Saturday, March 25, 2017

Comments by Kermit Cole

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  • His final statement, that schizophrenia will go the way of dropsy, is HUGE. I worked in SZ research in the early 2000s and, when I said this, was dismissed with gentle bemusement. I did change my career path to residential work, hoping to replicate Soteria and draw from Open Dialogue. I’ve seen some results of which I’m very proud. I’ve also been hurt and seen others hurt worse as a result of my choices; I believe that overall this was justified by what I think would have been greater harms of the other approach, but I have to live with the fact that nothing is 100% and the greatest harm comes when we think that something is. I know the greatest harm my decisions resulted in is probably directly correlated with how certain I was when I made the decision.

    I’m not sure it’s appropriate to hold scientists responsible for what people do with their results. (Excepting, of course, cases like Joseph Biederman and many others who deliberately created industries and benefitted from bad research. For them, I do propose a special circle of hell.) But I think there needs to be room for forgiving, if not appreciating, people who find out they were wrong, and admit it. Science, and maybe human life, has no future without this. None of us is right about everything we believe. If we had eyes on the back of our heads, we wouldn’t need to watch each others’ backs. I think that maybe that needs to be part of the plan.

  • You may not be aware of the people who have taken professional risks, and indeed they are few, but the reality is that they exist, and you do not know them because the universe took them up on their offer to risk it all, and they lost everything.

    It’s well and good to say what others should do, but the reality is that asking others to risk their livelihood, their home, their children’s future, when the people who will benefit are unlikely (at best) to be there to put out the flames when their world gets set on fire is somewhat hypocritical. It’s all very aesthetic to cajole people into heroism. But lives really, actually, truly do get ruined. And not just the person; their families.

    So I’m just saying; when someone is able to take such a public stand and say “I made huge mistakes, for decades,” it’s just good strategy to be appreciative and encouraging, rather than piling on. If there is judgment to be rendered and justice to be served, I think it should happen elsewhere. MIA is about cultivating the dialogue, not suppressing it.

    That is what I mean when I suggest having “faith” in people. Faith is not about evidence; it’s about aspiration. If it were about evidence, it wouldn’t be faith, and it wouldn’t get us what faith gets; the future realization of our hopes, rather than the grudging acknowledgment of what we feel is due us.

    Also, I have known people who looked back on careers they regret, and tried to do the right thing, and were just blocked and hammered. They died bitter. Other than some nice sentiments from the choir, they had little to show. It’s up to us to make speaking truth as positive as possible.

  • I think it’s important in addressing these things, at least in this venue, to shift from a focus on “blame” to a focus on understanding. There are places to address questions of guilt. But MIA, ideally, is about understanding. This does not preclude a redress of past harms, at all; it’s just that MIA is about getting there by way of inviting an “open dialogue.” To that end, for instance, it’s about seeing that there are traumas in life, and this can lead to experiences and behaviors that are sometimes called “psychotic.” This doesn’t mean it’s the only possible result of traumas, nor does it mean traumas are the only “cause” of “psychosis.” Just that there IS a connection, and it’s worth understanding it. And one kind of understanding, the one MIA is at its best when it’s about it, involves setting aside guilt and blame in favor of seeking understanding; the fact that traumas happen without anyone consciously intending them. They happen, sometimes, because it’s all people have known; they don’t know another way to live, so traumas continue. The problem with having arms is that they have elbows; anytime we do anything, even something good, we run the risk of hitting someone in ways we didn’t mean.

    So, in answer as well to Olga’s comment above, I think it’s important to focus our skepticism on facts here, not on people. Robin Murray is acknowledging mistakes. His comments are revealing of how, on a systemic level, these mistakes happen. People can believe, fervently, that they are right and find out they were wrong. MIA is about facilitating that process, ideally. I’m not sure that it helps to be “skeptical” of a person who comes to this dialogue, if that means questioning motive. I think our goal here is to watch each others’ backs. As in; what are you not seeing? What does the fact that you don’t have eyes on both sides of your head mean you can’t see? I think the ideal spirit of MIA is to seek to respectfully help, and that means everyone who shows up at the forum, even if unwittingly or unwillingly.

    Murray’s acknowledgment of mistakes is huge. I think the best response if we are to see more like it is appreciation, respect and encouragement. I say this with awareness of Olga as someone I respect (and love) most in the world, both for her experiences and what she has made with them. As it happens, we met four or five years ago on the same day I met Robin Murray at the World Hearing Voices conference in Cardiff. The fact that Dr Murray was presenting there meant that he was already in the road to writing this paper. The fact that he walked right into the Lion’s den was, in my opinion, commendable. I didn’t agree with much of what he presented; I thought there were things he wasn’t seeing. But the fact that he was there suggested he was looking in the right places, and I was hopeful. He got good feedback there and, from the evidence, has continued down that road.

    That’s why it’s important to be skeptical of ideas, but equally important to have faith in people. When we do the opposite; put our faith in ideas, and treat people with skepticism, we are heading down a road we may not find we like being on.

  • Certainly true. There have always been good people who did good work, quietly, modestly, and divesting themselves of glory, power or reward.

    I view what we are engaged with here as a perennial effort against the temptations of glory, power, “efficiency,” “effectiveness,” and “certainty.”

    Good parenting and good society has always been about the cultivation of a tolerance for uncertainty, and resilience against stress and pain (rather than hoping for its elimination). Open Dialogue is one more good example of the success of cultivating that on a community-wide level.

  • It’s interesting to note that the one way that Open Dialogue differs from psychoanalytic psychotherapy (at least in today’s world) is that Open Dialogue IS the approach to mental health care in Tornio. The clinicians of Tornio transformed the system over the decades that they have been in charge of it. Elsewhere, as Jaakko noted several times, it wasn’t just that psychiatry’s influence grew, it was that psychotherapy in general abandoned “psychosis” to it.

    We could look at many reasons for this, including a general societal shift that made it difficult to do otherwise. But what was demonstrated in Tornio isn’t simply a superior “technology” of mental health care. It is a demonstration of what happens when the overarching ideology that Open Dialogue rests upon IS the system of care.

    So the challenge isn’t merely to adapt or import it; it is to follow the example in reconstructing our cultures and communities. That could be the civil services, but the model holds in whatever network you we working with, down to our families, significant others, and people we meet on the street: try very hard to hear – completely – what they are saying (or not saying), and ideally to feel and understand what feelings they have that are driving them to say (or not say) it, BEFORE you make any decisions about whether what they are saying is right or wrong, good or bad. Focus on feeling with them, and perhaps the sense of what they are saying will change – for you, at least, and perhaps (almost certainly, I’d say) for the collective.

    That can be done whether or not we manage to change the world, or society, or psychiatry. It can be done today. It has been done throughout the world and throughout history by healthy communities, healthy families, and healthy couples. To the extent that psychoanalytic psychotherapy was – and is – successful, it could be argued, this (your point) is why.

  • We have looked at doing things like AdSense, and repeatedly found that we could not in good conscience capitalize on our constituency by giving our space over to a flow of ads that we could not really control. Ultimately, the monied interests would find a way to dominate and MIA, if anything, exists to serve the people and the approaches who do not have that kind of backing. So, as tempting as it was to cash in on the traffic flow, at every point that we’ve considered it, we felt that doing so would have compromised the clean space for thought and dialogue we have tried to hard to cultivate. It would have taken the joy out of what we started out to do.

    So, we’ve had to hope that the people who benefit from MIA, whose experiences were affirmed and validated by Robert Whitaker’s research and writing, and whose outpouring of energy in the quest for meaningful change brought MIA into existence, would be moved to help it survive. At every point that we looked for ways to capitalize on our traffic, we felt we couldn’t do it in a way that wouldn’t betray our readers’ faith. It would mean shutting out money from those who could afford to pay, and asking for money from those we wish to benefit – but who really didn’t have it. Hence the need to be nonprofit.

    Bob has, in the creation of this website, consistently made choices – whenever they were there to be made – that benefitted others over himself or the website. Hence, again, the need to become a nonprofit – and hope that those we aim to serve will be moved to help us continue. If not, and we cannot survive, at least we’ll know that we did the right thing when we had the chance to do it, and we benefitted those we wished to in an unsullied way. We came into existence in large part to provide a forum for voices that had gone unheard, and we could not have then cluttered up that space with anything that diminished the voices that we should be heard the loudest and clearest.

    But in answer to Pat Risser, below, we also exist to be a forum for discussion and debate. In order to do that we have to keep the door open to those who speak to a range of perspectives. We exist to make sure that people and perspectives that hadn’t been given a meaningful seat at the table in these discussions would get that seat and be heard. We do not exist to shut out people and perspectives. We exist to foster a dialogue and to keep it going, because it is – as the Open Dialogue experience has shown – exactly keeping the dialogue going that helps to resolve the madness. Any point at which a voice is summarily dismissed or shut out is the point at which madness begins. I think the big lesson from all this is that we can’t move forward by throwing anybody overboard, even if it’s in retaliation for those who have been thrown overboard in the past. We need everyone on board.

    However, for those who have no interest in reconciliation, I offer this; MIA is a place to sharpen your arguments. We are a dialogue space in which to track and develop the evolving language within which this debate takes place, and by which it is shaped. We bring in viewpoints that are relevant. That doesn’t mean that they pass a litmus test for ideological consistency and purity; it means they have something to add to the conversation, or sometimes something to which an argument should be developed. To ask for a space in which no divergent viewpoints exist would be like asking for a gym that doesn’t have a lot of inconvenient weights lying around that need to be picked up. The point is to engage with them. (And, ideally, pay your gym membership, so we don’t have to blast you with advertising while you work out.)

    In answer to one of Pat’s specific questions; the problem of what to do about people who may harm themselves or others has been a part of this conversation from the beginning, stretching back long before any of the terms currently used for it even existed. Thomas Szasz didn’t really solve the problem. Nobody has. It’s a perennial, ongoing problem, that probably can’t be dealt with in any global or permanent way. Dealing with it involves an engaged, vigilant citizenry, well-armed with the information, philosophy and rhetoric needed to make sense out of these problems if and when they arise. There is no perfect solution to the fact that life is inherently risky and dangerous, and people sometimes make choices – as they sometimes must – that run the risk of harming themselves or others. I think that Szasz’s argument to leave it to law enforcement leaves out an awareness of the fact that people come from, and are in, circumstances beyond their control that shape them and their behavior. How do we address that fact in a way that doesn’t run the risk of somehow being called “treatment”? Short of reshaping our society fundamentally (which I’m certainly all for) how do we address the current needs of people whose lives have been stolen from them by trauma and injustice?

    I think that over the short time MIA has existed we’ve seen meaningful evolution in the public awareness of the ways that stress and trauma contribute to what has been called “psychosis” and “mental illness.” We have done all we can to promulgate this awareness on MIA. We can’t end the conversation, but we can help to make sure that that part of it gets heard.

  • I think BPDTransformation is correct.

    On the other hand, Insel’s deal with Google means that this crowing matters. There will always be people who believe, want to believe, and look for this to believe in, and they will always hold some kind of sway with the part of the population that either believes or wants or needs to believe in it, too.

    I think the only real strategy in this perennial debate is to hold firm in what you believe, and continue to offer it, and to find ways to make sure that what you believe remains one of the options on the table. And to try as hard as you can that this option is within someone’s arm’s reach when they find themselves at that table. Although you might (with justification) think of it as a moral issue, it helps (at least in order to keep at it, when one feels dispirited) to think of it as a marketing issue. How do you make sure that what you believe is known about by the people who can benefit, at the time they find they need it?

    I believe that MIA is about keeping that option on the table, as part of a civil (in all senses of the word) dialogue. That way we do not commit the offense that we are most aggrieved by; shutting out peoples’ voices, especially those of the people who are most affected. “No sedation without representation,” we might say. I think that MIA is about creating a space to hold this much-needed conversation, but to make sure that those whose voices have long been shut out have at least an equal spot at the table. It is not about shutting anyone out of the conversation; it’s about making sure that everyone has a turn.

    I believe that the real evidence, and the statistics, and our hearts, point toward something much, much better than we have seen offered (and/or coerced) in the name of treatment for emotional anguish in the past. The trick is to find ways to make sure that that something better is part of a conversation that we are all participating in equally, and to have confidence that if what you believe is, in fact, better, it will appeal and prevail. Granted, the deck is stacked, but the way to win against that is to stay at the table and continually improve your game.

    I believe that MIA’s purpose is at least partly that; to provide the opportunity to improve the thinking and language around arguments for alternatives to the standard of care, and to provide an opportunity to practice and sharpen that argument.

    Actually, modifying that statement a bit; I think that when you look at history, there have always been quiet, compassionate people who provided an effective alternative, and who didn’t receive (or divested themselves of) rewards or glory out of either modesty or an impulse to stay under the radar, or because offering the alternative requires a modest, quiet temperament in the first place. This alternative has always been a part of the standard of care; it just didn’t get the same attention as approaches that offered the illusion of quick or certain fixes, and didn’t have the advantage of providing a mechanism for moving large sums of money around. (Large sums of money have a way of generating their own justification, either because they seem convincing in their own right, or because they provide everyone who comes in contact with them a chance to take their share – or both.)

    The trick, as I see it, is to find and support those who share your beliefs. That is MIA’s main raison d’être. Bob’s books provided affirmation for what had been many people’s experience, and became a gathering point for many who had felt alone and voiceless. We at MIA feel a deep sense of obligation – indeed indebtedness – to those people and that voice. Not out of a desire to shut anyone out – including Dr. Insel, whose motivation is, I am sure, principally to relieve suffering – but to keep the conversation going. I have personally found in my clinical work that when I could keep the conversation going long enough, eventually even people who had the most apparently adamant bio-medical view of the situation eventually came around to seeing a whole person in a whole system, and would then come around to a different approach. The trick was to make that happen without (necessarily) calling the person out or calling them bad names, which usually just ended the conversation, and not to the benefit of the person I was trying to help. It was less immediately satisfying to keep my temper – I’ve had my times of stomping around the streets filled with inchoate rage at what I’ve seen perpetrated in the name of “treatment” – but it was generally what I found actually got what I’d hoped for to happen.

    That said, I am thankful for those who storm the streets with inchoate rage. There is a place for that, for sure. But I believe that MIA is a place for civil dialogue that doesn’t shut anyone out. By “civil” in this case I don’t mean nice and pretty and neat. I mean by “civil” that we are all a part of this community, and we don’t have the option of cutting anyone out; we either find a way to all move forward together, or we all lose. Nobody gets tossed off of this boat without everyone paying a price.

    I recall Bill Clinton once saying of his opponents something like “you see, they don’t want you to think about it, because if you think about it, we win.” I think that applies here. MIA resolutely provides a place where we say “let’s keep thinking about this.” Because, if we think about it – together – we win.

  • I put David Healy’s articles on MIA for one reason; he does some of the most trenchant, incisive, persistent, creative, and relentless criticism of pharma that is to be found anywhere. And so in pursuit of MIA’s mission to help further the dialogue, and to help equip those who would be critical of the industry with the most informed, variegated, current, and robust arguments, I feel it would be a disservice to our readers to fail to present David Healy’s work.

    Healy has also created one of the most significant websites dedicated to unearthing adverse effects of medications – RxIsk.org. Also, he has taken, and continues to take significant risk, and incurs significant adverse consequences in his own life, as a result of this and his past work.

    But his work is presented on MIA on its own merits. Yes, he sometimes strains an analogy up to or beyond the breaking point. But for sheer exuberance and creativity in trying to find cracks in pharma’s armor, he is tough to match. So sometimes I let a strained metaphor slip by, rather than lose the energy that he brings.

    That is my fault. But it’s all in the interest of trying to offer up the most fecund rhetorical brew we can manage. And if we were to discredit everyone who holds a view that we don’t share, we wouldn’t have anyone left to publish. As Katie Higgins said; be careful whose bandwagon you jump on; not every critique is valid. Or, if a critique is valid, it also fails to take the whole picture into account. While many do differ with positions David takes – or seems to take – about ECT, I think that a blanket dismissal of him for that fails to take into account the full character of his position, and of the man. I don’t know whether it’s any less “ad hominem,” in this case, to speak in favor of a man’s character than against it, but I’ve known David for 15 years and feel obliged to say that his work on critiquing pharma is valuable, and he deserves appreciation for it.

  • We at Mad in America know Monica Cassani to be scrupulous in her research and writing, and stand by her. She does not speak prescriptively, nor does she invoke any authority other than her own experience. Rather, her consistent theme is to speak honestly about her own experience, and invite others to use that information in their ongoing pursuit of learning what works for them. Mad in America provides a forum for people to interact, inform, and strengthen their resources and resourcefulness in learning what is right for them in pursuit of their mental health, with the recognition that one impediment to this has been the overwhelming – and questionable – sense of authority that most people are faced with at the moment that they begin this pursuit; Monica was doing this on Beyond Meds before MiA started. She has been a trailblazer that we believe in and support. We personally know many of the people she has helped, and we are honored to be allowed to post her writing whenever she feels it would be appropriate. We also know – first-hand, and for a fact – that she has not and does not benefit materially from this work; certainly not in any way that could in any conceivable way influence her judgment, and certainly not anywhere close to the extent that she deserves. We are pleased and proud to steer people toward Beyond Meds any time we get the chance, knowing that they will find information and the forward-looking, positive view that it is sometimes challenging to find as we engage with the multitude of injustices that we have all witnessed or met with on the route to coming together in this forum. Having looked at the links in question, I cannot see (if I’m missing something, please enlighten me) any way that Monica benefits. I think it is a service to the reader to provide helpful links wherever possible; the link represents, in my view, the information that there is easily accessed information with which the reader can then evaluate for themselves whether the experience that is being presented resonates with them. For MiA to attempt to step into the role of vetting, accepting or rejecting everything that people relate from personal experience we would be stepping into the role of a monolithic authority – exactly what we are trying to work against. To that end, we have recently presented posts in which people spoke of how psych meds have in fact helped them; it isn’t for us to reject the experience, but to make sure they are telling the truth, that they are expressing themselves as clearly and effectively as possible, and providing appropriate evidence for the views expressed. We then provide the opportunity for people to engage with these views in a discussion that will hopefully strengthen the ability of everyone who is participating to present their view effectively. I view MiA as a sort of gymnasium, where people get access to the resources they need to strengthen their ability to engage in these topics effectively. We provide relevant research as it is published, and peoples’ experiences and expertise as they are moved to make them available; As long as this is done in a respectful manner, the next step is to open the topic up for discussion, as is largely happening here.

    Monica represents the best of what is happening. She deserves respect and, where possible, support. I am saddened that posting on MiA brings arouses such negativity and suspicion, because I know how much that hurts when all that she – and most of us who do this – get in return for our efforts is the satisfaction in our souls that we expended the best effort we could at a time that people needed help, and maybe we succeeded in helping them. I know that that is all the Monica has ever, and likely will ever get for her efforts, and so to take that good feeling away is, in my view, one of the most insidious forms of theft. It dispirits and impoverishes the best intentions of the people who gather here, and makes it hard – in fact impossible – to attract some of the best and most subtle thinkers on these topics.

    Monica’s writing is presented here not as being an unquestionable voice of authority; any statement made on MiA should ideally be the beginning of a discussion, not the end of one. But we do present Monica as someone whose motivations are beyond reproach, and we do ask that she – and everyone who makes the effort and takes the risks involved with writing or commenting on MiA – be treated with appropriate respect. None of us is or ever will be “correct” 100% of the time. We are all engaged in a collective journey of learning to make the most out of life, and the “correct” answer to how to do that changes person-to-person and even day-to-day. But one thing that never changes is that nobody can be healthy when their honest efforts are met with negativity and disdain. Therefore, it is a bottom-line necessity on MiA, as being the one forum that we have any control over, to try to make sure that that is what people can expect when they participate here. It is, we have found, IMPOSSIBLE to make sure we meet that standard all the time. All we can do is ask. I am asking.

  • I think that the goal should be as it is expressed in Thich Nhat Hanh’s third mindfulness teaching: “Aware of the suffering brought about when we impose our views on others, we are committed not to force others, even our children, by any means whatsoever—such as authority, threat, money, propaganda, or indoctrination—to adopt our views. We will respect the right of others to be different and to choose what to believe and how to decide. We will, however, help others renounce fanaticism and narrowness through compassionate dialogue.”

    What we are working against is fixed views; of people, of science, of others, of ourselves. We don’t further the cause by reacting to fixed views with equally opposite fixed views. We can only engage in “compassionate dialogue.” This is a timeless effort; it began the first time words were uttered, and will continue until we’ve destroyed ourselves. I don’t think that vivisecting anyone whose perspective we don’t understand, and who frightens us, will end that. We can only struggle to try to understand why people see things differently, and what about their view might be right as well as wha about ours might be wrong.

  • Just because I’ve had a ringside seat from the beginning of MIA as a webzine, I’d like to verify that the site has not benefitted anyone financially – and in Bob’s case it has been a large, unrecouped loss. In addition to that, every time we have been faced with a choice that could have benefitted Bob, whether financially or just by making his life a little easier or more pleasant, he has always chosen resolutely on the side of MIA’s greater mission, rather than for his own interest. In fact it has sometimes seemed to me that he had begun to choose against his own interest out of habit, or some sense of obligation. That is why I have hung in there, through some difficult times. The only way any of us has benefitted has been in the knowledge that we are doing something good at an important time in history, and for that we consider ourselves lucky.

  • I do feel moved to respond, because I’m saddened to have given the impression, if I have, that I am anti-science. I love science, and some of what I most cherish about what I feel I know, who I think I am, and what I believe about what it means to be human I have learned while buried deep in the stacks of a medical school library. Understanding more of how the body and brain function unlocked, for me, some understanding of the human experience that had been hidden from me. In fact I’m about to start working on a doctorate that is going to delve, in part, into the physiology (and the somatic experience of it) involved in certain mental processes, such as memory- and meaning-formation. This is obviously not anti-science.

    But in the same vein, questioning whether science has gone down some dead-ends and blind alleys is not anti-science. It’s pro-science. I might say (hoping that this does not come off as grandiose) that it’s as when Galileo said that pursuing science was not anti-religion or anti-God. It was simply learning more about God’s creation, at the pace that God had established as appropriate; certainly no more could be known (if I remember what he wrote correctly) than God would allow, so it is right to pursue it, and could only result in more reverence and wonder.

    That might seem tangential, but it feels connected. I feel deeply devout about science. I feel awe and wonder at good research. But I also feel disdain at bad science, especially when it makes claims to knowledge that is not justified, and those claims become the basis for beliefs that hurt people, especially when they are desperate for answers. And I do believe that psychiatry in the last few decades has been barking up the wrong tree. Not all psychiatrists, but the ones who I have found to be honest and wise operate far from the mainstream, usually without much support, and usually with a lot of opposition.

    I think that science, properly done, involves endlessly stepping back and questioning one’s assumptions and hypotheses, and that psychiatry has for the most part not done due diligence on its basic operating assumptions when the poor outcomes scream out that the paradigm has failed. Similarly, any manualized, operationalized approach is susceptible to the same thing. That’s just the nature of trying to do something good, in any kind of reproducible way; it becomes bureaucratized, and then is at risk of losing its humanity.

    There’s a joke; the devil and his minion are walking, and see a man pick up a piece of paper and get happy. The minion asks “what was that?” The devil says “he found a piece of the truth.” The minion says “well, doesn’t that concern you?” The devil says “no; I’ll just make him organize it.”

    That, to me, describes the problem here. Whenever any of us finds a good thing, whether it’s how to be meaningfully present for a fellow person in crisis, or a pill that seems to help them, we try to figure out how to make more of that; make it replicable, efficient, monetizable, and pervasive. The second we do this we are at risk of unintended consequences. Scaling up the good inevitably risks scaling up the bad as well.

    When I made a film I was proud of once, and it made it into theaters and on TV, I was proud of the scale I’d achieved; I thought maybe I’d helped to change the world in a good way. Maybe I had, but I felt completely disconnected from it, and therefore didn’t trust my judgment about it, and I realized I didn’t aspire to large audiences or to making big change any more; I aspired to be able to be with one person at a time, and KNOW in my bones whether it was right or not. I am still on that path. I will probably write about it on MIA soon, now that I’ve begun to feel that I have some actual traction on work I feel good about. This is why I’ve been content to limit my big-world contributions to supporting Bob and his work. I have far more confidence in his potential to make a positive impact on the larger world than I have in myself, and so I’m happy behind the scenes.

    I’ve rambled enough for now. Mostly I wanted to say; I’m not anti-science, at all. I’m just anti-bad science. Which includes science that fails to be humble about its achievements, remembering that the larger part of what it means to be human is not reducible to physiological mechanisms. There is something beyond the mere fact of life, the mere fact of having bodies and brains, that comprises the larger and more miraculous possibilities of being human. And I don’t think psychiatry, or any ONE approach to ministering to the fears, foibles and frailties that arise from the fact that every human is aspiring to the miraculous – to being more than just they themselves have been born to be – can credibly claim to have found the all the answers. I’m immediately suspicious of anything or anyone who does.

    I am ideologically agnostic. I think that CBT can be a very good thing, at the right time, for the right combination of people. I’ve also seen good results from acupuncture, Haldol, and barking at the moon. It’s all about timing, and being honest with ourselves and each other. Do that, and anything’s possible.

  • I’m afraid that this is why I need to be careful when I wade in, given that it’s difficult to say anything without inadvertently saying something that then becomes over-determined, and thought of as indicating a general trend of MIA.

    I do think it’s MIA’s job to be looking at any purported treatment with a critical eye. That said, I come to this believing that there is much that is true and beautiful in the ways of thinking, being, and helping that come out of many approaches to helping people who are suffering.

    That said, I was trying to say that when comparing CBT to pharmaceutical care, it was only because it was about the only psychosocial treatment for which there was even the basis to make the comparison, at least on any statistically meaningful basis. This was then immediately criticized for seeming to promote CBT, which wasn’t true; it wasn’t about promoting or criticizing CBT; it was just the metric that existed.

    And, that said, I’ll say this; from my perspective the problem of presenting anything “evidence-based” isn’t that there isn’t necessarily evidence for something, it’s just that that evidence doesn’t necessarily translate into anything meaningful in terms of efficacy in the real world. We all know this, but it’s a tricky concept in many directions: even if there is solid evidence for something called CBT, it’s my (and others’) observation that “CBT”, qua CBT, isn’t what is actually practiced in the world, hardly ever. People who recommend treatment to others say “CBT” either because it’s a term they know, or it’s the one they know there’s research on, or any number of reasons. This doesn’t mean that what is being practiced is CBT.

    And I question whether CBT is even CBT when it’s being practiced exactly per the book. As we know, the research on the “common factors” of what produces effective therapy finds, consistently, that something called “the quality of the therapeutic relationship” – whatever that is – is what makes the difference, no matter what treatment modality is being offered. I say that this suggests there is something “affective” going on, in addition to the cognitive or behavioral components of CBT.

    But CBT’s stock in trade, and/or its public image, has something to do with how “affective” is NOT included in the “cognitive” and the “behavioral.” So there’s some contortions it goes through to keep that out, if only to keep the appearance of a theoretical purity.

    But when a group of CBT researchers – Zindel Segal, et al. – researched CBT’s basic premise that when you change the thoughts, the affect changes, what they found was something quite different; the change in affect began prior to the change in thoughts; it began upon the change of relationship to thoughts themselves when realizing that thoughts were just “thoughts,” a realization that made letting go of them possible. From this came Mindfulness Based Cognitive Therapy for depression, which I teach.

    So, in a way, I am engaged in practicing CBT, of a kind. But I say that knowing that there are those who rightly criticize the ways CBT is used to buttress the medical model, when there is no justification for its use in that way. That’s not what I happen to be doing, but the criticism is not out of place, given that there are places where this is true.

    Ultimately I’m trying to say that it’s complex. And this may be the most important fact about all of this; that people suffer for myriad reasons, and any time someone tells you there’s an easy or quick fix, they’re probably selling you something. It’s about constantly stepping back, and stepping back again, and stepping back again any time someone offers you something that’s supposed to be a sure thing. One must train one’s self to enter any relationship with one’s eyes and ears – as well as one’s heart – open.

    I think people perceive MIA as being closed-minded. I think I just realized the way in which that’s wrong; I think the mission on MIA is to open minds, always. To open minds, and eyes, and hearts. Now that I’m writing this, I think I may be realizing something very important about our editorial stance; that we are trying to always expand the conversation, always be open to the next unknown.

    Because that’s the key to helping people; always remembering what you DON’T know yet; you don’t know everything about what and who a person is; you don’t know what they might be capable of. You don’t know this about anybody, ever. Once you think you do, you are not respecting them, and you cannot help them. This is as true if you are trying to “just be” with them as it is if you are offering a pill. If you cannot humble yourself in front a person, you have no business trying to help them.

    I think that one aspect of the complaint that is being expressed by people on MIA who might be described as – or who would describe themselves as – antipsychiatry is that they have been treated with this lack of respect; instead labeled, categorized, diagnosed, and prescribed as if this was all they were. Many have been deeply harmed, physically and/or mentally. This can result from psychosocial modalities just as much as it can from drugs. It happens any time people are treated with expediency and efficiency as being more important than realizing a person’s full potential, or at least more important than extending them complete justice.

    I wanted to respond since I saw Academic’s post this morning. This is the first chance I got, and I’m falling asleep at the keyboard, with much else to do as soon as I wake up. So in the interest of simply not failing to respond, I’ll hit “post,” and just hope I haven’t said anything that goes too off the rails.

    Basically I wanted to say to Academic; yes. It’s more complex than I initially managed to say. It’s always more complex. That’s the point of all this. Be humble; do the best you can. But what I’ve learned is that almost every time I “knew” that I was doing the right thing, I was about to make a huge mistake. It’s only when I’ve entered the space in which a person was in crisis with humility, and an appropriate fear, and was willing to start from square one – with whatever book learning I was able to meaningfully muster, but without “knowing” anything that we didn’t figure out together, that I did any good. I say this having study a whole slew of approaches, and being grateful for all of it. But when I walk into the crisis space with someone, I walk in empty. The people I really like to work with are people for whom “cognition” is scary to them, at best, and their “behavior” is scary to others. That is to say, not necessarily people for whom “CBT” in its classical sense is really apropos. This might be where the divide is – though I say this with some trepidation, because I would be offended (and have been) when people suggest that if things have turned out well, then the client must not have been so bad off in the first place (whatever diagnosis or prognosis they had walked in with). But perhaps when you’re talking about CBT you just don’t happen to be talking about working with people past a certain level of crisis.

    Again, I don’t know, and regrettably I have to post and sign off, lest I feel that I haven’t responded to you. So I’ll just hope for the best and hope I fall asleep after I get to bed, and not before.

  • One small point to add to Bob and Rob;

    My understanding, when I was doing the “In the News,” is that this section – in counterpoint to the blogs – was to function primarily as an aggregator. I looked for articles that would be of interest to our readership, and presented them in a straightforward manner. My editorial perspective was primarily in what I chose to be of interest; the mandate was to stay as current as possible, not to editorialize, while providing material that would contribute to an evolving conversation. I thought of it as a graduate seminar, where material is presented for discussion. As much as I might be appalled and/or horrified by yet another claim to the discovery of this-or-that prime cause of such-and-so, it was my job to present the material in as straightforward a manner as possible, so as to create a level playing field for intelligent – or at least passionate – discussion.

    I can say that I often thought of ironic (and sometimes even witty) headlines or commentary that Bob would wisely enjoin me from using. Sometimes this was frustrating and painful. But I hoped that some astute reader would pick up on what I thought was interesting and meaningful, and was rarely if ever disappointed. I believe that the discussions that followed were generally deeper than they might have been in the write-ups had been more directive. I think this is what an effective facilitator does; cull the material to frame a discussion, and step back.

    Of course this meant that people often assumed that I actually believed the study to be true as the researchers presented it. But they said this in the context of criticizing it in exactly the way I would have, if it had been my job to do so.

    As to the fact that many of the studies were just like so many others that had already been published; the point was to keep the conversation current. Right along those articles are other ones that found the opposite conclusions. It was a matter of keeping the conversation timely. I’ve so often found when I’ve been making the arguments that lead to being involved with MIA that among the reasons my arguments were dismissed was that I was basing them on old research. Of course, I happen to believe that old research is not necessarily less valid or important than new research, and much new research is based on faulty paradigms where the old research was still in touch with something true; but nevertheless there is strength in being able to stay current. So that was the point of “In the News.” Not that it was necessarily “newsworthy,” from our perspective, but that it was research that just happened to be “In the News,” and therefore was worth at least knowing about, if only because it was likely to be brought up by someone, somewhere, sometime, so it is helpful to know about it ahead of time and have your perspective on it at the ready.

    I will add that keeping current on the research in that way is a backbreaking, onerous, soul-sapping job. Once I managed to get through the 100 or so journals that I would review, sometimes daily, and sort through the relative significance of the articles, mustering the energy to write more about my perspective was more than I had in me, even if I were allowed to. I would get the articles over the goal line and collapse. For the first two years I loved doing it, and felt I was doing something important, and swore I would do it for as long as Bob would allow me to. I did get physically and spiritually depleted, eventually stepped away from it to make room for other things (such as getting some exercise, after two years of being at the computer from pre-dawn to dusk.)

    Since then I’ve been awed and amazed by Rob’s work. We’ve talked about trying to find ways to streamline the process, and it keeps coming around to the fact that there aren’t any. So I know better than anyone how hard Rob is working and it pains me to see him getting negative feedback. I can see how carefully he frames his outlines of the articles; allowing them to present themselves on their own arguments and their own merits, while deftly presenting exactly what needs to be presented to give the critical reader what is needed to see through the artifice. It’s a delicate thing to do, and I don’t think it’s augmented by adding any “those idiots” commentaries to what are supposed to be straightforward presentations of current events.

    In “In the News” the editorial position is all about what is aggregated. What is relevant; which means sometimes it’s research that seems to support a position that is critical of psychiatry, and sometimes it’s research that seems to support psychiatry. To address another of Paula’s criticisms of Jay Joseph’s piece, that it seems to support the existing diagnoses; I often found myself publishing research that presented, for instance, articles showing that CBT as equal to or better than medication. I got roundly criticized for promoting CBT. This was not my intent; my intent was only to show that medication was not the be-all, end-all; that early intervention, for instance, needn’t be only – or even at all – about medication. At the time there was little or no research available to make that point (there is much more now) so I was grasping at straws, and studies involving CBT were all there were. Now things have changed, and early intervention (and CBT) are getting the more critical look they deserve. But I had to work with what there was at the time.

    I think Jay’s piece is a good critical examination of whether the research that purports to show heritability in psychiatric diagnoses is valid. I was excited to post it. I happen to be very critical of existing diagnostic formulations. My divergence from a mainstream view began with reading the DSM and thinking “this doesn’t make any sense at all; you tug at one thread and it all falls apart.” From there I went on to discover the critical literature, including Paula’s. Still, it’s hard to deconstruct the whole edifice without taking it piece-by-piece, as in; does the statement that there is demonstrated genetic heritability hold up? The NEXT step after an answer of “no,” if one is being honest, is to look at the system itself.

    We look at this in so many ways – in terms of outcomes, in terms of the medical model, and – especially – in terms of the voices of those who have been directly affected, that I think it would be hard for anyone who looks at the totality of what we do on MIA to not at least begin to question their support for the existing paradigm. This would seem to be the case in terms of the many who decry MIA as “anti-psychiatry,” if not in terms of those who characterize themselves as “anti-psychiatry” who look at what we do and find us wanting. But we do try to hold a line that will keep those who are skeptical of MIA engaged, and continuing to read. And to that end, presenting the aggregated research in an apparently unbiased way on a daily basis is something that Rob does to all of our benefit. He acknowledges that the tone of this particular review wasn’t pitch-perfect. I’m sure that this discussion will inform future selection and presentation. I mainly feel obliged, being, as I said, perhaps the person in the world best in a position to appreciate the effort, passion, and personal sacrifice involved in doing what Rob is doing, to say – I hope for all of us – thank you. Keep up the great work. We are up against an endlessly resourced and implacable problem; which is the ease with which caring for people in the tried-and-true ways that we have known for generations, which can be difficult, frightening, uncertain, and often materially unrewarding ways, have always been and will always be in danger of being replaced by apparently easier, apparently less frightening, apparently more certain, and definitely more materially rewarding ways such as giving people pills. It is not even necessary to say here that pills are never helpful – just that the dangers of going in that direction are so great as to be potentially catastrophic for both individuals and society, and should not therefore be justified on the basis of a claimed benefit to the few without careful analysis. And, of course, we think that research such as Harrow’s, Wunderink’s, Open Dialogue’s and others shows that other approaches must be given their due.

    One more point, on Open Dialogue; it is a continual frustration that it is difficult to present the Open Dialogue research without someone saying “well, they’re not dealing with schizophrenia.” This is, of course, because the experience of those in Tornio has been that using this approach resolves crises that in earlier times would go on to meet criteria for schizophrenia – simply because the crisis has to go on for six months in order to do so. So, by the existing criteria, people are technically right to say that they were not dealing with schizophrenia in Tornio. As they say in Tornio; “schizophrenia is failed treatment.”

    But of course this means that it’s hard to get traction using the Tornio research on questioning the approach employed to treat schizophrenia, if you can’t call it “schizophrenia.” And while an intellectually honest appraisal of what the research finds would lead, inevitably, to a wholesale review of the schizophrenia treatment, if not the whole concept of schizophrenia, insisting that we question the construct itself at every turn – as meritorious as this might be – runs the risk of leaving some people who are currently caught in treatment under this failed paradigm still caught. Speaking for myself (and many others) I’ll say that I have been successful at extricating people who have been given life-long diagnoses and prognoses. And every single time I’ve succeeded at that the outcome was dismissed as an outlier, a fluke, a dodged bullet, a “misdiagnosis,” an unjustified risk, etc. Never, if ever – to my knowledge at least – has there been on those occasions a reappraisal of the diagnosis itself, and certainly not a reflection on the real and potential injustice of the diagnosis having been applied and of a life, therefore, having been potentially stolen. Certainly not a reappraisal of all the lives that had been impacted – and lost – as a result of similar “misdiagnosis.” But on those occasions my interest and loyalties lay with the individual, not the whole system, and I preferred to take my satisfaction at their good fortune rather than co-opt their success to further a larger agenda. It didn’t necessarily help, at that point, to say to a family member, or a psychiatrist, “you were wrong,” or “you are a terrible person for having done this.” They, like everyone involved, were scared. And, sometimes, the risk was real, and people got hurt, which hasn’t changed my view but has changed how I’m willing to calculate the odds when I’m taking risks like this. There was a time when I thought that the depth of the injustice being perpetrated on individuals justified any risk I might take, and I was willing to take any risk. Now, having experienced the consequences that can come even from people you are wholeheartedly committed to help, I don’t necessarily feel differently about the justice issues, but I’m just more respectful of the fact that to go against the paradigm is to willingly take risks on to yourself and others that have to be done very consciously and deliberately.

    So, I’m trying to say, that if all one article can do is say “hey, there might be a different way of looking at this,” but doesn’t happen to take on the responsibility of pulling down the whole edifice once and for – and risk getting crushed in the process – then there’s still a place for that article. And this is one of those. If we are going to criticize research for being overweening and hubristic in its claims, it’s on us not to be overweening and hubristic in the process. This is the strength of Bob and his work; he humbly takes on the science, and simply asks; by their own logic, and their own research, how are they doing? We try to aggregate this. And after three and a half years of being involved in MIA I can more conclusively than ever say; in the aggregate, by their own logic, and their own research, not so good.

  • Another relevant thing that the book covers that the movie does not is Nash’s sexuality. Obviously the movie focuses on the love story with Alicia, and for good reason. But it is also true, as Naser writes, that Nash slept with men from a young age, and had long-term relationships with some. This was at a time that being gay was dangerous for one’s career (he was fired from the RAND corporation following an arrest in his 20s) as well as for one’s life. He was bullied to the point of torture at college, as Naser writes. Knowing what we know now about the relationship of early stressful experiences, cultural dislocation, and bullying with psychosis, it seems worthwhile to consider how these stressors may have contributed to Nash’s experience.

    Nash spoke of these difficulties when he told his son about his “life and problems and life history” in what he hoped to be “my personal long-awaited ‘gay liberation.’” After this revelation, his son did not speak to him for 17 years, although it’s not clear from the book whether this was because of his revelation or because, as the book says, “having a mentally ill father was rather disturbing.” In any case, the interrelationship of these facts remains unexplored. Perhaps it was out of respect for Nash’s preferences in telling his story – although this seems inconsistent with the fact that his story of his own recovery is consistently disregarded. I think it’s more likely that it was, until the mounting research on the link between psychosis and trauma as made the connection unavoidable, just not clear that the sum total of the stressors Nash might have – and probably did – experience as a result of his struggles with sexuality could have meaningfully contributed to his extreme states.

    I guess it may seem disrespectful to bring this up, but I think it’s equally disrespectful not to talk about something that he clearly did care about, and remained relatively silent about, for most of his life. I personally know many people who put their sexuality – gay or straight – on the shelf once their identity became that of “mentally ill,” which in itself one of the tragedies of our current standard of care – which posits that people have to attend to “their” “illness” before they can have a relationship. My philosophy has always been – and I’ve been finding this confirmed in my recent studies of systemic couples and family therapy – that one of the best ways to help people toward health is to help them have fulfilling relationships first; and that health follows. This has become an accepted approach to working with trauma, for instance, where historically the approach has been to send people to individual therapy until they are deemed ready to have “real” relationships.

    I had hoped that this would be discussed while he was alive, and that he might talk about it. It is clear from the interviews above that he is more forthcoming than the media have generally chosen to pick up on. I am sorry that we can only discuss this in retrospect. But out of consideration for all the people who may find this other unrecognized fact of Nash’s life resonant with their own, I am glad to be able to bring it up now.

  • I did not see the removed comment. I will second that discussion of issues of justice is not against MIA policies. This is a place for the development of precisely that discussion and, hopefully, the crafting of better arguments – for which the presence of people to have the discussion is helpful. Invective against individuals, ad hominem attacks, and, basically, ranting, is not conducive to this.

    If you feel that a specific person is guilty of something, this just isn’t the place to do anything about it. In fact, attacking them here is counterproductive at best. It just isn’t going to accomplish anything, and does destroy what MIA might hope to accomplish; the development of elaborated, cogent, effective arguments on these issues. When people show up and angrily represent the mainstream view badly, it certainly doesn’t further the case for the medical model, either.

    If you have a case to make against an individual, this simply isn’t the place for it. It’s not going to do any good. That case should be made elsewhere, where it might. That is not the same as shutting down the discussion. That is trying to make it more productive.

    Also, taunting us is unproductive. Threatening “Delete this one, and I’m sure it will come to haunt MIA in the future” is very inconsiderate of the work we, and especially Emmeline, put in. The fact is that putting something like that in a comment is kind of a poison pill; we could and probably should remove the whole post. And in fact we don’t remove pieces of comments, because we’ve found that editing comments is worse than removing the whole thing and asking people to repost them with editing, as you did above. But putting taunts like that at the end is just, frankly, exasperating. Apparently Emmeline decided to let it stand, but I feel the need to say something about it.

  • It is definitely a good sign. We are having an increase of traffic from yahoo, google, and others, meaning that people are coming who are not already familiar with MiA content. So, naturally, some will be surprised. MiA exists to be a point of contact between perspectives that have not engaged on a level playing field before. At least some of the value here is in having the opportunity to learn new and better ways to get the message across. That means, of course, that that effort necessarily goes in both directions.

    Bill Clinton once said something to the effect of; “They don’t want to talk about it, because if there’s a discussion, we win.” You can fill in who he was talking about, but it bespeaks the idea that if the message that people generally come to MiA in order to feel part of putting forward is a valid one, then more dialogue, rather than less, is good. So to get the most out of these new commenters coming to MiA, it’s best to welcome them politely, and keep the dialogue open.

    The difference is; this is a table at which the views of non-medical approaches to distress are (at least) equal. Many who have suffered have sat at tables where the medical model held sway over them, and often was in fact dispositive. Those voices are respected and honored at MiA, and given full standing in this discussion. But that does not mean that shutting out the “mainstream” voices is going to get the conversation moved further forward, even if it seems to present an inviting and novel opportunity to do so.

    I think that the exciting and novel opportunity is to know that, here at MiA, these “alternative” viewpoints are not, in fact, “alternative.” They ARE the mainstream here. They are viewpoints that are accepted, honored, and validated. The opportunity is to experience how the conversation goes differently when that is the case. Ideally, it is a positive and life-affirming change.

    Rob Wipond expends inhuman amounts of energy digging up empirical support for this viewpoint on a daily basis. So, every viewpoint that is expressed is done in the company of the day’s news that informs it. Emmeline attends to making sure that all voices – and especially those of those who have suffered – are respected. Laura is one of the premier voices in America speaking to these issues. Bob has devoted his life to developing and crafting the message to an inhospitable audience that the common wisdom needs to be re-examined. And hundreds of authors and commenters have contributed in profound and substantial ways to making ours a website where this view – which was once ignored, then laughed at, then ridiculed, and is now on its way to being accepted (if we note the quasi-acknowledgment of Bob Whitaker’s argument in Thomas Insel and others’ public statements) – can be experienced for its truest, best, deepest, and most compelling reason; that taking these issues back from the authority of medicine is a life-affirming way to fully embrace life’s challenges as humans, in the company of the whole human community, rather than relegating struggle to be the province of a medical subspecialty with questionable validity.

    So; these “mainstream” commenters are best welcomed, hospitably, because they have perhaps unknowingly wandered into an unfamiliar house. How they are received will make all the difference in whether they might come back again, and possibly stay. The difference is that they are in “our” house. We may have an opportunity to change minds. But first, we have a duty to be civil.

    I am especially moved to comment on this post. When I met Bob Whitaker 13 years ago, the first thing he gave me to read was a draft manuscript by John Read. It meant a lot to me, and it means a lot to me now to have John writing on MiA. I am very glad that he is finding time in his schedule – which I know to be crushingly overloaded – to respond to comments. MiA is truly making inroads and, when Bob’s new book comes out later this month, coming, as it does, from Bob’s fellowship with the Safir Center on Ethics at Harvard, we are poised to have an increasingly significant effect. This speaks deeply to the value of the space we have created here, and I am especially moved and gratified to part of MiA at this time.

  • I see my job as being to post things that stimulate thought and debate. My influence extends to what it is that I find interesting to stimulate thought and debate about. The fact that I post something has more to do with thinking that there’s something worth thinking about, than what I might believe about the “validity” of any one construct that the item is based on. Often, when I post things, I actually think that the construct is invalid, and that an honest reading of the article cannot help but leave an observant reader to that conclusion. Almost always, there are astute commenters who get the ball over the goal line in this regard. Occasionally they might assume one way or another about what I believe, which is ok; it’s better than me being too explicit about what I believe. I think it’s my job to keep any overt beliefs I may have out of it, and instead try to keep coming up with grist for the conversation mill. As Clinton once said about his detractors on the other side of the political aisle; they don’t want you to talk about it, because when you talk about, we win. I like to believe that if the conversation is open enough, and full enough, it will end up where I happen to believe it should. On MIA, I’ve rarely been disappointed.

    As long, of course, as the conversation doesn’t get shut down by people being too reactive, and demanding expressions of fealty to one ideology or another. That’s the death knell for a living conversation. That’s where madness begins, in my opinion.

    I will say, though, that one thing I found interesting about the article is that, whatever approach one is using to approach the situation in which someone is being referred to as “borderline,” one can expect that a few years later the person has a reasonable expectation of the situation being resolved. This squares with the research I’m aware of that it’s the overreaction to the situation that causes more harm; that as long as people get through it, they generally go on to do well. My take=away is; then try not to over-react, and try not to do anything that is going to just further damage a person who has been injured.

    So; no. I guess I don’t accept the “validity” of the label. And that’s why I put the article up. So that perceptive people such as yourself would point out its flaws.

  • Apologies. I was hurrying to get Doug’s blog up, after a long weekend at the MiA film festival, when I was interrupted for what was going to be an hour and a half; I hit “publish” without realizing I hadn’t assigned Doug as the author (it defaulted to me).

    I was curious when I got an email from a friend offering me support in my dark time. Didn’t realize why until I opened MiA an hour and a half later.

    Sorry to all, especially Doug.

  • Cannotsay;

    Yes, I do have to agree that it was prone to misinterpretation, given that it was misinterpreted. What I’m uncomfortable with is the degree to which that misinterpretation took the form of ad hominem attacks. That is the problem with ad hominem attacks; they assume, they label, they presume to know things that can’t be known, leading to statements that the person cannot refute, or would be foolish to try. They do not invite discussion.

    The meaning seemed very clear to me when I read it, and more so when I spoke with him. I do not fault people for misinterpreting. But on these pages it should be sufficient to question the author’s meaning, challenge the facts or logic, and invite discussion. To go further into characterizing the person is to commit the same offense that so many here have experienced at the hands of psychiatry and psychology. If for that reason alone, I would hope we could avoid falling into that trap.

  • I think that interpreting the Michael Fontaine piece as intending to downplay and degrade the importance of Thomas Szasz is a misreading of the piece. I think the central thrust of it was only that, if Epicurus was more “successful,” it’s because his message was somewhat more appealing. When he says, in conclusion, “The other reason Szaszianism has failed is because—on my evidence— psychiatrists do not know what philosophers have to say about the mind or soul. They are committed to the Hippocratic, reductionist-materialist view that it’s just the brain. They aren’t taught that other views are out there. Perhaps they should be” he seems, to me, to be reflecting not on Szaszianism’s “failure” but rather on the shortcomings of psychiatry and psychiatrists. Honestly, I don’t understand how anyone who reads to the end of the piece could see it differently.

    Yes, of course, Szasz has not “failed,” insofar as there are legions of people for whom his thinking and work has been, and will continue to be, critically important. When I spoke with Mr. Fontaine about the piece we shared how appalled and saddened we were at the scant – and largely uncomprehending and unappreciative – notice his passing received. It was with this shared appreciation of Szasz’ work, and a shared hope and intention to remedy the deficit in some small way, that I put his piece on MiA. Which is why I have been saddened at the reception it initially received. I believe that it was unfair to Mr. Fontaine, whom I know to have a profound respect for Szasz, both personally and intellectually.

    I believe his article took a rhetorical slant that was somewhat nuanced – something of an “I come not to praise Caeser, but to bury him,” ironic device – owing I suppose to its initial venue, and I know that the result of the presentation at the APA was that many of the psychiatrists who did see it have continued to engage with Mr. Fontaine with a renewed appreciation for Szasz. It saddens me that his reward for such a public service, for which I can imagine no personal benefit he could have possibly expected, has included the harsh and demeaning treatment he received on MiA.

    I know Mr. Fontaine to be an ally of anyone who wants Szasz to be better known and appreciated. I also know that he has many more worthwhile articles on other topics that he and I discussed. I hope he will continue to be willing to post on MiA.

  • I would like to add to Emmeline’s comment that if Mad in America is to be taken seriously, it will involve more thoughtful discussion than “this is bs.”

    I am excited to have such a thoughtful piece as this on MiA. I know that Mr. Fontaine has put considerable thought and time into it, including time spent with Thomas Szasz.

    When Szasz died I was appalled at the lack of coverage and, where there was any (the New York Times), it was clearly unappreciative and uncomprehending of his true message. I tried at the time to solicit some articles to try to fill the gap a little, to some success. But when this article showed up, I was very excited at the depth of information, thought, and appreciation reflected in it.

    These days, unfortunately, aligning oneself with Szasz is a risky thing to do; one gets too easily tarred with various unfair labels, all missing the point. If MiA is to move the conversation forward, it will require expanding the conversation around these issues, not shrinking it, until people can see that the concerns we write about on MiA actually do have meaningful connections to all of human life. A piece like this, taking its inspiration from the ancient history, written by a classics scholar, is the kind of article that expands the range and depth of the dialogue, and we are lucky for it.

    But having the first comment be “this is bs” sends a message to the world about who MiA readers are and, unfortunately, people draw conclusions about what MiA’s mission is. Those who would wish to dismiss us are given all the ammunition they need with such careless comments. No matter how many reasoned, thoughtful pieces we publish, people conclude – or are allowed to continue to believe – from such offhand comments that this is the true spirit of MiA; this fact has severely limited the pool of authors we can draw from, and the range and quality of the discussion we can have.

    On the other hand, MiA considers it a profound responsibility to be as unrestricted a forum as possible, because we feel a profound obligation to people whose voices have not been heard. We like to think we offer a unique forum that has not existed, for people who have been harmed to speak to those who are at least a little open to hearing and changing the dialogue.

    So, Emmeline has properly chosen to let these comments stand. But I am saddened that articles that offer such a unique contribution to the conversation would be met, first, with such uncomprehending, dismissive comments. The article may not be your cup of tea, but comments such as these have the effect of dampening the pleasure others find in it. I think that if you look deeply in the article, you find an elegance of thought that can be applied far beyond these relatively circumscribed conversations. It is articles like this that help people realize that we are trying to do more here than thrash out past grievances; we are trying to reconnect conversations about human struggle, which have been made paltry and irrelevant by the false promises of a medicalized solution, to discussions that can encompass human aspiration as well as the beauty and joy to be found by transcending our material being rather than surrendering to it.

    That is what a return to the classics can help us appreciate in a unique way, and why I was thrilled to be able to post this article. I hope that the conversation proceeds in a more meaningful and inspiring – or at least appreciative and polite – way from here forward.

  • I suggest you consider whom Dr Tibaldi is collaborating with on this initiative; another MIA blogger, Tristano Ajmone, whose bio on MIA reads: “Tristano Ajmone is a libertarian psychiatric survivor, much influenced by Thomas Szasz’s writings and friendship. Tristano doesn’t believe in the existence of mental illness, drug addictions, nor the mind, but rather in individual autonomy, liberty and freedom, and that psychiatric coercion is a crime and a political issue, not a medical one.”

  • I think it’s fair for me to say that, based on Dr. Ragins’ personal communications with me, Donna’s interpretation is correct. Unfortunately, as the post notes, Dr. Ragins had a family emergency at the time the blog appeared and was unable to participate.

    Not, of course, that he was obligated to, or necessarily would have said more about his position. I just know that he was pleased that MHALA changed its position on AOT, to “against,” as a result of his advice.

    I think it is a good example of advice that presents the evidence in a balanced way, such that it is credible, but makes the conclusion – for anyone giving the advice careful consideration – clear and obvious.

  • I’d actually offer that “man is essentially meaning-making.”

    I think that people, once having found something they find meaningful, and experienced the rush of emotion and illusion of certainty that that seems to offer, will cling to that feeling and that illusion against all else. They will fight for that feeling and those ideas to the death. They will vote for parties whose policies actually work against them in the real world, because the feeling of meaning is so core to us that we will go – as history shows – without food or water or even life rather than give it up.

    This, I think, is what we are working with – or against – in changing the paradigm of “care” as currently offered, and why we must be mindful of being able to offer a meaning and purpose to replace it. Not speciously or vainly, but really; offering ideas that people can actually feel are “good.”

    When I have worked with people that psychiatrists had deemed “hopeless” or “chronic” or whatever variation of that that was on offer at the time, and managed to massage the situation into one in which the person was held more holistically or “environmentally,” I would often see that same psychiatrist who had been adamant that the person was ill shift wordlessly into being happy or even gleefully into seeing the person getting better. The idea that the person was ill – or even that they had been ill – slipped silently away, and we all enjoyed the satisfaction of being present at a person’s coming-to-be within themselves.

    We did not then review how wrong the psychiatrist had been. In those situations it wasn’t necessary or even well-advised. I was sad and even angry that we couldn’t then reflect on whether the person having been diagnosed with a “lifelong” illness with “no cure” should be seen in retrospect, as a mistake or even a potential crime against humanity; it wasn’t appropriate to turn a person’s life into a political football, and the psychiatrist’s willingness to relinquish control or authority didn’t need to be augmented by anyone calling them bad names.

    But the instinct and desire to turn those occasions into change on a social level has, for me, found some fulfillment in working on MiA.com.

  • I would respond to this similarly to how I did above; it’s a question of where one’s attention is most productively put. As a school of thought that I am becoming increasingly engaged with – “Social Constructionism” – might put it: it’s not about who (or what) is “right” or “wrong,” it’s about where does thinking this way get us? What sort of world does this way of thinking – or acting – create?

    To wit; I would rather put my time into promoting (in woeful reality “rehabilitating”) Szasz’s image than into excoriating anyone for failing to meet my hopes or expectations. Partly because, looking at history, often the people we hold up as models get very little out of it other than our fleeting appreciation, and usually suffer more than they gain. Loren Mosher, it is my impression, other than some moments in the alternatives to psychiatry limelight, was fairly angry and bitter and pessimistic about the “mental health” world for the rest of his life. When Thomas Szasz died the press response was slim to nonexistent, seemingly uncomprehending, often patronizing at best. People are afraid to come out as “Szaszian” in other than the friendliest (and most confidential) of circumstances. And most of the people I know who have taken principled stands have suffered terribly for it; lost jobs and reputations, getting torn apart in the rumor mill, because their message is so jarring to the existing paradigm that those who feel (rightly) threatened are left with little recourse in preserving their sense of balance but to destroy the messenger. And this is real. Good people lose jobs, homes, families, and their lives because they stand up for what is right. I think it’s better to appreciate than than to invest our time belittling others for not doing the same. People have children to feed. Maybe we should help figure out how they’re going to do that when the profession they’ve invested their faith, sweat and hope in turns out to be based on a false premise?

    This is no small thing. It’s real. We are talking about human beings. FELLOW human beings, after all, with hopes and dreams and fears and expectations, who are often surrounded by people who have hopes and dreams and fears and expectations that are dependent on them. They may be misinformed, they may not have the information we would wish them to have, they may not have the priorities we wish they had. And, yes, they may be cold, unfeeling, heartless bastards with nobody’s interest at heart but their own; in which case it’s doubtful mean words will influence them to our side, and probably will do the opposite.

    But, possibly, being shown a better way will. I cannot refrain from paraphrasing Kant: given perfect foresight, a nation of angels and a nation of demons would behave the same, recognizing that their individual well-being depends on it. This is not exactly the same as “compassion,” which, I would argue, is an absolute bedrock requirement if we are TRULY hoping for anything like the outcomes we all claim to hope for. In fact, I’d say, without compassion, the whole game is lost. It’s what we’re asking for – or demanding – from those we disagree with. I would think it reasonable to expect the same from ourselves.

    So, I wonder, what if rather than raise the level of vituperation, we throw our limited resources into real appreciation of that which people have to give? Personally, I would love to see more writing about Szasz, Laing, etc. I would like to see more writing that explores not just the fact that Open Dialogue has good outcomes, but why? What is it that that small band of merry women and men in Tornio are doing that can be learned from and adapted into other contexts, or used to invigorate those qualities as they are found in other contexts?

    What if we really rallied behind people that take the time and effort to write things we agree with, and equally in support of people who take the time and effort to venture their opinion where it might challenge ours? I am not preaching here; this is a question I constantly work on in myself; how might I learn to change fear into curiosity, and anger into compassion? I say this because what I have lost when I have failed to do so is considerable.

    Following on that thought, I’ll say it here; I am commencing on pursuing a doctorate on that very subject (in part), tracing collaborative and dialogical practice to their foundation in social constructionist and other thought, and toying with ideas for generalizing these ways of thinking and working with the construction and arising of meaning [or, as this process might sometimes appear to be when interrupted, psychosis]. In the process I hope to alloy my soul in some manner that will better my chances of reacting to challenge and crisis with a reflex of warm interest and curiosity. For myself, I have so far found this best when I’ve been able to open my mind to those of others not as threats to my equilibrium but as fellow warriors in the war against chaos and entropy. When I stop thinking about who is right or wrong, and think only “what is this person seeing or thinking that I am not,” or “what does the world look like from this perspective.” I am not obligated to agree, and I am at liberty to strongly disagree and argue that a different course of action is required. But in order to live in the world as I aspire to, I must at least TRY to understand why people see things as they do, and understand with compassion why they make the choices they do. It’s not because I’m an angel, and I might be just as inclined to do it if I were a devil; I’m saying I want to do it because, at long last, midway through the journey of my life, I have come to see that this is what WORKS. All other approaches offer fleeting feelings of security and satisfaction, then give way to the reality of an uncertain future to be faced amid fractious factions rather than friends and allies. This is, apart from any other arguments, unappealing to me.

    On the other hand I’ve found that when I’ve looked deeply into the spaces in which diverse perspectives commingle to create living realities, what I’ve found there was the closest I’ve come to experiencing love, safety, faith and hope. For people with traumatic backgrounds (all of us, most likely), those are the scariest spaces to look into; the places where people with their needs and fears intersect. But, sad to say, that’s where we have to go if we want friends, love, jobs, and – if not safety, which isn’t actually guaranteed to any of us – hope.

    I’ve allowed myself a ramble here. But it seemed warranted because, as I am in some way a member of this community, it seemed reasonable to announce that my role is changing, and why. I’m not handling much of the “news” any more, as I’m gearing up to start post-graduate and doctoral studies. Thankfully, Rob Wipond is on hand and bringing new energy to that task (which, admittedly, after two and a half years was wearing thin for me.) But what I can say is that all of this experience has extended and deepened my appreciation for one of the questions that brought me into this in the first place; What exactly is “Open Dialogue,” and what it is good for? I can say; it’s what we strive for here, as it’s our best hope for constructing the reality we hope for, and we must be constantly vigilant against the forces (emotions, “practicality”) that seek to close dialogue down and thereby foreshorten the possibilities.

    That is why we ask for and demand civility here. Not to quell discussion, but to make it possible. Strenuous argument for one’s values is great;

  • I don’t think it’s about “being nice.” Argue against the system. If you think crimes have been committed, make a case for that. If you think ideas are wrong, or perhaps even wrongheaded, say so. But if what you want is license to call people bad names, please find somewhere else to do it. MIA is for the discussion of ideas, research, evidence, and, yes, personal testimony. We believe that it is true that peoples’ personal experiences have been given insufficient attention; that is why we feature personal accounts right alongside analysis of research and philosophical reflections.

    I know lots of people, psychiatrists included, who hold good values, and struggle within a system that makes working in the way they wish to difficult or impossible. Among them are people who think and believe exactly as I do and, perhaps, as you would wish them to as well. They could use help, I think, in finding the words and arguments that will equip them to say the right thing at the right time to make something different happen. The things we talk about can be exquisitely, or excruciatingly, difficult to wrap in words. I know that people within “the movement,” people whom I would think should be allies, can be vicious with each other about word choice. Words, like “recovery,” that ten years ago one could barely utter for fear of being thought delusional, are now accepted to the point that using them pegs people as behind the times. Yet, there are still people who have not been introduced to the idea that “recovery” is possible, let alone the possibility that they should never have been told they were ill in the first place. I know people who have now written for MIA who 12 years ago excoriated me for presenting the possibility of “recovery,” saying I was offering “false hope.” I think that they felt threatened, that I was taking away an identity that gave connection and comfort, and proposing a world that, at the time, didn’t actually exist in a functional way. Now, with a lot having changed, much of it the result of Bob Whitaker, the same people are writing for MIA, saying they were never ill and that nobody should ever go to hospitals. That’s a lot of ground to cover. It was a process. And Bob’s part in that was done without calling anyone bad names. It was done with resolute dignity and respect, and hard work on presenting evidence and solid arguments.

    If Joseph Biederman chose to write a blog here, I would assume that it meant that MIA has gained a position in the world that he felt moved to do it, for whatever reason. That would be a good thing. There would be plenty enough to say in response to whatever case he would make for his actions, without resorting to calling him names. I think that would be wasted space, when there are much stronger arguments against what he has done, and what might be done about it. I think that would be a better use of the opportunity than proving peoples’ worst expectations of MiA readers.

    In the end, none of this is about one person; not you, not him. It’s about the ideas and values that we choose to hold or believe in, and it’s about painstakingly constructing the arguments for them. I think that a lot of well-intentioned people were given very bad information, and put in situations in which they could not get better information, and they did not do differently than they were told, believing it was the right thing. Some of them, it could be argued, should have known better or could have chosen differently. But I know good people who now say; I was misinformed – and now I am grappling with what to do with what I’ve done as a result. I think they need our help, not our calumny. We all suffer from being misinformed in some way, and making bad choices, unless we are enlightened, clairvoyant, and omnipotent. Truth always involves some collective effort; nobody has cornered the market on reality. I think MiA aspires to be a place where new realities can be constructed; this takes goodwill and civility. Name-calling can and should be done elsewhere. This is not about being “nice.” It’s about being adult.

  • We invite authors to engage in dialogue, but we do not require it. It’s nice when they can, but to require it would eliminate some of the very people who’s writing we hope to attract.

    On the same line, it’s not appropriate to pose questions that somehow imply that an author is being derelict or evasive by not responding. I think this is dirty pool; akin to calling someone out for a dual, or to defend their honor. We are grateful for everyone who takes their valuable time to participate; nobody should be put on the spot for not having more to give. I think this applies even more for people who have the willingness to take controversial positions or bring up difficult questions.

    The things we discuss on MIA are very, very difficult, on multiple levels. If we are to move the conversation forward, it’s going to involve finding new ways to express difficult things. I think that that is one of the chief contributions that MIA can make; being a forum to craft new language and arguments that will make inroads possible where progress has been obstructed before. Sometimes the people who seem to disagree with us are just trapped in old language and old “language games” relative to the issue, and coming up with new language can loosen the lid on new paradigms.

    I don’t think it’s essential that the author participate in the discussion that has been sparked. Their participation or lack of may or may not contribute to forward movement. But incivility, righteousness, and moralism will stop forward movement every time, IMHO. They give a momentary sense of satisfaction, and short-lived sense of accomplishment, and ultimately leave everyone where they started, and angrier for it.

    We hope to do better on MIA. So we hope to leave judgement and hostility, as justified as they may be for individuals, for other forums to house. Here, people should be applauded and thanked for their willingness to contribute at all, and their contributions should be welcomed and worked with respectfully. To judge a blogger for being unwilling or unavailable to respond to comment is to diminish the graciousness of those who do, as well as to willfully ignore the indecorous treatment many bloggers have received when they did contribute.

  • I don’t think this is a productive line of discussion. I don’t think the point is to compare whether one situation is more or less abusive than another one. I think that what was meant here was that there is a quality that defines the abuse that takes place that is unique to this relationship; one in which one person is, by virtue of their accreditation by the state – a simple statement of fact, here, as doctors are accredited by the state – empowered to make a determination about another – with very little if any oversight, and no effective means of review or redress on the part of the person being labeled – that will define and determine every aspect of their identity and life from that point forward. Whether you think that this is more or less abusive than another situation, or even abusive at all, is what is at issue here. Getting caught up in the “accuracy” of the statement, which is clearly meant as a term of art, not an empirically verifiable data point, is a pointless and distracting exercise.

  • When saying something like “which is seen as a scientology front group,” one should say more than that; by whom is it seen as such? What is the evidence that would support such a statement?

    I asked Sheila Matthews about Scientology connections, because I knew that Ablechild had received an award from CCHR, and so the question might come up. I knew, though, that her commitment to the issue is long and deep, and not motivated by Scientology. Her answer was “. . . as a 501c3, I do not have any political or religious affiliations. On a personal level, I appreciate CCHR’s work, but Ablechild is not aligned with CCHR. I also appreciate the support Ablechild receives from Mad in America when you post our pieces. And, if this is any help, I am a life-long Roman Catholic. I hope this answers your questions.”

    So, unless you are prepared to present evidence to the contrary, you should be careful with such allegations.

  • Thank you, Andrew, and others, for this clarification about MI. I have witnessed that MI is a very worthwhile approach, when it adheres to its foundational principles. But this article also shows how the most well-intended approaches almost inevitably will be co-opted, misused, and absorbed even by the perspectives they seek to provide an alternative to. This can happen both insidiously and innocently, such as when the basic ideas are misconstrued and adapted into an otherwise inhospitable paradigm.

  • Bob Whitaker has said of his work that its intention is to take the evidence offered and see if it stands up on its own merits. In like fashion, we take the evidence we find being offered within the standard paradigm that straightforwardly acknowledges contradictory findings, and offer it straight. We leave it to readers and commenters to make sense of it and draw broader conclusions; that is not for us to do, other than in the selection of material from which to draw inferences.

    So, thanks for your comment, and for all your invaluable and seemingly inexhaustible help in sending us articles and news items. It’s been a godsend.

  • Question: Is it only a matter of who pays for it? What is the responsibility of the study to the people who agree to be subjects? Can it be assumed that they are assuming that the information gathered will be used honestly, and for the greater good? Have they been fully informed as to how the data will be used? Or, if they are accepting money for their participation, is it allowable that they sign away any right to know how the data are used?

    Does the government have a responsibility to be sure that people are not used in this way, even if they are willing to sign up for it? Does a pharma’s use of some citizens as study subjects obligate it make the data available to all citizens of that community, rather than use the data to build and exploit the market within that community? Does a government have a right and/or responsibility to guard against that?

  • Yes, my questions were prompted by your statement “Since it opened, our respite house has stated that force of any kind (calling emergency services, police, etc, on someone) is not on the standard menu.” The questions you raise after are pertinent to both the respite context and the inpatient context; in some ways they are equivalent in both contexts, and in some ways they are different. What I was alert to was delineating the ways the contexts are alike and different, as I felt that addressing your very important questions warrants that. I did not mean to derail the conversation, but rather I think that this conversation often – perhaps always – reaches a dead end because of a lack of these distinctions. Perhaps an argument could be made that inpatient settings should not exist, or that the medications should never be used. Certainly the argument can be made that preferable options exist. But I don’t think that that those arguments can be made effectively without acknowledging the differences in the context.

    Nobody is obligated to follow my lead on this, and your questions are extremely important independent of mine. It was simply a hope of seeing as fully elaborated a conversation as possible that motivated me to add my questions to the mix.

  • I think it would be interesting to ask here:

    In what ways is your respite house like, and unlike, a hospital? What are the conditions under which you will or will not accept someone? Are these conditions a form of force, if it is understood that the person may not have a choice but to accept your conditions? What are your responsibilities to a person once they are accepted? Are you responsible to or for them until the crisis that brought them there is somehow ameliorated, or would you, upon reaching the limit of your resources or your the pre-defined limit of your obligation, ask them to leave? If so, could that be considered a form of force?

    Is the inpatient setting different in its responsibility; to somehow find a resolution for any situation it is faced with? What is its option when no resolution can be found, and yet clear and present danger remains? What is the implied responsibility of an inpatient setting, and how can that responsibility be fulfilled while honoring the both the rights and safety of all individuals to whom the hospital is understood to be responsible? Under what conditions can of should a hospital refuse its services?

  • From the editor: We understand that the topic of force and forced medication, in any situation, is upsetting for many of our readers. But it is a reality, and Mad in America needs to be a place where such difficult topics can be raised raised and discussed, and that the resulting dialogue can be a productive one.

    Jonathan, who is not a prescriber of meds, presents here that though he is opposed to force of any kind, and aspires to be part of a system in which it is not used or needed, he nevertheless works in a system which must respond to individuals who are agitated and potentially violent. So what is to be done? If the argument is that there shouldn’t ever be forced use of antipsychotics, then what alternative can be developed for instances where a person is acting in a violent or threatening manner?

    We hope that readers, in their comments to this post, will speak to this question, and to this dilemma. As such, we would hope that people who are in a similar position as Jonathan will weigh in with their thoughts, and we hope too that those who have been forcibly treated will tell of what that experience was like for them, and how it affected their future interactions with the psychiatric system. We would ask everyone to speak about what alternatives to forced treatment could be developed. And finally, we ask everyone who comments to do so in a way that promotes a real dialogue on this matter, where people can hear each other.

    We thank Jonathan for telling of his experience, and giving us this opportunity on Mad in America to explore this difficult issue.

  • From the prosecution’s questioning of the psychiatrist. It was clear that they were allowing for the possibility, or at least that the psychiatrist might or should have been aware of one, if only in relation to its addictiveness. This may be more represented in one of the articles on the trial.

  • True. And I generally don’t include stories like this until something truly dispositive (a verdict, for instance) has been reached. But here I used the word “implicated,” because it’s seemingly uncontested: both the prosecution AND the defense seem to be assuming the possible significant role of Adderall. This seems noteworthy.

  • I think one of the take-home messages is precisely that there is so much that is unknown. Research into this area is needed, and the funds for it are scarce-to-nonexistant. So we have only the experiences of individuals from which to try to reach decisions.

    One important point, though, is that this is not actually different even if the research exists; it might be presented as definitive, but it likewise does not apply to all cases. As Monica points out; though it may be very hard, nobody knows how things might go for an individual who manages to forge a path that has not been taken before. This is always true. Whether it’s research or anecdotes, we must make our own decisions and find our own way.

  • I’m sure that Dr. Shipko will respond, but I wanted to convey that I’ve actually been in conversation with him about this for a year. He acknowledges that he may have a select group; people who come to him tend to be in rough shape. We’ve discussed other ways to interpret what he was finding in his practice. He acknowledges that people do get off the drugs, and he is certainly all for it. But what he posted today is consistent with what he’s been saying to me for the past year, that there seem to be some people who really are permanently harmed. If true, it seems responsible of us to publish it in the interest of fully informed consent when one chooses to use a medication.

  • I think it was an important point; it should have read something like “at least 25 years, on average, off the lifespan of anyone who is captured.” In the moment I opted to refrain from suggesting the change, thinking that an op-ed has a certain degree more leeway.

    I’m not sure whether I’m sorry; the discussion and the points made were worthwhile. Though in retrospect I wish I’d at least checked in with Nancy about the point. I agree with Ron that, though it’s a small difference, it’s an important one that goes to credibility.

    I also understood Ron’s comment to be (at least in part) that we have to acknowledge that not all the problems people experienced can be attributed to the drugs themselves. I think it’s important point in that failing to acknowledge the reality of struggle and suffering as part of life is to perpetuate an aspect of the problem that leads to an overly “medical” approach; the idea that struggle and suffering, if they exist, must be attributable to an aberration or a disease, and therefore must also be eradicable.

    I think that the call to “destigmatize” illness is actually, inadvertently, stigmatizing of humanness, with all its frailties. What we might seek, instead, to destigmatize is suffering and struggle; that they should be reclaimed as part of the human experience, not signs of aberration or disease and, though they might be helped to some degree by the medical arts, should not be allowed to fall wholly under their aegis.

    I think that the kindest thing is to say; yes, life is hard, and it sometimes hurts, but the struggle is worth it, and sometimes the extent of the struggle and even of the pain is commensurate with the feeling of reward and satisfaction that comes with facing it straight on. Among the greatest losses are the missed opportunities that come with the hope of short-cuts and quick-fixes. At least that’s what we’ve always told our children. Or did, until we started giving them diagnoses instead.

  • I just got it up on the front page. As you may know; authors can post their blogs to the site at will, but we need to review them and put them in the “featured” section. This is a compromise we’ve worked out; we want authors and commenters alike to have immediate access to posting, but we reserve the right to vet front-page content. Some authors appreciate that we relieve them of the need to copy-edit; it means they can put all their energy into writing things quickly, and count on us to catch typos, grammatical errors, or fuzzy/imprecise language. It’s a collaboration aimed at everyone looking their best, hopefully. There have also been some occasions when authors have really strayed far from content that we consider (or, for that matter, interested lawyers might consider) to be appropriate; so we have been forced to adopt this failsafe.

    I didn’t happen to see that this article was here until five hours after Bruce posted it, and there were a lot of formatting and a few other edits that were required. When authors copy and paste their posts into the website, surprising things often occur that I have to fix manually. I’ve also been making a practice of trying to hyperlink everything I can so as to make the document more useful and informative. So all of this meant it was six or so hours before I put Bruce’s article in the “featured” section. But rest assured; I am only too eager to feature a Bruce Levine article as quickly as I am able.

  • In point of fact, no; I was not aware of another mention of this event. And I thought that where it was appearing was interesting, and the fact that it included a range of responses that seemed to fairly represent the event as I had heard about it from Bob. I thought that everything written within the blog was a fair and reasonable point; questions respectfully raised, with an openness to a range of possible answers. I thought it represented a clear sea-change in the reception that Bob and his viewpoint are receiving in the world. For someone as presumedly radical as Earley to place something so open-ended as this notice of Bob’s appearance could serve as an example of how we aspire MIA to be. So, to not include it on the basis of who’s website it appears on would have been prejudiced, and wrong.

  • I had always intended to put this blog on the front page this morning. There had been a large influx of blogs, and I wanted to give each a fair share of time on the front page. There are more blogs waiting to go up after this one; I am holding them in turn.

  • Yes, it’s just used as an example in this article, but I was unable to find any other news related to the change. It seemed worthwhile nonetheless to note the change. It’s definitely “In the News,” in more than one sense.

  • I am delighted to see these points made, Olga.

    We (P.J. Moynihan and I) are in the final stages of preparing a video from what we shot at the conference, and our main goal is to try to capture these precise points. I wish we had gotten some peoples’ reactions to this talk, which would have made it possible for us to include the talk and those reactions in the video. But we did get the talk with Allison, and I feel we just manage to capture the points.

    Perhaps in the future, in the larger videos we intend to make, we will be able to include interviews that help to flesh out these points even further. But reading Olga’s comment makes me even more excited to get this video out; I feel it does, to some small extent, capture exactly the moment in history that Olga describes.

  • I would also like to add that fairness demanded that we remove the comment, amusing though it may be, and irrespective of whether we might happen to agree or disagree with the message.

    We can’t pick and choose which targets deserve to be protected by our posting policies. It gets difficult to make the call about removing posts; we tend to be very conservative about that, and generally we all discuss it before we do. This means often things stay up that are questionable (I believe Donna makes a reference to a certain public figure in a comment above, which I’m ignoring for the moment in favor of writing this).

    The bottom line, I think, is that if we refused to print, or dismissed the opinions of everyone with whom we found some disagreement, there would literally be nobody left. The site, to cite the Open Dialogue term, is about polyphony. And it’s been my experience that the more and better polyphony is encouraged, the less such concepts as “crazy” and “psychosis” even have room to exist.

    As Donna posted recently in another thread: “…all disrespectful, controlling, invalidating behavior or emotional, verbal, psychological abuse is harmful to ANYONE AND EVERYONE even if in the best of emotional health.”

    She goes on to say (I’m paraphrasing a little): “…people should be expected to feel something when insulted or offended, but it is true that people have to control their reactions in that they aren’t allowed to hit someone with a bat or shoot someone when offended.”

  • I would like to echo Fred here. I’ve only taken the time to read through this post today (and I don’t have the time to do it today, either, but I’m glad I have). I responded to Donna earlier in the thread, not realizing all the ground that has been covered up until this point since then. It’s very edifying and gratifying to see all this.

    I do not think we have shied away from trauma issues on this site. It is certainly an important part of my perspective, and I seek out research to post that bridges the worlds where I can find it. I am grateful for all that anyone can bring to the discussion.

  • I also want to express my appreciation for your contributions to the conversation, Donna. I can assure you that the trauma-informed perspective is more than welcome here. I keep an active eye out for trauma-informed research that is pertinent to the MIA mission, as a means to encourage that dialogue. I am more than grateful for your perspective and knowledge base.

    The MIA mission is a delicate one, as I see it; to work from within the psychiatric theory and research. Robert Whitaker has accomplished what he has by doing this scrupulously; avoiding stands on what “psychosis” or what-have-you is or is not, and looking at outcomes. Within that framework, yours and others’ perspectives on the implications are welcome and necessary.

    I see Sandy’s reserve on the subject as appropriate. Within what she is saying there is room for discussion of alternate perspectives. More than that; alternate perspectives are called for, and we are all the beneficiaries of yours.

    You are every bit as essential and integral a participant in this website’s mission as is Sandy, Bob or myself. Thank you for staying engaged.

  • Just facts. The request was for stories of recovery, specifically not limited to a medical model. Any story of recovery. This could include, if taken literally, recovery from the medical model; recovery from diagnoses that shouldn’t have been given and prognoses proven to be wrong. Of course, there will be people who respond to the invitation with stories of how their diagnosis and their treatment helped them, but the invitation as I heard it was specifically directed toward people with other views as well. The message that telling people that they are fated to an identity and treatments they find abhorrent is dehumanizing and counterproductive was heard, if I am interpreting what I heard correctly.

    While I understand and complete support that skepticism is justified, I also think that if the view that medications played a deleterious role in this event is true, then it is absolutely essential that the views of people who rejected the medicalized view of their natural human struggles speak up as effectively as possible.

  • Actually, look at Leah Harris’ post: Sibelius heard Dan Fisher’s plea for messages of hope, and has launched a program to collect recovery stories and put them out as part of the dialogue. I know, from the conversations I’ve been privy to, that she is not asking for mainstream views of recovery, and that the door is wide open to comment on what has helped and hurt.

  • I think this is a classic dilemma of breadth vs. depth. I think Carl is picking away at a particular case, and the more he succeeds at it the more potential there is for universal lessons to be learned.

    I’m not sure the public is better served by waiting until some theoretical end-point, and publishing all of the learning then. That might present an illusory end-point. I think a blog offers an unique opportunity to go on the journey with someone of investigating, learning, turning things over and over.

    I think Carl does draw out the learnings and the universalities where he can. But I think it is another opportunity of a blog that the readers have the opportunity to do that collaboratively, as they go on the journey with the blogger. That’s how a blog is different than a magazine or a book; it’s living literature.

  • Thanks for this post; it makes important points. It skirts close to being an ad hominem attack, though; The general point is valid one, and can be made without disparaging an individual. I would think some of the personal references could put the person mentioned on the defensive. I hope we can focus on the ideas here, and not the individuals who put themselves forth, at some risk, in the interest of building a productive discussion.

  • Well, technically, CBT isn’t an umbrella term. It denotes (as you say) a specific body of theory and research. But in popular parlance it connotes any form of talk therapy, and may have little or nothing to do with the theory or research denoted (as you also say).

    Where it gets interesting is that the theory and/or research denoted may also have little or nothing to do with what has been experienced as successful in real-world situations, “success” being a term that can go through many shades and permutations in its travels from clinical and research contexts to the real world. But it’s referenced as if it means a specific thing, because that seems to lend validity to whatever argument is being made; the specifics of the theory and more importantly the people involved get lost.

    I agree, of course, that an interesting conversation is available and essential, and that assumptions, insinuations or extrapolations about motives, etc., make that impossible.

    I am sorry for the degree to which that has happened, happens, or will happen to anyone on this website. It has, does, and will happen again; we deal with essential and eternal dilemmas. We can only hope to find our way back from fixed views, our own and others’, and find our way forward to an ongoing, evolving, living, and fecund conversation.

  • From the (temporary moderator):
    I don’t see Belinda’s comment as an example of vitriol or personal attack, at least not to the degree that we would see it as a violation of our posting policy. I do think she mischaracterizes your reference to CBT as “obsessed,” when it seems more like a passing reference to something that you have seen as effective.
    I think one of the problems is the imprecision of what is referenced when people refer to “CBT.” I think it’s referenced as if it’s an homogenous, unified practice. While there may be such a thing as a manualized, operationalized, and codified “CBT” practice, I think that in reality it is the catch-all term for what is in fact an eclectic assortment of therapies.
    I see this imprecision play out in many ways, principally in the form of people saying about a person they have concern about “if only he would do CBT,” as if they know what that actually is or might be. I think that in the real world of practice today, that is rarely something anyone is in a position to say about what any one practitioner might be doing. It really means; “if only he would do something, preferably what I think he should do.” I can understand peoples’ frustration at mistaking the hoped-for end product for the means.
    So while Belinda is certain to be justified in her complaints of what she has experienced, I’m confident Brett has had experiences with which to justify believing that something that was being called CBT has been helpful for people in his experience.
    The helpful conversation would be about what CBT is thought to be, or has been experienced as, by all involved. Getting into a back-and-forth about whether it is good or not (or whether the individuals involved in the discussion are therefore good people or at least justified in their belief) seems less helpful.
    I hope this conversation can continue in an exploration of the ideas and the ideals involved, rather than about any assumptions about anyone’s personal characteristics or inclinations.
    We are dealing with difficult, subtle, highly charged subjects that have great and significant import for all involved, and in fact for everyone everywhere. Let’s try to carry that as a privilege and a responsibility, and be aware of the tenderness of the sensibilities of all involved in it.

  • Agreed that I should have acknowledged it is an animal study. I do cringe at “animal models of schizophrenia” and the like.

    However, I have been fascinated by studies, such as those coming from Robert Stickgold’s lab, that show how learning is dependent on the brain activity that occurs during various stages of sleep and dreaming. It seems to me that, where these essential processes are interrupted, it doesn’t seem far-fetched to hypothesize that something that looks or feels like psychosis might occur. That this study seems to get at some of the neural activity associated with that seemed interesting to me in this regard, and in my delight at that small but titillating aspect I failed to note the limitation of it being an animal analog.

    On the other hand; on certain levels, brains are brains. Our experiences of them are both fundamentally different from, as well as fundamentally connected to, those of all conscious beings (with a nod to the Buddha). I take delight in everything that suggests the potentially shared experience of consciousness, whether it’s with a family member or a rat.

    With that in mind (or brain, if you will) I’m allowing myself this maudlin reflection on Thanksgiving morning, about to be shared with those I’ve come to care about; which includes all you reading this, as well as the rats who are now part of our accumulated understanding.

  • Well, it’s helpful to have topics like this pointed out to us so we can create categories for them. So thanks for pointing this one out. I’ll look into creating it.

    If there isn’t a category, searches of the website may help. Not sure how to search the topic you mentioned, though. I just did a search for “early” and got a lot of stuff, some pertinent, some not.

  • Many studies I post are of things MIA readers know through direct experience. Very often the comments are of a “well, duh” variety. I post them so that the next time someone says to an MIA reader “but what’s the evidence”, they will have it. So, of course many studies will seem unnecessary.

    The problem is that when people assert things that are counter to the conventional wisdom, the response is always “show the evidence.” To which it can fairly be said that the evidence for alternative models of etiology and treatment have existed for decades, at the least. But given this, the response is then “we’ll, then, it’s old; show new evidence.” But then every new piece of evidence is dismissed as anecdotal or flawed.

    My mission is for this site to be an ongoing, up-to-date resource for new evidence for alternatives, the gradual accretion of which will give people working in these arenas what they need to assert their views.

    No single study will succeed or fail at this. And neither will the argument ever conclusively end, I think. My aspiration is to provide people what they need to assert their experience and their views with confidence, and with enough information to, at the least, raise doubt in the minds of those who have the privilege of complacency.

  • As noted elsewhere, we are mostly limited to research from within the established system if for no other reason than there is very little research that isn’t. But I think it’s valid to point out where the results actually fit a different interpretation than the one presented. I could make more explicit that, while noting their conclusions, I see a different possible one. In this case, I thought that the aspect I wanted to present was so apparent from the study that it was permissible to feature it. If I were to duly note every assertion I disagree with, there would be no room for what I find interesting and wish to feature. The fact that they also say something I disagree with doesn’t invalidate my interpretation.

    As noted, I anticipate lively discussion, and I try to say as little as possible past choosing the articles I find interesting. I certainly welcome suggestions, and usually run them.

  • Because it implies interesting questions about heritability, eugenics, etc, and I think it can be used to question the biomedical model.

    The Nazis wiped out a generation of people with schizophrenia diagnoses, thinking it would eliminate the “illness.” The next generation produced just as many people with the diagnosis. Clearly, their theory, having been tested in the starkest possible way, was incorrect.

    This study reminded me of that.

  • Because I think that studies like this can be used to show that the established diagnostic system is flawed. A continuum shows these are not discreet entities, and therefore questionable.

    Not every study is a blockbuster or a game changer, and all I can do is post what I find. I hope what I post will help people build the research base they need, and I do try to provide things that can be used. I don’t think it helps for me to make explicit in every case why I think it’s relevant; I hope and trust the commenters will and I’m usually rewarded.

    Sometimes I want to put things up exactly because they are another example of flawed thinking, but in my role I really can’t say that. So I usually don’t, instead trying to get someone to blog about it. This can be frustrating while watching the media flurry over flawed research that seems to confirm the status quo. I can’t post things just to be ironic, after all, and need careful analysis.

    I get criticism for being biased against research that confirms biomedical psychiatry. Guilty. There’s plenty of that out there; I try to fill in the blanks. But I try to do it with research that’s coming from the biomedical journals, when possible.

  • Usually it is meant to imply a pharmaceutical intervention, and the claim is that untreated psychosis is neurotoxic. Of course, the evidence for this is arguable and even if true is explained through other means (the neurotoxic effects of stress, etc.). Evidence such as this, however, which relies on behavioral outcomes, is also easily complemented if not countered by alternative explanations that do not necessarily imply pharmaceutical intervention.
    The tricky part is delving into research inspired by a certain hypothesis or paradigm with the intention of exploring another as, yet again, we find ourselves doing here. Without a research base commensurate to the prevailing biomedical paradigm, we are limited to such subversive activity.

  • As I understand it, the experience of the Open Dialogue people is that once people have been on neuroleptics for a long time, it is very problematic to get them off. For this reason they try to get in early, and the experience in Finland is that at this point they have the lowest rate in the world of people progressing from crisis to diagnosis.

    A lot of their older clients are still in hospital and on meds, but this is because of the difficulty of reversing the course.

    The Open Dialogue and Soteria projects in the states are oriented toward first break for these reasons, though as in all things the reality is case-by-case.

  • We want to make this site, moving forward, a place that people will look to for what is actually happening, what is being done, to change things. Some of that comes, necessarily, in the form of conversation: about research, about ideas, about language, and that is a good thing to have happen here. I am exploring ways to cultivate active dialogues; between bloggers, and among bloggers and commenters, in an “open” way. But we also want to have reports, written and in video, of concrete things that are being done. The Vermont Soteria project is one example, and I hope to have a brilliant presentation that Steven Morgan made at the Vermont DMH conference last week up very soon.

    I anticipate that the pace of reporting and conversation about changes will accelerate, because there is much to talk about and much to follow; and I hope that this will be the place that people think of to come follow it, if not become inspired and equipped to add to the momentum.

  • I’m trying to figure out what the actual model being presented here is. In pursuit of that, I have just now ordered Patel’s book; “Where there is no psychiatrist.” I have been unable to get a clear read on the actual approaches being suggested on a ground level; there is clearly some “medical model” thinking, but little or no info on what exactly is being suggested.

  • I am in the Cincinnati airport, soon to board to come back from NARPA. I spent two of my three and a half days there there bedridden with the flu, and got little MIA work of any kind done. Just mentioning this because i probably would have responded to this already. Perhaps unadvisedly, I will post whatever I have written when the airplane boards. If I offend, I’ll blame it on traces of the flu.

    Funny that you mention Descarte’s folly at the end; it’s what was drifting through my mind while reading the post. Having observed some Open Dialogue sessions up close last week, and done some training in it previously, what comes to mind is that Open Dialogue is about resolutely negating dualism in all its forms. Though it’s nominally about dialogue, its form is really all about creating a field of awareness in which connections form at a very experiential level, and the dialogue arises therefore on a solid (and perhaps improved-upon) ground.

    It’s often noted that people leading Open Dialogue sessions “use” a lot of humor. It was my observation that the sessions began with a notable shift into a shared physical/experiential space. This came from the intentionally “open” sense of time; there was simply no hurry to say anything or reach any conclusions. It seemed to me that mutual awareness increased, and that humor percolated up out of that connection. Since the sessions were in Finnish it’s hard for me to know the actual content or how on-task the conversation was, but I was told that the meetings had been very productive.

    One of the OD therapists was very proud of having been trained in Sensorimotor Psychotherapy, a modality I favor because of its very careful attention to both somatic and “conscious” experience.

    It occurs to me that one of the reasons OD always has two facilitators present is for reasons similar to those you mention, but with a different philosophy underpinning it. With three people, there can be no dualism (so long as there is no “in-group” formation, as you note.) This requires, though, a tremendous tolerance for uncertainty and ambiguity; which is another of OD’s strong foundational principles.

    This goes beyond tolerance, etc., and it goes beyond the reflexive understanding of relationship or family therapy. It goes, I think, to being open, on an ongoing basis, to reviewing our understanding how we “know” what we think we know. Does it arise from our somatic/perceptual experience, or vice-versa? Or does it arise in the space between ourselves or others, as some have theorized/philosophized. “Mind” or “consciousness” or “knowing” is always and only something of which there is a shared component; to experience any of them is to imply the actual or potential shared experienced of another. (See Daniel Dennett, or Durkheim).

    I think that Open Dialogue is built on such thinking. But when coming at it from a conventional perspective, it just looks like family therapy or the like, and is immediately suspect in the way that such work has come to be held, acculturated as we have become against anything that seems to imply that our families (or other environmental factors) may have had as much a role in our dysfunctions as our reverence for “family values” implicitly suggests they may have in our function.

    No one of these ways of seeing the totality of our experience is sufficient. Our bodies and minds are inextricable from each other. Pills DO affect us; the question is how, and what it means, and what they truly suggests they may or may not do for us in our search for a more fulfilled time on earth.

    My observation is that a tolerance for ambiguity and uncertainty is the most important thing in all that we discuss here. This is why the “I may disagree with what you say, but will defend to the death your right to say it” principle is so important here. I’m glad you express all that you do.

    The airplane is boarding. I look forward to discovering whom I have disgruntled.