Beautifully put! I agree these attitudes and systems which they support, create so-called āmental illnessā.
Fear of ambiguity is a very perceptive diagnosis
Thanks so much for sharing your story Jordan. Iām so sorry you were treated this way. I really appreciate how you explain so clearly the way that patients are ignored, overridden and gaslighted and how that disempowers us and causes extreme and life destroying harms to be perpetrated without accountability. We go to these people with trust and belief that they are doctors and know what they are doing, this is what we are taught to do. When something goes wrong, very often we are disbelieved and blamed.
This sums up the entire history of psychiatry/mind doctoring for me – experimental treatments which destroy lives and are enabled to continue by a systemic inability to believe patientās own words. It happens in medicine too, (I donāt believe psychiatry is a medical science) especially to women patients, but at least medicine has a history based in the scientific method and cannot gaslight so easily. Psychiatric treatment is little more than experimentation on systemically silenced people.
I hope and wish you all the best for your recovery.
Agree with all the above Birdsong, so much damage has been done by imposing clinical definitions and marginalising our knowledge.
These attitudes deny relationship and reinforce the power imbalance which violates our dignity and personhood and prevents recovery.
Belief and doubt are so powerful to recovery, as you say, and silencing our own meanings only disempowers us more.
Thank you! What I was trying to say, but we get so tired of saying it when it is a concept that seems so impossible for the industry to take in! So as usual we have more experts talking among themselves trying to define something when the people they claim to treat have all the knowledge they need. Studies like this are completely blinded by epistemic privilege – unable to recognise our ability to know or even speak.
Sadly this research misses the central point of the original recovery model which is that recovery is defined by the patient themself.
Concepts like recovery and person centred care have already been fully co-opted and reduced to rhetorical window dressing while the same dehumanising attitudes and practices continue as usual.
Determining whether services are actually meeting patient needs and supporting patients to achieve their own definition of recovery would be more useful than a trying to form a consensus idea of recovery as defined by clinicians (with a single token lived experience contribution).
Agree with everything you say! It must take some kind of split compartmentalised thinking to seriously believe this is a solution to the fundamental contradictions of psychiatric ideology.
I donāt think educating psychiatrists to be better debaters is going to change a mindset based in a corruption of the medical model. Psychiatry uses language and rhetoric – often dishonestly – to defend its model from the academic end. But psychiatry is not a philosophical endeavour or framed in social justice, It claims to be a science. So called ācultural competenceā in other power-based discourses will just be used as rhetorical self justification.
I agree with critical psychiatry that psychiatry needs to defend / critique / challenge its own scientific basis and its claim to be āevidence-basedā, it claims to be a science and that is what its power is based on. This is a diversion.
Cultural ācompetencyā looks like a power grab to co-opt discourses like philosophy and sociology to lend itself cultural legitimacy.
If psychiatry is really interested in cultural competence it needs to listen to its patients first. That would be radical!
I think I was quite explicit that I am not using the concept of trauma and traumatic injury as a psychiatric “disorder”. Please don’t misrepresent my words.
Iām so sorry to hear about your familyās terrifying experience and the traumatic effects it has had on your lives – the idea that these experiences canāt be talked about is horrific and shocking.
The determination of the Maga/Trump/2025 coalition to make some ideas unthinkable is authoritarianism 101.
I am not surprised to hear that trauma is considered a āwokeā concept – as the concept of trauma frequently draws attention to harms caused by abuses of power – so not a concept that an authoritarian regime would want to support.
I think the concept of traumatic injury – often as the real effects of power on our bodies and minds- can also be liberating and help us to reframe our experiences in terms of wider social forces. But the way it is framed as a ādisorderā in psychiatric discourse can hide these social origins and cover over real causes and prevent healing.
I agree we need to take the effects of adversity very seriously- that they cause deep and lasting effects for the individual and society. And that this understanding can be lost when everything upsetting is called trauma.
However, Iām not sure it is helpful to frame normal responses to adversity as an illness or disorder like OCD, GAD or āclinicalā depression – experiences which are not proven to be medical disorders and diseases – and, evidence is growing, are likely to be just different or more extreme responses to adversity.
Iām confused, it sounds like the authors of the paper are describing complex PTSD which was initially defined by Judith Herman as chronic, compounded, interpersonal trauma. I assumed that was clearly applicable to living through social and political upheaval, war and displacement.
I also am pretty sure that Herman in fact contextualised trauma very firmly in political and social conditions.
Interesting, but not surprising, that the authors identify a tendency to medicalise and decontextualise trauma – I thought by definition this would not be possible.
Great explanations of how trauma is a disruption of the individual-social , not just individual, in the paper.
I wonder if it is, not that the concept of PTS(D) depoliticises trauma, but that the people who use the concept as a diagnosis depoliticise it?
How can we ensure that any concept does not become commodified and individualised in a psychiatric industry that consumes every concept and shapes it to fits its own medical model?
I would include trauma in the social determinants of mental distress, rather than throw it out with the biomedical model.
Trauma is defined as the effect of social factors, which distinguishes it from the so-called “diseases”. This is why PTSD does not fit easily into the biomedical model and is not fully recognised by psychiatry.
Even “individual” childhood and developmental trauma always occurs in a context that is socially determined by factors such as parental isolation, lack of access to services, poverty, racism, intergenerational disadvantage etc.
Integrating our understanding of the effects of trauma with our understanding of the social factors that cause or contribute to trauma and psychological distress has seemed to be the obvious way forward for decades.
I agree that relational healing is probably one of the most important factors for trauma. But I don’t really get the jump from recognising the social determinants of psychological distress, to more drug treatment like psychedelics. Every decade or so psychiatry proposes a miracle chemical cure for harms which evidence overwhelmingly shows are socially and environmentally caused (or highly contributing) and therefore solvable, and chooses to kick the can of fixing them down the road.
If real attention, policy and action was addressed to social determinants and their effects, including trauma, the dominant psychiatric practices of diagnosis and medication would be mostly redundant. Support and healing could be better served by social workers and community support services, with therapy (or medication ) used only for temporary management of more serious effects of trauma and distress.
Loving the collective wisdom here! So funny how many āpatientsāā have similar views about clinicians lack of insight !
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Beautifully put! I agree these attitudes and systems which they support, create so-called āmental illnessā.
Fear of ambiguity is a very perceptive diagnosis
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Thanks so much for sharing your story Jordan. Iām so sorry you were treated this way. I really appreciate how you explain so clearly the way that patients are ignored, overridden and gaslighted and how that disempowers us and causes extreme and life destroying harms to be perpetrated without accountability. We go to these people with trust and belief that they are doctors and know what they are doing, this is what we are taught to do. When something goes wrong, very often we are disbelieved and blamed.
This sums up the entire history of psychiatry/mind doctoring for me – experimental treatments which destroy lives and are enabled to continue by a systemic inability to believe patientās own words. It happens in medicine too, (I donāt believe psychiatry is a medical science) especially to women patients, but at least medicine has a history based in the scientific method and cannot gaslight so easily. Psychiatric treatment is little more than experimentation on systemically silenced people.
I hope and wish you all the best for your recovery.
Report comment
Agree with all the above Birdsong, so much damage has been done by imposing clinical definitions and marginalising our knowledge.
These attitudes deny relationship and reinforce the power imbalance which violates our dignity and personhood and prevents recovery.
Belief and doubt are so powerful to recovery, as you say, and silencing our own meanings only disempowers us more.
Report comment
Thank you! What I was trying to say, but we get so tired of saying it when it is a concept that seems so impossible for the industry to take in! So as usual we have more experts talking among themselves trying to define something when the people they claim to treat have all the knowledge they need. Studies like this are completely blinded by epistemic privilege – unable to recognise our ability to know or even speak.
Report comment
Sadly this research misses the central point of the original recovery model which is that recovery is defined by the patient themself.
Concepts like recovery and person centred care have already been fully co-opted and reduced to rhetorical window dressing while the same dehumanising attitudes and practices continue as usual.
Determining whether services are actually meeting patient needs and supporting patients to achieve their own definition of recovery would be more useful than a trying to form a consensus idea of recovery as defined by clinicians (with a single token lived experience contribution).
Report comment
Agree with everything you say! It must take some kind of split compartmentalised thinking to seriously believe this is a solution to the fundamental contradictions of psychiatric ideology.
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Agree, and thanks! loved your analysis too!
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I donāt think educating psychiatrists to be better debaters is going to change a mindset based in a corruption of the medical model. Psychiatry uses language and rhetoric – often dishonestly – to defend its model from the academic end. But psychiatry is not a philosophical endeavour or framed in social justice, It claims to be a science. So called ācultural competenceā in other power-based discourses will just be used as rhetorical self justification.
I agree with critical psychiatry that psychiatry needs to defend / critique / challenge its own scientific basis and its claim to be āevidence-basedā, it claims to be a science and that is what its power is based on. This is a diversion.
Cultural ācompetencyā looks like a power grab to co-opt discourses like philosophy and sociology to lend itself cultural legitimacy.
If psychiatry is really interested in cultural competence it needs to listen to its patients first. That would be radical!
Report comment
I think I was quite explicit that I am not using the concept of trauma and traumatic injury as a psychiatric “disorder”. Please don’t misrepresent my words.
Report comment
Iām so sorry to hear about your familyās terrifying experience and the traumatic effects it has had on your lives – the idea that these experiences canāt be talked about is horrific and shocking.
The determination of the Maga/Trump/2025 coalition to make some ideas unthinkable is authoritarianism 101.
I am not surprised to hear that trauma is considered a āwokeā concept – as the concept of trauma frequently draws attention to harms caused by abuses of power – so not a concept that an authoritarian regime would want to support.
I think the concept of traumatic injury – often as the real effects of power on our bodies and minds- can also be liberating and help us to reframe our experiences in terms of wider social forces. But the way it is framed as a ādisorderā in psychiatric discourse can hide these social origins and cover over real causes and prevent healing.
I agree we need to take the effects of adversity very seriously- that they cause deep and lasting effects for the individual and society. And that this understanding can be lost when everything upsetting is called trauma.
However, Iām not sure it is helpful to frame normal responses to adversity as an illness or disorder like OCD, GAD or āclinicalā depression – experiences which are not proven to be medical disorders and diseases – and, evidence is growing, are likely to be just different or more extreme responses to adversity.
Report comment
Iām confused, it sounds like the authors of the paper are describing complex PTSD which was initially defined by Judith Herman as chronic, compounded, interpersonal trauma. I assumed that was clearly applicable to living through social and political upheaval, war and displacement.
I also am pretty sure that Herman in fact contextualised trauma very firmly in political and social conditions.
Interesting, but not surprising, that the authors identify a tendency to medicalise and decontextualise trauma – I thought by definition this would not be possible.
Great explanations of how trauma is a disruption of the individual-social , not just individual, in the paper.
I wonder if it is, not that the concept of PTS(D) depoliticises trauma, but that the people who use the concept as a diagnosis depoliticise it?
How can we ensure that any concept does not become commodified and individualised in a psychiatric industry that consumes every concept and shapes it to fits its own medical model?
Report comment
I would include trauma in the social determinants of mental distress, rather than throw it out with the biomedical model.
Trauma is defined as the effect of social factors, which distinguishes it from the so-called “diseases”. This is why PTSD does not fit easily into the biomedical model and is not fully recognised by psychiatry.
Even “individual” childhood and developmental trauma always occurs in a context that is socially determined by factors such as parental isolation, lack of access to services, poverty, racism, intergenerational disadvantage etc.
Integrating our understanding of the effects of trauma with our understanding of the social factors that cause or contribute to trauma and psychological distress has seemed to be the obvious way forward for decades.
I agree that relational healing is probably one of the most important factors for trauma. But I don’t really get the jump from recognising the social determinants of psychological distress, to more drug treatment like psychedelics. Every decade or so psychiatry proposes a miracle chemical cure for harms which evidence overwhelmingly shows are socially and environmentally caused (or highly contributing) and therefore solvable, and chooses to kick the can of fixing them down the road.
If real attention, policy and action was addressed to social determinants and their effects, including trauma, the dominant psychiatric practices of diagnosis and medication would be mostly redundant. Support and healing could be better served by social workers and community support services, with therapy (or medication ) used only for temporary management of more serious effects of trauma and distress.
Report comment