Even more important, 50 years of long-term studies have failed to show ANY benefit of long-term stimulant use in ANY major outcome area. This includes delinquency, test scores, teen pregnancy, college enrollment, illegal drug use, social skills or even self esteem. This should be in EVERY textbook so that doctors realize that AT BEST, stimulants provide some short-term changes in the “core symptoms” (meaning that they mostly make kids more manageable). The biggest selling point used to push stimulants is that “untreated ADHD” leads to all these bad outcomes, but as it turns out, NONE of these outcomes is improved by stimulants! What a scam!
Oh, I bet they objected – but they weren’t afraid of stigma to the “mentally ill,” they were afraid of well-earned stigma for their own warped professional history!
Semmelweis is a very sad story. He was apparently hospitalized after this happened because it drove him totally nuts that he had PROOF that hand washing worked and they just ignored it! So we have more proof that “mental illness” is CAUSED by the medical system!
You are correct that there is a high suicide rate among the group, which is a contributor, but certainly does NOT explain a 25-year (nearly a THIRD of an average lifespan!) decline in average life expectancy! Consider also that the suicide rate INCREASES with increasing contact with the psychiatric profession, partly because of the drugs they sell. And there is no denying that antipsychotics cause an increase in diabetes, huge weight gain, and a very significant increase in cardiovascular disease. To think that these don’t increase the death rate very significantly is, forgive the term, delusional. Additionally, cigarette smoking is commonly used by those on antipsychotics to reduce the side effects (it increases dopamine, which is what antipsychotics decrease), and we all know the impact of cigarette smoking on lifespan. So indeed, psychiatrists kill people.
If you were reading the other comments, you’d see that many (including me and the author) that local chapters can provide valuable services, particularly those like yours who allow or encourage leadership from survivors/consumers.
Your last comment I agree with completely, and that is one of the huge problems we face. Without an objective definition, almost anyone could be identified with a “mental illness,” and it is also very possible to redefine “mental illness” in a way that allows the drug companies to create “science” that supports their drugs. They do this by seeing what the drug does and then defining a “mental illness” based on whatever “symptoms” it “treats.” “Social Anxiety Disorder” is one such fake “disease” that didn’t exist before they decided to market Paxil to “treat” it. Juvenile Bipolar Disorder is a similar scam, long since proven to be utterly bullcrap by psychiatry’s own researchers, and yet many youth are still “diagnosed” with this non-existent “disorder,” and given these life-shortening drugs to “treat” their inconvenient childhood behavior.
8 years of medical school is actually a big DISADVANTAGE if you are being trained in things that are absolutely false or are based on false assumptions. Hence, it is actually often parents who are more adept than doctors at sensing what is really going to be helpful, but in any case, the invalidation of the client’s viewpoint is ultimately the most destructive thing that can be done if we have any hope of recovery, yet such invalidation is the core of how psychiatry is practiced today.
Have you read “Anatomy of an Epidemic”? I believe you really would benefit from reading it if you have not. It would help further your understanding of where this big protest energy is coming from. It seems you are not at all far away from my views on what is helpful, though our views on whether national NAMI can provide it seem to diverge.
Thanks for the rational exchange!
— Steve
Hi, Michael!
Well, a lot of people have a similar belief about doctors always being wise and scientific and reliable. It’s a very solid cultural belief, even when evidence speaks loudly to the contrary.
Are you aware that the august Journal of the American Medical Association published an article verifying that receiving medical care kills over 200,000 Americans every year? Which makes it the third leading cause of death in the USA, behind heart disease and cancer. And over 120,000 of these deaths were attributable to properly prescribed and administered medication. A LOT of those deaths are from psychiatric drugs. The average lifespan for those diagnosed with psychotic or bipolar disorders is 25 YEARS shorter than the average American. These doctors kill people. Can you imagine a cancer drug that killed off its patients years earlier than those who don’t receive treatment?
In steps NAMI. They promote a VIEWPOINT that “mental illnesses are just like diabetes” and have nothing whatsoever to do with how people are treated or what kind of stresses they are under, or even what they eat or whether they exercise. They are “genetic brain disorders” and no one needs to “feel guilty” about the damage done to our young people or to adults who have to experience this life-threatening “treatment.” The potentially deadly side effects, though very well documented, are minimized or denied, and the supposed benefits promoted under the tutelage of the drug company sponsors.
In addition, the people running NAMI are not “mentally ill” individuals, but parents and professionals who “know what is best” for their adult children/clients, and when the “recipients” complain, they are accused of having “anosognosia” or of acting out their “symptoms” instead of listening to their views.
Remember also that psychiatrists assured us that Benzedrine was not addictive, then assured us that Valium was not addictive, then Xanax. They also assured us that tardive dyskenesia was caused by “schizophrenia” and only later were forced to admit it was the drugs. So they have a very poor track record of reliability.
So being skeptical about a doctor’s advice is not silly or dangerous – it’s very, very smart. Trusting doctors blindly, especially psychiatrists, can get you killed. But national NAMI does not appear to care much about these problems, and is all too happy to blame them, including the 25-year earlier death rate, on the victims.
I hope that clarifies why it is that I and many here trust neither NAMI nor psychiatrists. I’d be very interested in hearing your specific response to this information. You seem like a smart guy, so perhaps a bit of hard data can help you see another viewpoint, even if you don’t agree with it.
—- Steve
Psychiatry is founded on violence and the judgment of others as “defective” in the eyes of society. “Modern” approaches are simply another way to force the “aberrant” back into line with society’s expectation. While individual psychiatrists may or may not be specifically committed to authoritarianism and invalidation, the entire field, starting with the diagnostic system, is still based on the primitive thinking that gave rise to “insulin coma therapy” and the like. While lobotomies are “out”, the barbaric ECT is still widely practiced, and of course, the drugs used on the brain are all based on stopping the brain from engaging in its normal functions in some way or another. So violence and invalidation continue to be the linchpins of the psychiatric worldview, even if individuals in the field are able to escape that viewpoint.
I think it’s also important to clarify that not all local NAMI branches are as bought out as national NAMI. NAMI Santa Cruz (or maybe Santa Clara) used to have an awesome website with lots of empowering articles and discussion boards. But they don’t appear to any more.
I encourage you to look on the national site and see how many times they talk about “biological brain diseases” and how infrequently traumatic experiences like child abuse are emphasized as causes. See how supportive they are of forcing “treatment” on the unwilling and how often they talk about “anosognosia” and how little they talk about hearing voices groups and peer support (except in the context of supporting peers in following their psychiatrist’s orders). They have improved somewhat since the late 90s when I first encountered them, but the national website is loaded with inaccuracies and power trips that have nothing to do with those who willingly or unwillingly engage in “mental health services.” The unquestioning support for enforced outpatient “treatment” (aka forcing drugs on people who aren’t even endangering anyone just because the psychiatrists think they MIGHT some day be dangerous) should be enough to convince any objective person that they are at best very far down the wrong track. Looking at their Big Pharma connections just explains why.
So yes, lots of people have found local NAMIs helpful, though lots have also found them awful. But national NAMI does not represent the “mentally ill,” it represents their family members and the pharmaceutical industry. Which is a VERY dangerous combination.
— Steve
“Breaking point?” That sounds totally sick! And they said YOU were “mentally ill?” What is wrong with these people?
“Neither expect nor demand.” That’s it, 100%!
MePat, not sure what your issue is, but you seem to be intent on provoking conflict here. I am not in favor of making personalized attacks, but your comments appear to be personalized as well in a more subtle way. Monica made a totally legitimate post, and your comment is simply attacking due to whatever issues you are bringing to the table. I suggest you take a step back and look at your reasons for doing this.
I think the MIA staff is creating a safe space for discussion, or trying to. The only “side” I think MIA is on is that the current way of doing things doesn’t work and needs to be “rethought.” And I agree, more “sides” means less cooperation and less success. We should be emphasizing what we agree on, and your postulates are a great starting point.
I agree. Perhaps they will feel compelled to publish it, as it is a direct response to the article they wrote. Perhaps you can even get other dissident MHPs to sign on to the article?
Fantastic piece of analysis!
Absolutely true. Unless you have the courage of your convictions and the skill to know how to help, the safe play is to hospitalize even if it’s totally uncalled for and totally destructive to any chance of further therapy. It’s no wonder that clients don’t tell their therapists when they are suicidal, but when they don’t, they’re then called “manipulative” and get labeled “Borderline Personality Disorder.” If you wanted to create a system to discourage healing, the current one would certainly do the job.
A very good article! I’ve always been very suspicious of “EBT” for the very reasons mentioned in the article, namely that it is both politically and financially motivated. The one issue not addressed in the article is that in order to be an “EBT”, someone has to spend the money to research something in a systematic way. Guess who has the most money to fund such research? Drug companies, of course. Drug companies can afford to run multiple research studies (and of course can afford to buy “results”) in a way that other entities can’t. So of course, most “EBTs” are drugs. Pretty sneaky!
I also like the emphasis on humility and individualized approaches, even in the purely medical world. That thinking is 50 times more applicable to the “mental health” world, where there is no concrete way to even say who is “ill” or if anyone is “ill” at all.
Thanks for the link!
— Steve
I did a training on suicide intervention with mental health therapists many years ago, when I worked at a volunteer crisis line. Our volunteer crisis counselors knew 10 times what the professionals knew about helping suicidal clients. Our emphasis was listening and understanding, focusing on what can be controlled vs. what could not, building relationships, and inviting further contact as frequently as needed. Most of the professional therapists didn’t seem to even have an idea what to do besides calling 911. They didn’t even have the skill to figure out who was contemplating doing something immediately vs. those who were feeling despairing but mostly needed to talk and connect. They were effectively clueless. That was in 1992. Things are far, far worse today, because at least the ones we were training knew they didn’t know, whereas now they can just diagnose them and send them to the psychiatrist or the hospital as soon as anyone even talks about the word “suicide.” Many therapists are simply scared by any suicidal statements and go with the safest approach for THEM, rather than the best approach for the client. Of course, there are many exceptions, but I’d say a majority of therapists are not really prepared to deal with a suicidal client, both in terms of training and in terms of their own emotional reactions. In fact, many therapists appeared to hospitalize people for much less serious things like self-harming in ways that are neither intended to nor capable of killing or even seriously hurting themselves. Which meant the self-harming people couldn’t even talk to their therapists about their urges without risking being hospitalized, so they called the crisis line to stay anonymous and to actually find someone who would listen.
So you’re not wrong. A lot of therapists don’t actually have any training in helping suicidal people, and as often as not, it is not really safe to tell them if you want to just talk without being hospitalized.
— Steve
Can’t ask for more than that. Sorry your first go was a little rougher than expected! I appreciate you hanging in through a difficult conversation, and I hope we’ll be hearing more from you in the future. I think in the end it was a very important conversation about topics that are central to this project of “rethinking psychiatry,” and while I wish we all could figure a way to have these discussions with less rancor, it’s a very emotional subject, especially for those who have been “helped” in some not very helpful ways by the system.
Keep the faith!
— Steve
Without feedback form the client, how would you ever know if you were making progress? This seems to obvious as to be trivial, but it’s clear from the data that the majority of therapists don’t practice this way. It’s a head scratcher, for sure!
Fantastic article, Kelly! I once handled a crisis call from a woman who was frantic about her ongoing depression and anxiety. She told me a list of at least 4-5 antidepressants she’d been on and nothing had changed and she was worried that she’d ALWAYS feel this bad and it was driving her crazy! That’s kind of how she talked. So I asked her one question: did anyone ever tell you there are other things you can do for depression and anxiety besides drugs? She stopped cold for a moment. Calmly said, “No.” I said, “Well, there are.” She said, “Oh. Well that’s good!” She instantly felt better knowing there was something she could do herself, but had been seeing mental health professionals for A WHOLE YEAR and no one had told her there was more she could do.
I’ve worked for years with foster youth who are put on these drugs sometimes in elementary school, despite the data saying they don’t work, and I can’t think of one who was told that s/he might become aggressive or suicidal on these drugs, nor were their parents or even their caseworkers informed. I ended up being the one who shared these facts. It is a very disturbing reality when people are given drugs that don’t work, not told of potentially dangerous or deadly side effects, and not given any alternative that might actually help them out. Not saying some people don’t feel good about their antidepressant use, but informed consent basically doesn’t exist for these drugs!
Wow, I just realized how appropriate the title of this article is! This really is a clash of perspectives, but not necessarily the perspectives outlined in the article. I think the real clash of perspectives is between the more powerful (professionals) and the less powerful (let’s just call them “recipients” for now) who meet in the crazy world of “mental health.” Maybe it’s easiest to understand if looked at that way – as a clash of worlds. The problem being that when worlds clash, the more powerful are able to continue to maintain that their world is the “right one.” Similar comments apply to the recent intense discussion of “reality” vs. “delusions.” Hence, my comments that power dynamics are the most important aspect of a helping relationship, and if they are not resolved, it’s hard to get beyond a fairly rudimentary level of “helping.” At least that’s my experience.
You mean being active isn’t a disease? Might even be good for you? Go figure!
I really do get both sides if this conversation, and I understand why it is uncomfortable for you, Kurt, and I also understand your frustration, Sera.
I don’t think Sera is trying to be hurtful but is speaking from the heart as a person who has experienced the “help” of the mental health system and found it quite harmful. It appears you have embraced the science that Bob has published, which is great. But I think. Sera’s getting at what I was talking about earlier, and it goes deeper than Big Pharma corruption.
Perhaps the clarity comes from your response to my comment when you said that “power dynamics have to be considered.” I think a different viewpoint, which I am trying to convey, is that “dealing with power dynamics between provider and client is central to ANY effort at creating healing.” I believe that people who have been harmed by the system tend to take the second view. I think it is hard for a professional person who hasn’t been in that position to really understand why, and it often comes across as hostility, and actually can BECOME hostility if enough frustration builds up. But what Sera says is absolutely true – the privilege of being “the professional” allows us (and I include myself as a fellow professional) to dismiss or minimize the impact of our power differential, and this gets in the way of or sometimes completely prevents a healing relationship from forming.
I don’t know why I have been granted the ability to bridge this gap, but somehow I really see and understand deeply the cost of resting comfortably in our “professionalness,” as well as the true power of stepping out of those shoes and meeting our clients where they are without the slightest judgment or condescension.
It is hard to describe if you haven’t been there, but it really does come across in your presentation that you don’t quite grasp this reality, although I am quite sure you do excellent work within the context of your role and that clients would be VERY fortunate to see you vs. the average mental health professional. There is just a possibility that you might be able to take one step further to seeing the reality of your clients, and I am hoping this discussion might make you aware of that step. Again, I’m not saying you’re doing something WRONG or that you are a bad actor and I’m not minimizing the work you’re doing to make the mental health world more respectful of those it serves. But Sera’s viewpoint is (I believe, not trying to put words in your mouth, Sera, so please correct if I’m off) just the viewpoint I was wanting to point out – the idea that it is the CLIENT (if that’s even the right term) who has the right to define his/her experience and whose viewpoint and needs must be the touchpoint of any intervention.
If you had been a recipient of these services yourself, I think you’d see a different perspective that comes from chronically being in that one-down power situation and having to be careful not to say the wrong thing because some “helpful professional” will decide what is “good for you” and make you have it whether you want it or not (and I don’t just mean drugs here). It’s like being a kid in school again, except the punishments for stepping out of line can actually imprison you, disable you for life or kill you.
Not sure what else I can say. I know not everyone is always a diplomatic as they might be on this site (though in fairness, I thought Sera’s first message showed a strong effort in that direction), still, a similar message has been communicated a number of times by a number of different people, and maybe there’s something there you’re not hearing. That’s all I’m saying. If I didn’t think you had it in you, I wouldn’t have put this much energy into it. If it’s not something you can get your arms around, that’s OK with me, but I don’t think the message is intended to hurt, it’s intended to inform, whatever form it has taken. I think there’s something there for you to take a look at, and I believe you’re enough of a real professional to hear that message if you can sit with it for a bit.
Hope that helps!
—- Steve
I would have to amend that to say I’d suggest being VERY CAREFUL about whom they might trust. There are definitely a few diamonds in the rough, and clients/patients/inmates are sometimes fortunate to find them, but I would most definitely counsel them that sharing in a hospital could be dangerous and to be very selective about whom they might trust. In fact, I’d tend to apply that to any counselor/social worker/mental health professional in any role. A lot of damage can be done by trusting the wrong person with sensitive information, and sometimes the very best thing we can teach our clients is how to figure out whom they can and cannot trust.
Thanks for sharing your story. It sounds just plain awful! It has always stunned me that they can forcibly “hospitalize” you against your will and then CHARGE you for the privilege! Stunning!
And we have to remember that it takes only one or two bad experiences to shut down trust in service providers for the long term. Even if 80% of providers are safe, the client doesn’t know which are dangerous until they open up and potentially get hurt. A bad experience often means no one else gets a chance. I always thank clients who extend their trust because I understand the risk the are taking. All clinicians should learn to appreciate how precious and delicate that trust is for the vast majority of clients.
Wow, what a sad and infuriating story! Good for you for standing up for yourself! Did you say your “symptoms” are decreasing but they still want to force you onto antipsychotics? Do you have a good attorney? Wish I lived in Michigan – I’d come and support you!
Sam, your comments are incisive and effective as always – thanks!
Kurt, I would very much be interested in hearing more about that project – do you have a link? It’s easy to give lip service to “informed consent,” but how many clinicians really do that even for adults, let alone kids? In my experience, not only do foster youth not get informed, they are outright lied to about what is being “treated” and what their options are, let alone the common fear of telling them about medication side effects. It sounds like this program would directly address that issue, and I’d love to hear more about it.
Personally, I think we should do a lot more than “consider the perspective” of the youth we’re treating. Their perspective should be the main jumping off point of any planned treatment, and should constantly be consulted as our guide to whether or not we are being effective in our work.
Thanks for your response!
—- Steve
Fair enough. The ACE study has brought an increased awareness if the impact of trauma, though my experience is that the mental health system has been very slow to respond. Perhaps you are fortunate enough to travel in more enlightened circles than those I have worked in.
However, years of advocating for foster kids has shown me that very often, we as adults really do care and BELIEVE what we are doing is right and helpful, and yet those receiving our services don’t feel that way at all. I suppose the lesson I find is that kids have a lot to say but the adults don’t often create safe spaces to listen. I just had occasion to talk to a young couple in their early 20s last night who had seen the whole series (I’m only about halfway through, and most definitely NOT looking forward to the suicide scene, it sounds AWFUL!) and both of them said that the conditions represented in the school in the series were not an exaggeration and seemed very familiar to them. I think it’s way too easy for those with power to imagine we are doing good without bothering to consult those we are purporting to help, and I hope that is the real takeaway from this provocative series.
And in perfect timing, here’s an article published on MIA that supports exactly what I’m saying:
I am quite sure that YOUR students are trained in a different way, Kurt, but I’m pretty confident that many if not most in the USA are trained in DSM diagnosis and brain-disease theory, even if some rebel psychologists/therapists provide different perspectives. And just like the kids at Hannah’s high school, whatever their prior training and beliefs, they have to deal with the oppressive system that they will be operating in, and that system challenges anyone who wants to look at “mental illness” in more human terms. I say this as a mental health professional who got out of the field and into advocacy after I could no longer stand seeing what happened to my clients who were hospitalized or even “treated” by the agency I worked for. I have many more than one anecdote to share (though it was actually a study, not a single anecdote), and the comments I make apply not only to the mental health system, but to almost any institution in US society today. That’s the point I was making – that Hannah’s difficulties were not a result of a “mental health issue,” but of her and her friends/associates having to survive in an oppressive environment day to day and the absence of anybody in a position of power willing to or capable of intervening. Perhaps I have put this in better terms this time and you can comment on this aspect of suicide prevention, which I believe is the main point the series is trying to highlight, namely, that someone has to acknowledge and challenge the power dynamics in the school and the larger environment for this kind of depressing hopelessness really to be challenged.
— Steve
You captured what I wanted to say in many fewer words. The teens’ behavior is a response to the structure provided (or not provided) by the responsible adults. Those setting up the system are responsible for making sure it works, not those who are powerless participants. Thanks for your comments!
Thanks!
Thanks! Back at ya!
Perhaps you misunderstand me. I have helped run a suicide hotline and have done involuntary hospitalization evaluations. I’ve placed many people into involuntary holds, directly or indirectly, and have also intervened with many, many more suicidal people and prevented many, many hospitalization with on-site or telephone crisis interventions. I have also spoken with many folks who have been hospitalized after the fact. To suggest that traumatization by involuntary hospitalization is rare suggests a Pollyanna view of reality. Sure, clients in the hospital often express relief that they didn’t end up killing themselves, but they also learn very quickly that telling the staff you’re pissed about how the situation was handled or that you feel powerless is both pointless and dangerous. I don’t know if you watched the show in question, but you ought to, and you ought to look at how often the teens tell the staff and/or their parents and even each other that everything is “fine” and there are no problems, even though they are seething with discontent, fear and grief. You have to develop sufficient trust for people to tell you their true feelings. I am very good at doing so, and I guarantee you that feeling traumatized is far from a rare thing.
As for suicidality from antidepressants and antipsychotics, gosh, there are warnings on the labels to this extent. Not sure how you can actually argue that point. New evidence more recently has shown rather conclusively that these effects are not limited to teens and young adults. Aggression is also sometimes a consequence of messing with the serotonergic system, as is listed on the label of all of these drugs, and as a recent MIA article has documented.
Naturally, preventing immediate suicide IS important and is the priority in a crisis situation. That was not my point. My point is that IN THE CONTEXT OF THIS SHOW, talking about methods to reduce the likelihood of suicide without looking at the causes misses the entire point of the production. The point is, people had MANY opportunities to intervene and perhaps prevent this suicide LONG before the crisis situation ever began to arise. This is true in many, many situations and the main intervention is to have people care about you and have the guts to stand up to bullying, sexual assault, and harassment instead of keeping quiet until the victim can’t stand it any more.
The secondary lesson also appears to bypass you completely based on your comments. The show demonstrates how our INSTITUTIONS, parents, police, schools, and the mental health system itself, fail to create a safe place where talking about the above issues is realistic. To give you an illustration, a recent survey of kids in residential treatment centers showed that they revealed significant trauma histories to complete strangers in 80% of the cases. Oddly, only 20% of the cases had traumatic events documented in the file! So at least 60% of the kids were willing to share their abuse stories with TOTAL STRANGERS but were either never asked by staff, didn’t feel safe telling them, or worse yet, told staff who didn’t feel the information was significant enough to include in their files.
Perhaps you have to watch the series to know what I’m talking about. Perhaps you need to step down from your professional pedestal and actually meet your clients where they live. Maybe you should ask a couple to DESCRIBE what being taken into custody was like, rather than asking them if they are grateful to be in the hospital. You might be surprised how many people appreciate that someone cared enough to try and stop them, but most definitely did NOT appreciate the violence and invalidation involved in being taken into custody. I’m sure you’ll hear from many of our regular posters on this point.
Lastly, your comments on how benign the SSRIs have since been found to be are questionable to me and lack any reference. It might help if you can provide links to these statements.
Appreciate your candor in responding, but you might want to avoid questioning my experience and credentials before you know anything about me. It is that kind of approach that encourages people to say they feel fine when they really don’t.
— Steve
While I appreciate the important emphasis on compassion for suicidal teens, I’m really not sure what to say about this article. While I agree that putting resource numbers at the end of each episode is a good idea, I’m kind of astounded at how badly the author appears to miss the point of the series. The comments about not needing to understand the “why” and simply removing “means” seem to invalidate the important issues that the series raises, namely the importance of understanding the context in which suicides occur. The whole point of the series is to show that there ARE whys and that many people COULD have done something about the situation but did not! It also emphasizes that systemic changes are needed, as administrators and the counselor don’t appear to understand that bullying is rampant in the school, and the kids are unable/unwilling to trust the adults BECAUSE THE ADULTS HAVE NOT SHOWN THEMSELVES TO BE TRUSTWORTHY! The counselor and assistant principal had Clay on the verge of talking about the whole situation, but their authoritarian and accusatory approach caused him to clam up. The similarities to the situation in the “mental health” system can’t be missed by anyone who has been on the receiving end of “services.”
The incredible challenges involved in reporting sexual assault are also highlighted, and contributed very significantly to Hannah giving up. One very good way to reduce suicides is to make it easier and less traumatic to report events like sexual assault and domestic abuse, but the author fails to even mention these points in the article.
From the article: “Part of the problem here centers on what happens after a person is hospitalized and the time immediately after discharge. As clinicians we can sometimes be lulled into a false sense of security that as long as the acute crisis is dealt with, we are out of the woods. Regrettably this is often not true.” This suggests that suicidal feelings somehow “sneak up” on clinicians because the clinicians are overconfident that “the crisis is over.” This ignores more significant reasons why suicide happens AFTER hospitalization. First, hospitalizations are TRAUMATIC for most clients, especially if they are enforced or not entirely voluntary. This trauma is denied or minimized, just as the administrators at Hannah’s school deny or minimize the enormous reality of bullying in their school. As a result, no one talks about this to clients, nor acknowledges the feelings of powerlessness that often occur in the context of a psych ward. Additionally, many clients describe being unwilling to communicate their feelings to their professional support people after being hospitalized against their will, because they are afraid to be hospitalized and traumatized yet again.
Second, the main thing that happens during psych hospitalization is that the client is tried out on a new drug regimen. It is well established at this point that antidepressants and antipsychotics, the two most common prescriptions given in psych wards, both can induce suicidal ideation or action. To ignore this important variable shows a limited commitment to scientific reality.
To talk about “suicide prevention” outside of the context of why people kill themselves seems bizarre and disconnected. In fact, it seems to reflect the same kind of disconnectedness that kept Hannah and Clay and the other students from reaching out for help. I think the author does a great disservice to both clients and professionals by suggesting that preventing the ACT of suicide is more important than preventing suicide by understanding our clients and by revising and reforming our institutions so that trauma is less common and easier to talk about with authorities and less traumatic to resolve.
— Steve
Actually, they can’t even objectively identify who belongs to the group “addicts.” It’s downhill from there.
I object to the labels because they are not scientific, as not a one of them defines a group that can be accurately and objectively distinguished from a group not having the “disorder” in question. That’s not a political objection, it’s a scientific one. If you can’t establish a reasonable amount of variable control, you can’t do science. You can’t do studies on heterogeneous groups and expect to learn anything. It’s about that simple.
— Steve
Jill, this simply can’t be true. There are many, many people who experience similar disruptions in their dopamine system temporarily and yet don’t become addicted. It is claimed that this difference proves a biological underpinning, but I don’t think there is much evidence that that is true, because it should be very evident from both research and a casual survey of the addicted population that there is an ENORMOUS disproportion of people who have been severely traumatized in their childhoods or later on who then become addicts. While it is possible that there is a subset of addicts who simply “can’t stop” for biological reasons, this subgroup has never been identified, as is usual for all psychiatric “disorders,” simply because the profession is comfortable sorting people into boxes based solely on behavior and have never bothered to try and make any kind of distinction between the reasons that people become addicted. It is both more convenient and more financially remunerative to dismiss the importance of causes, but it doesn’t serve the addicted person very well at all. As a result, neuroscience can tell us a lot about what happens to a brain after it’s soaked in dopamine for long periods of time with some accuracy, but it can tell us essentially nothing at all about why some people choose to so bathe their brains while others choose not to.
— Steve
Arguing about which drug “relieves stress” more effectively is a ludicrous proposition. Alcohol can make anyone feel less anxious in the short term. Getting drunk is not a medical treatment.
Excellent analysis, Richard!
Your comments make sense to me. We need to seek a balance, and stop trying so hard to be “right” at the expense of someone else being “wrong,” which to me is the very essence of authoritarianism. I’m sure we’d have some fascinating discussions in person! Thanks for sharing your thoughts so articulately.
— Steve
Exactly. It’s about having the power to define one’s own experience. Parents “advocating” for “eliminating” what some people view as parts of their personality is more than a tad invalidating!
I know what you mean. I think it’s hard to really understand the level of trauma and disrespect and outright shaming and humiliation many of these survivors have experienced, usually from the hands of authorities like their parents or teachers or “mental health” professionals. I find their anger quite understandable, having spent enough time in “mental health” agencies and a couple of psych wards and heard enough stories to see what really goes on. It is unfair when overgeneralizations are made, and it does make some folks anxious about posting. And some of those comments, like calling you a “NAMI Mommy,” are just insulting and inappropriate. But it is important to realize how much hurt is there and that such comments are not really directed at you personally, they are directed at all the “mommies” and “professionals” and other authorities out there who have hurt them and not even noticed or cared.
You are clearly a good person who likes to deal with facts and has done some great work confronting the system with its own failures and mean-spiritedness. I’m glad to have you hear with us, despite the challenges you have faced!
— Steve
The video was pretty disturbing, to say the least!
It is also important to note that a lot of parents are unable to recognize how they are harming their children or encouraging or creating the very behavior that bothers them. Giving them this “explanation” prevents any meaningful dialog with caring parents who might actually be willing to CHANGE their behavior if they understood what was going on. The whole point of the DSM labels seems to be to blame the person who is suffering and absolve those with the power to actually do something about it from any responsibility whatsoever.
— Steve
Love it!
Wow, you mean you’d try to distinguish between possibly disparate CAUSES of “depression” instead of treating all “depressed” people in the same way? Wow, what a concept!
Thanks for your comments – glad I can beat out the catfish for empathy, but sad that a catfish beats out the psychiatric profession!
Good for you for beating NAMI into submission! You must be a proud ODD victim!
— Steve
“The criticisms of small effect sizes raised by these letters imply that we should only use the term brain disorder when everyone with the disorder shows the same pattern of brain abnormalities. By that definition, no psychiatric disorder would be a brain disorder.”
Excellent point! They have accidentally drawn the correct conclusion – no psychiatric disorder can qualify as a “brain disorder.” This is like saying that not all people with cancer should show the same indications of inappropriate growths, or that not all people with high blood pressure need to have higher than average blood pressure. Such idiocy is what passes for “science” in the world of psychiatry!
—- Steve
I’d add also that the support of the pharmaceutical companies for these supposedly “patient advocacy” groups and the pushing of pharmaceutical solutions to every problem adds to the lack of trust in these organizations. Further, the lack of any apparent interest in consumers/survivors contributing to their agenda is a barrier to trust.
I’d have look at the youtube from Autism Speaks if you had any doubts of their lack of connection to the actual needs of autistic people:
I think the anger toward Autism Speaks and toward NAMI is not a result of people denying the existence of conditions that are called “mental illness” or “autism,” but rather of the “professionals” and parents of such people deciding how to define what is “wrong” with their clients/children as well as what they HAVE to do to “fix” themselves to the satisfaction of the parents/professionals. It is a very undignified position to put someone in and folks are understandably upset/angry about having that done to them.
It is important to distinguish also between saying that no one SUFFERS from conditions that are called “mental illnesses” in the DSM, and saying that the DEFINITIONS of the “disorders” in the DSM are unscientific and damaging. No one is saying that people don’t suffer or that they usually want their “symptoms” back if they go away. What I think most people are saying is that LABELING someone with a “disorder” and prescribing “treatment” based on fraudulent notions of “chemical imbalances” while completely ignoring trauma, social conditions, nutrition, sleep and other factors that may cause or contribute to the distress. It’s kind of a shorthand to say “mental illnesses are a myth” when we mean “mental illnesses as defined in the DSM are unscientific and misleading.” Based on what you’ve said earlier, I don’t think you and I are very far apart on that question, though I’m happy to be corrected if I got that wrong.
People definitely experience all forms of distress and difficulty, and no one is saying they don’t need or deserve help. All I’m saying is that DSM labels and condescending “professionals” who are unable to see past their own biases and issues are not helpful to anyone.
— Steve
Well, of course not, silly! How can psychiatry and the drug companies keep the money coming in if you actually CURE people of what ails them?
I tend to agree with Richard in that it seems kind of over the top to suggest that “matriarchy” is anything close to a power in the USA. I have heard from my own son that there is a certain authoritarianism that can arise in his left-leaning college and that he finds that offensive. However, this is not a manifestation of “matriarchy” so much as of AUTHORITARIANISM. Anyone who believe the right has cornered the market on authoritarianism has something big to learn, and there are also plenty of conservatives who are open minded and not sexist or racist. So we shouldn’t be making over-generalizations as if they are the truth, because that’s another form of authoritarianism right there.
I think authoritarianism itself is the real enemy, and both Martin and Richard are recognizing it in different forms, but I find we get into trouble when we allow ourselves to be herded into the classic “liberal-conservative” discussion frame, as this seems to me to be an anachronistic frame. Richard and especially Frank hit hard on this – it is this belief that the global capitalists/corporatists have our “best interests” at heart and the unchecked power they now wield that should be our target. And I gather that all of us agree on that point. So I’d suggest we get away from blaming liberals or conservatives or those under 35 or their parents or matriarchy and direct our energy toward the hegemony of the rich and powerful, as well as all the manifestations of authoritarianism, both on the left and the right, which impede our ability to attack those targets. At the same time, civil discourse, including cross-cultural awareness and sensitivity, is going to be very important to moving forward with these goals, not because people “aren’t tough enough,” but because people are very susceptible to being misdirected into foolish discussions such as whether Democrats or Republicans are responsible for the mess we’re in (or for that matter, which party is more likely to be “mentally ill”) and it requires diplomacy to help get people over these barriers and to see what’s really going on and that their enemy isn’t black people or women or white people or liberal universities or matriarchy, but CORPORATE POWER AND AUTHORITARIANISM. It’s not a matter of rightness, it’s a matter of effectiveness.
— Steve
Yes! They have been beating down Autism Speaks because they have organized a resistance movement. That’s what we need to do!
And how did s/he respond? Did logic actually have any positive effect?
So here’s the big question, Pat: how exactly does one distinguish between these two purportedly distinguishable groups? Psychiatry has no answer for this, none at all. They give lip service to the idea of “endogenous” vs. “situational” depression, but their DSM checklists don’t even attempt to make that distinction that I can discern. I’m quite serious when I ask this question – how would you tell the difference?
— Steve
Only if you’re genetically vulnerable to car accidents.
Perhaps they should just eat a lot more yogurt? Oh, but that can’t be PATENTED, can it?
You are so right! The diagnostic process itself is a means of “blaming the victim” and distancing ourselves from the “mentally ill” individual, as well as avoiding any and all responsibility for doing something about the situations that may have caused the problem. ADHD is a great example. The fact that a child can’t stand sitting through your class does NOT mean there is something wrong with the kid! Maybe your class is incredibly boring, or this kid simply hates to sit around doing nothing with his body, or the kid is super smart and figured out what you’re “teaching” about two years back, or you’re talking over the kid’s head and he has no idea what you’re talking about but is embarrassed to admit it, or the kid is distracted by the fact that his dad threatened to kill his mom last night and he’s wondering if she’ll still be alive when he gets home today… you get the drift. But with “ADHD”, no one has to ask any of those uncomfortable questions, and the teacher doesn’t have to change a thing! We simply blame the kid’s brain and put him on a drug that makes him less annoying to the teacher, despite long-term evidence that this does NOTHING to improve the kid’s overall well being down the road.
It’s a cop out. The least powerful person in the room takes the blame, which is probably what got them to be labeled “mentally ill” in the first place!
—- Steve
I agree. It is also important to recall that these studies showing increased suicidal thinking or behavior SCREEN OUT suicidal people before starting the experiment! So the results are actually reflecting not the total number of suicidal thinkers in the group, but the total number BECOMING suicidal as a result of “treatment.” Especially when we look at the long-term outcomes being so poor, “antidepressants” are not only generally ineffective, they are overall more dangerous than they are useful.
You know, not everyone who gets hit by a car has internal injuries. Probably 90% escape with no internal injuries at all! There MUST be something wrong with that other 10%… Let’s do some genetic analysis and see if there are commonalities among those who appear vulnerable to internal injuries so we can counsel these folks to wear extra protective gear when walking around near traffic, or perhaps prescribe some organ-toughening or bleeding-suppressing drugs for them to take all the time, just in case it happens again.
What, install a traffic light? What kind of naivete is that? “Common sense” has failed these poor people who are obviously genetically vulnerable to damage from being hit by cars, so let’s dispense with it altogether! After all, 90% of those hit by cars had NO internal injuries whatsoever! What’s wrong with the rest of you wimps?
—- Steve
I actually believe that this discussion was a very healthy one in many ways, and is full of learning opportunities if we can all put our hurt feelings aside.
There are some comments which possibly could have been moderated, but the rate of comments is so fast, I’m not sure it’s realistic for anyone to intervene quickly enough. But I still find discussions like this INCREDIBLY valuable, because we are now discussion one of the most fundamental problems/issues/conflicts with the current system, not just the mental health system but our social system as a whole: WHO GETS TO DEFINE WHAT IS TRUE/REAL/VALID? And it’s not an easy question!!!
I would exhort ALL posters to take this thread as a lesson on how important it is to be respectful and to own our own views without invalidating others who post. After all, isn’t that the very thing our most passionate posters are objecting to? The idea that “mental health professionals” are allowed to invalidate your reality? Well, let’s not do that to our allies in the mental health professions, either, or better yet, let’s all commit not do that to ANYONE who posts here!
There are many professionals who have been extremely courageous in their battle to make things better for those condemned to interact with the system for whatever reason, and Brett and James are certainly two who qualify. If they say something that we object to, let’s treat them the way we’d want to be treated, respecting their viewpoint while respectfully disagreeing and expressing our own. Let’s model how helpful human interaction SHOULD be right here on our site! Similarly, we who come from a more professional background, let’s understand that feelings will get strong in this kind of discussion, for very good reasons, and let’s not take it personally and use our best professional skills to moderate the conversations ourselves rather than escalate them with our own emotional reactions.
“Be the change you want to see in the world” – we can do this, all of us, right now. It’s really the best, maybe the only way to counter the crappy treatment that so many authorities dish out.
In the end, this was a very valuable discussion. It will be more readable and will affect more people in the way we want it to if we ALL take the time to moderate our own comments, as well as accepting it if we may have offended someone else and taking steps to make it right. Stephen is right (as usual) – if we consider that we’re dealing with very different cultures colliding here, and act accordingly, we’ll come out much stronger and more effective in the end.
— Steve
P.S. One last thought – I wonder if we might have a cadre of “on-call” moderators available for the times when a discussion like this one gets big and deep and powerful? I’d be happy to volunteer for that role. Emmeline, let me know if you’re interested!
Brett, I really appreciate this reply – it certainly reflects that you fully read and digested my comments, and I feel fully heard. It is actually quite a conundrum to me: I’d really LIKE to have lots of mental health professionals join this site and the movement in general, and I know that angry survivor voices most likely impede that; at the same time, the main REASON I’d like to see more professionals is because we generally don’t pay attention to or block out the very voice that is being expressed here. I don’t see any real progress in the field until and unless hearing the voice of those harmed by the system, and even those not yet harmed but who are at high risk to become so, becomes the PRIMARY voice by which we operate.
I was fortunate to come into the mental health field by the “back door,” so to speak (my MS is in Education, actually), and I was in a position initially where I had very little theoretical training but a lot of compassion, and I actually developed my initial knowledge base almost entirely from talking to clients and seeing what they needed and how they reacted to my approach. Of course, I made lots of mistakes, but I did so with an open heart and an open mind and was almost always prepared to be corrected by the client’s verbal or nonverbal communications. I think this last part is what many professionals are lacking, and the DSM and the current system of dismissing trauma and blaming the victim makes it WAY too easy for professionals to dismiss their clients’ righteous indignation (at them or at their previous traumatizers) as irrelevant or “inappropriate” (I HATE that term!) That absolutely HAS to change – the client’s emotions and reactions and information HAVE to be the basis of all we do, or there is really no point in putting ourselves out there as helpers. Which is why my initial reaction to this idea of “correcting” the perceptions of others was so strong – it just plain doesn’t work, and it leads to exactly the kind of anger we’ve seen on this thread. Survivors of the MH system are not ever going to be OK with having their own realities invalidated, because it’s happened WAY too many times both before and after entering “the system.”
That being said, I really do appreciate your efforts and I also really do understand your frustrations. As I said, it is a conundrum of major proportions. All in all, I’m really glad this discussion happened, and in my view, by taking the risk of expressing your own experience here, you were a catalyst for the conversation going much deeper than it otherwise would have gone, and I really appreciate you for putting yourself out there and taking some hits to get folks to dig down deeper. I hope you can reflect back on what’s happened and see the value in the discussion, even though I know it caused you some personal pain to participate.
Thanks again for all you have done to move this project along!
—- Steve
I would most definitely miss you and your contributions!
— Steve
Exactly!
Or be therapists to anyone who is actually experiencing emotions of any sort.
It feels like entitlement – that “professionals” somehow are entitled to be protected against anger and being perhaps unfairly targeted of others’ rage. Naturally the recipients/victims of the “mental health” system are not entitled to any such protections.
An important contribution of Freud was the idea that clients who have been unable to speak their rage and helplessness will make us FEEL their rage and helplessness through their behavior. Professionals worthy of the name ought to know that well and understand that especially if they are “safe” professionals, they WILL be targets of these emotions, and they should expect it. I would go so far as to say that any professional who can’t handle this should stay far away from trying to “help” people and do something where they won’t have to deal with the discomfort of people’s real emotions.
Thanks for your lovely comment!
Excellent point!
VERY well said!
I agree, Sandy sets the ultimate example of how to handle criticism professionally. Her humility and her willingness to learn from other viewpoints makes any attempt to needle or provoke negative responses from her fall flat. That is the kind of professionalism we need from professional bloggers and from professionals in general who want to change the system. If we can’t listen to the distrust and anger our wonderful “system” has helped to create, how will we ever be able to alter things in a healing direction?
I would also add Johanna Moncrief and Lucy Johnstone to the list of professionals who are not afraid to roll up their sleeves and swim into the seas of conflict!
— Steve
Brett, I am sorry you have felt so attacked by this discussion, and definitely can see how you might have felt that way, as some comments did seem very personal.
I generally find your comments highly enlightening and thought provoking, but I have to say, this last set of comments makes me wonder if something has triggered your own issues here. I could be wrong, but it doesn’t feel to me like you’re simply working to improve the quality of the comments or improve the likelihood of the mission being effective – you sound angry and irritated, and you’re making gross generalizations, for instance, about people in general being anti-science or positing that there is no objective reality, which characterizes a VERY small proportion of the comments I’ve read.
I agree that professionals posting here are sometimes attacked unfairly, but again, I think that is a function of the kind of audience this type of a website will inevitably attract, and I agree with Richard that it is part of our job as professionals to be able to respond to such apparent attacks without rancor or judgment. The voice of the oppressed can be harsh, especially toward the perceived authorities, but that is a function of the trauma they have experienced and their righteous rage, not necessarily any reflection on you and your contributions to the movement.
Which gets to the real point of the discussion, which I wish you had tried to hear behind the anger. The point is not whether there IS an objective reality, the point is whether PROFESSIONALS like you and James and Richard and Stephen and Ron and I are entitled by virtue of our professional titles and experiences to DICTATE what reality is to our clients? Or is it our job to negotiate, test, communicate, question, probe, and encourage our charges to look at things from different viewpoints and make their OWN evaluation of what reality is. I heard one commenter only who pitched the idea that reality is whatever we make it – the vast majority accept objective reality exists, and are objecting instead to the idea that it is James’s or my or any of our jobs to CORRECT the client’s perceived misconceptions of reality, but suggesting instead that our job is to explore with them how and why their “misconception” makes sense to them and move forward from there. Of course, there are times of danger when we may feel we have no choice but to act protectively, but the VAST majority of the time, the client’s “delusions” are no more delusional than the psychiatrists’ idea that their lives can be fixed by drugging their brains, and actually far less dangerous. It’s a question of whether reality is something that the authorities dictate to their subordinates or is something we discover together, understanding that none of us has the full scoop on what “objective reality” truly means.
I hope this clarifies at least where I and where I think a lot of other posters are coming from. It is really not personal, even if it may seem like that. And being a professional means being able to make that distinction. You are getting the suppressed rage from every time these posters had something to say to a professional but didn’t feel safe saying it or was punished for doing so. It may not be good politics, but it is a natural outgrowth of a certain part of objective reality that professionals in similar roles to you and me have historically tried very hard to deny exists. It’s gonna happen, and it’s not fair, but it’s reality. For all this talk of clients denying reality, I think we as professionals need to be honest enough to admit that the clients’ reality as conveyed, whether fair or not to us individually, is a VERY big reality to be dealt with, and the system change we want to see happen will NEVER happen until we as professionals can not only accept but embrace that reality, the reality of the very clients we are trying so hard to help.
— Steve
Actually, I think a goodly percentage are actually that delusional. The ones at the top know what they’re doing, but a lot of the rank and file are just emotionally crippled people who have been trained to say certain things, so they say them.
Another fox guarding the henhouse. Such corruption is unprecedented, in my opinion.
I am with Richard. I think being a professional means taking responsibility for the effect you have on your audience/client base, whether intended or not. I always figured that people have the reaction they have, and whether they were polite about it or not, there was almost always important information to be gained from hearing and clarifying their reactions. Part of being a professional is understanding that the client is going to have reactions and that it’s your job to set the tone of respectfulness, not theirs. Not that this means a professional has to put up with abusive behavior, but the professional has a responsibility to handle it, well… professionally.
— Steve
“I’m learning that I don’t have to agree to find things of value.” I think this sums up the big lesson of this comment thread. There may be “objective reality” but no one is the final authority on what “objective reality” is, and it looks different from different perspectives. Even when I think someone is totally “out there” in terms of what’s actually true, there is a lot to learn from finding out WHY the world looks the way it does to them. As long as no one is being hurt, I think we do best to simply realize that agreement is not required to respect someone’s viewpoint on reality.
So wondering where your next meal comes from makes people anxious and depressed? Who would have guessed?
I don’t think so. I think Vlado is trying honestly to provide his perspective, and I think it’s important that we respect his experience, even though I think most of us would not adopt his suggestions as a good general policy on how to engage with someone in distress. He’s found a way that works for him – good for him! And I think his argument holds elements of empowerment – that psychiatrists should enable their customers to utilize the offered drugs in ways that work best from the customers’ point of view. This would, of course, involve psychiatrists admitting that their entire approach is not scientific, but is basically the offering of substances to make people temporarily feel better subjectively while making no effort whatsoever to figure out what is really wrong, which they would never allow, but still, there is a legitimate point in there that deserves recognition.
— Steve
“Consensus reality,” by definition, requires consensus, doesn’t it? The word itself is basically an admission that many viewpoints can constitute reality, and that common reality is defined by consensus. Hence, the only thing really “wrong” about “delusions” is that they defy what most people choose to believe is true. Your point about slavery is very well taken. There are plenty of “consensus reality” beliefs (such as the belief that psychiatry is a scientific field!) that are of pretty questionable validity.
I do believe there is a “reality” out there that we all perceive, but even physics, the most reality-based discipline there is, has run up against the problem that even perceiving reality alters that reality. So any perception of reality, no matter how precise, is always an approximation. Admittedly, some approximations comport more closely with the actual DATA of reality, but they are still approximations and subject to modifications when new data comes in.
Bottom line, reality for humans exists as a relationship between the perceived and the perceivers, and no two people perceive reality the same way. Consensus reality is always a negotiation, and I think you’ll agree that we get into big trouble when only a small subset of humans get to be involved in the negotiations and the rest of us have to live in their “reality!”
A fascinating study looked at US immigrants’ health measures over three generations. While health indicators for first generation immigrants were all over the map, by the third generation, they had all “normalized” to USA-typical health problems, including increases in obesity, heart disease, diabetes, anxiety and depression. So much for genetic causes of “mental health problems,” or even physical health problems, for that matter! Our way of living makes people ill!
Very well said. Thanks for the clarification!
Sam, you’re a gem! And it sounds like your wife is, too, despite everything.
— Steve
Well, you never seemed too interested in hearing others’ views, which is kind of the point of this forum. Since you already seem to believe you’ve got it all figured out, I encourage you to go back to toenail picking.
The law of gravity and all other scientific laws/theories are human inventions. Gravity (as in the tendency of massive objects to move toward each other, at least in the 3-D conception of space) does appear to exist, but it can be viewed in a number of different ways, both mathematically and philosophically.
While reality does clearly exist, we know, even in physics, that perception can and does alter the very nature of reality itself. Without a consideration of viewpoint and perception, any description of reality is incomplete, hence the need to create AGREED-UPON reality between the clinician and the person they are trying to help, even if the client’s viewpoint appears to us to be distorted or “wrong.”
— Steve
I would suggest that you add the provisions of the Harrow study, which found that patients with BETTER prognoses did worse on neuroleptics than patients with WORSE prognoses off neuroleptics. This really undercuts the idea that only the “less ill” do better off drugs. I don’t think you should concede that point at all.
Otherwise, great data, well argued. Thanks for keeping up the fight!
Not to mention that there is no objective way to even approach determining who the “right patients” are except by giving them the drugs and seeing what happens. And the claim that they are “life-saving” flies in the face of the horrific early death rates for those taking the major tranquilizers aka “antipsychotics.” I agree 100% – it is the responsibility of the medical and psychological professions to actively discourage the long-term use of these agents and to explore other options that are more likely to lead to a real improvement in life quality.
Your comments also remind me of the qualitative study showing that “psychotic” people in countries where voice hearing was accepted or even valued as a special gift had friendlier voices, whereas ones where “psychosis” was rejected and feared had scarier experiences. It appears the social environment not only affects the presence of voice hearing, but also the quality and content of the voices! So your thesis makes total sense – it may be that suppressing the voices may be the WORST approach we could take!
—- Steve
These studies also generally fail to distinguish between SYMPTOM REDUCTION (usually the clinician’s goal) and QUALITY OF LIFE (usually the client’s goal). If you focus only on symptom reduction as an outcome measure, neuroleptics will be judged “beneficial,” at least in the short term. But if you look at quality of life measures, it appears that neuroleptics are at best of limited use, and more likely generally destructive. I think that’s where a lot of the conflict and confusion comes in – psychiatrists are often only concerned with making the “symptoms” go away, and frequently have little to no concern for long-term quality of life outcomes.
“Nerve seizing.”
“The only authority on my perceptions and my reality is me.”
VERY well said!
— Steve
Wait for what, and see what?
Thanks! Honestly, I really don’t know what others are perceiving or why they are perceiving what they are. And I’m genuinely interested in understanding how and why they believe what they do. Perhaps it’s because I didn’t receive any formal training before starting my work as a counselor, so I had no illusions that I understood anything except as the client explained it to me. That approach has never failed me yet!
I agree 100%. But the way you frame that is YOU think the truth is x” vs. “You are wrong and need to listen to what I say.” There is all the difference in the world between letting the client know what you honestly think vs. telling the client that they need to think the same way you do. It is subtle but can make the difference between eating the rat poison and not eating it.
I find your last paragraph to be the most important. We fail our clients, or the people we’re trying to help in any capacity, when we believe we know more than them and are entitled to dictate reality to them, and when we believe our knowledge is “right” and infallible. Being open to our own vulnerability and potential lack of understanding allows the client to also be open to the possibility that their viewpoint may not be the only “right” way to view the situation, either.
— Steve
Exactly! That is what works!
I am not sure the critique is exactly what you’re suggesting, at least in my case. You might want to see my post above. I believe, from direct observation, that it is not only quite possible to influence someone’s views while still being totally validating of their viewpoint, it is actually the key to good therapy. A woman living in a domestic abuse situation and imagining she can make it better if she tries harder is not a situation I want to see continue. However, it’s very clear from my experience that telling the person she’s wrong about her ability to make her abusive partner change either alienates me from her or makes her feel stupid and incompetent, neither of which leads to the desired reconsideration of her reality. What I have found DOES work is exploring her belief that something good is happening by staying or at least that something bad is being prevented by staying, and validating that reality, which almost always makes a lot of sense when you take the time to hear the reasons behind it. I then try to turn the discussion to one regarding what THE CLIENT wants and whether or not the current situation provides it IN THEIR VIEW, and honestly explore the pros and cons of staying vs. leaving, at NO TIME telling the client she is wrong for staying, and in fact letting her know that many if not most DV victims stay for long periods of time trying to fix up the situation, and for very understandable reasons. Of course, I am also willing to share my personal thoughts on what is happening and why if they are interested, and also how likely I believe it is or is not that this will work out, but I don’t present them as REALITY, simply as my personal views based on my own experience with this kind of situation.
So one doesn’t have to AGREE with a “delusional” (is there not implied negative judgment in even using that word?) viewpoint to validate that it looks that way from the client’s perspective. Nor does one have to invalidate that viewpoint in order to help the client see that other viewpoints also exist and may have validity as well. It’s the difference between saying, “There are no voices talking to you – you are imagining it” and “I understand you are hearing these voices, but I personally can’t hear them and don’t know what they’re saying.” The first invalidates the other person, the second merely states the reality that you’re having two different experiences, and doesn’t privilege the therapist/helper to having the “right” viewpoint.
— Steve
Not sure how validation and confidence/independent thought are not compatible. While I have very strong personal ideas about what is right and wrong, I also understand that I don’t always see how things look from others’ viewpoints. I’m not shy about sharing my views, and strongly, but I’m also always interested in hearing where others come from, and especially WHY they come from that viewpoint. In the cases where I do think a person would benefit more from being able to see things my way (I’m a pretty smart and observant guy and I think have a lot of insights to share in many situations), it still works much, much better if I understand what the person is thinking before I intervene.
A great example: I used be a supervisor for a community suicide/crisis hotline. Once I got a call from a woman who was suicidal, and I asked, as I always did, what benefits they thought would occur from suicide, or in essence, what problem they saw suicide solving for them. She said, “Because the pain would end.” Now I don’t know why I said this, never have said it before or since, would probably be criticized roundly by most “mental health” professionals for doing so, but for some reason, it seemed the best thing to do. I said, “How do you know that?” She said, “What?” I said, “How do you know the pain would end?” She said, rather heatedly, “What are you talking about??!!” I said, “What if when you die, the pain doesn’t end, but you have no body but you still have the pain?” She said, “Oh, my God, I never thought of that!” We were then able to talk about other options she might have short of suicide to reduce her pain, keeping in the background that suicide was always an option she could return to if need be, but a rather uncertain one at best. At no time did I tell her that she shouldn’t commit suicide, nor that committing suicide would NOT end her pain, I merely pointed out the possibility that her certainty about the outcome might be misplaced.
So I validated her pain and her desire to be rid of it, but I neither validated nor invalidated her solution. I simply created grounds where we could talk honestly about the pros and cons. I showed I understood her and accepted her viewpoint and needs, but let her know that other viewpoints might be possible, as well as other solutions. I was certainly both confident, even bold, and quite independent in my approach, while still validating her reality. It can be done.
— Steve
And all side effects of the “medication” will be attributed to “the disorder.”
VERY well said!
Well said. My oldest is super gifted in math – could translate negative 100 Centigrade to Fahrenheit degrees IN HIS HEAD at the age of 6, and even knew without being told that he had to add 32 degrees to adjust for the difference in the zero points of the two scales! But he was failing 6th grade math. Found out that the teacher gave them “steps” to memorize and repeat, and they got one point for each “step,” and if he skipped half the steps, he got 50%. Her most common quote was, “Math is just a mechanical process.” The next year, he did independent study and covered two year of material in 7 months and was taking math at the high school by 8th grade. But this dumbass lady was flunking him for not following her steps. Idiocy!
Even more important, 50 years of long-term studies have failed to show ANY benefit of long-term stimulant use in ANY major outcome area. This includes delinquency, test scores, teen pregnancy, college enrollment, illegal drug use, social skills or even self esteem. This should be in EVERY textbook so that doctors realize that AT BEST, stimulants provide some short-term changes in the “core symptoms” (meaning that they mostly make kids more manageable). The biggest selling point used to push stimulants is that “untreated ADHD” leads to all these bad outcomes, but as it turns out, NONE of these outcomes is improved by stimulants! What a scam!
Oh, I bet they objected – but they weren’t afraid of stigma to the “mentally ill,” they were afraid of well-earned stigma for their own warped professional history!
Semmelweis is a very sad story. He was apparently hospitalized after this happened because it drove him totally nuts that he had PROOF that hand washing worked and they just ignored it! So we have more proof that “mental illness” is CAUSED by the medical system!
You are correct that there is a high suicide rate among the group, which is a contributor, but certainly does NOT explain a 25-year (nearly a THIRD of an average lifespan!) decline in average life expectancy! Consider also that the suicide rate INCREASES with increasing contact with the psychiatric profession, partly because of the drugs they sell. And there is no denying that antipsychotics cause an increase in diabetes, huge weight gain, and a very significant increase in cardiovascular disease. To think that these don’t increase the death rate very significantly is, forgive the term, delusional. Additionally, cigarette smoking is commonly used by those on antipsychotics to reduce the side effects (it increases dopamine, which is what antipsychotics decrease), and we all know the impact of cigarette smoking on lifespan. So indeed, psychiatrists kill people.
If you were reading the other comments, you’d see that many (including me and the author) that local chapters can provide valuable services, particularly those like yours who allow or encourage leadership from survivors/consumers.
Your last comment I agree with completely, and that is one of the huge problems we face. Without an objective definition, almost anyone could be identified with a “mental illness,” and it is also very possible to redefine “mental illness” in a way that allows the drug companies to create “science” that supports their drugs. They do this by seeing what the drug does and then defining a “mental illness” based on whatever “symptoms” it “treats.” “Social Anxiety Disorder” is one such fake “disease” that didn’t exist before they decided to market Paxil to “treat” it. Juvenile Bipolar Disorder is a similar scam, long since proven to be utterly bullcrap by psychiatry’s own researchers, and yet many youth are still “diagnosed” with this non-existent “disorder,” and given these life-shortening drugs to “treat” their inconvenient childhood behavior.
8 years of medical school is actually a big DISADVANTAGE if you are being trained in things that are absolutely false or are based on false assumptions. Hence, it is actually often parents who are more adept than doctors at sensing what is really going to be helpful, but in any case, the invalidation of the client’s viewpoint is ultimately the most destructive thing that can be done if we have any hope of recovery, yet such invalidation is the core of how psychiatry is practiced today.
Have you read “Anatomy of an Epidemic”? I believe you really would benefit from reading it if you have not. It would help further your understanding of where this big protest energy is coming from. It seems you are not at all far away from my views on what is helpful, though our views on whether national NAMI can provide it seem to diverge.
Thanks for the rational exchange!
— Steve
Hi, Michael!
Well, a lot of people have a similar belief about doctors always being wise and scientific and reliable. It’s a very solid cultural belief, even when evidence speaks loudly to the contrary.
Are you aware that the august Journal of the American Medical Association published an article verifying that receiving medical care kills over 200,000 Americans every year? Which makes it the third leading cause of death in the USA, behind heart disease and cancer. And over 120,000 of these deaths were attributable to properly prescribed and administered medication. A LOT of those deaths are from psychiatric drugs. The average lifespan for those diagnosed with psychotic or bipolar disorders is 25 YEARS shorter than the average American. These doctors kill people. Can you imagine a cancer drug that killed off its patients years earlier than those who don’t receive treatment?
In steps NAMI. They promote a VIEWPOINT that “mental illnesses are just like diabetes” and have nothing whatsoever to do with how people are treated or what kind of stresses they are under, or even what they eat or whether they exercise. They are “genetic brain disorders” and no one needs to “feel guilty” about the damage done to our young people or to adults who have to experience this life-threatening “treatment.” The potentially deadly side effects, though very well documented, are minimized or denied, and the supposed benefits promoted under the tutelage of the drug company sponsors.
In addition, the people running NAMI are not “mentally ill” individuals, but parents and professionals who “know what is best” for their adult children/clients, and when the “recipients” complain, they are accused of having “anosognosia” or of acting out their “symptoms” instead of listening to their views.
Remember also that psychiatrists assured us that Benzedrine was not addictive, then assured us that Valium was not addictive, then Xanax. They also assured us that tardive dyskenesia was caused by “schizophrenia” and only later were forced to admit it was the drugs. So they have a very poor track record of reliability.
So being skeptical about a doctor’s advice is not silly or dangerous – it’s very, very smart. Trusting doctors blindly, especially psychiatrists, can get you killed. But national NAMI does not appear to care much about these problems, and is all too happy to blame them, including the 25-year earlier death rate, on the victims.
I hope that clarifies why it is that I and many here trust neither NAMI nor psychiatrists. I’d be very interested in hearing your specific response to this information. You seem like a smart guy, so perhaps a bit of hard data can help you see another viewpoint, even if you don’t agree with it.
—- Steve
Psychiatry is founded on violence and the judgment of others as “defective” in the eyes of society. “Modern” approaches are simply another way to force the “aberrant” back into line with society’s expectation. While individual psychiatrists may or may not be specifically committed to authoritarianism and invalidation, the entire field, starting with the diagnostic system, is still based on the primitive thinking that gave rise to “insulin coma therapy” and the like. While lobotomies are “out”, the barbaric ECT is still widely practiced, and of course, the drugs used on the brain are all based on stopping the brain from engaging in its normal functions in some way or another. So violence and invalidation continue to be the linchpins of the psychiatric worldview, even if individuals in the field are able to escape that viewpoint.
I think it’s also important to clarify that not all local NAMI branches are as bought out as national NAMI. NAMI Santa Cruz (or maybe Santa Clara) used to have an awesome website with lots of empowering articles and discussion boards. But they don’t appear to any more.
I encourage you to look on the national site and see how many times they talk about “biological brain diseases” and how infrequently traumatic experiences like child abuse are emphasized as causes. See how supportive they are of forcing “treatment” on the unwilling and how often they talk about “anosognosia” and how little they talk about hearing voices groups and peer support (except in the context of supporting peers in following their psychiatrist’s orders). They have improved somewhat since the late 90s when I first encountered them, but the national website is loaded with inaccuracies and power trips that have nothing to do with those who willingly or unwillingly engage in “mental health services.” The unquestioning support for enforced outpatient “treatment” (aka forcing drugs on people who aren’t even endangering anyone just because the psychiatrists think they MIGHT some day be dangerous) should be enough to convince any objective person that they are at best very far down the wrong track. Looking at their Big Pharma connections just explains why.
So yes, lots of people have found local NAMIs helpful, though lots have also found them awful. But national NAMI does not represent the “mentally ill,” it represents their family members and the pharmaceutical industry. Which is a VERY dangerous combination.
— Steve
“Breaking point?” That sounds totally sick! And they said YOU were “mentally ill?” What is wrong with these people?
“Neither expect nor demand.” That’s it, 100%!
MePat, not sure what your issue is, but you seem to be intent on provoking conflict here. I am not in favor of making personalized attacks, but your comments appear to be personalized as well in a more subtle way. Monica made a totally legitimate post, and your comment is simply attacking due to whatever issues you are bringing to the table. I suggest you take a step back and look at your reasons for doing this.
I think the MIA staff is creating a safe space for discussion, or trying to. The only “side” I think MIA is on is that the current way of doing things doesn’t work and needs to be “rethought.” And I agree, more “sides” means less cooperation and less success. We should be emphasizing what we agree on, and your postulates are a great starting point.
I agree. Perhaps they will feel compelled to publish it, as it is a direct response to the article they wrote. Perhaps you can even get other dissident MHPs to sign on to the article?
Fantastic piece of analysis!
Absolutely true. Unless you have the courage of your convictions and the skill to know how to help, the safe play is to hospitalize even if it’s totally uncalled for and totally destructive to any chance of further therapy. It’s no wonder that clients don’t tell their therapists when they are suicidal, but when they don’t, they’re then called “manipulative” and get labeled “Borderline Personality Disorder.” If you wanted to create a system to discourage healing, the current one would certainly do the job.
A very good article! I’ve always been very suspicious of “EBT” for the very reasons mentioned in the article, namely that it is both politically and financially motivated. The one issue not addressed in the article is that in order to be an “EBT”, someone has to spend the money to research something in a systematic way. Guess who has the most money to fund such research? Drug companies, of course. Drug companies can afford to run multiple research studies (and of course can afford to buy “results”) in a way that other entities can’t. So of course, most “EBTs” are drugs. Pretty sneaky!
I also like the emphasis on humility and individualized approaches, even in the purely medical world. That thinking is 50 times more applicable to the “mental health” world, where there is no concrete way to even say who is “ill” or if anyone is “ill” at all.
Thanks for the link!
— Steve
I did a training on suicide intervention with mental health therapists many years ago, when I worked at a volunteer crisis line. Our volunteer crisis counselors knew 10 times what the professionals knew about helping suicidal clients. Our emphasis was listening and understanding, focusing on what can be controlled vs. what could not, building relationships, and inviting further contact as frequently as needed. Most of the professional therapists didn’t seem to even have an idea what to do besides calling 911. They didn’t even have the skill to figure out who was contemplating doing something immediately vs. those who were feeling despairing but mostly needed to talk and connect. They were effectively clueless. That was in 1992. Things are far, far worse today, because at least the ones we were training knew they didn’t know, whereas now they can just diagnose them and send them to the psychiatrist or the hospital as soon as anyone even talks about the word “suicide.” Many therapists are simply scared by any suicidal statements and go with the safest approach for THEM, rather than the best approach for the client. Of course, there are many exceptions, but I’d say a majority of therapists are not really prepared to deal with a suicidal client, both in terms of training and in terms of their own emotional reactions. In fact, many therapists appeared to hospitalize people for much less serious things like self-harming in ways that are neither intended to nor capable of killing or even seriously hurting themselves. Which meant the self-harming people couldn’t even talk to their therapists about their urges without risking being hospitalized, so they called the crisis line to stay anonymous and to actually find someone who would listen.
So you’re not wrong. A lot of therapists don’t actually have any training in helping suicidal people, and as often as not, it is not really safe to tell them if you want to just talk without being hospitalized.
— Steve
Can’t ask for more than that. Sorry your first go was a little rougher than expected! I appreciate you hanging in through a difficult conversation, and I hope we’ll be hearing more from you in the future. I think in the end it was a very important conversation about topics that are central to this project of “rethinking psychiatry,” and while I wish we all could figure a way to have these discussions with less rancor, it’s a very emotional subject, especially for those who have been “helped” in some not very helpful ways by the system.
Keep the faith!
— Steve
Without feedback form the client, how would you ever know if you were making progress? This seems to obvious as to be trivial, but it’s clear from the data that the majority of therapists don’t practice this way. It’s a head scratcher, for sure!
Fantastic article, Kelly! I once handled a crisis call from a woman who was frantic about her ongoing depression and anxiety. She told me a list of at least 4-5 antidepressants she’d been on and nothing had changed and she was worried that she’d ALWAYS feel this bad and it was driving her crazy! That’s kind of how she talked. So I asked her one question: did anyone ever tell you there are other things you can do for depression and anxiety besides drugs? She stopped cold for a moment. Calmly said, “No.” I said, “Well, there are.” She said, “Oh. Well that’s good!” She instantly felt better knowing there was something she could do herself, but had been seeing mental health professionals for A WHOLE YEAR and no one had told her there was more she could do.
I’ve worked for years with foster youth who are put on these drugs sometimes in elementary school, despite the data saying they don’t work, and I can’t think of one who was told that s/he might become aggressive or suicidal on these drugs, nor were their parents or even their caseworkers informed. I ended up being the one who shared these facts. It is a very disturbing reality when people are given drugs that don’t work, not told of potentially dangerous or deadly side effects, and not given any alternative that might actually help them out. Not saying some people don’t feel good about their antidepressant use, but informed consent basically doesn’t exist for these drugs!
Wow, I just realized how appropriate the title of this article is! This really is a clash of perspectives, but not necessarily the perspectives outlined in the article. I think the real clash of perspectives is between the more powerful (professionals) and the less powerful (let’s just call them “recipients” for now) who meet in the crazy world of “mental health.” Maybe it’s easiest to understand if looked at that way – as a clash of worlds. The problem being that when worlds clash, the more powerful are able to continue to maintain that their world is the “right one.” Similar comments apply to the recent intense discussion of “reality” vs. “delusions.” Hence, my comments that power dynamics are the most important aspect of a helping relationship, and if they are not resolved, it’s hard to get beyond a fairly rudimentary level of “helping.” At least that’s my experience.
You mean being active isn’t a disease? Might even be good for you? Go figure!
I really do get both sides if this conversation, and I understand why it is uncomfortable for you, Kurt, and I also understand your frustration, Sera.
I don’t think Sera is trying to be hurtful but is speaking from the heart as a person who has experienced the “help” of the mental health system and found it quite harmful. It appears you have embraced the science that Bob has published, which is great. But I think. Sera’s getting at what I was talking about earlier, and it goes deeper than Big Pharma corruption.
Perhaps the clarity comes from your response to my comment when you said that “power dynamics have to be considered.” I think a different viewpoint, which I am trying to convey, is that “dealing with power dynamics between provider and client is central to ANY effort at creating healing.” I believe that people who have been harmed by the system tend to take the second view. I think it is hard for a professional person who hasn’t been in that position to really understand why, and it often comes across as hostility, and actually can BECOME hostility if enough frustration builds up. But what Sera says is absolutely true – the privilege of being “the professional” allows us (and I include myself as a fellow professional) to dismiss or minimize the impact of our power differential, and this gets in the way of or sometimes completely prevents a healing relationship from forming.
I don’t know why I have been granted the ability to bridge this gap, but somehow I really see and understand deeply the cost of resting comfortably in our “professionalness,” as well as the true power of stepping out of those shoes and meeting our clients where they are without the slightest judgment or condescension.
It is hard to describe if you haven’t been there, but it really does come across in your presentation that you don’t quite grasp this reality, although I am quite sure you do excellent work within the context of your role and that clients would be VERY fortunate to see you vs. the average mental health professional. There is just a possibility that you might be able to take one step further to seeing the reality of your clients, and I am hoping this discussion might make you aware of that step. Again, I’m not saying you’re doing something WRONG or that you are a bad actor and I’m not minimizing the work you’re doing to make the mental health world more respectful of those it serves. But Sera’s viewpoint is (I believe, not trying to put words in your mouth, Sera, so please correct if I’m off) just the viewpoint I was wanting to point out – the idea that it is the CLIENT (if that’s even the right term) who has the right to define his/her experience and whose viewpoint and needs must be the touchpoint of any intervention.
If you had been a recipient of these services yourself, I think you’d see a different perspective that comes from chronically being in that one-down power situation and having to be careful not to say the wrong thing because some “helpful professional” will decide what is “good for you” and make you have it whether you want it or not (and I don’t just mean drugs here). It’s like being a kid in school again, except the punishments for stepping out of line can actually imprison you, disable you for life or kill you.
Not sure what else I can say. I know not everyone is always a diplomatic as they might be on this site (though in fairness, I thought Sera’s first message showed a strong effort in that direction), still, a similar message has been communicated a number of times by a number of different people, and maybe there’s something there you’re not hearing. That’s all I’m saying. If I didn’t think you had it in you, I wouldn’t have put this much energy into it. If it’s not something you can get your arms around, that’s OK with me, but I don’t think the message is intended to hurt, it’s intended to inform, whatever form it has taken. I think there’s something there for you to take a look at, and I believe you’re enough of a real professional to hear that message if you can sit with it for a bit.
Hope that helps!
—- Steve
I would have to amend that to say I’d suggest being VERY CAREFUL about whom they might trust. There are definitely a few diamonds in the rough, and clients/patients/inmates are sometimes fortunate to find them, but I would most definitely counsel them that sharing in a hospital could be dangerous and to be very selective about whom they might trust. In fact, I’d tend to apply that to any counselor/social worker/mental health professional in any role. A lot of damage can be done by trusting the wrong person with sensitive information, and sometimes the very best thing we can teach our clients is how to figure out whom they can and cannot trust.
Thanks for sharing your story. It sounds just plain awful! It has always stunned me that they can forcibly “hospitalize” you against your will and then CHARGE you for the privilege! Stunning!
And we have to remember that it takes only one or two bad experiences to shut down trust in service providers for the long term. Even if 80% of providers are safe, the client doesn’t know which are dangerous until they open up and potentially get hurt. A bad experience often means no one else gets a chance. I always thank clients who extend their trust because I understand the risk the are taking. All clinicians should learn to appreciate how precious and delicate that trust is for the vast majority of clients.
Wow, what a sad and infuriating story! Good for you for standing up for yourself! Did you say your “symptoms” are decreasing but they still want to force you onto antipsychotics? Do you have a good attorney? Wish I lived in Michigan – I’d come and support you!
Sam, your comments are incisive and effective as always – thanks!
Kurt, I would very much be interested in hearing more about that project – do you have a link? It’s easy to give lip service to “informed consent,” but how many clinicians really do that even for adults, let alone kids? In my experience, not only do foster youth not get informed, they are outright lied to about what is being “treated” and what their options are, let alone the common fear of telling them about medication side effects. It sounds like this program would directly address that issue, and I’d love to hear more about it.
Personally, I think we should do a lot more than “consider the perspective” of the youth we’re treating. Their perspective should be the main jumping off point of any planned treatment, and should constantly be consulted as our guide to whether or not we are being effective in our work.
Thanks for your response!
—- Steve
Fair enough. The ACE study has brought an increased awareness if the impact of trauma, though my experience is that the mental health system has been very slow to respond. Perhaps you are fortunate enough to travel in more enlightened circles than those I have worked in.
However, years of advocating for foster kids has shown me that very often, we as adults really do care and BELIEVE what we are doing is right and helpful, and yet those receiving our services don’t feel that way at all. I suppose the lesson I find is that kids have a lot to say but the adults don’t often create safe spaces to listen. I just had occasion to talk to a young couple in their early 20s last night who had seen the whole series (I’m only about halfway through, and most definitely NOT looking forward to the suicide scene, it sounds AWFUL!) and both of them said that the conditions represented in the school in the series were not an exaggeration and seemed very familiar to them. I think it’s way too easy for those with power to imagine we are doing good without bothering to consult those we are purporting to help, and I hope that is the real takeaway from this provocative series.
And in perfect timing, here’s an article published on MIA that supports exactly what I’m saying:
https://www.madinamerica.com/2017/05/school-driving-kids-literally-crazy/
I am quite sure that YOUR students are trained in a different way, Kurt, but I’m pretty confident that many if not most in the USA are trained in DSM diagnosis and brain-disease theory, even if some rebel psychologists/therapists provide different perspectives. And just like the kids at Hannah’s high school, whatever their prior training and beliefs, they have to deal with the oppressive system that they will be operating in, and that system challenges anyone who wants to look at “mental illness” in more human terms. I say this as a mental health professional who got out of the field and into advocacy after I could no longer stand seeing what happened to my clients who were hospitalized or even “treated” by the agency I worked for. I have many more than one anecdote to share (though it was actually a study, not a single anecdote), and the comments I make apply not only to the mental health system, but to almost any institution in US society today. That’s the point I was making – that Hannah’s difficulties were not a result of a “mental health issue,” but of her and her friends/associates having to survive in an oppressive environment day to day and the absence of anybody in a position of power willing to or capable of intervening. Perhaps I have put this in better terms this time and you can comment on this aspect of suicide prevention, which I believe is the main point the series is trying to highlight, namely, that someone has to acknowledge and challenge the power dynamics in the school and the larger environment for this kind of depressing hopelessness really to be challenged.
— Steve
You captured what I wanted to say in many fewer words. The teens’ behavior is a response to the structure provided (or not provided) by the responsible adults. Those setting up the system are responsible for making sure it works, not those who are powerless participants. Thanks for your comments!
Thanks!
Thanks! Back at ya!
Perhaps you misunderstand me. I have helped run a suicide hotline and have done involuntary hospitalization evaluations. I’ve placed many people into involuntary holds, directly or indirectly, and have also intervened with many, many more suicidal people and prevented many, many hospitalization with on-site or telephone crisis interventions. I have also spoken with many folks who have been hospitalized after the fact. To suggest that traumatization by involuntary hospitalization is rare suggests a Pollyanna view of reality. Sure, clients in the hospital often express relief that they didn’t end up killing themselves, but they also learn very quickly that telling the staff you’re pissed about how the situation was handled or that you feel powerless is both pointless and dangerous. I don’t know if you watched the show in question, but you ought to, and you ought to look at how often the teens tell the staff and/or their parents and even each other that everything is “fine” and there are no problems, even though they are seething with discontent, fear and grief. You have to develop sufficient trust for people to tell you their true feelings. I am very good at doing so, and I guarantee you that feeling traumatized is far from a rare thing.
As for suicidality from antidepressants and antipsychotics, gosh, there are warnings on the labels to this extent. Not sure how you can actually argue that point. New evidence more recently has shown rather conclusively that these effects are not limited to teens and young adults. Aggression is also sometimes a consequence of messing with the serotonergic system, as is listed on the label of all of these drugs, and as a recent MIA article has documented.
Naturally, preventing immediate suicide IS important and is the priority in a crisis situation. That was not my point. My point is that IN THE CONTEXT OF THIS SHOW, talking about methods to reduce the likelihood of suicide without looking at the causes misses the entire point of the production. The point is, people had MANY opportunities to intervene and perhaps prevent this suicide LONG before the crisis situation ever began to arise. This is true in many, many situations and the main intervention is to have people care about you and have the guts to stand up to bullying, sexual assault, and harassment instead of keeping quiet until the victim can’t stand it any more.
The secondary lesson also appears to bypass you completely based on your comments. The show demonstrates how our INSTITUTIONS, parents, police, schools, and the mental health system itself, fail to create a safe place where talking about the above issues is realistic. To give you an illustration, a recent survey of kids in residential treatment centers showed that they revealed significant trauma histories to complete strangers in 80% of the cases. Oddly, only 20% of the cases had traumatic events documented in the file! So at least 60% of the kids were willing to share their abuse stories with TOTAL STRANGERS but were either never asked by staff, didn’t feel safe telling them, or worse yet, told staff who didn’t feel the information was significant enough to include in their files.
Perhaps you have to watch the series to know what I’m talking about. Perhaps you need to step down from your professional pedestal and actually meet your clients where they live. Maybe you should ask a couple to DESCRIBE what being taken into custody was like, rather than asking them if they are grateful to be in the hospital. You might be surprised how many people appreciate that someone cared enough to try and stop them, but most definitely did NOT appreciate the violence and invalidation involved in being taken into custody. I’m sure you’ll hear from many of our regular posters on this point.
Lastly, your comments on how benign the SSRIs have since been found to be are questionable to me and lack any reference. It might help if you can provide links to these statements.
Appreciate your candor in responding, but you might want to avoid questioning my experience and credentials before you know anything about me. It is that kind of approach that encourages people to say they feel fine when they really don’t.
— Steve
While I appreciate the important emphasis on compassion for suicidal teens, I’m really not sure what to say about this article. While I agree that putting resource numbers at the end of each episode is a good idea, I’m kind of astounded at how badly the author appears to miss the point of the series. The comments about not needing to understand the “why” and simply removing “means” seem to invalidate the important issues that the series raises, namely the importance of understanding the context in which suicides occur. The whole point of the series is to show that there ARE whys and that many people COULD have done something about the situation but did not! It also emphasizes that systemic changes are needed, as administrators and the counselor don’t appear to understand that bullying is rampant in the school, and the kids are unable/unwilling to trust the adults BECAUSE THE ADULTS HAVE NOT SHOWN THEMSELVES TO BE TRUSTWORTHY! The counselor and assistant principal had Clay on the verge of talking about the whole situation, but their authoritarian and accusatory approach caused him to clam up. The similarities to the situation in the “mental health” system can’t be missed by anyone who has been on the receiving end of “services.”
The incredible challenges involved in reporting sexual assault are also highlighted, and contributed very significantly to Hannah giving up. One very good way to reduce suicides is to make it easier and less traumatic to report events like sexual assault and domestic abuse, but the author fails to even mention these points in the article.
From the article: “Part of the problem here centers on what happens after a person is hospitalized and the time immediately after discharge. As clinicians we can sometimes be lulled into a false sense of security that as long as the acute crisis is dealt with, we are out of the woods. Regrettably this is often not true.” This suggests that suicidal feelings somehow “sneak up” on clinicians because the clinicians are overconfident that “the crisis is over.” This ignores more significant reasons why suicide happens AFTER hospitalization. First, hospitalizations are TRAUMATIC for most clients, especially if they are enforced or not entirely voluntary. This trauma is denied or minimized, just as the administrators at Hannah’s school deny or minimize the enormous reality of bullying in their school. As a result, no one talks about this to clients, nor acknowledges the feelings of powerlessness that often occur in the context of a psych ward. Additionally, many clients describe being unwilling to communicate their feelings to their professional support people after being hospitalized against their will, because they are afraid to be hospitalized and traumatized yet again.
Second, the main thing that happens during psych hospitalization is that the client is tried out on a new drug regimen. It is well established at this point that antidepressants and antipsychotics, the two most common prescriptions given in psych wards, both can induce suicidal ideation or action. To ignore this important variable shows a limited commitment to scientific reality.
To talk about “suicide prevention” outside of the context of why people kill themselves seems bizarre and disconnected. In fact, it seems to reflect the same kind of disconnectedness that kept Hannah and Clay and the other students from reaching out for help. I think the author does a great disservice to both clients and professionals by suggesting that preventing the ACT of suicide is more important than preventing suicide by understanding our clients and by revising and reforming our institutions so that trauma is less common and easier to talk about with authorities and less traumatic to resolve.
— Steve
Actually, they can’t even objectively identify who belongs to the group “addicts.” It’s downhill from there.
I object to the labels because they are not scientific, as not a one of them defines a group that can be accurately and objectively distinguished from a group not having the “disorder” in question. That’s not a political objection, it’s a scientific one. If you can’t establish a reasonable amount of variable control, you can’t do science. You can’t do studies on heterogeneous groups and expect to learn anything. It’s about that simple.
— Steve
Jill, this simply can’t be true. There are many, many people who experience similar disruptions in their dopamine system temporarily and yet don’t become addicted. It is claimed that this difference proves a biological underpinning, but I don’t think there is much evidence that that is true, because it should be very evident from both research and a casual survey of the addicted population that there is an ENORMOUS disproportion of people who have been severely traumatized in their childhoods or later on who then become addicts. While it is possible that there is a subset of addicts who simply “can’t stop” for biological reasons, this subgroup has never been identified, as is usual for all psychiatric “disorders,” simply because the profession is comfortable sorting people into boxes based solely on behavior and have never bothered to try and make any kind of distinction between the reasons that people become addicted. It is both more convenient and more financially remunerative to dismiss the importance of causes, but it doesn’t serve the addicted person very well at all. As a result, neuroscience can tell us a lot about what happens to a brain after it’s soaked in dopamine for long periods of time with some accuracy, but it can tell us essentially nothing at all about why some people choose to so bathe their brains while others choose not to.
— Steve
Arguing about which drug “relieves stress” more effectively is a ludicrous proposition. Alcohol can make anyone feel less anxious in the short term. Getting drunk is not a medical treatment.
Excellent analysis, Richard!
Your comments make sense to me. We need to seek a balance, and stop trying so hard to be “right” at the expense of someone else being “wrong,” which to me is the very essence of authoritarianism. I’m sure we’d have some fascinating discussions in person! Thanks for sharing your thoughts so articulately.
— Steve
Exactly. It’s about having the power to define one’s own experience. Parents “advocating” for “eliminating” what some people view as parts of their personality is more than a tad invalidating!
I know what you mean. I think it’s hard to really understand the level of trauma and disrespect and outright shaming and humiliation many of these survivors have experienced, usually from the hands of authorities like their parents or teachers or “mental health” professionals. I find their anger quite understandable, having spent enough time in “mental health” agencies and a couple of psych wards and heard enough stories to see what really goes on. It is unfair when overgeneralizations are made, and it does make some folks anxious about posting. And some of those comments, like calling you a “NAMI Mommy,” are just insulting and inappropriate. But it is important to realize how much hurt is there and that such comments are not really directed at you personally, they are directed at all the “mommies” and “professionals” and other authorities out there who have hurt them and not even noticed or cared.
You are clearly a good person who likes to deal with facts and has done some great work confronting the system with its own failures and mean-spiritedness. I’m glad to have you hear with us, despite the challenges you have faced!
— Steve
The video was pretty disturbing, to say the least!
It is also important to note that a lot of parents are unable to recognize how they are harming their children or encouraging or creating the very behavior that bothers them. Giving them this “explanation” prevents any meaningful dialog with caring parents who might actually be willing to CHANGE their behavior if they understood what was going on. The whole point of the DSM labels seems to be to blame the person who is suffering and absolve those with the power to actually do something about it from any responsibility whatsoever.
— Steve
Love it!
Wow, you mean you’d try to distinguish between possibly disparate CAUSES of “depression” instead of treating all “depressed” people in the same way? Wow, what a concept!
Thanks for your comments – glad I can beat out the catfish for empathy, but sad that a catfish beats out the psychiatric profession!
Good for you for beating NAMI into submission! You must be a proud ODD victim!
— Steve
“The criticisms of small effect sizes raised by these letters imply that we should only use the term brain disorder when everyone with the disorder shows the same pattern of brain abnormalities. By that definition, no psychiatric disorder would be a brain disorder.”
Excellent point! They have accidentally drawn the correct conclusion – no psychiatric disorder can qualify as a “brain disorder.” This is like saying that not all people with cancer should show the same indications of inappropriate growths, or that not all people with high blood pressure need to have higher than average blood pressure. Such idiocy is what passes for “science” in the world of psychiatry!
—- Steve
I’d add also that the support of the pharmaceutical companies for these supposedly “patient advocacy” groups and the pushing of pharmaceutical solutions to every problem adds to the lack of trust in these organizations. Further, the lack of any apparent interest in consumers/survivors contributing to their agenda is a barrier to trust.
I’d have look at the youtube from Autism Speaks if you had any doubts of their lack of connection to the actual needs of autistic people:
https://www.youtube.com/watch?v=9UgLnWJFGHQ
I found it pretty awful!
— Steve
I think the anger toward Autism Speaks and toward NAMI is not a result of people denying the existence of conditions that are called “mental illness” or “autism,” but rather of the “professionals” and parents of such people deciding how to define what is “wrong” with their clients/children as well as what they HAVE to do to “fix” themselves to the satisfaction of the parents/professionals. It is a very undignified position to put someone in and folks are understandably upset/angry about having that done to them.
It is important to distinguish also between saying that no one SUFFERS from conditions that are called “mental illnesses” in the DSM, and saying that the DEFINITIONS of the “disorders” in the DSM are unscientific and damaging. No one is saying that people don’t suffer or that they usually want their “symptoms” back if they go away. What I think most people are saying is that LABELING someone with a “disorder” and prescribing “treatment” based on fraudulent notions of “chemical imbalances” while completely ignoring trauma, social conditions, nutrition, sleep and other factors that may cause or contribute to the distress. It’s kind of a shorthand to say “mental illnesses are a myth” when we mean “mental illnesses as defined in the DSM are unscientific and misleading.” Based on what you’ve said earlier, I don’t think you and I are very far apart on that question, though I’m happy to be corrected if I got that wrong.
People definitely experience all forms of distress and difficulty, and no one is saying they don’t need or deserve help. All I’m saying is that DSM labels and condescending “professionals” who are unable to see past their own biases and issues are not helpful to anyone.
— Steve
Well, of course not, silly! How can psychiatry and the drug companies keep the money coming in if you actually CURE people of what ails them?
I tend to agree with Richard in that it seems kind of over the top to suggest that “matriarchy” is anything close to a power in the USA. I have heard from my own son that there is a certain authoritarianism that can arise in his left-leaning college and that he finds that offensive. However, this is not a manifestation of “matriarchy” so much as of AUTHORITARIANISM. Anyone who believe the right has cornered the market on authoritarianism has something big to learn, and there are also plenty of conservatives who are open minded and not sexist or racist. So we shouldn’t be making over-generalizations as if they are the truth, because that’s another form of authoritarianism right there.
I think authoritarianism itself is the real enemy, and both Martin and Richard are recognizing it in different forms, but I find we get into trouble when we allow ourselves to be herded into the classic “liberal-conservative” discussion frame, as this seems to me to be an anachronistic frame. Richard and especially Frank hit hard on this – it is this belief that the global capitalists/corporatists have our “best interests” at heart and the unchecked power they now wield that should be our target. And I gather that all of us agree on that point. So I’d suggest we get away from blaming liberals or conservatives or those under 35 or their parents or matriarchy and direct our energy toward the hegemony of the rich and powerful, as well as all the manifestations of authoritarianism, both on the left and the right, which impede our ability to attack those targets. At the same time, civil discourse, including cross-cultural awareness and sensitivity, is going to be very important to moving forward with these goals, not because people “aren’t tough enough,” but because people are very susceptible to being misdirected into foolish discussions such as whether Democrats or Republicans are responsible for the mess we’re in (or for that matter, which party is more likely to be “mentally ill”) and it requires diplomacy to help get people over these barriers and to see what’s really going on and that their enemy isn’t black people or women or white people or liberal universities or matriarchy, but CORPORATE POWER AND AUTHORITARIANISM. It’s not a matter of rightness, it’s a matter of effectiveness.
— Steve
Yes! They have been beating down Autism Speaks because they have organized a resistance movement. That’s what we need to do!
And how did s/he respond? Did logic actually have any positive effect?
So here’s the big question, Pat: how exactly does one distinguish between these two purportedly distinguishable groups? Psychiatry has no answer for this, none at all. They give lip service to the idea of “endogenous” vs. “situational” depression, but their DSM checklists don’t even attempt to make that distinction that I can discern. I’m quite serious when I ask this question – how would you tell the difference?
— Steve
Only if you’re genetically vulnerable to car accidents.
Perhaps they should just eat a lot more yogurt? Oh, but that can’t be PATENTED, can it?
You are so right! The diagnostic process itself is a means of “blaming the victim” and distancing ourselves from the “mentally ill” individual, as well as avoiding any and all responsibility for doing something about the situations that may have caused the problem. ADHD is a great example. The fact that a child can’t stand sitting through your class does NOT mean there is something wrong with the kid! Maybe your class is incredibly boring, or this kid simply hates to sit around doing nothing with his body, or the kid is super smart and figured out what you’re “teaching” about two years back, or you’re talking over the kid’s head and he has no idea what you’re talking about but is embarrassed to admit it, or the kid is distracted by the fact that his dad threatened to kill his mom last night and he’s wondering if she’ll still be alive when he gets home today… you get the drift. But with “ADHD”, no one has to ask any of those uncomfortable questions, and the teacher doesn’t have to change a thing! We simply blame the kid’s brain and put him on a drug that makes him less annoying to the teacher, despite long-term evidence that this does NOTHING to improve the kid’s overall well being down the road.
It’s a cop out. The least powerful person in the room takes the blame, which is probably what got them to be labeled “mentally ill” in the first place!
—- Steve
I agree. It is also important to recall that these studies showing increased suicidal thinking or behavior SCREEN OUT suicidal people before starting the experiment! So the results are actually reflecting not the total number of suicidal thinkers in the group, but the total number BECOMING suicidal as a result of “treatment.” Especially when we look at the long-term outcomes being so poor, “antidepressants” are not only generally ineffective, they are overall more dangerous than they are useful.
You know, not everyone who gets hit by a car has internal injuries. Probably 90% escape with no internal injuries at all! There MUST be something wrong with that other 10%… Let’s do some genetic analysis and see if there are commonalities among those who appear vulnerable to internal injuries so we can counsel these folks to wear extra protective gear when walking around near traffic, or perhaps prescribe some organ-toughening or bleeding-suppressing drugs for them to take all the time, just in case it happens again.
What, install a traffic light? What kind of naivete is that? “Common sense” has failed these poor people who are obviously genetically vulnerable to damage from being hit by cars, so let’s dispense with it altogether! After all, 90% of those hit by cars had NO internal injuries whatsoever! What’s wrong with the rest of you wimps?
—- Steve
I actually believe that this discussion was a very healthy one in many ways, and is full of learning opportunities if we can all put our hurt feelings aside.
There are some comments which possibly could have been moderated, but the rate of comments is so fast, I’m not sure it’s realistic for anyone to intervene quickly enough. But I still find discussions like this INCREDIBLY valuable, because we are now discussion one of the most fundamental problems/issues/conflicts with the current system, not just the mental health system but our social system as a whole: WHO GETS TO DEFINE WHAT IS TRUE/REAL/VALID? And it’s not an easy question!!!
I would exhort ALL posters to take this thread as a lesson on how important it is to be respectful and to own our own views without invalidating others who post. After all, isn’t that the very thing our most passionate posters are objecting to? The idea that “mental health professionals” are allowed to invalidate your reality? Well, let’s not do that to our allies in the mental health professions, either, or better yet, let’s all commit not do that to ANYONE who posts here!
There are many professionals who have been extremely courageous in their battle to make things better for those condemned to interact with the system for whatever reason, and Brett and James are certainly two who qualify. If they say something that we object to, let’s treat them the way we’d want to be treated, respecting their viewpoint while respectfully disagreeing and expressing our own. Let’s model how helpful human interaction SHOULD be right here on our site! Similarly, we who come from a more professional background, let’s understand that feelings will get strong in this kind of discussion, for very good reasons, and let’s not take it personally and use our best professional skills to moderate the conversations ourselves rather than escalate them with our own emotional reactions.
“Be the change you want to see in the world” – we can do this, all of us, right now. It’s really the best, maybe the only way to counter the crappy treatment that so many authorities dish out.
In the end, this was a very valuable discussion. It will be more readable and will affect more people in the way we want it to if we ALL take the time to moderate our own comments, as well as accepting it if we may have offended someone else and taking steps to make it right. Stephen is right (as usual) – if we consider that we’re dealing with very different cultures colliding here, and act accordingly, we’ll come out much stronger and more effective in the end.
— Steve
P.S. One last thought – I wonder if we might have a cadre of “on-call” moderators available for the times when a discussion like this one gets big and deep and powerful? I’d be happy to volunteer for that role. Emmeline, let me know if you’re interested!
Brett, I really appreciate this reply – it certainly reflects that you fully read and digested my comments, and I feel fully heard. It is actually quite a conundrum to me: I’d really LIKE to have lots of mental health professionals join this site and the movement in general, and I know that angry survivor voices most likely impede that; at the same time, the main REASON I’d like to see more professionals is because we generally don’t pay attention to or block out the very voice that is being expressed here. I don’t see any real progress in the field until and unless hearing the voice of those harmed by the system, and even those not yet harmed but who are at high risk to become so, becomes the PRIMARY voice by which we operate.
I was fortunate to come into the mental health field by the “back door,” so to speak (my MS is in Education, actually), and I was in a position initially where I had very little theoretical training but a lot of compassion, and I actually developed my initial knowledge base almost entirely from talking to clients and seeing what they needed and how they reacted to my approach. Of course, I made lots of mistakes, but I did so with an open heart and an open mind and was almost always prepared to be corrected by the client’s verbal or nonverbal communications. I think this last part is what many professionals are lacking, and the DSM and the current system of dismissing trauma and blaming the victim makes it WAY too easy for professionals to dismiss their clients’ righteous indignation (at them or at their previous traumatizers) as irrelevant or “inappropriate” (I HATE that term!) That absolutely HAS to change – the client’s emotions and reactions and information HAVE to be the basis of all we do, or there is really no point in putting ourselves out there as helpers. Which is why my initial reaction to this idea of “correcting” the perceptions of others was so strong – it just plain doesn’t work, and it leads to exactly the kind of anger we’ve seen on this thread. Survivors of the MH system are not ever going to be OK with having their own realities invalidated, because it’s happened WAY too many times both before and after entering “the system.”
That being said, I really do appreciate your efforts and I also really do understand your frustrations. As I said, it is a conundrum of major proportions. All in all, I’m really glad this discussion happened, and in my view, by taking the risk of expressing your own experience here, you were a catalyst for the conversation going much deeper than it otherwise would have gone, and I really appreciate you for putting yourself out there and taking some hits to get folks to dig down deeper. I hope you can reflect back on what’s happened and see the value in the discussion, even though I know it caused you some personal pain to participate.
Thanks again for all you have done to move this project along!
—- Steve
I would most definitely miss you and your contributions!
— Steve
Exactly!
Or be therapists to anyone who is actually experiencing emotions of any sort.
It feels like entitlement – that “professionals” somehow are entitled to be protected against anger and being perhaps unfairly targeted of others’ rage. Naturally the recipients/victims of the “mental health” system are not entitled to any such protections.
An important contribution of Freud was the idea that clients who have been unable to speak their rage and helplessness will make us FEEL their rage and helplessness through their behavior. Professionals worthy of the name ought to know that well and understand that especially if they are “safe” professionals, they WILL be targets of these emotions, and they should expect it. I would go so far as to say that any professional who can’t handle this should stay far away from trying to “help” people and do something where they won’t have to deal with the discomfort of people’s real emotions.
Thanks for your lovely comment!
Excellent point!
VERY well said!
I agree, Sandy sets the ultimate example of how to handle criticism professionally. Her humility and her willingness to learn from other viewpoints makes any attempt to needle or provoke negative responses from her fall flat. That is the kind of professionalism we need from professional bloggers and from professionals in general who want to change the system. If we can’t listen to the distrust and anger our wonderful “system” has helped to create, how will we ever be able to alter things in a healing direction?
I would also add Johanna Moncrief and Lucy Johnstone to the list of professionals who are not afraid to roll up their sleeves and swim into the seas of conflict!
— Steve
Brett, I am sorry you have felt so attacked by this discussion, and definitely can see how you might have felt that way, as some comments did seem very personal.
I generally find your comments highly enlightening and thought provoking, but I have to say, this last set of comments makes me wonder if something has triggered your own issues here. I could be wrong, but it doesn’t feel to me like you’re simply working to improve the quality of the comments or improve the likelihood of the mission being effective – you sound angry and irritated, and you’re making gross generalizations, for instance, about people in general being anti-science or positing that there is no objective reality, which characterizes a VERY small proportion of the comments I’ve read.
I agree that professionals posting here are sometimes attacked unfairly, but again, I think that is a function of the kind of audience this type of a website will inevitably attract, and I agree with Richard that it is part of our job as professionals to be able to respond to such apparent attacks without rancor or judgment. The voice of the oppressed can be harsh, especially toward the perceived authorities, but that is a function of the trauma they have experienced and their righteous rage, not necessarily any reflection on you and your contributions to the movement.
Which gets to the real point of the discussion, which I wish you had tried to hear behind the anger. The point is not whether there IS an objective reality, the point is whether PROFESSIONALS like you and James and Richard and Stephen and Ron and I are entitled by virtue of our professional titles and experiences to DICTATE what reality is to our clients? Or is it our job to negotiate, test, communicate, question, probe, and encourage our charges to look at things from different viewpoints and make their OWN evaluation of what reality is. I heard one commenter only who pitched the idea that reality is whatever we make it – the vast majority accept objective reality exists, and are objecting instead to the idea that it is James’s or my or any of our jobs to CORRECT the client’s perceived misconceptions of reality, but suggesting instead that our job is to explore with them how and why their “misconception” makes sense to them and move forward from there. Of course, there are times of danger when we may feel we have no choice but to act protectively, but the VAST majority of the time, the client’s “delusions” are no more delusional than the psychiatrists’ idea that their lives can be fixed by drugging their brains, and actually far less dangerous. It’s a question of whether reality is something that the authorities dictate to their subordinates or is something we discover together, understanding that none of us has the full scoop on what “objective reality” truly means.
I hope this clarifies at least where I and where I think a lot of other posters are coming from. It is really not personal, even if it may seem like that. And being a professional means being able to make that distinction. You are getting the suppressed rage from every time these posters had something to say to a professional but didn’t feel safe saying it or was punished for doing so. It may not be good politics, but it is a natural outgrowth of a certain part of objective reality that professionals in similar roles to you and me have historically tried very hard to deny exists. It’s gonna happen, and it’s not fair, but it’s reality. For all this talk of clients denying reality, I think we as professionals need to be honest enough to admit that the clients’ reality as conveyed, whether fair or not to us individually, is a VERY big reality to be dealt with, and the system change we want to see happen will NEVER happen until we as professionals can not only accept but embrace that reality, the reality of the very clients we are trying so hard to help.
— Steve
Actually, I think a goodly percentage are actually that delusional. The ones at the top know what they’re doing, but a lot of the rank and file are just emotionally crippled people who have been trained to say certain things, so they say them.
Another fox guarding the henhouse. Such corruption is unprecedented, in my opinion.
I am with Richard. I think being a professional means taking responsibility for the effect you have on your audience/client base, whether intended or not. I always figured that people have the reaction they have, and whether they were polite about it or not, there was almost always important information to be gained from hearing and clarifying their reactions. Part of being a professional is understanding that the client is going to have reactions and that it’s your job to set the tone of respectfulness, not theirs. Not that this means a professional has to put up with abusive behavior, but the professional has a responsibility to handle it, well… professionally.
— Steve
“I’m learning that I don’t have to agree to find things of value.” I think this sums up the big lesson of this comment thread. There may be “objective reality” but no one is the final authority on what “objective reality” is, and it looks different from different perspectives. Even when I think someone is totally “out there” in terms of what’s actually true, there is a lot to learn from finding out WHY the world looks the way it does to them. As long as no one is being hurt, I think we do best to simply realize that agreement is not required to respect someone’s viewpoint on reality.
So wondering where your next meal comes from makes people anxious and depressed? Who would have guessed?
I don’t think so. I think Vlado is trying honestly to provide his perspective, and I think it’s important that we respect his experience, even though I think most of us would not adopt his suggestions as a good general policy on how to engage with someone in distress. He’s found a way that works for him – good for him! And I think his argument holds elements of empowerment – that psychiatrists should enable their customers to utilize the offered drugs in ways that work best from the customers’ point of view. This would, of course, involve psychiatrists admitting that their entire approach is not scientific, but is basically the offering of substances to make people temporarily feel better subjectively while making no effort whatsoever to figure out what is really wrong, which they would never allow, but still, there is a legitimate point in there that deserves recognition.
— Steve
“Consensus reality,” by definition, requires consensus, doesn’t it? The word itself is basically an admission that many viewpoints can constitute reality, and that common reality is defined by consensus. Hence, the only thing really “wrong” about “delusions” is that they defy what most people choose to believe is true. Your point about slavery is very well taken. There are plenty of “consensus reality” beliefs (such as the belief that psychiatry is a scientific field!) that are of pretty questionable validity.
I do believe there is a “reality” out there that we all perceive, but even physics, the most reality-based discipline there is, has run up against the problem that even perceiving reality alters that reality. So any perception of reality, no matter how precise, is always an approximation. Admittedly, some approximations comport more closely with the actual DATA of reality, but they are still approximations and subject to modifications when new data comes in.
Bottom line, reality for humans exists as a relationship between the perceived and the perceivers, and no two people perceive reality the same way. Consensus reality is always a negotiation, and I think you’ll agree that we get into big trouble when only a small subset of humans get to be involved in the negotiations and the rest of us have to live in their “reality!”
— Steve
Here is one link:
http://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html
A fascinating study looked at US immigrants’ health measures over three generations. While health indicators for first generation immigrants were all over the map, by the third generation, they had all “normalized” to USA-typical health problems, including increases in obesity, heart disease, diabetes, anxiety and depression. So much for genetic causes of “mental health problems,” or even physical health problems, for that matter! Our way of living makes people ill!
Very well said. Thanks for the clarification!
Sam, you’re a gem! And it sounds like your wife is, too, despite everything.
— Steve
Well, you never seemed too interested in hearing others’ views, which is kind of the point of this forum. Since you already seem to believe you’ve got it all figured out, I encourage you to go back to toenail picking.
The law of gravity and all other scientific laws/theories are human inventions. Gravity (as in the tendency of massive objects to move toward each other, at least in the 3-D conception of space) does appear to exist, but it can be viewed in a number of different ways, both mathematically and philosophically.
While reality does clearly exist, we know, even in physics, that perception can and does alter the very nature of reality itself. Without a consideration of viewpoint and perception, any description of reality is incomplete, hence the need to create AGREED-UPON reality between the clinician and the person they are trying to help, even if the client’s viewpoint appears to us to be distorted or “wrong.”
— Steve
I would suggest that you add the provisions of the Harrow study, which found that patients with BETTER prognoses did worse on neuroleptics than patients with WORSE prognoses off neuroleptics. This really undercuts the idea that only the “less ill” do better off drugs. I don’t think you should concede that point at all.
Otherwise, great data, well argued. Thanks for keeping up the fight!
Not to mention that there is no objective way to even approach determining who the “right patients” are except by giving them the drugs and seeing what happens. And the claim that they are “life-saving” flies in the face of the horrific early death rates for those taking the major tranquilizers aka “antipsychotics.” I agree 100% – it is the responsibility of the medical and psychological professions to actively discourage the long-term use of these agents and to explore other options that are more likely to lead to a real improvement in life quality.
Your comments also remind me of the qualitative study showing that “psychotic” people in countries where voice hearing was accepted or even valued as a special gift had friendlier voices, whereas ones where “psychosis” was rejected and feared had scarier experiences. It appears the social environment not only affects the presence of voice hearing, but also the quality and content of the voices! So your thesis makes total sense – it may be that suppressing the voices may be the WORST approach we could take!
—- Steve
These studies also generally fail to distinguish between SYMPTOM REDUCTION (usually the clinician’s goal) and QUALITY OF LIFE (usually the client’s goal). If you focus only on symptom reduction as an outcome measure, neuroleptics will be judged “beneficial,” at least in the short term. But if you look at quality of life measures, it appears that neuroleptics are at best of limited use, and more likely generally destructive. I think that’s where a lot of the conflict and confusion comes in – psychiatrists are often only concerned with making the “symptoms” go away, and frequently have little to no concern for long-term quality of life outcomes.
“Nerve seizing.”
“The only authority on my perceptions and my reality is me.”
VERY well said!
— Steve
Wait for what, and see what?
Thanks! Honestly, I really don’t know what others are perceiving or why they are perceiving what they are. And I’m genuinely interested in understanding how and why they believe what they do. Perhaps it’s because I didn’t receive any formal training before starting my work as a counselor, so I had no illusions that I understood anything except as the client explained it to me. That approach has never failed me yet!
I agree 100%. But the way you frame that is YOU think the truth is x” vs. “You are wrong and need to listen to what I say.” There is all the difference in the world between letting the client know what you honestly think vs. telling the client that they need to think the same way you do. It is subtle but can make the difference between eating the rat poison and not eating it.
I find your last paragraph to be the most important. We fail our clients, or the people we’re trying to help in any capacity, when we believe we know more than them and are entitled to dictate reality to them, and when we believe our knowledge is “right” and infallible. Being open to our own vulnerability and potential lack of understanding allows the client to also be open to the possibility that their viewpoint may not be the only “right” way to view the situation, either.
— Steve
Exactly! That is what works!
I am not sure the critique is exactly what you’re suggesting, at least in my case. You might want to see my post above. I believe, from direct observation, that it is not only quite possible to influence someone’s views while still being totally validating of their viewpoint, it is actually the key to good therapy. A woman living in a domestic abuse situation and imagining she can make it better if she tries harder is not a situation I want to see continue. However, it’s very clear from my experience that telling the person she’s wrong about her ability to make her abusive partner change either alienates me from her or makes her feel stupid and incompetent, neither of which leads to the desired reconsideration of her reality. What I have found DOES work is exploring her belief that something good is happening by staying or at least that something bad is being prevented by staying, and validating that reality, which almost always makes a lot of sense when you take the time to hear the reasons behind it. I then try to turn the discussion to one regarding what THE CLIENT wants and whether or not the current situation provides it IN THEIR VIEW, and honestly explore the pros and cons of staying vs. leaving, at NO TIME telling the client she is wrong for staying, and in fact letting her know that many if not most DV victims stay for long periods of time trying to fix up the situation, and for very understandable reasons. Of course, I am also willing to share my personal thoughts on what is happening and why if they are interested, and also how likely I believe it is or is not that this will work out, but I don’t present them as REALITY, simply as my personal views based on my own experience with this kind of situation.
So one doesn’t have to AGREE with a “delusional” (is there not implied negative judgment in even using that word?) viewpoint to validate that it looks that way from the client’s perspective. Nor does one have to invalidate that viewpoint in order to help the client see that other viewpoints also exist and may have validity as well. It’s the difference between saying, “There are no voices talking to you – you are imagining it” and “I understand you are hearing these voices, but I personally can’t hear them and don’t know what they’re saying.” The first invalidates the other person, the second merely states the reality that you’re having two different experiences, and doesn’t privilege the therapist/helper to having the “right” viewpoint.
— Steve
Not sure how validation and confidence/independent thought are not compatible. While I have very strong personal ideas about what is right and wrong, I also understand that I don’t always see how things look from others’ viewpoints. I’m not shy about sharing my views, and strongly, but I’m also always interested in hearing where others come from, and especially WHY they come from that viewpoint. In the cases where I do think a person would benefit more from being able to see things my way (I’m a pretty smart and observant guy and I think have a lot of insights to share in many situations), it still works much, much better if I understand what the person is thinking before I intervene.
A great example: I used be a supervisor for a community suicide/crisis hotline. Once I got a call from a woman who was suicidal, and I asked, as I always did, what benefits they thought would occur from suicide, or in essence, what problem they saw suicide solving for them. She said, “Because the pain would end.” Now I don’t know why I said this, never have said it before or since, would probably be criticized roundly by most “mental health” professionals for doing so, but for some reason, it seemed the best thing to do. I said, “How do you know that?” She said, “What?” I said, “How do you know the pain would end?” She said, rather heatedly, “What are you talking about??!!” I said, “What if when you die, the pain doesn’t end, but you have no body but you still have the pain?” She said, “Oh, my God, I never thought of that!” We were then able to talk about other options she might have short of suicide to reduce her pain, keeping in the background that suicide was always an option she could return to if need be, but a rather uncertain one at best. At no time did I tell her that she shouldn’t commit suicide, nor that committing suicide would NOT end her pain, I merely pointed out the possibility that her certainty about the outcome might be misplaced.
So I validated her pain and her desire to be rid of it, but I neither validated nor invalidated her solution. I simply created grounds where we could talk honestly about the pros and cons. I showed I understood her and accepted her viewpoint and needs, but let her know that other viewpoints might be possible, as well as other solutions. I was certainly both confident, even bold, and quite independent in my approach, while still validating her reality. It can be done.
— Steve
And all side effects of the “medication” will be attributed to “the disorder.”
VERY well said!
Well said. My oldest is super gifted in math – could translate negative 100 Centigrade to Fahrenheit degrees IN HIS HEAD at the age of 6, and even knew without being told that he had to add 32 degrees to adjust for the difference in the zero points of the two scales! But he was failing 6th grade math. Found out that the teacher gave them “steps” to memorize and repeat, and they got one point for each “step,” and if he skipped half the steps, he got 50%. Her most common quote was, “Math is just a mechanical process.” The next year, he did independent study and covered two year of material in 7 months and was taking math at the high school by 8th grade. But this dumbass lady was flunking him for not following her steps. Idiocy!