Thursday, June 21, 2018

Comments by Steve McCrea

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  • Well, you start your comment off with an insult and then avoid almost every comment I made, and then simply declare that you are right, and that Alex’s brutal shooting of himself is “romanticized” or “glorified?” It is very hard to take you seriously when you approach conversations in this manner. I’m not simply contradicting you. I made very specific points, such as the clear and severe consequences of Hannah’s suicide for others she loved, and the completely cold and pointless and totally UNGLORIFIED nature of Alex’s act. And of course, you utterly avoid the rest of the show and focus only on two scenes, one of which you don’t even really discuss at all but simply claim to have been “glorified” through some mysterious psychological mechanism.

    Your comments about “mental illness” continue to be confusing and illogical to me. If “mental illnesses” are just “symptoms that present in a psychological manner and have no clear somatic cause,” then my statement is completely true – there is nothing to say about Hannah’s “mental illness” except that she hated her life and wanted to die. I’ve never asserted anywhere that people don’t feel depressed and have related ‘symptoms’ or don’t “meet the criteria” for these DSM “disorders.” Hannah would 100% meet the criteria for “Major Depressive Disorder.” So you can easily say she was “mentally ill” just by watching the show. What did you want from the producers? That she be “diagnosed” during the show? If being “mentally ill” is simply grouping together unexplained “symptoms,” how is that different from saying that a person, for whatever reason, is overwhelmed by the conditions of his/her life? Any fool knows that a person’s experience is a combination of their own view/perception of things and the experiences that they have in the world. So what’s it mean to say she was “mentally ill”? And why is that important?

    These two questions are what is bothering me about your post. There is no logical path from “Hannah’s suicide was romanticized” or “The show had a bad impact on me and people I know” to “Hannah should have been depicted as ‘mentally ill.'” It makes no sense at all. Hannah WAS depicted as “mentally ill” by your definition. So what should the producers/directors/writers have done differently that would have made it better in your view, other than not writing a show about teenage issues from the teenage viewpoint?

    Oh, and just to be clear, you also completely dodged my comment that I did NOT recommend this show for people who are suicidal. I said that it showed teenage issues from a teenage viewpoint, and that’s what makes it valuable. Apparently, you don’t find that point worth responding to, even though it was the main point of my original comment, which made me wonder what your agenda really is here. Based on that observation, it did not appear to me to be your agenda to have a reasoned discussion. I’ll see how you respond to this one and draw the appropriate conclusion.

  • I would probably start by researching myself and asking when this started and what set it off. The answer might be in the realm of the physiological (it started right after I took X, which can cause “psychiatric” symptoms), or psychological (it started just after an ugly confrontation with my mother in law) or a combination (I haven’t slept well for four days due to worrying about Z). It could be something altogether different that I am unable to imagine now. But I’d look for the source before I decided what to do.

  • And yet the overwhelming majority of people who are killed by someone else are killed by people who are not experiencing a “psychotic state,” and the overwhelming majority of people in a “psychotic state” never attack or harm anyone at all. People who use drugs and alcohol to excess, domestic violence perpetrators, sex offenders, gang members and wannabes, all of these categories statistically are MUCH more dangerous than “psychotic” people. Not to mention the professional business CEOs (like pharmaceutical companies) who murder millions indirectly and get off with no consequences. Raising the “dangerous psychotic” meme here doesn’t really hold a lot of water, because we know better.

    I do respect, however, your statement that psych drugs and even non-psych drugs do cause violence at times, just like street drugs do. Unfortunately, the “treatment” for “psychotic states” is giving more mind-altering drugs to the people who are so diagnosed, which as I think you are intimating can actually increase the odds that they’ll do something dangerous. And when they do, lo and behold, it’s all blamed on their “psychotic state.”

  • So you were SEEKING support for your decision from Kurt Cobain’s letters. People can seek and fund such validation if they want to find it.

    I also very much doubt that anyone watching the entire series could view that Hannah’s suicide was “worth it.” It was clearly an act of despair following many attempts to find a way forward with her life. The consequences for her mother, her father, her friends, and her school were obviously devastating. How does it seem “worth it?” Just because she lit some candles before slashing her wrists? It is clearly a TRAGEDY from start to finish. I’d suggest that seeing what her mom and her dad and Clay had to go through as a result of her decision would discourage anyone from considering suicide. The idea that “they’d be better off without me” is clearly and completely dashed by the production.

    You continue to suggest that someone has to be “mentally ill” before they’d consider suicide. What on earth can you mean by that? Many people (including me) have suicidal thoughts that stem from having difficult experiences that they have difficulty coping with, including rape or incest or child abuse or neglect or war or gang violence or any of a myriad of crappy things that life has to offer us sometimes. Unless you define “mentally ill” as “having a hard time coping with life”, you have no grounds to stand on here.

    I am assuming that you are one of those who believe that “chemical imbalances” are behind “mental illnesses,” and conclude that Hannah or someone like her could never consider taking her own life unless such an “imbalance” was present. If that is the case, it is understandable why we disagree. However, I would love to see any actual evidence you can present to support such a hypothesis. At this time, no “mental illness” can be defined by any physiological process or measurement, including depression. As such, saying someone “has a mental illness” has as much meaning as saying someone “feels like crap because s/he has been abused and mistreated all of his/her life.” The idea that a person has to be “mentally ill” in order to commit suicide is simply an opinion with no scientific backing, if only because “mentally ill” is a vague and subjective term that doesn’t allow any kind of scientific conclusions to be drawn.

    In other words, people kill themselves or feel like doing so for a million reasons. Saying they are “mentally ill” avoids looking at the individual’s experience and values and process of decision making, which is, of course, what the series is really all about.

    Last comment: how is it glorifying suicide when another kid shoots himself because he can’t deal with the reality of your actions? Was Alex’s suicide romanticized? Was it?

  • I find your post confusing, as you seem to accuse me of things that I didn’t say. Of course, the suicide scene is overdone, and of course, they’re trying to make money. Obviously. I never said otherwise.

    You clearly have your own view of “mental illness” being the cause of Hannah’s suicide. I find that view somewhat bizarre in the face of all the crap that happened to her. Do you really think that people aren’t driven over the edge by bullying, by lack of support, by rape or sexual assault? What is the meaning of “mental illness” in this context? Are you implying that Hannah or a person like her would NOT kill herself despite all the abuse she tolerated if she were not “mentally ill?” Is there a proper, “normal” way to respond to being raped by a peer and then having to face him in school the next day?

    If you have specific responses or comments you are upset with, please let me know what they are before you go off on me. It’s impossible to really understand what you’re saying. However, I want to be clear that I NEVER said that this was ‘a good show for suicidal people to watch.’ I said that it depicts the dilemmas that kids face from the kids’ point of view, and that is why I found it valuable.

    I will end with the observation that I’ve talked to many, many suicidal people over decades, and not one has ever said they became suicidal because they watched a show or read a book or watched a movie. They all had difficult life circumstances they were trying to navigate, and were struggling to find a way forward. The idea that a show would put something like this in someone’s mind is, again, naive. People don’t suddenly become suicidal just because they see a show. You of all people should know this, having been there yourself. I also have been there, and the things that put me there or kept me there were real things that happened to me, or that didn’t happen, or that I imagined or feared would happen, and while a show or a song might remind me of a certain dilemma or depressing event, there is no way that any show could possibly have affected my decision to kill or not kill myself. Maybe other people are different, but that’s my reality.

  • This was published in the Journal of the American Medical Association, as mainstream a journal as there is in the USA. The data is from the Institute of Medicine, one of the most trusted government organizations. Here is a link to a summary.

    Over 100,000 people are killed IN HOSPITALS by drug side effects. Many more are killed outside of the hospital.

    It is scary!

  • I agree with most of what you said, though I see your clinic as being an anomaly compared to the low-income clinics I am aware of.

    Also, the woman I was talking about wasn’t too depressed to consider taking action (and honestly, I don’t buy that such a condition is anything but exceedingly rare – people CAN take action, but they have to find a REASON to take action and have HOPE that it will make a difference!) She was EXCITED to hear there was something else she could do. No one ever bothered to tell her that she had options.

    Glad to hear your clinicians are up on the BS involved in DSM diagnoses. I hope it spreads!

  • Unfortunately, my experience is that the majority of psychotherapists these days adhere closely to the “medical model,” including applying DSM diagnoses uncritically and referring clients for drugs when they fit certain diagnostic categories. In particular, people who don’t have great insurance (which includes probably the majority of Americans) don’t have much choice and are not informed of options that are or should be available, nor are they informed of the potential damage these drugs can do.

    I recall talking to a woman on a crisis line who was frantic after a year plus of trying different antidepressants without results. She was feeling completely hopeless until I asked her, “Has anyone ever told you that there are other things you can do for depression besides drugs?” She stopped for a second, and said, “No…” When I told her that there were, she was SO relieved! Imagine, a whole year plus interacting with mental health professionals, and not one had told her there was another alternative?

    The idea that therapy is better today than in 1970 doesn’t seem right to me. At least back then, they had the idea that talking and listening was part of the process. Today, it’s much more about categorizing and changing “symptoms” rather than exploring meaning and options. At least that’s my experience.

  • What do you think about the euphemistic use of the term “overprescription,” Frank? Wouldn’t it be more accurate to say “unneeded prescription” or “Unjustified drugging of children?” To me “overprescription” implies that there would be a ‘right’ level of prescription, which of course is impossible to determine when your criteria for diagnosis include such objective measures as “sometimes fails to wait his turn in line” or “sometimes acts as if ‘driven by a motor.'”

  • Very true. The first mistake is assuming that all “hyperactive” kids have a problem, and then assuming that they all have the SAME problem, and then assuming that the problem lies in the CHILD (or more specifically, the child’s BRAIN). None of these assumptions are supported by even a slight degree of evidence. Catering to individual needs is, indeed, the answer, but that would require the adults in charge to take responsibility, and it is SO much easier to blame the kids, especially when billions in profits are to be made into the bargain.

  • Perhaps it is a success, because the proponents had a different goal in mind than actually helping people. I agree that if we assume the purpose of psychiatry is to assist people in becoming more functional and dealing better with emotional distress, it is a disastrous failure. But if the actual purpose is making a lot of people rich by creating permanent “clients” who can be forced to accept “treatment” even if it doesn’t work or makes things far worse over time, and establishing power for the psychiatric profession to define what is “normal” in support of the current status quo hierarchy in society, I’d have to say it’s been a roaring success.

    People’s biggest mistake in engaging with psychiatry (and to a lesser extent, the entire medical/pharmaceutical/insurance industry) is making the assumption that helping us obtain better health is the primary objective. Receiving medical care is the third leading cause of death in the USA annually. If patient health were really the objective, this statistic would horrify the medical world and lead to massive efforts to find and eliminate the causes of these unnecessary deaths and harms. The fact that it has not led to such an outcry and effort should be enough for us to realize that their objective is something very different, that has very little to do with maintaining their clients’ health and well being.

  • I think this is a very important clarification. We have spent way too much time attacking each other for being “too extreme” or for not being “antipsychiatry enough.” Both goals are legitimate and necessary to move forward, because however much we’d like to remove psychiatry from the face of the planet, people are suffering TODAY as part of this system, and such people need help TODAY and can’t wait for capitalism to collapse and some other better system to take its place that recognizes that psychiatry as practiced today has no place in a civil society. At the same time, it is VERY important to recognize the degree to which participation in the system suggests a degree of tacit approval of some of its principles, and that those very principles are the things that need to be tossed out!

    There are a lot of aspects to this whole process of moving in a new direction, and I agree that identifying one’s goals is important, but it’s equally important to recognize that others may have different goals and that as long as we’re all working toward ending the abuse of the “mentally ill”, having different final outcomes in mind should not keep us from working together.

  • Like the story of the frog in the slowly-warming water. Apparently, if you heat the water up slowly enough, the frog never realizes s/he’s heating up and dies despite being able to leave the water at any time.

    Of course, we might want to ask who exactly thought up this experiment…

  • “Very few” doesn’t mean “nobody.” I have never argued for an elimination of the drugs, as I am well aware that a significant percentage of those labeled as “mentally ill” find them helpful in one way or another. I simply object to the psychiatric profession defining your reality for you, and especially to them forcing “treatment” onto you whether you find it helpful or not.

  • They claim that the increase in stimulant prescriptions is “unexplained.” But it is easily explained! When you start with a “diagnosis” that has no objective criteria to “diagnose” with and which has no boundary between it and “normal,” and you add a drug which provides both a financial incentive to the prescriber AND a social incentive to the parent/teacher looking for a prescription, you have a formula for an ever-increasing rate of “diagnosis” and prescription.

    One thing that would help is if we stopped saying “overprescription” or “overdiagnosis” and we started saying “unjustified drugging” and “malpractice.” These euphemisms make it seem like it’s just a little “whoopsie” instead of a massive and continuing abuse of both a “diagnosis” and a drug that are being used mainly to control unruly or active kids for the convenience of the adults involved.

    It is also important to add that this trend toward increasing “diagnosis” and drugging flies in the face of decades of long-term studies showing that the kids who receive stimulant drugs do not improve in any long-term outcome area relative to other “ADHD” kids who are forced to take stimulants only in the short term or not at all. Given the clear risks that giving a kid stimulants entail, there is no excuse for this continuing malpractice.

  • Hi, Rasselas.redux,

    It appears I have not communicated clearly enough. I had no intention of minimizing your suffering or that of those who have similar experiences. I have worked for years with people who have difficulties that get labeled as “mental illnesses” as both a therapist and an advocate, and I have a very good idea of the kind of pain and confusion such conditions can bring about. I am also not opposed to using drugs for those who find them helpful, and never have been. Nor am I arguing against individuals such as yourself embracing a particular label or identity that you might find helpful, nor am I proposing that I have some magical understanding of “what is wrong” with people who get these labels or what you or anyone else should do about it.

    What I object to, and I make no apologies for it, is a profession getting together and deciding to create these arbitrary names and categories that they give to people based solely on how they act or feel, and then act as if these names are some kind of scientific reality that they can apply with confidence to anybody that comes through the door. I object even more strenuously to the “profession” blaming people’s brains for any kind of distress or upset that they exhibit, as if their surroundings and experiences and the people and stresses they have to deal with have nothing whatsoever to do with their suffering. I object most strenuously of all to those embracing the DSM categories using them to look down on those so categorized and treat them with disrespect and prejudice and discrimination based solely on the category that the “professionals” have chosen to put them into, including locking some up and forcing “treatment” on them that may or may not be helpful and may or may not be totally destructive, without that person having a word to say about it.

    As the person who is suffering, I consider that you have every right to decide what your suffering means to you and what you think may be helpful or destructive. I don’t think it’s someone else’s job to make up subjective or arbitrary categories and then tell you what is “wrong” with your brain (even when they have almost zero knowledge of your brain) and what you have to do about it, and it’s especially not their job to force you to do it if you disagree with them. There is good evidence that this approach encourages a lack of empathy and a prejudiced approach to people who receive such labels, all of which I believe makes your life a lot tougher.

    So by all means, identify as you feel is appropriate and use whatever means you think will best help you deal with your reality. My comments are not about you and your choices, but about the intentional efforts of the psychiatric profession to create a false, pseudoscientific narrative to keep people like you under their control and to make billions for their profession and its big corporate allies. I will never apologize for attacking these efforts, but I want to be very clear that you and your needs are a completely different story, and I’ll fight for your right to define your own experience and needs.

  • Except that the labels create the culture that supports the drugs. If there were not the belief that psychiatrists “know something about the brain,” and that their labels represented some kind of scientific truth, the whole edifice would fall on its ugly ass. It’s people’s belief in the labels that makes all of this possible. I really believe that if pseudo-scientific labeling were eliminated, very few people would want these drugs.

  • I’m confused by this particular conflict. It seems to me that the Spotlight report reframes the mistreatment and abuse of the so-called “mentally ill” as the human rights issue that it really is. I don’t expect a mainstream bunch of attorneys who are pissed at their clients’ treatment and are trying to do something about it to meet some “antipsychiatry” standard. They are fighting for the rights of their clients, and GOOD FOR THEM! I think there is a lot there that is very useful for the most radical antipsychiatrist to use, and for the mainstream language and the rest of it, I consider it simply the reality that not everyone has come to the same degree of awareness of how the system works and what’s behind it. My thought is that we should engage anyone of goodwill in this discussion, and that anyone who understands and is genuinely opposed to the status quo (as opposed to having a financial interest in the outcome) is AOK by me. If we expect everyone to be in favor of eliminating psychiatry, we’ll be preaching a lot to the choir.

  • The problem I see is that those in power are factually opposed to the idea of peer specialists and/or patients having any increase in power or voice. It’s possible to create little pockets of enlightenment, and I truly value and admire those who manage to do so (having been such a person myself at one time). I just think it’s too easy to co-opt or silence those whose interest is to genuinely empower the clients. Lots of clinicians talk a good game, but when push comes to shove, they are disturbed and threatened on a very deep and usually unconscious level by anything that supports clients making their own decisions and being let out from under the full control of the clinical staff.

  • There really are such things as “scientific values,” but unfortunately, anything can be co-opted.

    My understanding of scientific values includes: 1) Observable data is the only basis for determining what is true; 2) Human beings are inherently susceptible to confirmation bias, therefore, the primary role of science is to be skeptical and to intend to disprove potential hypotheses rigorously rather than searching for data to support them; 3) Scientific models are only as “true” as they are useful in predicting real data and events, and they are true only as long as they consistently produce this kind of result; 4) ALL data relating to any particular hypothesis must always be made available to all researchers – per #2 above, any data potentially REFUTING a hypothesis is particularly important to make available.

    There are more and there are other viewpoints on what makes an inquiry scientific, but the idea that scientists have some special knowledge and ability to determine truth and that those less qualified should stand back and let the scientists do their jobs is certainly not valid. Many scientific discoveries (or invalidations) are made by people in a different field entirely. Science is about finding the truth, and no one has special access to the truth.

  • It’s also important to remember that “works” is defined here only as “temporarily makes ‘symptoms’ less bad than they were.” It does not imply feeling good, nor does it imply long-term improvement in prognosis or outcomes. Whitaker has done a great job showing that even if these drugs “work” for the short term, they tend to make things worse in the long run. And for many, even the short-term results can be disastrous, even if they are judged “helpful” on the average.

  • Not sure why we appear to be arguing here. I have never spoken against using science to study human behavior. I am a scientist (chemist) by training and am well aware of the advantages and limitations of the scientific method. I also posted my clear understanding that general trends can be arrived at scientifically using norms and averages. What I objected to is the idea that certain therapy “brands” can be identified as “evidence based” and therefore considered reliably better or more effective than those lacking this “evidence base” in most or all cases. I and others have outlined in several posts both the limitations of such evidence when applied to individuals AND the financial and other biases that warp the “evidence base” in favor of certain kinds of interventions (drugs being the MOST supported by “evidence” because, of course, they get the most funding for research since they make the most MONEY.)

    It seems to me that your arguments mostly support an evidence base for certain very specific signs/symptoms being best approached (at least initially) by certain means. I don’t have any real argument with that. The problems arise when we either overgeneralize (if phobias are most likely to improve with exposure therapy, then exposure therapy is the best therapy for ALL forms of anxiety) or fail to adapt to individual circumstances (some people WON’T improve with exposure therapy but will with something else, and some don’t have elimination of that “symptom” as their goal). So the science involved in psychology is mostly applicable to people considered as a group, but only if that group has very specific characteristics in common, which we all know that most people working in the field don’t grasp.

    The greater danger of “EBP”, though, is when it is applied to entire DSM categories, or to therapy in general. I can’t tell you how many stories I’ve heard where CBT or DBT (or drugs) have been forced on someone because “that’s what works” or “it’s evidence-based practice.” I recently heard from someone that they and others were FORCED to do “mindfulness” exercises every day as part of a DBT group (they got in trouble if they refused). I’m not sure how familiar you are with mindfulness, but I think it’s fair to say that forcing someone to do mindfulness exercises is deeply ironic and defeats the very purpose of the concept, kind of like your Dad saying, “We’re going on a trip and you are going to have FUN, do you hear me? FUN, whether you like it or not!” Oddly, this person did not find “mindfulness” very helpful…

    You can (perhaps rightfully claim) that this isn’t really the “EBP” that was studied, and that it’s being misapplied, but that is what clinicians tend to do when presented with this EBP concept. As a scientist, my observation over many years is that science is by far the best at showing what DOES NOT work by falsification. This is particularly true when humans are involved. It is, again, arrogant, in my view, to suggest that a particular therapy is THE BEST for any diagnosis, or that ANY particular therapy is bound to work for a particular person. I think that science itself has shown us that the DSM categories are not scientific entities and are grossly heterogeneous, such that proposing any single solution based on grouping people together by how they feel or think is bound to lead to unscientific practices.

    BTW, I noticed you didn’t address my point regarding “EBPs” for a diagnostic category like “Major Depressive Disorder.” It seems to me that your example of phobias is a very focused and specific category compared to any DSM diagnosis. Do you think there can be an “evidence based practice” that applies to all people who are diagnosed with “MDD” or “Bipolar disorder” or “Borderline Personality Disorder?” Do you see a danger in prescribing a particular approach to take with ALL people in such a category? Do you see potential corruption in marketable “workbook strategies” that would encourage the marketers to claim more general success than is actually observed?

    In my experience, what these “EBPs” provide are concepts that can be applied or attempted in specific situations, but the bottom line continues to be whether or not the client him/herself accomplishes his/her goals in his/her own opinion, and any clinician who considers his/her school of therapy more important than the client’s response is going to have a lot of failures, and will be very tempted to blame his/her clients for those failures instead of coming up with a different approach.

  • I agree with oldhead that it is not possible to objectively measure emotions, behaviors, and beliefs with behavioral rating scales. First off, we are relying on either self-report, which depends on the reporter both being honest and sufficiently self-aware to answer accurately, or on observer report, which opens us to prejudice and value judgments that are almost impossible to sort out. Additionally, what we are measuring doesn’t really have width or weight or pressure – things like “do you sleep well at night” or “do you frequently have trouble concentrating?” don’t have yes/no or scalable answers. Normalization allows for some kind of statistical studies, which makes it possible to look at large groups and draw some very general conclusions about probabilities, but as for measuring individuals’ emotions or thoughts or anything of that sort, we’re getting into a realm so subjective that the term “measurement” can’t really be applied. And applying probabilities to individuals is part of what doesn’t work about “mental health” interventions.

  • I agree 100%! There is NO evidence that I’ve ever seen that assigning homework is correlated in any way to improved learning. My son had to do sometimes 3-4 hours of homework every night for days at a time. He was also on the wrestling team which had meet run until 9 PM a couple nights a week. It was ridiculous, and for what?

    I’m also a great believer that free time is at least as educational, probably moreso, than any work assignment kids ever receive. We learn best from things we’re interested in, not something we’re forced to do to make someone else happy.

  • I agree in principle. However, the problem right now is that “training” doctors in the area of “mental health” would mean they’d be trained in the crappy DSM/chemical imbalance/Drugs first paradigm. Before we start training doctors, we would need to figure out how they need to be trained. Moreover, just training someone doesn’t make them able to handle difficult issues with compassion and skill. I have no idea how we could assure that all doctors are capable enough to be a safe place to go with this kind of intimate issue. My personal belief is that peer support is a much safer and more reliable option.

  • That’s why I find the DSM to be more problematic than the drugs themselves. It provides a rationalization to distance oneself from both the clients and one’s own personal issues. Instead of making oneself open to hear where another person is coming from and feel compassion and help them figure out what action they might take, clinicians are now allowed and expected to categorize people based on their particular “brand” of suffering, and their suffering IS the problem instead of an indication of some personal problem they may have. It also makes it easy to blame your “client” if your own approach fails, as the article points out.

  • Now I’m really confused. Laughing gets me committed, but failing to laugh somehow means I’m denying my “illness,” and I get committed anyway? This would certainly wipe out any tendency I’d ever have toward excessive cheerfulness. I think I’m cured! (Oops! Still with the exclamation points…)

  • The situation is even more dire than your comments suggest. If the suicide rate is higher amongst the “treatment group”, and the treatment group has been PRE-SCREENED for suicidality and suicidal people are removed in advance, it means ALL of the suicidality reported is caused by the drugs! So the drug doubles the suicide rate AMONG THOSE WHO ARE NOT SUICIDAL. What it would do when we include people with suicidal feelings into the cohort? Frightening to think.

  • I agree with the captioned statement 100%. Unfortunately, I think many people don’t understand what that means. I think a lot of people think it means that all white people are racists, or all white people are bad people. It doesn’t. It means that we’ve all been exposed to racist images and stories and ideas, and that it take a strong, conscious effort to be aware of that and to set it aside as best we can. I think acknowledging this fact is a fantastic first step for people to realize that racists beliefs and ideas aren’t something held by some small percentage of evil people who use the “N” word and beat up black people. They are a part of our entire culture It is much bigger than some bad individuals doing bad things. It’s a part of our culture, and to change it, we have to start by being aware of it, and that good people, even the best people, still have to work to be aware of and counteract these racist images which have become embedded in our own experience.

  • I agree with you 100%. Epigenetics and neuroplasticity directly undermine the “broken brain” model and are therefore conveniently ignored by the mainstream of psychiatric research. This is not new information, either – neuroplasticity was uncovered back in the late 1990s, almost 20 years back. But you can’t use neuroplasticity to sell drugs, so it seems to get very short shrift.

  • For those who don’t know, I’m moderating this week while Emily is moving to her new digs in another state.

    I’m speaking with my moderator hat on here. Personal attacks of any sort are not allowed, regardless of perceived provocation.

    If a post seems personal or inappropriate to you, the correct handling is to report the post and let the moderator handle it. At this point, we’d like to see everyone get back to the topic of the article.

    Your help is appreciated.

  • Well, it sounds like we’re not too far apart here. I think just approaching the problem from different directions. My big concern about manualized therapy approaches is that they convey the idea that if you follow certain steps, you’ll get results, regardless of who you are or what the client’s full presentation is. The corollary to that quickly becomes: clients who DON’T respond to the ‘recommended technique’ are “resistant clients” or have “treatment-resistant depression (or anxiety or whatever)” and are classified as somehow “difficult” clients because they don’t cooperate with the therapist’s biases. In addition to the problems with warped data collection and some approaches failing to ever BE researched (as I discussed above, and as I THINK you agree), calling some therapies “evidence based” has been used to dismiss anything OTHER than the “evidence based” approach, so that instead of saying, “Let’s start here, as this is what is most likely to work,” the field quickly devolves into “This is the only way to do it, and anyone who denies this or tries anything else is “antiscientific.” There is simply NOT enough scientific research available to make such claims, especially (a point you have not really addressed) as the groups being so “treated” are by definition highly heterogeneous in nature.

    As to your quote at the end, the discussion of “classification” and “misclassification” really does suggest a power relationship of the therapist to the client with which I strongly disagree and have found to be detrimental to any kind of help. No one needs or wants to be “classified.” They want help finding a way to survive and thrive better in their lives. It is exactly this kind of “classification” that concepts like “evidence based practices” enshrine. And of course, it is not by chance that both classification AND “evidence based practice” are most strongly supportive of the sketchiest intervention of all – giving drugs for every ailment. I sometimes wonder if that was the original purpose of the concept.

  • While I hear your views and totally get where you’re coming from, I can’t agree that psychiatrists always go into the field because they want to help. Just like some police go into it because they like to be able to run stop signs and give orders, and some join the army because they like to shoot guns, and some teachers go into teaching because they want summers off, some psychiatrists (like any field) go into it for less than altruistic reasons. I’ve seen some psychiatrists with such incredible power needs and egotism that all the staff at the facility are terrified of them, not to mention their clients. I’ve seen some who appear “nice” on the surface but actually enjoy setting up double binds and manipulating both clients and staff. Sure, the majority probably believe they are helping, but the fact that they chose this particular way to help does say something about who they are. There are a few wonderful psychiatrists out there, but I am afraid to say that most I have known are neither thoughtful nor very sensitive to their own clients, and many stories support this.

    I’m glad your son is able to tolerate the drugs and they have the desired effects for him. I know there are many others who feel similarly. But there are also many who feel their lives have been destroyed by psychiatrists and the mental health system, and those people don’t have advertisements and celebrity endorsements to support them. A lot of them come here to be heard.

  • You are too right. Doctors are accused of “overtreating” or “overmedicating” instead of MALPRACTICE. Additionally, most of the deaths are not from medical ERRORS, but from the side effects of properly prescribed and administered drugs. So accepted medical care is killing off over 100 million people annually, no errors involved. Scary situation, but no one seems to want to do a thing about it.

  • I think we’re speaking to two different issues here. Is it possible that a certain approach works better for a certain kind of problem? Yes. Is it scientific to suggest that you can train anyone to use a workbook to apply such approaches to anyone who comes to them and expect success? No. You’re talking about probabilities with an incredible number of variables. I do believe in probabilities, but the variable of who is talking to the person and how they treat the person is AT THE LEAST as important as the technique they choose to use. Moreover, suggesting that “CBT”, for instance, is a “better therapy” because a larger percentage of people with a certain kind of condition respond positively by some subjective measure is a gross oversimplification.

    Let’s get off of your one example of phobias and talk about something more general. Is CBT the “best” therapy for “major depression?” You know and I know that the name “major depression” can be assigned to a huge range of conditions that vary from childhood abuse to low thyroid function to a bad job situation to domestic abuse in a current relationship to existential concerns about the meaning of one’s life to feelings of hopelessness regarding a chronic medical condition that is drastically reducing one’s quality of life. Do you think that one brand of therapy is going to address every case of this “diagnosis?” Do you think that the style, emotional health, flexibility, creativity and life experience of the therapist would not be at least as important a factor?

    I have used CBT techniques plenty. I’ve also used Motivational Interviewing (though I kind of invented that myself before I realized I was using it), regressive techniques, exposure, “rejection therapy,” spiritual guidance, meditation, journaling, dreams, empowerment techniques, reflective listening, reframing, positive reinforcement, and a few inventions of my own that I won’t get into trying to explain. It all depends on who the person is and what needs they have. My experience is that a) what works for one or even most people won’t work for everyone, and 2) the PREREQUISITE for ANY of these techniques working well is the establishment of sufficient rapport and trust with the client, which is not something that ANY manual can teach – it is learned through having good therapy oneself and/or through humility and the hard work of introspection over many years. Again, I’m not saying that techniques don’t have their place, or that a particular technique might not work well for a lot of people with similar “symptoms.” I’m saying that pulling out a workbook and going through the steps of CBT or exposure therapy or any kind of manualized therapy doesn’t work without these other elements, and I’m also saying that trying to suggest that one particular therapy is “evidence based” and therefore BETTER than other techniques creates unfortunate dynamics that don’t really connect with the intangible stuff that HAS to be present, nor does it allow for the observable fact that people presenting with the same “symptoms” don’t always have the same problem or the same needs.

    Not being argumentative here, just trying to be clear. I have NO problem with knowing a range of techniques AND knowing such data that informs when they may be more likely to be effective. What I have a problem with is deciding that “CBT” or whatever is the ONLY approach that can be applied and that any other approach is “less than” because it doesn’t have an “evidence base.” None of what I’ve said even gets into the sketchy research techniques used to gather such evidence, nor the effect of financial incentives to research or not research particular techniques or areas (impossible to be “evidence based” if no one is motivated to pay to research your particular approach). Bottom line, I think that knowing how to handle a wide range of techniques is important and helpful, but will never overshadow the essential elements of establishing and maintaining genuine rapport and flexibility with clients, which of course will never be a focus of any research.

  • I would add that while I think techniques are handy and valuable to have around, and do not in any way diminish their potential value to a particular client, it is more than possible that the next client you have will not respond well at all to the approach that worked so well for this particular person. The idea that a therapy is “evidence based” appears to suggest that it is the better therapy for everyone with a particular problem. Since the problems that we’re talking about can’t be defined in any kind of objective way, it seems arrogant, at the minimum, to suggest that “science” has somehow come up with the “best way” to deal with problems that are heterogeneous in both origin and in meaning to the client.

    So I’m not dismissing therapeutic techniques here. I’m saying that suggesting one school of therapy is superior for all based on the fact that it has been “studied” and that more people with a particular complaint on the average seem to benefit is a very big leap. It may well be that exposure therapy is more likely to be helpful for a specific phobia, and we should all know that, but that doesn’t make exposure therapy better for everything, nor does it mean that a particular client will do better with exposure therapy for their particular phobia. It also doesn’t mean that some goofball who is thoughtless and insensitive and has lots of personal issues that make him/her emotionally unavailable and difficult to relate to can take out the “exposure therapy” manual and be trained up to do “exposure therapy” on anyone successfully.

    Evidence is important and should be considered, but making out that one school of therapy is the best and should be used on everyone, or that the characteristics and interpersonal skills of the therapist are irrelevant, is simply not true.

    — Steve

  • I agree – it appears to me that the very choice to identify “mental illness” as anything at all immediately creates “otherness” and invites prejudice and discrimination. Instead of saying, “She has depression,” why not say, “She is sad a lot of the time and struggles to find anything positive to look forward to in her life.” The latter formulation affirms the person’s individuality and implies a possibility of change and development over time. The former simply slots a person as belonging to some group of afflicted people whom we can readily decide are not like us, so we can feel pity for them while at the same time not really bother to care, since they have a “disease” and it’s now the doctors’ problem.

  • Seems like nobody believes anything until there are brain scans these days. Anyone with an ounce of common sense (though as baseball announcer Tim McCarver once said, “If it were all that common, more people would have it!) would know that most “mental illnesses” are caused or massively exacerbated by high stress environments. Of course, no one in power really wants to tell this story, because it doesn’t sell pharmaceuticals, so this kind of report is relegated to the back pages of “Science” and no one ever reads about it, even when the conclusion is so obvious.

  • You are clearly obsessed with the silly idea of being treated respectfully by the psychiatric profession. You’re also delusional because you imagined such a thing was possible. You’re only healthy when you believe all you are told and stop worrying about silly little things like being listened to and respected. After all, you’re just a brain, and how can something like respect or listening make a difference to a big mass of chemical reactions?

    (Just in case anyone is unclear – the above is intended to be utter sarcasm!)

  • While I am not well versed in the various arguments and data in favor of one form of therapy over another, I am agreement in the author that calling “CBT” an “evidence-based therapy” privileges it in a way that is not deserved. In fact, my observations and my limited exposure to research on particular therapeutic schools suggests that the school of therapy is a very small part of what makes therapy effective. I regard CBT as ONE tool (or maybe one TYPE of tool) in a large toolbox, and psychodymanic approaches are another set. But bottom line, what seems to matter most is 1) the relative emotional health of the therapist, and 2) the ability of that therapist to support the client in his/her own discovery process by whatever means appear to be most effective in his/her case. This requires therapists to be genuine, real, honest, non-judgmental, safe, creative, thoughtful, and sensitive regarding verbal and nonverbal feedback they receive from the client. It also requires the therapist to be aware of his/her own unresolved issues and constant vigilance to keep these from directing his/her intervention and support in any way.

    None of this can be taught in a manual, and I doubt it is even measurable. Nor is a client’s progress really measurable in real terms. Most studies use “symptom reduction” as their outcome measure, but clients generally have a lot more than symptom reduction in mind when they come to see a therapist. How do you measure things like an increased sense of personal power? Hope for the future? Ability to set boundaries? Ability to connect with difficult emotions without recoiling or acting out to avoid them? These things are subtle and don’t improve on a 1-10 scale. They are things that are more FELT by the client than observed by the therapist directly, and even if they were measurable, “evidence based medicine” doesn’t have either the means or the interest in measuring them.

    Evidence Based Medicine is more appropriate to actual disease states where outcomes like lowered blood pressure or failure of a tumor to return can objectively be recorded. There is no objective measure of even who HAS a particular “mental disorder.” How can we measure improvement when we have no objective measure, or even any real objective CONCEPT, of what improvement looks like? Given the circumstances, the only possible worthwhile measure of success in therapy is the client’s opinion of whether or not it was worth his/her time and energy. And of course, no one is ever going to care enough to try and measure THAT!

  • I agree that power is the real issue, and that eliminating psychiatry might very well lead to some other “profession” taking their place in exercising the same kind of power and control. I will note, however, that money is absolutely power in our society, and that Big Pharma and the psychiatric “profession” have used finances to sell the “broken brain” story, and that a large degree of psychiatry’s accepted authority comes from marketing. It seems to me that even if psychiatrists are unable to force “treatment” on the unwilling (which I agree 100% is Job #1), their use of massive funds to manipulate people’s perception of reality also needs to be address.

  • Such people have no business calling themselves therapists. I am very familiar with this type and have criticized their “trade” since my earliest days in the field. Eventually, I couldn’t stand being around such “services” and went into advocacy. I was fortunate that my therapist actually cared about me and knew how to be helpful. No diagnoses, no drugs, no hospitals, just good, solid questions and good listening. A vanishing breed.

  • ALL Starbucks employees? I have met many Starbucks employees who appear to be decent or even very interesting people. While I am not a black person and can’t say I’ve been able to directly test out your comment, I’d say it is important not to overgeneralize about people just because they happen to work at Starbucks. Which takes nothing away from your argument that “designer coffee” joints like Starbucks definitely promote snob appeal and elitist attitudes to sell more coffee for more money.

  • Nope. Dogma is dogma. This doesn’t mean we don’t have values that drive our decision making. The point is whether other people are bent on defining my values for me. I get to make my own decisions regarding what is a priority for me, just as you do. I have plenty of issues with folks in groups claiming to be “social justice” oriented groups using hostile language toward people deemed to be “less than.” I also am not afraid to point out when a person is being inconsistent or irrational, whether they are “left” or “right” leaning or lean some other direction. Not saying I don’t have my own biases and “dogma,” but they are MINE and not foisted on me by some outside group demanding I comply in order to belong.

    But you dodged the point a bit, didn’t you?

  • I think it’s very legitimate to let someone know how s/he is affecting others. I’m not sure it’s quite true to say that someone “wants to suffer.” But there are “secondary gains” that sometimes make it harder to throw off the “suffering victim” role. It can take a lot of strength to be willing to examine what you’re really doing to harm other people, especially if you have “professionals” backing you up on your inability to make any changes.

  • Well, I can’t really argue with that, though the same can be said for many academic disciplines. I believe all education should lead to action. What I would object to is setting up a course of study that did not allow a range of viewpoints and honest discussion of potential strategies, or even a questioning of the goal itself. I detest anything that even vaguely smells of propaganda and/or dogma, even if it’s something I tend to agree with. I don’t want to replace one set of dogma with a new one!

  • This has certainly been a fascinating discussion, and I’ve mostly just watched so far. I have to say, I’m a little puzzled by the critique of MIA for hosting such a seminar. If Bonnie Burstow is endowing a “Chair for Mad Studies,” then I feel comfortable assuming that “Mad Studies” has a distinctly rebellious intent. That being said, MIA has a mission and part of that mission is to show a wide range of views and information on the topic. That this information is slanted away from supporting the status quo can not be doubted, but MIA doesn’t appear to have some “litmus test” regarding who is ideologically pure enough to post here, and I’m glad they don’t. Some of the blogs that are closer to mainstream views generate fascinating and important discussions, as do some of the clearly antipsychiatry blogs. I personally prefer to have a wide range of information and views available rather than being limited only to the “acceptable” range of opinions on the topic. My assumption would be that
    “Mad Studies” would similarly look at a whole range of data and opinions and experiences and encourage students to draw their own conclusions, which I personally think is how education should work. If the administrators decide ahead of time what you’re allowed to read or hear, then it’s indoctrination, not education.

    That’s my two cents’ worth!

  • Interesting that caring about the needs and context of the student’s experience doesn’t seem to make the list of important counselor qualities. Let’s be honest, the whole idea that you can “assess” a child and label them provides excellent cover for continuing ineffective classroom and schoolwide practices. Maybe we should keep it simple and just work on teaching each child in the way s/he needs and leave all the “assessment” and “evidence based practices” to those with too many degrees to play with?

  • Where did I say that? I’m merely differentiating between psychological impacts (which are to some degree within the control of the one being mistreated) and the physical and social consequences, which are not controllable by the victim. It’s all well and good to say “don’t care what someone thinks about you,” but if they don’t hire you or won’t speak with you or won’t rent you an apartment or shoot you or lock you up for being “mentally ill”, your attitude doesn’t stop them. So attitude is important, but wanted to make sure to clarify that attitude is not an antidote to oppression.

  • Let’s be honest, the system’s biggest fear of “peers” is that they will talk about the possibility of not following orders, especially as regards “medication.” Their second biggest fear is that the “peers” will call them out on their lack of knowledge regarding how to help, or will show them up in some way that embarrasses them. Both very “patient centered” reasons to be worried, eh? It’s all about control, and those who fear “peers” fear losing control, usually because they have no idea how to establish any kind of helpful relationship with anyone.

  • Yeah, I hear you. Unfortunately, if you insisted on full scientific rigor in psychiatric/psychological research, MIA wouldn’t have much left to publish, since it all starts with the disproven assumption that people who act the same way as described in the DSM have something “wrong” with them, and in fact have the SAME thing wrong with them which has to have the SAME “treatment.” Kind of like prescribing medical treatment based on someone’s astrology chart. Probably not going to get much that’s truly of scientific value!

  • I think MIA sometimes just reports on relevant research, most of which is written from the “medical model” viewpoint. It is a bit frustrating, but the report does offer up some good information that actually supports the idea that external conditions and events (in this case, physical activity) have a major impact in how people feel and behave. So I’d rather read the information and put their comments into perspective rather than filtering out anything that uses medical model language, which would mean missing a lot of interesting data.

  • I agree with you here. “Not caring” is really more of a coping measure than a means of addressing abuse. It’s something I’ve learned to get by, but it is less and less easy to do the lower down a person is on the social hierarchy. As I said, “not caring” doesn’t stop people from ganging up on you or discriminating against you or the group you’ve been identified with. Not so easy to “not care” when you’ve been locked up in a psych ward and then put on an AOT order that threatens to lock you up if you don’t “take your medication” per their orders!

  • Because the ruling powers in society need them, and because their “diagnoses” shift the blame off of those with the most power and place it onto those with the least. Because it absolves our society from having to do anything about the adverse conditions we create, because those who can’t “adjust” are found to be failing, rather than the conditions they are expected to tolerate.

  • Why not just categorize people as violent based on their acts of violence? “Schizophrenia” doesn’t need to enter into it, any more than “black violent person” or “rich violent person” or “Canadian violent person” would be legit labels. People from ANY category can be violent. It’s the intentional association of violence with “mental health issues” that needs to be negated.

  • I do the same. I have actually gotten to the point where I really DON’T care what a lot of people think, but still, people who I care about have an effect. I’ve worked on being honest about this effect, but it’s still a very natural source of anxiety for me and a lot of people. Not caring means being disconnected, and we all want to feel connected to someone or something, or most of us do, anyway. It’s the disconnected ones who are OK with it that scare me!

  • Thanks, Julie! I am well aware that some women choose not to worry about glamour and whatnot, as my wife is one of them. Nonetheless, she and all of us have received countless messages that say “women can’t be fat.” The fact that some rise above it doesn’t make the shaming any less real, or any less differentiated by gender. I’m glad you’ve somehow managed to like yourself the way you are – I find that you are a rare person in our culture!

  • I am SO glad someone is finally talking about this issue. Look at those stats – 3/4 of the women diagnosed with “postpartum depression” were current domestic abuse victims!!! The authors neglect to mention that physical abuse is known frequently to begin or significantly increase before or soon after a baby is born.

    It is simply inexcusable for anyone to conduct any kind of research or scientific discussion of “postpartum depression” without taking domestic abuse into account, yet this topic is almost NEVER discussed by anyone supposedly researching the area. This is one more way that psychiatric labeling is not only inaccurate and unhelpful, but actually PREVENTS genuine research into major causal factors that contribute to the distress psychiatry is claiming to want to ameliorate.

    — Steve

  • The thing is, I don’t think she said that; I think she said that what is healthy/unhealthy or that what is a priority or not a priority is not something that an outside person can determine for someone else. And if you read my posts carefully, you’d see that offering support and perspectives is most definitely an important part of how I see people helping each other. It’s the paternalistic part that I object to, and it’s very, very easy to slip into that mode once we decide that WE know what is “better/worse” for someone else without bothering to consult them on their priorities and reasons.