Thursday, June 4, 2020

Comments by Kermit Cole

Showing 258 of 261 comments. Show all.

  • These two things do not negate each other. People seek comfort where they know to look. I was only saying that, so far, at least in other countries (I don’t think anyone is in a position to say what’s going on in the U.S. as a matter of policy) the response has been that of communities tending to their own after a disaster; not communities singling out and “othering” people through diagnosis.

    I’m not saying this categorically or 100%. Just that it is more true than not true so far, AND that it is in danger of changing at any time.

  • None of the panelists or hosts are being paid. Some people behind the scenes are being paid for their time doing technical support, graphic design (the flyer) and the like; though I can say that the enthusiasm of each person in this role is sufficient they probably would have done it for free if necessary. (I’m glad they were paid.) To the extent that things such as paying for the zoom platform is made possible by the OSF grant, it is support. Basically, this is an offering from a community that feels moved to do it.

  • Well, I’d add that language is what it is; a way to connect, and a way to differentiate one thing from another. That means that language can also have the effect of highlighting how difficult connection can be, and when it fails. It also can mean that when we differentiate one thing from another, for instance by saying “that is a rock, and that is a mountain,” we are NOT saying that a very large rock can be a mountain, or to an ant a rock can be a mountain,” etc, or that when we say “that is a rock, and that is water,” we are omitting that on Pluto water would be considered a rock, and on Venus many things we call rocks would flow like water. My point is; what we “know” of the world we know through language, and language makes the world what we know of it. It is both very useful, and a bit dangerous to believe that calling something a name makes it so. The fact that people suffer is real; calling it a name as if we know what that suffering is and what to do about it is tempting but dangerous. But having the conversation is good. It just get dangerous when we are tempted to bring the conversation to a close by trying to “know” something definitive. I think life is an ongoing dialogue. It’s dangerous to hope for the conversation to end.

  • I would like to add that much of the value of the inspiration Open Dialogue provides is not about what can happen if you DO Open Dialogue per se; it’s the value that can come from starting from its basic principles. Sometimes that’s all it takes; knowing that a different path is possible. This comes with some challenges, however; understanding that our mental health is intertwined with others’ means that we can offer to be a part of helping with theirs, but we also have to accept that we may have been a part of their struggle and suffering as well. I’m speaking, of course, about family. Basically; be careful what you wish for; Open Dialogue means that a conversation about a family member’s mental health can (and ideally should) become a conversation about our own.

  • Yes, Open Dialogue does point toward the example of a particular circumstance of a particular philosophy being implemented system-wide. In that sense it is an inspiration for what is possible, and poignant (or worse) for those who cannot access it. But the fact that it is not available in exactly that form is not the end of the story; we can take the inspiration, and the philosophy, and implement it, if not to replace what’s available in our networks, then at least to make sure it is available to people who need it at the right time. We will never eliminate the dominant biological model of psychiatry we live with. In fact, they haven’t in Finland. But the fact that Open Dialogue is available has crept into their community to such a depth that school counselors, for instance, call family and network meetings for episodes for which we would send a child in America to the hospital.

    I like to think that the way to think of it is to work with the network you have access to, if not the one you might wish to. If you can’t change the whole system in your community, you might be able to work with a family to help them see that a different response to their members’ distress is possible. This is not a challenge that should be underestimated when people are confused and frightened; I think we should forgive ourselves and others for not being at their best at those times; that is where the work STARTS.

    If we can’t work with a family, maybe we just work with a person and their most significant others. Or just with the person. And where we can’t get a person to do the work, maybe we just work with ourselves to remember that nobody is just themselves; they are everyone they care about, and everyone that cares about them, and in an important way they are everyone who has ever lived. The Open Dialogue inspiration can bring significance results, and an entirely different path to follow, when we let go of trying to recreate it like it’s some kind of miracle. Hearing Voices, for instance, is (in some ways, I believe) a more grassroots version of OD. So that’s available. With minimal training you can get going with that.

  • I take as a matter of “faith” that “therapy is, in fact, soul work. And that we all have souls, whether we choose to recognise it not.” How I relate to that, though, is that I automatically translate in my head whatever words someone is using into something that I hold as universal; that we are all trying to organize the light; make sense of the world. We are all allies in the war against entropy. At the most superficial level only, we seem separated by what we hold to be “true”; the more profound reality is that we are ALL intrinsically dependent on each other to make sense of the world at all. Even someone who seems diametrically opposed to our way of seeing things is only showing us what our common object of interest looks like from the other side. That is how we get a three-dimensional picture of the world. In that sense we benefit from all the eyes there are in the world, or have ever been. We might call the space from which that arises “soul,” or “truth,” or “knowledge,” or “psyche,” depending on whether we are coming from religion, or philosophy, or science, or psychology. But whatever lens we are using, if we are using it with humility, we can experience awe. I don’t feel the need to quibble about which language anyone is using.

  • Well, some difficulty can arise with the word “love”. For many it’s a scary word; it’s been used as a threat, as an accusation, as a cover. For some it’s anything but positive or even neutral. Not to mention that it’s a threat to some peoples’ livelihood. I try to avoid it. I think about “clarity,” because I believe that if we look to the point of connection with others, we can (strive to) find clarity there, and when we do we will experience the things we call “love” and “goodness.” I know this seems like an act of faith, and I guess it is, but I believe it is true; when we look deeply enough into another person, we find what we hope to find eventually; but it’s been covered up by years of traumas and adaptations. Louisa is my main teacher in this; the harder it is to find the good in someone, the more she’ll keep looking. (For many this may help to explain her attachment to me.) Only once or a notable twice have I seen her give into exasperation.

  • I think this is precisely on point. Much of our malaise is a mistaken search for “self”, and then “self-worth”, or what is wrong with that self, when what matters is what arises between us. I think Open Dialogue and the philosophies it points to are about locating self, and with it reality, truth, and “meaning” as arising in the connections between us. “We are, therefore I am.”

    I’ve also thought of it as “I think, therefore I wonder (or worry about) what you are thinking.” As alarming as it can be to realize that our understanding of the world is so interdependent with others’, it is also elevating, even transcendent, if we can get over the fears (and hurts) that arise in the points of connection.

  • We are all set to the challenge of meeting the paradox of being spiritual beings in physical bodies. I see this debate as being an ongoing effort to hold the multiple, seemingly irreconcilable perspectives. To remember that we see the world not as it is, but as WE are, and therefore learn about ourselves from what we see.

    That said, I have said, as you do, that one of the first victims of the dominant view of psychiatry as it is currently instituted is the poetry. This was not always the case, and is not the case now for many psychiatrists I know. But it is a greatly diminished profession from when it was humbler in the answers it purported.

    THAT said, there have always been people who claimed to have fixes for all the fears and pains we face. They tended to gather glory and fortune, usually while hurting people, while others worked quietly and without much reward; perhaps that is because that is what good work requires us to do. I think this has always been the case; we can find stories of good people doing good work in every era, and it always looked pretty much the same as it does now. I don’t think this is a fight we win; it’s a responsibility we have: to take our turn, do the best we can, and hope to leave things a little better — or none the worse — for whoever picks up the baton after. Obligating ourselves to “changing the paradigm” can have the unfortunate effect of disparaging the daily work, which isn’t always successful — but is always worth doing. I think that is the paradigm, and it is our job to help and encourage each other to keep at it; not denigrate each other for failing to change the world.

  • Yes; I think “we lost” risks demeaning those for whom there has been benefit, and the value of those benefits more generally. Best to look at the ways in which we’ve both lost, and won.

    And to do that requires a level of humility that is at the root of what we are asking for more generally. I believe that the trouble starts whenever someone makes assertions that are meant to be true throughout the universe and for all time. Such statements have a pleasant feeling of reassurance, such as the pleasant feeling one gets when someone says “believe me,” or “trust me.” These phrases themselves elicit a desire to do just that, because belief and trust are in themselves desirable.

    The problem is that all truth is necessarily local; between the people who are present with each other in that truth. Efforts to extrapolate to universal principles form a given observation (such as “because someone behaves themselves when medicated, then all psychosis is genetic, and can and should be treated with medication”) result in harm.

    The enemy, in other words, is economies of scale; the hope of promulgating general truth from specific instances, therefore relieving ourselves of the burden of being fully present for each instance, each person, each crisis, but affording ourselves the pleasant sensation of having solved the problem. I think that what we are called to do is exactly what those we would influence or oppose are not; reconcile and commit ourselves to ongoing vigilance, ongoing presence, in each arising moment with those we do or would care for.

    And that this movement – along with many other similarly spirited movements – can and has done. Many have benefitted. Many of them have benefitted directly (and/or indirectly) from your work, Will, as well as the work of so many of your colleagues. It’s an injustice to yourself, your colleagues, and those people who have benefitted to sweepingly dismiss the movement as a failure. To say it can only succeed by “winning” is, perhaps, just a self-fulfilling prophesy. Given the choice between a self-fulfilling prophecy (of doom) and a Sisyphean task, perhaps it’s best to grit our teeth, put our shoulder to the wheel, and start rolling that rock uphill again.

    Because it’s really about what it has always been about; the daily work of dissolving the barriers between selves and others. Every day that this occurs, we have not lost; no matter what happens or doesn’t at any other time or place..

  • 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.

  • Yes, but they also mentioned that if they have meetings without “the person” present, the focus of the discussion is on the people who are present and what is up for them, not what they speculate might be up for anyone else.

    That this conversation takes place is, I think, a product of the fundamental understanding that “the problem” exists between people, not within any one person. So it’s not germane to speculate on what is going on inside anyone, present or not, and to focus on what is going on between people who are present. Or, I suppose, if someone is not, to focus on your end of it.

    I think this can be a legitimate and productive thing to do, not least because it is a step away from assuming that the person MUST be present because they ARE the problem. It is possible for people to have realizations about their own end of things that might never have if the other person whom they have presumed to be the problem is always present.

  • I just arrived back in the states, having been at the same Open Dialogue conference (and having done trainings in it before).

    I will add that the originators of it are very insistent that it not be a technology or a thing, let alone the next new thing. Once it becomes that, it isn’t what it is any more.

    On the other hand, it does represent an approach that has brought that area of Finland in 30 years from having the highest rate of “schizophrenia” in the world, to the lowest. They have done careful research to document that, and yet this fact is so startling that mainstream people simply refuse to believe it.

    Especially as they are not doing a “thing.” It’s mainly about certain assumptions and very fundamental approaches; things that have always been true, but which have been forgotten since “mental illness” began to be treated with a presumption of underlying biology.

  • I have been traveling for the past week, and quite unavailable to follow comments, post new material, etc. I’m taking a few moments now to say this: I’m at the Open Dialogue conference in Finland. This fall I will be at many other conferences that are pertinent to this website’s mission. I’m meeting a lot of people with wonderful projects under way, and gotten commitments from many of them to blog about them. The conversations I’m hearing, some of which I am videotaping for inclusion on the website, reflect a sense of change and hopefulness I really was not seeing just a few years ago. I am excited to see these things unfold, and I think that this website can provide a true service in helping people around the country and the world stay abreast of substantive developments, see and hear the wonderful people who are creating them, and draw inspiration for doing the same where they live.

    The video we put up of Steven Morgan and the Vermont Soteria project is just the beginning, but I’ve already met people at the conference here in Finland who saw it and were moved and excited by it.

    My involvement with this website started, in part, when I mentioned to Bob Whitaker a couple of years ago that I didn’t feel I could continue doing this work unless it somehow involved substantive, real change in the system; that I would rather sell aluminum siding that feel like I’m tinkering around the edges. I had done work I was proud of, but always feeling like it was covert, as if I was running an underground railway. That can be challenging, sometimes fun, and even intellectually kinky; but it is not sustainable as a way of life.

    I now have the opportunity to participate in chronicling the substantive change. Open Dialogue is, indeed, coming to America; Jaako Seikkula told me yesterday there seems to be more opportunity for it there than in Scandinavia at the moment; I hope to interview him more on that point. Earlier this week I videotaped an interview with Mary Maddock in Ireland. I came away thinking she is a latter-day Rosa Parks or Angela Davis.

    I’ve had conversations with Sandy Steingard, who is here at the conference. I think I can fairly say that she is excitedly, courageously, embracing ways of thinking and approaches to this work that had not been obvious to her. She has told me she will write about her ongoing process, and I believe that for those who will entertain the conversation that ensues the rewards will be rich.

    All of which is to say; we have a lot to look forward to. I think the fact that there has been a (largely) civil conversation about difficult topics on this website is merely a warmup for things to come. This is where my attention is directed at the moment. I think that these current conversations will fade into the rear-view when we really get up to speed.

    And I honestly believe that, if we can manage to remain civil, we may be surprised at who we find is riding with us.

    Open Dialogue is, as much as anything, an exploration of reality as something that arises as part of a social fabric. I like to think that everybody who contributes to the website in these early days is weaving it with us. I’ve had conversations with Dr. Moffic that leads me to believe he is every bit as much a seeker after new knowledge and new truths as anyone here. Call me pollyanna (or worse, as I’m sure some will), but I like to think everyone has a place on the bus.

  • I think one of the fundamental criteria for success on this website is whether the various ideas, beliefs, sets of facts, organizing principles, etc., that are explored or embraced here lead to people connecting in positive, productive, life-affirming and life-fulfilling ways.
    Without casting aspersions it might be said that, here, the tenets of the disease “model” of mental illness are being questioned; that is, that even if we assume that those who pursued it as an explanatory model meant well, it has not proven to result in “the greatest good for the greatest number” and as such is subject to review.
    So, then, of the remaining “models” (stress, trauma, social construct, spiritual emergence, alien abduction, “stuff happens,” “welcome to monkey house”) available to us, which produces the greatest good for the greatest number?
    I think it might reasonably be said that no one model answers every question at all times for all people. It really comes down to have a flexibility of thought, perception, etc., and being open to how various perspectives “feel” or “work” at a given time. By “work” I mean, does looking at things this way get me closer or further from that which might be called a fulfilled and fulfilling life? Does it bind me well to others, or further separate me from them? Does it truly help me to relate to myself, others, the world and the unfolding future in adaptive, integrative ways?
    Toward that end, the opportunity to participate in discussing all the various ways and means that are discussed on this site is a tremendous opportunity and privilege. The opportunity to connect with like-minded or at least similarly-intended people can lead to all kinds of good things.

    Not least among them: a date.

  • Time for a little disclosure. When Dr. Shipko sent me this post, there was no title, so I just lifted the “Psychiatry as a Mixed Blessing” meme from the text as a temporary one, expecting we would change it. When I told him, he laughed and – well, I won’t speak for him, but he said something more aligned with Duane’s sentiment, if not even more extreme. But he said to go with it. I said the title alone would probably draw some fire. But he was on the way to the gym and clearly one who enjoys some heat.
    I think we’re going to enjoy the posts he’s working on.

  • Fair questions. Speaking for myself; what Dr. Healy writes about the pitfalls of research in general and SSRIs specifically he does with a vigor and inciveness that earns my respect. It’s important stuff. He also puts out a steady stream of material. Like you, I don’t agree with every position he takes, but I have respect for his energy around the interests we do share. And even where we may not agree, his output has certainly stimulated a lot of conversation here. If we can all assume each other to be of good faith, then we can assume that more conversation will be better than less, in which case Dr. Healy’s output is helpful in keeping the conversation percolating.
    That said, I will admit to struggling with this piece. I have a sense of what it is getting at, especially after gathering the comments on it from his twitter posts which I put on the front page link. As these comments only appear if it is a featured blog, I ran it as one, even though I was concerned that the piece itself is too opaque. I thought, in the end, it was worth the experiment to see what the comments would be like.
    As far as that goes, I’m gratified so far. Your comment is entirely reasonable, and apt. I feel compelled to consider and respond to it. I do stand by my belief that his contributions are an important part of what we do here. I do wish he were available to engage with our readers. (Though, I hope you will consider it fair of me to say that it is reasonable to assume he has good reason to be wary, given the evidence so far of the reception he might expect). I will say by way of support for him that he was very vocal about not wanting any criticisms of him to be removed, which we respected except for when the expressions crossed the line into something like obscenity.
    So here it is; when you’re engaged in a struggle in which you are part if a relative minority, you don’t have the luxury of picking and choosing your allies. At the least it’s risky to cannibalize from within. I may not agree with everything Dr, Healy espouses; I would welcome the opportunity to know more about his positions where I don’t. And some of his writings are stronger than others. But I’m grateful for his willingness to put himself on the line.

    I guess I was interesting in seeing where the conversation might go. I have declined to post some pieces by less prominent people when the pieces were similarly oblique. Is this because, given that he is a known figure, I figured I could at least count on people to go the extra mile to parse it? I don’t know; perhaps. I think I was interested in a change of pace, at least; a certain amount of expressionism if not surrealism perhaps isn’t out of place in a discussion that includes altered states of consciousness. A touch of poetry, perhaps.

    In fact; as it’s four am and I’ve been up for hours, following the impulsive and unusual ingestion of an “espresso-rubbed steak” at a favorite restaurant, I will indulge as well in wondering whether we would do well to take this thought further and invite some actual poetry. It might be an appropriate way to round out some of what we’re doing here.

    I’ve been thinking recently about the thread in bioethics that asks physicians to not just treat the body, as if the body is separate from the person, but to understand that the body is inextricable from the person and the person within the context of the person’s sense of their own story. I’ve attended lectures in which this theme was pursued in relation to such conditions as cancer, etc., and physicians were exhorted to join with the patient’s sense of story in pursuing treatment; that it would in fact be unethiical not to. And it strikes me how often absent this sense appears to be from psychiatry, a specialty where it would seem to be (and perhaps once was) more intrinsic to it.

    I was thinking to go seek out some writers on bioethics to blog for us, or at least to find some articles to point to that write on these matters from a bioethics point of view. And, if that includes finding ways to join with a person’s story, I think there may be a particular nexus of biology and story that finds its best expression in poetry. It was in this spirit that I was curious to see where this post might lead the conversation.

  • Yes. I’m still fidgeting with the details of exporting and uploading video, but when I do we intend to provide regular updates on the process, material and philosophical, of the Soteria Vermont project. (Along with many other things and people we honor and would like to get a wider and larger audience for. We believe that high-quality video is one way to do this, and are gearing up to provide it. (My first career was in film, so I like to think I can create images that will showcase the wonderful people that this movement has produced in a manner that befits their contributions.
    In the interview that Steven has given me so far you will see (which, god and this cafe’s internet connection willing will be soon) what a well-spoken, well-informed, well-prepared man Steven is for this project. He also speaks with excitement of Vermont’s support; the state’s legislation mandating non-pharmacological alternatives for those who choose it, their funding of the Soteria project at $1 million per year, and the general sense of excitement he feels for this opportunity.
    At the same time, being on the frontline of anything is bound to be hard and he will need all of our support. I am very pleased and proud to be able to provide some in the form of giving him a forum in which others might be inspired to follow Vermont’s lead.
    A few years ago it seemed that the question was “will there ever be another Soteria?” Now, we will get to follow the progress of a second one, the first in the contiguous 50, and see if it inspires the other 48 to follow. We intend to glean and distribute as much insight as possible in the hope that it might.

  • In fact, I have done a video interview with him that I will be getting up on the site (in pieces) as soon as possible. It would be there now if I could work out the workflow from Final Cut to YouTube. He is brilliant and we will be documenting his progress with Soteria via blogging and video; I am sure it will be riveting. I am extremely excited about it.

  • Thanks for the thought.

    I think, though, that for a full discussion of what are supposed to be the roots of the problems variously called mental illness, etc., we can’t leave out any of the areas of human life that have historically defined and/or ameliorated them. Clergy used to be the people we turned to in sorting out life’s challenges and distresses: I think it could be argued that religion’s loss has been psychiatry (and late-night television)’s gain. Care of the soul has moved from the church to the marketplace. Some people feel that is a net positive. I think that, at the very least, there is much to discuss about that.

    It is true that people will disagree about what the “true” religion is, or the “truth” of any one religion. It’s a certainty that almost any declarative statements made about anything pertaining to faith with rile either sympathy or enmity. But that “religion” or “spirituality” or “practice” is one of the historical if not present or future paths to healing rifts within the self and between the self and others is hard to ignore while still having a full discussion of the options.

    I think the separation of church and state has had some unintended consequences in the secularization of human life, and the consequent loss of institutions that many have found helpful and productive, even given the occasional crusade or inquisition. I might argue that even crusades or inquisitions are not limited to the religious, and can be just as harmful no matter who wages them or what interest they serve.

    I guess the main thing, for me, is as much dialogue (as opposed to monologue) as possible. Any silencing of a topic is a step away from dialogue and toward monologue. I suppose some will find this ironic, given that we have been accused on occasion of silencing people on this website. We would say that we have only done that when we felt that certain trains of thought have had the effect of silencing other ones, and we sought balance.

    I’d like to add that it should not be assumed that a blogger represents the views of the website. We had a discussion, as a matter of fact, about whether to allow bloggers to turn the comment section on or off. We decided that this would only worsen the situation of bloggers appearing to be monolithic or authoritarian. We thought that, if a blogger can’t engage with readers, then this might not be the place for them to blog.

    This is, of course, with the hope and necessity that we can keep the conversation at least civil.

    I think that there is much in this particular blog that could be discussed, and/or argued with. Whether all the statements in it are in fact true, historically or otherwise, is perfectly up for discussion. Some would argue with the characterization of Freud, some with the role of shamans, psychiatrists, clergy, or therapists and how they do what they do. Whether “therapist”, “shaman”, “prophet”, or “scientist” have overlapping or congruent properties is a potentially ripe conversation, though, so I’m happy for the extent to which this blog might provoke it.

    As long as people manage to respect alternate views. It’s all about more dialogue, not less.

  • Because when I posted it I realized I had neglected to put in the graphics that the author intended. Then, while working at the formatting, Bob and I agreed that we really wanted to invite the writer to blog for us because the piece is so good. So we’re just waiting until I can get all the pieces necessary for that in place.
    But you’re right; it’s an excellent piece that we’re excited to have up.

  • I don’t think any of this is necessarily about absolving anyone of anything. But if it is true that these meds cause SOMETHING to happen, then even if it is true that for most people that SOMETHING turns out well (even if it is only for a short time, which is another matter entirely), and it is also possible that that SOMETHING could statistically be expected to lead to SOME people having a different reaction that turns out badly for themselves or others, then it seems at least a worthwhile conversation to have. Is it worth the “benefit,” knowing that some occasional shooting sprees might occur? If so, who chooses? Because “informed consent” is perhaps an insufficient model if I’m told that, while I might briefly benefit, it could be at the cost of someone else suffering. That’s what we call a “moral hazard.”
    At the very least, the effects of these medications need to be considered in a broader context. Either they have no effect, which is one thing, or they have some effect, which is another. Psychiatry has slipped by with the easy “chemical imbalance” rubric. Even if it’s true that the meds can be helpful, I believe, they could only be helpful with a consummate mindfulness as to their effects; not a hammer-and-nail situation. Perhaps if that were they way there were used, more benefit would be derived and more “adverse events” would be avoided.
    I am not arguing anything, here, for or against the use of meds. All I’m saying that there is more to talk about, and it’s much more interesting, than merely a to-and-fro about whether psych meds can or cannot induce specific behaviors. This is a specious, simplistic, and unsatisfying conversation. As with everything; it’s more complicated than that. My motto: isn’t this interesting?

  • We do not know whether Holmes was on psychiatric meds. Which is why I’ve more or less ignored putting up any news on the matter, other than the fact that he was under a psychiatrist’s care. It would be difficult to imagine that he would not be medicated, as most psychiatrists consider it to be an exposure to liability NOT to medicate someone under their care, but even so it is rash to assume this was the case.
    Nevertheless, given that the overwhelming preponderance of such events have in fact involved people on psych meds (in fact every one for which I have been able to find any information on the matter, which I have spent time doing), it seems it’s hard not to consider that at the very least the meds don’t seem to have helped much.

  • – When we force ourselves to smile, we feel a little better.
    – When we stand straight up rather than slouch, we feel a little better.
    – When we sip tea, get a massage, or hum a tune we tend to relax a little.
    – When we are ill, we might feel a little more hopeless or defeated.
    – When we breathe air that has a higher percentage of carbon dioxide, we tend to panic sooner, attributing the sensations of panic to anything from heart trouble to unidentified malevolent forces.
    – There are many pathogens which specifically cause behavior change in order to increase their efficient spread via host organisms, from fungi that cause ants to crawl to the top of grass leaves, clamp on with their jaws and die so the fungus can sprout a fruiting body from the ant’s head, to rabies which spreads by getting mammals to go on ferocious attacks at the same time that the virus is propagating in the animal’s saliva.
    – So it’s perfectly plausible that physical causes and conditions influence states of being and consequential or concomitant cognitive structures, schemata, etc. I don’t think there is any question that this is the case. It’s a question of what conclusions can be drawn from this. And the evidence seems to suggest that SSRIs influence a state of being that may lead to many things, perhaps depending on states of being or foundational beliefs of the person taking them. Perhaps, for some, an increased sense of motivation for momentum leads to something that is experienced as “less depressed.” This is not necessarily exclusive of the possibility that for others this augmentation results in aggression toward self or others. The question is: if we assume this is true, is it worth it?

  • Yes; as with so many studies that fail to prove their hypotheses; the conclusion is “more study is needed” rather than “oops.” It goes well with the item above; that implausible hypotheses are more prone to false positives. It sort of goes with one of Skinner’s findings: that intermittent reinforcement can lead to persistent, even “superstitious” behavior in animals. Pigeons, for instance, who once they had made an association between a rocking-stepping motion and the intermittent (but random) reinforcements they had received, persisted in rocking and stepping forever expecting to get more.

  • I think that it need not be about whether the APA and Big Pharma allow NAMI’s members to reject psychiatric labels. It can be about whether the alternatives are sufficiently and vigorously explored, that pharma begins to pale. It’s known (I’d have to find the citation, but it’s out there) that 80% of people would opt not to use drugs given the option. The challenge is to make sure they know the option, and have the opportunity to use it.
    I don’t think this is really a new problem, or one that will go away. There have always been “miracle cures,” “snake oil,” etc. Always. And there always will be, because life is challenging and sometimes scary, and things happen to people that make even that worse than it has to be, and people will always want the comfort of certainty, even when it’s patently illusory.
    But we can keep the conversation going; and I’ve found that as the picture gets fuller, the less people leap to the temptation of miracle cures. Throughout history there have been people who offered them; and those people generally got money and fame for a while, but they hurt people. And there have always also been people who faced the uncertainty of life quietly, without glory or reward, but they got to experience the pleasure of being with people at the moment that the clouds broke and life began to seem possible.
    I like to think that this website is about learning and sharing in that; it’s a place where we can compare notes on how to do that.

  • And here is what Bob wrote in Psychology Today:

    A Rorschach Test for Psych Meds
    Off Meds and Enjoying Robust Recovery: Reimagining What Is Possible
    Published on November 2, 2011 by Robert Whitaker in Mad in America
    On October 23, the New York Times ran a very nice feature story about a Los Angeles woman, Keris Myrick, who, even though she has a diagnosis of schizoaffective disorder and obsessive-compulsive disorder, thrives today as CEO of Project Return Peer Support Network. Today, the mental health community regularly speaks of promoting “recovery,” and her inspiring story serves as an example of how robust that recovery may be. Indeed, when you meet Keris, you are struck at once by her extraordinary grace, warmth, and intelligence.

    However, the story didn’t clearly detail the role of medications in her life, and as Keris can attest, the published article seems to serve as something of a Rorschach test for readers. Those inclined to think of medications as essential to recovery may read the article and conclude that must be true in her case. Those who think of psychiatric medications in a more critical light may read the story and conclude that she probably uses the medication very infrequently. I ran into Keris last weekend, where I asked about this Rorschach aspect of the story, and she thought it would be important to publicly clear up the details of her medication use, since she has now been presented, in this very visible newspaper venue, as a model for what is possible.

    In the Times story, her treatment regimen is said to consist of a “combination of medication as needed and personal supports, including an intuitive pet dog, the occasional weekend stay at a luxury hotel — and, not least, a strong alliance with a local psychiatrist.” Then, a little further along in the story, she is said to have started on her journey to recovery in 2006, when her psychiatrist got her to “try certain antipsychosis medications.” Finally, readers learn that researchers in southern California are studying a small number of people with a diagnosis of schizophrenia or schizoaffective disorder who are thriving, with Keri one of those in the study, and that the researchers state that most in the study, like Keris, “adhere to a medication regimen.”

    Add those bits of information together, and some readers conclude that Keris, in one manner or another, must take antipsychotics — and perhaps other psychiatric medications as well — on a regular basis. Keris told me that many doctors and other readers called her psychiatrist, asking for information on the specific drugs, or drug combination, that she takes. However, other readers focus on the line that she takes “medication as needed,” and concluded that she probably takes them fairly infrequently.

    Here is the detailed story of Keris’s use of psychiatric medications. From 2000 to 2006, she regularly suffered from thoughts of suicide and hallucinations, and it was toward the end of that time that her psychiatrist, Timothy Pylko, convinced her to take antipsychotic medications on a daily basis. She did so for about six months, but it has been at least five years since she used antipsychotics or any other psychiatric medication in that regular way.

    Once she stopped taking psychiatric medications daily, she began to use them on an as-needed basis “when all of the [non-drug] techniques I usually use do not work and I am truly unable to work, hang out with my friends or participate in life.” For a time, she found that she would need to take an antipsychotic on the “very rare occasions” when “the voices are very distracting and any kind of stimuli (light, noise and touch) cannot be tolerated.” She would take the antipsychotic for two weeks or so, “while also engaging as much as possible in life.”

    However, she found that even this occasional use of an antipsychotic had its drawbacks. “Truly, what I have found in returning to work is that this approach is not as successful, as the meds usually make me too tired and ‘cognitively slow’ to work effectively. It has been a while since I used this approach, and the last time I did, I more than likely took time off while on the meds until the side effects diminished, and then I came back to work and tapered off.” She has not used any antipsychotic medication for more than a year now.

    She still does use an anti-anxiety medication on “rare occasions.” She’ll turn to this class of drugs when “I have so much anxiety that I am incessantly pacing, cannot physically keep still and the type of OCD that I have kicks into overdrive.” She says such moments are now “incredibly rare,” and that when she does take an anti-anxiety med, she does so “mainly at night.”

    Keris is fortunate to have a psychiatrist who has supported her use of medications in this way, on an as-needed basis for those rare occasions today when her anxiety or her voices flare up to intolerable levels. She consults with him on the dosage and for how long to take the drug, and “he provides instructions on how to taper [from the drug] as well.” As a result, she has a therapeutic relationship with her psychiatrist that works very well and is an essential part of her recovery.

    The reason that is it important to know this aspect of Keris’s story is that, in her use of medications on “rare” occasions, she is not following the model of “medication adherence” that is usually promoted to the public-and to patients-as essential and necessary. If you look at her story of recovery, hers is one of using antipsychotics on a daily basis for a relatively short period of time, and then developing “personal supports” and finding meaningful work as a foundation for a more lasting wellness. And once she stopped taking psychiatric medications on a daily basis, she used them only as temporary aids when her symptoms flared up. In essence, she was “non-compliant” with the usual model of drug treatment for someone with a schizoaffective diagnosis, and today, given her very infrequent use of any psychiatric medications, she would be best described as “off meds.”

    There may be many paths to robust recovery, but what is clear from the research literature — and from stories like Keris’s — is that one possible path involves being “off meds,” or using them in the selective, occasional manner that she does. In Martin Harrow’s 15-year study of schizophrenia patients and patients with milder psychotic disorders, the off-med patients had much better long-term outcomes, and for those with milder psychotic disorders, those who got off psychiatric medications — as a group — had good long-term outcomes.

    It is refreshing to see the New York Times publish Keris’s story, for it presents a vision of recovery that our society needs to know and embrace. We can read such stories and then ask, okay, so what do we, as a society, need to do to help make such recovery commonplace? But as we ask ourselves that question, it is important to know the details of Keris’s story in terms of her medication use, because such clarity can help us reconceptualize what is possible. Her story, together with a close look at what the research literature tells us about long-term outcomes, can ultimately help us imagine a radically different paradigm of care.

  • Here is a possible response, in Keris’ words, from a Project Return Blog (copied from Beyond Meds).

    The New York Times and all that…
    Posted on November 3, 2011 by Keris Jän Myrick, M.B.A., Ph.D.c

    It has been indeed an honor to have my story fea­tured on the front pages of the New York Times. It is rare that peo­ple with a men­tal health diag­no­sis, fea­tured on the front of any news­pa­per, are seen as recov­er­ing, com­pe­tent and active cit­i­zens in soci­ety. Add the many neg­a­tive stereo­types asso­ci­ated with being African-American in the United States and indeed the front page story might look dras­ti­cally different.
    What is most impor­tant for me in shar­ing my story of recov­ery pub­licly has in some ways been fil­tered through the lens of how men­tal health treat­ment and paths to recov­ery are gen­er­ally con­cep­tu­al­ized. In our society’s world­view, the path to recov­ery includes med­ica­tion. The ter­mi­nol­ogy used is “adher­ence to med­ica­tion” and recov­ery can­not hap­pen with­out it. How­ever, we are now find­ing that there are many things that con­tribute to one’s recov­ery inclu­sive or exclu­sive of medication.
    When Bene­dict Carey approached me to be involved in the series of pro­files (Lives Restored, Liv­ing with Men­tal Ill­ness), I was imme­di­ately attracted to his approach; high­light­ing the many resources, skills, tech­niques, sup­ports and cop­ing mech­a­nisms each indi­vid­ual dis­cov­ers and uses to lead mean­ing­ful and full lives despite hav­ing a diag­no­sis of ‘severe men­tal ill­ness’. The series focuses on every­thing that works for a per­son in their recov­ery by shin­ing the light on the many, many things that rarely receive atten­tion and dimin­ish­ing the focus on the role of med­ica­tion. In my pro­file for the series, the word med­ica­tion is used only 4 times in a word count for the entire story of 2, 771.
    I am a per­son who val­ues what works for each indi­vid­ual in their recov­ery, from med­ica­tions, to yoga, to walk­ing. We are all dif­fer­ent! I am not anti-medication, I am not pro-medication. What I am is pro-education and choice. I believe each per­son should have as much infor­ma­tion as pos­si­ble so they can make the deci­sions with their treat­ment team, fam­i­lies, and other sup­port­ers that will help them real­ize the mean­ing­ful lives of their dreams.
    I find it very inter­est­ing that some of the sum­maries of the New York Times arti­cle, state that my recov­ery was due to “adher­ence to med­ica­tion”. This is not what the arti­cle said nor is it the pri­mary focus of the piece. I started to won­der if peo­ple were miss­ing the point – that recov­ery hap­pens for me (and I have heard for oth­ers as well) due to a mul­ti­tude of fac­tors. The New York Times fea­ture clearly states that work has indeed been my treat­ment of choice. Also, fam­ily sup­port, a great dog, a won­der­ful psy­chi­a­trist with whom I have a strong ther­a­peu­tic rela­tion­ship, and other tech­niques, inclu­sive of med­ica­tions on occa­sion, are all the things that con­tribute to my recov­ery and are the high­light of this profile.
    Jour­nal­ist Robert Whitaker, author of Anatomy of an Epi­demic, asked me if I would share with him more detailed infor­ma­tion about the use of med­ica­tion in my life. He too was unsure of the role med­ica­tion played in my recov­ery. Because of its min­i­mal focus on med­ica­tion, the arti­cle may have unin­ten­tion­ally ampli­fied the issue. What is impor­tant in my story is this: By work­ing in con­junc­tion with my doc­tor, and using all the tools avail­able, I have found the com­bi­na­tion of inter­ven­tions that allow me to lead the best pos­si­ble life and be engaged in the world in a way that I could never have done in the past. Each per­son is dif­fer­ent. My jour­ney is not a pre­scrip­tion, but a very per­sonal story of recovery.

  • I have spoken with Keris and Bob about it; they are both excited and hopeful. Keris cautioned me that, even as president, she is not all-powerful, but she spoke of the many positive and progressive things she has observed, such as people wanting Bob to speak at NAMI national, NAMI chapters sending people to Finland to learn about Open Dialogue, and she feels she will be in a position to encourage and promote such energy.
    Bob thinks that this is a “sea change” and a potential “paradigm shift.” He will be writing a blog about it shortly.

  • I think that it is not an issue of whether a drug causes any one person to do any one thing. But there does seem to be solid evidence that SSRIs cause an increased rate of violence, whether toward self or others. It is not a 1:1 rate; it is only an increase. But the question is: if the drug is causing a demonstrable increase in these kinds of behaviors, then what other increased behaviors are there that can be construed as being connected that have not even been accounted for yet? It may well be that the “antidepressant” effect, if there is one, could come at the cost of these increased behaviors, in which case it becomes an utilitarian analysis of whether the greater benefit to the greater benefit justifies these risks.
    In fact, if one looks at the research on serotonin levels in primates, such as that by Sapolsky (and leaving aside for a moment the debate about serotonin specificity in relation to depression), it seems that serotonin levels correlate with both social status and aggression in primates.
    This is a very simplistic presentation, of course, but I think the data are there with which to make an argument that would go; artificially jiggering serotonin levels might provide benefit to some and risk to others.
    Of course, personal responsibility is always a part of things, but how that plays out in any individual is also complex. If we know that there is the risk, as there seems to be (according to the data) that some will get into trouble, then is it really fair to hold those who happen to be the ones who experience these predicted, if not precisely predictable, outcomes? Do we not at the very least, on behalf of those who may have benefitted, owe something to those who incur the cost? If there is, in fact, a greater social good to the use of these drugs, is there not some debt to those who randomly experience the downside?
    This is leaving aside completely the question of whether the antidepressants do, in fact, deliver the benefit that had been promised. That is another conversation.
    But if, as the data seem to suggest, some small percentage are experiencing a high level of aggressive impulses, as manifested in suicide or murder, and if, as might be argued, perhaps those in whom that general trend is reflective of a tendency that may have lay dormant in them that they had kept under control and so, perhaps, their failure to continue to keep that impulse under control can still be thought of as their responsibility, then at the very least it is worth considering: what smaller effects might be manifesting in a larger number of people? Competitiveness? Ambition? Drive? Achievement? Lack of Netiquette? Shoplifting? Gambling? Publication Bias?
    Getting too tightly focussed on the worst outcomes, which in any one case can be (and – so far – is) dismissed as being demonstrably directly connected to the medication, overlooks the larger trends that come with a choice that has become such a fact of life in our society.
    Substances do affect behavior. But the Vaillant study – of 600 people followed over 40 years – among others, found that social mores and archetypes play a larger role in peoples’ relationship to addiction and to substances than perhaps any other factor. So being aware not only of how substances affect people, but of how the ways that we think about substances affects the that way substances affect people, is another aspect of why the conversation that occurs here is so potentially important and – in fact – vital.
    Because it’s being honest about all this that will empower people to relate to these substances in a meaningful and adaptive way – whether it is to use them wisely or to stop using them safely. The thing that makes the substances dangerous is shutting down the conversation about them prematurely, whether the intent is to induce people to use them or to stop using them.

  • Here we have an interesting conundrum, worth exploring:
    Much of what drives the conversation in the scientific and medical communities is what gets published in journals. And mostly that is a handful of “peer”-reviewed journals that are well-regarded. These, of course, are the ones that ask for subscriptions. Individuals can buy them, of course, but it does get expensive.
    I can get access to many of them, but not all, because I am currently a student. I always do when I can, and I try to at least get a sense that the abstract can be supported by the research.
    It may be that if and when this website has some funding and/or cash flow (currently it does not, as should be obvious) we may buy subscriptions to journals; but it would be prohibitive to get subscriptions to all the ones I look at. Currently, most mornings, I look at the “online first” or “early view” or “in press” articles in about 70 journals. I also do a pubmed search that returns about 200 articles on an average morning, which I week through to find articles in journals that aren’t on my list of 70 yet. I do this because many interesting things DON’T make it into the more mainstream journals, precisely because they are “interesting.” Also because sometimes things pop up in journals that are not immediately obvious as ones that would have articles that are of interest to us; journals on obstetrics & gynecology, for instance, which in retrospect would obviously have articles on the issues with psychotropics, but I might not have thought to subscribe to them.
    So this means that it is inevitable that there will be articles from journals that neither we nor readers are likely to have subscriptions to. Does this mean we should not post them?
    I don’t think so. I’m trying to provide a “running banner,” like on the bottom of the screen on CNN, that gives you a taste of what’s being talked about, and how that conversation is going. Sometimes I put things up knowing it will make people angry (or hoping so, because I was) and sometimes I put things up because it just seems interesting and enlightening that someone thought to ask a particular question. Often the articles are things that people would be justified in saying “well, duh” to; things that either SEEM intuitively obvious, or seem like they should just be accepted facts, or that this community (whatever that means) has known for a long time.
    Still, it makes a difference when someone validates something that seems obvious in a hopefully rigorous scientific way. It helps take it out of the realm of folk-wisdom or received wisdom, and makes it justified to say “here’s how we know this is actually true, rather than presumed to be true.”
    So I think there’s some value in pointing out the existence of studies, even if access is not readily available. At least it opens some windows on the ivory tower and the industry; and anybody is free to find a door if they want to. Most of these journals are available in a medical library near you.
    Would it be better not to do this just because some people may not have access, or the access might be difficult? I don’t think so. I think that would be complacent. Whenever anyone tries to argue any of the points made on this website with anyone, especially an academic or a doctor, but really anyone; a journalist, a family member, etc; they are likely to be asked “how do you know that” or “where is the evidence?” I’m trying to provide people with the opportunity to say “it’s in this journal, and it was just published this week, so shut up already.”
    What I cannot provide in access, I try to provide in volume. I like to think that the 400 articles I’ve posted since starting this provide something of an evidence base. Most of the articles in “Mad in America” or “Anatomy of an Epidemic” are similarly unavailable (except through fair-use public services such as the PsychRights website – all praise to Jim Gottstein, as always and forever). I’m trying to continue that into research that is coming out today; I hope the tide of it can become convincing in its own right by-and-by. I think it’s good to know that people are at least looking at non-pharmacologic approaches, and something about what they’re finding, or that they are actually finding contraindications in the pharma research. Often I have found articles that employ twisted logic in the abstracts to gloss over the seemingly obvious finding that the medication did not work. I think it MAY be unconscious when that occurs – a paradigm is a very, very difficult thing to shake loose of – but I’ve been seeing this (what seems like nonsense) for a long time now. When I was working in research a realized at some point that it all looked like word salad and it seemed like article titles were being put together out of refrigerator magnets (in fact I marketed a set of “Diagnostic Refrigerator Magnets” for a while; I have some left, if anyone’s curious.)
    So it pleases me now to be able to find this stuff and put it up somewhere to be seen for what it is, or seems to be, to me. For the most part it’s been very gratifying for me to see the discussions about the articles. I like putting them up for that.
    This is, of course, why it is sometimes disheartening to see the discussion turn sour. I think there are lots of interesting things to talk about about these studies – the “bad” ones as well as the “good” ones – without resorting to derisiveness. Clearly, there is much to be derided – but derision is not new nor particularly enlightening or actually productive. Nor, in the end, is it interesting. It just stops a conversation cold that might otherwise have resulted in people feeling, armed with new ideas, new frameworks, new paradigms, new – well – new knowledge, that they might actually be in a position to make something new happen in the world.
    And that is happening. Monoliths are falling. Change is happening, and it is gathering speed. I think we have an opportunity on this website to coalesce a conversation – the one that started with Bob’s impassioned as well as informed and thoughtful books – into a community that is empowered to be part of making that change happen.
    I think there are lots of corners of this conversation that can truly be part of the solution. The books, and the information from the WHO studies, Harrow studies, Soteria, Gheel, Open Dialogue, etc., all point toward something. What it is waits to be more fully elaborated. Much is known but there always more to know. I personally think that the intersection of mindfulness practice and intentional community – not unlike the sorts of things societies have cultivated for millenia to ensure the safe passage of children into productive adulthood – is the living core of the conversation that springs from all the above-mentioned modalities. But there is lots and lots of conversation to be had in fleshing all this out. And having this conversation is, in fact, perhaps arguably, itself the answer to the problem.
    So while I would love to provide free access to every article I mention, I still think it’s valuable to just point at them and say “here’s what I’m talking about.” I don’t presume to have all the answers, nor even all the information.
    All I can claim to have is my interest, my attention, and the fact that I care; because I’ve seen enough of the things that I don’t want to see happen in the world. I’ve seen enough of people dying, or of being needlessly lost while still alive. That’s why I’m doing this. No one person loses a mind; we all lose it together.
    So there, I’ve gone and explored this conundrum. It’s Friday. I indulged.

  • My understanding is that Freud said there is neurosis (which are the result of inner conflicts and thus accessible to his method) and psychosis (which involved some sort of disordered relationship with the world, and he did not consider accessible to his method but rather hoped someday medicine would find a way to understand) and something in-between (which he referred to as “borderline”). I believe there was actually a split between the American psychoanalysts and Freud which was provoked (at least in part) by the Americans’ desire to gain the credibility that medical “science” could give them.

  • “Although it is well established that physical and sexual abuse, emotional neglect, and other severe forms of maltreatment in childhood are associated with mental illness, this is one of the first studies to show a link between non-abusive physical punishment and several different types of mental disorders, says epidemiologist Tracie Afifi, lead author of the study in today’s Pediatrics.” (Found on HuffPost)
    I think the usual correlation-causation question has to be asked. It may be that it’s not the punishment itself, but the environment in which that is believed to be the best, or at least an expedient, way to do things that really causes to problems down the road. I might even argue that, if those conditions exist; an authoritarian, harsh, and inherently unsafe environment, it doesn’t matter whether or not the physical punishment occurs, and the small percent of problems attributable to it are just the tip of the iceberg. It can even be argued, and I believe there is research to support this, that the presence of physical punishment can serve as a trigger for a person to objectively understand that they need to separate from a problematic situation, where otherwise people developing under these kind of harsh conditions are challenged to develop internalized self-awareness and self-determination despite the environment rather than as a result of it. Those who don’t manage this quite difficult task are left more challenged than they might have had they been able to objectively identify conditions that justify or impel them to develop autonomy.

  • I agree that Jonah’s posts are extremely valuable. I actually don’t remember or particularly care whether the post in question was Jonah’s or not. I’m sure it was not pulled for being critical; it was for being derisive in a way that it felt would make it difficult for following readers to comment.
    And I agree that “unscientific critiques” are valuable. In fact, more; they are essential. Because all science can meaningfully do is answer the question of whether “if A, then B”
    is true. If the study is well designed, all you can say is that one fact is connected to one other fact in some significant way. I object to trashing studies completely only because these associations, if true, mean SOMETHING; we are not obliged, though, to take the authors’ opinion of what it means. Their interpretation could be owing to what they’ve been told, lead to believe, etc. It could even be that the actual authors don’t believe the interpretation. Sometimes a study’s results could have been interpreted an entirely different way, but the limits of the study meant that comment in that direction was simply not supported within that particular study. For that, the best the authors can do is suggest that a future study take it in that direction.
    So putting studies up here is not an empty exercise. It can potentially be part of getting conversation going where people can say “did you think of looking at it this way?” I have gotten emails from psychiatrists who are following these studies, and are being influenced by them. There’s something to the “breaking news” quality, even if it’s stuff that is old news or, to some, not news at all, that impacts on people in a different way. So it seems worth doing and perhaps counterproductive to just reflexively deride a study. There’s usually SOMETHING worth noticing; not to accept it as gospel truth, but simply to ask “what, if that’s true, might be implied?”
    At that point it’s open season, and everybody and anybody is entitled to weigh in. I don’t think any of these studies are well examined unless they’re looked at through sociological, philosophical, theosophical, Marxist, and/or antidisestablishmentarian frameworks. It is possible that the authors are the LEAST able to comment, at times, being well established in a particular view.
    But I still don’t think that means its productive to impugn their motives or integrity. It’s better, I think, to consistently offer alternate interpretations as a means of changing the paradigm. It seems slower than calling someone names. But it is what actually produces results, because it preserves your own credibility along with theirs.
    I do believe the paradigm is shifting; it never will completely, if only because “medical model” thinking has been with us since trepannation, “humors,” snake-oils and tonics. But there are large scale trends now occurring that I’d all but given up on years ago. In fact, within the next few days, we will be releasing some news on this website that will mark, we believe, the beginning of a true paradigm shift that we never thought we would see.
    Stay tuned.

  • Yes. “Torn apart” was a bad choice of phrase. Studies should be “torn apart.” Then, the pieces should be looked at, for consideration of whatever honest intent there may have been and valid info obtained, as well as for bias, blindness, invalidity, etc. But simply trashing them reflexively from a single point of view helps nothing and nobody.

  • I tried a few variations of the headline. “Physical Punishment” seemed like it could be about torture of adults. “Spanking” was shorthand for physical punishment of children, and I figured it was an excusable one since the summary spells it out a little more as “physical punushment” immediately below. I tried a version with the whole list, but it just didn’t feel right to put it in peoples’ faces on the front page. I figured people who were interested would get the whole list as soon as they clicked on the link.
    It’s interesting trying to get everything into a few words.

  • I was quoting the article. Using quotes is delicate, as it makes it seem (usually rightly) that I’m questioning the word or phrase’s use. I don’t like to do that too much, and try just to let articles stand or fall on their own merits upon scrutiny. As, in this case; yours.
    But after you pointed it out I realized that I did feel better putting it in quotes. “Overmedicated” could mean “too much” or “more people than should have been,” so I was allowing that because of that vagueness I would just use the word “in situ,” as it were.
    But after your comment I was less comfortable with that. It’s reasonable to ask whether “over” might just as well be “ever.”
    Mainly I put the article up so people would know the event was happening in case they want to do anything about it.

  • We are working to come up with a new approach to moderating the discussions. I have been holding the role while waiting for others who have specific interest and experience to become available. Thankfully, this is happening now.
    I truly do appreciate all the contributions that people make to the site. Even when they cross over into the more “expressive” range, I understand, appreciate, and often sympathize with where they are coming from. In my work I have taken pride in weathering and even championing peoples’ anger: I know that this is always coming from something real and often what is necessary to drive change – if only it can be directed somewhere or in some way that a change will actually make a desired difference.
    We are working to come up with more specific and specified guidelines. This may not always help – it seems, as pointed out above, that there’s always an “I know it when I see it” aspect to these things. That, and because we really try to hold back on the moderating, I don’t really know how it will happen in a way that always and everywhere is consistent. We’re dealing with complex thoughts, feelings, and interactions; I often squint and puzzle at comments, trying to figure out whether they are impugning the person or the thought.
    This website is in partial reaction to the fact that many peoples’ lines have been crossed; that at times in their lives when they might have benefitted from understanding, they didn’t get it, and got “labeled” instead. The people doing it may have been well intended, and may have been misinformed, but they nevertheless did something other than what might have helped.
    And so it is in a certain way unfair that now we’re saying that there is a line, and that it should not be crossed in the other direction. But that is what seems necessary in order to have the discussions we hope to have here.
    As Corinna quoted Bucky Fuller; “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” To the extent this is true here, it may be futile to engage “psychiatry,” if “psychiatry” is viewed as the only game in town and sitting at the head of the table. As such, there is a lot of energy on this site and elsewhere directed toward creating something new (or rediscovering what has always been).
    Still, I think it’s interesting to continue to reflect on exactly how and why medical-model psychiatry has held the sway that it has. As Bob lays out in “Mad in America,” there is a long history of medicine offering sure and quick fixes. This goes back to prehistory, in fact. There is something almost innate in us that is drawn to that.
    And it also may be that the medical model even now has something to offer. Trauma research, for instance, has shown how the traces of stress become fixed in the body and compound over time – possibly taking on the appearance, in behavior and physiology, often associated with “mental illness”
    But teasing this apart is a delicate process, and perhaps helped by having medically trained people at the table.
    The most important thing in my book is that people maintain authority over their own well-being. Once given up, whether to a medical professional or a guru, something is almost certain to go awry. The most important thing is to generate the language that will equip people to communicate meaningfully with any potential “care giver.” Language that will enable them to be aware of their own authority even as they avail themselves of another’s. This is a tricky thing to do and may be, in its essence in fact, the way to characterize “mental health.”

  • Good point. I went back and put quotes around “overmedication,” for what it’s worth. I do believe that a lot of the discussion is and will be about whether the medication is ever appropriate, and that that is inevitable, once pulling on the tail – how many children are being drugged for “patently” inappropriate reasons – that the cat may thereby get walked backwards.

    Still, your point is well taken. Thank you.

  • This is a good point. The best I can say in response is that we’ve withheld from pulling comments until they really were, in our opinion, egregiously derisive. It’s really hard to say what that will look like in advance, and it means the implementation will be uneven.
    But your points are well made. True as they are, I believe we have refrained from pulling many comments by readers that were much harsher than any that I’ve seen by bloggers; though I will agree that some bloggers’ posts were not paradigms of civility.
    If I have overlooked any that should have been pulled, I apologize and hope (and expect) that they were duly upbraided for it.

  • I, too, have always admired Jonah’s comments; they have been civil, rational, and thoughtful, as you say. There was just one small exchange between three commenters at the very beginning of the comment section of a new blogger’s post that had become uniformly derisive and seemed to be squelching the development of a conversation. One of the participants in that exchange has expressed regret for it. Since the removal of the comments, there has been a fuller discussion, with some perhaps enlightening points made on both sides. Whether that would have happened had we not removed the comments, we can’t know, which is regrettable.
    As I said; I do respect the level of Jonah’s comments. In fact, I had recently had an exchange with him in which I invited him to take his writing further, and submit it as an op-ed or possibly in some other category. So I am sad that the fact that we have stated that we will hold the line on civility, and that this means we must occasionally enforce that line, becomes the problem that it does. We believe that unbridled derision and disdain are not a foundation on which dialogue can be built. We are all susceptible to it when discussing things we’re passionate about. But that energy, channeled instead into a cogent statement of the points of disagreement, will go further toward creating the foundation for actual change. It may not be as satisfying in the short run, but it is what we are trying to invite here. It is not meant to be a dis on any individual.
    We have chosen to not go another way that we could have to get a handle on this; we do not hold comments for approval, as some websites do. In fact, we do not screen blogs either: bloggers post them. I look them over for spelling and formatting when I happen to see them, and occasionally point out when something just doesn’t make sense, but I generally don’t say anything about content.
    Until recently; someone submitted a blog that I thought for sure would invite a firestorm. It seemed the writer was unaware of how and why this was true, so for the first time I decided to point it out (since it was someone who needed me to post it for them). I saw no possible benefit to anyone from an unanticipated firestorm, so I suggested some changes that I thought might make it lead to a discussion, rather than derision. So far the blogger has declined to take this further.
    So, I’m saying; the change we’re hoping for is not easy, on any level. But I know this website started with Bob’s heartfelt intention to bring about actual change. I know this for a fact, because it’s the reason I signed on, immediately and completely, when he asked me. It is because I have seen him do remarkable things by being both well-informed AND polite, even when speaking to people whose viewpoints I found infuriating.
    So when we ask for civility, I feel we are asking for that quality of Bob’s that, more than anything, inspired me to say yes to the opportunity to help out with the project that started when he saw that there was something fishy in the field of psychiatry.

  • One more thing; sometimes when a blog was going up, we knew it would invite harsh response. We thought that that would be part of the process, and part of people feeling heard, which seemed like a fine thing. It is the quality of the dialogue moving forward that matters, not any one perspective.
    In my experience in clinical work, when I’ve been able to keep the conversation moving, it generally succeeded in moving past a reductive medical framework and into a more inclusive, “holistic” one, even when that seemed very unlikely at the outset. In fact, I’ve seen that happen often enough, even in very scary situations, and I’ve seen enough situations move from a purely “psychiatric” framework through to one in which the person walked away, sans diagnosis or medication, to a full life – even after being told that this would never happen – that I am also intrigued to see if that can happen here.
    When it’s happened, it’s happened because I managed to keep my temper under control, and to foster dialogue with all involved. Eventually the psychiatric part of the conversation would fade away. It generally happened better for me if I wasn’t trying to “win.”

  • The books started with looking at the existing evidence base, and Bob’s work has been at least in part a process of finding ways to present that evidence base back to the medical profession. He has been working at ways to be heard, and so I believe he wants to keep that dialogue underway. This is, in part, why I spend so much time looking through medical journals for new research that can be seen in support of non-medical (or at least more “holistic”) approaches. It is about having something to put on the table when challenged for evidence; while there is room for a lot of perspectives, there are times when a bit of hard science can contribute significantly if it’s used right.
    I’ll say again; we never removed a comment because of WHAT it was saying; only because of how it was saying it, and only when it really went over the line.

  • Well, this website is a project underway. I know that Bob wants to have as large a tent as possible. That said, he is also cognizant of the need for radical change; so it would not be prudent to judge based on any one blogger. Any help in bringing in more people would be very welcome.

  • Yes; a lot of what needs to be ferreted out here has to do with the dynamics of communication between people in authority (doctors, website editors) and people seeking to avail themselves of the opportunity to express themselves, etc. It is intrinsic to the mission here, so; not simple.
    As such, civil communication is a good starting point. There are a lot of hot buttons.

  • It’s one thing to address the ills and harms of psychiatry; there is certainly room for that, and we have never removed a post for doing this. We have removed posts for outright incivility, derision, name-calling, etc. There is plenty of room to question a person’s assumptions, conclusions, even beliefs without being rude.
    In our efforts to find new people to blog, we have spoken to some very well-known people who would likely contribute substantially to the conversation here who declined to do it because of the level of rancor they had seen. This is what we have been trying to avoid. And I am talking about people whose positions would likely be embraced here, were they to be heard.
    At the same time we don’t want a “preaching to the choir” dynamic here. No blog should be viewed as monolithic; all of them are open to comment, question, criticism, etc. We are very conscious of the fact that we are trying to address problems that are inextricable from peoples’ experiences of not having been heard; in families, at work, in “treatment;” and so we really want people to feel free to speak, and we really, really, truly do not wish to silence anyone.
    But that only works if we can somehow ask for and expect a minimum level of civility.
    We’re basically trying to create an “Open Dialogue” space here; where everyone can engage in an exchange that may lead to real change. I do believe that Open Dialogue also asks for a modicum of civility.
    This is a problem across the web, apparently; nobody has figured out how to solve the problem of incivility crowding out other dialogue other than to simply ban posters who repeatedly violate the guidelines. We are very conscious of the fact that everybody who has violated the civility guideline has also contributed meaningfully and substantially elsewhere, so we feel a responsibility not to ban people lightly. There have been some moments at which it was tempting, to be sure, but we took a breath and reminded ourselves that we really have to hold to a higher standard, at the same time that we ask others to.
    I met Will Hall about ten years ago, when I attended a Freedom Center meeting (at Bob’s suggestion). I was running a group home at the time and wanted to open a Soteria-style project; I was picked to pieces because I was perceived as coming from the mainstream, and not to be a peer. I told Will that I didn’t know how anything could be accomplished if everyone they approached to do such a project got the same reception, and I remain impressed by his response to this day; “we’re trying to create a space for people who haven’t been heard, so if that means a project doesn’t happen, then that’s how it has to be.”
    I think of this every time we find a comment that goes too far. I like to think that if people know they can be heard, they don’t have to scream or get “violent.” We’ve been discussing ways to make sure people feel truly empowered to comment on what is written here.
    Perhaps it can be said that one reason we have bloggers that people don’t agree with is for the very purpose of having bloggers that they don’t agree with. We’d welcome more who augment as well, but a lively conversation is a lively conversation.
    But we also need to maintain a level of civility that will encourage others to write, or it will be a website that serves a small handful of people who just want to shout the loudest, whether or not anyone’s listening.

  • The work of Robert Sapolsky and Peter Levine on stress in the wild and in society shows that what would be normal, adaptive responses to stress in the wild, with their own natural course, go awry in our wholly constructed social world. There are many ways to ameliorate this and, among them, drugs at least have the appearance of doing the trick – but are not the only choice. The discussions on this website have the potential to add to the awareness of options and contribute to the information needed to make (at least adequately) informed choice.
    There will always be disagreement about WHICH information is needed, or when it’s even possible for informed choice to occur (Samaritan laws exist because there are in fact times peoples’ choices need to be assumed for them). But we can at least choose the company we keep when we get our information, and we can hope that we are creating a community on this website in which people will feel comfortable with the information they are getting.
    Sapolsky’s work on serotonin in primates, while not supporting the serotonin theory of depression, did demonstrate a role of serotonin in social hierarchies and depression, without suggesting anything about the role of it in human depression. But it’s interesting to contemplate this nexus of community, individual experience and serotonin in considering how and why the serotonin theory of depression did gain the ascendency it has. This does not replace a thorough interest in and exploration of peoples’ individual experience, and does not suggest what sort of ‘remedy’ might help, but it’s just interesting to contemplate.
    That’s what keeps me going through the research every day. No one study is dispositive, but each tiny factoid, if allowed to find some places to nestle, can potentially help to create a picture. I spend my time looking for studies that may provide grist for people who come to the website looking for support for alternate theories. There are some people who will only respond with “where is your evidence,” and it’s nice when I can offer studies from the world of hard science research that can be interpreted to support non-medical theories. I understand that some of the studies I post may seem reductive and objectifying, but I only look at them as traces left by larger forces at work, and hope that over time we build up enough of a base of research here to be able to offer credibly supported arguments built on current, or at least recent, research.
    It’s a lot of work to find them; three or more hours a day of sifting through the volumes of research that comes out, but it is out there and when it’s good, it’s good.

  • But, isn’t it possible that there are times when the body thinks there is an extreme danger, and goes into an extreme reaction (which may be to something real; an injustice, an irreconcilable conflict, but not something for which a bodily stress response is likely to be helpful), when a short-term medication may be helpful to get out of fight-or-flight response and into a more adaptive way of functioning? Bob Whitaker’s research indicates that small amounts of antipsychotics for short periods are proven to be helpful. Could this be because the body needs a way to de-escalate from stress?
    If so, it is possible that some have mistaken this effect for both an underlying pathophysiology and its cure, and extrapolated from this to a life-long condition that never was.
    I like your point that admitting to “extreme cases” opens the door, or leaves the door open, to a medical model. But does shutting that door completely really solve the problem, given that the body is still involved, still implicated, one way or another, in everything we do?
    I think that trauma research shows the body is involved. The medical model doesn’t have to be ALL wrong to have gone wrong. The question is; how do we explore the whole range of entry points at which we might address the problem?
    Open Dialogue does not refuse a seat at the table for psychiatrists; it just doesn’t start with the assumption hat the problem exists within an individual, either medically or psychologically. Even then, it admits to the possibility that psychiatry may have something helpful to offer; albeit short-term and in limited quantities.
    This point has never occurred to me before; that the “pathology” involved is not necessarily itself an aberration, but is instead a natural reaction that happens to be imperfectly adapted to our unnatural world. This, over time, can lead to physical problems in their own right, but perhaps the elusiveness of these problems owe to this mismatch between stimuli and reactions, and it’s in this gray area that our anger and frustration simmers.

  • The following is a response from Nancy:

    “Dear Keren; I know it’s very frightening when one comes to the conclusion that they are being poisoned. The temptation is to stop these medications immediately. That is the most dangerous thing to do. No cold turkey. Some Positives in your son’s case are:

    1. He is young, and his nervous system is more resilient.
    2. He has not been on these medications, according to what you’ve written, for a great length of time.

    “The quickest reply to your question is that the safest way to wean off is one drug at a time under medical supervision. James Harper, the author of “How to Get Off of Psychiatric Drugs Safely,” and many other experts in psychotropic drug withdrawal are very clear on saying that the safest way to withdraw is to reduce the medication 10% at a time – however this does differ between people and must be done with caution. Things to watch for are disturbed sleep – sleep is the most important thing to maintain during the withdrawal process.

    “Lastly, if your son is taking an XR form (Extended Release), switching to a single dose should be done before beginning to wean. As you read in my account, I was refused medical supervision, and this happens to many people. Becoming an expert may be the only recourse.

    “My heart goes out to you and your son, and I will be thinking of you.”

  • I don’t know how significant the BPS is, but talking about the dimensional spectrum of symptoms in the general population is one small step from questioning the whole diagnostic construct. This was a question that ten years ago felt utterly subversive, and risky to say publicly, and is now the official statement of (what may be) a significant psychological society.

  • I should have made a note: this initiative was spearheaded by Peter Stastny, a founder of the International Network of Treatment Alternatives for Recovery. He’s been one of the key people fomenting change from the medical model. The need adapted treatment model is, as Robert Whitaker says, a “selective use” of medication model, in the vein that Bob finds there is evidence for. I spoke to Peter about the initiative a year ago, and he was not highly optimistic about getting it funded. The fact that it has been can only be taken as a positive sign. Peter would have liked the initiative to be even more out of “the system,” but the fact that it’s getting so well funded I can only hope means Peter has truly prevailed in his argument that the NATM is truly effective and a cost saver.

  • From the study:
    “Six patients were receiving no antipsychotic medication at time of testing. Others received first-generation antipsychotics only (n = 11), second-generation antipsychotics only (n = 64), or a combination of the two (n = 6). Pharmacology was unavailable for one patient. Median chlorpromazine-equivalent dosage for those receiving antipsychotic medication was 350 mg per day (mean = 455.0, SD = 374.1 mg). A number of patients were also receiving antidepressants (n = 25), hypnotics (n = 6), anxiolytics (n = 12), mood stabilizers (n = 3), and anticholinergic medication (n = 9).”

    “Trait or State Marker?
    The eye-movement abnormalities are unlikely to be secondary to treatment or mental state at the time of testing. No patients were from acute hospital wards or were acutely mentally or behaviorally disturbed at the time of testing. All were reported to be stable or in remission by the clinical teams supervising their psychiatric care. The abnormalities are independent of effects of neuroleptic medication; all medication-free cases scored within the same range of abnormality as the medicated schizophrenia patients, as did the few patients on very small amounts of neuroleptics (see Results). There was no correlation between duration of illness, age of onset or amount of medication and the severity of the abnormalities we observed. Eye-movement abnormalities also showed no correlation with presence or absence of cigarette smoking or daily cigarette consumption. The likelihood of an individual’s eye movements being classified as “schizophrenic” was independent of his or her symptom severity. Finally, our results showed good test–retest reliability when individuals were retested after 9 months. A few patients did show a modest degree of improvement on repeat testing. However, there was no suggestion of different scanning styles at retest even though stimuli were identical in each test. Further repeat testing at yearly intervals are planned.”

    They seem to have attended well to the effects of medication status. The study mentions that “Cases and controls were assessed on a broad spectrum of tests as part of the protocol, and results will be reported elsewhere.” It would be helpful to get those data, of course; without them any discussion about the role of anything other than a schizophrenia diagnosis within the context of this study is merely speculation.

  • I have put quotes on headlines for this reason. I just like to try to say something about why I’m including a study, when the reason may not be obvious, and usually the headline is the only chance I get to do that because I try to keep the text really neutral. But I must guard against irony where I can’t include an emoticon. Bob has always pulled me back from more blatant irony; this time I thought it was relatively innocuous and I didn’t run it by him.
    All said, I don’t mind at all your critique. I don’t feel I’m pushing hard enough if I’m not getting some push back, and I haven’t had much for a week or so – so I guess this will have to suffice.

  • Now that we have a registration system, we’re not removing posts unless there are potential legal consequences. We do ask people to respect each other, respect bloggers, promote an atmosphere of inquiry that is welcoming to all who want to participate. This does not mean people cannot disagree on the issues; in fact, the more the merrier. We love a good discussion. A little humor; all the better. We just hope people can do it without character assassination. We reserve the right to suspend accounts of people who are not respectful of other posters. We want everyone to feel they can post, and read, without anticipating feeling badly about it.

  • One more thing; I feel that my job here is to present research, as much as is possible, on its own terms. So, while I might be inclined toward phrases like “person with a diagnosis of schizophrenia” rather than “schizophrenic,” it is often difficult to summarize a study in a way that translates its premises into language that aligns with my assumptions without unfairly or misleadingly twisting the study’s original intent. Though there may be something in a study I think is interesting for a reason other than the authors’ intent or conclusions, I cannot simply recast the study as I see fit. I have to frame it, as much as possible, from within the authors’ intent and hope that I can sufficiently highlight what I think is interesting about it.
    Often, it’s taken me days to come up with a “spin” that seemed fair to both the authors’ intent and my interest, and sometimes I’ve just not included studies that seemed interesting because I couldn’t do both without editorializing to a degree that I feel would stifle conversation or risk seeming to characterize MiA’s editorial position.
    If there is an editorial position it is that more dialogue is needed on the areas this site explores, and so anything that adds to that dialogue is good and anything that impedes it is not so good. I do rely on the interest and intelligence of the people who come to this site to bring out the points that I like to think are important, as you do here.

  • I will say what interested me, which is any contemplation of a continuum between what is seen as dissociation and what is seen as psychosis. I think that once that contemplation begins in earnest, the diagnostic categories and concepts that separate them begin to break down. This study, like many, struggles to preserve the distinction and therefore, in my opinion, is in fact a little confusing in its conclusions. So when I put something like this up it’s not so much that I agree with the conclusion as that I anticipate it to stimulate a vigorous discussion, perhaps on the validity of the concepts on which the study is premised. But I don’t feel it is helpful or appropriate for me to add my views to the discussion, except perhaps here where it may be that the relevance of this study to the themes of this website may seem a bit obscure if not tangential.
    When I look for studies, I am often looking at the ones from within conventional areas of focus that somehow highlight the inconsistencies and tensions of the operating assumptions. This is because of the sheer numbers involved; there isn’t much research that is concerned with exploding the “common wisdom” of things; the financing, and professional and academic pressures make that difficult and rare. That’s just the nature of things. “Positive,” or confirming results tend to get published and noticed far more than studies that fail to prove their hypotheses and may therefore call a prevailing paradigm into question.
    When I got involved in research I was dismayed at the lack of attention to what seemed the clear connection between dissociation and psychosis on every conceivable level. It seemed that everything was set up to prevent any research or contemplation along this line. I managed to get a look at a manuscript of a book laying out a traumagenic neurodevelopmental model of schizophrenia, and it felt like reading a draft of the communist manifesto. I had conversations with top researchers, established names in both trauma and schizophrenia who at first denied the connections and then acknowledged them but added that pursuing that line of thinking was “a career ender.” To even raise the question marked you as a radical and, at the time, their areas of interest could not have been sustained by pursuing what seemed from their perspectives to be a side show.
    So when I see a study that takes on the question head-on, it excites me to include it. Even if the logic is dense or perhaps convoluted, I think it adds to the evidence base of a relatively little explored connection. But there is rarely if ever one “magic bullet” study that answers everything concisely, or even a string of studies that resoundingly make the point. Especially if you’re trying to tear down what had been commonly accepted wisdom. More often it’s a slow accretion of studies that vaguely circle the inconsistencies and tensions in the constructs that are commonly accepted.
    So, here, I think this study’s conclusions are hard to parse. But for me the important thing is that they are looking for connections, and clearly finding them.

  • I agree with everything you say. I meant the headline to be ironic, if not rueful. You are right that the original headline captures it, but I don’t feel I can just re-use a headline, so I try to come up with one that adds something. In this case I actually assumed that any reader of this website would begin with the premises you lay out here, and thus catch the irony I intended. But I appreciate you reminding me that I shouldn’t assume that. Thanks.
    I do think the “paradigm shift” referred to is toward more searching for genetic linkage in an even greater field of possibilities, and thus an escalation of what has been an unproductive and distracting field of research. I generally keep my views out of the way when I put posts up, and hope that commenters flesh out what interested me. As you did here, beautifully. I couldn’t claim that the headline I wrote served my purpose, then, but you did write out a view I am happy to endorse, and could not have written.

  • On further reflection, this goal of weeding out things that have the effect of silencing others is in some way consistent with the core mission and content of this project. Open Dialogue, of course, demonstrates that when communication is furthered the experience and perception of what is called “psychosis” goes away. My experience in clinical practice has been that the surest way for the outcomes I hope for to occur has been simply to keep the conversation going, not necessarily with an explicit intent or content. Even psychiatrists who seemed diametrically opposed to my way of thinking very often came around, often without the need to acknowledge any shift in position because our positions did in fact converge on a fuller, more whole-person awareness (of everybody involved).
    So, again; when posts have felt like the chilled me and would chill others, and result in less dialogue rather than more, I pulled them. This is the intent we are striving for in our posting guidelines, not the promotion of one perspective over another. I have been quite sympathetic to the content of many posts I pulled, but I was aware that they were having the effect of driving away more people and more content than they were contributing. It does seem that we have a responsibility to keep the space clean in that way.
    I think that things will change when we have forums, and a place to initiate and sustain many more content threads, and a place to direct discussions that risk overriding those that might arise directly from specific blog posts.

  • I do not WISH to silence anyone, and certainly not any one perspective. In looking back over the thread this morning, I see there are lots of comments remaining that examine all the issues mentioned from various perspectives. On reflection, I think that the question that guided my decision to remove any specific post wasn’t its content per se; it was: “does this comment lead me to feel that I could contribute constructively to a conversation here, or does it leave me feeling like tuning out, turning away, and/or shutting up?”
    In short, I removed posts that left me feeling that they had the effect of censoring others. So, to the extent that I succeeded, I hope it was to have the net effect of REDUCING censorship.
    I acknowledge that, in trying to find a balance point between all considerations, the teeter will totter and occasionally be imprecise, perhaps arbitrary, unfortunately unfair. I did leave comments that, though they were not specifically germane to the blog’s content, nevertheless felt that they contributed momentum toward a rich discussion. So, mea culpa on being inconsistent; I just felt that more net dialogue, as long as it’s civil, is good. So, yes, on balance positive comments do feel like they add momentum more often than negative ones. This does not mean that negative comments are not vital, important, appropriate, essential, and wanted. But we are seeking to foster a culture that draws people to participate, rather than further silences them. I hope that a rising tide of constructive dialogue may someday wash away my awkward efforts.
    I think censorship can be effectively accomplished by any participant in a discussion; not just those “in power,” however powerless they may in actuality be.

  • In all honesty, I really don’t like having to do this. It is very difficult to decide which comments go over the line. We are trying to figure this out as we go; how to make a safe place for people who have not been heard to speak up. It’s simple to say that this simply would involve not removing any posts. That was a hoped-for approach when this all started. But when some people repeatedly ignore or fail to discern a line not to cross, we are being unfair to others who would wish for a civil and civic dialogue without interpersonal attacks and character assassination. So we have to wade in and try; but once doing so it becomes a massive undertaking to do oversight on every single comment on every blog. So, yes, it may look at first like favoratism. But really it’s just the result of trying to order back the tide. It would be vastly preferable if people would bear in mind that there are many equally wounded people, with different and perhaps opposed viewpoints, who wish to be part of the conversation but refrain because it’s hard to find a place to insert themselves.

  • I simply don’t have time to review every single comment, and certainly not enough to sit by the computer waiting for them to be posted so that I can vet them as they come in. What happened today is that there were a slew of particularly uncivil and off-topic comments that Bob and I agreed had finally reached the point that we simply couldn’t ignore. We are working on being able to ban posters who repeatedly ignore requests to be civil, etc. Meanwhile, I started to remove some of the really offending comments. Once that starts, it becomes harder and harder to decide about each one; we don’t WANT to remove posts ever; ideally we wouldn’t have to. But once it becomes necessary it becomes arduous to figure out which; many have lots of great content, but maybe a sentence or two that it would be wrong to leave while taking others down. So what to do? It almost seems I would have to take down ALL the comments in this thread, which I can’t bring myself to do.
    What I have tried to do today has not worked. But we put up a notice that we would remove uncivil, off-topic comments, and I’m getting requests from other readers to enforce this notice and I feel I must. This, or course, invites repeated angry posts from the offenders, all of which cheapens the experience of people who would like to come to the website for a source of substantive and useful dialogue and information rather than interpersonal jousting and character assassination.
    I have focused on Dr. Healy’s blog for the moment, because at least other bloggers are in fact responding personally and seem to take care of themselves. There doesn’t seem to be any legally actionable posting going on. But the question of Dr. Healy’s blog is a tough one: ECT is a perfectly legitimate target for debate, criticism, inquiry, etc. I am sure this will happen on this website. I am sure there are ways in which discussing it in the context of the larger conversation about medical/nonmedical thinking and “treatment” is important and legitimate. But on this thread it has grown to the point of displacing all other conversation, and in fact driving away interested readers and posters.
    So, you can’t please everyone; but if I have to choose between pleasing noisy people vs. people whose voices are valuable and would not be heard above the fray, at the end of the day I feel moved to make sure this space is safe for those who are relatively quiet and might not find an equally welcoming place. I am interested in making a space for the quiet people; the noisier ones will always find someplace to be heard.

  • Dr. Moffic and I had originally agreed to post this on the Monday morning, to allow time for more posts to go up between this and his prior installment. But when I saw Corinna’s post, it seemed better to put it up right away keep them all in close proximity.
    This was my call, not Dr. Moffic’s, who is only too happy to make sure there is plenty of space for discrepant views.

  • What interested me is, if you read the abstract, they actually say “not accounting for planned readmissions may lead to overestimations of negative outcomes.”
    It’s plausible to think that, given the clear belief of the researchers that ECT is effective, the “planned” nature of readmission might obscure its effectiveness. It takes a step back from that to ask why readmissions for a supposedly effective treatment are so predictable as to be planned. Within the context of severe depression and the concern of all involved it’s easy to see it as being an understandable mistake. Not an innocuous one, but explicable.
    What I appreciate is that they did publish it, and in the Journal of ECT, where we can find it and ask the question in a public way; does this make sense?
    Some of the news lately has been about the bias toward publishing positive results. Part of that is to take results that might be seen as negative and interpret them as positive. I believe this can happen innocently, as I believe it happened here; looked at through a certain lens, it all makes sense.
    But we can also see it as a negative result, and I’m glad we have the chance to.

  • I put part 3 up briefly, then realized I wanted to give Bob’s latest piece a chance to stay up longer on the front page, and wait until Dr. Moffic’s previous post had moved off the front page. So I asked Dr. Moffic’s permission to do that. Other bloggers put theirs up by themselves, and we have not asked them to hold to having one up on the front page at a time, though we might.

  • I was mostly interested that Fox news was taking an interest, and then that the APA president was moved to respond. I did not know anything about Ablow. It’s interesting to me that he would be looking to make his bones on debunking the DSM; I wonder whether he would have a few years ago. So I mostly put the post up as a barometer.

  • It is true that, as I have said, I really can’t read every word that everyone writes here. I just don’t have the time. And I also wouldn’t want to respond to every example of less-than-ideal civil discourse even if I could. So I will admit that when I’m pressed for time, and not reading for pleasure, I might skip over some posts by people with whom I’m generally familiar and zero in on some about whom I’ve received complaints or otherwise am aware I should keep notice of. I apologize if this means I’ve missed posts that should have been noted; but since most of the conversation is about trying to find a generally understood and accepted tone and standard, not necessarily ferreting out every possible candidate for deletion, I hope that’s okay. You, for instance, write extremely interesting things that occasionally become somewhat bellicose. So I hope you can note the uneven attention, if in fact it has been so, for both its positive and negative implications.

  • I think of the Stanford prison experiment, wherein those placed in a position of power took on roles and attitudes in relation to those without power, and vice versa, that were in no way present prior to the experiment. The effect was so swift and extreme that the experiment was halted in less than a week. All involved returned to their pre-experiment states, identities, and roles unharmed.
    I like to think the same can happen here (if we will grant that there is an analogy). I do believe that everyone does the best they can in the circumstances they find themselves in, as they see them. For something different to happen, the circumstances have to change, or the perception of them, or both.
    But when people are angry or afraid, it takes longer or becomes impossible for any of that to happen. Choices become limited and absolute. I’ve always found that if the anger or fear is ferreted out, amazing changes can and usually do occur; much more so and much more quickly than they do as a result of anger.
    This is not meant to say that people do not have good reasons to be angry or afraid. I certainly do not mean to say that.

  • Thanks. I was merely happy for the opportunity to say that I had put the study up. It’s nice when I get to say that.
    Also that I’m hoping for there to be more fora, blogs, etc., available for the discussion of ECT. Somehow it persists as an almost more intransigent topic of conversation than medication, as many people who are inclined against medication seem to say; “however, for the most intractable depression, it seems…” So I do believe this is a conversation that needs more and better space than as merely a sidebar and distraction.
    It is our hope and intention to bring psychiatrists to this watering hole. I think the conversation that is evolving among the few that are here is proof of the benefit of that; as the initial, and predictable, points of difficulty are reached and dispensed with, there is room for deeper reflection on personal as well as academic and professional dimensions. I believe I see this happening and, if we can maintain, we can hope for more professionals, medical and otherwise, to join the conversation.
    I believe this is all happening. But threads that stay on topic, and civil, will help it to happen more.

  • Thank you for this deeply thoughtful comment. I will admit to rushing through it (girlfriend and weather await) but I look forward to taking it in more deeply tonight. It is yet more evidence that we are creating something meaningful here. Thank you again.

  • Bob has set as a priority that people feel free to express themselves. He does not want posts removed unless it involves a direct, personal attack. If we want people to show up for real here, talking about a subject about which they are rightly passionate, it is inevitable that people will get heated. Unfortunately that can also have the effect of silencing others, so it’s a tough balance to strike. So far, we have deleted very few comments, white-knuckled it through some others, and we have lost a few readers who did not appreciate the tone. It’s a hard balance to strike. Of course, we can hope that people, once knowing that the goal is for all comers here to feel respected, will feel enough comfort and safety to think carefully and respond to others rather than react. But on the way to them knowing that, what do we do? I prefer to try to make the space safer so that it will be respected, rather than to chastise or admonish.
    Please, everyone; please, keep it civil. A lot of people who come to this site have been hurt. Nobody here has a monopoly on that.

  • Please keep the Nurse Ratched comments out of this. I know you are not calling Altostrata Nurse Ratched here, but it feels uncomfortably close. Nurse Ratched has come up before here, and it turned out badly, so I’m asking you please to refrain.

  • Absolutely. It was just hard to post this one because of the particular crime, and the possibility that the drugs were not the cause. If a history of such behavior were to come out, it would discredit the Zoloft defense for a long time. But when the judge agreed to hear it, I hoped it would turn out to be proveable.

  • I agree. I resisted putting this piece up for several days, because the levels of irony, complexity, dark implications and potential precedents were painful to think about when it was just a hypothetical defense, however valid that defense may turn out to be. But I just couldn’t get on the prurience bandwagon. Not to mention how awful it is to contemplate all these implications in respect to the issues we discuss here, when it’s impossible to also ignore how awful, whatever happens or happened to him, the experience of the woman was and, I’m sure, still is. But now that the judge has allowed the plea, it starts to become something greater on a social level, and I felt I had to post it here to be part of the discussion. I just wanted to say it was not an automatic or easy thing for me to do.

  • I think that one reason Alice’s blogs get so much attention is the quality of the dialogue she both invites and sustains. She consistently engages with in a respectful way, and is clearly engaging in her own process of discovery as well. It’s the kind of discussion this site was created to host; not merely to advocate from one side or the other, but to engage in inquiry where the various perspectives meet, and see what evolves.
    When I’ve been on teams that were gnashing their teeth at a psychiatrist, my call has been to not do what we were angry at the psychiatrist for; being so certain of our own point of view as to cut off all other options from consideration.
    Of course, it’s hard, and I’ve spent a lot of time walking off anger after conversations with psychiatrists, sputtering with incoherent rage at the casual dismissal of other perspectives. It was the presumed weight of evidence, or at least hegemony, that the psychiatrist seemed to enjoy that raised the anger.
    But on this website the bias skews the other way, and Alice has so far been the MVP MD as far as willingness to see where that goes. I’m not sure how long she can keep up a conversation with so many people, but her effort so far has created a lot of good for all of us.

  • Perhaps, Michael, in the case of Laing and Mosher at least, the part of the warning that some heed is that they died frustrated and at least a little bitter. Sure; they had the satisfaction of seeing the beauty of their beliefs realized for a time, but frustrated at the reception they were met with moving forward.
    Szasz, as lauded as he is by us, is a pariah in his profession. Healy is a pariah even on this website. Stastny soldiers on, and I won’t speak for him, but I know it’s not easy. It’s a lot to ask someone to take on the mantle of the people you mention. It’s no mean task. To create a space where the kind of work their beliefs imply is embraced and sustainable is almost a magic trick. Dan Edmunds wrote today (in a response to a query on his blog) about his short-lived therapeutic community running out of funds, and sustaining his med-free clinic out of book sales and his own personal investment.
    Dan Fisher, coming from the “peer” side of things, finds brilliant ways to mobilize that interest; but as for creating services for people who are not yet identified or don’t wish to be identified as part of the “peer” movement; if you charge enough for it to be sustainable in a system that won’t support it, you are pilloried as mercenary by the people you need as allies. And everybody arrives at the door exhausted of spirit and treasure by the system we decry, asking to have the wrongs righted without having to spend more.
    So maybe it’s a matter of which warning people heed at a given time. How many times, and how hard, do we expect any one person to beat their head against a wall? I know beautifully intended, spiritual and holistically-minded people who went to psychiatrist school to be one of the ones who changed things, only to emerge beaten and bedraggled, with kids to feed and educate, and little margin left. Their spirit may be willing, but their too, too solid flesh is weak.
    I say this, Michael, as you know, as someone who is wont to dive in heedlessly if there’s a chance of making good on the promise of the names you mention. But I am not constrained by college debt or the potential loss of a license, tenure, the kids’ college fund, or anyone’s respect. What I lack in stature I make up for in stealth.
    Even so I have empathy for people who have something to lose. I (and many others, yourself included, I believe) really appreciate Alice putting herself and her process out on this website. To suffer the slings and arrows of outrageous criticism, standing out in the open with a bucket on her head, deserves a moment of appreciation.

  • I’ve been thinking about how interdependent we are for our experience of reality, for what we can trust and feel to be “true.” How, when someone’s guiding principles are or seem to be at odds with ours, it is disorienting, dissociating, and maddening. When I’ve been able to get under the anger, to get curious about the other point of view, the anger goes away and the possibility of something new arises.
    But it’s so hard to see that when you’re angry.
    I’ve been thinking about how I used to get infuriated at psychiatrists. And I have so much less to be angry about than most – mostly things I’m angry about having happened to others. I’ve had my perilously dark days and years – and I’ve experimented with pharmaceuticals – but I’ve never been forced to do anything. But I would completely lose my cool when a psychiatrist was high-handed or autocratic or dismissive, because I knew they usually had little basis to be dismissive of me in terms of our relative education – at least in the areas I was trying to engage on.
    But, when I was able to find a way to simply keep the conversation moving, rather than becoming reified one way or the other, I found that more often than not the conversation wound up where I wanted it to without either of us being the worse for wear. It wasn’t the argument that did it. Certainly not the anger. It was simply that when more awareness was created, and more known, the situation tended to evolve in the more inclusive, holistic, contextual way I had hoped or fought for in times past. “Intractable” diagnoses gave way to formulations that included perspectives on family and personal history, environment, phenomenology, etc.
    My anger arose when it seemed the conversation might end. I learned to trust that – if my view had merit – it would prevail as long as I kept the conversation going. Or, if not, at least the conversation would continue, within which there is always hope. Or, perhaps even better, being in dialogue is itself the goal; itself the prize for having shown up.
    Often enough for my sense of satisfaction, I have experienced my sense of things as having been – if not correct – at least sufficient. Reading “Mad” and “Anatomy” affirmed things I had suspected or felt to be true, and working from or within the principles they (and other works) suggest has been for me a good-enough proof of concept.
    That’s not the same as knowing everything or resting on my laurels. But it is enough to say that – even if I don’t win the fight – I know enough to be comfortable with what I feel I know. And that’s a pretty good day in my book, whether or not what is “known” remains “known” into the next day. It has worked for me to say “I believe what I believe not because I know it’s right, but because today I know it’s what I will fight for.” I am comfortable that what I believe will continue to be, if not fixed and eternally true, at least sufficiently true, and therefore there is no reason to be at war any more.
    I’ve thought a lot about why people get SO angry at the “mentally ill.” They are thought of as the people who don’t “get it.”
    I think that what gets seen as illness is the mark of people who are still trying to “get it.” This may arise from not being satisfied with or complacent about the answers they have encountered so far. Usually, in my experience, they are unsatisfied and non-complacent for some very good reasons.
    But that can be fundamentally, existentially frightening because it’s hard to think about how fragile this sense of reality is – that it is so inextricable from that of others. We depend on others’ ability to scan the horizon as much as or more than we depend on our own; our ability to see being limited to such a small fraction of 360 degrees.
    But others get angry at people whose perspectives seem suspect because they want to believe that the “it” that is there to be gotten is the right and only and eminently good “it.” (This is known as the ‘just world bias,’ I think.)
    But it is never so simple, and while some enjoy the luxury of thinking it is, or are merely content with what they “know” already, there are some who are compelled to keep looking. For this they start to feel, or are called, “crazy.”
    “Crazy,” in my book, is simply the moment when we are saying or doing things we or others can’t explain, and feel frightened by. This can arise in any context, and can be thought of as good or bad, depending. But I don’t think it’s more complicated than that.
    If we are to heal the schisms in the way we think about the challenges that come to be thought of as “psychiatric,” we must be able to hold that space and moment between the meetings of minds. There is no margin for error here. Minds are not things that it is any one person’s to lose; they are property of the collective, and none can be wasted. Loving people involves holding people in mind while they are lost in theirs.
    I was so sad when it seemed that some of the conversation on this particular board had reached an impasse. Much if not most of the conversation on this site is elevated and idea-driven. But just as I have always been drawn to the hard cases – the people who it seemed might not be coming back – I feel bereft when a good conversation between clearly good people goes awry the way some have here.
    But, it’s not over yet.

  • I don’t mind working on the weekend. I do mind the feeling that people are afraid to post, feel hurt by posting, or that others will lose interest in following the posts because it’s painful to witness others work out interpersonal issues in what is meant to be a public space for discussions of issues and, hopefully, bridge-building.

  • I have, at the request of a poster, removed all of her posts from the website. I have also removed all posts that reference her by her full name, including replies to her posts that include her full name in the header. This is an extremely regrettable outcome as her posts were voluminous and high-quality, as were the many thoughtful responses to them. This is a real loss to the conversation here. We will be increasingly vigilant about preserving the sense of safety required for people who want to engage in this necessary dialogue.

  • These cannot be the pages on which interpersonal issues get worked out. These must be pages for the discussion of ideas. If anyone has issues with how they or anyone has been spoken to or about, please bring it to my attention.
    These pages are for anyone who has been affected by the “Bad Science, Bad Medicine, And the Enduring Mistreatment Of The Mentally Ill” mentioned in the title of “Mad in America.” That means all of us, including, if we are correct, psychiatrists and people who have either chosen or fought against “treatments” with less-than-fully-informed consent. If it is true that something must be corrected, it affects everyone who is touched by this issue and needs the full involvement of everyone involved with this issue. That is why civility in the process of ferreting out the injustices all of us have endured must be paramount, and grievances between this website’s participants interpersonally must be worked out as well as possible behind the scenes.
    I had thought that editing a post with the intention of leaving the thought intact while removing the ad hominem content was respectful. I understand that, for some, it is not. I hate to delete posts in their entirety. For one thing, it seems to mess up the thread. So I am left with deleting a post’s content in its entirety but leaving the name up. None of these options are ideal. So I am left to ask again that people try to be civil to each other and, if someone feels wronged, to bring their grievance to an administrator so that the many people who come to this site for information and discussion are not turned off by finding themselves party to heated conversations that they are not really a part of. I know I have stopped going to other websites for this reason, and it saddens me to think of it happening here.
    Soon, we will have forums up and running and the forums editor, Matthew, will be taking over moderation of these discussions. He will be placing a button on the comments window for flagging unacceptable content: sometimes there is simply too much happening for us to keep up with, and that will make it easier to be sure we get to unacceptable content in a timely manner.
    Meanwhile, I will spend my evening going through these posts and doing the best I can to remove the ones that seem to be personal attacks. If I miss some, I am sorry; please let me know. If I remove some and you take exception, please let me know that and hopefully we can speak about it with a problem-solving spirit.

  • I have been talking with Bob today about how to handle this. I can’t watch the board every minute, nor can I always read everything that gets posted. Certainly Bob can’t. I only know about this pist becase someone emailed it to me. I am in the woods, playing frisbee golf right now, but this is important enough for my friends to wait while i respond on my phone.
    I intend to edit ad hominem attacks, rather than delete them. It will take more time, but it’s important to us to be as respectful as possible toward everyone’s contribution.
    But we will block posters who repeatedly fail to respect others. When I get home I will look at this more closely.

  • This was exactly the conversation I had with Bob about posting. I was initially averse, but it’s interesting that something with no actual statistical significance can get so much press coverage, when things with real significance that challenge the status quo can find none.
    Not that this study doesn’t tell us something, but the things we can learn from it don’t have much to do with what generally gets picked up on.
    It’s interesting to think of the causes and consequences of a study like this. What are the interests of the researchers? What funding do they have, or might they hope to get?
    Or, less nefariously, what are the assumptions and where do they lead? Would this provide a test that insurance will require to fund antidepressants? It’s all interesting to think about.
    After some of the exchanges of the last few days I am more hopeful than ever that MIA can become a forum wherein professionals (psychiatrists included) might find the dialogue and information that may change the status quo. I have had feedback that encourages me that some of the research and conversations have been helpful in this regard.

  • It’s great to see psychiatrists talking with psychiatrists in this forum, which is in itself a good argument for keeping it safe for them. The dictum that everyone is more human than otherwise, if I remember it accurately, applies to all of us; psychiatrists included. I have seen beautifully intentioned people go into the training and come out brutalized at the other end of it and, in my opinion, forgetting some of what originally inspired them.

    Along with being human comes the shock of trying to make one’s way in a world that is confused with lots of information – some if it good, some of it not so much.

  • Almost everything that gets done involves some money for somewhere. Where the money comes from and to whom it goes has something to do with what that thing looks like and what it does.

    I think there is room for different kinds of things, with different kinds of cash flows. That is the only way to have a heterogeneity of viewpoints. It is a myth to think that anything might be completely objective. It is even a myth that any one type of financial structure would be completely representative of the truth, whatever that is.

    I think there is room for all kinds of different things. When the material is made available by the good graces of a website’s founder, for instance, then it inevitably represents that person’s view to some degree. If the readers pay, then the website owner is thinking perhaps a little bit more about what they want to read.

    I like Corinna’s point about setting up services that take back ownership; of media, of services, from moneyed interests – be they charities, governments, benefactors, whatever. When the people who receive services pay for them, then those providing the services know to whom they are looking for approval. If someone else pays, as is necessary for many people who cannot, something else happens. In my experience it doesn’t always turn out well for the people to whom services are being provided. Sometimes yes, sometimes no.

    There’s room for all kinds of enterprises. Some will do good, some less so. No one of them corners the market on that. I’ve seen charities labor on unaccountably; their dismal outcomes shielded by money that is separate from the service that people actually receive, and perhaps even ratcheted up by dire need that the charitable service may unwittingly cause. The people who work in non-profits are just as interested in the preservation of their own well-being as anyone else, and just as susceptible to rationalizing away failure in their drive to maintain the status quo. I have also seen for-profit enterprises think very carefully about what they were doing and deliver excellent service in very creative ways.

    There is no one way to do anything.

  • Your post could not have come at a more timely time for this website. We need the voices of those who are struggling with these issues, at all phases of the struggle. This post helps to frame that beautifully and, hopefully, provide a window through which people from various perspectives might see each other better. Thanks for this.

  • Some posts have been removed at Bob’s request. He will be writing soon to address the issues in the hope of nurturing a fruitful discussion on these pages. He is currently on the road, and will post his comments as soon as possible. Meanwhile he wanted you all to know that he does not take the removal of posts lightly, and also that it is he who invites bloggers on the website.

  • My reading of the efficacy of “monitoring of mental state alone” was that it suggests the power of mindful awareness itself. In research on cognitive therapy, it was the recognition of “thoughts as thoughts,” rather than the changing of the thoughts’ contents, that was associated with change. It was that research that lead to the development of Mindfulness Based Cognitive Therapy and Mindfulness Based Relapse Prevention. So, in this study, with or without the cognitive therapy, simple awareness of mental state, presumably in the company of another but independent of “therapy” and perhaps even of empathy (though that’s rarely a bad thing) was sufficient to mediate a lower conversion to psychosis.

    Just a thought.

  • I agree with what you wrote, Donna. I hesitated about putting this item up for the reasons you mention, but I put it up without comment because it does seem to help a little bit toward untying the Gordian knot of the diagnosis.

    Principally, I was thinking of someone I had worked with who arrived with a book of “symptoms” to watch out for, lest she become “manic.” She had spent years living by this book, with the result of a very circumscribed life that she had recently seriously tried to end. I looked at the book and said “everything in here seems like something that could be called ‘living,’ or even ‘living on a good day,'” and we changed it into a manual for living. The items mentioned in this study all reminded me of items in her book. When she and I redefined the “symptoms” as good things to be strived for, and found ways to do this without losing control, things changed for the better and her regular trips to the hospital stopped. Eventually she stopped thinking of herself as “bipolar” altogether, and decided that she had never in fact been ill at all; just told that she was. This was done, for the most part, without directly addressing the validity of the diagnosis; just looking for alternate ways of thinking that she ultimately experienced as more adaptive and so adopted them as her own.

    Similarly, I feel that I need to maintain as much of a neutral tone as I can, and therefore don’t add qualifiers to things I post. In fact, Bob wants me to remain as neutral as possible and has occasionally reigned me in when my headlines got a little “editorial” (snarky). I just put things up that I think will add to the discussion, and that I think are academically defensible, and hope that the discussions that ensue will flesh out the issues without any further comment from me. But when someone finds an article “upsetting and dishonest” I feel it might be okay for me to step in with a comment, for what it’s worth. “Neutral” needn’t mean “heartless.”

    The conversations we have here are necessary built on terms and concepts that were created and currently controlled by paradigms that merit reconsideration. That means that there will inevitably be tension around the meanings or legitimacy of these terms and concepts, as new understanding is developed. I hope that these conversations will contribute to changing the creating this new understanding, definitions and paradigms, and I look for articles that will contribute to that. It seemed to me that it was possible that the authors of this study might be trying to do the same thing.

    I agree that the “genius and madness” rubric is simplistic and sometimes counterproductive, but it seemed to me that they might have been trying to do something more subtle that ultimately undermines the “illness” concept of bipolar disorder altogether. So, in the hope that that was true or could at least lead to such a discussion, I put the item up without comment.

    Thanks for your lively engagement in these discussions. It’s the reward I get.

  • It is gratifying to me to think that this article provided some validation to you as well. While some people receive solace from the medical model, it is also true that having one’s personal experience validated by empirical research can be equally reassuring. I am pleased to be able to find research and make it available that may help in this way.

  • Yes, I agree, however (and for the sake of conversation); if the trauma has adulterated the nervous system, are people not entitled to whatever might restore it back to a manageable range of function? If so, is there a medication that might be included in that? Is that what, perhaps, some medications that seem to “work” DO, if only for a short time, but their effects are mistaken for correcting a “disease”?

  • Just came across this as well, in Applied Psychophysiological Biofeedback. 2012 Mar 30.:

    “Psychology Moment by Moment: A Guide to Enhancing your Clinical Practice with Mindfulness and Meditation” was written by Labbe (Psychology moment by moment: A guide to enhancing your clinical practice with mindfulness and meditation. New Harbinger, CA, 2011) to review the literature supporting many mindfulness-based interventions and to highlight evidence-based practices. It is written for the mental health clinician who is interested in integrating mindfulness-based interventions into their practice. Chapters range from an initial description of the construct of mindfulness to later chapters that introduce treatment protocols for special populations (children, aging adults, couples) and specific illnesses (chronic illness, stress, anxiety, depression, eating disorders).

  • I just came across this reference, which is relevant here:

    Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy Versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse. J Consult Clin Psychol. 2012 Mar 12. [Epub ahead of print]

    Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT’s effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Results: Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p < .01) and Decentering (p < .01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p < .05) and Curiosity (p < .01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. Conclusions: An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.

  • I have lead courses in Mindfulness Based Relapse Prevention, working with people who come identifying themselves as addicts to everything from crystal meth to alcohol to pot. The chief joy to me about this kind of work is that, by the fourth or fifth session, the discussion about addiction (or at least the addiction in the ego-syntonic sense) falls away, and the conversations become pretty much like the kind that would take place in any mindfulness or meditation group anywhere in the world; discussions about how we manage the ongoing, evolving, emerging experience of being human and interacting with ourselves, the world and each other in a manageable, sustainable, fulfilling way.

    I’ve always looked forward to pointing out the shift in the conversation, which takes place without any comment on the perils and pitfalls of “diagnosis” or “identity.” Simply working at bringing attention to what is merely happening, with interest if not curiosity, and without judgment, is the process and the goal. It ain’t easy, but it’s the way to detangle fear from the experience, which is usually what makes the difference.