: there is always a lot of extraneous “noise” in the images. Multiple methods are used in an attempt to filter out the “noise” so some semblance of order can exist upon which to compare “ill” with “normal” brains. Researchers cannot agree on which of these methods to use, and depending on which method is chosen, the results can be completely different from each other.

  Also, where imaging produces “differences” between “mentally ill” and “normal” brains, the difference is simply between group averages, and a very large number of individual “normals” have scores that fall in the “mentally ill” classification, and vice versa.

  Unrelated to imaging, it surprises me that Dr. Phelps agrees that most mental problems don’t require psychiatric intervention. I whole heartedly agree with him. But how can there be any real appetite among the majority of psychiatrists for this proposition? Widespread recognition of this would lead insurance not to cover the many things psychiatry is now involved in, and psychiatry would have to relinquish its position as the 500 pound gorilla and the “mental health” room. I don’t believe there is much chance of institutional psychiatry making such a move, PhARMA giving up its tool for marketing meds, and individual psychiatrists giving up their current livelihoods. A major reason psychiatry turned to the medical model decades ago was that it was losing market share to talk therapy.

• Steve,
  Thanks for your comment. It mirrors my experience. The “mental health” system (basically the “psychiatric” system), is overwhelmingly stacked against any real change, and punishes those who don’t comply.

  When I was doing foster care, every child entering the system was required by the state to undergo a “psychiatric evaluation.” Given the usual 10 to 15 minutes (max) for psychiatric visits, this had to be crazily superficial. Kids came out labelled “oppositional defiant disorder” or “bipolar disorder,” with little or no apparent attention to their impoverished, violence-scarred, trauma-ridden homes, or to massively under-resourced community situations. And of course these labels brought with them scrips for psych drugs.

  It seemed to me that if a child was sad (why not, given her/his life experience and then landing in foster care?), and he/she also got violent once or twice (again, why not, given his/her circumstances?), he/she was labelled “bipolar.”

  I attended children’s periodic court review hearings, and always feared we would get disciplined for doing whatever we could to keep children off the drugs, or at least keep proscribing down to a dull roar. I always feared WE, who spent dozens and dozens of hours per year with children and their foster parents would be sanctioned for not fully embracing the drug paradigm, while psychiatrists who saw children once a month for 10 minutes, sometimes sitting with their backs to the children and their foster parents, sometimes typing at a screen without looking up, were free and clear.

  Just one time, we got a psychiatrist to take a child off her meds – turns out she was not “retarded” as she was diagnosed (that was due to the antipsychotic she was on). Another time, we reviewed the child’s chart, history of trauma, relationship with family, peers and school, the ongoing success of our psychosocial program, the adverse effects of the drug the psychiatrist proposed for her – and when the social worker attended the next med review, her presentation was dismissed out of hand. This guy, who had spent maybe a total of one hour (over many months) with the child, did not care what a licensed clinical social worker, who regularly did hours of in vivo therapy with the child and her foster family – paid no attention.

  One parting shot, and then I just have to give it a rest: it appeared to me that the large majority of social workers either didn’t know that antidepressants did not correct imbalances, or didn’t care. I wrote a program policy that no med changes could be made without the presence and approval of our social workers – I think some did what they could about this, but to little effect. My impression was that most willingly went along with the system, chalking my trainings with them up to my having a bee in my bonnet. I think the majority of licensed counselors and psychologists may have some doubts about psych drug, but most basically go along with the system. That’s how it goes with PhARMA’s billions and psychiatry’s steely grip on the system.

  I appreciate how Dr. Phelps has worked and expresses his opinions out loud. But untiil massive numbers of psychiatrists take a stand, things will not change much.

• Thanks, Steve.

  While I’m at it, I left out a glaring fiction psychiatry routinely pushes at “patients” and the general public: they know (per then-head of NIMH Thomas Insel in 2012) that the DSM has terrible validity problems, and that only by manipulation of the numbers can it be called reliable. Yet “patients” are constantly told they “have” DSM diagnoses of bipolar, schizophrenia, depression, anxiety – virtually never being apprised of DSM’s manifold problems.

  Along the same lines: I once gave a training for a group of 40 to 50 treatment foster parents – none had ever been told by a psychiatrist of the adverse effects of the psych meds given to their foster children.

  One last thing: most antidepressant prescriptions are written by primary care doctors. Has there ever been a concerted effort by psychiatrists to educate these doctors that depression is not caused by a serotonin imbalance, or that antidepressant clinical trials do not show what PhARMA says they do? (See Irving Kirsch’s The Emperor’s New Drugs, and recent meta- analyses).

  Psychiatrists like Dr. Pies, claim that good psychiatrists are more sophisticated that those in my experience. I doubt there are many – certainly that they are not in the majority. My work was in Baltimore – our foster children were seen at Sheppard Pratt, the Kennedy-Krieger Institute, Johns Hopkins Hospital and the University of Maryland Hospital. There may have been some exceptions to the general pattern, but over my 11 years doing treatment foster care, I can think of only one.

• I am an LCSW-C. I spent 13 years in treatment foster care, as a social worker, supervisor and program director. I never saw any credible evidence that most psychiatrists share Jim Phelps’ point of view. In my experience, if most of them at least share his doubts, they keep them on the down low with their friends. Patients get told: they have chemical imbalances; “mental illness” is a physical disease like diabetes or heart disease; psych drugs are safe and effective; psychiatric drug research is reliable science, etc.

  Even most so-called enlightened psychiatrists, if you scratch the surface, aren’t much different from the others when it comes down to what they do with their “patients” (see some of the comments above). For years I attended continuing education presentations at Sheppard Pratt Hospital – while occasional presenters (Bessel van der Kolk) offered viewpoints that were meaningfully outside conventional psychiatry, a number that purported to do so, did not.

  Psychiatry and PhARMA are a massive juggernaut enforcing their orthodoxy by spending more on promotion than on research, and (especially PhARMA) using their overwhelming finances to make it prohibitive for mistreated patients to seek redress in court. Some states’ and U.S. attorneys general have challenged PhARMA in court, but this is not the rule.

  Even if most psychiatrists do share Dr. Phelps’s opinions and doubts, it really doesn’t make much difference to “patients” and the general public. PhARMA’s lobbying and PR machine overwhelm any but the bravest and most resourceful psychiatrists (Sandra Steingard, David Healy, Peter Breggin and some others – all of whom have written for Mad in America). A psychiatrist who speaks out risks getting fired; others like Breggin and Grace Jackson, have had to fight to keep their medical licenses. It is simply an extremely risky career move for most psychiatrists to say out loud what Dr. Phelps says.

  PhARMA and Psychiatry assiduously enforce their orthodoxy. They allow some deviation – psychiatrists such as Daniel Carlat get away with presenting themselves as critics and non-conformists, but they still take care to allow that some psych. drugs are effective, and “mental illness” is a brain-based physical illness.

  The private opinions of psychiatrists will make little difference to those who suffer mental problems unless they speak out forcefully – as a large and persistent group – in newspapers, on TV, in medical schools, peer reviewed journals, the political arena. That isn’t happening any time soon – most psychiatrists know their careers would be destroyed.

  I am grateful for those psychiatrists who have spoken out, but they are most certainly not in the majority.

• Compared to what a rational approach to human suffering might look like, even that may be giving too much credit, but whatevah.

• This study dramatizes psychiatry’s ability to interpret a glass 3/4 empty as a glass half full.

• Bravo! Having taken part in community-based peer counseling for over 50 years, it is great to hear of your work.

• This is a valuable article, but psychiatry’s errors of omission and commission go much deeper than what appeared in the peer reviewed journals.

  Psychiatrist Daniel Carlat, in “Unhinged,” a so-so expose of psychiatry, debunked the “chemical imbalance theory,” while admitting he promoted it to patients to induce them to take SSRI’s:

  ” … when psychiatrists start using what I call neurobabble, beware because we rarely know what we are talking about. I fall into this habit with patients all the time. When I find myself using phrases like “chemical imbalace” and serotonin deficiency,” it is usually because I’m trying to convince a reluctant patient to take a medication. Using these words makes their illness seem more biological, taking some of the stigma away from having a mental illness. The implicit message I deliver in using such language is “Your illness is biological, it is not your fault and you are not going to be able to cure it by thinking it away.”

  Indeed, how could mental illness not be, ultimately, biological? All thoughts and emotions come from the brain, and so disordered thoughts and emotions must come from a disordered brain. But few laypeople realize how little we actually know about the underpinnings of these disorders.” (“Unhinged,” 2020, at 74-75)

  He’s clearly a smart guy, but his words reveal how compromised most individual psychiatrists truly are. He knows he’s BS-ing patients, but he attributes his doing so to “falling into this habit,” and says he “finds” himself doing that – like he finds himself eating too much popcorn at the movies, or he’s “falling into this habit” as though he’s spending too much time on Twitter.

  No – he’s lying to patients.

  And he’s one of the more self-aware and feisty psychiatrists who dared to speak out about psychiatry’s flimsy “evidence.” But the trick is that he, like a number of other psychiatrists, knows where the line is and doesn’t cross it. Psychiatry tolerates a certain amount of internal criticism, as long as it doesn’t cross that line. Carlat saves himself by saying he does prescribe psych drugs, and by supporting psychiatry’s claim that “mental illness” is “ultimately biological.” So he remains in the club, even though his reasoning is ridiculous: to say the brain is involved in thoughts and emotions does not prove mental suffering is due to “disordered” brains – any more than saying all car accidents involve cars necessarily means that all car accidents are caused by mechanical malfunctions. In fact, somewhere around 95% of all accidents are caused by environmental factors external to the car’s mechanics – black ice, snow, fog, drunken/distracted/speeding drivers – essentially the environmental input in which the car is operating.

  And where were psychiatrists when the evidence against “chemical imbalance” was accumulating? Only a handful bothered to point out that evidence. They were perfectly willing to repeat PhARMA’s ad copy as though it were science. For the most part, even PhARMA’s ads didn’t expressly claim the “chemical imbalance theory” was factual. Mostly, they said, “While the exact cause of depression isn’t fully known, it is thought to involve low serotonin etc. etc.” Cloaking itself in the mystique of science was enough for PhARMA to persuade the public, and psychiatrists were happy to go along for the ride, without going out of their way to tip off the public.”

  So Dr. Pies can disingenously call this theory “urban myth” that psychiatry never fully endorsed. There may have been some level of doubt in some psychiatrists’ minds, but they were happy not to rock the boat, riding the gravy train as far is it would take them, rationalizing the deception and its damage as they went.

• Well done. Your posts have been important contributions. I know first hand that cutting back can be difficult.

  I wish you all the best, and new satisfactions, perhaps popping up from unexpected places.

• It’s tempting to call people like Dr. Morehead names – it is infuriating to read such self serving ad copy. But it’s simpler to point out that Pharma spends more on promotion than it does on research; and so much of its promotion is essentially free advertising for biological psychiatry. Dr. Morehead’s point of view is just silly – portraying psychiatry as victim, while in fact it wields the biggest PR megaphone anywhere, ruthlessly enforcing its orthodoxy on psychiatrists and other “mental health professionals.”

• Hazel,
  Thank you for your inspiring story of how you used your own fine mind to recover from long-ago mistreatment and loss.

  If someone is struggling, the so-called “experts” should a) stop asking “what’s wrong with him/her,” and be curious about “what happened to this fine person that led to her struggles?” b) listen to the person and take her lead, and c) throw out “diagnosis” and DSM. People need to be welcomed, listened to, and have faith expressed in their ability to make sense of their world – even if it takes a long time with many twists and turns.

  No “expert” is smart enough to be an “authority.” We need to be met where we are, welcomed and honored as the whole, smart, strong and good people that we are.

  This, your first published article, is a fine one. I hope there is more to come.

• Thanks for showing yourself to be a caring and honest person who is not wrapped up in yourself – you are exactly what anyone who is struggling needs most. Your position as a real thinker in the lockstep field of psychiatry has to be a very lonely one. While you are greatly outnumbered by the co-opted, self-preserving and predatory members of your profession, there are some great people who you might connect with. They are well worth contacting and/or reading their books. Try reaching out – here are two I met years ago:

  Peter Breggin (pioneering author of numerous books critiquing psychiatry); Grace E. Jackson (author of Rethinking Psychiatric Drugs and Drug-Induced Dementia) – both have made livings treating patients without psychiatric drugs or by helping them get off them . You will find kindred spirits in ISEPP (International Society for Ethical Psychology and Psychiatry); also England’s Critical Psychiatry Network has a number of brilliant thinkers, Joanna Moncreiff among them.

  I recommend the writings of David Healy, former secretary of the British Psychopharmacological Society – an insider who cites chapter and verse on the shenanigans of psychiatriatry. A web cite, 1 Boring Old Man, written by a now-deceased psychiatrist, is a treasure trove. Bessel van der Kolk (author of The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma) is a reminder that not all psychiatrists are pill pushers.

  Knowing you are not alone and getting support from kindred spirits – not easy, but a big help. I wish you good fortune. People need what you have to offer.

• “Neuroecosocial” isn’t an improvement over “biopsychosocial.” “Neuro” is even more dangerous than “bio” – it gives psychiatry the privilege of having their spurious biological preoccupation first in line, and it goes “bio” one better by aiming our attention directly at the brain.
  I’m glad the authors are focused more on the social and physical environment by adding “eco,” but any parsing snippets of words into a technical label is messy. It always leaves relevant disciplines out, and referring to human emotions and suffering that way diverts us from the main point – we are human beings who think, feel, act, suffer and succeed. It objectivizes us as “things” to be studied by “experts.”
  If I had to use a multi-hypenated label, I would use – in order of importance – “phenomenological-psycho-social-eco.” I would omit biology entirely – it invites psychiatry to dive in to protect its guild interest, and it invites individuals to interpret their and others’ lives in medical terms.
  The whole run-on naming business is wrong. Why not just say “emotional suffering”? That invites us to apply our whole human selves, as sufferers and supporters of others, without specialized mumbo jumbo. We can talk to and listen to each other, empathize, support, and use our whole minds and souls to love each other, change environments, fight for justice, be close to those who are hurting. Any human undertaking that works we can use – poetry, music, spirituality, religion, touch, talk, peer support, “therapy” stripped of exploitation, sociology – whatever.
  My pet peeve – “mental health” just sucks us into the medical model. It’s hard to use those two words together without being drawn to bio-thinking. It perpetuates the fiction that that there are people who don’t suffer, and a separate group who are “mentally ill.” We all suffer and struggle at times; we’re not “ill” or “different” because we run into something very hard.

• Karin – Thanks for sharing your powerful story. There are so many spots in your writing that struck a chord with me that I want to take some time to think about them, but I just wanted to say for now, well done!!!

• Thank you for this excellent piece. Two things:
  1) It is great to see your references to psychiatry’s PR buzz words like “severe mental illness” in quotation marks. Those words are key to psychiatry’s colonization of our emotional lives, how we think about ourselves and what we do about our problems. This is the same PR trick politicians use all the time to herd voters to rush in whatever direction suits them.

  Examples: Years ago, Republicans took a pretty rational law – taxing inheritances above $5,000,000 – and portrayed it as an arbitrary and confiscatory thing by labelling it a “death tax.” Later, Maryland enacted a small fee for people and businesses with paved driveways and parking lots, to help pay for the damage to the Chesapeake Bay caused by the runoff of polluted water from paved surfaces into the bay. Politicians re-labelled this “the rain tax,” implying “big government” over-reach in taxing us for the rain that fell on our heads.

  As long as you can dictate the words people use, you can control how they think. Writers at Mad In America shoot their own cause in the foot when they use mental illness, mental health, diagnose and disorder, in pieces arguing against the medical model. Those are psychiatry’s brand names, the things they want to stick in the minds of “consumers'” as they decide whether to take a pill versus seeing a counselor. It’s basic ad-biz, and it works – that’s why Pharma spends more each year on “promotion” than on research.

  Imagine writing to support humane treatment of asylum seekers at the U. S. border, while calling them “illegals” (or, per our (not) Glorious Leader, “rapists and murderers”). We should not reinforce psychiatry/Pharma propaganda by using their own key buzz words.

  2) Thank you for your reference to the WHO study. It is very heavy reading, but I recommend their final report, Recovery From Schizophrenia – an International Perspective. I didn’t even try to hang in for all the graphs and statistical analyses – Robert Whitaker summarizes it in Anatomy of an Epidemic. But I could get through some of their chapters and their statements of conclusions. As Whitaker points out, not only were recovery rates in developing countries better than in developed countries, but there was a consistent correlation – the developing countries used fewer psych drugs, and Agra, India, the study center with the lowest use of the drugs, also had the best recovery rate of all.

  The most striking thing: the WHO concluded, as you say, that family structure, etc. influence outcome, but they did not choose to notice an obvious possible factor – the less psych drugs, the better the outcome. So even a publication from the WHO, via Oxford University Press seems to have been too intimidated by psychiatry/Pharma’s hegemony to tug on Super Man’s cape by mentioning the obvious.

• Please stop “diagnosing” Donald Trump. It’s just labelling, a rhetorical device, and the fact that so-called “experts” apply the label is just window dressing. Do you agree with his policies? Do you think he treats people with respect? Do you think what he does or says can have dangerous consequences? What do you believe is important for human beings, their survival and flourishing? Do you think he advances or hinders what you think needs to be done?

  Talk about those things. Calling him a “narcissistic personality,” or whatever, is just a disguised form of name calling and advances nothing.

• It is so heartening to hear of the spread of Open Dialogue, and to see such a thoughtful account from Marion! One thing about outcomes: it isn’t surprising that, after using OD for only a few years, she has not seen much difference between OD and FACT outcomes . The OD research is for 5-year outcomes – which have been very good re quality of life: living independently in the community, working and/or attending school, and lack of dependency on psych drugs. It seems pretty clear that if outcome measures had been at 1, 2, 3 or 4 years, they would have been uneven.

  OD’s “Tolerance of uncertainty” is a wonderful – it opens up thoughts, feelings and possible futures. It also seems a euphemism that pushes “professionals,” family/friends and so-called “patients” to not freak out when things don’t go the way we think/hope they will. The current “mental health” system is driven by people getting scared and resorting to panic-y anti-human “treatments” to get the “patient” back into other people’s comfort zones. We often don’t notice how damaging these “treatments” are because we are so relieved the “patient” isn’t upsetting us so much anymore.

  I am struck reading accounts of individuals’ successes with Open Dialogue, that many arrived at five years in a pretty good place, but they clearly got there via trial and error, with ups and downs. OD’s principle of “tolerance of uncertainty” helps people and their teams to persist through a messy process, trying again, making mistakes, and fixing things. Just like most of us move through life!!

  So, again, I am not surprised that Marion doesn’t see great changes after a few years, but I suspect there will be great changes eventually – OD works by simply treating everyone the way we all want to be treated. That pays off long term; short term “diagnosing” and “treating” works badly in the short term and even worse long term.

• Corinna,
  Thank you for this piece, and for the work you have done. By all means, do what you have to do to feed your soul. You, as a person, are important and your life is important; your work is important too, and I’m guessing that by taking good care of yourself you will find new doors opening in your work. All the best.

• Not a recent thing: Long before 2012, when I retired from running a treatment foster care program, I saw seriously traumatized foster children getting monthly med management where even psychiatrists at nationally known institutions took 10 minutes with their nose buried in laptops (sometimes not even facing the child) asking pro-forma questions to foster parents about the child’s “behavior”. At best, these were sessions for harassed foster parents to unload a few grievances – not accurate updates on what was going on with the child. Multiple psych. Rx’s were then written and the child was out the door. Psychiatrists seldom paid attention to the input of our social workers; they almost never advised foster parents of drug adverse effects. Our advocacy for weaning children off the drugs almost always went nowhere.

  Meanwhile, we were able to get psychotherapy for children that mostly consisted of bi-weekly, or even monthly, sessions. Exactly what was this going to do for children who had been monstrously traumatized (including the trauma of having been removed from the only family and community they had ever known and placed at the tender mercies of the foster care system)?

  I lobbied long and hard for small caseloads (of 7) for our masters level licensed social workers. They were the ones who saw the children anywhere from at least twice a month to 3 times a week. They often spent hours with children – not minutes – and often an equal amount of time with foster parents. The goal was to treat every moment of these encounters as opportunities for in vivo “therapeutic interventions” – usually the best thing was just to listen, listen, listen without trying to play “expert.” Often enough – especially on long car rides in which children didn’t feel they were being put under a microscope – children would open up about things conventional therapists would be thrilled to hear in office sessions.

  The takeaway? A) Still further evidence of the damage done by psychiatry; B) Dr. Gnaulati is surely right about the lack of availability of meaningful therapy for most people (although it is a tribute to clients and therapists that even bi-weekly therapy can work for some); C) People are hungry to be listened to, can open up and move toward better lives if someone in their lives takes the time to really listen, to express confidence in their goodness, intelligence and basic humanity, and to stay calm and positive when people show their pain. We need more creative ways to encourage this between people in our daily lives. The peer support movement seems to me an excellent start in this direction.

• Something I left out: psychiatry has sold to the public and professionals that the disease model of “mental illness”reduces stigma. That mantra is so pervasive that you almost never see it challenged. Yet studies consistently show that attributing mental problems to genetics and/or disease actually increases stigma. People tend to avoid those branded with permanent biological labels; and have more empathy when mental problems are described as deriving from life experience.

• Propagandists know the enormous power of words, and the current occupant of the White House focuses like a laser on labelling, never missing a chance to drive home the image he wants burned in his supporters’ minds: 30 to 40 percent of voters automatically disregard anything he calls “fake news,” no matter what the evidence shows. Ditto “lying Hillary,” “lock her up,” “the deep state.”

  Same thing with psychiatry. Thomas Insel, then head of NIMH, says the DSM is invalid, but psychiatry’s (and PhARMA’s) decades-long treating DSM as its scientific “bible” of “disorders” and “illnesses just like heart disease” makes all media and even writers at this site talk as though this reified BS is real.

  This article is just nibbling around the edges, kind of like being a “nice” doctor who nonetheless regularly prescribes Haldol. Establishment psychiatry can pose as enlightened and still do what it has always done.

  The starting point needs to be dumping the heading “mental health.” As long as the whole subject refers to the medical-friendly word “health,” it just a short hop for psychiatry and PhARMA to slide right into the same old schtick about synapses and circuitry. Ditto “biopsychosocial” – there is overwhelming evidence that psychosocial factors are enormously important, and hardly any evidence that bio factors actually cause or fix mental problems (beyond sound nutrition and healthful lifestyle). Saying “bio” is primary simply because bodies and brains are necessary for our having behavior or emotions makes as much sense as saying defective celluloid is the primary cause of bad movies.

  As Steve Scharfstien, former head of the APA observed, “biopsychosocial” long ago came to stand for “bio-bio-bio.”

  We need to refer to diagnoses as “so-called depression,” “so-called bi-polar”; “diagnosis” needs to be seen as simply acquiring a label. We need to change “mental health” to something with a basis in fact – “feeling overwhelmed by sadness, isolation, fear, unusual thoughts” etc. Others can figure out more elegant ways of putting it – just don’t use terms that are based on fraudulent science and unsupported supposition.

  The British Psychological Society has made a promising start of ending diagnosis and substituting a profound process of supporting “patients” in constructing answers to questions about the power has shaped their lives and how they can see themselves taking back the power to lead the lives they want to lead.

• Lots of great information. One question: I always wonder about comparing outcomes of those on antidepressants vs. outcomes of those never having taken AD’s. How much information do they have re the comparability of the 2 samples?

  In this world, it makes sense that anyone who comes near the “mental health”industry will quickly be offered/railroaded into taking AD’s. What causes some people NOT to end up on AD’s? Was their original “depression’ less severe or less chronic than those talking AD’s? Did they have only peripheral contact with the MH industry, so they stayed mostly clear of the industry’s clutches? Did they get a therapist who disliked AD’s? Did they have a personal aversion to AD’s? Did they have none of these, but a really good social and family support system that made them not feel the need. Or, unlikely as it may be, did someone actually give them adequate information on which to base informed consent?

  It is important to know how these comparison studies control for these influences. Bob specifically mentions one study in which the non-AD group had comparably severe “symptoms” – that makes me think these issues may not be well accounted for in all such studies. If I were flacking for psychiatry, I would try to claim that the AD and non-AD outcomes stemmed from bias in selection of the groups and their resulting incomparability.

• A lovely account. But one glaring omission: psychiatry has ridden the coat tails of the most successful public relations-branding campaign of the modern era: PhARMA spends more on promotions than on research, convincing modern civilization to apply the bio-bio-bio model to all aspects of life – all to get us to buy pills and see psychiatrists. It’s beyond insane that psychiatry could blame insufficient marketing for its troubles. If anything, Pepsi, cosmetics, car sales and politics are pikers compared to PhARMA and psychiatry’s marketing.

• I haven’t heard of this formulation. But I would definitely not put bio 3rd. I can see various plausible combinations, but in each of them bio would definitely come LAST. I’d be happy to omit bio entirely, except for nutrition and other elements of self care – otherwise, bio is just such an invitation to disregard all the other factors and embrace the disease paradigm.

• Oldhead,
  1. Re “new age crap”: “be the change you want to see” is mistakenly attributed to Gandhi, but he did say substantially the same thing. He did ok for being “new age-y” – led India to independence over a militarily superior England.
  2. You seem to assume my “criminal arrogance,’ and my unwillingness to listen. My post states, “I have fought what seems like a losing battle against the effects of those assumptions throughout the “mental health” industry.” My working years were spent in public service – VISTA volunteer, 8 years as a community organizer (sometimes confrontational, sometimes not), assistant professor in a Historically Black College, prosecutor handling cases on behalf of low income tenants and neighborhood associations, director of a treatment foster care program (advocating for “what happened to him, not what’s wrong with him,” and against drugs – in court and within and outside my program). In retirement I am working on behalf of a Central American immigrant, and with a good, smart young man in inner city Baltimore who fights to make his way against hard obstacles. I was writing a book against psych drugs, until a brain injury made me stop extensive reading and writing.

  I have often raged at the injustice and oppression in my home city. But I’ve found I was most effective when I found friends to blow off a lot of steam to, and then figured out what to do/say. That doesn’t mean always compromising or getting squishy – I have risked my job and physical injury taking stands – but it does make you more effective. In my experience, calm and firm generally works better than acting mad.

  I’m guessing if we met, we’d get along.

• I have torn my hair out for decades over the unexamined and damaging assumptions of biological psychiatry; I have fought what seems like a losing battle against the effects of those assumptions throughout the “mental health” industry. I agree with the substance of the vehement responses to this post, but am also disheartened by some of these same responses.

  In the present political climate, it should be clearer than ever that demonizing those with whom we disagree just contributes to polarization, with each side unwilling to acknowledge anything the other has to say. If we wish to be heard, we need to listen.

  I agree with much of what Dr. Ragins said here. I also believe strongly that psychiatry needs to acknowledge the lack of science behind – and damage done by – the disease model, the DSM, labelling, and treating those who suffer (or are just different) as in need of mechanical “fixes” instead of profound, respectful relationships. But I still admire Dr. Ragins’ apparent efforts to extend himself, human-to-human, to others.

  We need to be the change we seek.

• Monica,
  Thanks for the many wise observations. Congratulations on what you have done for yourself, and thanks for your valuable support of others.

• I’m all for dumping the invalid DSM. But I can’t understand why DSM is almost never called out for its lack of reliability. DSM III was deemed reliable only after the APA lowered the bar for what constituted good reliability (and after smoke and mirrors testing of reliability). DSM IV was still less reliable, and DSM 5 was just the pits. Why is this never stressed, when common mental problems have inter-rater reliabilities in the 20, 30, 40 and 50% range, and only a few “disorders” approach 70%? Letting the APA (and the rest of the “mental health” industry) off the hook on this only helps them maintain their “scientific” facade.

• Re my comment, I wonder if this claim, ” 42 different sets of SNP’s sets account for 70% or more of the risk of schizophrenia” means that 70% of all people labeled with schizophrenia have one of these 42 sets of SNP? That would be huge – meaning that 70% of all “schizophrenics” have these SNP’s. But it could also be trivial, if it only means that of the few people who have those SNP’s 70% are “schizophrenic.”
  Can anyone clarify this?

• True, psychiatry’s hypotheses have been regularly debunked over the decades (centuries). But the complexity of genetics invites psychiatry to just move on from one failed claim to other, less explored genetic hypotheses.

  I’m satisfied with MIA’s response to the genetic “synaptic pruning” hypothesis. But there’s a lot of research activity re single nucleotide polymorphism (SNP), with some pretty grandiose claims. A Washington University publication claims that C. Robert Cloninger et al have shown specific SNP’s associated with 95% and 100% chances of being diagnosed with specific types of schizophrenia.

  And Joe Pierre M.D., in 3/23/16’s Psychology Today (“Schizophrenia Doesn’t Exist!?”) wrote that SNP researchers “…reported that 42 different sets of SNP’s sets account for 70% or more of the risk of schizophrenia, with certain genetic variations conferring as much as 100% risk of schizophrenia among those with specific types of psychotic symptoms.”

  I’d bet money that the SNP claims are overblown and/or manipulated (e.g., if they actually found these associations, they probably apply to only something like 1% of all people labeled “schizophrenic”). But if anyone has looked at these studies, can you comment on what’s right and wrong with them?

• In my program, many foster children were placed in very loving homes, remained for years, and their lives greatly improved. It was not uncommon for such children to be adopted by their loving foster parents.

  The drugs are not “used to treat them for unhappiness and lack of love.” Psychiatry, uses made-up diagnostic labels that supposedly represent “mental illnesses … medical illnesses just like diabetes and heart disease.” These labels have no validity, per Thomas Insel, former Director of NIMH; yet they are the pretext for giving children “medications” that have numerous dangerous adverse effects, and all by themselves can ruin people’s lives. If you knew anything about foster children or the drugs they are given, you would know the drugs do NOT make them happy or make up for lack of love. Reliance on the drugs distracts from what can actually work – love, relationship, well thought out psychosocial interventions, persistence and the ability to hang on for a long time during what is often a very bumpy ride.

• Wayne – Thanks!!!

  I worked 15 years in treatment foster care – 3 as a social worker, 3 as a supervisor and 9 as program director. I used to tell social workers, “Don’t tell me what’s wrong with him, tell me what happened to him.”

  About 10 years ago, the U. of Md. School of Pharmacy’s Dr. Julie Zito’s national study found foster kids 17 times more likely to be on psychiatric drugs than other kids receiving Medical Assistance. It is inconceivable that foster children have “brain based mental illnesses” (which have never shown to exist) at 17 times the rate of other kids on M. A.

  Random observations of Foster care’s entanglement with psychiatry and PhARMA:

  –Every child entering foster care is traumatized, simply by being placed in foster care. Even children from the most harrowing environments are almost always loyal to their parents and family. They can feel it was their fault they were removed; they can long for an idealized relationship with their parents; they often wonder if they are “just like” the tortured parents who neglected or abused them (they can face identity crises in their teens, struggling to choose between their parents’ life paths vs. those modeled by foster parents); they can feel it’s disloyal to “succeed” where their parents “failed’; they can feel they must have deserved their treatment. The list goes on …

  –Foster children are likely to be confused, grief stricken, terrified and angry – sometimes all at once. My state required each child entering foster care to be evaluated by a psychiatrist. Imagine the labels they got from psychiatrists whose specialty ignores context, places “blame” within the child’s head, and “medicates” them “for their own good” (really, to dampen behavior caused by their multiple traumas). Many children – even young ones – were already on several psych drugs when they were referred to us.

  –Don’t get me started on specific labels; just one example will do: Any kid who was sad, and occasionally got mad or into a fight was “bipolar.” Then bang – on to SSRI’s and “antipsychotics.”

  –Ditto “care” provided by the psychiatric system: Evaluations were generally 10 -15 minutes, resulting in Rx., then 10 – 15 minute monthly med checks as follows: Psychiatrists in nationally known institutions might greet children and foster parents without turning around from their desks – and ask a series of questions without looking up. One social worker sat next to a hand-flapping autistic foster child, with psychiatrist sitting next to them, nose in laptop – psychiatrist asked, “Any unusual gestures?” Social worker just stared in disbelief.

  My favorite: psychiatrists didn’t seem to realize that many foster parents came to appointments full of frustration and worry (many are heroic in their patience with the “acting out” of traumatized foster children).

  When I made home visits, my first order of business was to listen as foster parents vented fears and frustration: “He’s always …”; “He never …”; “I can’t get him to …”. It is so important that foster parents be heard. After an hour or so, I could ask re-framing questions: “How often did he do this last month? Three weeks ago? Last week? This week?” “Any encouraging things happen lately?” Often enough, having released the pressure, foster parents might say, “He’s done it less and less lately; he’s not doing too bad.” and we could find psychosocial ways to deal with problems.

  Yet psychiatry’s 10 – 15 minute med checks didn’t get to this point. Psychiatrists heard foster parents begin sessions of their own; they often mistook the un-processed opening statements of such sessions for factual reporting, and then “medicated” kids based on foster parents’ frustration.

  Foster children frequently moved from foster home to foster home – a product of too many systemic irrationalities to catalogue. Often this meant changing psychiatrists. One social worker was greeted with amazement by a new psychiatrist because she had prepared a history of the other psychiatrists the child had seen, and all the conflicting diagnoses and drugs she received over the years. This was the first time the psychiatrist had gotten such a rudimentary history.

  Once children were put on the drugs, it was almost impossible to get them off. I wrote a policy for our program requiring that no child be started on psych. drugs without the consultation and agreement of our social workers; and no medication was to be changed without prior consultation with us. It did little good. Med checks were perfunctory, many of our recommendations were brushed aside, and the overwhelming majority of foster parents reported that psychiatrists did not discuss possible adverse effects when prescribing new drugs.

  Psychiatrists paid scant attention to context provided by social workers. I once documented with a social worker a child’s traumatic history, the connection of her behavior to that trauma, the psychosocial measures in place to support the child and her foster family, the progress since those measures were implemented, the FDA warnings about the dangers of the child’s drugs (and how her behavior fit with those warnings). The psychiatrist simply said, “Who’s the expert here?” and ignored us.

  Our program employed only MSW social workers, most with the state’s highest clinical certification. Our average caseload was only seven children per social worker. We made a minimum of two home visits per month, and could make 3 per week when needed. We advocated for all children at school IEP meetings; we prepared and presented court reports for children’s periodic court reviews; we met with school personnel and sometimes made random classroom visits; we did in vivo counseling with children, foster parents and sometimes bio parents. Every contact was viewed as an opportunity for us to make therapeutic interventions (car rides were great opportunities for children to open up about their trauma histories and feelings). We arranged other services – educational, recreational, cultural, psychotherapeutic – for children, and maintained contact with service providers. We were relentless advocates for the kids with public agencies – courts, DSS, “mental health providers” and others.

  And with all our involvement, most psychiatrists pretty much ignored us, justifying their monthly med checks with a polite or brusque, “Who’s the expert here?” There were some exceptions – but they were not the rule.

  I agree, Wayne, that the attempt to “tease out real mental illness” is the kiss of death. Foster care is a high stress environment in which the temptation to drug our way out of frightening jams is seldom resisted. Most psychiatrists and primary care providers will agree that “medications” are “sometimes (even often) overused.” But, especially when the stakes are high, they almost always decide, “This kid really needs it.”

• I agree it’s destructive to dwell on the effects of ACES on the brain. It invites stigma from outsiders and demoralization within those who struggle: it becomes too easy and convenient to conclude that, whatever the cause – ACE’s or genetic brain defects – this person’s brain is really messed up, and it’s well nigh impossible to reverse.

  Brain changes or not, the important point is that people always have an inherent drive and ability to recover. We need profound safety, loving relationships among peers, and people willing to go to the mat for each other. None of that is enhanced by potentially fatalistic talk about all the ways a person’s brain has been messed with.

  I am a social worker, but I strongly agree that we often hide behind our degrees, diagnostic labels and theories and offer top-down “help.” Instead, people need respect and to be listened to, listened to, listened to. I hate talk of “empowering” people – that implies that “we” have the power and can “give” it to someone else. I assume each of us already has power, and we are just waiting for an honest and safe relationship that supports our using that power.

  In terms of reducing ACE’s, I think we inflict ACE’s on others (and fail to support their recovery) to the degree that we ourselves have not lived with close, loving, supportive relationships – usually because we and those around us are systematically mistreated, to one degree or another, by the social system (based on race, sex, class, religion, ethnicity, age etc.)

  We don’t get people to recover from their own oppression and to stop oppressing others by lecturing them about their brains and the brains of those around them. It’s all about honest and loving relationship, offered with the humility of knowing that when it comes to basic humanity, there are no “experts.” We’re all just people, in this thing together.

• Thanks to Dr. Moncreiff for years of clear thinking and advocacy for good sense in this area. I too am glad to hear of such a study. I share Rob Unger’s concern that 2 years is not enough time – the Open Dialogue positive 5 year outcomes were, at least in some cases, not nearly as positive at two years. Sometimes people go through high adventure sorting out their lives before they appear “calm” and “organized.” During such a period it can look like they are “sick”; it isn’t until later that their long term outcome emerges as a lot better than that of someone who has remained sedated, struggled less openly, and at 5 years hasn’t reached as high a quality of life.

  I also wonder what the “support” of psychiatrists will be for those who are reducing their meds. Much of psychiatry’s “support” for patients is simply the act of giving out pills and assuring patients that they will help. What will the “tapering” psychiatrists do? I hope there will be real psychosocial support for both groups, including meaningful support for patients experiencing the stresses of coming off drugs. It is crucial that, when patient fear, anxiety or “high adventure” arises, doctors don’t think to themselves, “Well, this isn’t working, he’s really sick” and directly or subtly convey this to patients.

• Noel,
  A very interesting piece – I agree with just about all of it.
  A couple questions:

  If I understand correctly, the C4 variant is associated with a 0.25% increase in the chances of “schizophrenia” in the general population. The usual (probably wrong) estimate of “schizophrenia” in the general population is 1%.

  As near as my non-statistician mind can make out, a 0.25% increased risk in the general population, when the “known” general population risk is 1%, would mean that this variant is associated with 25% of the overall risk of “schizophrenia” in the general population. Do I have that right? If so, it’s at least a hefty correlation, setting aside the question of causality.

  Next question: what percentage of the general population has this variant? If it is a small number, that would mean most or almost all of those with the variant become “schizophrenic.” While not proving causality, this would indeed be an interesting finding. But if a large percentage of the general population has the variant, it would mean the vast majority of those with the variant never become “schizophrenic,” and the potential impact of this study would be greatly diminished.

  Thanks for any help you can give me.

• Congratulations on all you have accomplished. I have tried to donate to MIA, but when I try to sign up online, I get rejected by a notice that says my email or my password are already in use on this site. I emailed MIA for help on this, but never heard back.

  I am light years from being a pro at computers. Can anybody tell me how to fix this?

  I look forward to reading about MIA’s plans for the future. It is very effective – it is one of several sources I rely on for decent information about the “mental health” industry and its shenanigans.

• Thanks for all the great writing you have done on this site. Your present piece has beautifully exposed exactly this point about psychiatry in general and Dr. Pies’ positions in particular – they are either naive or dishonest. His response to your piece is probably as close as he could ever force himself to come to admitting how off base he is. He now resorts not to argumentation or facts, but simply hides behind plausible deniability – “Am indeed honest and you can’t prove otherwise.” And ads a “harumph” for good measure.

  Millions of patients have heard psychiatrists endorse and/or tacitly approve the “chemical imbalance” narrative (which Pies has called an “urban legend”). If Pies has always been so exercised about this, he needs to offer a credible reason why he waited a few decades to object.

• Bravo.

  Pies threatens legal action based on the tiniest quibble over who first used the phrase, “little white lies,” and puffs indignant over the slightest implication that he might have engaged in “promoting.”

  Pies’ profession and PhARMA took unconscionable liberties with the truth and with real informed consent – in consulting rooms, in public and in print. These liberties dwarf his nit-picking (and spurious) complaint about Dr. Hickey.

  Dr. Pies, and his profession remained silent while countless patients were lied to or allowed to believe PhARMA’s weasel-worded ad copy. The media endlessly swallowed the lies, while hardly a peep was heard from psychiatry to protest PhARMA’s brilliant marketing ploy.

  Now Pies seeks to divert attention from his sins of omission simply by saying he should have spoken sooner. He’s right – he should have spoken out at least 25 years ago. I wonder how many “unrestricted grants” he would have gotten from PhARMA if he had done that.

  Would that Dr. Pies had been one thousandth as vigilant about his own profession’s rectitude as he pretends to be about Dr.. Hickey’s.

• Corinna,
  You do a great service to share your experiences. It helps to read of someone using guts and real intelligence to make sense of, and grow stronger from, powerful and scary experiences. You model for all of us what the open dialogue people call “tolerance of uncertainty” – a euphemism for keeping a cool head even when your head doesn’t feel cool at all, and continuing to think. I love your “aspiring psychonaut” – it reminds me of my significant other’s tee shirt “keep calm and surf on,” and my favorite mantra, “disaster as opportunity.” They put the focus where it should be: we are human beings, not victims or lab specimens – we can hold on, think and solve our problems. Our minds are intact and functioning even when things get confusing and terrifying.

  I got a concussion about the same time you got hurt. through a combination of being 69 years old and brushing it off like I did when I was 20, I’m still dealing with some relatively minor – but important to me – damage. It has been hard, but also interesting, to keep thinking even when the thing you’re thinking with is hurt.

  One question – you refer to “meltdowns.” If you want to, I’m interested in knowing what you mean by that. There are some kinds of “meltdowns” I definitely would not want to have. But others – if you have trusted people to be with you and reassure you, and help you pull out of them when you need to – can be an important part of working through confusing and frightening feelings. Just a thought.

  Thanks again for sharing your experience.

• Bravo. Thank you for for going against the grain of modern social work. Most social workers knuckle under to biological psychiatry’s orthodoxy. Social work is supposedly distinguished by its “person in environment” approach to emotional and mental issues; its embrace of DSM is a massive betrayal of that crucial perspective. You have done a wonderful job of exposing that betrayal.

• It isn’t “dogmatic” or uncompromising to fully reject practices of psychiatry that are as wrong as was blood letting, septic surgery and lobotomy. There is plenty of evidence that this is a “blood letting” kind of case that should not be portrayed otherwise.

  It strengthens our position, rather than weaken it, if we look objectively at whether other factors besides psychiatric drugs could also be influencing SSDI numbers. This rebuttal is fine, but it doesn’t really address the SSDI issue directly. We need to do that to stay out of the “dogmatic” category. “Dogmatic” is what psychiatry does, by refusing to consider negative evidence; that should not be us.

• Thanks, Will Hall, for this wonderful account of being a human being in the presence of another human being. It is inspiring, and reminds me of what went on at Soteria House, and what I’ve read of Open Dialogue.

  The “mental health” industry needs a radical make over – one that is more than a change of institutions, training, and methods. It needs to stop being an industry altogether. It needs, instead, to become a logical extension of a humane, compassionate society in which “normal” people can face their own demons, show their true selves to others, and respond with calm compassion when others show extreme emotions and unusual thoughts.

  We live in a world where the very thing needed to handle strong emotion – showing tears with those who love us, showing real anger in a safe place, admitting to and showing terror – are assumed to be signs of “mental illness.” Those of us who escape the label of “mental illness” are often not free of overwhelming sadness, anger and fear – we have just managed to cover it up. But we do so at a cost to ourselves and our relationships with others. We perpetuate the distance and fear of showing ourselves that lets smaller emotional problems balloon into huge ones; and when a loved one becomes overwhelmed, our fear of intense emotion keeps us from relating to them – just when they need relationship the most.

  We’re often so terrified that we just want to “make it go away.” That’s when we turn to commitment, drugging and the rest of what the “mental health” industry eagerly offers – in exchange for a tidy profit.

  To be sure, a new “system” is needed, along with resources to support real human interaction with those who struggle. But we need to change what now passes for “normal.” Today’s “normal world” is a vast machine that divides us, oppresses us with our own shame, making inevitable that a certain number of us will become “psychotic” and will then be oppressed by the “normals” attempt to escape the “psychotic” person’s reminder of our own pain and shame.

• Luaren – Thank you for a courageous, profound and moving account.

• Dr. Hassman – People have chosen the “chemical cure” throughout history, and even without biological psychiatry, some would still do so. But PhARMA has spent from $40 to $60 billion per year on promotions for a few decades, and psychiatry has been right there with them. The promotion has been about getting our entire culture to interpret daily experience – sadness, fears, worries, spiritual struggles, interpersonal conflicts, sense of being overwhelmed – all in terms of physical brain illness. As Healy argues, mental “diseases” were marketed more than their chemical cures. Once one is convinced they have a brain disease, the pills almost sell themselves.

  Psychiatry embraced this: ran with it via DSM,
  with individual psychiatrists accepting tens, hundreds of thousands, and in some cases millions per year from PhARMA in speakers’ fees, lending their names to ghost written journal articles, consulting contracts – not to mention millions in PhARMA research grants (or research institutes) for med schools, and dozens of pages per issue of PhARMA ads in major journals, and the PhARMa-funded APA convention.

  Psychiatrists who resisted risked their licenses, their jobs or seeing their career hit dead ends. The vast majority of psychiatrists did nothing to correct the excesses or untruths pushed at the public by PhARMA. Psychiatry was silent in the face of direct to consumer TV ads pushing SSRI’s “thought to correct chemical imbalances.” Ronald Pies claims – ridiculously – that no well-trained psychiatrist in the past 30 years endorsed the chemical imbalance theory. But even if that were so, psychiatry still sat by and allowed PhARMA to push this marketing ploy on the public.

  Where is the groundswell from psychiatry against journals’ refusal to withdraw obviously inaccurate (if not fraudulent) articles like those promoting Paxil’s Study 329? Why hasn’t psychiatry led the charge against ghost written journal articles, or decried drug companies’ billion dollar pratfalls in court over Zyprexa, Risperdal, Neurontin and others? One reason PhARMA’s promotions have been so successful is that, in the face of PhARMA’s campaign, psychiatry has been, at best, supine, and more often than not has eagerly abetted PhARMA.

  Psychiatry needs to speak out – forcefully and often – against PR juggernauts that mold opinions in ways that hurt patients. So do psychologists, social workers, counselors and primary care doctors – I fault these too-often lazy and cowardly professions too (I am often ashamed that I belong to one of them). But none has had remotely so much to gain from this juggernaut, and none has so passionately embraced it, as psychiatry.

• Steven – thank you for a clear and inspiring presentation.

• Thanks for the cogent summary connectING the dots psychiatry fervently wishes not to connect. I would add another dot:

  The WHO’s final report on its international schizophrenia longitudinal studies puts an exclamation on its earlier 5 year studies. “Recovery from Schizophrenia,” (2007) reports another follow up that showed the WHO’s prior findings held up after 25 years. If anything, the developing countries’ advantages were even more unavoidable.

  Here is the report on the Agra, India center patients: “ Forty-five (73.8%) of the 61 cases alive at the 25-year follow-up had been in complete remission at the initial 2-year follow-up, and 77% were currently asymptomatic.” (p. 80).

  Moreover, “In the last 2 years of follow-up, 72.7% of the Agra cases never used neuroleptic medication.” (p. 82). The authors give an understated nod to the implications of the connection between high recovery and low drug use: “… the fact that recovery rates were so high suggests a much lower need for maintenance medication.” (p. 82)

  However, the authors minimize the fact that the study center with the lowest neuroleptic use had by far the best outcomes. They conclude: “In spite of the fact that use of neuroleptics is uncommon and hospitalization is not the usual treatment choice, global outcomes in the final 2 years of follow-up was noted as much better. Examining various variables yielded no relationship that could be specifically related to outcome beside family care. It is therefore surmised that schizophrenia runs a natural course, and the longer the survival, the better the outcome.” (p. 84)

  The chapter on the 25-year follow up at the Cali, Colombia center similarly noted “the short duration and the small number of hospitalizations as well as the sporadic use of treatment,” concluding, “Such evidence suggests the existence of a disease process less malignant than the one usually attributed to schizophrenia. Similar findings in several contemporary studies indicate the need for a change of paradigm – namely, the notion that schizophrenia inevitably evolves toward chronicity and deterioration should definitely be eradicated.” (p. 98)

  The book’s concluding chapter: “Consistent with the earlier findings … course and outcome for subjects in the developing centers were more favorable than for their developed world counterparts. Most of the difference registers early on, in the initial two years of illness …. But even for subjects whose early course was poor, the likelihood of later recovery favors those in the developing centers (42 vs. 33%).” (p. 178).

  But in an apparent effort not to be drummed out of the psychiatry club, and to avoid having their conclusions ignored altogether, the authors’ conclusion chapter doesn’t breathe a word about freedom from neuroleptics affecting developing nations’ good outcomes. They focus instead on culture and family.

• Dr. Moncreiff,
  I join other posters here in thanking you for your profound work. I just viewed your presentation at UNE, which was excellent – not at all surprising, in light of your other work.

  A few comments on the video:

  You have a wonderful way of presenting information in an impartial and non-inflamatory way that must greatly reduce the risk that disease centered adherents will react defensively. I do think, however, that you sometimes let questioners off easy – especially the pharmacy dean who cited peer reviewed literature to support a disease centered view. Much evidence (especially presented by David Healy) indicates that peer reviewed literature often functions as a PhARMA marketing arm and a cozy incubator of unsupported medical model assumptions (ghost written articles, peer reviewers with multiple conflicts of interest, publication bias, sequestered data, etc.)

  Your presentation of what one would tell patients about a drug, based on the disease model vs. the drug model, is very clear and helpful. But I would add that even using the drug centered model is far from giving patients the ability to give informed consent. Patients should also be told that numerous psychosocial interventions often prove to be more effective long term, with far fewer adverse effects than drugs. Moreover, given the tidal wave of PhARMA-funded disease based promotion, informed consent requires at least a brief statement, based on your video, that what patients see in direct to consumer ads “ain’t necessarily so.”

  I recommend both your books to others. Thank you again for your very important work.

• Jim – You take me back 45 years to when, as a law student, I spent the summer working for the New York State Mental Health Information Service helping to represent “mental patients” at Bellevue in NYC, trying to spring them from the clutches of the system. You look to have a good case – the Alaska court’s reasoning is lame – how do they know the docs who evaluated the patient were “impartial,” and since when do parties in legal proceedings have to, as Blanche DuBois said in Streetcar Named Desire, ” … rely on the kindness of strangers” to secure their legal and constitutional rights? Your argument is completely reasonable – nobody was “endangered” (except maybe the patient himself) since he was already in the hospital.

  I think the only way “mental patients” will get rights is via a full court press on all fronts – legal, cultural, politics, personal. So I think you should go ahead and file for cert.

  Thank you for the great and courageous work you have been doing for years.

• I am struck by the fact that the CBT group was given weekly sessions for only 9 months, but then over the remaining 9 months of the study, only another 4 optional CBT sessions was offered. That is no real test of a non-drug therapy. Certainly the drug group was encouraged to stay on the drugs for every day of the 18 months; why, with what is generally seen as a life-long affliction, would they essentially discontinue the CBT after 9 months (or for that matter, confine sessions to just once a week)? That reminds me of the Metro study of “ADHD” in which they discontinued the non-drug therapy well before the end of the study.

  This is, indeed, a proof of concept study. I just hope they grasp what the concept really is. There’s nothing magical about CBT – it’s no better than a lot of approaches, except it lends itself to clinical trials because it is manualized. This looks like an example of the street light effect, where they study something because it’s easy to study, not because it’s the most promising approach. CBT alone does not represent the many possible psychosocial approaches to the “patient’s” family, social environment and work and educational environs – all of which could greatly enhance the effectiveness of psychosocial approaches to “psychosis.”

  Open Dialogue is the best documented example of a real “full court press” psychosocial approach, and it puts the effectiveness shown in this study in the shade. It is easy to see why the Lancet study doesn’t appear to undertake something like Open Dialogue: 1) conventional psychiatry won’t touch the “unscientific” Open Dialogue, while CBT looks far more “scientific” to them, and 2) Mobilizing resources and training staff to implement Open Dialogue where it hasn’t previously existed is a daunting task.

  The study is helpful, but I hope people see how far reaching its “proof of concept” really is.

• Dr. Martin –

  Thanks for writing here – it is always encouraging to hear from a psychiatrist who is willing to grapple with this stuff. Whatever you are able to do to bring some sense to it, will be a boon to some child.

  Dr Julie Zito of the U of Md school of medicine did a nationwide study about 8 years ago that showed kids in foster care were 16 times more likely to be on psych. drugs than other kids on MA. I saw this up close in my 15 years as a social worker, supervisor and program director in treatment foster care. I wrote a policy for our program: psychosocial interventions were to be given every chance to work before any drugs were to be considered; foster parents were to discuss it with our social worker if they wanted to request the drugs from a doctor; no psych meds were to be started or changed unless our social worker (not someone from DSS who isn’t really a social worker) is present at the appointment when the change is made. I gave several in-service trainings for foster parents and staff. I pushed the issue whenever I could.

  Very disheartening: Maryland now requires kids to see a psychiatrist when they first enter the system, resulting almost always in rx’s – so the kids would come to us already dx’ed and on drugs. We had a few successes getting kids off drugs, and a few in getting poly-pharmacy or dosages reduced. But in general, the docs acted like we were nuts.

  I am hugely disappointed in the social work profession, whose basic premise is person in environment. If anyone would fight against this tide, you would expect social workers to do it. But only a few social workers troubled themselves to read a single thing about these drugs or go out of their way to object to the drugging. My letters to statewide social work leaders have been ignored.

  And most of the psychiatrists (and primaries who often prescribe) were clueless. One sat with his back to the child and the foster parent, asking rapid fire questions and typing on a lap top. Another, sitting right next to an autistic girl who was vigorously flapping her hands, asked, “Any unusual gestures?” – nose in lap top, didn’t notice.

  The biggest thing they never realized: Many foster parents are loving and dedicated, but they can get overwhelmed by treatment foster children’s behavior. When I did home visits, I would often let the parent complain for about 45 minutes (hopefully out of the child’s earshot). Essentially, the parents were getting a session in, unloading their frustration. After a while, I could ask questions like, “How often did he do that last week? Last month?” and it would usually turn out that what the parent originally said he “always” did, was not nearly so frequent, and was often getting better. I would ask what’s going on in the child’s life that might cause such behavior, and if the parent noticed anything that was effective in de-fusing situations.

  Usually we came up with psychosocial solutions, and the parent would end our 2 hour visit saying, “Yeah, he’s really not a bad kid.” And life would go on.

  But at 15 minutes doctor visits, when the foster parent would blow off steam, the doctor would not realize he wasn’t hearing reportage but simply the foster parent getting his/her own distress off their chest. Then would come the rx. In effect, the doctor was drugging based on the foster parent’s distress – not on the child’s emotional or behavioral issues.

• Dear Mad in America – I really want to see the Times article, but when I click on “Article”, nothing comes up. My computer seems to be working ok, so I’m guessing it’s a problem at the site. Please check it out, and if it’s at your end, can you fix it? This looks like a landmark retraction of one of the biggest BS studies about ADHD (See Breggin’s critique of the MTA study), which the CHADD-types have hung their hats on for years. I’d LOVE to see the Times article, so I hope you can help me.

  Thanks.

• Enough.

• The writer posted this on a “progressive” psychiatrist’s web site, in response to the psychiatrist’s blog discussing the fact that psych drugs often don’t work. Both the place she posted her comment, and the content of her post make it more than likely that her sister has a problem she and her sister identify as related to her mental state.

  They seem aware that going to typical suicide hot lines, family physicians or most others in the medical establishment will result in her being referred to the usual “mental health” establishment, which they fear could result in hospitalization and psych drugs.

  That is a reasonable fear – most of the medical and “mental health” establishment embrace the medical model, with psych drugs as the primary “treatment” for “serious” mental problems. The medical and “mental health” establishment are conduits that suck “patients” into the drug and/or hospital scenario.

  The sister wants to see someone who can help her sort out what she needs (nutrition? rest? antibiotics? counseling? peer support? a respite house? a good therapist? help with her rent or with dealing with her kids? a combination of these things?). We don’t need to know what her specific problem is, to see that she doesn’t want to go to some establishment provider who will assume that any serious emotional issues means she needs psych. drugs, and if she feels suicidal she automatically needs to be hospitalized and drugged.

  She’s asking for resources like those advocated by people on this site. She’s afraid of the usual professionals who are irrationally biased in favor of psych drugs and are dismissive of the kinds of support advocated on MIA.

• The point was to get her in touch with someone who could help her sort this out in a way most people on this site would see as a better alternative to the “mental health” industry’s medical model. You are preaching to the choir here, and that isn’t helping this person who seems scared and without resource to find the resource she needs.

  Do you have any suggestions about where she could start to find support in deciding what she needs to do and how she can do it?

• I don’t know what the writer means by “loosing it.” But come on – the woman feels she’s in real trouble and is looking for a way to deal with it without taking drugs. I was hoping for some actual helpful comments that might help her deal with whatever her problem is without getting drugged – and hopefully without going inpatient or even getting tangled up with the worst parts of the “mental health” industry.

  I told her of MIA’s resources section, and about Peter Breggin’s site, and hoped others on this site with lived experience could advise her about support outside the system. One thing any of these resources could do would be to answer the questions you ask.

• I apologize if this is an inappropriate use of this space, but I just received an email with the following message (I had posted a comment on Steve Balt’s web site and requested notification of any responses):

  theresa w commented on If Medications Don’t Work, Why Do I Prescribe Them Anyway?.

  in response to stevebMD:

  I have a confession to make. I don’t think what I do each day makes any sense. Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice (one of the reasons why I haven’t posted much to this blog, but I hope to pick up the pace again!). I made […]

  Hi this is a cry for help. My sister is losing it but won’t go inpatient as doesn’t believe in meds. there MUST be places around where you can get admitted and not be given meds? are there any? how would you find them? thanks so much theresa

  I don’t know resources like many commenters and bloggers on this site do – can anyone point Theresa in some helpful directions?

• Just wrote out my second check. David has selflessly supported countless people; and deserves no less for himself.

• Sandra,

  Thanks for this study. It, along with your other writings, is a major contribution to human rights and honesty in this field.

  One question about your tables – what does the “no change” column mean?

• A number of drug company insiders have given similar accounts of how PhARMA operates, and sometimes internal memos have confirmed the allegations. But it is sweet to know that at least one company has been caught red handed with a wire.

  I’m just starting Peter Gotzsche’s “Deadly Medicines and Organised Crime.” This article is a peek inside PhARMA that makes that book title seem apt.

  Thanks to these whistle blowers, from my old home town of Buffalo. They could have kept their heads down and just taken the money, but they didn’t.

• Diagnosing needs to be done away with – period. Open Dialogue has by far the world’s best outcomes for “first episode psychosis,” and they do not diagnose. They just interact with “patients” and their social networks – over many years, if that’s what it takes.

  As long as we even use the term “diagnosis,” we are playing on psychiatry’s medical model home turf – the finding of “illness” within the “patient,” and, overwhelmingly, the use of “medications” (which should just be called “drugs”).

  If we have to even indirectly refer to “diagnosis,” it should be called what it is – LABELING. That makes clear what’s really going on with “diagnosis” – nothing scientific, nothing accurate about the person, and it’s being imposed on the person by an outsider for the outsider’s own purposes.

  If you need to describe the person, do so in matter of fact, common language: if he is “depressed,” say what’s really going on. For example: “Mr. Smith says he feels very sad most of the time,” or “He says he’s lost interest in things he usually enjoys.” This doesn’t imply a “disease,” or that he’s fundamentally different from the rest of humanity; it simply says why Mr. Smith is seeking some help (if he is seeking help).

  Instead of mucking about with scientific sounding terms like “schizophrenia” or “psychosis” that are not connected to reality except by the value judgments of others, why not say, “Ms. Jones says she hears voices that others don’t hear, and that scare her;” or, “She says she receives disturbing secret messages from the TV programs she watches.”

  This is better than “diagnosis,” but the truth is, people should not be summed up in labels or brief statements. Humans are the most complex entities in the known universe. Each of us is unique in all the universe, and we interact with thousands of other equally unique/complex humans, who are in turn influenced by cultures made up of millions or billions of humans. Why would a single word, phrase or paragraph be useful in saying anything meaningful about any one of us.

  My significant other recently attended a lecture by a Johns Hopkins associate professor of psychiatry. He said he was taught in psychiatric residency that you can’t “diagnose” someone until you have known them for a year. The lecturer was pleased to say, “We have come a long way since then. Now we can do it in 2 hours.” (Actually, make that 15 to 60 minutes for most psychiatrists).

  We don’t need to “diagnose” or label people. We need to GET TO KNOW THEM. And too bad if that makes billing more complicated.

• “I do not think it is imperative that we decipher the workings of the brain to be able to help people who are in distress.”

  Exactly. The vast majority of mental problems come from our interaction with each other and with our environment. The question, “What happened to you?” is infinitely more productive than “What’s wrong with you?” (which, as many on this site point out, pounds people into the ground).

  Attending to our experience and what it means to us is an elegant approach; trying to manipulate the brain – the most complex single entity in the known universe – is a fool’s errand, given the vast amount we don’t know about the brain.

• As a former prosecutor, I can attest to the difficulty of sending corporate officers to jail. The standard of proof in criminal cases is “beyond a reasonable doubt,” and it’s hard to penetrate the corporate veil to reach that level of proof for individuals. That’s a major reason corporations were invented – to insulate principals from the fallout of their actions. Unless there’s an iron clad “smoking gun,” it’s an uphill battle. Of course, there’s also the matter of the power these corporations wield, and the indirect reprisals they can take against anyone who goes after the big shots.

  But there is some real value in prosecutions like La.’s. If they win, it becomes a matter of record that a court actually found Pfizer to have committed fraud. Then when we criticize PhARMA and psychiatry, and they respond with ad hominem arguments about how we’re just “anti-psychiatry” or “Scientologists,” we can simply say, this is not my opinion – it’s the opinion of the La. Supreme Court, or the U. S. District Court.

  That’s why PhARMA settles so many suits. If they reach an agreement, and the case doesn’t go to trial, they don’t have to admit any wrongdoing – they just reached a settlement. Good chance that’s what will happen here, unfortunately.

  Even though these suits are kind of a “wrongdoing tax,” simply a cost of doing business, PhARMA and psychiatry are very, very interested in money. It still hurts. I would bet these lawsuits are one reason PhARMA’s psychiatric research activity has dramatically declined. They really don’t like to lose a dime.

• Chaya,

  You are doing a great service to the kids and the adults around them. The filmed workshop is a wonderful idea.

  Congratulations.

• Thanks a lot for your complement. I appreciate it very much.

  Pete

• Dr. Mark,

  It’s clear you are making real efforts to be caring and ethical. But near the end of your post, you state a conclusion that appears to underlie most of your article:

  “I’ve come to the conclusion that neither the pro-medication nor the anti-medication sides are correct. It isn’t a question of figuring out whether untreated psychosis is damaging to your brain or long-term medications are damaging to your brain. The most likely answer is that both are damaging.”

  This sets up a straw man that is commonly used by psychiatry to support its assumption that drugs must have a dominant role; and it makes almost inevitable the conclusion that the decision to prescribe at all is required for patients’ well being.

  The fact is that virtually all on the “anti-drug” side are not proposing to just stand by and watch people become increasingly psychotic without any “treatment”. The choice is not “nothing at all” vs. prescribing drugs.

  The “anti-drug” side simply does not accept that the only form “treatment” is drug treatment. The fantastically successful Open Dialogue model is largely drug-free – and when drugs are resorted to, they are generally benzodiazepines, not neuroleptics and are generally discontinued within weeks. Instead of drugs, Open Dialogue uses the kind of intense psychosocial “interventions” that are not available anywhere in the U.S.

  Soteria House also went largely drug-free, and did as well as, or better than standard drug-based treatment. This again was accomplished with intense, patient-oriented psychosocial “interventions.”

  The Agra Center in India, used drugs the least of any center in the 25 year-long World Health Organization studies. And Agra’s outcomes were markedly better than first-world drug-based treatment. The WHO’s final report concluded that as-yet unidentified “cultural factors” were the source of Agra’s remarkable 25 year outcomes. Being part of the psychiatric establishment, the WHO was shy about mentioning the obvious fact that culture without drugs had soundly beaten drugs in virtually every setting.

  This web site contains the stories of many whose recoveries from psychosis began when they left standard drug treatment and found the support of compassionate fellow travellers. The recovery movement is not advocate “doing nothing” – it advocates all kinds of psychosocial support.

  I applaud your determination to honor and support the “patient”. And it may be that the resources for the kind of support provided by Open Dialogue are so lacking in the U.S. that it appears there’s no choice but to at times use at least some level of medication.

  But that doesn’t mean medication is the best choice – it just means that the resources for providing the best choice are currently unavailable for the vast majority of “psychosis” sufferers in the U.S.

  Serious consideration of the full power of psychosocial “interventions” cannot happen when the problem is cast in terms of “no treatment” vs. “drug treatment.” If the question becomes “a full exploration of intensive psychosocial approaches based on the dignity and strength of the sufferer” vs. “drug treatment,” and if billions are spent to support and study the psychosocial side, we have a chance to get some real answers. It very well may turn out that the psychosocial wins, and the drugs become far less important than even you have assumed.

  Posing the issue by setting up a straw man vs. drug treatment gets essentially no real information.

• I don’t want to give Corinna and Dr. Seeman a hard time. His article has positive implications for the view that trauma of various kinds begins the cascade that produces “psychosis.” Dr. Seeman’s post is a lot more to my liking than you would get from most of psychiatry. And Corinna correctly points out that progressive psychiatrists have to be careful of what they say – straying too far from orthodoxy all at once can damage credibility within the profession.

  But Dr. Seeman’s scenario for a first episode “schizophrenia” sufferer is pretty medical/disease model: it is Corinna who edits into his writing the provision about non-or-limited drug programs like Open Dialogue or Soteria, and there is no acknowledgement of the WHO studies showing better results with little or no drug treatment. Dr. Seeman advocates initial drugging and gradual tapering to a low dose (apparently not anticipating complete withdrawal); and he qualifies that taper with the exception of periods of stress. I appreciate the desire to taper to low dose, but it is worth noting the ways Dr. Seeman’s model overlaps with mainstream psychiatry.

• Corinna – I’m sorry to hear you’ve hit a bad spot, and hope you’re though it asap.

  I remain very skeptical that the article’s characterization of the D2 system’s role in psychosis is as 1-to-1 as it presents. Animal models are important, but don’t say it all about humans; Seeman may have ruled out some transmitters, but I doubt he controlled for all 100+ neurotransmitters; the fact that D2 is common to all psychotic reactions doesn’t mean other systems aren’t critical to psychotic reactions; there have to be many blanks to fill in re how particular traumatic experiences translate to D2 sensitivity; ditto blanks re the internal process by which we recover from psychosis; what is the relationship between D2 and the meaning that is inherent in “psychotic” experiences?

  I think our minds/brains have inherent drives to recover from trauma and “mental illness,” and in some sense our “mental illness symptoms” are purposive attempts by our minds to work through whatever has hurt us. I don’t think anyone has approached understanding this process anatomically.

  I’m putting too great a burden on the article – it shouldn’t be dismissed because it doesn’t answer every question. But I’m still stuck on the unqualified bulleted claim. You obviously know a lot about brain science and the body of research – maybe it would help many of us if you wrote something to translate the technical research into lay terms?

• Somehow my latest post didn’t get put under Corinna’s last response to me. I intended my last post to be a reply to Corinna.

• I understand the cascade that you describe. But it isn’t possible to say that D2 super sensitivity is like the clotting cascade, because we simply don’t have much of an idea about most of what goes on in the brain, and therefore can’t rule out what else is happening with the brain’s other 100+ transmitters, much less what some of those transmitters and other chemicals do elsewhere in the body (see Candace Pert’s “Molecules of Emotion”).

  Also, I don’t completely agree that, “everything is biochemistry.” It’s true that without biochemistry, there wouldn’t be humans or “schizophrenia” – but I am drawn to the analogy of movies and film. There wouldn’t be movies without celluloid, projectors and various chemicals, but it’s not very productive to critique the plot, the dialogue, the acting, music and sets in terms of celluloid. Those things involve relationships of things or concepts to each other that are more directly involved with the success or failure of a movie than are the components of the celluloid.

  I get your distinction between “medical model” and “disease model,” but cultural, political and professional conditions make it impossible for the public and doctors to keep the two models distinct. The pull of doctors to turn problematic human phenomena into “diseases” seems irresistible, and until there is far more consensus about the non-disease model, doctors and the rest of us will constantly find our thinking dragged back to “disease model” when “medical model” is used. I think we need a radical re-working of how we talk about the whole area – ditching “disorder,” “diagnosis,” “mental illness,” and at least putting quotation marks around “schizophrenia,” “depression,” etc. Kind of like the way Open Dialogue works without using diagnostic labels.

  I’m glad to hear that Seeman is not an apologist for bio-psychiatry. And I understand that he has to put things in terms that will pass peer review. But I’m not sure he had to be absolute in saying “schizophrenia” is caused by the dopamine system. He could have been closer to the truth without running afoul of the establishment if he had said D2 is “implicated” in the process – scientific writing is full of that kind of language. But maybe the politics wouldn’t even allow that.

  Finally, I want to thank you for your many contributions to this site. What you say is interesting and helpful.

• One of the bullets at the beginning of the article is, “The schizophrenia reaction is one of dopamine overactivity.” There are somewhere over 100 neurotransmitters (I’ve heard the number estimated as high as 200). Yet psychiatry has focused on only maybe six. It’s interesting that various psychosocial and environmental stressors produce changes in the dopamine system, but it is an incredible over reach to say, “The schizophrenia reaction IS one of dopamine overactivity.”

  This reinforces the distorted brain science behind the medical model’s narrative that dopamine is at the heart of “schizophrenia” – based solely on the way neuroleptics suppress all kinds of brain activity, making people indifferent to their “psychotic” symptoms (and to much of their lives).

  Giving aid and comfort to psychiatry’s flawed model is the opposite of what we need: honest, non-blinkered research that doesn’t play to the prejudices of the huge economic powers that control and distorted the field.

• Madmom – I am sorry about your step daughter; I wish her and your whole family the best. Your post makes excellent points. Why, indeed would psychiatrists seek to remedy what they see as dopamine disregulation by lobbing bombs like Haldol and Zyprexa into the dopamine systems of people who are already struggling?

• I’ve just scanned this article, and will go over it more closely. But the authors focus on dopamine as though it is already established as the physical cause of “schizophrenia.” That would be warranted if dopamine were specifically shown to be the cause, as, as for instance the HIV virus is isolated as the cause of AIDS.

  But that is very far from the case with “schizophrenia.” It is not true that neuroleptics, affecting dopamine, are the “cure” for what is called “schizophrenia.” It is nice that the authors at least focus on environmental influences on the Dopamine system, instead of the usual insistence that genetics is the primary culprit. But the failure to acknowledge that anything but the never-proven dopamine hypothesis could be at work appears to be another example of psychiatry’s “street light” behavior:

  Midnight. Drunk on hands and knees under street lamp.
  –Cop: “What are you doing””
  –Drunk: “Looking for my glasses.”
  –Cop: “Where did you lose them.”
  –Drunk (pointing to the other side of the street): “Over there.”
  –Cop: “Then why are you looking here?”
  –Drunk: “The light’s better here.”

  This article conveniently accepts that dopamine is where they should be looking.

• I agree with Seth. There is solid ground to say that the scientific evidence for neuroleptics’ long term safety and effectiveness is questionable at the very least, and that the scientific evidence favoring Open Dialogue/Soteria/Recovery Movement-type approaches with little or no use of these drugs, is very promising.

• Steve – Right about foster care, but it’s even worse than that. Bipolar is the latest fad, and foster kids are labelled bipolar even before they’ve been exposed to psych drugs. The willy nilly use of this bogus label is so extreme that it seems any kid who is capable of having more than one mood is likely to be swept up in the bipolar pile. If he (almost always a “he”) is sometimes sad (which anyone put in foster care is likely to be), and if he is occasionally aggressive (which kids traumatized by their environment often are) – he is at risk for being called “bipolar.” Works great if your goal is to numb him out and make him easier to “manage” (i.e., “stable”); it isn’t so good if you’re interested in who he actually is, what he’s going through and how he can live the full life he deserves.

• MJK – Thank you for a very, very smart observation.

• Duane, I don’t know why you label Peter Breggin a “conservative.” I see him as a tireless, brilliant and courageous fighter for the rights of “mental patients” over the space of many decades. He worked with John Conyers (a liberal Democrat), and has worked with conservative politicians – all on the basis of finding allies wherever they could be found for the cause he has championed.

  Peter doesn’t get nearly the credit he deserves. He and Ginger pretty much single handedly stopped NIMH’s plan to drug black inner city teens to prevent “violence”; he exposed psychiatry’s rampant use of lobotomy; he blew the whistle on psychiatry in general, and on SSRI’s connection to suicide – on and on. He took the full blast of psychiatry’s and PhARMA’s wrath when few besides Thomas Szasz and Lauren Mosher were standing up to the establishment.

  So many things Peter has said are now – decades later – being reluctantly acknowledged as true by the establishment. He deserves a place in Huffpost, and on many other platforms as well. I think he and his work get shunned by some because he’s feisty and doesn’t suffer fools well, but a very large part of the progress we see today rests on his shoulders.

• I’m confused. I found the petition, but didn’t see how to sign it or comment. Can anyone help with this?

• Sera – Thank you for this post. It is a given that the irrational system will move to co-opt change that threatens the status quo. Constant vigilance is required against this, and to assure that progressive change doesn’t itself become frozen into its own form of dogmatism. Your post is a valuable contribution on both scores.

  “Evidence based practice” imposes a conformity that has little to do with real human progress. Barry Duncan et al have documented that “evidence based practice” is illusory – there is little real evidence, and scant difference between one or another such practice. But there is a lot of difference WITHIN each practice, based on the personal qualities of the “helper.” Whether something is “evidence based” matters a lot less than the working relationship between the “client” and the “helper”.

  I don’t want to get lost in defining all the “common factors” of good “helpers” that Duncan et al identify as making a real difference. But here’s my own starting point:

  Decades ago (before the women’s movement thankfully made the language archaic) a friend (who was a supervisor) posted this sign posted above his desk: “No man is good enough to be another man’s boss.” My version of that: “No human is good enough to be another human’s therapist, counselor, advisor, or “helper.” That pretty much defines us all as peers and requires that whatever our labels, we must treat each other as peers. Any interaction – regardless of titles, regulations and strictures imposed from the outside – needs to occur on the basis that we are equals.

  This doesn’t solve all the problems caused by bureaucratization, regulations and co-optation, but it provides a good check on how we define ourselves and our organizations, and what we do moment to moment. To be of any real use to someone who struggles, we must assume he/she is a “genius at work”. If we offer ourselves to them as human beings – peers – and if they choose to enter a relationship with us, they will use that relationship to work out their problems. Requirements and regulations based on today’s “evidence based practice” more often than not block this process, rather than promoting it.

• It concerns me that, like a Greek chorus, we all chime in, piling on whenever postings on this site reflect badly on biological psychiatry and PhARMA. But the reaction here to an article casting doubt on non-medical perspectives seems to draw no interest. That is the kind of uncritical approach that allows bio-psychiatry to roll along undisturbed by anyone on the inside.

  There is good reason to think the potential of psychosocial perspectives is immense. But that doesn’t mean there isn’t right now plenty of nonsense and wishful thinking in the psychosocial pot. It’s a bit over the top to say this, but it is also true: if we aren’t willing to think critically about ourselves, we are not much different from the lazy thinkers who let the senseless medical model dominate the mental health industry.

• An added thought: On second thought, I can imagine a lot of psychosocial research being overstated. The whole “evidence based practice” paradigm is barking up the wrong tree. Barry Duncan et al have critiqued this paradigm as based on shaky research, and overlooking the “common factors” that cross all the different “evidence based models.” There really isn’t any significant difference between the models – the real differences are explained by common factors such as connection between therapist and client, agreement on how they will work, and therapists really seeking and paying attention to client feed back about how the therapy is going.

  So there probably is a lot of puffery in the studies purporting to show each specific model is particularly effective. Is this the cause of what this article says it found?

• I haven’t spent the $30.00 to access the article itself. I would be very interested to know what others with more information have to say about this article. I can imagine a lot of counter arguments here, e.g., a) Why should one trust something come out of Brown University, when its recently-departed head of psychiatry was a driving force behind the notoriously deceptive Study 329? b) How can the hugely manipulated/biased/sometimes outright fraudulent psychiatric studies be profitably be used as a comparison with any other discipline’s study?

  But if this article really does present credible evidence of overstated conclusions drawn from psychosocial research, we absolutely should know about it and learn what needs to be done to create better studies. We can’t scream about psychiatry’s manipulations unless our own house is in order.

• I don’t see the patient’s mother’s obtaining her child’s record as fraudulent at all. If I were in her position, I would be very worried about the doctor’s possibly “doctoring” the records to avoid liability. That doctor tried to condition release of the patient’s own records to the patient him/herself on not using those records for the purpose of exercising the patients legal rights – that would make me distrust what would happen if the doctor knew litigation might follow.

• If Toby Watson prevails (and, given the money involved for psychiatry, doctors in general and for PhARMA, this could go to the Supreme Court), it could be a great way to control the prescription of all kinds of off label psych drugs to foster children. Congratulations to Toby, who has worked for years to bring sanity to the psych drug picture.

  I love the court’s slap at Toby and his attorney for what it calls the “quasi-fraudulent” means of obtaining the child’s medical record. Patients should have access to their records – period – for whatever use they want to make of them. The court’s characterization is especially jarring considering the “quasi-fraudulent” way PhARMA and the medical establishment so frequently behaves.

• Amen. It occurs to me that she was putting into action what Open Dialogue acknowledges as a cornerstone of its success – “tolerance of uncertainty,” by which, if you read Seikkula’s book, turns out to mean not becoming completely unhinged when someone on the edge looks like they might fall off or push someone else. Just imagine the carnage if a stuffy “professional” tried to diagnose this man and then follow an “evidence based protocol”. The first thing we all need to do is be convinced in our core that the “patient” is a full human being, much like us, that we are also fully human, and that the safest thing to do is to make real human to human contact. Without that foundation, nothing but harm will follow from “treatment,” whether psychosocial or biological.

  It will be interesting to see how this man’s “mental health” history is spun to protect the medical model and to push for still more of the medical model. We need to push publicly for recognition that psych drugs not only often cause people’s lives to spiral out of control, but also are direct contributors to violence. I’ve never seen any of these news articles point out that initiating, stopping or changing doses of SSRI’s greatly increases the risk of violence.

• This woman was just wonderful – talk about a REAL role model. She offered true human compassion and he responded.

• Stephen,

  Thanks to you too, for your comments.

• I think many – most? – of us have some fear about loving and being loved. But I think it’s likely because we have been painfully rejected at least once (or often) and have not found the resource to heal in a world where many people are too preoccupied with their own pain to fully support another. Really good, affirming listeners who can sit still long enough for another person to really process their pain, can be hard to find – so the hurt person can be left high and dry.

  Someone without the support to recover from painfully lost love can easily become afraid to love or accept love again, for fear that if they do, they will lose again. A very, very painful spot to be in.

• Stephen,
  I think the “creepy crawlers” are what virtually everyone is terrified of. There isn’t all that much difference between the “mad” and the “normal” among us. There is a powerful baseline of disregard of each person’s humanity in society that affects us all – those who maintain the posture of “normality” generally do so by finding ways not to deal with the dehumanization and oppression that permeate our environment.

  We call general society “normal” by ignoring the fallout of this pervasive dehumanization and oppression – racism, sexism, classism, adultism, ageism, etc.. We act as though it’s “normal” to have the highest incarceration rate in the world, to be polluting the planet, poisoning ourselves and other creatures, heedlessly overheating the planet, engaging in one war after another … on and on … and then we call “crazy” those people who openly react to the private or public insults to our souls experienced by most everyone.

  As you say, we panic when the “creepy crawly” fallout of the oppression and dehumanization are pushed in our faces by the “mad.’ It’s one of the ways those around the “mad” become terrified and reach to drug the “mad” into passivity.

  “Trauma” is kind of a red herring. Surely there are terrible experiences that push people into experiencing “madness.” And in a world where most of us are desperate to ignore pain and trauma, it’s clear a lot more things are “traumatic” than we even now admit. But in addition to this, oppression and dehumanization also affect us in mundane ways day in and day out – “death by a thousand cuts.” And we are all so different that “smaller” accumulated cuts can affect one person very differently from another. Even just observing unfairness endured by others can cause great pain to us.

  Whether officially-approved “trauma” or not, it’s all humans experiencing being de-valued, exploited and oppressed, and it is very damaging. We all come into the world eagerly expecting close, loving relations with others – and it is very painful for us to experience the lack of these things in our daily lives.

  Open Dialogue is a wise way of restoring a semblance of humanity to human relationships that have become stuck in conflict, fear and misunderstanding in the social network of the person who is labelled “mad.”

• And I might add – the same terror drives those who so viciously defended medicalized “ADHD” clinging like a drowning man to a floating piece of wood to the magic bullet that would make them unafraid.

• Jeremy,

  I knew that the rest of Finland was not on board with Open Dialogue. Having read Jaako Seikula’s book, your statement about his remaining “quite sanguine and philosophical” makes me smile: the book at first frustrated, then entertained me, as it too was sanguine and philosophical – not academic and bristling with citations as I’d expected. Reading it felt like I was being treated to a slice of an Open Dialogue meeting, in which the same gentle, calm touch is called “tolerance of uncertainty.”

  It seems Seikula’s “tolerance of uncertainty” would translate in the U.S. to not totally flipping out when people show overwhelming pain. I think, other than PhARMA’s love for profits, and psychiatry’s attachment to hegemony, the primary driver of biological psychiatry and drugs is simply terror of permanent loss of control. The terror seems to exist as much in those around “patients” as in “patients” themselves – and “tolerance of uncertainty” is Seikula’s lovely way of dissolving that the grip of that spell on professionals, “patients” and families. Brilliant.

• Chilling – although the primary point is the damage done to children and the shutting down of a promising way of dealing with “ADHD”, this suggests just how corrupt, sinister and ossified the U.S. “mental health” establishment is. PhARMA and psychiatry have the resources and influence to pursue and squelch a researcher over virtually nothing, while Barkley and the establishment can be as irresponsible as they want with impunity. Their blatant conflicts of interest and/or transparent manipulations do them virtually no harm.

  As for the U. S. establishment, just imagine if these same sharks had been in Finland: they would have cooked up the same kind of PR soufle and made mince meat of Open Dialogue’s years of sound research. The world would never have known of the huge potential represented by Open Dialogue.

  This shouldn’t be shocking – we already know about similar pressure on Loren Mosher, Peter Breggin, Grace Jackson, David Healy and David Stein. But it still makes my blood boil.

  Many thanks to Dr. Watson for doing this work, and to all the authors for pulling this story together.

• This is the tip of the iceberg. Dr. Julie Zito, of the University of Md, reported in 2008 that foster children were 16 times more likely to be prescribed psych. drugs than other children receiving M A. I ran a treatment foster care program in Md. for 9 years; I wrote a policy requiring our social workers and foster parents to do everything possible to limit the use of these drugs. sometimes we were successful, but for the most part, the machine ground on, handing out psych. drugs like candy, with virtually no informed consent from social workers or foster parents – primarily to dull kids out so they would be easier to handle. The standard of psychiatric practice with foster children is vastly worse than for others – much of the time the psychiatrists have no idea of the child’s history, his/her medical history, or the trauma and stresses that are effecting the child and his/her foster family. I could fill a book about this. And everyone just goes along with it.

  It is heartening to see some questions raised – but how much can we really expect from this review, when the cases of drugging will be assessed by pediatric psychiatrists, whose bias in favor of these and other psych. drugs is palpable?

  I urge others with concerns about this issue to communicate with the writer of the Wall Street Journal article, and with those who are conducting and will be evaluating the review,

• Sandy,

  Thanks for another helpful piece. The main thing I would change:

  “The aggressive marketing tactics of the drug companies would not have succeeded if there were not scores of physicians working with them to promote their message.”

  Really, it is so much more than “scores of physicians” who actively or passively promote the message. A survey showed something like 2/3 of psychiatrists in Minnesota had taken money from PhARMA in the prior year. I would guess thousands of psychiatrists have been actively complicit with PhARMA, most making signifiant profit from it (either directly or indirectly via grant funding); or at the very least playing along with PhARMA and medical model myths to advance their careers. Virtually all of psychiatry colludes passively – some because they believe, some from indifference. Constantly in the background for all is the realistic fear for their careers if they step out of line.

• If your “mental health” system is based on the de-humanizing and unscientific premises of biological psychiatry – to the point that you think life on Haldol is really a good idea – it might make sense to force people to take the drug. This article sets up a straw man – the idea that the only choices for the “seriously mentally ill” are to run around naked in traffic, assaulting innocent bystanders or to be constantly drugged on Haldol (which, as recently noted in this blog, has been acknowledged to be “neurotoxic.”) Given only these two possibilities, it makes sense to force drugs on people.

  But of course, those aren’t by any means the only choices . Just one of the lessons of Open Dialogue is that standard medical model approaches to “psychosis” actually turn people into the stereotyped “revolving door” menaces the system then points to as justification for forced “treatment.” The Open Dialogue catchment area would be astonished by this study – given that Open Dialogue has now become so effective at providing real human- to human support within the community that first episode “psychosis patients” there are are virtually never hospitalized in the first place.

• Bob’s books, this site, and his presentations are invaluable sources of sound, fairly-presented information pointing us toward the reality of human suffering.

  At the same time, I find the mother’s letter compelling – not as a policy prescription or depiction of fact, but as the expression of someone who has done their best with what they knew, and who has suffered greatly in the process. She wrote in the midst of a replay of the catastrophe she had endured many times before, under the reasonable fears that she may never see her son again.

  We must not dismiss her feelings simply because she misses the larger contextual problems with her position that Bob so clearly points out. The trick to correcting vast social wrongs is not to shout down those who support those wrongs, but to understand the profound reasons why good people come to embrace such harmful ideas. This mother is not an odious PhARMA marketing executive who makes incredibly dangerous decisions just to increase market share; she is like the rest of us – struggling with often-overwhelming stresses and feelings, and doing the best she can. This mother is the target – a victim – of the cynical PhARMA executive. She is not “the enemy”; she is a potential ally we need to reach.

  We need to get good at maintaining human contact with people like her. Biological psychiatry and PhARMA have figured out ad-biz ways of “connecting” with people like this mother, and they will continue to beat us like a drum unless we find more profound ways of establishing genuine human connections that are better than that.

  We see clearly that those struggling with mental and emotional problems respond when they are offered attention and humanity – they deserve nothing less. We are less clear that the same is true for all people, including those who believe whole-heartedly that NAMI’s vision is the only thing standing between them and profound personal disaster.

  One lesson from this episode: any presentation should contain a very, very clear warning that stopping psych. drugs abruptly and without a lot of support is very risky. As Bob said, the danger is increased by the system’s lack of resources to support gradual withdrawal. I would refer people to Glenmullen’s and Breggin’s books on withdrawal, and to the many groups and individuals who are working to provide real support.