Thursday, December 1, 2022

Comments by Igor

Showing 40 of 40 comments.

  • Except it is noticed anecdotally and proven statistically for many people:
    1. If somebody is depressed given everything is good in their life – you give them antidepressants – they get better.
    2. Somebody thinks the CIA is spying on him (and nobody is really spying on them) – you give them antipsychotics – they kind of stop thinking that CIA is following them.

    Also as a doctor you probably aware that no illness is verified by a lab test. It takes a physician, symptoms and complaints, then a lab test is appointed then only diagnose confirmed. The whole medicine works on Bayesian reasoning.

    Yes, there is no lab test currently for mental illness (there are many pieces of evidence of brain pathology involved in the case of schizophrenia or bipolar or borderline).

    But read the history of medicine – there were no diagnostic tests for many autoimmune diseases for many years and even now there are plenty of diseases without an unequivocal test.

    In medicine, many diseases were discovered just by autopsy.

    So for many diseases, physicians do the diagnostics but then use the treatment response as confirmation of their reasoning.

  • My comment would probably be against the tide. But your letter puzzles me.

    1. Psychiatric drugs, antipsychotics, and mood stabilizers do not cause psychotic episodes. They might kind of do rarely when you try to get off them. But when you are on them they just don’t cause psychotic episodes.

    2. You had repeated psychotic episodes while being on drugs which is a strong indicator that you don’t have a “brief psychotic episode”. What you do have is a chronic disease.

    3. You changed statistically proven treatment for “playing with puppies” and “acupuncture”. You refused treatment from the best hospital, and choose instead some questionable form of help. There are no evidence that acupuncture is curing mental illness en masse.

    Psychiatric drugs are not candies. Yes. We are in need of better drugs. Yes. Apart from drugs, the psychiatric treatment of people is downright unacceptable. Yes.

    But you really do have a disease. Just from what you’re saying. There is something really wrong with you. And what you need – is drugs. Better drugs. Newer drugs. A minimal dose of drugs. Drugs that won’t interact with your thyroid. Maybe only mood stabilizer (e.g. not lithium, Depakote), maybe no antipsychotic or some kind of better antipsychotic. But you do need real serious medical help.

    So you won’t be psychotic again. Nor depressed. Maybe only hypomanic for example.

    You’re a smart person. You have worked in the academy. You don’t have anosognosia or whatever. Just don’t ruin your life. Try to find a better doctor or a better drug combination.

    You are sick. Don’t be.

  • > that ‘schizophrenia’ and ‘bipolar disorder’ are almost the same thing
    > By reducing it to purely biological explanations (for which psychiatry has failed so far to provide any > concrete proof)

    I disagree with those. I do believe in existing evidence that some mental illness e.g. schizophrenia cause massive gray and white matter disruptions. And also on the surface schizophrenia is characterized by negative symptoms which are not present in bipolar disorder. But what I want to show is that biological psychiatry is biting itself.

    Since people here like to claim that ‘brain matter loss and negative symptoms is due to antipsychotic administration’ I’d like to offer a simple experiment:
    1. We take two groups of people. The first group is diagnosed with bipolar with psychotic features, the second one is diagnosed with schizophrenia.
    2. We give them a comparable amount of antipsychotics.
    3. We measure their brain afterward.

    I believe data on this matter already exists and there is much more gray matter loss in case of schizophrenia. There is also data on unmedicated schizophrenics which also show gray matter loss. And negative symptoms of schizophrenia were known even before antipsychotic emergence.

    Data on brain abnormalities are replicated many times so for me it is pretty strong evidence that there is an underlying disease.

    But what I don’t like about current treatment is that: antipsychotics do cause additional brain matter loss and antipsychotics do cause additional negative symptoms. And this is without talking about other horrible side effects.

    I applaud to everybody here who managed to live without antipsychotic drugs (this doesn’t work for me, although I’m striving to function on as minimal dosage as possible).

    Basically, my path was from antipsychiatry after first psychotic breaks, towards biological psychiatry (Alright, I’m going to be a second-class citizen here with these guys, but at least have a life) then back. Severely disappointed after getting fat, becoming severely depressed and suicidal and having an absolutely blank mind on their ‘minimal effective dosage’.

    The psychiatrist is something like tyrannical impotent who commands his wife, again and again, to lie this way and dress this way, but nothing works. Psychiatric treatment is almost orthogonal to the underlying disorder.

    So, f*ck psychiatry. And f*ck big pharma.

  • It’s just an awful disease – the disease itself is hell, gray matter loss, cognitive loss, negative symptoms, etc. Then the treatment comes which turns out to relieve only part of the symptoms by so huge price. You sleep a lot, work jobs which are probably below your intellectual level and people hate you.

    It’s just awful. Good to hear that you hold on.

  • I’m kind of feeling a lot of hatred towards Elyn Saks and her book ‘The center cannot hold’ since she said exactly what everyone wanted to hear:
    1. Psychiatry is cool
    2. I’m sick bad person
    3. I should always take my drugs
    Then it becomes a best-seller, everybody happy – poor bad ugly creepy schizophrenic

    Now let’s say someone writes a book with opposite view, today, in 2018 – how many would seriously read this?

    I’m the one btw who currently takes the drugs – I took low dosage of anti-depressant, mine is helping me with anxiety. Antipsychotics made me fat, slow, without ability to experience emotions and/or imagination. They made me suicidal – but I don’t believe that this is somehow drug problem, in my case life become so shitty – you couldn’t bear it. Lithium is something disastrous – goodbye, kidney, goodbye, liver, goodbye thyroid.

  • I looked through some of your modules and I believe the program is suffering from the same problem as many others cognitive therapies (CBT, ACT, DBT) – the text is always something like a workbook with assumption of targeting retarded people. It’s difficult to read. For me it’s incredibly difficult to stay focused on such material.

    I’d like to compare it to Daniel Kahnemann’s work Thinking Fast and Slow, this book is CBT-like, it touches the subject of cognitive biases, but it is also an interesting book and an interesting experience, you could immerse in it. And it is highly therapeutic too. I would put ‘Narrative CBT for Psychosis’ somewhere in between your work and Kahnemann.

    I hope someone in the future would write a CBT-book with central idea and a lot of anecdotes and vignettes illustrating the point so you would be basically reading something resembling good fiction.

    So to summarize: my major criticism is in the are of digesting this kind of information. If it sound too critical – please also note that I’m Russian and it may come from my lack of knowledge of the language.

    As someone who have suffered from psychosis (I’d be among the continuum of psychotic bipolar – schizoaffective) I would confirm your idea that delusional beliefs come from snowballing of cognitive errors (partly reinforced by the speedup of thinking and affect). And a typical paranoid is definitely jumping to conclusions all the time.

    Nevertheless, I really like what you and your team doing. CBT is the only thing that you can sell to mainstream mental health now and it is working so more CBT means not only better overall mental health and higher life satisfaction, but also less medications. Less medications means less diabetes and heart disease.

  • I like your point. I gained 40 pounds after going on pills, but my dosage wasn’t so high, I gained probably due to ‘self-medicating’ the stress of asylum. There is statistical evidence that weight gain is present but not so big (less then 20 pounds in most people)

    However some drugs are extremely devastating like risperidone is really destroy your blood sugar. Pills also make you more complaint, drowsy, also make you sleep to much. If you sleep for 12 hours a day and have low energy, how much you can fight?

    What Whitaker cites is basically true for long term service users. Take a look for Monica Cassani case, this woman.

    So probably both factors – drugs and casted disability role are at play here.

  • Hi, Frank! I think you definitely know history of mental illness better then me.

    I’m actually really interested on your opinion of psychopharmacology in the sense that we stop putting people in asylums forever due to psychopharmacology.

    Otherwise if you mad you were condemned for life in prison. So what do you think – are drugs really bad?

    I mean the story of many peoples there – they comply with drug regime, get out and then stop using drugs.

  • Many Freud claims are pretty testable and “falsiable”.

    Many others are phenomenologically testable e.g. you hear the interpretation, feel something and then after some time your behaviour changed.

    The therapy practice is probably testable using many questionnaries from clinical psychology.

  • I definitely agree that some of the Freud’s theories were breakthrough, probably valid and changed the field forever.

    I myself could say that without psychodynamic books (like Murray Jackson’s work at, I wouldn’t be alive today.

    However there are many problems with psychoanalysis. Like the classical analysis (‘lay down on the coach’ with distant analyst who gives interpretations). There are also currently like a hundred different schools of psychoanalysis.

    Also you can easily find out that e.g. Winnicott, Melanie Klein and Lacan’s ideas are contradicting each other in many ways. So the question is – which way to use?

    In order to go through my schizo-affective problems I was just reading everything, especially clinical cases and tried to extract ‘whatever works’. It helped and it helped tremendously, but could I extrapolate? I doubt so.

    I need to point out also that Freudian and Jungs work is the basis of the language in which you can understand psychotic symptoms. Freudian-based analysis of psychosis is the way to extract traumatic events which you relieve in psychosis, and Jungian ideas helps to extract some common material e.g. ‘spiritual dimension’ the way which unconscious works and of what it is consists.

    Otherwise you just throw all the psychotic material out and claim that this is ‘random firing of neurons’.

    Finally, I don’t disagree completely with biologists – given that you don’t have immortal soul, all your experiences technically must happen somewhere inside your brain, however it’s probably not possible to determine the mapping.

  • Hi, Brett!

    You mention in your comment: “credible psychological approaches to understanding and alleviating psychological problems”.

    I see you are a clinical psychologist and have a PhD. So from your standpoint what is exactly credible approaches to extreme – CBT? Family therapy? Empathic therapy? Some king of Langian stuff?

    That would be a tremendous help to me or other survivors. Thank you.

  • The news are still awful. What could I say – the best thing is of course to never be diagnosed as schizophrenia even if you extremely psychotic.

    I think there should also be the resource which would help people lie and deceive common diagnostic psychiatric thinking (e.g. a little bit of training on what not to say to psychiatrist ever and if you don’t say you know they tend to give you milder label).

  • @registeredforthisside.

    Well, first thing is that most of the people are not so much into abusing. And the abuse is already an indicator. And chronic emotional abuse of crazy kind – is the feature from Cluster B.

    Unfortunately, people who pass the diagnostic criteria simultaneously have caused enormous amount of suffering in other people. That’s just the reality.

    I don’t equate BPD label with abuse, however the chances are pretty high.

    THere are many types of shitty mothers, my particular mother was extremely psychologically abusive due to her borderline traits.

    It won’t bring me my childhood but understanding particular type of abusers I can work on my traumas and heal them.

  • Yes, but.

    There is a specific kind of psychological abuse which is created by people with so-called Cluster B personality disorders.

    My mom is BPD, my first girlfriend was someone high both in narcissistic traits and BPD, my second girlfriend was more like pure narcissist.

    I probably would wind up with some kind of stigmatizing label, in best case I’d get away with some kind of anxiety and depression or PTSD but I know mental health system too well.

    But if you fit the criteria for BPD and you DON’T abuse other people – that’s ok for me.

  • In no way I’m pro-eugenics. But given how many things can go wrong, you should be confident in your mental state and your judgement. I wouldn’t allow even healthiest people to have kids without intensive psychotherapy.

    I do think that raising a healthy kids is extremely difficult job which you can compare to successfully running a big enterprise.

    From the diagnostic standpoint I’d say that if you match 5 out of 9 criterias you are not ‘BPD’ but you are probably have 5 problems (maybe different, maybe interrelated) and that you are probably should take care of them.

    It shouldn’t stop somebody from having kids but you shouldn’t then lie to yourself that you’re not responsible.

  • Of course he shouldn’t be drugged off. Nobody ever should.

    What my point is – you probably should receive good quality long-term psychotherapy but you can’t do it by force.

    I’d say I have some kind of split in relationships towards BPD diagnosis – I’m full of empathy, some of the people I’ve known with that diagnosis are extremely great.

    But my whole attitude changes (probably because I’ve been studying childhood trauma too much) when you have kids – your job is not to affect your kids with any kind of your own stuff ever. Either fix yourself or don’t have kids. You just not allowed to.

  • I’m going to disagree with you.

    Please be aware that my mom also fit the criteria for ‘borderline personality disorder’ and I think of my mom as a major traumatiser.

    Now, first I need to point out that ‘BPD-Lifestyle’ is extremely toxic and dangerous for the kids if you have any, however even typical neurotypical parenting is extremely toxic and dangerous and the best thing that you can count to be a Winnicott’s ‘good enough parent’ the kind of parent who wouldn’t create serious mental illness or serious drug addiction or a serial killer.

    Second – I don’t by the idea that all neurotypicals are ok with breakups, etc. Most of the neurotypicals are actually pretty codependent.

    Third – abandonment issues, manipulation and search for drama (‘fear of mundane’) – are all different kinds of childhood trauma. Of course we should accept the person. But I myself for example was a pretty paranoid person. And it’s absolutely ok to be a paranoid if you are in prison or in a concentration camp. My childhood was a concentration camp – constant tension, constant stress, constant drama.

    But when you grow up being paranoid most of the time is absolutely inappropriate since your model of world is not in accordance with real world. The same with abandonment issues – like you mention your boyfriend, well, does abandonment from this particular person was so awful and devastating experience? Probably not. The fear was much stronger.

    So the borderline personality disorder from my perspective should be regarded as some chronic disease like having heart issues – it’s your heart, nobody forces you to take any drug, but you kind of have a problem and you’d better do anything about it.

  • I need to tell in advance that by no means I want to belittle your pain and all your negative experience.

    But just wanted to say that from the text you story sounds like a lot of fun, actually.

  • There is a strange biological disease where nobody can find a trace of biology and there is also a strange ‘cure’ drug for this disease (also for bipolar, autism, dementia, ptsd, depression and probably everything else) – an antipsychotic drug.

    Thanks, Jay, for what you are doing. I actually really think that your books and articles have a significant psycho-therapeutic effect in a way by a example you can learn to think critical. And I believe a great critical thinking course is one of the antidotes for psychosis. Sometimes probably more effective then haldol.

  • Saks used classical analysis (“lay down on the coach”) which proved to be not so effective.

    I don’t know specifically on clozapine weight gain though, quick search showed that clozapine is highly hepatotoxic. So given that Saks is cancer survivor is not a great choice anyway. If I’m recalling properly she was previously on Navane, which 1st generation and is not causing morbid obesity.

    I also don’t think Saks specifically sensitive. You can see it in her interview. Also from her book you’d get that she wasn’t widthdrawn from the drug for too long.

    I don’t know Yeiser biography so well, but I belive when the person in psychosis is ‘denying anything is wrong’ it is more about desire to be left alone.

    These two women would be even more intelligent and inline with their ambitions if only.

  • I don’t like Elyn Saks and Bethany Yeiser both because that’s exactly the story that everybody wants to hear ‘Bla-bla-bla, I’m awful condemned schizophrenic, I’m awful and probably shit but thanks to beautiful modern smart doctors with their drug cocktails and awful antipsychotics I’m finally got my stuff together and although I would be fat and ugly and dumb that’s all I can be because I’m schizophrenic’.

    And you also need to say that you forgive everybody who treated you like crap like your parents, your psychiatrists and all your peers, and you understand them and they are great people etc.

    Their stories is something like Hollywood romantic comedie, good guy gets the girl in the end and everybody is happy.

    Elyn Saks would get positive reviews and her book would be sold in thousands while the stories about trauma, abuse, humiliation and force hospitalization are swept under the rug.

    That’s one of the reason we lost so many beautiful people and continue to lose, like Matt Stevenson. All that lie, all that indiffirence, all that humiliation and all that contempt to traumatized people.

  • Bipolar is the worst diagnosis now. Although statistically the prognosis is better then schizophrenia, if you have bipolar especially psychotic bipolar you’d going to get:
    1. antipsychotic.
    2. mood stabilizer (sometimes lithium + lamotrigine)
    3. anti-anxiety pill (some kind of klonopin)
    4. anti-depressant
    5. anti-seizure meds (carbamazepine or valproic acid).
    While with schizophrenia you may get away with only an antipsychotic (although rarely nowadays).
    This drug cocktails are especially dangerous and in no way ‘evidence based’. No wonder that mortality gap is widening.

  • When I get out of psych ward I was scared, then I started to read the typical psych shit and decide to commit suicide. Matt Stevenson story showed me that there is a hope and there is a psychotherapy cure for schizophrenia. I started to read books on psychotherapy from then on.

    Thank you Matt for saving my life and for providing hope. I will not forget it. Ever.

  • (I’m non native, so pardon my language)

    I want to actually say couple of words in defense of the psychiatric worldview.

    The biological model and the idea to interpret all the delusions and hallucination as something inherently random, noisy, non-meaningful leads to non-human approach. That psychosis is something of outer to nature, that the psychotic process is an outside guest inside the person’s mind, completely separated from the person’s consciousness.

    In Russia, where I live the history off trauma which lead to psychosis are completely dismissed in psychiatry tradition (there is a special term among psychiatrists for the person’s story – OBYASNYALOVKA which means something like ‘excuse’ or ‘pretense’ with strong negative notation).

    I think both ideas – treating psychosis as something human and meaningful and treating psychosis as a random fluke are too contradictory in order to have any compromise on them. You either this or that.

    The treatment compromise e.g. psychotherapy or a mix of psychotherapy/antipsychotics is possible when you actually choose a human approach.

    But with biological model of the disease I believe you can’t have a valuable compromise. If you accept the biological noisy idea – then you certainly would stick to increasing meds. Because what else you can do? If the person still have residual delusions or mood changes then the only way is to either switch medications or add another one / increase dosage which in turn lead to almost criminal treatment plan with concurrent multiple antipsychotics (As far as I recall there is no scientific data on concurrent administration of antipsychotics).

  • After psychotherapy it’s clicked and I realised that there never were ‘random awful sudden changes’. The whole psychotic experience was pretty understandable and explainable.

    I could only recommend the book ‘Schizoid phrenomena, object-relationships and self’ which is basically the psychoanalytical masterpiece if you’re interested.

    Bollos work ‘The enigma of schizophrenia’ is also good

  • Psychodynamical therapy has extreme amount of clinical information about schizophrenia. Basically, psychodynamists worked with schizophrenics extremely closely and gave pretty meaningful albeit noisy explanation of the illness.

    I can’t let go of feeling how much things clicks when you read old psychodynamic stuff. I’m now going through ‘Schizoid Phenomena, Object-relations and the Self’, and sometimes you need to skip all the libido interpretations but it gives clear easy to grasp framework on what caused psychosis what is the structure of psychosis and what cases relapse.

    Was incredibly useful read for me. I believe Matt Stevenson also mentioned a lot of psychodynamical works in his article on schizophrenia-recovery. Also many of books are psychodynamical in nature.

    So I would recommend at least take a look if you are affected by psychosis. Pretty interesting read. When you affected by psychosis you take ‘whatever works’ approach.

  • One problem of course that the clinician assessment is taken as ultimate truth. So those who assess closely to clinician they obviously more adequate then those who assess their functioning differently.

    >Interpersonal functioning refers to the degree of initiating, accepting, maintaining social contacts, and >effectively communicating. The daily activities domain aims to provide a measure a person’s >involvement in activities such as shopping, using a telephone, paying bills, use of leisure time, and use >of public transportation. Lastly, the vocational functioning domain captures the individual’s employable > skills, the level of supervision required to complete tasks, ability to stay on task, complete tasks, and punctuality.

    I just don’t see HOW clinician may provide more accurate assessment here.

    There are many ways to speculate about this study. One path – is that clinicians are more pessimistic in their assessments so as depressed people. So both assessments are pessimistique.

    Also What if someone is overly optimistic vegetable? Plus one to discrepancy
    What if highly functioning but overly pessimistique? Guess what, he and clinician will probably provide the same estimate.

    Also in some ways even healthy depressed people don’t overestimate themself. This is probably well-known result from the domain of cognitive psychology.

    The whole study is dumb and waste of money.