Monday, September 20, 2021

Comments by Peter C. Dwyer

Showing 137 of 137 comments.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.


  • 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?

  • 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.

  • 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?

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.”

  • 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.

  • Kathy,

    Thanks for your thoughtful response to Bob Whitaker’s presentation. Your questions are good ones. Can I suggest some possible resources that may help you sort things out?

    I think it’s Jaakko Seikkula (sp?)who developed Open Dialogue and wrote a good journal article about its outcomes, plus a book that gives the flavor of how Open Dialogue offers community support to those suffering with first episode psychosis, and to their families. It can seem meandering, but I think its pace and gentleness helps the reader experience a bit of Open Dialogue, as opposed to just describing it. I got the book on Amazon – entering his name should turn it up.

    Grace Jackson is an extremely smart and compassionate psychiatrist who can approach the drug issue from a scientific point of view. Her best known book is Rethinking Psychiatric Drugs.

    Joanna Moncreiff is a British psychiatrist who I think presents a detailed and persuasive evaluation of how psychiatric drugs do – and don’t – work.

    Check Amazon for Paris Williams, PhD – a clinical psychologist who himself has recovered from extreme emotional states. His book takes a close look at how those with “psychosis” recovered after years in the conventional psychiatric system by getting off drugs and finding other means of support. It is a very human and hopeful book.

    There are many others whose writing might help. Peter Breggin recently came out with a detailed book on how to withdraw from psychiatric drugs. Almost everyone who tries it goes way too fast and without enough support. David Healy’s book Pharmageddon is a scathing indictment of the evidence base of the current medical profession (including psychiatry). As harsh as it is, he is someone who speaks with authority – former secretary of the British Psychopharmalogical Society and author of the most comprehensive book on the history of psychopharmacology.

    And there is a LOT of important information out there from “survivors” who have so much to say that needs to be heard. There are so many compassionate and intelligent people among them who are willing to share their own experiences. Try this web site, as well as Mind Freedom International and ISEPP.

    A lot of people are thinking and working in this area, and there is so much reason for hope for your son. I wish him and you all the best in making up your own minds about what is right for both of you.

  • Bob Whitaker goes to NAMI and speaks with inte3grity. He doesn’t change his message or cosy up to his audience; he just communicates with human beings. Apparently a lot of them were quite receptive to what he said.

    This isn’t about Kumbaya – it’s about reaching people. Bob is right: most people involved with NAMI care very much about other people. They should be treated with respect, not mane calling.

    I get that there are people high up in PhARMA who have adopted the cynical strategy of using NAMI for their own purposes. And probably some in NAMI knowingly go along with the strategy. But I don’t think most NAMI members, or those who listen to NAMI are that different from the rest of us – they are torn up over the suffering they witness and are doing the best they can.

    It is self defeating and insulting to those people for us to circle the wagons and not engage in dialogue with them unless they are willing to listen to our unrelenting insults. Let’s see – Circling wagons, congratulating oneself on the correctness of one’s views and insisting on complete capitulation from those who disagree with us – that’s how psychiatry operates. It shouldn’t be how we operate.

  • It seems obvious that Insel took part in this weasel-worded exercise in psychiatric ad copy because to avoid completely alienating the APA power structure. Those emperors wanting to protect their non-existent clothes aside, this is really a hilarious bit of writing. Insel doesn’t really take back any of the main points in his piece; and by signing on to this one, his APA buddy is tacitly agreeing with much of Insel’s first piece.

    The funniest sentence in this “non-retraction retraction”:

    “DSM-5 … reflects the scientific progress seen since the manual’s last edition was published in 1994.”

    Since virtually nobody thinks DSM 5 is really better than DSM 4, they must be saying there hasn’t BEEN any “scientific progress” since 1994.

  • Michael,

    I very much admire what you are doing. You are likely reading your situation correctly, but you never can tell what might happen when people actually run into someone who takes a caring, principled stand and sticks to it. Sometimes it brings out good things in others – even those who seem very unlikely.

    If you are indeed fired, I hope you will share with us the model you have developed. You might be surprised where this all can lead you. As I said almost every day of my 15 years in treatment foster care, “disaster as opportunity.”

    I wish you all the best.

  • Here is an email I just sent to the Texas lawmakers:

    Dear Legislators,

    i urge you not to pass the captioned bill. In addition to my JD degree, I have an LLM in Law, Psychiatry and Criminology from the George Washington National Law Center. I also have a masters degree in social work and am licensed to practice clinical social work in Maryland (LCSW-C). I have been an assistant professor of Criminal Justice, an Assistant State’s Attorney, the director of a Treatment Foster Care program, and have worked in a program that re-integrated former mental patients into their community.

    Based on my 40 years of experience in the field, I do not believe forced outpatient drugging is effective; moreover, it is an intrusion on citizens’ bodies and basic freedoms. A recent article by a British psychiatrist ,who for 20 years had advocated for and helped design such programs, acknowledged that these measures do not work: Dr. Tom Burns, head of the social psychiatry department of the prestigious Oxford University, recently wrote this in Lancet, one of the world’s great medical journals regarding Britain’s Community Treatment Orders (“CTO’s”)

    “The evidence is now strong that the use of CTOs does not confer early patient benefits despite substantial curtailment of individual freedoms. … Their current high usage should be urgently reviewed. I think there should be a moratorium on their use at least for a year or so while we think through how we can improve on the quality of evidence we’ve got. If we can’t do that I think it really is unjustified to continue to use them.”

    Another unrecognized problem is that public safety can actually be compromised by forced outpatient drugging. The most common psychiatric drugs – SSRI’s and other antidepressants – carry “black box warnings” (the most urgent warnings given by the FDA) that these drugs pose a serious danger of increased suicidality. These drugs also carry FDA warnings of increased agitation, anxiety and aggression. The “antipsychotic” drugs carry similar warnings about agitation, suicidality and violence. It is not at all clear that forcing outpatients to take these drugs will increase safety for either patients or the public.

    A large number of mass shooters in the U.S. have been involved in the mental health system, and have had therapeutic doses of antidepressants or other psychiatric drugs in their systems at the time of their crimes. Given that the FDA has warned of increased risk of these types of actions while on these drugs, there has been a stunning lack of public concern over whether these drugs actually make such tragedies more likely. Some crimes may be avoided by the use of psychiatric drugs, but quite possibly many other crimes occur because of the same drugs.

    Under these circumstances, and particularly with freedom as the foundation of our country, I urge you not to approve House Bill 2212.


    Peter C. Dwyer, JD, LLM, MSW, LCSW-C

  • Here is an email just sent to the Texas lawmakers:

    Dear Legislators,

    i urge you not to pass the captioned bill. In addition to my JD degree, I have an LLM in Law, Psychiatry and Criminology from the George Washington National Law Center. I also have a masters degree in social work and am licensed to practice clinical social work in Maryland (LCSW-C). I have been an assistant professor of Criminal Justice, an Assistant State’s Attorney, the director of a Treatment Foster Care program, and have worked in a program that re-integrated former mental patients into their community.

    Based on my 40 years of experience in the field, I do not believe forced outpatient drugging is effective; moreover, it is an intrusion on citizens’ bodies and basic freedoms. A recent article by a British psychiatrist ,who for 20 years had advocated for and helped design such programs, acknowledged that these measures do not work: Dr. Tom Burns, head of the social psychiatry department of the prestigious Oxford University, recently wrote this in Lancet, one of the world’s great medical journals regarding Britain’s Community Treatment Orders (“CTO’s”)

    “The evidence is now strong that the use of CTOs does not confer early patient benefits despite substantial curtailment of individual freedoms. … Their current high usage should be urgently reviewed. I think there should be a moratorium on their use at least for a year or so while we think through how we can improve on the quality of evidence we’ve got. If we can’t do that I think it really is unjustified to continue to use them.”

    Another unrecognized problem is that public safety can actually be compromised by forced outpatient drugging. The most common psychiatric drugs – SSRI’s and other antidepressants – carry “black box warnings” (the most urgent warnings given by the FDA) that these drugs pose a serious danger of increased suicidality. These drugs also carry FDA warnings of increased agitation, anxiety and aggression. The “antipsychotic” drugs carry similar warnings about agitation, suicidality and violence. It is not at all clear that forcing outpatients to take these drugs will increase safety for either patients or the public.

    A large number of mass shooters in the U.S. have been involved in the mental health system, and have had therapeutic doses of antidepressants or other psychiatric drugs in their systems at the time of their crimes. Given that the FDA has warned of increased risk of these types of actions while on these drugs, there has been a stunning lack of public concern over whether these drugs actually make such tragedies more likely. Some crimes may be avoided by the use of psychiatric drugs, but quite possibly many other crimes occur because of the same drugs.

    Under these circumstances, and particularly with freedom as the foundation of our country, I urge you not to approve House Bill 2212.


    Peter C. Dwyer, JD, LLM, MSW, LCSW-C

  • The good news: a) Insel clearly admits DSM is NOT valid – that DSM “disorders” are NOT just like other medical dx’s; b) He admits psychiatry DOESN’T have the physical data to define mental problems the way medicine does elsewhere, and that psychiatry SHOULD have that; c) He admits this will take a decade to remedy – gives us time to make our own headway, and in the meantime, he himself is exposing psychiatrys emperor as having no clothes (which should make our task easier)

    The bad news: a) he doubles down on the medical model orientation; b) psychiatry can now dribble out PR to a breathless public about the “exciting breakthroughs” this new “research “ will produce – making a splash even though nothing immediately useful exists yet (just like psychiatry does now with the latest “genetic discoveries”) – it is more money and grist for the PR mill to shape public perceptions in favor of the medical model.

    Viewed rationally, Insel’s open acknowledgement of DSM’s invalidity should be a shot through the heart of virtually all medical model psychiatry. After decades of pretending to be scientific, the biggest cheese of them all is admitting that the very framework of all psychiatry’s clinical trials and journal articles is hopelessly flawed – kind of like centuries ago, admitting that alchemy was barking up the wrong tree. How can all these “experts” in white coats with confident demeanors explain this big “oops”?

    Of course they will try, with the same PR machinery that’s given psychiatry and the medical model a virtual lock on our culture’s view of our emotional lives. They’ll still have the $60 billion/year promo budgets to throw at this.

    But I am still very hopeful: we will make headway by being rational, and Insel’s admission makes our point that much easier to make. And ten years from now, there’s every chance that NIH will have egg on its face again, when it has to admit there are STILL no workable “biomarkers” and pathophysiologies for mental problems.

  • This is fascinating. I too am concerned about the lack of inclusion of someone to speak from the point of view of lived experience. I am also surprised that the Vatican is involved – maybe more things are possible than cynics would imagine with a new Pope who would wash the feet of a Muslim woman.

    I was thrilled with the chance to watch the presentations from the recent conference in Sweden, and I can’t wait to hear from this group of writers whose work I have devoured and admired.The least that will happen is that we’ll get updates on their work – which is great in itself; the prospects for reaching more people worldwide through the Catholic Church are a potential huge upside.

  • Thank you, Sera for your thoughtful and articulate communication with Dr. Pies. Psychiatry’s reaction to questioning and criticism reminds me of the responses of white people when black people challenged racism, and those of men when women began speaking out against sexism. (By the way, I am white, male and 68, so am old enough to have lived through these exciting and challenging events).

    It is hard for those in power to have a clue about what they and their system look like to those who are systematically mistreated. Forceful statements from “below” are usually dismissed as extreme or abusive. The powerful try to re-cast the debate into bland terms that essentially neutralize or trivialize any criticism. Dr. Pies seems to be doing this by statements like, “the theoretical legal safeguards for those diagnosed with mental illness are not always put into practice, and that some individuals facing civil commitment are not adequately represented by legal counsel”, and by other euphemistic language – sort of like in birthing classes where “pain” is referred to as “you may experience some discomfort.”

    This kind of neutering euphemism can – understandably – drive those who’ve suffered in the “mental health system” up a wall, and they express themselves even more forcefully – which then makes people like Dr. Pies dismiss their criticicism as shrill, abusive, irrational or “anti-psychiatry.”

    I find it’s most effective to follow the advice I have been given – “Lose the zealotry, but keep the zeal.” When I’m tempted to just explode at psychiatry, I try to get specific and cite chapter and verse of what I have observed. I refer to my 9 years running a treatment foster care program, in which psychiatrists in prestigious institutions conducted entire med checks with their backs to their patients, or who never looked up from their lap top. I cite times when I asked meetings of foster parents how often psychiatrists explained adverse effects of psych. drugs, and received the near unanimous response, “never.” I cite times when we reviewed children’s files and found psychiatrists had changed a child’s diagnosis four times in four years, went from one med to another without knowing that previous psychiatrists had already tried and abandoned the same meds and dosages. I love how Robert Whitaker uses psychiatry’s own studies and pronouncements to expose psychiatry’s unfounded assumptions and conflicts. For instance, we should be hammering away at the use of antidepressants to prevent violence and suicide – when the FDA requires black box warnings about suicide, and clear warnings about aggression that can be caused by these drugs. The list of shooters who were on antidepressants makes this clear.

    People with lived experience have a huge amount to say that everyone else needs to hear, and clearly some of that isn’t going to be pretty or polite. But I would also love to hear a lot more from those in the recovery movement – real specifics about things you have accomplished in your lives, things you are proud of, others you have helped, things that give you great pleasure, your aspirations. That’s inspiring to me, and it also counters the “mental health” system’s assumption that those in the system are fundamentally different from other people. I think what makes us all most human is our capacity to be inspired and to inspire, and the more we share those things about us with each other, the easier it becomes for people on the outside to look at ‘mental health” mistreatment and say, “Of course that shouldn’t go on.”

  • Iraq and Afghanistan are irrelevant. Iraq had neighbors and jihadists who supplied weapons and fighters to throw into the mix. Unless we think Canada and Mexico would do the same here, those factors are not present in the US. Afghanistan’s forbidding, mountainous terrain have made it unconquerable for centuries – again, not like the U.S. But really, we are already living under tyranny, but it isn’t imposed by the U.S. Government; it is imposed by large corporations who set the terms of our everyday life, and who pull the strings on the federal government. One example – this web site fights against the fraud and imposition on human liberty brought about by the mental health system – that is dominated by PhARMA and the mental health industry, which renders the federal government impotent to oppose it.

    And the most powerful weapon used by PhARMA and psychiatry to control the public is PhARMA’s $60 billion/year promotional budget that frames the terms of debate in a way that makes it next to impossible for a significant slice of the public to think outside PhARMA’s box. Guns aren’t necessary to their domination – their promotion persuades us to do it to ourselves, without even realizing it. The same thing is happening through the promotional budgets of other corporately controlled industries – energy, food, etc. – so that we take no meaningful action on climate change, etc. Guns won’t help us out of this – clear thought and communication and intelligent voting will. Those who shape our thoughts are perfectly happy for us to scrap with each other about guns – that’s a diversion that allows them to do what they want.

    Anyway, all this is tangential to the real point here, which is that OF COURSE “mental patients” should not be singled out as scapegoats without procedural rights regarding their ability to own guns. This is part of the systematic mistreatment of “mental patients,” and should be resisted whether we agree on overall gun policy or not.

  • It could be an April Fool. It’s sad, though, that most of what comes out of the mental health industry – not just psychiatry – could be April Fool, or out of Saturday Night Live, but it’s not.

    Stephen Gilbert, I completely agree with you. You ask where is the human contact that begins the process of healing – it’s about the same place that human contact has gone in the rest of our lives: five hours/day of TV, Facebook, texting, twitter and all the other ways we avoid directly seeing, touching, speaking with, actually being with each other.

    Not to mention drugging (er – medicating) to dull out feelings. One of my favorite (if appalling) cartoons was in the New Yorker about 10 years ago. Dad looks up from his book, and says to his forlorn 5 year old standing in her bedroom door, “A bed time story? Wouldn’t you really rather a nice sedative?”

  • Alice,

    Thanks for the view from the inside – very interesting, because from other vantage points within the mental health industry psychiatrists look like the All Powerful Oz. I definitely see what you were up against – another psychiatrist I know, Grace Jackson did what you did, and she was not only forced to leave her job, they tried to take her license too. They also went after Peter Breggin’s for speaking out.

    But my perception is that the majority of psychiatrists don’t even try. If they aren’t drinking the cool aid, they give every appearance of doing so. They generally act entitled, superior condescending and dismissive of anyone who seriously questions them. I have attended numerous grand rounds at one of the country’s most prestigious mental institutions – and the party line medical model is seldom questioned, and when it is questioned, it is in a perfunctory way that is somehow more cover up than questioning. Kind of like the cigarette industry pretending to search its soul about tobacco, finding a few issues of “concern” but generally giving itself a pass and a pat on the back for being so broad minded in being willing to question itself. More of an inoculation than a soul searching.

    I insisted that the manual for the program I directed have a provision that no child would be put on psychiatric drugs or have meds changed without consultation with our social workers and our social workers being present at the medical appointment. I wrote to the head of the state chapter of the National Association of Social Workers about the need to examine the drug question – no response. I challenged drugs at grand rounds, speaking out and distributing a bibliography of honest literature about the drugs. I repeatedly educated my staff and our foster parents about the drugs. I supported the social workers I supervised in trying to get psychiatrists to reduce, eliminate (or not start) drugs – usually to no avail.

    Meanwhile, our state foster care regs just expanded the bureaucratic requirements on treatment foster care – check list measures of “progress,” reports ad nauseam – just before I retired I asked my social workers how much time they spent on paper work. It was 75%!!!!!!!!!!! But the real killer is the recently imposed requirement that all children entering treatment foster care have a psychiatric evaluation – that of course almost inevitably leads them to be put on drugs even before they are referred to our program.

    Psychiatry is not the sole culprit. Social workers, psychologists, LCPC’s, nurses, GP’s are all drinking the cool aid. Some will confess to reservations, or will grant that drugs are “overprescribed,” but that means next to nothing in terms of what actually happens.

    People DO need to risk their livelihoods and $300k houses. This is a human rights issue. It won’t change unless people are prepared to throw themselves into the cogs of the machine. Psych drugs and the medical model are the intake mechanism to the whole rest of the mental health industry, ending in forced drugging and incarceration. There are virtually no patients who actually have the opportunity to give real informed consent before they start these pills – that is a human rights issue.

    Thanks for your writing. This is a great site. We do need to keep writing and thinking, but eventually this needs to involve action – and most psychiatrists don’t even seem in the game to me.

  • Douglas,

    What a wonderful thing.

    It reminds me of something discussed in Dialogical Meetings in Social Networks, by Jaakko Seikkula and Tom Erik Arnkil. This book is mostly about Open Dialogue ( ow which Seikkula was a founder), but it also describes “anticipation dialogues” in which clients, their families and support networks and their professional helping team meet. The client is asked to “recall the future”: “A year has passed and things are quite well in your family; what are you particularly delighted about?” The facilitator also asks the client to answer from the standpoint of the future, “What were you worried about a yeqr ago and what made your worries lessen?”

    Hope, love and community.

  • This book is excellent. Paris Williams actually asks people what their experience of “psychosis” was like, what they did to move through it to a better life, and what/who helped and didn’t help them along the way. He then puts their responses in a very coherent framework that doesn’t try to pigeon hole anyone, but gives us a way of making sense of our own experiences (whether “psychotic” or not).

    I can get pretty worked up about what’s wrong with the “mental health” industry and what I think is a really human way of dealing with “mental health” problems. Part of this book’s value is that Dr. Williams doesn’t get into this frame of mind, and I didn’t go there either as I read the book. It is very human, persuasive and encouraging – not the least because the book itself treats those in the book intelligently and compassionately, and in the process also treats the reader that way.

    “Rethinking Madness” does what we all should do – ask the person who is suffering what’s going on, and take him/her seriously. It models what has long seemed to me what is really needed when we see someone going through frightening mental and emotional experiences – counter all the scary thoughts we may have (and may get from others) by just assuming this is a “genius at work,” and ask what we might do to support the person as a human being.

  • Dr Thomas – Thank you for a concise and insightful piece.

    Some thoughts:

    I think when you say “scientific,” you should say something like “conventional medical.” We usually assume that “hard” data like that revealed by autopsy, microscopes or modern imaging is required for science. But science is defined more by method than by the object of observation.

    Really, all we ever have to go on is phenomenological data – the “hard science” phenomena we study are just constructs we infer from phenomenological data. And it is possible to apply the scientific method to our own phenomenological data. To be “scientific” about how we think, feel and act, we do not necessarily have to observe the inner workings of the human body at all.

    Paris Williams, in his book – is it Re-Thinking Madness? – refers to psychosis as a “placeholder” – not a real “thing” that can be defined once and for all. It is a blank that in different eras, cultures, groups and even individuals, fill in differently. Williams also sees psychosis not as an “illness” or even an affliction, but as a process some of us go through in the course of working out serious issues in our lives. It seems the most horrendous aspects of that process largely come from the fact that those around the “psychotic” person are unprepared to provide the nurturing, supportive environment needed to move through the process to a resolution.

    With all the medical and psychiatric attempts to define “madness,” one common element exists, and it is the reason for the failure of medical diagnosis: We define others as “mad” when we get scared, overwhelmed and hopeless about our ability to deal with them. When we feel helplessly out of our comfort zones and see no end to it – we pathologies “them,” saying “it’s genetic” or something of the kind.

    NOT doing this is key to Open Dialogue’s success. They see psychosis as a client’s response to difficult experiences that their social environment doesn’t allow them to process; the key to Open Dialogue is the therapists’ “tolerance of uncertainty” – not flipping out when the client and family system flip out. By not diagnosing, not pathologizing or correcting client or family; by setting an atmosphere where nobody is judged and everyone is heard, by making it safe for client, family and support system to re-examine the experience of psychosis, over 80% of clients actually recover.

    Open Dialogue values the phenomenological and virtually eliminates conventional diagnosis. After the most effective sessions, people often can’t analyze exactly what worked – they just know they shared an experience in which client, family and therapist all changed.

    So, my working assumption is that: people encounter distress in their lives; sometimes they can’t resolve it within their social support network, and it causes problems for them and those around them; if it becomes bad enough for long enough, people get scared feel helpless, and attribute the problem to one or more person’s “mental illness’; if the social system can be helped to calm down and communicate in new ways, the problem can be resolved.

    Conclusion – looking for “madness” within an individual’s brain doesn’t work, because the “diagnosis” that he/she is “mad” is a group phenomenon rooted in human relationships and communication – not (with rare and identifiable disease exceptions) within the individual client or his/her brain.

  • “how people recover from it”

    Actually, I need to correct myself. It’s misleading to even accept psychiatry’s definition of “schizophrenia,” as Mary Boyle and others have shown so well. And I don’t know if “recover” is the best word either – “respond to” or “process the experience of” or “work their way through” the experience of what is labelled “schizophrenia.” We really don’t know that much about it, and a number of people with “lived experience” have different perspectives on what works and doesn’t work for them, and what they view as satisfying, meaningful lives. They need to be listened to very carefully.

  • Even if some gene (or combination thereof) is found to be strongly correlated with schizophrenia, AND even if a genetic variation is found to be a necessary condition for schizophrenia, it is still not necessarily a DEFECTIVE gene. It can simply be connected with a trait that is not well received in the social environment. “Sensitive” children can grow into strong, caring adults if they are not treated as though the only acceptable thing to be is a middle linebacker (to stick with Jay’s football analogies – go Ravens, by the way) as opposed to a hair stylist.

    “Strengths” can be made into weaknesses, and vice verse, depending on how they are nurtured or squashed. Changing analogies now – if you hitch a quarter horse to a plow, you get a lame horse. Run a Clydesdale in the Kentucky Derby and you get a lame horse. Neither is a case of defective genes. It is up to adults to recognize who children are and nurture them accordingly.

    There is a lot of evidence that experience (“trauma” is just the most obvious) strongly influences all kinds of mental problems; as Jay has shown, there’s little honest, credible evidence to support genetic flaws as culprits. But of course nobody knows the whole story. The problem lies in emphasis: evidence of environmental influence is all over the place and nobody in power cares, while any unverified scrap of genetic (or other medical) evidence is greeted like the holy grail. If psychiatry and PhARMA weren’t so desperate to sell the medical model, there wouldn’t be so much harm in people poking around genes. The trouble comes when unverified genetic “discoveries” are used as reasons to sell drugs that “correct” chemical imbalances that don’t exist.

    In any case, the biggest question is not how schizophrenia starts, but how people recover from it. Evidence is accumulating that psychosocial approaches are more effective than what psychiatry offers now, after spending hundreds of billions.on real or phony research. Read the book and articles on Open Dialogue’s work with first episode psychosis – the results have been remarkable for over twenty years; they even indicate that good psychosocial intervention may actually prevent the development of psychosis and schizophrenia. The psychosocial approach could have been recognized and improved on long ago, but the mental health industry turned its back on the results of Soteria House and Burt Karon’s work for decades.

    Psychosis and schizophrenia can be terrifying and confusing, and seem utterly intractable. That by itself doesn’t necessarily make it the product of physics defects or medical illnesses. Open Dialogue has demonstrated people really can recover, with little or no psychiatric drugs.

  • BRAVO!!!!! I realize this is just beginning, but this is wonderful. We need demonstrations right here in the U.S. that Open Dialogue and other programs like it work. It seems Americans are insular and are somehow able to dismiss it from their minds when something in Europe or elsewhere works (like the resounding lack of interest in the provocative WHO study findings). Great thanks to Sandy Steingard, and to others in the US who are backing Open Dialogue, Soteria and other programs.

    This has made my day – make that week, possibly month.

  • I’m not by any stretch expert in genetics or statistics. But as I understand it from Jay Joseph’s writing, “heritability” isn’t what it sounds like. It does NOT mean that something is genetically caused – the fact that it runs from one generation to the next could be due to environmental factors. So it’s interesting that the abstract of this article makes the claim about heritability and appears to proceed on the assumption that depression IS genetic.

    Moreover, David Healy’s writing about clinical trials indicates that when gigantic sample sizes are required to produce “statistically significant” findings, it is a sign that the actual clinical difference is miniscule. “Real” and “significant” effects don’t require 50,000 subjects to “tease out” associations.

    This study’s conclusion seems odd to me. They could as easily have noted the billions and decades spent on this research, and wondered if they’re barking up the wrong tree – six of seven candidates didn’t prove out, and the seventh showed an extremely weak association.

    I’d be interested in comments from people who know a lot more about genes and statistics.

  • Alice,

    Some people are headed in that direction. Sandra Steingard, M.D., who blogs on Mad in America, went to Finland last summer for a course in Open Dialogue, and she will follow up with more training. She is on the board of the Foundation for Excellence in Mental Health Care, which funds an effort to propagate the Open Dialogue model in the U.S. I recommend reading her posts on the experience, and maybe contacting her. The primary creator of Open Dialogue, Jaakko Seikkula, is also involved in this grant.

    This Foundation is a group of very accomplished people, including Gina Nikkel, the president and CEO, her husband Bob (former Oregon State commissioner of mental health), David Healy and Courtenay Harding. I think the Foundation was formed in response to Anatomy of an Epidemic, but I don’t know if Robert Whitaker has a formal connection with it. You might want to contact the Foundation, which seems based in both North Carolina and in Wilsonville, Oregon (the Nikkels live in Oregon).

    I find Open Dialogue very exciting, but am not prepared to get directly involved now. I just finished 15 years as a social worker, supervisor and director in treatment foster care, and am in the process of writing things about “mental health” that I couldn’t publish while representing my agency. I want to use Open Dialogue as an example of how things should work. I probably won’t be through with this project for another year and a half.

    Your writing is a fine contribution to MIA pushing things in the right direction. I look forward to reading more from you.


  • Alice,

    I think we have run out of space for replies, so here is my guess about cost of Open Dialogue: First, it appears to work with people who don’t have much resource. As I understand it, the region in Northern Finland is not economically well off – a small city with a fair amount of poverty. Second, although they might cost a lot locally, and up front – they assign teams (e.g., psychiatrist, psychologist, nurse, social worker) to stick with each client until they are better, in or out of the hospital and for five years or more, if necessary. And they meat 10 – 12 times in the first two weeks of crisis, and thereafter as needed; so that costs too.

    BUT the overall savings should be enormous. They rarely use drugs, and when they do, it is not long term maintenance, so that’s a lot saved. And they rarely hospitalize – another huge savings. On top of that, the program is so user-friendly that instead of avoiding the “system” for years, families and clients contact the program on average within 3 months of onset of psychosis – which makes a huge difference in recovery time. In fact, where Open Dialogue was started (per the 2008 book) has gotten its catchment area so well served with early intervention (even before full psychosis) that they report new instances of psychosis have dropped dramatically, and the book claims they simply do not hospitalize anyone any more.

    If even close to true, these dynamics would save tons of money – few drugs, next to no hospitalizations and quick voluntary intervention without the “screening” scams advocated in the US. But: the US system is designed to spend money, not save it. PhARMA and organized psychiatry aren’t going to be put out of the drug business; hospitals won’t forego reimbursement for hospitalization. So local programs will have a hard sell getting bigger budgets, and PhARMA and the hospitals won’t stand for the lost income. The problem is political, not substantive. The best bet is for someone somewhere to duplicate Finland’s success and then embarrass the establishment into doing something.

  • Alice, Open Dialogue is in northern Finland. It is described in the book I cited, but a shorter, more technical piece that describes its excellent 5 year outcomes is: Five Years’ Experiences of First-Episode Non-Afffective Psychosis in Open Dialogue Approach, in Psychotherapy Research, 16 (2): 214 – 228. At 5 years, over 80% of patients were without psychosis and working, in school or actively seeking employment. I recommend the book, though – it is hard reading but if you stick with it, you get an eye-opening, phenomenological paradigm not based on diagnosis (and with very limited drugs) – that works. It is what the phrase “paradigm shift” was coined for. Thanks for your contributions – Pete

  • Alice,

    As to, ” … I think there is a place for psychiatric drugs still,” – you sound like one of the few who can be trusted with that statement. 99.9% of psychiatrists cannot; they will likely agree that the drugs are “overprescribed” or “misused.” But the devil is in the details, and when it comes to specific cases, they almost always decide drugs are needed.

    It’s all about informed consent, and a setting in which considered decisions are possible. I like Open Dialogue’s practice of discussing drugs at 2 or 3 meetings with the client and her/his support network before any prescription is written, and generally a short course of benzos takes the place of neuroleptics.

    Open Dialogue values the meaning behind the content of delusions and hallucinations (and the client’s freedom to express what they experience), as important contributions to the process in which the client and his/her social network develop new understandings about their relationships and the client’s problems. Open Dialogue wants clients alert and feeling things so they can express what’s going on with them and respond to others. Therefore, they have less incentive to drug clients just to knock down psychosis as a precondition to any progress. This allows them to truly give drugs sparingly.

    American psychiatrists don’t have the chance to work within an Open Dialogue setting, in which the treatment team meets with client and support system 10 to 12 times in the first two weeks. The ability to really interact with clients makes the “need” for drugs a lot less. But it is something to aspire to. The greater the chance for psychosocial contact, the less the temptation for drugs, and the less clients feel drugs are their only credible route to relief.

    I recommend Dialogical Meetings in Social Networks, by Keikkula and Arnkil, in addition to Paris Williams’ book on all this. Thanks for your valuable contributions.


  • Madinamericana,

    Wonderful – great achievements by both you and your son. I agree that Robert Whitaker and this web site make a huge difference.

    All the best to both of you for many more good things.


  • Alice,

    A lovely post – compassionate and accepting of how complex we and the world are. Paris Williams, in his book Rethinking Madness, formulates a definition of “recovery” that is compassionate, honors our humanity, and at the same time provides standards that can be used in research. At the same time I don’t think he would argue for a minute that those who don’t “meet” his standard of recovery are in any way “less than” or “sick” – just living and addressing their concerns in a different way.

    For me, “recovery” is not very useful. I assume each of us is inherently intelligent, loving, strong, courageous and possessed of energy and enthusiasm. Whatever, in our own minds, stands in the way of feeling, thinking and acting in ways consistent with that picture, is what we will be working on. As we change, progress or get pushed back, there are always new goals we can choose to work on, if we want to.

    For myself, the goal is to have a meaningful life. That can take many forms and is a far more profound and worthwhile goal than simply being “free from psychopathology.” Abraham Lincoln spent years being “depressed,” yet he apparently also got much satisfaction from life, worked tirelessly and made a difference to his fellow humans. Churchill took his country through WWII, yet he drank like a fish. I admire people like Martin Luther King, Eleanor Roosevelt and others who cared deeply about people. It is a disservice to anyone you propose to “help” not to have the attitude that they can have dreams, work for them and fulfill them.

    “Mental health” and “mental illness” are constructs imposed by others, for their own purposes, on us. Living like a real human is a far higher calling, and is a goal that is worthy of how good people actually are.

  • spkliewer,
    It is great what you are doing, and we need much more of it. Unfortunately, there are a lot more programs and professionals out there who absolutely do NOT work as you do, and they dominate the field. I think this is particularly true for people labelled with “serious mental illness” – it seems professionals are so desperate to promote
    “medication compliance” that they lay it on thick about chronic brain-based disease, medication for life, etc. The medical model’s message is much rosier for other labels like “depression,” “adhd” or anxiety. TV ads don’t stress the broken brain or drugs for life themes for these labels – they show scenes of people having a lovely time. This could be seen as much more encouraging, but it is also insidious, inducing people to take drugs that can be medically dangerous, can cause anxiety, agitation, aggression, psychosis, addiction and suicide.

    In my 15 years experience, there are a lot more professionals who think, once they’ve labelled someone with a diagnosis or two, that they’ve described the person; his/her history, relationships, aspirations, strengths, dreams and resources are largely ignored. So many professionals do this unconsciously, not aware of how they have discounted the person. At some level, people know when they are truly respected – and being in the presence of a professional who does not respect you is an excellent way to be drained of hope.

  • This is just great. Anyone who hasn’t, reading Paris Williams’ Rethinking Madness puts across the same message: lots of people do “recover” from “psychosis,” and if you just ASK such a person what went on, what helped and hindered, you get lots of good information. Williams extensively interviewed six people who had fully “recovered” from long term “psychosis.” They said what helped them was accepting, supportive relationships, regaining a sense of hope, of meaning, and of their own being alive with important feelings, thoughts and ambitions. And – no big surprise – they saw just about all of psychiatry as opposing the things that helped them, with the same messages discussed in this blog and responses.

    Thank you to MindFreedom for this project – it is tremendously important. We need a lot more like it. Someday the public and the “mental health” industry will get the idea that if you want to know about mental problems, you really ought to ASK people with lived experience what it is like, what helps and what doesn’t.

  • This article accepts almost all of psychiatry’s unproven assumptions about “mental illness.” But what just occurred to me is the article’s use of the word “experts” to apparently refer exclusively (at least in this context) to psychiatrists. That needs to be challenged. It accepts that the definition of mental problems psychiatry produces is the final word on the subject – why?

    Exactly who is it who proved that a profession that devotes itself almost exclusively to mental problems as physically caused and physically fixed, should be the ones who can tell the rest of us what “mental illness” is – when they have never yet produced persuasive proof physical causality or physical diagnosis?

    Why should not psychologists, sociologists, anthropologists, social workers, counselors and neurologists have more than equal say in the matter? Among them, they know more about research, psychosocial causes, phenomenological data, and brain science than do psychiatrists. And, unlike psychiatry, their objectivity isn’t obliterated by hundreds of billions of dollar (actually, probably more than a trillion over the last 20 years) from PhARMA.

  • Random thoughts.

    1. “Disorder” promotes the belief that something is wrong with a person’s brain, when psychiatry has yet to find a persuasive pathophysiology or physical diagnostic test for any mental/emotional/behavioral problem. “Disorder” drives us into the arms of those who argue, without proof, that our problems come from “broken brains.”

    Psychiatry’s rush to “diagnose” and extinguish “symptoms” is like someone who pulls the wires on a smoke detector because it’s interfering with their sleep. Psychiatry doesn’t consider that the detector is functioning just fine, and the “symptom” is not part of a malfunction, but a properly working signal that a serious problem in the environment or in the person’s social history needs addressing.

    Another physical analogy: do we think a ship’s bilge pump kicking on is a “malfunction” or “disorder”? It is working fine and serving an important function. How many “symptoms” and”disorders” are natural human responses to human problems that, if allowed to proceed in the presence of confident caring people, could help to resolve the problem.

    2. “Diagnosis” imposes an illusory certainty on something about which we have almost no clue. We have 100 billion neurons with thousands of potential connections between them; according to a Nobel laureate in medicine, there are more possible different connections between these neurons in our prefrontal cortex alone than there are atoms in the known universe. Our brains have 100 billion glial cells, about which very little is known; we have well over 100 neurotransmitters, and only about six are being researched. And that’s just within one person – when each amazingly complex individual interacts with families, groups, communities, cultures and countries, it is unimaginably complex.

    The certainty of a “diagnosis” is silly in the face of our complexity and what we don;t know. But it isn’t funny when diagnoses are used as the basis of actions that determine life choices of vulnerable people. Check out Paris Williams’ new book, Rethinking Madness – Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis – he argues that “psychosis” is what our minds do to reorganize our psyches to correct desperate problems caused by very bad experiences. He doesn’t nail everything down, but then psychiatry nails very little down, and most of the world listens to psychiatry.

    3) We assume that we must “diagnose” before we can do anything about someone’s mental/emotional/behavioral problem. Open Dialogue, the world’s most successful approach to first episode “psychosis,” doesn’t rely on “diagnosis”. In Open Dialogue, professionals to meet almost daily for the first few weeks, and regularly thereafter, with the “patient” and anyone who is significant in his/her life – they could be family, friends, neighbors, teachers, employers, colleagues, clergy. Everyone, including the “psychotic” patient, is listened to with respect and without interruption or correction. The group is non-hierarchical; professionals do not offer diagnose, but take part as equal listeners and speakers, with the goal of promoting a safe atmosphere where all are taken seriously. Over time, new meanings are developed between the “patient” and his/her social network.

    Sounds totally unscientific, except a 5 year follow up showed about 83% of “patients” without psychotic symptoms, living in the community and working (or actively seeking work) or in school. Only a small percentage ever took neuroleptics , and most of them only short-term.

    So here is a system whose main means of acting doesn’t even require a diagnosis – and it works better than any other. Now add the World Health Organization’s three longitudinal studies over 25 years that found consistently better “schizophrenia” outcomes in “developing” countries. The studies’ final conclusion was that these outcomes were due to complex cultural factors (not diagnosis and treatment by professionals). In fact, the WHO studies may well stand for the idea that the further “patients” were kept from the modern medical model, the better they got.

    4) Until proven otherwise, my money is on this paradigm: our mental problems come from being overwhelmed by negative interactions with other humans, or other kinds of trauma. Generally, we would recover from these (mostly childhood) experiences if we were consistently in the presence of loving, calm and strong people who paid warm attention to us, were not put off by how we look when we are hurting, and could provide sensible structure to keep us and others safe.

    If that is so, the first, most important step for those concerned about someone in emotional pain is not to “diagnose” them, but to be the kind of person they should have been exposed to all along. The psychiatrist/therapist/counselor/social worker/friend/family member needs to be the one who starts that ball rolling and helps others to be there for the “patient” too. The attention, the support and the faith in the suffering person IS the “treatment”.

    The argument that we need “diagnosis” so professionals can communicate with each other, or so they can get paid by insurance companies, is lame. I was a social worker, supervisor and director in a treatment foster care program for 15 years (don’t get me started on the abuse of “medications” to keep those kids quiet). I know it is perfectly possible to describe someone’s problem in common sense terms: “he hears voices that say frightening things to him,” he is desperately sad about the loss of his brother and his inability to see his biological parents,” “he touches people inappropriately, most likely because of sexual mistreatment he received in the past.” And regarding insurance, if there must be a manual, just call it an insurance reimbursement manual; the better route would be just to reform the insurance industry – but we would generally rather mistreat “mental patients” than insist that for-profit industries behave in a rational manner. I am sorry to say that, at the present time, the “mental health system” is also a “for profit industry.”

    People get really hammered and put in untenable binds when they are treated like objects. “Diagnosing” “mental illnesses” is unlike other medical diagnoses in that it is global – it labels the person, not just their pancreas or their ankle. That is like putting the whole person in a petri dish, “observing” them, and then saying what is “wrong” with them. It just adds insult to injury – taking people whose pain comes from having been treated like objects, and “helping” them by treating them like objects again.

  • You are right that not everyone who commits suicide while on anti-depressants does so because of the drug. But it is worth pointing out instances when the two go together (which they often do without notice) as long as PhARMA, with its $60 billion/year promotions budget and its lap dog press, continues to pump out ad copy that anti-depressants prevent suicide. Do you write equally negative comments to PhARMA and the press every time they lie to the public with claims that PhARMA’s own clinical trials (manipulated as they are) show to be untrue?

  • Dear Sandy,

    Thanks for actually going to Finland to learn about Open Dialogue, and for your posts about it. I am extremely interested in it because it embodies so much of what I have observed over many years. I have read Seikkula’s journal article on the OD 5 year outcomes, and am half way through Dialogical Meetings in Social Networks by Seikkula and Arnkil. Can you shed any light on how Open Dialogue regards physical manifestations of emotion like crying, laughing or non-aggressive displays of anger or frustration? It seems these must come up in the course of meetings, but so far I haven’t seen them referred to specifically.

    Pete Dwyer

  • David,

    I think I understand more of what you are saying. We do seem to have some common ground:

    Dependent Generation resonates with how I see things, for instance. I also agree many/most of our thoughts are influenced – often driven and distorted – by very gut level emotions. Even so, I do believe we can think clearly, without simplistic reductionism. That usually happens when we’ve had the chance to heal from traumatic experiences that create defensive and distressing gut level emotions.

    In my experience, healing can take place in many ways, but it’s almost always best in the presence of another person who assumes you have something important to say, and accepts you without demanding that you first be rid of all your gut-level feelings. It’s good to have people welcome you, what you have to say, and what you feel.

    You mention “… the metamorphosis of another six week long psychosis … ” I know people who have used such experiences to greatly increase their ability to live the lives they want to have. I hope that is so for you. You are obviously very smart and passionate about what you are doing. I encourage you to cultivate direct contact with people you feel safe with, and to process your experience with as much support from others as you can. I’ve found that sometimes even unlikely people can come through for me when I give them the opportunity.

    Thank you for your thoughts and obvious caring about what goes on with people. And all the best on your journey.

    Pete Dwyer

  • Anonymous,

    The point is, PhARMA and mainstream psychiatry promote their financial interests and the medical model by citing the “results” of clinical trials. As such, it is fair to point out that, using the same measures they claim show SSRI’s relieve “depression” and prevent suicide, the studied’ “results” actually show SSRI’s are more likely to “cause” suicide. It’s just showing that their own argument defeats them – not that all of us believe SSRI’s “cause” suicide in a vacuum, although it appears that does happen sometimes.(See the cases Breggin reports of people with no indication of violence going on wild sprees within a week or so of starting on SSRI’s).

    You are right that the medical model influences people to feel helpless and to wrongly assume they are powerless over their own lives. But this is not an argument against many who post on this site – we are critical of the medical model for that reason, among others. And this learned helplessness is intimately connected with PhARMA/psychiatry’s use of SSRI trials – the trials are used to convince us that we are in fact helpless without the drugs.

  • Sinead,

    Thanks – that helps. It is somewhat clearer, and if I understand what you’re saying, there’s some common ground here with what I’ve been thinking. For starters, your example of the psychiatrist and the patient seems connected with my view that we should throw out the word “intervention” and replace it with “interaction; and on the deepest level, I don’t think anyone “treats” anyone else. We are indeed all in this together, and the best way to be useful to someone else is to work full tilt on our own issues and do everything we can to bring about a world in which we don’t hurt or exploit each other.

    But I’m going on scant information, considering I don’t understand that much about what you’re saying, and as you say, you can’t speak for David.

    I would still very much like to know – again, in concrete terms – how David would describe and interpret the situation Bob wrote about.


  • Dear David Bates,

    I have read your two posts here, and a few of your other comments on previous blogs. I don’t understand what you are saying. Would you please describe, in a few paragraphs, in as concrete and non-conceptual terms as possible, what you believe Bob should have said? How do you think he should have described the events, and how should he have interpreted what he described? If you believe other events are relevant, what are they and how should he have described and interpreted them?

    Thank you.

    Pete Dwyer

  • Congratulations to Ms. Myrick!. This is great news. I have no idea how it happened, but I’m guessing it has something to do with being an open human being who makes positive connections with other human beings and isn’t put off by any different views they might have. Connecting with people, with positive energy, makes a huge difference. All the best in this new chapter.

  • “Expressed emotion” is a bad, misleading name for this. It always turned me off because it seems to denigrate lots of positive emotions too, as well as expressing negative emotions in constructive ways – in contexts that let others know you aren’t attacking them, and let them know they don’t have to bury their own emotions to stay on your good side.

    It could take some thought to name this just right, but I think they are referring to the kinds of feelings and ways to express them toward oneself, one’s spouse and one’s child that we associate with being more hurtful than helpful. I may be expanding the concept here, but if so, it would still be interesting to explore it as expanded.

    To me, the importance of this study is that it addresses what has been suggested as a psychosocial contributor to schizophrenia. Studies show high EE in patients’ families is associated with bad outcomes when patients returns home. It’s easy to extend high EE in this context to high EE as a potential cause of schizophrenia. That then stirs up the debate over whether psychosocial family dynamics help cause schizophrenia, or whether medical model advocates and NAMI say no – that’s blaming the parents and the real problem is inherited brain defects.

    The medical model would say high EE in the family is likely caused BY the patient’s problems, not the cause OF his/her problems. This study sheds light on this – it takes parents of virtual newborns and shows high EE existed too early for a child’s not-yet-manifested “schizophrenia” (or whatever) to have caused the hight EE. If they later correlate negative child outcomes with high EE parents, it would support that EE DOES as a possible cause in the child’s negative outcome, and the child’s outcome did not cause the high EE.

    This debate over the direction of causality is pretty important.

  • This looks like a slightly whimsical look at what has been known for years. But I think it’s critically important. We can criticize PhARMA, psychiatry and most of the “mental health” world all we want for collusion in the drug scam; but words count – a LOT.

    That’s why PhARMA spends $60 billion a year on promotions. If you control what people call something, you control what they think and do about it. As long as we let PhARMA, psychiatry and others get away with calling these pills “antidepressants,” they’ll keep doing a land office business in them.

    Same with “mental health.” How can we stop the medical model’s hegemony while psychiatry has us referring to mental, emotional and behavior problems as “mental health”?

    This article provides a great service – a wonderful summary of the worst of “anti depressions,” and a completely accurate account of why these drugs are NOT antidepressants.

    Oh – another pet peeve: don’t call them “psychiatric medications,” and don’t call their use “psychopharmacology.” What are they? DRUGS that doctors prescribe.

  • Lowry,

    That’s why corporations were formed – to insulate individuals and their assets from liability. As a former prosecutor, I can tell you it is much harder to prove that a specific individual within a corporation violated a criminal statute than to prove the case against the corporation itself. Absent a lot of “smoking gun” memos, prosecutors will have a very hard time proving an individual’s direct involvement in a corporate crime “beyond a reasonable doubt.” Then you must factor in PhARMA’s monstrously deep pockets – they have unlimited funds to throw at litigation, and according to reports, are unscrupulous (read Breggin’s account of the Wesbecker case).

    Also, in response to a couple posts, it really doesn’t matter if the company has a good case against Jim or not – they have so much money they can afford to sue and force individuals to spend funds they don’t have to defend – the company is ok as long as it doesn’t run afoul of prohibitions against frivolous suits.

  • I’m going to have to ready David Bates’ comment over many times to absorb it. But here’s a first reaction to one passage:

    “The best thing we can do for psychiatry, is pile up the research and knowledge base which points out natural cause, to highlight the way forward. You cannot effectively shift a delusion by destroying it (by fighting), nothing will change until the solid platform of new ground & new direction is clearly articulated.”

    The research and knowledge base have already piled up. While more knowledge is always welcome and needed, there is already more than enough information to point a “way forward” out of the delusion. That is part of what Mad in America and Anatomy of an Epidemic do so well; they take information that’s existed for decades and connect the dots, providing a more rational perspective.

    We need to approach all conflicts and differences of opinions with humility, recognizing there are human beings on all sides of each issue, and the ultimate solution is not to vanquish but to reinforce our common humanity. But it is possible and sometimes necessary to confront injustice and untruth in clear terms without trashing the humanity of your “opponents.” That is how I see this site and this particular piece – Robert Whitaker is always respectful and factual. The headline refers to “hats” – roles played by participants, not characterizations of of their souls.

    We could pile up evidence until the cows come home and PhARMA would be perfectly happy to crank out its $60 billion/year spin machine to neutralize the evidence. Real gains in justice for humanity do not always rely solely on the accumulation of evidence. Calling out those who wield the stick, by those who are on the receiving end of the stick, can be constructive. Where would African Americans be today if the reliance was solely on “accumulated evidence”? Ditto Black South Africans, or Indians, or gays, or women, or to use an often-tortured reference, those who opposed the Nazis?

    I agree – demonizing perpetuates injustice. But Martin Luther King used powerful moral argument to confront power in no uncertain terms, as did Mandela and Ghandi, without demonizing. The irrational Greek-chorus-selective-cheering-section nature of online discussions doesn’t negate the possibility of intelligently and humanely making forceful moral arguments backed by a determined stance. I think of Abraham Lincoln, at the site of the Battle of Gettysburg: “With malice towards none, with charity for all …” He wasn’t apologizing for the fact that there was a battle, but he was pointing us all toward our common humanity. This isn’t an argument for violence, but it is for the need to take a principled, determined and active stand against systematic mistreatment and exploitation – which is what is clearly happening to so many drugged “mental patients.” Robert Whitaker does us all a service by citing hard facts that illustrate the dishonesty and economically motivated exploitation practiced by PhARMA.