I was so sorry and devastated to read your blog. What happened to you is outrageous. Therapists who come from a deficit-driven viewpoint (regardless of their methodical orientation) can do so much harm!
You are absolutely right, psychotherapy can harm as well. In more than one way.
Daniel Macler has some good conversations about the downsides of psychotherapy. Here is one of them, focusing on psychotherapy within the American (NY) system: https://www.youtube.com/watch?v=f0Fi32LbXHA
I wish more practitioners, both doctors and therapists, would be more critical and careful, and more honest about the harm-benefit profile of their interventions, and equip their clients to have a good critical view themselves.
Thank you for this essay. I read it with interest.
I took particular interest in the part discussing the need to expand our understanding of the body-mind connection. I am totally into it. I would add to your list the potential issues of nutrients deficiencies, the feminine hormonal cycle and hormonal contraceptive methods that might greatly affect emotional well-being.
Your argument confirms my suspicion that what we call “the bio-medical approach” to mental health is flawed, not just due to its indifference to social-emotional and societal factors, but also due to its narrow, not-enough-biomedical lenses.
I would like to add a few points of criticism:
A) Among other biases, is the extraordinary professional bias towards psychotic symptoms and away from post-traumatic features. This bias is shown frequently in mental healthcare, and not by psychiatrists alone. The literature talks about the “diagnosis gap” of people with “severe mental illness” who often carry PTSD as well, but are rarely diagnosed with it. Watching this diagnosis bias in action, I daresay that more than a gap, we might be facing systemic misdiagnosis of psychosis, depression of people whom their main issue is post-traumaic mechanisms. This misdiagnosis is extremely harmful.
2) I do not agree that the requirement to undergo therapy helps improve practices. My close observations of a psychodynamic-oriented professional culture, in which psychotherapy students/candidates.professionals were expected to undergo treatment, didn’t reveal such advantage. In fact, it might creates other unpleasant biases.
I don’t care if psychiatrists undergo therapy themselves. I care very much to see them acquiring good counselling skills during their training, and then being ongoingly prompted to apply them.
3) What about the MEntal Health Acts? How does it support the moral corruption of doctors, and how should psychiatrists resist it?
4) Maybe most important is the way in which Psychiatry took a turn away from the ethos and ethics of healthcare provision, and sigled itself out as permitted to treat its patients according to substantially different standards.
I would iket to invite the readers to read the first paragraph of the article Ethical Principles and Skills in the Care of Mental Illness
(https://focus.psychiatryonline.org/doi/10.1176/foc.1.4.339)
Here is a quote:
“Mental illness influences beliefs, feelings, perceptions, behaviors, and motivations across time. It may interfere with one’s ability to speak, to arrange one’s thoughts, to know one’s preferences… Mental illness ultimately can shape one’s development, personality, and capacities for love, self-knowledge, self-reflection, and societal contribution. It is these qualities that define us as human, as individual, and perhaps as moral agents (1, 2).”
In other words, the authors suggest that people with “mental illness” are less human than the rest of us, and potentially immoral.
🙁
Steve, what is implied from your answer, and supported by something Nancy said, is that clinical researchers would be wiser to define intervention groups by complaints and “experienced issues in their lives” rather than by diagnosis.
Would you agree with that? Do you think designing research groups this way might improve the validity or usability of clinical research?
Hear, hear!
I loved your article. I loved your story and your message.
I think you are absolutely right: no treatment method guarantees success. We need to be flexible. We need to experiment with different things and understand what works / doesn’t work – and why.
Do you think there is a lack of honest conversation with therapy clients about the potential and limitations of therapy? Like, encouraging new clients to flag if things don’t work for them? I think that adaptations and personalisation of the therapy approach are crucial. And I hate the feeling that in some spaces there is a patient-blaming such as “treatment-resistant depression” [or whatever other ‘disorder’].
As a part B of it, I wish you agreed to write about the social and societal drives of suicide & suicidalily.
What does current evidence say about that?
I both worked in a psychiatric hospital and was admitted to medical/surgical wards, on the same timeframe and within the same health organisation.
I can testify that the medical doctors and nurses respected both my physical needs, emotional needs and my refusal to undertake certain intervention, in sharp contrast to what I witnessed and many testimonies I collected in the psych space.
In the “mental health” service, not just the staff suffered from reduced empathy, they could also neglect people’s physical and medical needs, dismissing their sound complaints as “poor insight”.
And I don’t believe it is due to lack of funding, as some people suggest. It is first and upmost due to the rotten culture and corruptive training provided by the field.
Steve, coming from this viewpoint, what would you think about initiations that try to bring emotional support back to community members? Things like Emotional CPR or Just Listening Community?
If you are right (which I am not entirely sure about), we need to stir away from professionalised emotional support and find “common” ways to provide it to one another. https://www.justlistening.com.au/
Thank you for this article! It is clear and brings up many good points.
I am not sure, however, about the necessity or wisdoms in expecting therapy trainees to undergo therapy themselves.
Clearly, they do need to have SOME kind of process to enhance their self-awareness and work through their challenges.
But is mandatory psychotherapy the solution?
In my home country, where psychodynamic approach is dominant, candidates are expected to have therapy themselves. Observing the professional culture, I am sceptical this leads to good outcomes.
More likely, I believe it leads to dogmatism and the continuing of poor professional culture. If you have therapy as a professional candidate, and you know that this is a factor in your chances to be accepted to an exclusive training program, you are likely to adopt and internalise whatever modelling your therapist offers you, with little healthy criticism of the process.
I don’t know what is the answer for that. Perhaps mandatory and frequent supervision, plus effective reporting channels that could help the client discuss and understand their experiences in therapy.
A friend of mine is a firm advocate for the client’s right to bring a companion to their therapy session, just like it is with medical appointments. So that therapy is not necessarily done behind closed doors.
MIA gives a proper stage to critique about police use in mental health crises, which is great. It also gives space to the stories of military and police personnel who have unique issues when being traumatised at work and suffering the consequences – for example, the (unethical?) lack of medical confidentiality and the reporting channel between her treating professionals and her supervisors, as described in the blog. I think it’s fair enough.
This research is nice, but it’s only Part 1 of what needs to be done.
In Part 2, responders need to be asked to delve into the professional education programs of MH professionals (from undergraduate courses up). They should be asked to identify components of this training that facilitate the staff’s wrong and harmful behaviours and other adversities they experienced in their hospitalisation.
We must break the wall between “consumer perspective” and “professional perspective” and give psychiatric survivors a real chance to reflect not just on their trauma, but also on what led to it, what enable it.
Research that focuses on direct patient experience only, might tempt policy makers to change the clinical environment while neglecting its roots. Or they might decide to add this or that tiny component to the clinical education about “person centre approach” or “trauma informed care”, while ignoring the existence of trauma-generating and dehumanising concepts such as ‘schizophrenia’, ‘BPD’, ‘poor insight’ and many others.
Trying to change the clinical practice while ignoring its rotten roots is likely to be futile.
This is outrageous.
The falsified STAR*D results have sent millions of people down an ineffective path. Moreover, they hinder recovery and remission that could have happened otherwise. They might have created increase in morbidity and mortality rather than decreasing it, due to significant side effects. The subsequent trend of widespread, long-term prescriptions of antidepressants has probably fuelled the chronicity of depression and devastating, debilitating withdrawal symptoms. In simple words, this publication helped to kill people and destroy lives.
We need to keep pushing the truth forward. We need to keep telling and retelling it over and over again.
Thank you, Robert. Thank you very much.
I was so sorry and devastated to read your blog. What happened to you is outrageous. Therapists who come from a deficit-driven viewpoint (regardless of their methodical orientation) can do so much harm!
You are absolutely right, psychotherapy can harm as well. In more than one way.
Daniel Macler has some good conversations about the downsides of psychotherapy. Here is one of them, focusing on psychotherapy within the American (NY) system:
https://www.youtube.com/watch?v=f0Fi32LbXHA
And here is one I am watching right now… critical thoughts of psychotherapy in general.
https://www.youtube.com/watch?v=G2-p4A7Bl6s
I wish more practitioners, both doctors and therapists, would be more critical and careful, and more honest about the harm-benefit profile of their interventions, and equip their clients to have a good critical view themselves.
Report comment
Thank you for this essay. I read it with interest.
I took particular interest in the part discussing the need to expand our understanding of the body-mind connection. I am totally into it. I would add to your list the potential issues of nutrients deficiencies, the feminine hormonal cycle and hormonal contraceptive methods that might greatly affect emotional well-being.
Your argument confirms my suspicion that what we call “the bio-medical approach” to mental health is flawed, not just due to its indifference to social-emotional and societal factors, but also due to its narrow, not-enough-biomedical lenses.
I would like to add a few points of criticism:
A) Among other biases, is the extraordinary professional bias towards psychotic symptoms and away from post-traumatic features. This bias is shown frequently in mental healthcare, and not by psychiatrists alone. The literature talks about the “diagnosis gap” of people with “severe mental illness” who often carry PTSD as well, but are rarely diagnosed with it. Watching this diagnosis bias in action, I daresay that more than a gap, we might be facing systemic misdiagnosis of psychosis, depression of people whom their main issue is post-traumaic mechanisms. This misdiagnosis is extremely harmful.
2) I do not agree that the requirement to undergo therapy helps improve practices. My close observations of a psychodynamic-oriented professional culture, in which psychotherapy students/candidates.professionals were expected to undergo treatment, didn’t reveal such advantage. In fact, it might creates other unpleasant biases.
I don’t care if psychiatrists undergo therapy themselves. I care very much to see them acquiring good counselling skills during their training, and then being ongoingly prompted to apply them.
3) What about the MEntal Health Acts? How does it support the moral corruption of doctors, and how should psychiatrists resist it?
4) Maybe most important is the way in which Psychiatry took a turn away from the ethos and ethics of healthcare provision, and sigled itself out as permitted to treat its patients according to substantially different standards.
I would iket to invite the readers to read the first paragraph of the article Ethical Principles and Skills in the Care of Mental Illness
(https://focus.psychiatryonline.org/doi/10.1176/foc.1.4.339)
Here is a quote:
“Mental illness influences beliefs, feelings, perceptions, behaviors, and motivations across time. It may interfere with one’s ability to speak, to arrange one’s thoughts, to know one’s preferences… Mental illness ultimately can shape one’s development, personality, and capacities for love, self-knowledge, self-reflection, and societal contribution. It is these qualities that define us as human, as individual, and perhaps as moral agents (1, 2).”
In other words, the authors suggest that people with “mental illness” are less human than the rest of us, and potentially immoral.
🙁
Report comment
Steve, what is implied from your answer, and supported by something Nancy said, is that clinical researchers would be wiser to define intervention groups by complaints and “experienced issues in their lives” rather than by diagnosis.
Would you agree with that? Do you think designing research groups this way might improve the validity or usability of clinical research?
Report comment
Hear, hear!
I loved your article. I loved your story and your message.
I think you are absolutely right: no treatment method guarantees success. We need to be flexible. We need to experiment with different things and understand what works / doesn’t work – and why.
Do you think there is a lack of honest conversation with therapy clients about the potential and limitations of therapy? Like, encouraging new clients to flag if things don’t work for them? I think that adaptations and personalisation of the therapy approach are crucial. And I hate the feeling that in some spaces there is a patient-blaming such as “treatment-resistant depression” [or whatever other ‘disorder’].
Report comment
Thank you for this blog.
As a part B of it, I wish you agreed to write about the social and societal drives of suicide & suicidalily.
What does current evidence say about that?
Report comment
Hear, Hear!
I support every word.
I both worked in a psychiatric hospital and was admitted to medical/surgical wards, on the same timeframe and within the same health organisation.
I can testify that the medical doctors and nurses respected both my physical needs, emotional needs and my refusal to undertake certain intervention, in sharp contrast to what I witnessed and many testimonies I collected in the psych space.
In the “mental health” service, not just the staff suffered from reduced empathy, they could also neglect people’s physical and medical needs, dismissing their sound complaints as “poor insight”.
And I don’t believe it is due to lack of funding, as some people suggest. It is first and upmost due to the rotten culture and corruptive training provided by the field.
Report comment
Steve, coming from this viewpoint, what would you think about initiations that try to bring emotional support back to community members? Things like Emotional CPR or Just Listening Community?
If you are right (which I am not entirely sure about), we need to stir away from professionalised emotional support and find “common” ways to provide it to one another.
https://www.justlistening.com.au/
Report comment
Thank you for this article! It is clear and brings up many good points.
I am not sure, however, about the necessity or wisdoms in expecting therapy trainees to undergo therapy themselves.
Clearly, they do need to have SOME kind of process to enhance their self-awareness and work through their challenges.
But is mandatory psychotherapy the solution?
In my home country, where psychodynamic approach is dominant, candidates are expected to have therapy themselves. Observing the professional culture, I am sceptical this leads to good outcomes.
More likely, I believe it leads to dogmatism and the continuing of poor professional culture. If you have therapy as a professional candidate, and you know that this is a factor in your chances to be accepted to an exclusive training program, you are likely to adopt and internalise whatever modelling your therapist offers you, with little healthy criticism of the process.
I don’t know what is the answer for that. Perhaps mandatory and frequent supervision, plus effective reporting channels that could help the client discuss and understand their experiences in therapy.
A friend of mine is a firm advocate for the client’s right to bring a companion to their therapy session, just like it is with medical appointments. So that therapy is not necessarily done behind closed doors.
Report comment
MIA gives a proper stage to critique about police use in mental health crises, which is great. It also gives space to the stories of military and police personnel who have unique issues when being traumatised at work and suffering the consequences – for example, the (unethical?) lack of medical confidentiality and the reporting channel between her treating professionals and her supervisors, as described in the blog. I think it’s fair enough.
Report comment
This research is nice, but it’s only Part 1 of what needs to be done.
In Part 2, responders need to be asked to delve into the professional education programs of MH professionals (from undergraduate courses up). They should be asked to identify components of this training that facilitate the staff’s wrong and harmful behaviours and other adversities they experienced in their hospitalisation.
We must break the wall between “consumer perspective” and “professional perspective” and give psychiatric survivors a real chance to reflect not just on their trauma, but also on what led to it, what enable it.
Research that focuses on direct patient experience only, might tempt policy makers to change the clinical environment while neglecting its roots. Or they might decide to add this or that tiny component to the clinical education about “person centre approach” or “trauma informed care”, while ignoring the existence of trauma-generating and dehumanising concepts such as ‘schizophrenia’, ‘BPD’, ‘poor insight’ and many others.
Trying to change the clinical practice while ignoring its rotten roots is likely to be futile.
Report comment
This is outrageous.
The falsified STAR*D results have sent millions of people down an ineffective path. Moreover, they hinder recovery and remission that could have happened otherwise. They might have created increase in morbidity and mortality rather than decreasing it, due to significant side effects. The subsequent trend of widespread, long-term prescriptions of antidepressants has probably fuelled the chronicity of depression and devastating, debilitating withdrawal symptoms. In simple words, this publication helped to kill people and destroy lives.
We need to keep pushing the truth forward. We need to keep telling and retelling it over and over again.
Thank you, Robert. Thank you very much.
Report comment