Monday, December 5, 2022

Comments by Eugene Epstein

Showing 33 of 33 comments.

  • Sorry, but to me, this study was just a waste of money. You don’t need a study to know that every child or adolescent who gets sent to a psychologist, psychiatrist, social worker or any other professional for mental health services, gets a diagnosis. Without a diagnosis, the professional doesn’t get paid. The professionals I know fall into two categories: those who believe there is such a thing as mental illness and who believe that giving persons diagnoses is somehow helpful, and those, like myself, who believe that the language of diagnosis is narrow, unnecessarily pathologizing, unaesthetic and often harmful to persons receiving them. Persons like myself, who believe this, try to pick the least damaging, least pathologizing diagnoses to use in order to receive health insurance reimbursement. It is a pact with the devil and I am not proud of it. But I think professionals do a disservice to themselves and their clients when they are dishonest or intransparent about this issue.
    And Frank, yes we would better serve our clients by diagnosing them all as mentally healthy. And in my talks with clients I do just that. We professionals have to speak different languages with different persons. I speak the language of pathology to the “health” insurance companies because they would not pay for a diagnosis of mental health and I explain that to the clients as well.

  • Having been released concurrently with the APA’s new campaign to get the “mentally ill” out of jails and into treatment (meaning on psychotropic drugs!), this report might just communicate the wrong message (kind of like out of the frying pan and into the fire!). Whether in prisons, locked up in psychiatric hospitals, or being forced to ingest psychotropic drugs on an outpatient basis, the abuse of the term “treatment” to mean the coercive management of undesirable behavior remains the same. This is really the larger context that HRW should be examining and critiquing.

  • I couldn’t agree with you more! To quote my colleague and mentor, the late psychologist and family therapy pioneer, Harry Goolishian: “By the very questions that we ask, we (professionals) are responsible for producing the ‘pathologies’ that we see. We are not like microscopes, seeking to uncover pathogens. Rather we actively co-create the persons sitting across from us… always!” If, for instance, I think of the person sitting across from me as being a potentially and uncontrollably violent chronic schizophrenic, as opposed to, say, being in a state of overstimulated or agitated panic, I am going to speak with him/her differently, relate to him or her differently, and our exchange is going to produce a very different relationship and in all probability, a very different outcome.
    So yes, let’s work on changing the meaning of the word “asylum” in our cultural vocabulary!!

  • Thanks for sharing your correspondence Joseph, it does indeed help to clarify the contours of the debate!
    In your response to Torrey’s paper you raise the following question (Point 12): Why would one want to damage an already damaged brain? One possible answer results from the “Snake Pit Theory” of psychiatry, namely, the idea from ancient times that if you threw a “normal” person into a snake pit, it would make them crazy, ergo if you throw a “crazy” person into a snake pit, it should make them normal!! This principle is perhaps the central guiding principle for most all of the brain damaging methods developed by psychiatry over the centuries.
    Thanks for a fine blog.

  • You make some very excellent and critical points about the Finnish OD assumptions and approach, Daniel. Turning it into a “model” and packaging it for global reproduction, would simply be a recreation of various distasteful aspects of mainstream psychiatry that this approach has largely and quite successfully managed to avoid over the years. The very idea that a set of assumptions or a way of thinking is NOT the same as a method or technique to be applied independent of context, is particularly difficult for many professionals to understand. For example the community psychiatrist Tom Andersen’s ideas about reflecting processes, which were very influential in the early development of the Finnish OD, became popularized and taught to family and systemically oriented therapists as “the reflecting team”, thus transforming a very powerful set of philosophical assumptions into a mere technique (and one often applied to families to “induce” their cooperation with respect to the therapists’ preferred notions of positive change!).
    The assumptions, shared not only by Tom Andersen but also by a long tradition of other colleagues like Harry Goolishian, that people are capable of making their own choices about how they live, that they are neither inherently “normal” or “mentally ill” independent of context and observing (labelling) diagnosticians, that most “problems of living” dissolve, evolve and change over time with or without so-called “professional help”, all these assumptions cannot be “tested” in double-blind studies or packaged in a set of universally applicable techniques. Indeed the only justification we can have for holding these assumptions over others, is that they help us to create and sustain relationships that are less hierarchical, less coercive and more respectful and tolerant of differences. That is the tradition and message that the Finnish OD exemplifies and sustains. And that is the spirit that, combined with creativity and energy, can be adapted to local conditions elsewhere.
    Another perhaps less hopeful comment, sparked by your excellent post: Here in Germany, there has been widespread interest in the Finnish OD Approach and I have been involved with others in teaching and training in a variety of settings throughout the country. So far so good. Where things get difficult (if not impossible), is on the level of implementation and system change. The manifold efforts to transform psychiatric (revolving door) in-patient treatment as well as biologically oriented out-patient treatment have proved to be disappointing at best. It seems that the seemingly endless bureaucratic hurdles (not to mention the influence of the pharma industry and the medical lobbies) all serve to squelch most all attempts at meaningful change of our bankrupt systems of care.

  • Yes indeed, we do need to connect all the dots! The very fine documentary Doctors of the Dark Side describes in disillusioning detail the complicity of psychologists and other medical professionals in the use of torture by the Bush-Cheney Regime and the website includes other additional source material, including the 2013 Task Force Report Ethics Abandoned . Taken together with America’s number 1 rank as having the highest per capita rate of imprisonment, the Snowden revelations about the ever-expanding surveillance state, the shocking numbers of children and adolescents (and especially those more vulnerable who are living in foster care settings) who are being “behaviorally managed” with neuroleptic drugs, the increasing militarization of local police forces and college campuses, the outsourcing of military functions to private security corporations, the hostile climate against whistleblowers and investigative journalists, the growing animosity against the poor and the unemployed… (to name but a few trends, as the list is very long!) and one can see psychiatry as but one of many building blocks towards an ever-expanding coercive system. The society that we are creating is one that even Richard Nixon and his thuggish buddies couldn’t have imagined and one that even former Stasi members could wet their pants over!
    Thanks Bruce. I am definitely pessimistic and certainly paranoid about the future, but does that make me clinically depressed or crazy??!

  • I cannot agree more with your last comment Richard. It reminds me of work I did years ago as a streetworker, working with drug users in southern Germany. Many experienced long-term users told me that, when given the choice, they would rather go to jail than to enter rehab, because at least in jail they could make decisions autonomously, while in rehab the therapists ruled autocratically.

  • I have yet to hear from any psychiatrist, whether it be apologists for the APA like Allen Frances, or from any other of my many more critical psychiatric colleagues, as to what it is exactly that the profession of psychiatry has to offer, AND what it is, that is unique to psychiatry alone (as opposed to the various therapeutic technologies of psychologists, social workers, family therapists, community workers, etc. etc.), other than dangerous and damaging psychotropic medications and the pathological labels of the DSM. The profession of psychiatry is indeed suffering from a very deep identity crisis, belittled by other medical specialties for its lack of evidence-based rigor, and with the collapse of the biological mythology, no longer able to justify its dominance among the various mental helping professions. Psychiatry’s last identity crisis, back in the 1970’s, which was largely due to the challenge posed by other less expensive professionals to psychiatry’s dominance within the psychotherapy market, led to the biological reinvention of the psychiatric identity.
    So my question for Allen Frances and all of his psychiatric colleagues is this: What is a psychiatrist without his medications and diagnoses and what is it exactly that he/she has to offer people in need and our society? (N.B. As I ask this question, I hear the voice of David Cohen whispering the word “coercion” repeatedly!)

  • Yes I agree with you Ted, Allen Frances is not a friend and not necessarily an ally. He came to the filmfest with an arrogance that is hard to bear. He told the participants what “they don’t know”, threw around a lot of statistics and made a plea for not fighting with each other because “we are all really on the same side of things”. Instead of begging for more tolerance of supposedly good-willed psychiatrists, I think he should be thinking about exactly what it is that psychiatry might actually have to offer. Thus I asked him and the panel of psychiatrists at the filmfest the following question: What exactly does a psychiatrist and psychiatry have to offer besides diagnoses and medications that are at best, not useful, and at worse, most harmful? Frances responded with a “let’s not throw the baby out with the bathwater” argument that diagnoses are heuristically useful and medications help people too. Saying that diagnoses are “heuristically useful” simply means that doctors have created a rather exclusive language that creates the illusion of reliability. In other words, it allows them to create and throw around terms like “depression” or “bi-polar disorder” or “borderline personality disorder” or “schizophrenia” and act like they are always talking about the same thing. You know, if we were not so tolerant of people who think differently, we might just think that such an illusion is really a delusion!
    A more fitting answer to my question was given by Peter Stastny, who basically said that mainstream psychiatry has nothing useful to offer a movement of reform and we should simply continue to go it alone.

  • AAHH! Now you are talking about an important aspect of our ever-expanding therapeutic state. Yes, no professional group has resisted the expansion of its power (or market share). Social workers pushed to achieve health insurance billing privileges in all states, as did the family therapists, and psychologists likewise have been pushing to achieve prescribing rights. And one big reason that psychiatry got out of the psychotherapy business and started promoting biology big time some 40 years ago was the market encroachment and competition from other (cheaper) psychotherapy professionals (psychologists, social workers, family therapists, counselors, etc. etc.). The big question for me in all of this, is are we really healthier and happier as individuals and as a society today with all of these therapists and counselors and doctors running around offering us their various therapeutic wares? Or as I tend to think, is this expanding therapeutic state intimitely connected with the neoliberal ideology (with all of its individualizing, victim blaming, and depoliticizing perniciousness) that dominates our western societies?
    Thanks again for this rerun of your great talk at the MIA filmfest!

  • Now if guns weren’t legal and readily available for purchase by any and everybody, this ridiculous situation would not have arisen. In other words, if people didn’t have guns, then they couldn’t shoot each other! And of course, it is not the people who have been diagnosed as mentally ill that are dangerous and need to be keep away from guns, it is everybody.
    So here’s my suggestion: Let’s pass a law that says that anybody who is taking any kind of psychotropic medication, should be prohibited from owning a firearm. This might not reduce the number of guns sold and held in the US, but it might just help reduce the number of folks on psychotropic medications.

  • This is the very same E. Fuller Torrey who has declared that schizophrenia is most probably caused by a virus picked up from cats!! The problem is not a shortage of hospital beds, and it is not a problem of “mentally unstable” persons alone. What we are seeing is yet one more effect of the mass destruction caused by neoliberal economic policies that have only served to further the gulf between the haves and the have-nots, that have further dismantled the social contract while blaming the victims of this vicious system, thus leaving large swaths of the populace impoverished, ignored, without protection and without hope. This is NOT a medical problem to be solved by pouring more money into psychiatry and will certainly not be solved by the likes of Fuller Torrey. It is a social problem and will only be solved by rethinking the question of how we wish to live together on this planet.

  • This is a largely untold, but extremely disgraceful and tragic story here in Germany as well. In particular, children and adolescents of limited cognitive abilities who are living in institutions, are medicated at alarming rates (often with several different psychotropic substances at the same time). The children usually don’t know better and often don’t have the language skills necessary to complain or resist, the institutions maintain that they would not be able to care for such children with out the use of psychotropic medications to manage behavior, and the parents of these children are put under tremendous pressure from the institutions to agree to the doping of their kids lest the child be moved to an institution much farther away from home. Nobody talks about “treating illness” or “taking meds to get healthy” because it is clear that the prescription of these psychotropic medications is simply to control and manage behavior, and to do it more cheaply than by hiring more staff to interact with the children. Michel Foucault and Thomas Szasz are most likely rolling around in their coffins!!

  • This is the same strategy that the oil, petrochemical and the nuclear industries have been using for decades, so it isn’t surprising that the pharma industry does the same. If it wasn’t for the toxic by-products of oil production, we would not have plastic bottles, tupperware or lego toys. Agent Orange was used in Vietnam to defoliate the jungle in the search for Viet Cong supply lines, repackaged it is Monsanto’s latest weed killer. The idea that every household should have its own little nuclear reactor in the basement arose as a response to the growing problem of nuclear waste. Einstein was right in saying that human stupidity knows no bounds!
    Good article, thanks.

  • I like the term “beyond the therapeutic state” (and that is why we are putting on a conference with that very name next week in Drammen, Norway:, as opposed to “anti-psychiatry” or “post-psychiatry”, because I think the problem is much larger than just psychiatry. Therapies, including the psychotherapies, that serve to help people adjust to unjust conditions within our neoliberal economic system are also part of the problem. Coercive therapies and manipulative therapies, that are implemented without informed consent, are problematic. The very idea that there are expert therapists, be they biological psychiatrists or psychologists or psychotherapists, who purport to “know better” about how others should live their lives, is problematic. The medicalization of everyday life is problematic, and so is the dominance of the medical model at the expense of all other forms of care and treatment.
    Perhaps we might conclude that the very vocabularies of therapy and treatment, with all the assumptions they engender, are part of the problem because they transport particular forms of power relations that are anathema to our preferred visions of care and collective responsibility.
    Psychiatrists, as the group with the least status and acceptance within the medical elites, provide an easy target for our outrage. Their hubris and insensitivity to public opinion, despite a history of “treatments” from electroshocks to lobotomies, that are hard to differentiate from other methods of torture, indeed their persistent belief or grand delusion in the myth of mental illness, as well as their tendencies to rationalize and legitimize coercive procedures under the guise of “treatment”, do not make them more appealing as a group.
    Can we begin to envision and realize a post-therapeutic future that goes beyond the therapeutic state?
    Thanks for opening this discussion.

  • I’ve been daydreaming of a post-therapeutic, post-psychiatric future for more than 30 years and I don’t think that psychotropic medication of the kind prescribed by psychiatrists is ever going to cure my daydreaming! The only thing sluggish here is the cognitive constriction of the APA and the reductionistic worldview of biological psychiatry, not to mention their symbiotic ties with the pharmaceutical-industrial complex. Nice article!

  • Though the link between psychotropic medication and violence is very important, we must also not lose sight of the simple fact that if people did not have guns, then they could not shoot each other. Call me a dreamer and an unrealistic idealist, but as long as the NRA and the military-industrial complex control the American political agenda, as long as we continue to provide easy access to a wide range of lethal weaponry, as long as we continue to train (brainwash?) large numbers of impressionable youth in killing methods while at the same time providing them with all sorts of rationalizations legitimizing that killing (i.e. war on terror, war on drugs, love and protection of country, fighting evil etc. etc.), as long as we continue sending them to foreign lands where they can experience the crazy-making realities of shooting people and being shot at first hand, as long as we then handle returning veterans as financial ballast and fail to help them make sense of their experiences, then we will continue to experience tragic events like Fort Hood. It is not that mentally ill people should not have guns, NOBODY should have them!!

  • Hi Michael,
    nice blog! Since the 1970’s, when Methylphenidat (or Ritalin) got banned from being (ab)used as mothers’ little diet helper, the pharmaceutical industry has marketed it as the cure all for behavioral problems in children, ….and then in adolescents, …..and now in adults (who either supposedly had ADHD as kids or supposedly went undiagnosed all those years)! The marketing strategies of the psychiatric-pharmaceutical-industrial complex know no bounds. I would not be surprised if the next step will be to market these same drugs for those suffering from Alzheimer’s.
    The arguments against medicating children have all been laid out many times by many authors over the last several decades, but in my opinion and based on my experience as a therapist working with children, adolescents and families for over 30 years, the most damaging, persistent as well as change-resistant side effect to result from medicating children, has little to do with pharmacology. Rather, it has more to do with the very seductive belief that behavior change can be implemented simply and quickly through the intake of a few pills. That means that providing children with contexts and especially, with relationships, in which they may experience love, attention, respect and everything else that might be understood as associated with the raising of healthy, self-assured children, suddenly becomes less important than inquiries about whether the children have taken their medications and whether the dosages have been calibrated correctly. How naïve, how reductionistic, how unaesthetic, how unfortunate, this biologically oriented paradigm!
    Congratulations on your new book. Looking forward to reading it!
    Eugene Epstein

  • Hi Jack,
    just a couple of additional puzzle pieces from a fellow (former) NYC social worker and street worker: Over fifty years worth of federal funding for research has failed to find evidence of damaging effects of pot use, but has inadvertently managed to provide support for claims of a variety of therapeutic effects. And though there has never been evidence that pot is in any way associated with violence, American jails are still filled with consumers and small dealers. And let’s not forget that Americans who have been jailed, lose their right to vote among others (but that is another issue). In the late 70’s M. Duncan Stanton did some very interesting NIDA (National Institute of Drug Abuse) funded research into returning Vietnam veterans and found that of those who were heavy users of heroin in Vietnam, more than 80% returned home and spntaneously stopped using heroin WITHOUT treatment of any kind! They simply didn’t know that they were supposed to be “addicted”!
    Drug testing and the War on Drugs have been used by Dick Nixon and a number of other presidents since to police the work force (your employer can legally require you to pee in a cup on demand and fire you if you refuse!) , expand police powers, control “unruly” minorities, illegally intervene or invade third world countries, and on and on.
    But back to the 1st world: In the late 70’s and early 80’s a drug researcher in Vancouver did some studies that called the dominant paradigm of “physical addiction” into question. By showing that rats, when provided with a rodent-friendly environment, will avoid drugs like heroin or cocaine even after heavy ingestion over several weeks time, the research exposed gaping holes in biological models of addiction, while proposing a more complex ecosystemic model. This research was so compelling that it was even presented before the Canadian parliament. But alas, we must forgive the researchers their naivete in underestimating the power of the international (aka American) war on drugs- their funding was simply cut.
    A psychiatrist in Liverpool prescribed heroin, cocaine, amphetamines and various other illicit substances for over 10 years. The overdose death rate dropped to zero, there was a significant decrease in new HIV infections, criminality decreased, and many of those receiving drugs via prescription sought and found employment. Within a month after 60 Minutes had done a report about this wonderful program, the DEA applied enough pressure upon their English colleagues that the program was dismantled and turned into a methadone-maintenance clinic.
    I could go on and on, but I’ll stop here with the words of the late great Gil Scott-Heron “makes you wanna holler…!!”
    In solidarity,

  • Having spent the better part of the last twenty years as chief psychologist in a German clinic for child and adolescent psychiatry, I must say that the most persistent and perhaps most damaging aspect of this whole mess is the very seductive idea that a child’s behavior can be explained biochemically and that it can be changed by ingesting pills. Lest we forget the very clear and uncompromisingly critical words of the late Thomas Szasz, “Labeling a child’s behavior as pathological is stigmatization. Medicating a child for their behavior is poisoning.” Good article, thanks.

  • Just a small addition to this very pointed, and from my perspective, right on the money, blogpost: The American Psychological Association was the only professional association that declined to issue a statement distancing itself from the Bush administration’s policy of sanctioning the use of torture in interviewing suspected terrorists. Both the psychiatrists’ APA and the social workers’ NASW readily joined the AMA in rejecting such practices. These interrogations were conducted under the observation/supervision of medical professionals including psychologists working for the military, who in turn were coerced by post-9/11 military policy to ignore professional ethical standards (like “do no harm”!).
    And Helen, please don’t feel offended. This article was surely not written to piss off allies in the struggle against the medical-industrial complex. The real danger is getting distracted from our collective efforts by quibbling amongst ourselves.

  • I agree with both Ron and Duane, BUT caution is indeed called for. I think a study in which a very small sample of but 10 heavy pot smokers (and one needs to define what exactly is meant by “heavy pot smokers” as well) who have undergone all sorts of fancy imaging (MRI, CRT etc) has little to say about any links between the long-term ingestion of psychoactive substances and schizophrenia (another term that sorely needs definition!!).
    If one looks back on the drug/mental illness research of the last century, one finds that researchers have been persistently trying, though without success, to find evidence that pot smoking is dangerous and damaging to individual health and behavior. And interestingly, it is psychiatric researchers that have then tried to define this as self-destructive behavior and therefore pathological in a psychiatric sense,thus requiring coercive intervention. Lest we forget what most drug researchers these days never learned, psychoactive substances have been used (and abused) by cultures (as well as other animals) throughout history. The late great drug researcher Norman Zinberg (who should be required reading for all young drug researchers) reminds us that factors like set, setting, dose, cultural acceptance and ritualization of drug use, etc., not to mention the biases of the observer, are much more important determinants of whether the ingestion of psychoactive substances may be termed pathological, socially acceptable or medically necessary. How else to explain that in America today, a child can be forced to take pills that most closely resemble cocaine (Ritalin or Methylphenidat) while an adolescent who ingests cocaine in any form may be prosecuted and incarcerated.
    And yes Duane, to narrowly reduce all mental distress and suffering (or behavioral diversity) to a notion of trauma is simplistic and disparaging.
    When confronted with mindless research like this, my first thought is to toke up and calm down before I get all hot and bothered!

  • Gee, I guess everybody suffers from memory lapses once in a while. In fact, there is probably a DSM 5 diagnosis for such memory lapses along with failure to acknowledge conflicts of interest. Why don’t we just ask the Chair of the DSM 5 Task Force David Kupfer if the new DSM 5 has a way to determine whether this kind of memory lapse is associated with serious psychiatric pathology or merely a sign of anti-social but non-pathological capitalist greed.

  • The very government that legitimates the extralegal drone strike and paramilitary killing of foreign as well as US citizens (see Jeremy Scahill’s film “Dirty Wars” for more details) is now declaring that mentally ill persons are dangerous and violent and therefore preventatively in need of psychotherapeutic treatment? Call me paranoid, call me simplistic, but I always thought it was (legally bought and/or distributed) guns that usually killed people. And of course let’s not forget all those millions of persons the government keeps training at home and abroad to kill people. Gee I am a psychotherapist myself, but I really don’t think that more psychotherapists (or more precisely, more insurance billings by psychotherapists) are the solution to this conundrum.

  • I am sure that, as an art school graduate, you are familiar with this famous line from Pablo Picasso:
    “Si hubiera una sola verdad, no se podrían hacer cien lienzos sobre un mismo tema.” or “If there were only one truth, it wouldn’t be possible to do 100 variations on the same theme.”
    The challenge is in expanding our tolerance for all of those possible variations.

  • Yes, I think that one of the most powerfuladvantages of postmodern narrative theory, from a political standpoint, is that it shows the limits of the single (global or universal) story, and points toward the many positive aspects of polyvocality, along with the idea that multiple stories may exist concurrently.

  • The good Dr. Lieberman has forgotten to disclose his ties to the pharmaceutical industry while at one and the same time ranting about a “small but loud group of anti-psychiatry radicals”. As a proud member of the growing movement of professionals who are increasingly distressed by psychiatry’s growing dysfunction, I do happen to feel unjustly discharged by the good Ivy League Dr., and I do feel the need to clarify one particular point: I am not totally against psychiatry as he would claim (in fact some of my oldest and best friends are psychiatrists!), but I am truly against bad psychiatry.

    Here’s what the good Dr. Lieberman himself has reported about his own pharmaceutical connections: “Dr. Lieberman has served on the advisory boards for Bioline, Pierre Fabre, and PsychoGenics. He has received grant support from Allon, GlaxoSmithKline, Eli Lilly and Co., Intercellular Therapies, Merck, Novartis, Pfizer, F. Hoffman-La Roche, Pepracor (Sunovion), and Targacept. He holds a patent from Repligen.” In another article: “Dr. Lieberman reports having received research funding from AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline, Janssen Pharmaceutica, and Pfizer and consulting and educational fees from AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, Eli Lilly, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Novartis, Pfizer, and Solvay.” In addition, he has published studies where he failed to report his pharmaceutical ties. Need we say more about this man?