Saturday, February 16, 2019

Comments by Steve McCrea

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  • I used to be a staff person for the Long Term Care Ombudsman program in Oregon. I was called once to a nursing home to see a guy whose daughter thought he was “overmedicated.” I could barely get him to open his eyes. He had bruises on his head because he’d walked into the doorframe instead of through the opening in the door. I interviewed the activities director and she told me that a week ago, he’d been hitting a volleyball back and forth with her in the courtyard! The difference: he was now on Risperdal.

    How anyone could call this an “improvement” is beyond my comprehension. It shouldn’t take an outsider coming in to point out that they’ve now disabled a perfectly capable person for nothing but the convenience of the staff.

  • “Moreover, the study suggests that although it may seem that further questioning about suicidal ideation would elicit more information to facilitate accuracy in assessment, it is also associated with a higher false positive rate. In other words, detailed questioning increases the likelihood of inaccurately assessing people as at-risk for suicide when that is not the case.”

    “Clinicians sometimes rely on suicidal ideation as a crucial test for short-term suicide risk, and it has been argued that asking about suicidal ideation could form part of a screening test for later suicide.”

    I think these paragraphs highlight the real problem with this kind of questioning. The clinician is “assessing” or “screening” or “testing” for “short-term suicide risk.” They aren’t having a real conversation with the client – there is nothing here about establishing rapport, about finding out what is going on in this person’s life, about exploring why the client would feel that ending his/her life was a good or necessary idea. It is no small wonder that their clients/patients aren’t willing to share the truth with them. Would you tell someone whom you knew was “assessing” you that you were considering suicide, when that their “assessment” could get you locked up if it went the wrong way?

    There is nothing wrong with asking someone if they’re thinking about suicide, IF you have a sufficiently trusting relationship and have the clear intent of listening and helping rather than “evaluating” the person you’re talking to from some elevated pseudo-“objective” viewpoint. The problem isn’t the question, it’s the intent of the person asking it that causes the difficulty.

  • I think perhaps you are confusing the effect on certain individuals with the character of the institutions involved. The fact that there may be some psych wards that get good reviews, or that some teachers run very democratic and engaging classrooms, or that some kids love school for whatever reason, does not change a thing about the underlying purpose and structure of the institutions involved. If the basic design of schools is to teach children compliance and snuff out creative thinking, and that is the general effect on the population as a whole, the fact that a small or even moderate number enjoy their time being brainwashed and trained to bark on command doesn’t alter that effect.

    A similar argument is commonly made about DSM diagnoses – “Some people like their diagnoses.” Well, sure, they do. But does that change for one second the fact that the diagnoses themselves are complete social constructs with no actual validity in the real world, or that they are used to undermine and blame those who experience psychological and social oppression by claiming their adverse reaction to their oppression is due to malfunctioning brains, rather than a malfunctioning social and economic system?

    When I worked as an advocate in nursing homes, a home was taken over and put into federal receivership because it was so awful in terms of patient care. Yet they received approval ratings in the mid to high 80% range. Most people are satisfied with the status quo, even if it isn’t something they ought to have to put up with. They simply aren’t aware that other options exist.

  • In addition, there are misunderstandings and personality misfits between parents and children which contribute to later “mental illness” diagnoses. Moreover, there is research showing that sibling relationships can do a lot of damage, especially in families where feelings are not processed and problem-solving is done in a mostly unconscious manner. No overt abuse or trauma need necessarily be present. For instance, I was assigned a role as a “scapegoat” in my family and was picked on by an older sibling. I became seriously ill and was no longer an acceptable target, and my youngest brother was born about the same time, so my next youngest brother got the job of “scapegoat.” I suddenly became aware, though I could not have verbalized it, that I wasn’t the scapegoat because of some flaw, it was an assigned JOB.

    Anyone looking at my family would have thought that all was well. There was very little in the way of overt trauma per se, but plenty of subtle undertones of hostility and unspoken emotion and unspoken rules and defined roles, all of which caused a great deal of emotional damage without any discreet “trauma” on which to hang one’s hat.

  • I would recommend it. DV professionals seem to be the ones who really understand and speak from a position of empowerment and understanding of oppression and the pain it causes. I don’t know Seattle at all (I live in Olympia, and before that Portland), but the DV programs there might be able to help you find a good person to help. At the least, you will experience that you are very far from the only one to experience such disrespect and foolishness in the Court system.

  • I don’t disagree with what you’re saying. The research in question is about children healing while still children, and the ability to have a safe dependency on a caring adult appears to be the most important aspect of their psychic healing, which apparently manifests in the brain as well. When we get to adulthood, we have to figure it out on our own if we are not fortunate enough to have had such a person, but similar considerations still come into play. What is quality therapy but a person listening to and caring about another person in a safe space? And why can’t non-professionals do the same for each other? Of course they can, and they do, as you (and I) have observed.

  • Ornish was absolutely on target when he started writing this stuff back in the 70s. Naturally, he was roundly attacked and ostracized by his peers at the time. Now everyone makes Ornish’s recommendations, but I never heard any apologies or crow-eating on the part of the big medical system. It is amazing how often truth is obscured in medicine when it conflicts with habit or profits.

  • As JRR Tolkien wisely said, “It takes but one enemy to make a war.” And we know who created THIS war. It’s not the fault of the downtrodden who rise up against the oppressors that the oppressors fight to maintain their power. They could simply acknowledge that these drugs have little positive effect and a lot of potential harms, and redo their “algorithms” accordingly. No war would be necessary if those in charge would simply admit the facts and work from them.

  • I often do the same. If we’re going to use a label, I use the ones that indicate damage from trauma. Though I talked to a psychiatrist once who said “PTSD” was not caused by the trauma, because not everyone who was traumatized got “PTSD.” What? So being hit by a car doesn’t cause broken bones, because not everyone’s bones break when they get hit by a car??? The problem is apparently “vulnerability,” because I guess everyone should be able to handle being traumatized without having flashbacks or nightmares. Very weird!

  • I am SO sorry to hear all this! I wish it were an isolated incident, but it is not. What amazes me is not that abusers engage in this behavior, but that the “professionals” seem so ready to fall for it. The fact that you’re teaching school all this time despite the abusive crap he’s been spewing at you should be enough to make it clear you’re a very sane person in an insane situation. Additionally, his focus on controlling how much time you spend with your child and ACCUSING you of wanting to spend more should be an obvious indication that he is abusive and controlling and doesn’t care a whit about the child.

    Are you connected with any kind of domestic abuse agency or services? They can be really helpful! And keep reading your Lundy Bancroft – he is the best guide to how to deal with these suckers.

  • That is an excellent point! The psychiatric worldview is in actuality a religious one, and it attempts to supplant other belief systems. Perhaps enforced “treatment” can be objected to on the grounds of freedom of religion?

  • I very much like your first statement – if anyone is “mentally ill,” we all must be, because there is really no way to distinguish “normal” from “abnormal” people.

  • I would rather suggest that the new/old way of thinking is not at all compatible with the DSM or any of its definitions. If things defined as “mental illness” are to be considered common reactions to difficult circumstances, we need to dispense with the idea that a particular emotional/behavioral reaction is in any way a “disorder” or “disease.” Moreover, the idea that lumping people together based on their particular reaction to their particular history and context and saying they all are “suffering from the same disorder” is, to me, inherently invalidative of the very context it seems you and I both want to see brought to the forefront. I hope that makes sense!

  • I have seen this many times in my work with foster kids and Juvenile Court. I got to the point where when I saw a crying, emotional, seemingly out of control mom and a super calm, confident, under-control dad, I thought, “OK, we know who the real problem is here, and it’s not her.” I also saw how things changed in the cases where the survivor was believed and things started turning against the abuser. All of a sudden, the calm, confident person became increasingly angry, agitated, and even bizarre as the control slipped away from him. But someone has to start by believing that the person who is upset has a reason for it, and the reason is usually sitting across the courtroom from her.

  • I have to agree. The very fact of being told that your brain is broken and there is nothing you can do about it would make anyone feel hopeless. Add to that the frequent invalidation of one’s own experience and internal knowledge about what is going on, and you don’t need a drug to make someone give up. Not even getting into the horrors of “involuntary treatment.”

  • https://www.merriam-webster.com/dictionary/meanwhile

    meanwhile adverb
    Definition of meanwhile (Entry 2 of 2)
    1 : during the intervening time
    meanwhile, however, new projects are being undertaken this year
    — Jonathan Eberhart
    2 : at the same time
    You can set the table, and meanwhile I’ll start cooking dinner.

    Seems like you were thinking of the first definition, while I was intending the second.

  • I don’t disagree with a word you said. Helping people “game” the system and helping them recognize the true sources of oppression in their lives is a huge effort that has its own challenges and rewards, and is very clearly distinguishable from “helping people accept their illness” and other such nonsense. Domestic abuse is a good analogy – we all want to stop domestic abuse from happening, and working at a societal level to alter perceptions and biases and privileges enjoyed by abusers is the ultimate game. But meanwhile, helping those ensnared in such a situation is most definitely needed and contributes to the larger goal, especially when part of the process is political engagement for the survivor.

  • For one thing, many “antidepressants” don’t affect serotonin and still are considered “antidepressants.” For another, studies back in the 80s showed that lots of “normal” people have lower serotonin levels. For a third point, no one knows what a “normal” level of serotonin is – serotonin levels vary widely from moment to moment. Have you read Anatomy of an Epidemic yet?

  • Gotta say, I see both viewpoints here. On the one hand, we don’t want to do anything to validate the dangerous nonsense that is the current system. On the other hand, I don’t want to simply abandon those in the clutches of the system when they are suffering. I think we need to do both – provide practical support to those in trouble while still insisting that the current system is utterly wrong from the ground up. How to do that is the tough question, but I think both/and is the essential way to go.

  • It is my understanding that his withdrawal of the trauma theory was made under great pressure from his colleagues and Victorian society in general. However, we can’t absolve Freud of his decision to create a confusing and dishonest counterexplanation that served to baffle and mislead the public and the profession for generations. His cowardice in the face of social pressures had enormous negative consequences for millions of people.

  • There are definitely points at which men experience bias, but on the balance, women are far more likely to get the short end of the stick, even today (though it is better than it used to be by a long way). For instance, there is this idea that women usually get custody in divorce proceedings. But this is mostly because men usually don’t contest. Many studies done in many US states in different jurisdictions have showed the same thing: men who contest win custody 60-70% of the time.

    There’s a lot more I could say about this, but suffice it to say that while things are better than they were in 1965, men still receive plenty of protection just because they’re men. The Kavanaugh hearing and DT’s comments on how “hard it is for young men” now that they have to worry about being called to task if they’re too aggressive toward an unwilling “partner” should be enough to remind us that there is a LOT of work still to be done.

  • Just my two cents here. I don’t hear anyone wanting to deny membership or participation to people like me or others who don’t fit the “survivor” description. And I’m not sure the most important issue is honesty or trust, either, though I don’t want to invalidate Kindred’s raising of this as a vital issue. It seems to me that the issue is one of social power. It is pretty easy for those in the one-up situation to believe they are being “fair and equitable” when they are actually exerting their unearned authority based on social biases. So making sure that the direction and priorities of an antipsychiatry movement are not only informed by, but directed by survivors seems a very important point to me. It’s not that others can’t help and be passionate and come up with new ideas. To me it’s that the ultimate test of any idea is whether those who have been through the ringer think it makes sense and would work. Survivors have to ultimately direct the effort, even if a lot of hard work is done by people from all walks of life who interact with the system in some way.

    That’s MHO, for what it’s worth.

  • Wow, that doesn’t even make any kind of sense! “However, given the increased risk of suicide in untreated depression and the absence of an increased risk of suicide associated with pharmacotherapy, currently available evidence does not support the avoidance of initiation and continuation of pharmacotherapy for depression in children and adolescents.” Didn’t he just say there WAS an increased risk of suicide with SSRIs???

  • Such a fantastic story of how your own “commonsense” understanding of the situation was repeatedly invalidated or ignored by the “professionals” in favor of their own worldviews and beliefs. It is wonderful that you had the courage and historical models to tell the doctors to shove off when you needed to do so. I also find it important to note that your political analysis of the society you grew up in factored into your ability to resist the inappropriate and abusive authorities. I think such political awakening is often critical to folks “recovering” from their ostensible “disorders.” In the end, our social system has abuse built right into it from the foundations, and recognizing that may be the most “therapeutic” act a person can engage in.

  • I appreciate the perspective of unearned privilege that you lay out in this piece. I had not really thought of it that way, but it makes total sense. “There are some good ones out there” doesn’t do a thing to address systemic oppression, and in fact impedes the effort. I love the idea of convincing local NAMIs who “get it” to go rogue and disavow the NAMI moniker and all the nasty history (right up to the present!) that goes with it. I’d love to see that happen, but even people with respectable levels of integrity have a hard time walking away from privilege, however unearned it may be.

    Thanks for another great article!

  • I agree with all of this, and could go on for days talking about it. My book is in part an effort to raise consciousness, especially in women, regarding how our culture tells us men and women should act, and how acts of abuse are normalized and even romanticized (fighting over a woman, pursuing someone who says “no” as a sign of how much he “loves you,” etc.) I think this is particularly true for those victimized early in life,o or who witnessed their parent being abused, who have little or no model of what a loving relationship looks like and who are therefore less able to distinguish grooming tactics from genuine affection. Our culture does them no favors by romanticizing “bad boys” and making excuses for abusive behavior by men, and putting women in the role of “peacemakers” or “fixers” if the relationship doesn’t seem to be working as it should.

    Domestic abuse is a very, very complex dynamic. It is perhaps natural for those who aren’t aware of this to ask, “Why doesn’t she just leave?” but too few are willing to look at the very real and very dark and difficult answers to that question when they make the perhaps understandable mistake of asking it.

  • Depression may “feel like a disease,” but that doesn’t make it a disease. I say this as a person who struggled with depression and anxiety for the first 30-40 years of my life, including times of feeling suicidal and seeing no point in life at all. I am GRATEFUL that no one ever “diagnosed” me with a “brain disease,” but instead people (including my therapist) encouraged me to believe that I could DO something about it, and helped me take small steps, one at a time, that led me to a place where I actually spent most of my day NOT feeling anxious or depressed, and where I knew what to DO if I felt that way to find my way quickly to a more effective approach to whatever was bothering me.

    Some approaches that helped: recognizing being over tired or having low blood sugar, learning to meditate, learning to emotionally process difficult experiences from my past in a safe place, spending time hiking and biking, finding meaningful work, listening to clients about their own experiences and seeing what they seemed to find helpful, challenging myself to confront injustice when I was scared of the outcome, raising some wonderful but at times incredibly difficult children, learning how to grow with my wonderful but at times incredibly difficult partner…

    ALL of these things and more have contributed to my learning how NOT to be depressed, and it took a couple of decades and a lot of support from a lot of people, some professionals but mostly just “regular people” who cared about me, or for whom I was responsible in some way or another. How could such a complex interaction of forces be considered a “disease?” Depression didn’t just HAPPEN to me – it was the result of many years of experiences and decisions and goals and accomplishments and failures and relationships. The body was certainly involved, and may perhaps have colored the way I reacted to things. But to reduce my feelings of depression to a random problem in my brain would be absurdly reductionistic and invalidative – it would take away the meaning of the work I’ve done and the things I’ve learned in the process.

    There may be a tiny percentage of depressed people who actually have something wrong with their bodies, and they certainly deserve medical help if it is available. But the vast majority of depressed people have a history of their own, very different than mine and yet in some ways very similar. Reducing their suffering and their emotional experiences to a malfunctioning brain is not only insulting, it is ultimately disempowering in that it denies that person’s ability to look at, sort out, and address whatever range of experiences lie underneath their emotions and behavior. If the indications of depression can be in any way viewed as “symptoms,” they can only be considered “symptoms” (aka clues) of the actual problems or challenges a person has to face. And those problems and challenges are intensely personal and unique to each person, and will never be able to be categorized as a “mental illness” in the physiological sense.

  • Again, we know from scientific research that meditation can change the actual structure of the brain – MENTAL activity can restructure the brain! So to suggest that fixing the brain can fix the mind seems to fly in the face of evidence that it is the mind (whatever that is) that affects the brain, or that at a minimum, it’s a two-way street.

  • Not sure how else I can put it. Mental/emotional suffering does exist. That is not in dispute. The dispute is the idea that “mental illness” can be defined in scientifically precise terms. “Mental illness” is an analogy, a metaphor, a squishy-soft social construct that has no scientific definition at all. Even the former head of NIMH agrees with this. But it is a common argument in favor of the concept of “mental illness” to say that, “saying mental illness isn’t real means that you’re saying that mental suffering isn’t real.” It’s a false equivalence.

  • Your statements are very consistent with my experience with hundreds of domestic abuse survivors. Accusing partners of being “mentally ill” is a very common and very effective tactic used by abusers in domestic relations hearings and in juvenile court child abuse cases. There has been a lot of improvement in terms of professionals’ understanding of domestic abuse, but this strategy still works in way too many cases. And intentionally pushing a partner to retaliate is also very, very common in domestic abuse situations. The threat of involuntary commitment and/or loss of children is a very powerful tool that a “diagnosis” puts into the hands of the abuser, yet a lot of mental heath professionals seem to have no awareness of this kind of manipulation.

  • Expert opinion is, in my view, not relevant to this discussion. We’re talking about science, or I thought we were. The concept of “neural connections” is very soft science at this point – there are not “connections” in the same sense that wires connect to each other. It is certain that neurology comes into play when talking about distressed states, but saying that provides no evidence regarding the causes of distressed states, which is the really relevant point here.

  • I’m not arguing against studying the brain, Shaun. I’m arguing against the idea that you can assume that the brain and the mind are identical, and that studying the brain will yield an understanding of the mind. And I reiterate: the results to date suggest strongly that we are barking up the wrong tree, and in fact probably in the wrong forest. Studying the brain gives information about the brain, which may be very useful information. But so far, the study of the brain seems to have created nothing but confusion about what the mind even is, while studies like Buddhism, which look at the mind as a separate entity, seem to have let to much more satisfying results.

  • The question is not whether distressed states exist. No one disputes that. The question is whether these states can be explained and understood by studying the organ of the brain. I suggest that they can not.

    Of course you can see no distinction, because it violates your basic beliefs. I do assert that the mind boils down to the decisions we make, but more importantly, WHY we decide to make the decisions we do. And I defy you to show where values and principles and priorities are stored in the brain. We don’t even have a clue how memories are stored. You can’t tell me where to find values.

    Perhaps a clearer way to put it is that the brain is kind of like the computer processor. It doesn’t work without a program, which you can NEVER understand just by studying the circuits. But more importantly, the computer requires an OPERATOR. To me, the mind is the operator of the brain. We may one day find the operator within the brain’s structures, but as of now, no one can say where the operator is or how it works. A true scientist would have to admit that this is the case.

  • Millions of people believe a lot of stuff that isn’t true. What is the scientific underpinning of any “mental illness” you can name? How is a person objectively determined to “have” vs. “not have” a particular “disorder?” And even if such “disorders” could be objectively identified (which they can’t), what evidence is there that all people with the same “disorder” have the same thing wrong with them or need the same kind of help?

    The DSM itself proves that neither of the above conditions can be met. It admits in the introduction that there is no line between having one disorder or another or no disorder at all. It also states that there is “no assumption that people with the same disorder are alike in all important ways.” In other words, they admit that these “diagnoses” are actually heterogeneous groups of people who may have little to nothing in common with each other. What on earth is the use of a “diagnosis” that labels people arbitrarily into groups where the people don’t even share common characteristics? It makes about as much sense as saying someone whose knee hurts has “knee pain disorder” which causes his knee to hurt.

    If you claim to believe in science, you ought to think carefully about how these “diagnoses” are arrived at. There is very little science involved, actually.

  • So in other words, yes, you do think the mind and the brain are the same.

    The fact that all information goes back to the brain to be processed proves nothing. The fact that science can’t distinguish between “mind” and “brain” simply means that science has no idea what “mind” is and is incapable of speaking intelligently on the topic.

    MIND, to me, is that part of us that has intentions, valued, priorities, goals, scruples, etc. It demonstrates such qualities as courage, anticipation, regret, integrity, faith, etc. As long as none of these qualities and qualities like them aren’t definable in terms of the brain, then science can not claim the brain is the same as the mind.

    For materialists (like you, I guess), there is no possibility of anything existing beyond the physical. This forces them into a position where they can have no clue what “mind” is, and yet be completely certain it must be part of the brain, “Because where else could it be?” But again, that’s a matter for philosophical discussion, not scientific.

    Science is supposed to be skeptical. This means that if something is not shown by data to be true, it is simply unknown. It can’t be assumed to be true, in fact, any such hypothesis would need to be thoroughly tested and all alternative possible explanations eliminated before we could conclude this is the case. Obviously, nothing remotely close to this has ever been accomplished, or as far as I know even attempted. The fact is, the mind is a MYSTERY to science. It can’t even be defined, let alone located in the brain. (Let me know when you find where “courage” or “integrity” are located in a brain.) Just because you or others are materialists doesn’t mean materialism is “right” or “true.”