I first encountered Paula through her amazing and brilliant book They Say Youāre Crazy. It was one of those rare moments of finding a professional expressing ideas in a way consistent with the beliefs of the psychiatric survivorsā movement. She was a great teacher and a wonderful ally to psychiatric survivors and rights advocates everywhere. Paula was so generous- I contacted her as a stranger asking for a blurb for my book, wrote a powerful blurb, and became a valued friend. I will miss her so much.
For starters, please stop referring to it as trauma-informed ācare,ā which implies an unequal, hierarchical relationship. Letās call it trauma-informed āapproachesā or something similar.
Weāre not talking about how organizations operate or ābusinessā – weāre talking about how people with power and influence use their position to take advantage of others.
Weāre not talking here about a āprofessionā that needs to be āregulated.ā Weāre talking about people who play various roles in a movement- some paid, some not- who are activists in a movement. So your suggestion isnāt applicable.
What we need is for the movement to stop turning a blind eye when people who have influence in the movement use it to harm or take advantage of others.
Bob, thank you for addressing this outrageous behavior on the part of the NYT. Itās shameful that the paper printed a vicious attack as part of an obituary – as a former obit writer, Iāve never seen that done before. And Shorter should have had the decency to say nothing, under the circumstances. Thanks for calling them out!
Thatās exactly who Iām talking about. Yes, they still exist. And in the article, we discussed their advocacy activity in the 80s and 90s. Not really sure why youāre trying to argue about this?
Don Karp, I’m not sure why you say our history is “off.’ There is indeed an organization in New York State called Mental Patients Liberation Alliance of ex-patients that has been doing advocacy since the 1970s.
And I’m not clear what you mean by a “trained peer.” What Sera’s article discusses is the MHA’s pseudo “national certification” of peer staff – I don’t see how that relates to our article.
Oldhead, please explain your strategy for eliminating forced psychiatry. In the decades Iāve been working on this issue, itās only gotten worse. Yes, itās an incredible evil. No, I donāt realistically see a way to stop it. But thatās not what this article is about. Itās about trying to stop one egregious manifestation of involving people with psychiatric histories in the oppression of others.
If you mean should peer support staff be unionized and should their union negotiate terms that would protect them from having to do unethical tasks, yes, I think thatās an interesting idea to consider. But I also think those job categories are a bad idea.
I agree that we need to work to end the legal power of the metal health system to force ātreatmentā on people. I doubt that will happen in my lifetime. In the meantime, I think itās ethically problematic to put āpeerā staff in positions where their work is implicitly or explicitly involved with coercion.
As usual, Bruce Levine gets at the heart of the matter. Many people who work on trauma issues believe routine ACEs screening is a bad idea that can potentially be re-traumatizing and shouldnāt be done in schools or medical settings. Trauma should only be discussed in the context of a relationship of mutual trust. The essence of trauma-informed approaches is to assume that everyone is a potential trauma survivor, and to do everything in a trauma- informed way.
Thank you so much for very carefully and factually rebutting the lies that Torrey, Jaffe, and their followers have used for 20 years to spread this assault on the liberty of people with psychiatric labels. But please stop referring to this practice by its 1984 Doublespeak name āAssisted Outpatient Treatmentā without quotation marks. Force-drugging people with dangerous, ineffective drugs is is no way āassistance.ā When we unsuccessfully fought to stop its implementation in NY 20 years ago, we called it Involuntary Outpatient Commitment, and thatās an accurate description.
Paula, thank you so much for stating this so clearly! I feel similarly whenever I read a piece on MIA that uses diagnostic language without stating that these labels have no scientific basis. I have tremendous respect for Bob Whitaker and all he has done for our movement, but I completely disagree with his stand on this issue. Continuing to use diagnostic language without critiquing it just because the general public is familiar with it is not a reasonable position. I fail to see how thatās any different from using racist, sexist, or homophobic language because you think people understand those terms better.
Marie, I don’t understand why you think that Sera’s analogy (“not all white people” “not all NAMIs) insults you as a white person. You don’t seem to understand the concept of white privilege. To over-simplify, it’s not saying that white people don’t face hardship, it’s saying the hardships white people may encounter are NOT because of the color of their skin. Why is that hard t understand and why do you feel insulted?
No, Oldhead, the āpeer industryā was not created to undermine the psychiatric survivor movement. Those of us who did some of the early work in this area – which we never envisioned as an āindustryā were trying to find ways to bring genuine grassroots peer support to people who were trapped in the system. With hindsight, I can say we were naive, that the entire idea was co-opted and disfigured by the system. In hindsight, it was a bad idea, and Iām sorry I had anything to do with it 25 years ago. But we were certainly not ātreasonous,ā and you give the system too much credit if you believe that the system created this on purpose to hijack the movement. The system is not that organized to dream up such a thing. What they did to the original idea is horrible, I agree. But you donāt seem to be fully aware of the history.
Iāve spent years studying the history of public mental health systems in the US, and there were no āgood old days.ā The folks like Dix who argued for creating bucolic refuges instead of the admittedly vile county poorhouses that often locked up people deemed mad in the 19th century sold the public a bill of goods. These mid-late 19th century āasylumsā were horrid places of often life-long confinement in inhumane conditions.
Christian, I am still in tears from reading your account of the horrors you experienced in UeckermĆ¼nde, and am so sorry that this happened to you. I appreciate you sharing your experiences and those of your friends so that people understand that psychiatry is often brutal and harms real people. You have done a great service to other survivors and to people concerned about these abuses worldwide.
Thank you – Darby
Itās just a statement of fact- Dontre Hamilton was given a diagnosis of āschizophreniaā by the mental health system. The author didnāt endorse the concept of āschizophrenia,ā she just reported a fact.
Sera, thank you for calling out the widespread and offensive belief that racism is a āmental illness.ā And thanks especially for successfully turning the spotlight from an obnoxious white celebrity to the systemic racism that led to murder by police of a black man with a psychiatric label.
Julie, many of us have been telling our horror stories for years, and I agree, we don’t get listened to very seriously. For 30 years, I’ve been part of the human rights movement for people with psychiatric histories, and I know/knew people who’ve been involved in that movement for 40 years or more. I’m not really sure what the “recovery” movement is or who identifies with it – I certainly don’t, and I don’t personally know people who use that kind of language. Are you familiar with the National Association for Rights Protections and Advocacy (NARPA)? I’ve been involved with them for 25 years, and I think you’d find people there who feel like you do.
knowledge is power, I disagree with your perspective on “peer” staff; in fact, your attitude is precisely what my blog post is trying to warn about. I think it would be ideal if peer support were provided through stand-alone, independent organizations run by people with psychiatric histories instead. I think it’s next to impossible for “peer” staff to work in clinical organizations and maintain the integrity of peer support values. The only training “peer” staff need is about how to be in genuine, mutual, trauma-informed supportive relationships with others.
Julie, I appreciate you sharing the bizarre situations you’ve encountered trying to apply for “peer” jobs. Most of the places that have these jobs have no clue what peer support is, they are just looking for cheap labor, in my opinion. A number of people have told me they are sharing this blog and my article with employers or with state mental health agencies that promote “certified peer specialists.”
The original Soteria House was a residential program for people who met the DSM III criteria for “schizophrenia” that did not use psychiatric drugs. To my knowledge, some staff were clinicians and some were not, but I’ve never read anything that said any staff were ex-patients who provided peer support.
rcarr, I think that “peer support” in the psychiatric survivor movement and “peer support” in the school systems have very different origins and practices.
Madmom, thank you so much for your comments about this piece. In terms of what qualifies people as “peer staff,” I think it varies from state to state or organization to organization, and I certainly don’t feel qualified to make that determination.
I said nothing about āthe mental health movement, āthe recovery movement,ā nor the āpeer movementā – whatever those are. Iām part of the psychiatric survivor/human rights movement. Iām not sure why you feel the need to attack me and other psychiatric survivors who blog on MIA.
Thanks, Ron. Sometimes I find it hard to believe I was that naive. It is painful to reflect back on that time when we were so hopeful. Maybe itās a sign that itās time for me to retire.
Oldhead, I did not say those terms were used in the 69s and 70s- I said I created these categories while I was doing my lit review. As far as I can recall, no one used the term āpeer supportā unti the late 80s-early 90s, and I think the term originated in the system, not the movement. Before then, people I knew called it self-help.
What I mean by co-optation is: “The process by which a dominant group tries to absorb or neutralize a smaller, weaker group that poses a threat to its continued power.”
I’m not sure that people who identify is “psychiatric survivors” are the folks who take these “peer” jobs.
Thanks for your comments. Itās been my experience that many professional staff donāt understand the philosophy of peer support, and that, as you point out, many do understand but are threatened by it. What I find particularly disturbing is the extent to which this co-optation is entrenched throughout the system. I wish I could see a way out.
I donāt disagree with your assessment, but there are literally thousands of people currently employed in these co-opted āpeerā jobs, so it is a real thing.
Iām not sure I understand your comments. My post is indeed about the co-optation of psychiatric survivor knowledge and the psychiatric survivor movement.
And while it was beyond the scope of this blog, Iām not a fan of the word āpeer,ā except as an adjective. āPeer supportā works for me because it describes Support by oneās equal. But referring to human beings or job titles as āpeersā doesnāt work for me.
Forced treatment is a human rights violation according to the UN. Making forced treatment illegal is the first step toward fixing the mess that is called the public mental health system. Getting rid of the DSM is the second step.
Sera, your meticulous, powerful response to the way youāve been treated as an activist mirrors my feelings about my 30 years in this movement. As painful as it is to read, youāve articulated so brilliantly the daily othering and degradation many of us face in our work. Iām really tired too. But I also find strength in reading and identifying with your analysis. Thank you!
Kat, thank you so much for your willingness to share your narrative about your trauma history from childhood and the re-traumatization youāve been subjected to by the mental health system. You expressed this all-too common situation so powerfully! Until the system understands that most of us with psychiatric diagnoses are trauma survivors, and make an honest effort to change policy and practice to end the systemās continued abuse, nothing will change. Thanks for speaking out for us all!
Thank you, Noel! Thanks especially for clarifying the extent to which trauma is at the root of what gets diagnosed as “mental illness.”
As a trauma survivor and a psychiatric survivor, I must take issue with Slaying the Dragon contradicting the statement that “aspects of mental health treatment can be very helpful for many.” While most of it wasn’t helpful to me, I found EMDR extraordinarily helpful in resolving many trauma responses; in fact, it was just short of a miracle.
I wish people would recognize that in this context, “peer” is not a noun but a descriptor. As we all know, “peer” simply means “an equal.” It has come to be used as a euphemism for “mental patient.” It’s fine to talk about “peer support,” which means “support among equals.” It is not OK to refer to a person as “peer” when what you really mean is they work in a peer role.”
I could write a treatise on why MHA (which is now indistinguishable in its philosophy from the Treatment Advocacy Center) taking it upon themselves to create a national certification contributes to the on-going downfall of peer support, which has been happening for 20+ years, but I’m going to save that for my own article on the subject. Very briefly, the main problems is that for more than 20 years, people in power – mostly people who have not experienced the mental health system first-hand – have conflated the practice of peer support (or what those of us in the ex-patients movement used to call self-help back in the 80s and early 90s) with a job title called “peer specialist,” in which people with psychiatric histories are hired to work within the system, often to do tasks that support the system in oppressing other people with diagnoses, rather than in providing genuine peer support based on mutuality. I know – I was in the thick of this 25 years ago, helping to create the first Peer Specialist civil service title in the nation in NY. I naively thought this was a way to bring genuine peer support to people trapped in the system. What I saw instead was people hired in those roles browbeat and demeaned by professionals into doing things like pressuring people to take drugs against their will, reporting on people to professionals, and also being treated like dirt by their co-workers. I’m sorry I was involved in this fiasco – it was a serious mistake. What I learned from that experience was that so-called “peer staff” should never be hired by traditional agencies, that the only way to bring genuine peer support to people involved in the mental health system is through independent, free-standing peer-run organizations that are dedicated to mutuality. Anything else is harmful. What is happening now with “peer specialists” working in mainstream organizations makes me despair.
Thanks, Eric Coates – you make a number of crucial points and it is important that people be reminded of the tragedy of the Nazi extermination of people with psychiatric labels and also of the lack of proof that so-called “mental illness” is inherited. But can we please stop referring to people with that diagnosis as “schizophrenics?” It’s demeaning.
This is incredibly offensive. You are playing onto the hands of people who use psychiatric language to demean others. I’m sick to death of trying to explain to progressives why it is harmful to people with psychiatric histories to weaponize psychiatric language against political opponents, but I’m disturbed that someone in our movement is doing this. Shery Mead, Chris Hansen, Sera Davidow, Cathy Bustin and I will be doing a workshop at NARPA next week about why this is harmful.
This article only makes sense if one believes that DSM diagnoses have any validity, which I do not. While I agree that practitioners shouldn’t publicly diagnose people they don’t know or speculate about their “mental health,” I think that misses the point. People- practitioners and the public- should stop talking about Trump’s “mental health,” which is a red herring deflecting attention from the real issue – his reprehensible behavior. Putting a psychiatric label on it is not relevant, and only serves to inflame the public’s dislike and dismissiveness toward those of us with psychiatric labels.
Unless I somehow missed it, I didn’t see anything in your article proposing ending forced treatment. I can’t work collaboratively with anyone who sanctions forced treatment in any circumstances. That’s pretty basic. The rest is window dressing.
Michael, 30 years ago, I began working at the policy level at the NYState Office of Mental Health and first encountered NAMI, which was indeed pushing drugs and forced treatment, which they continue to do. They were responsible for the passage of Involuntary Outpatient Committment in 1999 in NY, which has hurt 1000s of people over the years. They also perpetuate the medical model myth, which says that so-called “mental illnesses” are “diseases” just like diabetes. The research says otherwise. Psych drugs, according to recent research, kill more people than heroin. Research shows that people on long-term psych drugs due in average 25 years early. And you want to defend the Big Parma funded lobbying & hate group that perpetuates this dangerous stuff? I don’t understand.
Sera, thanks for critiquing the parallels between these two hate groups. It’s really chilling that these groups have so successfully hijacked the conversations and made it so hard for people speaking for themselves to get a public platform.
I have mixed feelings about this piece. I don’t believe in the concept of “substance use disorders,” nor am I thrilled with the idea of psychiatrists “prescribing” hallucinogens to people. But I personally benefited greatly in my own development from the conscious use of hallucinogens 40-some years ago, and I think they should legal and available to people who want to use them. And I don’t believe that back in the 60s and 70s “the psychiatric wards were full of psychedelically induced schizophrenia” (not a term I think is valid in any event) – I’d like to see some citations that show this.
Good point, Laysha! (And excellent piece, Sera!). There is no “gap” – as Laysha noted, many of us believe there should be no certification, national or otherwise. I find state certification equally as appalling, excellent in the rare instance where it’s controlled by people who’ve been through the system. I fought certification in NY when I worked for the state, but the person who followed me in that role has imposed it.
Danny, thanks so much for writing this important piece! I’m so glad you had the opportunity to learn about non-illness ways of looking at distress and that you have so articulately expressed this for others who have only heard illness explanations!
Frank, I simply don’t understand that argument that “institutional psychiatry IS slavery.” That’s just patently false. Psychiatry does not have legal ownership of a human being for her/his entire life. Institutional psychiatry is coercive, it is damaging, it is harmful. However, it is not – literally nor figuratively – “slavery.” And like Sera, I can’t even wrap my head around why some white people in this movement insist on using this term even though black people have made it clear they find that language hurtful.
I don’t understand the vitriol of many of the comments from white people on this thread. Why can’t people have an honest , respectful conversation about racism without getting all nasty and defensive?
Thank you, Iden, Sera & Earl for this much-needed piece. In particular, I’m relieved that you told people to stop using the term “psychiatric slavery” – I’ve had an on-going argument for years with a white movement activist who insists on using this term, and I hope this person will listen now. I also appreciate your calling out the white SAMHSA administrator whose distortion of black leaders’ words at Alternatives (and the puzzling Oprah reference) was so appalling. I’m sure you will get offensive (or at least eye roll-worthy) comments to this piece… but I guess at least it’s good to know where people are coming from. Oh … I see there are some already! So thank you again for saying so clearly what we as a movement need to hear!
dkjamil, I am opposed to the many ways that psychiatry oppresses people, and I think it’s incorrect and very harmful to call it “slavery.” This is a hurtful false analogy which dishonors the memory of actual enslaved people and it is racist. Making these kinds of claims fuels the sense I’ve heard expressed by many African-Americans that our movement is not welcoming to them.
Corinna, I agree – when certain trauma advocates start talking about neurobiology, I see it as just another way to call it all a “brain disease,” and I completely reject that approach. I’m tired of hearing people ask psychiatrists about what drugs are best for trauma.
Bruce, thank you so much for this important critique. I especially appreciate the phrase “The Rehumanizing Resistance!ā And thank you for pointing out the co-optation inherent in hiring “peer” staff, not to provide genuine peer support, but to help maintain psychiatry’s control.
Perhaps one reason for Everyday Feminism’s knee-jerk love-fest with psychiatry may be explained by the fact its co-publisher is a man with a degree in Cognitive Neuroscience from Brown. http://everydayfeminism.com/about-ef/about-derek-ellerman/
Apparently LOTS of us get EXACTLY what Sera is writing about! As a psychiatric survivor who’s been involved in progressive movements for 40+ years, it’s really clear from my experience that the left mostly doesn’t “get it” about psychiatric oppression. Progressives seem able to reject the biased b.s. of the mainstream media about every issue except this one. Why is that? And why is railing against oppression “finger-shaking” in your mind?
I find it frustrating but not surprising that comments on a blog post about the serious issue of women being silenced and mistreated in the movement have turned ugly, with men ranting about the non-existent issue of “reverse sexism” instead of acknowledging the truth: that the practices Sera described in her blog post happen in our movement every day, and that women – and the movement as a whole – are harmed by this. I’ve been involved in this movement for almost 30 years. It was a problem then, it continues to be a problem, and it needs to stop. I appreciate comments from men who recognize this as a problem and who express their solidarity with women.
Sera, thanks for calling public attention to this widespread problem, which I’ve certainly both witnessed and experienced way too often over the 25+ years I’ve been part of this movement. It’s ubiquitous and I’m sure many other women are fed up with this, too. And one wonders why funders and non-profit boards who are aware of these issues are not holding men accountable.
There are significant differences between peer respite programs and Soteria. The most obvious difference is that peer respites are staffed by people with psychiatric histories who provide peer support. Peer respites (which i believe is an unfortunate choce of terms for many reasons), are intended for brief stays, while Soteria programs are more open ended. There are also major definitional differences among programs that call themselves peer respites. I think this is a complicated area that requires a lot more examination and discussion.
Jeanne, thank you so much for being willing to publicly express such intense personal experiences in such a thoughtful and powerful way. As a trauma survivor, I was deeply touched by your piece. I look forward to reading more from you!
David, thank you for addressing this important issue. The same thing has been happening in the US for years,as these roles have been re-defined by professionals not as “peer support” roles, but as low-paying paraprofessional roles that don’t really require experiential knowledge as an ex-patient, but are just a cheap labor force . As Alberta & Ploski note in the article you cited, the entire enterprise has been co-opted. Also I wanted to say as a non-Dutch person, I had some trouble understanding the acronyms you used. But that did not detract from the importance of your message. Thanks for putting this out there!
Sera, as ever, you have named a problem that seems invisible to most non- survivors one will encounter at conferences and trying to work with bureaucrats. And sadly this particular problem seems to have remained unaddressed in the 25+ years I’ve been doing this work. It’s very discouraging that we keep saying these things and people still don’t get it. It’s not rocket surgery.
I agree, Sera, it’s not enough to keep talking to ourselves- although there are plenty of people who attend Alternatives Conferences who have never been exposed to such ideas – and that approaches like Hearing Voices and Alternatives to Suicide need to be presented and highlighted at conferences that tend to attract “professionals.” But as you recently noted, attending those conferences can be painful.
As always, thank you, Sera, for saying strongly and clearly what needs to be said! I hope people form the Hearing Voices network will flood Alternatives with workshop proposals AND I hope you will push them for a keynote!
Huh. Tell that to Ronald Pies. He claims that psychiatry never ever even told anyone anything about a so-called chemical imbalance. Maybe he should have a chat with Colin Powell and the presenter who misunderstood your question. Thank you, as always, for being incredibly clear and on point. I would not have it in me to be so nice in print to people spreading dangerous lies like this.
Sera, Thanks for writing about one of my favorite ridiculous ideas, “evidenced-based.” As an evaluator by profession, I think it is important for us to ask “whose evidence?” and “evidence of what?” when people throw this silly phrase around. Researchers (and the people who pay them) can make data say pretty much anything they like, so who paid for and conducted the research that is being cited as “evidence” is a key question. Also, exactly what did they set out to prove? There’s probably evidence that forced drugging and community treatment orders lower hospitalization rates, but that in no way proves that forced drugging and keeping people under surveillance is a good thing. If survivor/ researchers had the opportunity to set the research agenda, develop outcome measures for liberation,and were funded to conduct research, maybe we could start talking about evidence.
Noel, thank you for your honest and enlightening report of your experience at the ISPS meeting -now i wish I had gone! I avoided it because I had a negative experience in the past, where psychiatric survivors were treated rather dismissively at the meeting.Perhaps things ARE changing, after all!
David Walker, thank you so much, both for calling attention to the ground-breaking work of Pemina Yellowbird, and the vital work that you did in the archives to document the treatment of Native Americans by the psychiatric system. Documenting the history of institutionalized psychiatry in America is a crucial undertaking – so many thousands of people’s lives were literally stolen from them. And the powers that be would like to sweep all that under the rug as if it weren’t still happening in a way that differs more in style than in substance from the horrors of the past.
While I appreciate that the author raised issues related to the social and economic aspects of disability, he did not acknowledge that these get short shrift precisely because of the hegemony of he medical model. And I agree with commenters who did not like the academic tine of this post, which is not appropriate for a popular website and serves only to create distance between the author and the audience. And the unreflective rant about “rigid anti-psychiatry” views was not helpful in furthering the author’s arguments. It was a nasty cheap shot.
Among the key points the author glossed over is that even though people like Torrey and Insel may say things that acknowledge many of the flaws of Big Pharma and the medical model, that has no bearing on how psychiatry -particularly public psychiatry -is practiced. People are still put on an assembly line of poly-pharmacy, which DOES cause significant harm and disability to many people,even if the author does not wish to acknowledge this.
The message I got from this post is that those of us who are concerned with the dangers of psychiatric medication and forced treatment should just shut up or it will be our fault if a right-wing congress passes n oppressive mental health bill. That is nonsense.
It’s hard to comment without seeing the instrument, but this is certainly not a new approach. Sally Rogers, Judi Chamberlin & colleagues developed the Empowerment Scale in 1997. In the the early 2000s, survivor/researchers Dumont, Ridgway,Onken,Dornan, & Ralph developed the ROSI (Recovery Oriented Systems Indicators) & Ridgway developed the Recovery-Enhancing Environment (REE) measure.
Bob, thanks for writing this informative piece. I was appalled at how off-base the Bazelon Center’s position is on this issue. With alleged “friends” like that, we certainly don’t need enemies.
While this is positive,it just points out that “mental health act detentions” are punushment, not treatment. If it were actually treatment,people would be released when the treatment was effective, rather than after an arbitrary time limit.
I hate to over-use quotation marks, but it’s important to me that I make it clear that I don’t consider extreme states “illnesses” or “disorders.” Also, based on almost 30 years of reading the literature on the effecicacy (or lack thereof) and “side-effects”of a range of psychiatric drugs, I don’t advocate their use – or at least, I advocate that people who consider taking them fully inform thmeselves of the potenital risks and benefits.
But based on personal experience, I feel very differently about the voluntary use of psychoactive substances for the expansion of counsciousness and personal growth. I’ve experienced what others might call “depression” most of my life – although I call it alienation and despair. One of the things that has made a difference in my understanding of myself and my relationship to the universe is nitrous oxide (not done recreationally, but in the dentist’schair). On one such occaission, I experienced the purest joy, the deepest calm, a sense that everything was completely and impeccably understood and that all was perfect as it was. I merged seamlessly with all matter and energy ā I WAS all matter and all energy – and no longer a separate entity.
More than any psychiatric treatment or therapy I experienced before then -or in the 40 years since then- this experience with nitrous oxide had a more profound amelioration of my sense of alienation and despair. Theimperfectly recollected feeling of that moment is often the only thing that keeps me in this body. So it’s hard for me to understand why this might be a problem.
The last think I expected to see in an MIA headline was the term “the mentally ill.” Does youreally not undertand why this phrase – which is the quivalent of a racial epithet- is offensive?
I’m glad this issue is being discussed, but I think it’s important to state a few things that weren’t explicitly mentioned. First, sexual abuse is not the only form of childhood abuse that may result in trauma responses. Second, events that occurr in adulthood can also result in trauma responses. Third, not every horrific experience results in a trauma response. Trauma happens when a horriying event overwhelms an individual’s ability to cope. Everyone’s coping skills and abilities are different, and each person’s may be different at different times in their lives. And fourth, the overwhelming majority of people in the mental health system are trauma survivors,so the system needs to adopt trauma-informed approaches to be used universally with everyone.
I found this piece very confusing and hard to follow; in fact, I’m not even sure I understand what the author is trying to say. Is she really advocating a return to solitary confinement, which research has shown is detrimental to physical, mental and emotional well-being, and which some of us equate with torture? And it is news to me that commitment to a psychiatric facility is no longer “unlimited.” Tell that to people who have spent the last 40 years in state hospitals and are still there.
It seems obvious to me why many people who are homeless do not want to enter frightening unsafe shelters that impose all kinds of infantalizing rules on people in order to have a roof over their head.
The author seems to accept Allen Frances’s terms of debate, but I do not accept DSM terminology (i.e., psychosis) related to the experience of extreme states. Why, in the face of all the evidence to date, must we assume that some kind of drug is the “answer” for people experiencing extreme states? The people I know who recovered from so-called “psychosis” did so after rejecting the drugs.
I have no idea what is meant by “dine and dash.” In fact, my primary reaction to this piece is simply that I don’t understand its message.
While I fully agree that “depression” is not a biochemical matter, there is a robust literature – including works like Aldous Huxley’s The Doors of Perception – addressing the notion that positive altered states, including those induced by hallucinogens- can be helpful in personal growth. So while I’m not endorsing the use of ketamine for “depression,” I don’t think we should dismiss hallucinogens as potentially useful tools for people experiencing emotional distress. As someone who has been labled with “depression,” I personally have benfitted greatly from such experiences over the decades.
Thanks, Ted, for saying what needed to be said ver concisely. I’m kind of amazed when I hear some people in the movement embrace Allen Frances as if he is an ally. He clearly is not.
Thnak you for pointing out this glaring omission, Phil. I don’t understand how such an obviously well-intentioned report overlooked the need to include the participation of people of color.
I must agree with B, above – āmedical harm aware advocateā is not a clear term. Corinna, of course you are free to use whatever terms work best for you; why do you want to deny others that freedom as well? People who use the term “anti-psychiatry” know what it means; that’s why they use it.
This is an appalling breach of trust and quite unethical. Such services ought to be transparent. If the crisis line bills itself as confidential and then secretly sends police to people’s house, it is dishonest. The ethical thing to do, if they really feel compelled to intervene, is to warn callers up front that this is their practice.
Thank you so much for this clear, concise explanation, Bonnie Burstow!. There are literally hundreds of people with whom I want to share this, immediately!
I did a workshop yesterday at NARPA on Trauma-Informed Peer Support in Traditional Provider Agencies. Brief description: “There has been a recent, rapid expansion of āpeer support specialistā positions within traditional mental health programs. These jobs are usually designed by professionals who are unfamiliar with the principles and practices of peer support. Research shows that this often places āpeerā staff in untenable workplace situations and impedes clientsā access to genuine peer support services. This workshop will provide concrete examples of how administrators, managers, supervisors and non-peer colleagues can facilitate the successful integration of trauma-informed peer support into their agenciesā service offerings.”
Tthis is a difficult question with no easy answers.More than 20 years ago, my staff and I at NY State Office of MentalHealth created the country’s 1st civil service job title for “peer specilaists.” For many reasons,I feel that was a mistake. The role was not understood by managers and clinicians, “peer” saff were often badly mistreated and made to do things that violated peer support values. I wish we had never created this job title, but that train has long ago left the station. It’s important to try to fix the way “peer”staff are used. It would be much better if all such peer support servcies could be delivered through peer-run organizations instead of within the system.
While I don’t support the use of drugs to alter memories, I’m wondering in what way the techniques described in the article are substantively different from what happens in EMDR therapy. My experience with EMDR is that a traumatic memory is recalled and then I am able to distance myself from the emotional impact of the memory by figuratively cutting the emotional cord between the memory and my current self. In this case, the memory is altered because the psychic and emotional charge has been disconnected from it. I think that’s altering a memory in a positive and healing way, and I don’t see an ethical problem with that.
I haven’t read Aslam’s piece in Psych Services yet, but my initial reaction to this brief notice is that “peer” staff should absolutely not be receiving services from the same agency where they work. It’s completely unethical to put these staff members in that kind of a dual role. In fact, it’s amazing to me that the administration of the agency would allow such a thing.
Thank you for raising this discussion. I spend most of my time working on issues related to trauma and especially to trauma-informed peer support. It’s clear that most people with psychiatric labels are trauma survivors, and the way the DSM manufactures diagnoses tends to keep that fact from being obvious to professions and people who would just as soon not have to deal with this issue. I think there are plenty of possible reasons why the field chooses to ignore the evidence, including financial interests and the fact that many professionals are also trauma survivors and may have not addressed the ramifications of that. A larger issue is that to deal with the impact of trauma, we would have to address the root causes of violence in our world, which is an overwhelming thought.
I appreciate the very concrete suggestions you offered here. But I’d like to point out that for some of us, these feelings are not a “temporary problem,” but a long-term or recurrent burden that doesn’t ever really go away.
Wayne raises good points. I’ve found that advanced degrees in the mental health field tends to equal indoctrination into the medical model. And I’m glad he raised the issue that we are not “cases” and don’t need to be “managed.” So for me the question is not what kind of standardized training should a “case manager” have, but how can we create alternatives to the existing mental health system to provide voluntary support to people in emotional distress that they will find helpful? The existing system pretty much does everything wrong. It takes distressed people who are mostly trauma survivors and subjects them to the very things that make trauma survivors feel worse – forced drugging and attempts to control their daily lives. And Peter, I wonder what you mean when you talk about “prevention” and “treatment”? I don’t have an illness, so I don’t need treatment. And what would have prevented a lifetime of emotional distress would have been stopping child abuse, and a safe caring place for an abused child to heal. The system offers nothing like that.
Francesca Allen, so you think censorship is justificed if people use rhetoric you don’t like? Did you really just say that?
I don’t see how the Unitarian Church’s decision is anything but cowardice based on a serious misunderstanding of human rights and social justice on their part.
Well, actually, Dr. Torrey, there IS such a thing as “anognosia,” and it’s a very specifc neurological term that you routinely use incorrectly… but theb, I’m sure you know that, since you routinely use langauge in a distred way, sucj as calling involuntary outpatient commitment “assisted outpatient treatment,” like people are being “helped” when they’re force-drugged with dangerous toxic chemicals. And then there’s the possibility that emotional and mental states that you call :sicknesses” are not sicknesses in any logical sense of the word at all.
Leah, thank you so much for telling your story, which echoes the experiences of so many of us who have been shamed, blamed, and forced to accept “treatment” that didn’t meet our needs because we wanted to die. One would hope that the so-called “helping” professions would react with compassion to people who are in such despair that the only escape they can see is to end their lives. And the public seems to have absorbed these ideas – people say things like how selfish people are who complete suicide, or how “unfathomable” it is that someone would want to die. Those of us who have been there understand and our insights would be valuable to the field if they would only listen. I’m so glad you are out there saying this to people who need to hear it!
Jim, I’m conflicted… While I agree with Peter Dwyer’s comments about the strength of your case, I also agree with Mary Saunder’s assertion that this is not a very rights-friendly SCOTUS. I’m deeply appreciative of all the work you do, and I expect that you probably have a gut feeling about what you want to do here? Whatever you do,just know how valuable your work is to our movement!
Tina, thank you for this thoughtful commentary on a book I’ve always felt I should read but never actually attempted (yet). It is fascinating that although Foucault was in some sense one of us (madpeople), he did not bother to discuss the writings of other people deemed mad.
The following example form my own experience illustrates the idea of “entering into a personās reality to persuade them of a beneficial act.” I had a friend on a locked unit who wanted to leave, but because he kept telling the staff he was Jesus Christ, they wouldn’t release him. I advised him that if he wanted out, he should stop saying that. And he said “But Jesus cannot lie.” I’m not sure where this came from, but I responded “But Jesus doesn’t brag, either,” and he agreed that he could stop telling them who he was, and they let him go the next day.
Greg, I love what you wrote, but in my experience, the general public, public officials,Big Pharma, the media, politicians, academia, and organzied psychiatry have no idea that biopsychiatry has been been disroven and that the the argument is over and we won. The public mental helath system, and those who organize and pay for the system, are still in charge and they continue to do harm to countless thousands of people. So we haven’t won yet.
This headline strikes me as misleading, since it sounds like it’s saying that cannabis use causes psychosis (which in fact does not seem to be what this reserach says at all).
I first encountered Paula through her amazing and brilliant book They Say Youāre Crazy. It was one of those rare moments of finding a professional expressing ideas in a way consistent with the beliefs of the psychiatric survivorsā movement. She was a great teacher and a wonderful ally to psychiatric survivors and rights advocates everywhere. Paula was so generous- I contacted her as a stranger asking for a blurb for my book, wrote a powerful blurb, and became a valued friend. I will miss her so much.
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For starters, please stop referring to it as trauma-informed ācare,ā which implies an unequal, hierarchical relationship. Letās call it trauma-informed āapproachesā or something similar.
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Weāre not talking about how organizations operate or ābusinessā – weāre talking about how people with power and influence use their position to take advantage of others.
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Weāre not talking here about a āprofessionā that needs to be āregulated.ā Weāre talking about people who play various roles in a movement- some paid, some not- who are activists in a movement. So your suggestion isnāt applicable.
What we need is for the movement to stop turning a blind eye when people who have influence in the movement use it to harm or take advantage of others.
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Bob, thank you for addressing this outrageous behavior on the part of the NYT. Itās shameful that the paper printed a vicious attack as part of an obituary – as a former obit writer, Iāve never seen that done before. And Shorter should have had the decency to say nothing, under the circumstances. Thanks for calling them out!
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Thatās exactly who Iām talking about. Yes, they still exist. And in the article, we discussed their advocacy activity in the 80s and 90s. Not really sure why youāre trying to argue about this?
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You’re welcome. And yes, we’d be pleased for you to reprint our article in your organization’s newsletter – thank you.
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Don Karp, I’m not sure why you say our history is “off.’ There is indeed an organization in New York State called Mental Patients Liberation Alliance of ex-patients that has been doing advocacy since the 1970s.
And I’m not clear what you mean by a “trained peer.” What Sera’s article discusses is the MHA’s pseudo “national certification” of peer staff – I don’t see how that relates to our article.
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I don’t disagree. But in the meantime, the system needs to stop hiring people with psych histories into jobs that require them to oppress their peers.
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Oldhead, please explain your strategy for eliminating forced psychiatry. In the decades Iāve been working on this issue, itās only gotten worse. Yes, itās an incredible evil. No, I donāt realistically see a way to stop it. But thatās not what this article is about. Itās about trying to stop one egregious manifestation of involving people with psychiatric histories in the oppression of others.
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I agree that thereās a need to end coercive psychiatry. Thatās a larger discussion and isnāt what this article addresses.
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Yes, thatās what our article was about.
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The message of our article was to stop using peer workers to prop up the coercive psychiatric system. Was that not clear?
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If you mean should peer support staff be unionized and should their union negotiate terms that would protect them from having to do unethical tasks, yes, I think thatās an interesting idea to consider. But I also think those job categories are a bad idea.
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I agree that we need to work to end the legal power of the metal health system to force ātreatmentā on people. I doubt that will happen in my lifetime. In the meantime, I think itās ethically problematic to put āpeerā staff in positions where their work is implicitly or explicitly involved with coercion.
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As usual, Bruce Levine gets at the heart of the matter. Many people who work on trauma issues believe routine ACEs screening is a bad idea that can potentially be re-traumatizing and shouldnāt be done in schools or medical settings. Trauma should only be discussed in the context of a relationship of mutual trust. The essence of trauma-informed approaches is to assume that everyone is a potential trauma survivor, and to do everything in a trauma- informed way.
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Thank you so much for very carefully and factually rebutting the lies that Torrey, Jaffe, and their followers have used for 20 years to spread this assault on the liberty of people with psychiatric labels. But please stop referring to this practice by its 1984 Doublespeak name āAssisted Outpatient Treatmentā without quotation marks. Force-drugging people with dangerous, ineffective drugs is is no way āassistance.ā When we unsuccessfully fought to stop its implementation in NY 20 years ago, we called it Involuntary Outpatient Commitment, and thatās an accurate description.
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Paula, thank you so much for stating this so clearly! I feel similarly whenever I read a piece on MIA that uses diagnostic language without stating that these labels have no scientific basis. I have tremendous respect for Bob Whitaker and all he has done for our movement, but I completely disagree with his stand on this issue. Continuing to use diagnostic language without critiquing it just because the general public is familiar with it is not a reasonable position. I fail to see how thatās any different from using racist, sexist, or homophobic language because you think people understand those terms better.
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Marie, I don’t understand why you think that Sera’s analogy (“not all white people” “not all NAMIs) insults you as a white person. You don’t seem to understand the concept of white privilege. To over-simplify, it’s not saying that white people don’t face hardship, it’s saying the hardships white people may encounter are NOT because of the color of their skin. Why is that hard t understand and why do you feel insulted?
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No, Oldhead, the āpeer industryā was not created to undermine the psychiatric survivor movement. Those of us who did some of the early work in this area – which we never envisioned as an āindustryā were trying to find ways to bring genuine grassroots peer support to people who were trapped in the system. With hindsight, I can say we were naive, that the entire idea was co-opted and disfigured by the system. In hindsight, it was a bad idea, and Iām sorry I had anything to do with it 25 years ago. But we were certainly not ātreasonous,ā and you give the system too much credit if you believe that the system created this on purpose to hijack the movement. The system is not that organized to dream up such a thing. What they did to the original idea is horrible, I agree. But you donāt seem to be fully aware of the history.
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Iāve spent years studying the history of public mental health systems in the US, and there were no āgood old days.ā The folks like Dix who argued for creating bucolic refuges instead of the admittedly vile county poorhouses that often locked up people deemed mad in the 19th century sold the public a bill of goods. These mid-late 19th century āasylumsā were horrid places of often life-long confinement in inhumane conditions.
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Thank you , Sera. This piece moved me to tears and I appreciate both what you taught me through this piece and how beautifully you wrote it.
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Christian, I am still in tears from reading your account of the horrors you experienced in UeckermĆ¼nde, and am so sorry that this happened to you. I appreciate you sharing your experiences and those of your friends so that people understand that psychiatry is often brutal and harms real people. You have done a great service to other survivors and to people concerned about these abuses worldwide.
Thank you – Darby
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Itās just a statement of fact- Dontre Hamilton was given a diagnosis of āschizophreniaā by the mental health system. The author didnāt endorse the concept of āschizophrenia,ā she just reported a fact.
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Sera, thank you for calling out the widespread and offensive belief that racism is a āmental illness.ā And thanks especially for successfully turning the spotlight from an obnoxious white celebrity to the systemic racism that led to murder by police of a black man with a psychiatric label.
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Noel, thank you for this very thoughtful article!
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Yes, language matters… and the “illness” language Veryan Richard suggests in the Lancet piece is not helpful. This just perpetuates the problem.
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Julie, many of us have been telling our horror stories for years, and I agree, we don’t get listened to very seriously. For 30 years, I’ve been part of the human rights movement for people with psychiatric histories, and I know/knew people who’ve been involved in that movement for 40 years or more. I’m not really sure what the “recovery” movement is or who identifies with it – I certainly don’t, and I don’t personally know people who use that kind of language. Are you familiar with the National Association for Rights Protections and Advocacy (NARPA)? I’ve been involved with them for 25 years, and I think you’d find people there who feel like you do.
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knowledge is power, I disagree with your perspective on “peer” staff; in fact, your attitude is precisely what my blog post is trying to warn about. I think it would be ideal if peer support were provided through stand-alone, independent organizations run by people with psychiatric histories instead. I think it’s next to impossible for “peer” staff to work in clinical organizations and maintain the integrity of peer support values. The only training “peer” staff need is about how to be in genuine, mutual, trauma-informed supportive relationships with others.
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Thank you! While I don’t share your optimism, I admire it!
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Julie, I appreciate you sharing the bizarre situations you’ve encountered trying to apply for “peer” jobs. Most of the places that have these jobs have no clue what peer support is, they are just looking for cheap labor, in my opinion. A number of people have told me they are sharing this blog and my article with employers or with state mental health agencies that promote “certified peer specialists.”
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Again, Frank, I’m not sure what the “mental health movement” is or who is part of it.
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The original Soteria House was a residential program for people who met the DSM III criteria for “schizophrenia” that did not use psychiatric drugs. To my knowledge, some staff were clinicians and some were not, but I’ve never read anything that said any staff were ex-patients who provided peer support.
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Historically, I stand by what I wrote.
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Julie, your experiences sound awful but, rom the things I’ve heard over the years, sadly not uncommon.
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One point I was trying to make, lissen, is that it has already become that unrecognizable creation.
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rcarr, I think that “peer support” in the psychiatric survivor movement and “peer support” in the school systems have very different origins and practices.
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Madmom, thank you so much for your comments about this piece. In terms of what qualifies people as “peer staff,” I think it varies from state to state or organization to organization, and I certainly don’t feel qualified to make that determination.
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I said nothing about āthe mental health movement, āthe recovery movement,ā nor the āpeer movementā – whatever those are. Iām part of the psychiatric survivor/human rights movement. Iām not sure why you feel the need to attack me and other psychiatric survivors who blog on MIA.
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Thanks, Ron. Sometimes I find it hard to believe I was that naive. It is painful to reflect back on that time when we were so hopeful. Maybe itās a sign that itās time for me to retire.
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Thanks so much for sharing your positive experiences with IPS.
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Oldhead, I did not say those terms were used in the 69s and 70s- I said I created these categories while I was doing my lit review. As far as I can recall, no one used the term āpeer supportā unti the late 80s-early 90s, and I think the term originated in the system, not the movement. Before then, people I knew called it self-help.
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John Hogget, thatās fascinating! Thanks for sharing that information!
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Thank you for your thoughtful response- I wish I shared your optimism. I really donāt believe that this situation can be fixed.
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What I mean by co-optation is: “The process by which a dominant group tries to absorb or neutralize a smaller, weaker group that poses a threat to its continued power.”
I’m not sure that people who identify is “psychiatric survivors” are the folks who take these “peer” jobs.
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Thanks for your comments. Itās been my experience that many professional staff donāt understand the philosophy of peer support, and that, as you point out, many do understand but are threatened by it. What I find particularly disturbing is the extent to which this co-optation is entrenched throughout the system. I wish I could see a way out.
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I donāt disagree with your assessment, but there are literally thousands of people currently employed in these co-opted āpeerā jobs, so it is a real thing.
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Iām sorry – I seem to have posted this comment in the wrong spot- I was replying to Frank Blankenship ās comment
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Iām not sure I understand your comments. My post is indeed about the co-optation of psychiatric survivor knowledge and the psychiatric survivor movement.
And while it was beyond the scope of this blog, Iām not a fan of the word āpeer,ā except as an adjective. āPeer supportā works for me because it describes Support by oneās equal. But referring to human beings or job titles as āpeersā doesnāt work for me.
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Forced treatment is a human rights violation according to the UN. Making forced treatment illegal is the first step toward fixing the mess that is called the public mental health system. Getting rid of the DSM is the second step.
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Seriously? You find this blog funny? I don’t get it.
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Sera, your meticulous, powerful response to the way youāve been treated as an activist mirrors my feelings about my 30 years in this movement. As painful as it is to read, youāve articulated so brilliantly the daily othering and degradation many of us face in our work. Iām really tired too. But I also find strength in reading and identifying with your analysis. Thank you!
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Kat, thank you so much for your willingness to share your narrative about your trauma history from childhood and the re-traumatization youāve been subjected to by the mental health system. You expressed this all-too common situation so powerfully! Until the system understands that most of us with psychiatric diagnoses are trauma survivors, and make an honest effort to change policy and practice to end the systemās continued abuse, nothing will change. Thanks for speaking out for us all!
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Thank you, Noel! Thanks especially for clarifying the extent to which trauma is at the root of what gets diagnosed as “mental illness.”
As a trauma survivor and a psychiatric survivor, I must take issue with Slaying the Dragon contradicting the statement that “aspects of mental health treatment can be very helpful for many.” While most of it wasn’t helpful to me, I found EMDR extraordinarily helpful in resolving many trauma responses; in fact, it was just short of a miracle.
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Amity Green, I published this article 14 years ago based on an extensive oral history interview with Kate about her experiences as a psychiatric survivor: http://www.community-consortium.org/pdfs/Interview%20with%20Kate%20Millett.pdf
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I wish people would recognize that in this context, “peer” is not a noun but a descriptor. As we all know, “peer” simply means “an equal.” It has come to be used as a euphemism for “mental patient.” It’s fine to talk about “peer support,” which means “support among equals.” It is not OK to refer to a person as “peer” when what you really mean is they work in a peer role.”
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Squash, I have no clue what your comment means.
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I could write a treatise on why MHA (which is now indistinguishable in its philosophy from the Treatment Advocacy Center) taking it upon themselves to create a national certification contributes to the on-going downfall of peer support, which has been happening for 20+ years, but I’m going to save that for my own article on the subject. Very briefly, the main problems is that for more than 20 years, people in power – mostly people who have not experienced the mental health system first-hand – have conflated the practice of peer support (or what those of us in the ex-patients movement used to call self-help back in the 80s and early 90s) with a job title called “peer specialist,” in which people with psychiatric histories are hired to work within the system, often to do tasks that support the system in oppressing other people with diagnoses, rather than in providing genuine peer support based on mutuality. I know – I was in the thick of this 25 years ago, helping to create the first Peer Specialist civil service title in the nation in NY. I naively thought this was a way to bring genuine peer support to people trapped in the system. What I saw instead was people hired in those roles browbeat and demeaned by professionals into doing things like pressuring people to take drugs against their will, reporting on people to professionals, and also being treated like dirt by their co-workers. I’m sorry I was involved in this fiasco – it was a serious mistake. What I learned from that experience was that so-called “peer staff” should never be hired by traditional agencies, that the only way to bring genuine peer support to people involved in the mental health system is through independent, free-standing peer-run organizations that are dedicated to mutuality. Anything else is harmful. What is happening now with “peer specialists” working in mainstream organizations makes me despair.
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Thanks, Eric Coates – you make a number of crucial points and it is important that people be reminded of the tragedy of the Nazi extermination of people with psychiatric labels and also of the lack of proof that so-called “mental illness” is inherited. But can we please stop referring to people with that diagnosis as “schizophrenics?” It’s demeaning.
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This is incredibly offensive. You are playing onto the hands of people who use psychiatric language to demean others. I’m sick to death of trying to explain to progressives why it is harmful to people with psychiatric histories to weaponize psychiatric language against political opponents, but I’m disturbed that someone in our movement is doing this. Shery Mead, Chris Hansen, Sera Davidow, Cathy Bustin and I will be doing a workshop at NARPA next week about why this is harmful.
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I agree, oldhead… I’m fed up with people weaponizing psychiatric language against political opponents.
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This article only makes sense if one believes that DSM diagnoses have any validity, which I do not. While I agree that practitioners shouldn’t publicly diagnose people they don’t know or speculate about their “mental health,” I think that misses the point. People- practitioners and the public- should stop talking about Trump’s “mental health,” which is a red herring deflecting attention from the real issue – his reprehensible behavior. Putting a psychiatric label on it is not relevant, and only serves to inflame the public’s dislike and dismissiveness toward those of us with psychiatric labels.
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Unless I somehow missed it, I didn’t see anything in your article proposing ending forced treatment. I can’t work collaboratively with anyone who sanctions forced treatment in any circumstances. That’s pretty basic. The rest is window dressing.
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Michael, 30 years ago, I began working at the policy level at the NYState Office of Mental Health and first encountered NAMI, which was indeed pushing drugs and forced treatment, which they continue to do. They were responsible for the passage of Involuntary Outpatient Committment in 1999 in NY, which has hurt 1000s of people over the years. They also perpetuate the medical model myth, which says that so-called “mental illnesses” are “diseases” just like diabetes. The research says otherwise. Psych drugs, according to recent research, kill more people than heroin. Research shows that people on long-term psych drugs due in average 25 years early. And you want to defend the Big Parma funded lobbying & hate group that perpetuates this dangerous stuff? I don’t understand.
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Sera, thanks for critiquing the parallels between these two hate groups. It’s really chilling that these groups have so successfully hijacked the conversations and made it so hard for people speaking for themselves to get a public platform.
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I have mixed feelings about this piece. I don’t believe in the concept of “substance use disorders,” nor am I thrilled with the idea of psychiatrists “prescribing” hallucinogens to people. But I personally benefited greatly in my own development from the conscious use of hallucinogens 40-some years ago, and I think they should legal and available to people who want to use them. And I don’t believe that back in the 60s and 70s “the psychiatric wards were full of psychedelically induced schizophrenia” (not a term I think is valid in any event) – I’d like to see some citations that show this.
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Good point, Laysha! (And excellent piece, Sera!). There is no “gap” – as Laysha noted, many of us believe there should be no certification, national or otherwise. I find state certification equally as appalling, excellent in the rare instance where it’s controlled by people who’ve been through the system. I fought certification in NY when I worked for the state, but the person who followed me in that role has imposed it.
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Danny, thanks so much for writing this important piece! I’m so glad you had the opportunity to learn about non-illness ways of looking at distress and that you have so articulately expressed this for others who have only heard illness explanations!
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I guess you haven’t read Loren Mosher’s resignation letter from the APA? http://www.narpa.org/mosher.htm
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Frank, I simply don’t understand that argument that “institutional psychiatry IS slavery.” That’s just patently false. Psychiatry does not have legal ownership of a human being for her/his entire life. Institutional psychiatry is coercive, it is damaging, it is harmful. However, it is not – literally nor figuratively – “slavery.” And like Sera, I can’t even wrap my head around why some white people in this movement insist on using this term even though black people have made it clear they find that language hurtful.
I don’t understand the vitriol of many of the comments from white people on this thread. Why can’t people have an honest , respectful conversation about racism without getting all nasty and defensive?
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Thank you, Iden, Sera & Earl for this much-needed piece. In particular, I’m relieved that you told people to stop using the term “psychiatric slavery” – I’ve had an on-going argument for years with a white movement activist who insists on using this term, and I hope this person will listen now. I also appreciate your calling out the white SAMHSA administrator whose distortion of black leaders’ words at Alternatives (and the puzzling Oprah reference) was so appalling. I’m sure you will get offensive (or at least eye roll-worthy) comments to this piece… but I guess at least it’s good to know where people are coming from. Oh … I see there are some already! So thank you again for saying so clearly what we as a movement need to hear!
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dkjamil, I am opposed to the many ways that psychiatry oppresses people, and I think it’s incorrect and very harmful to call it “slavery.” This is a hurtful false analogy which dishonors the memory of actual enslaved people and it is racist. Making these kinds of claims fuels the sense I’ve heard expressed by many African-Americans that our movement is not welcoming to them.
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I’m sorry, mistyped your name, Noel!
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Thanks, Nicole, for this important piece!
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Corinna, I agree – when certain trauma advocates start talking about neurobiology, I see it as just another way to call it all a “brain disease,” and I completely reject that approach. I’m tired of hearing people ask psychiatrists about what drugs are best for trauma.
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Bruce, thank you so much for this important critique. I especially appreciate the phrase “The Rehumanizing Resistance!ā And thank you for pointing out the co-optation inherent in hiring “peer” staff, not to provide genuine peer support, but to help maintain psychiatry’s control.
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Perhaps one reason for Everyday Feminism’s knee-jerk love-fest with psychiatry may be explained by the fact its co-publisher is a man with a degree in Cognitive Neuroscience from Brown. http://everydayfeminism.com/about-ef/about-derek-ellerman/
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Apparently LOTS of us get EXACTLY what Sera is writing about! As a psychiatric survivor who’s been involved in progressive movements for 40+ years, it’s really clear from my experience that the left mostly doesn’t “get it” about psychiatric oppression. Progressives seem able to reject the biased b.s. of the mainstream media about every issue except this one. Why is that? And why is railing against oppression “finger-shaking” in your mind?
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I find it frustrating but not surprising that comments on a blog post about the serious issue of women being silenced and mistreated in the movement have turned ugly, with men ranting about the non-existent issue of “reverse sexism” instead of acknowledging the truth: that the practices Sera described in her blog post happen in our movement every day, and that women – and the movement as a whole – are harmed by this. I’ve been involved in this movement for almost 30 years. It was a problem then, it continues to be a problem, and it needs to stop. I appreciate comments from men who recognize this as a problem and who express their solidarity with women.
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Sera, thanks for calling public attention to this widespread problem, which I’ve certainly both witnessed and experienced way too often over the 25+ years I’ve been part of this movement. It’s ubiquitous and I’m sure many other women are fed up with this, too. And one wonders why funders and non-profit boards who are aware of these issues are not holding men accountable.
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There are significant differences between peer respite programs and Soteria. The most obvious difference is that peer respites are staffed by people with psychiatric histories who provide peer support. Peer respites (which i believe is an unfortunate choce of terms for many reasons), are intended for brief stays, while Soteria programs are more open ended. There are also major definitional differences among programs that call themselves peer respites. I think this is a complicated area that requires a lot more examination and discussion.
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Hmmm… I actually had an article published in that journal more than 2o years ago but I can’t remember what it was about…. I’ll see if I can find it.
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Jeanne, thank you so much for being willing to publicly express such intense personal experiences in such a thoughtful and powerful way. As a trauma survivor, I was deeply touched by your piece. I look forward to reading more from you!
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David, thank you for addressing this important issue. The same thing has been happening in the US for years,as these roles have been re-defined by professionals not as “peer support” roles, but as low-paying paraprofessional roles that don’t really require experiential knowledge as an ex-patient, but are just a cheap labor force . As Alberta & Ploski note in the article you cited, the entire enterprise has been co-opted. Also I wanted to say as a non-Dutch person, I had some trouble understanding the acronyms you used. But that did not detract from the importance of your message. Thanks for putting this out there!
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Sera, as ever, you have named a problem that seems invisible to most non- survivors one will encounter at conferences and trying to work with bureaucrats. And sadly this particular problem seems to have remained unaddressed in the 25+ years I’ve been doing this work. It’s very discouraging that we keep saying these things and people still don’t get it. It’s not rocket surgery.
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I agree, Sera, it’s not enough to keep talking to ourselves- although there are plenty of people who attend Alternatives Conferences who have never been exposed to such ideas – and that approaches like Hearing Voices and Alternatives to Suicide need to be presented and highlighted at conferences that tend to attract “professionals.” But as you recently noted, attending those conferences can be painful.
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As always, thank you, Sera, for saying strongly and clearly what needs to be said! I hope people form the Hearing Voices network will flood Alternatives with workshop proposals AND I hope you will push them for a keynote!
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Huh. Tell that to Ronald Pies. He claims that psychiatry never ever even told anyone anything about a so-called chemical imbalance. Maybe he should have a chat with Colin Powell and the presenter who misunderstood your question. Thank you, as always, for being incredibly clear and on point. I would not have it in me to be so nice in print to people spreading dangerous lies like this.
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Sera, Thanks for writing about one of my favorite ridiculous ideas, “evidenced-based.” As an evaluator by profession, I think it is important for us to ask “whose evidence?” and “evidence of what?” when people throw this silly phrase around. Researchers (and the people who pay them) can make data say pretty much anything they like, so who paid for and conducted the research that is being cited as “evidence” is a key question. Also, exactly what did they set out to prove? There’s probably evidence that forced drugging and community treatment orders lower hospitalization rates, but that in no way proves that forced drugging and keeping people under surveillance is a good thing. If survivor/ researchers had the opportunity to set the research agenda, develop outcome measures for liberation,and were funded to conduct research, maybe we could start talking about evidence.
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Noel, thank you for your honest and enlightening report of your experience at the ISPS meeting -now i wish I had gone! I avoided it because I had a negative experience in the past, where psychiatric survivors were treated rather dismissively at the meeting.Perhaps things ARE changing, after all!
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Thank you, Bob, for this insightful critique of Lieberman’s book, and for saving me from having to read it.
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David Walker, thank you so much, both for calling attention to the ground-breaking work of Pemina Yellowbird, and the vital work that you did in the archives to document the treatment of Native Americans by the psychiatric system. Documenting the history of institutionalized psychiatry in America is a crucial undertaking – so many thousands of people’s lives were literally stolen from them. And the powers that be would like to sweep all that under the rug as if it weren’t still happening in a way that differs more in style than in substance from the horrors of the past.
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While I appreciate that the author raised issues related to the social and economic aspects of disability, he did not acknowledge that these get short shrift precisely because of the hegemony of he medical model. And I agree with commenters who did not like the academic tine of this post, which is not appropriate for a popular website and serves only to create distance between the author and the audience. And the unreflective rant about “rigid anti-psychiatry” views was not helpful in furthering the author’s arguments. It was a nasty cheap shot.
Among the key points the author glossed over is that even though people like Torrey and Insel may say things that acknowledge many of the flaws of Big Pharma and the medical model, that has no bearing on how psychiatry -particularly public psychiatry -is practiced. People are still put on an assembly line of poly-pharmacy, which DOES cause significant harm and disability to many people,even if the author does not wish to acknowledge this.
The message I got from this post is that those of us who are concerned with the dangers of psychiatric medication and forced treatment should just shut up or it will be our fault if a right-wing congress passes n oppressive mental health bill. That is nonsense.
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Ron, thanks so much for sharing these reflections and for honoring the memory of Leonard Frank with your words.
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It’s hard to comment without seeing the instrument, but this is certainly not a new approach. Sally Rogers, Judi Chamberlin & colleagues developed the Empowerment Scale in 1997. In the the early 2000s, survivor/researchers Dumont, Ridgway,Onken,Dornan, & Ralph developed the ROSI (Recovery Oriented Systems Indicators) & Ridgway developed the Recovery-Enhancing Environment (REE) measure.
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Bob, thanks for writing this informative piece. I was appalled at how off-base the Bazelon Center’s position is on this issue. With alleged “friends” like that, we certainly don’t need enemies.
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While this is positive,it just points out that “mental health act detentions” are punushment, not treatment. If it were actually treatment,people would be released when the treatment was effective, rather than after an arbitrary time limit.
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I hate to over-use quotation marks, but it’s important to me that I make it clear that I don’t consider extreme states “illnesses” or “disorders.” Also, based on almost 30 years of reading the literature on the effecicacy (or lack thereof) and “side-effects”of a range of psychiatric drugs, I don’t advocate their use – or at least, I advocate that people who consider taking them fully inform thmeselves of the potenital risks and benefits.
But based on personal experience, I feel very differently about the voluntary use of psychoactive substances for the expansion of counsciousness and personal growth. I’ve experienced what others might call “depression” most of my life – although I call it alienation and despair. One of the things that has made a difference in my understanding of myself and my relationship to the universe is nitrous oxide (not done recreationally, but in the dentist’schair). On one such occaission, I experienced the purest joy, the deepest calm, a sense that everything was completely and impeccably understood and that all was perfect as it was. I merged seamlessly with all matter and energy ā I WAS all matter and all energy – and no longer a separate entity.
More than any psychiatric treatment or therapy I experienced before then -or in the 40 years since then- this experience with nitrous oxide had a more profound amelioration of my sense of alienation and despair. Theimperfectly recollected feeling of that moment is often the only thing that keeps me in this body. So it’s hard for me to understand why this might be a problem.
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The last think I expected to see in an MIA headline was the term “the mentally ill.” Does youreally not undertand why this phrase – which is the quivalent of a racial epithet- is offensive?
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I’m glad this issue is being discussed, but I think it’s important to state a few things that weren’t explicitly mentioned. First, sexual abuse is not the only form of childhood abuse that may result in trauma responses. Second, events that occurr in adulthood can also result in trauma responses. Third, not every horrific experience results in a trauma response. Trauma happens when a horriying event overwhelms an individual’s ability to cope. Everyone’s coping skills and abilities are different, and each person’s may be different at different times in their lives. And fourth, the overwhelming majority of people in the mental health system are trauma survivors,so the system needs to adopt trauma-informed approaches to be used universally with everyone.
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I found this piece very confusing and hard to follow; in fact, I’m not even sure I understand what the author is trying to say. Is she really advocating a return to solitary confinement, which research has shown is detrimental to physical, mental and emotional well-being, and which some of us equate with torture? And it is news to me that commitment to a psychiatric facility is no longer “unlimited.” Tell that to people who have spent the last 40 years in state hospitals and are still there.
It seems obvious to me why many people who are homeless do not want to enter frightening unsafe shelters that impose all kinds of infantalizing rules on people in order to have a roof over their head.
The author seems to accept Allen Frances’s terms of debate, but I do not accept DSM terminology (i.e., psychosis) related to the experience of extreme states. Why, in the face of all the evidence to date, must we assume that some kind of drug is the “answer” for people experiencing extreme states? The people I know who recovered from so-called “psychosis” did so after rejecting the drugs.
I have no idea what is meant by “dine and dash.” In fact, my primary reaction to this piece is simply that I don’t understand its message.
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While I fully agree that “depression” is not a biochemical matter, there is a robust literature – including works like Aldous Huxley’s The Doors of Perception – addressing the notion that positive altered states, including those induced by hallucinogens- can be helpful in personal growth. So while I’m not endorsing the use of ketamine for “depression,” I don’t think we should dismiss hallucinogens as potentially useful tools for people experiencing emotional distress. As someone who has been labled with “depression,” I personally have benfitted greatly from such experiences over the decades.
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Thanks, Ted, for saying what needed to be said ver concisely. I’m kind of amazed when I hear some people in the movement embrace Allen Frances as if he is an ally. He clearly is not.
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Thnak you for pointing out this glaring omission, Phil. I don’t understand how such an obviously well-intentioned report overlooked the need to include the participation of people of color.
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I must agree with B, above – āmedical harm aware advocateā is not a clear term. Corinna, of course you are free to use whatever terms work best for you; why do you want to deny others that freedom as well? People who use the term “anti-psychiatry” know what it means; that’s why they use it.
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This is an appalling breach of trust and quite unethical. Such services ought to be transparent. If the crisis line bills itself as confidential and then secretly sends police to people’s house, it is dishonest. The ethical thing to do, if they really feel compelled to intervene, is to warn callers up front that this is their practice.
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Thank you so much for this clear, concise explanation, Bonnie Burstow!. There are literally hundreds of people with whom I want to share this, immediately!
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I did a workshop yesterday at NARPA on Trauma-Informed Peer Support in Traditional Provider Agencies. Brief description: “There has been a recent, rapid expansion of āpeer support specialistā positions within traditional mental health programs. These jobs are usually designed by professionals who are unfamiliar with the principles and practices of peer support. Research shows that this often places āpeerā staff in untenable workplace situations and impedes clientsā access to genuine peer support services. This workshop will provide concrete examples of how administrators, managers, supervisors and non-peer colleagues can facilitate the successful integration of trauma-informed peer support into their agenciesā service offerings.”
Tthis is a difficult question with no easy answers.More than 20 years ago, my staff and I at NY State Office of MentalHealth created the country’s 1st civil service job title for “peer specilaists.” For many reasons,I feel that was a mistake. The role was not understood by managers and clinicians, “peer” saff were often badly mistreated and made to do things that violated peer support values. I wish we had never created this job title, but that train has long ago left the station. It’s important to try to fix the way “peer”staff are used. It would be much better if all such peer support servcies could be delivered through peer-run organizations instead of within the system.
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While I don’t support the use of drugs to alter memories, I’m wondering in what way the techniques described in the article are substantively different from what happens in EMDR therapy. My experience with EMDR is that a traumatic memory is recalled and then I am able to distance myself from the emotional impact of the memory by figuratively cutting the emotional cord between the memory and my current self. In this case, the memory is altered because the psychic and emotional charge has been disconnected from it. I think that’s altering a memory in a positive and healing way, and I don’t see an ethical problem with that.
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I haven’t read Aslam’s piece in Psych Services yet, but my initial reaction to this brief notice is that “peer” staff should absolutely not be receiving services from the same agency where they work. It’s completely unethical to put these staff members in that kind of a dual role. In fact, it’s amazing to me that the administration of the agency would allow such a thing.
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Sera, as always, thank you for your insights and your extraordinarily articulate way of expressing them.
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Thank you for raising this discussion. I spend most of my time working on issues related to trauma and especially to trauma-informed peer support. It’s clear that most people with psychiatric labels are trauma survivors, and the way the DSM manufactures diagnoses tends to keep that fact from being obvious to professions and people who would just as soon not have to deal with this issue. I think there are plenty of possible reasons why the field chooses to ignore the evidence, including financial interests and the fact that many professionals are also trauma survivors and may have not addressed the ramifications of that. A larger issue is that to deal with the impact of trauma, we would have to address the root causes of violence in our world, which is an overwhelming thought.
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Yes. Yes to everything you wrote, Bonnie. Thank you for putting it so clearly and brilliantly.
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I appreciate the very concrete suggestions you offered here. But I’d like to point out that for some of us, these feelings are not a “temporary problem,” but a long-term or recurrent burden that doesn’t ever really go away.
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Wayne raises good points. I’ve found that advanced degrees in the mental health field tends to equal indoctrination into the medical model. And I’m glad he raised the issue that we are not “cases” and don’t need to be “managed.” So for me the question is not what kind of standardized training should a “case manager” have, but how can we create alternatives to the existing mental health system to provide voluntary support to people in emotional distress that they will find helpful? The existing system pretty much does everything wrong. It takes distressed people who are mostly trauma survivors and subjects them to the very things that make trauma survivors feel worse – forced drugging and attempts to control their daily lives. And Peter, I wonder what you mean when you talk about “prevention” and “treatment”? I don’t have an illness, so I don’t need treatment. And what would have prevented a lifetime of emotional distress would have been stopping child abuse, and a safe caring place for an abused child to heal. The system offers nothing like that.
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Francesca Allen, so you think censorship is justificed if people use rhetoric you don’t like? Did you really just say that?
I don’t see how the Unitarian Church’s decision is anything but cowardice based on a serious misunderstanding of human rights and social justice on their part.
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Andrew, thanks for saying all this so clearly. I wish more people with psychiatric labels had someone to tell them this every day.
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Well, actually, Dr. Torrey, there IS such a thing as “anognosia,” and it’s a very specifc neurological term that you routinely use incorrectly… but theb, I’m sure you know that, since you routinely use langauge in a distred way, sucj as calling involuntary outpatient commitment “assisted outpatient treatment,” like people are being “helped” when they’re force-drugged with dangerous toxic chemicals. And then there’s the possibility that emotional and mental states that you call :sicknesses” are not sicknesses in any logical sense of the word at all.
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Leah, thank you so much for telling your story, which echoes the experiences of so many of us who have been shamed, blamed, and forced to accept “treatment” that didn’t meet our needs because we wanted to die. One would hope that the so-called “helping” professions would react with compassion to people who are in such despair that the only escape they can see is to end their lives. And the public seems to have absorbed these ideas – people say things like how selfish people are who complete suicide, or how “unfathomable” it is that someone would want to die. Those of us who have been there understand and our insights would be valuable to the field if they would only listen. I’m so glad you are out there saying this to people who need to hear it!
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Jim, I’m conflicted… While I agree with Peter Dwyer’s comments about the strength of your case, I also agree with Mary Saunder’s assertion that this is not a very rights-friendly SCOTUS. I’m deeply appreciative of all the work you do, and I expect that you probably have a gut feeling about what you want to do here? Whatever you do,just know how valuable your work is to our movement!
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Tina, thank you for this thoughtful commentary on a book I’ve always felt I should read but never actually attempted (yet). It is fascinating that although Foucault was in some sense one of us (madpeople), he did not bother to discuss the writings of other people deemed mad.
The following example form my own experience illustrates the idea of “entering into a personās reality to persuade them of a beneficial act.” I had a friend on a locked unit who wanted to leave, but because he kept telling the staff he was Jesus Christ, they wouldn’t release him. I advised him that if he wanted out, he should stop saying that. And he said “But Jesus cannot lie.” I’m not sure where this came from, but I responded “But Jesus doesn’t brag, either,” and he agreed that he could stop telling them who he was, and they let him go the next day.
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Greg, I love what you wrote, but in my experience, the general public, public officials,Big Pharma, the media, politicians, academia, and organzied psychiatry have no idea that biopsychiatry has been been disroven and that the the argument is over and we won. The public mental helath system, and those who organize and pay for the system, are still in charge and they continue to do harm to countless thousands of people. So we haven’t won yet.
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This headline strikes me as misleading, since it sounds like it’s saying that cannabis use causes psychosis (which in fact does not seem to be what this reserach says at all).
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