Wednesday, November 13, 2019

Comments by Jonathan Keyes

Showing 456 of 456 comments.

  • Yes indeed there is hope and indeed there are many people here who can attest to recovering without meds after polypharmacy treatment. Great to hear that you were able to successfully wean off.

    I have worked with a number of people who are deeply challenged when tapering and feel understandably extremely angry at being trapped by having to take meds to avoid relapse into worsening mental health due to iatrogenic nervous system disregulation.

    It would be so much easier to not go down that road at all if at all possible, especially in light of this meta study which repeats the idea that long term recovery and prognosis is likely worse on meds than off.

  • Yes Stephen. Agreed that it is the elephant in the room. Ground zero for this is the hospital setting where “first break” folks invariably go. They then will almost always be prescribed neuroleptics, often at high doses and often multiple drugs.

    That is where this has to change and where true “evidenced based practice” needs to occur. And that means full information that includes the meta study Whitaker referenced.

    Until then, a whole new generation of young folks will be ushered down the same path that can be very challenging to walk away from.

    I recently helped somebody get out of a court commitment. They were going through an extreme state and were then prescribed a combination of high dose haldol cogent in. Klonopin and Prozac. This was a young underweight person who then had horrible reactions and felt a million times worse. There was no discussion. No communication with family members and no listening to the needs of the patient.

    We were able to get this person out quickly enough and the person stopped all meds and quickly recovered.

    We need a sea change in our approach to crisis states.

  • Bob thank you so much for your work. Though many in the field have argued against your views, it will be much much harder to ignore this study. I am also very interested to see how Torrey, Jaffe and Lieberman respond to this.

    On a deeper note, in my work as a private practice therapist with young people going through a “first break”, I often work with people who are choosing not to take medications. I support that decision in large part because of the longitudinal studies that show worse prognosis. But I am often very much alone in my field and I really hope that this view becomes mainstream soon.

    It is much much harder when I work with people who have started down the road of long term neuroleptic usage. If they are looking at trying to reduce or come off meds, it can become much more challenging, especially if there is large dose polypharmacy- as you well know.

    My hope is that this information is disseminated to anyone who is going through a “first break” so that they can have adequate informed consent before deciding to embark on taking neuroleptics long term.

  • David thanks of your piece. I think it is pivotal that we have more and more conversations between different groups, including with people with whom we very much disagree. I think of Bob Whitaker speaking at NAMI or Will Hall speaking to the APA. These are pivotal moments where we are witnessing a sea change. Whether you want to call it reform or attrition, dialogues like these are the first steps in changing the entire system as we know it. Perhaps some would like to have abolition in one fell swoop but even many abolitionists support an attrition model.

    Thank you David for all the hard work you have been doing all these years.

  • In my mind this is huge news and is validating Open Dialogue and the work of Whitaker and others in raising these questions. This seems like the final blow for the “high dose polypharmacy neuroleptic/throw away the key you have a permanent disease” model of care. I want to see this translated into on the ground care as soon as possible.

    Just recently I worked with a client who had been committed and had to strenuously advocate for her meds to be dropped significantly…and they did do that- down to a very low dose- but that took a lot of effort and willingness to fight and stand up to the doctors at that hospital. Most people don’t have advocates doing that for them and it should be required practice to not prescribe high poly pharmacy doses anymore.

    I’m very happy this article is strongly highlighted in the NYT.

  • I wrote a comment on Ronald Pies thread that somehow came out as being from Kermit-perhaps because it car right after Kermit’s link. Here is my comment referencing your article…

    “For those of you who want a shorthand reading of that article…Whitaker outlines the numerous places the APA has promoted the “chemical imbalance theory.”

    Here are some quotes:

    “However, let’s now continue with the laying down of cards. The “Let’s Talk About Facts” brochures that the APA published in 2005 were part of an ongoing pr campaign titled “Healthy Minds, Healthy Lives,” and that same year the APA also published a brochure for the public titled, Let’s Talk Facts About Depression. This brochure, in a section titled “How is Depression Treated,” informed the public that: “Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.”

    There is more. That same year, 2005, the APA put out a press release celebrating the fact that, based on a survey it had conducted, “75 percent of consumers believe that mental illnesses are usually caused by a chemical imbalance in the brain.” The survey results, said APA President Steven Sharfstein, was evidence of “good news for [public] understanding of mental health.” Indeed, the APA stated in its press release that a psychiatrist was “a specialist specifically trained to diagnose and treat chemical imbalances.”

    There is more in there but it really belies what you are saying here Dr. Pies- that the APA had a cursory “crush” on the chemical imbalance theory. In the last few decades the APA has helped promulgate this theory until it has become common parlance amongst the lay public.

    Though you may suggest that psychiatrists more strongly believe in a biopsychosocial model, the proof is in the pudding. 20 percent of Americans are now on some form of psychiatric drug. Ten percent of Americans take an antidepressant. That is an enormous rise in the last few decades. Though there may be a discussion of environmental social factors, the answer is generally the same- take medication. And often the reasoning has been that a person has a “chemical imbalance”.

    I’m afraid your article does not properly express the intertwining relationship psychiatry has had with the chemical imbalance theory.”

    And then this is his response. It is baffling and nonsensical as he seems to somehow try to pretend that the APA didn’t say what they said…

    “One additional point that critics tend to confuse: The statement in one APA publication–“Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.” –does not entail an endorsement of the claim, “Depression is caused by a chemical imbalance.” There are many drugs that are prescribed because they address some component of a pathophysiological process that may or may not be–by itself–the “cause” of the illness or disease. For example, if we say, “Statin drugs may be prescribed in order to correct an imbalance between “good” and “bad” cholesterol”–we are not necessarily claiming that the patient’s lipid disorder is caused by this imbalance. The “cause” may lie in a combination of the person’s genetic make-up; fatty diet, excess synthesis of low-density lipoproteins, etc. Thus, I stand by my point: The APA did not endorse the claim that depression is “caused by” a chemical imbalance, or, indeed, that any mental illness is so caused. And of course, most knowledgeable psychiatrists never did either! Q.E.D.

    Ronald Pies MD

    – See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/serotonin-how-psychiatry-got-over-its-high-school-crush?GUID=1333E4FC-A3C0-42D9-9672-036BAE50FEB9&rememberme=1&ts=19092015#sthash.c1osfOf4.dpuf

  • One of the concerns I have with just using a probiotic supplement is that they tend to carry only a few different strains of beneficial bacteria but there are upwards of a thousand different types of bacteria. When we are adding just a few strains as a supplement we ignore hundreds of others.

    As an herbalist I support using fermented foods and bitter herbs that generally promote good intestinal flora without specifically focusing on similar probiotic strains. It’s also important to note what Madmom said…which is that psychiatric drugs impact gut health adversely, (as well as antibiotics) so we engender worse intestinal and mental health with prolonged chronic use.

    The use of fermented foods and bitter herbs (chicory, dandelion, burdock, angelica, dock) are time honored ways of improving digestive health which in turn improves emotional wellbeing.

  • Interesting thoughts. With marijuana there has been increasing research as to its efficacy for a lot of complaints…mainly done abroad in places like Israel. And Sandra you’re right that there are many active ingredients and potencies that make it more complex to offer as medicine.

    But really up until the 1950s and the psychiatric revolution we were primarily using plants as medicine. Part of the magic of plant medicine is that there are a variety of constituents that often work synergistically and in ways that are hard to reduce to single constituent effects.

    In many ways we wildly changed course when we decided to use single chemicals as ways of chronically managing complex emotional states. It is like eating only one food for years when we are hungry.

    Herbs are not so easily reduced to randomized control studies as their constituents are variable and the method of administration and dosage affect the outcome. But certainly some have already been shown to be effective…such as St. Johns Wort for mild to moderate depression. Offering an herb such as this instead of embarking on a risky course of antidepressants is already a common practice in places like Germany.

    Outside of acute situations, my hope is that we begin to review traditional and indigenous ways of approaching “mental illness” that seemed to have served us far better than the modern drug model, and often involved the use of plants with their complex and varied constituents.

  • Hey yes Monica…the strains that I have seen be very effective for certain people have been high CBD varietals…either smoked or used a edibles. However even high CHD strains have affected many of my clients poorly. Even though high cannabidiol varietals seems to be much more effective for calming pain, for insomnia, severe restlessness and extreme states, I am continuing to see many folks with already taxed nervous systems react poorly to these strains.

    As an herbalist I think of marijuana as one very strong tool amongst many tools. Some people do well with it but others do better with milder anxiolytic herbs as well as a variety of tonic and adaptogenic herbs. And as you know so well, I have found diet to be paramount in assisting people to recover.

    I think when exploring helping people through extreme states we should be looking at a whole panoply of plant medicines…and that should very much include marijuana as one option. Several people I work with use pot as their primary tool for reducing the potential for mania. That should be legal and easily accessible for anyone.

  • This is an important discussion and as therapist and herbalist who often works with people in extreme states marijuana has had a mixed record. I have seen pot increase susceptibility to severe distress and for a smaller group pot has been an effective tool for decreasing anxiety, reducing manic symptoms and extreme states.

    Though dosage and the specific strains play a key role, one of the main factors in the decision to use pot has been personal neuro chemistry. Most of my clients are extremely sensitive due to their constitution and due to iatrogenic damage from psych drugs. Pot only increases their sensitivity, anxiety and potential to dissociate and experience confusion. I would say this is for about 80 percent of the people I work with. For a smaller percentage pot is a life saver and extremely useful.

  • Great piece Jeremy. My father is an anthropologist who was colleagues with Arthur Kleinman in the 70’s. He did his field work in NorthEast Thailand and amongst many things, he wrote about their approach to working with grief, sorrow and extreme forms of distress. One woman had lost her son and spent many years deeply sad. Her process of healing involved talking to the village monks and deepening her Buddhist practice. Healing took place in a culturally specific way without western therapy or meds.

    I am reminded of a recent Guardian article that talked about how western therapists were parachuted into Rwanda to help…only to find out that Rwandans were horrified by the idea of sitting in a “dingy room” rehashing the horrible atrocities that occurred and much preferred the idea of drumming and being out in the sun wth community to help heal those wounds.

    I think of this a lot when I hear the term “evidence based medicine” and I wonder if a Quichua Indian who has lost his home and been displaced by an oil company really needs antidepressants and cognitive behavioral therapy for his “major depression.” Bu imposing our western models of mental health on other cultures we reenact the same imperialism and “cultural cleansing” that has taken place for hundreds of years. Perhaps it’s time to honor culture bound notions of emotional illness and wellbeing without imposing our value system.

  • Thanks so much for this piece Joanna. I have helped a number of people who have chosen to get off lithium after an initial diagnosis of bipolar. And I entirely agree that the long term health implications far outweigh the potential for reducing “episodes.”

    I think we need to move towards examining how to help people work through manic states without reliance on any long term pharmacological agent. There can definitely be place for the short term use of psych drugs- especially benzos- in the case of strong episodes of mania/psychosis.

    At the same time, there is a strong move by alternative mental health practitioners to examine non-pharmacological tools – including managing environment, diet, herbal medicine, acupuncture, etc that I have seen in my practice as effective in helping people- even in strong heightened complex manic states.

    Most all of the relapses I have seen into mania have been due to people stopping meds- usually due to their horrendous side effects. I believe that the mania that occurs afterwards is almost always iatrogenic in nature- due to the withdrawal.

    We would not look at a heroin addict who is withdrawing and experiencing horrendous hallucinations, severe anxiety, panic and insomnia as having a mental illness. Why do we call someone experiencing withdrawal off of lithium “mental illness?”

  • I think this again is an issue of language and terminology. Language using labels like ADHD and bipolar, even if there is a basis in biological temperament, is inherently stigmatizing and I plies a medical condition needing medical treatment…namely meds.

    While in traditional societies, the language of temperaments and constitutions was not perjorative.

    For example, In Indian medicine, someone born with a Vata temperament might be excitable and restless and prone to anxiety, but also sharp minded, clever and bright. Diet and lifestyle is geared to making sure this type does not fall into imbalance.

    Traditional medicine cross culturally takes into account these temperamental differences, and also acknowledges the potential for falling out of balance and distress. But traditional systems of healing from throughout the world emphasize nourishment, not drug intervention.

    The language of modern DSM labels implies disease, permanence and drug intervention. DSM language is about 70 years old. The language of traditional medicines are thousands of years old.

    We have been led astray.

  • Interestingly, the Meyers-Briggs system (ENTJ here) came from Jung, who borrowed from the ancient Greek system of constitutional assessment and healing (choleric, sanguine, phlegmatic, melancholic). Like you said, The Meyers Briggs system points out sensitivities but also points our strengths and capabilities.

    At core the whole battle is over language. The language of health and distress created by our ancestors has been marginalized in place of a language that is reductionist and based in pathology instead of potential strengths.

  • The main issue I have with labeling is that by and large the terms are social constructs that are simply ways for insurance companies to reimburse providers and for drug companies to niche market drugs. Psychiatry and Big Pharma learned the strong advantages of labeling long ago.

    And yes there are realms where labeling can be important. You start out with autism…which is a permanent condition…and then morph to anxiety disorders and bipolar, which are far more murky. While the first one can be helpful and not necessarily tied to Big Pharma/psychiatry, the next ones are.

    The language that we use is deeply important. In older times, traditional societies might point to constitutional differences- choleric or sanguine in Greek medicine, pitta, vata, kapha in Indian medicine. But these labels would point to tendencies that could be modified by diet and lifestyle. These were not disease labels, but ways of describing personality and health characteristics as ways to guide healing when someone fell out of balance.

    Today we have created a panoply of labs that imply disease and permanence. While autism may fit as a permanent label, labels like ADHD, bipolar II, borderline and histrionic personality disorder often appear to be no more than shorthand for the marketing and prescribing of drugs.

    Labels also tend to pigeon hole vast swaths of people into one size fits all categories, while human complexity is far greater. I have never met two people labeled with schizophrenia alike, but they tend to all be treated the same way- neuroleptics. Again, traditional systems of seeing imbalance describe a wide variety of emotional suffering but tend to imply that the condition need not be permanent and that tailored healing approaches for unique people are key.

    So yes I get that some folks feel happy to have a label, as a way of externalizing experience, reducing shame, etc. But the language of labeling has morphed from traditional holistic conceptions to reductionistic, medical jargon tied to drug regimens. Deeply problematic.

  • Very interesting article. I’m wondering if anyone here has experience of working with people using the herb kratom to try and detox off opiates. There have been quite a lot of stories of people using this herb to help them through both methadone and heroin detox. I have worked with a few people who have found it effective. It is also addictive in its own right but appears much easier to discontinue than prescription opiates.

  • What’s strange is the idea that there is this distinct differentiation between Axis I (mood disorders) and axis II (personality disorders). The belief has been that axis I disorders such as depression, bipolar and schizophrenia can be “treated” while disorders such as narcissism, borderline tendencies and sociopathy are inherent, ego-syntonic and cannot be treated. So it used to be that folks with axis II disorders were not given drugs- because they can’t treat underlying personality traits.

    But now pretty much everyone is given axis I diagnoses- because you can bill insurance for them. So everyone labelled with a personality disorder also has a co-occurring mood disorder (as Sandra said). That way everyone gets paid. And that means people who are “borderline” and have experienced abuse, and trauma- are not only accused of having this awful borderline personality disorder but they are also pushed to take psych drugs to manage the severe emotional distress associated with trauma.

  • Good news that psychiatry is ceding ground on the language of distress, even if they aren’t acknowledging the real issues (validity, reliability).

    I think the real issue is less whether counselors, psychologists and others stop using psychiatric language, its when insurance companies stop giving all the money to psychiatry.

    One of the worst aspects of Obamacare is the focus on increased “treatment” for the low income and impoverished “mentally ill”. Anyone who has low income insurance essentially only has access to a doctor, diagnoses and meds. High co-pays and deductibles act as a firewall to getting any other type of holistic care.

    Essentially, insurance companies are approving prescribing seroquel and prozac for poverty. This is where the real battle is- changing how insurance companies operate and shifting money away from drugs and “treatment” to modalities that are far more effective at addressing societal based problems.

  • What is the alternative?

    Well that is a very large question. But I would suggest that seeing that ECT is the *only* solution at that point is deeply myopic.

    When the only solution renders a portion of those they treat with grave brain damage, one must really wonder about the “cure.”

    Psychiatry has not really ever looked at “alternatives”, have they? They are pretty much stuck on drugs and electroshock.

    I think it would be wonderful if they actually, truly explored alternatives. Imagine if they looked at nutrition, socio-economic factors, peer supports, acupuncture, and yes…greater access to individual counseling (which insurance companies makes impossible via co-pays and deductibles for low income earners.)

    But really there aren’t too many insurance supported “alternatives” because psychiatry takes all the air out of the room. The money all goes to…meds…or ECT.

    And perhaps we should ask a deeper question. If someone is deeply suicidal due to depression because “they have tried everything else”, meaning gone through taking reams of SSRIs, mood stabilizers, antipsychotics and TCAs, perhaps…perhaps…the suicidal depression is happening in large part…

    due to the iatrogenic effects of the meds themselves?

    Consider that possibility the next time you see some one who is considering ECT.

  • How can you have fully informed consent for someone who is deeply desperate and depressed? If you offered almost anything they are likely to say yes…even while telling them all the risks…because they are looking for anything at that point.

    But the larger point is that while some may feel relief, this barbaric procedure leaves some with severe memory loss, cognitive decline, deepening depression, anxiety and suicidality.

    Is that really a treatment that should be promoted?

  • Yes- I agree that a lot of folks are doing this on their own with groups of supportive peers who really understand the work… without true support from the medical establishment… and they are figuring out much safer ways to do this.

    As to colleagues who understand this stuff?

    Sadly very few. Tapering is a complex and very unique process and though a general caveat of going slow is helpful, each person must find their own way in terms of when to hold, when to taper, how quickly, what supportive techniques work best, etc. It really is a unique process.

    Most therapists I know have very little understanding of this. Or they may have a general understanding and want to put that in the hands of a doctor- as it is “outside their purview” or “practicing medicine”, etc.

    Here in Portland, there are a few good therapists, NDs and NPs who do understand this- but even with them it can be complicated.

    It can easily become complex when family members don’t understand the length of time tapering can take, or feel that the iatrogenic injury is made up and couldn’t be that bad. This leads to strong family dynamics tension which causes further deepening issues.

    Tapering and iatrogenic injury don’t just affect the individual- they affect the whole family and the extended network of friends and allies the person is in contact with. These are complicated problems that are easily brushed off in the medical system.

    Anyways- again I thank you for this very important work Laura. I’m spreading the news in my circles…

  • Interesting. Has there been lawsuits by people who feel they have received poor advice from support groups? Or lawsuits against groups saying they are practicing medicine without a license?

    Whats crazy is…if your doctor says you shouldn’t go off the meds…but you want to and need additionaly supports…where can you go? The only main places for this type of work has been online support groups of people who actually have gone through this process. (And a few good NPs, Docs and NDs).

    And yes I get that there could be erroneous or conflicting advice which indeed makes it a bit like the Wild West- but this is because the medical community has not acknowleged the dangers and suffering in discontinuation- or created effective protocols for people who are tapering.

  • Sometimes when I am wearing my herbalist hat, I am blown away by how the FDA and the media tries to scare the jeewilikers out of anyone taking an herb but ignore information that shows obvious deleterious health effects.

    Kava- the Polynesian herb used for hundreds of years with rare damaging side effects- “Dangerous! Ban it! Herbs are scary. Who knows what could happen?”

    Recently invented pharmaceutical that ends up causing grave harm to many….”Well its for the greater good”, or “Oops sorry…but have you tried our new product?”

  • In my private practice I work with a number of people who have been labeled as having a “first break” and who have been trying anything to avoid labels and neuroleptics. As you well know psychosis is complicated with many different etiologies and trying to create sanctuary for folks going through unusual experiences can be very challenging. It feels increasingly important that these individuals be given a chance to process their experience without drugs, even if that means ongoing, or recurring “episodes.” And the reason is very much along the lines of what Harrow and Wunderink have discovered. If you give a person a chance, there is a place for integration and recovery. Long term with the neuroleptics, the chance goes down.

    You said that many folks dismiss these findings because they use the argument that these people were likely not very sick to begin with. But that begs the question- how do they know who will recover and who won’t? And seeing that long term use definitely worsens prognosis, isn’t it far better to attempt non-drug interventions?

    I think the big challenge is creating that support and sanctuary for those experiencing psychosis- and it is far easier to sedate a person than to support them through that process. Creating the template for support is far more expensive and complex. But if we viewed an episode like drug rehab, then there would be centers where people could go, often for a month or more, paid for by insurance, that would support reintegration without drug intervention.

  • Yes I think it can be deeply challenging for people to avoid medications for psychological distress in this society. Insurance willingly pays for it. Doctors recommend it and it promises an easy solution. Therapy tends to have large copays and deductibles that act as a firewall for most low and moderate income people.

    But underlying that, there is a general desire to simply feel better, or at least- not be tortured by the…depression, anxiety, panic, mean voices, fill in the blank. In some ways psych drugs fill that role- they sedate and stimulate in a measurable way and change biochemistry. Instead of wading through the miasma of complex narratives, previous trauma and current stressors, psych drugs promise immediate (or very quick) relief of pain. Evidence based too!

    I sometimes think therapists who tend to critically appraise psychiatry underestimate this desire to simply “feel better”, to feel more pleasure and relaxation, to reduce the horrible symptoms please.

    If one thinks in simple forms of pleasure and pain, people see psych drugs as increasing pleasure and reducing pain. However, over time, it is often clear that they often cause more pain- in the form of deteriorating health, reduced cognitive function, metabolic issues, apathy, and lowered libido. Essentially, like most drugs- the beginning is great and down the road can often be bad.

    As a therapist and an herbalist, I am often struck by people’s desires to…simply feel better…to feel physically, somatically, cellularly better. Folks in distress truly do feel ill…mentally, emotionally and physically. We would do well to honor that physical feeling of illness and address it. Yes there is importance in honoring pain, exploring the root of issues, developing insight- but there is also importance in alleviating suffering- offering tools and techniques to reduce the pain, to offer alternatives to medications which promise immediate pain relief, immediate tranquility.

  • Very interesting Emma and thank you so much for your research and words. I work with many young people in private practice who are deemed “psychotic” who I think are deeply sensitive souls, often having experienced trauma. I think of “psychosis” as a form of emergence and a deep process of unfoldment. At times people go through experiences that are so overwhelming that they need a safe place, a sanctuary- to work through these complex states. It sounds like Spiritist hospitals an example of this type of sanctuary.

    I also work in a psychiatric hospital setting very part time as a therapist and we use a variety of “unusual” tools such as drumming, aromatherapy, chanting, singing, dancing and movement in different group settings. What you wrote about spiritist hospitals sounds deeply healing and hopefully we can truly create sanctuaries such as you describe.

  • I think its key to bring up the issue of money and its generally what I think of as the achilles heal of psychiatry. Hospitals are shuttering hospital beds at an astounding rate for just the reason you have outlined. They can make far more money doing medical procedures than for managing complex emotional problems through psychiatric consultations and temporary housing, aka psych units.

    In Portland this last week, all the main hospitals went on “divert” because they were overloaded with people coming to the hospital for a mental health crisis and looking for a bed. For those that don’t know, going on divert means having so many patients in the ER that there is not enough room for them and they have to be diverted to other hospitals if possible. For many mental health patients, this also means “boarding”, staying for days in a small room waiting for a bed.

    Going on “divert” is extraordinarily expensive for hospitals and they try to avoid it like the plague. Even though my hospital was losing quite a bit of money in their psychiatric units, they chose to keep them open because it was still more cost effective than often going on divert.

    This has led Portland to creating a new hospital that will be devoted to psych admissions (sometime in late 2016.) The new Unity hospital will replace most all the hospital beds in the city. In many ways it is likely that they will try to turnstile patients out the door as quickly as possible because it is simply too expensive to manage emotional crisis using a medical model.

    I think this is the number one argument to make with people who don’t care about mental health, issues with medications, coercion, etc. Creating non-medical alternatives is….cheaper.

    The problem is that there once one has gone down the road of taking meds for long periods of time, there is no way to avoid working with the medical model- meaning someone who has gone off their meds, or is experiencing instability with their psych drugs, has to see a doctor in order to adjust them, or restart them and taper down if possible. Essentially, those in crisis are forced to use the excessively expensive medical model of crisis because of their need for medication assistance. Its a snake eating its tail.

  • Thanks for your article Peter and Anne, and the links to other critiques and comments, some of which I had not read and were fascinating. Really this feels like a watershed moment where psychologists and therapists, at least in Europe, are finally saying no more. No more to reductionist ways of perceiving psychosis that elicit labels and prescriptions far too readily. This is a very positive statement that posits that we must perceive extreme states as complex and highly individuated narratives that are often rooted in trauma.

    My quibble is this, and it looks like it has already been somewhat addressed. I come from the perspective as a therapist but I see this statement as having the implicit suggestion that many of these folks would be far better served working with a therapist, and esepcially one steeped in CBT.

    I see you address this by saying that in fact many people would be helped by a wide variety of support…friends, family and community. But the suggestion is still there to visit a therapist…”later.”

    In the wider world, many people experiencing profound distress go to traditional healers, herbalists, spiritual ministers, etc. The thought of sitting down in an office for 50 minutes to talk about problems, esepcially by a practitioner using a particular “evidence based” treatment style, does not fit global pan-cultural needs. I think its key to note that there have been an enormous number of ways of approaching “psychosis” that do not fit into the mold of therapy or psychiatry.

    I applaud this statement heartily for expanding our understanding of extreme states as quite common and certainly not requiring medicalization and patholigization…but I worry that it is not expansive enough to be open to the complex unique worldviews and systems of healing found throughout the world.

    In any event, thanks so much for your hard work. I am very interested to see how the ongoing debate unfolds.

  • Hey Lovelife, that is indeed an awful and sadly all too common story. A seemingly innocuous prescription of an antidepressant turns into a merry go round of SSRIs, mood stabilzers, benzos and antipsychotics with a bevy of ever increasingly severe psychiatric labels. It is wonderful that your family is on board with creating a safe space to taper off the mood stabilizers. As a therapist I am often confronted by people who want to taper off but their family is not on board and that makes it far more challenging. The only suggestion I would have is to go slow. Some docs want to taper folks off far too quickly and there is much evidence that a slow taper is the best bet. I also would suggest trying to optimize your diet with lots of whole foods and reduce stimulants such as caffeine and sugar as they can make the taper much harder. Even though you are tapering off mood stabilizers, http://www.survivingantidepressants.org is a good resource and support forum for tapering. Good thoughts sent your way…

  • The new focus on orthorexia has been fascinating to me. I get that deeply unhealthy eating patterns, whether it’s junk or “health” food can cause severe mental and emotional concerns.

    At the same time, I am surprised there is a desire to label people who eat “too healthy” as having a mental disorder. Should we label a diabetic who continues to eat junk food with a disorder? Should we label people who eat a lot of fast food with a disorder?

    Where does it stop? And is it simply a convenient way to market yet another drug for yet another “mental illness”?

    Like you said in the article, we’ve already done this in the 60s…uppers for weight control, downers for anxiety, often caused by the “pep pills.”

    How does a Big Pharma 11week study equate to “science” and evidence based practice?

  • I have just been working with someone and helping her as she tapered off of vyvanse for binge eating. She had taken part in one of these studies to determine its “effectiveness”. It certainly helped curb her appetite and to lose weight. I asked her what she was eating and she said she snacked here and there. She described feeling very anxious a lot of the time and had difficulty in sleeping.

    When I explained that vyvanse is essentially a form of amphetamine and that it is likely to have long term repercussions as well as these side effects she tapered off.

    I’m wondering why I had to be the one to tell her. I guess I should no longer be shocked that doctors are now willing to prescribe speed for weight loss and appetite control.

    I think it’s interesting to note that there is a new disorder that some are bandying about called orthorexia…essentially focusing on eating “healthy food” to the point of malnutrition. Perhaps they will have a drug for this too?

  • I recently worked with someone who i helped get off vyvanse for binge eating. She said it was making her feel way too wired and anxious but she said she had lost a lot of weight and it curbed her appetite (big surprise). I gently explained that it was essentially a form of speed and she was quite surprised. Once she stopped it she gained aslo the weight back…which I suppose is one of the big disincentives to ever stop it. She says she feels way better, way more grounded now.

    How is this possibly legal? I’m surprised they don’t prescribe it for obesity…or would it be…extra overly large syndrome? No need to diet and exercise…just take this scientifically proven pill…

  • The whole idea that an amphetamine…sorry… adderall….is effective and benign medicine for people who suffer from ADHD but is a dangerous illicit drug for everyone else is just a fanciful mythology.

    Speed makes *anyone* concentrate harder, work more efficiently, get things done, stay more clear and focused….in the beginning.

    Excederin take the time to really read the testimonials. Go through them one by one- especially the long term users. There are some positive ones- but by far you will see a list of woes…a litany of misery and heartbreak.

    Frankly I don’t care if they find a biological marker, gene codes and brain imaging scans that absolutely tells you you have “ADHD.” That just doesn’t translate into- and therefore you should take amphetamines the rest of your life. Craziness.

    Look at the types of things Steve recommends. There are plenty of ways of helping kids that does not involve drugging them with speed. They don’t get to say…no thanks.

  • Well if you look at the testimonials…it seems like a large share of people have experienced very poor effects. I would suggest looking at the long term users of both ritalin and adderall (similar testimonials). At that point…”if the price is too great”, they can’t just “stop.” These testimonials describe the harrowing suffering inherent in withdrawing and then the severe post-withdrawal issues.

    If you don’t like corrective lenses, you can, indeed, just stop. For those who have been taking them a long time…”just stopping” sounds ludicrous.

    Here’s someone who rated adder all a 5 out of 5…

    “This is a life long decision with a high potential for negative outcomes. I think you should allow yourself or your children to be the way they are, and find social, mental, physical outlets and ways to be accomplished and successful without the drug. Also research what it does to your dopamine stores in your brain. Coming off of it after years of use can lead to a pretty lack luster view of life. That being said… time for another dose. Sigh.”

    Another “positive” testimonial…

    “I’ve become reckless. And it’s addictive as all get out. There are many days I find myself taking twice my dose. If I run out early, I count down the days to my refill, finding myself incapacitated otherwise. But – I’m a junior at a prestigious college and I have straight As. My teachers rave about my work ethic and my dedication. It’s boosted my sex drive significantly, as has my confidence. I juggle a full school schedule with several internships, side projects, a boyfriend, etc. My focus is often streamlined and my the work produced is high caliber. Ultimately – it’s a double sided sword. Has it helped me? Enormously. Am I a different person than when I started taking it? Unquestionably, almost unrecognizably transformed. So seriously weight the consequences before you start. Because no matter how strong you think you are, the drug will suck you in. Some days, it’s beyond worth it. Some days i’m in hell.”

    Please don’t preach pollyanna…or ease in stopping. These people will tell you your wrong.

  • No problem Steve.

    This has been my “go-to site” for anyone interested in starting a course of psych drugs (of any kind). There are plenty of pro-drug reports so it is not one sided. But the reports of adverse effects are common and overwhelmingly tragic.

    It is important for people to know they are rolling the dice when they start psych drugs. This site is about as clear as day on those risks.

  • To me, stimulants like adderall/ritalin, are a lot like their counterpart benzodiazapenes such as valium/xanax/klonopin.

    At first they seem miraculous. They indeed “work” in the short term providing immense short term benefits. But like speed and downers, they start to catch up to you. They start to not work. You can’t stop them without horrendous withdrawal effects and they lead to complicated emotional and health problems down the road.

    Like downers and speed, both benzos and stimulants are sold illegally on the street for a reason- they get you high. But for some reason we’ve created an entire field of medicine that supports them as being effective and evidence based.

  • A diagnosis of ADHD almost always leads to a prescription of stimulants…

    More testimonial fro askapatient.com….http://www.askapatient.com/viewrating.asp?drug=11522&name=ADDERALL+10

    “Insomnia, flushing of face, anxiety, sweaty at random times, back pain, teeth grinding, depression, Loss of social interaction I only took this drug because I felt pressured from how my grades were and my parents when I was a freshman in high-school, my grades went from d/f’s to B’s and A’s feeling like I was on-top of the world(especially after the first couple of months).. now a senior I feel like I’m really depended on it, this drug has messed my life up in every way possible. Yes I got those grades, but is it really worth it to now have anxiety, depression, dependents on adderal, secluding myself from society?… ”

    “Adderall seemed to work for me at first. But it’s facade quickly faded to reveal a chain-smoking, binge drinker. I became socially withdrawn, lost my job, & lost my passion for life. Adderall has caused me to lose the best years of my life. I hate this drug with my whole heart. Never ever take adder all.”

    “weight loss, lack of appetite, rapid heart-rate, failing vision, bruxism and resulting tooth fracture, gum recession, personality changes, seasonal depression, anti-social behavior, bipolar & borderline personality disorder tendencies, hair loss, decreased libido, insomnia, poor short term memory, headache, hyper-focusing on unnecessary tasks, dry mouth, increased thirst, rapid decline in BMR (basil metabolic rate), cold hands and feet, abnormally low body temperature, overall detachment from the natural ‘cadence’ or rhythm of life.”

    Why are we giving these drugs to our children?

  • Hmmmm. its key to examine testimonials of people who have been taking stimulants- especially for prolonged periods of time….

    Lots and lots and lots of adverse reactions. Even the people who rated the drugs high (4 and 5) describe lots of adverse reactions.

    http://www.askapatient.com/viewrating.asp?drug=11522&name=ADDERALL+10

    Take a close look at what many kids are going through when taking speed…Here’s a few testimonials of people who have been taking adder all for a long time…

    “Very OCD, depression, loss of sex drive, impulsiveness, any symptom you can think of I had while taking this medicine. I have serious heart problems, social anxiety, rice developed an eating disorder, lost every friend I’ve ever had from isolating. I don’t feel like a human being anymore, nor do I remember how to live a normal life. I permanently feel bugs crawling on me and have destroyed my skin from the length if time on this drug. I am a pretty girl but adderall has ruined my appearance more then you can imagine. It’s great at first, your on top of the world but it doesn’t last and it is NOT worth what I’ve been though with health problems the past year linked directly to adderall. ”

    “I can tell through years of taking it that my brain goes fuzzy when I don’t. Even now when I’m on it I seem to have trouble with my memory. When I mix it with alcohol (horrific mix) I only need a drink or two before I blackout. I fear telling people when I do because I don’t want to know what I said or did. Lately, I have been having bad insomnia. I’ve taken this for years and didn’t have this problem until recently. I’m trying to get my life together, doing things I don’t want to do, which this pill is good for, but I’m starting to think the physical side effects and long term damage aren’t worth it. So then what? Fuck off my life until I give in and start taking it again? I’ve seen this medication do wonders, I’ve seen it wreck lives. I don’t really know where I fall in this spectrum, but I know this stuff is nasty… super bad for me, but I depend on it now. I truly wish I had never taken this stuff. Parents or people considering taking this drug, seriously reconsider….”

    “It’s tricky, because Adderall has done some wonders for me, but not without it’s heavy price. Most significantly: I am much, much more antisocial when I take Adderall. I used to be a hard partier, going out four nights a week. Now I go out once a month. I’ve lost touch with many friends. I get irritable or uncomfortable around people. I get very paranoid. I have a hellish sleep schedule. I was always lean, but I’ve lost about 20 lbs. I have to force myself to eat.”

  • Randy I don’t know if I would classify you as Pro-medication…but how about “pro-selective use without bias from pharmaceutical companies and a hell of a lot less than what we have been doing medication? “. That might not fit on a bumper sticker though.

    I think there a re a number of people who are fine with a model of using psych drugs much more cautiously as long as people are informed of their long term complications and are not given false information such as Meds are necessary for “mental illness” just as insulin is necessary for diabetes.

    There are people who take meds intermittently, or only during a crisis, or at a low dose.

    I think the main ire I have is against the excessive over prescription of the drugs, the corruption in the industry, massive unnecessary polypharmacy, irresponsible use of drugs for youth and the elderly, and on and on. But I am not against the idea of using psych drugs so I would agree with you. I don’t think I would characterize that as “pro-meds” though. :).

  • Very interesting article Randy and thanks for the info. The dollar amount used to “influence” doctors is mindboggling.

    I though this piece of your article was also interesting…

    “Nevertheless, the end of patent means fewer free samples, fewer visits from pharmaceutical reps, fewer paid lunches, fewer “opinion leaders” making the rounds showing the companies’ own slides, fewer conference symposia lavishly funded by patent owners, and less general noise distorting the environment. Medical decision-making is likely to be based at least somewhat more on science than on enthusiasm and hoopla.”

    I guess my question would be…what science? The biased big Pharma studies fill many of the medical journals and alternative interpretations of the effectiveness (or non-effectiveness) of antidepressants is likely to be downplayed even after the “patent cliff.”

    I would like to think that the medical profession would reexamine the merits of these drugs using more unbiased non-industry studies and “science’ but I fear I have become fairly cynical.

  • Timothy, I think this really comes down to the interpretation of these studies (and several others). Sadly, I think most of the psychiatric profession dismisses these longitudinal studies in the same way you do.

    Essentially, these studies wedded with personal experiences of long term suffering by survivors due to iatrogenic illness from meds form the key component of this national debate over the merits of psychiatry.

    Dismissing them out of hand simply doesn’t jibe with the experience of tens of thousands who have been damaged by medications.

    Though I agree we should augment the discussion by discussing other issues (social injustice, poverty, etc), I don’t personally want to see it watered down too much. The key issues of medications affects too many people to be dismissed so easily.

  • Really interesting piece Timothy – thanks for the in depth analysis.

    I also think there are intersecting issues that have led to rising disability rates. You mentioned socio-economic issues such as poverty, racial injustice as well as issues such as the tacit “built in disincentives to exploring and pursuing meaningful work for people on disability.

    I would add one more factor to this kaleidocope of reasons for increasing disability levels and that is the profound change in the global food system since the advent of the Green Revolution in the 60’s. I believe that the vast increase in the consumption of the processed form of just a few crops (wheat, soy, corn) and the subsequent massive rise in rates of obesity, metabolic disorders, diabetes and “mental illnesses” also contribute to the great rise in disability rates.

    At the same time, I think the issue of medications is a key part of this discussion. Whitaker has pointed to studies done by the WHO as well as longitudinal studies by Harrow et al and studies done by Wunderink et al that all show worsening prognosis and disability for chronic use of neuroleptics.

    Though these studies may not show that neuroleptics are the definitive reason for rising disability rates, they definitely are implicated as a strong part of the equation.

    I would agree with you however that there are certainly other factors that play into this complex issue.

    Thanks for your detailed thoughts.

  • First off I just want to say thanks Scott for looking at alternatives for helping people that do not immediately involve psychiatry. That is a much needed and welcome step and your program sounds innovative.

    However, I echo the concerns for creating alternatives that are cheap, accessible, “low-tech” and that also allow for people that have “safety issues.” I recently was talking to a woman who was describing the place she would have loved to find when she was deep in crisis and suicidal.

    The place would be in nature, quiet and low stim with people cooking nourishing meals. There would be activities available such as yoga, meditation, therapy, but for some people it would simply be a place to rest, talk to peers and eat healthy food without having to think of their problems medically. But it would differ from a retreat center in that the staff would understand that people were coming because they are in crisis and are looking for support/love. Ultimately, it would be paid by state or private insurance and available as much as hospitalization is available.

    I support any and all endeavors to create alternatives and I heartily support your approach Scott- we need more people not just thinking and talking- but doing and creating…Thanks for being part of that effort!

  • Thanks so much for your piece Dick. It reminds me more than ever the need to make sure people don’t get started on strong neuroleptics because the road becomes much more challenging if you’ve been taking them for long periods. As a therapist I have been working with several young people who were diagnosed “First break” and then given whopping doses of mood stabilizers and antipsychotics. Each one has been told that taking meds for their “illness” is just like taking insulin for diabetes.

    With the help of holistic minded NPs and naturopaths, they have weaned off these neuroleptics as quickly as possible and a team of us support that process. The problem comes that some people are not on board…family members, friends, and it can create a split because it defies psychiatric “advice”.

    As you write…the evidence is clear. Chronic use of drugs like Zyprexa rearrange neurochemistry to make one increasingly sensitive with a heightened potential for disability and “relapse” into psychosis.

    The shamanic piece is very interesting as well as I believe we have completely discounted traditional techniques of healing that have long been a part of indigenous cultures throughout the world. There is a pressing need to explore these deeper fountains of wisdom. Thanks for your words.

  • Oliver’s piece was amazing and Chuck you are right…those were “non responses.”

    Though Oliver addressed the corruption inherent in direct advertising (“Ask your doctor!”), scripted lectures from Pharma for “thought leader” doctors, the amazing over prescription of meds (70 percent on at least one med), he did not address the poor outcomes of many of these drugs and especially the deleterious effects of long term use of psychiatric drugs.

    The movement here to address the ills of psychiatry easily bleeds into a wide critique of modern medicine in toto.

    Lovely to see Oliver’s piece get so much play though.

  • This was a study that caught the attention of a lot of people I know who aren’t particularly interested in issues related to psychiatry…mainly because of many articles highlighting Benadryl/dementia. Perhaps it will help people to further delve into the complications of long term use of anticholinergics.

    But I was not aware of that site that you link to that shows the breakdown in anticholinergic properties of most psych drugs. In the category that shows strong anticholinergics effects (scoring a 3), that is quite a list that includes most of the “1st generation” antipsychotics but also the very commonly prescribed seroquel and Zyprexa.

    Sadly, I assume this won’t have a great effect on prescribing patterns, but I wonder why. Will the APA try to dismiss these findings? Simply ignore them?

  • Great piece Joanna. I often look to askapatient.com when I want to see a more comprehensive, longitudinal and subjective experience of drugs and their effects. I really would like anyone who wants to start a drug to go there first. It is an amazing compendium of stories and voices of lived experience.

    One of the singularly frustrating things I hear in the mental health world is the term evidence based treatment. It implies that a course of psychiatric drug therapy is a scientifically effective modality. Yes there may be partial alleviation of symptoms (perhaps), but at what cost? What side effects? What long term health consequences? What long term effects to metabolic and organic functioning?

    In any event- Lived experience- It trumps all RCTs in my book. Here’s seroquel…1349 ratings…

    http://www.askapatient.com/viewrating.asp?drug=20639&name=SEROQUEL

    And here’s Paxil…943 ratings…

    http://www.askapatient.com/viewrating.asp?drug=20031&name=PAXIL

  • This is a key point Joe- alternatives such as psychotherapy are often out of reach due to lack of insurance or due to excessive deductibles which act as a paywall for the economically disenfranchised. And other types of alternatives- massage, yoga, acupuncture, herbs, alternative healers, etc- can also be prohibitive due to cost.

    Alternately, “meds” are often free or close to it. The system is economically rigged to favor psychiatry.

  • Exciting and wonderful work Yana- thank you. I was not aware of Inner Fire before this. There are a number of us here in Portland interested in trying to create a template for a non-medical center for healing for people who are in crisis or who are tapering from meds and need a non-disease-centered approach. Very inspirational.

  • Great comments from all here and I just want to continue on with what madmom says. Imagine a campaign where the expenses for “helping” someone is tallied up. Put a monetary figure on each person in terms of hospitalizations, psych drugs, health complication medicine and surgeries, disability checks, etc…

    Call these folks the million dollar man or million dollar woman. Then describe how that money could be spent…as you just did Madmom. Then simply ask…is this how you want your taxpayer money spent?

  • I agree- well said Corinna.

    I think the assertion that there may or may not be high presynaptic dopamine production in the brain for folks labeled with schizophrenia, or going through psychosis- is not the main issue.

    The main issue is the idea that antipsychotics somehow “correct” this.

    Even if what they posit is correct: there are higher levels of dopamine- neuroleptics in no way “correct” this. Certainly they are dopamine agonists, but they work at such a global level as to damage organic and metabolic pathways when taken chronically.

    An antipsychotic “corrects” dopamine levels as much as a shotgun kills a mosquito on a wall.

  • Thanks for the piece Sandra. I agree that there should be a” safe place for people to stay while they work through their crisis.” The complexity arises when we talk about the varieties of crisis.

    Here in Portland, the various hospitals have found themselves increasingly squeezed and are losing large amounts of money in their acute settings. This is largely due to the fact that acute hospitalization tends to involve people who have limited or state insurance. This leads to poor reimbursement while funding the payroll for all the doctors and nurses is exorbitant.

    For this reason, the largest hospitals are pooling their moneys to centralize and create one large inpatient facility in Portland with its own psychiatric ER. This is mainly a cost savings measure but points to the inherent problem with crisis mental health care. Generally, the medical system is far too expensive to “manage” crisis. Its just not a model that has made fiscal sense.

    We are in desperate need of alternatives that are not only cheaper, but far more humane. One of the main problems I see is that most anyone in crisis is funneled into one monolithic system. Those who are high, drunk and acting bizarre and agitated, someone with dementia who is violent, someone who has stopped taking strong neuroleptics, people experiencing “first-break” episodes- all get funneled into this one system and tend to receive very similar care- psychiatric drugs and often a short stay of a few days before being sent out for services (generally lacking) in the community.

    We need systems where we funnel a number of these folks to systems of care that do not prioritize med management. This is especially important for “first break” folks. In my perfect world there would be “asylums” designed to allow crisis to run its course without medical intervention. But my second best choice (and likely more realistic) is to promote a non-interventionist model for first-break in a hospital setting where people are not immediately started on strong doses of neuroleptics, or at least offered a choice for selective use.

    In this way we may not create a group of folks who require long term med management. Once this happens, folks often cycle in and out of hospitals due to intermittent and understandable “non-compliance.” Then it becomes much harder to create non-medical alternatives for crisis. I believe we have to really start at the beginning when people first start taking strong meds and try to avoid that as much as possible. Once an individual has been taking psych drugs for a while, it is deeply challenging to offer alternatives that don’t in some way involve psychiatric intervention, even if it means to help taper someone safely as you have been talking about. And when someone is agitated and has been cycling on and off meds, soteria and respite models are not effective. We have to go the root and start from the beginning and address how this epidemic has happened. Trying to fix it midstream is deeply challenging.

  • Fascinating piece and one that gets to the heart of our cultural assumptions about “mental illness.” I had not seen the statistic of 90 % cross cultural belief in possession before but it rings true. Though we disregard it as an absolute relic of pre-scientific superstition I think it is key to understand that metaphysical explanations of extreme states are extremely common outside of the Western psychiatric model.

    I once witnessed an orthodox Russian exorcism of a woman who was diagnosed with schizophrenia. The process of a community coming together to offer healing to someone in distress was beautiful…but also complicated. many would not only dismiss this experience, they would consider it dangerous and contrary to what she really “needs”…namely psychiatric drug treatment.

    We have heard many stories of people foregoing medical treatment for spiritual healing coming under extreme scrutiny for abuse and negligence of family members. This is somewhat understandable in life and death medical matters.,.but seems grossly unfair to those going through emotional distress…as many of the Pharma drugs have severe well understood problems. Which is worse? An exorcism or a lifetime course of neuroleptics?

    When I lived in Ecuador for a while I worked with some of the indigenous “shamans”, aka ayahuasceros, and they held a deeply complex syncretic animist and catholic cosmology. They often thought illness patterns developed due to black magic…brujeria. They envisioned sorcerers sending evil invisible “darts” to hurt others and the ayahuascero could remove that dart through ritual and communion with plant and animal spirits.

    I also saw ayahuasceros describe remarkably prescient visions that could only be thought of as telepathic. Something deeply mysterious and incomprehensible was going on, which often mirrors the experience of those in deep crisis. I think we should deeply explore these frameworks, and should certainly honor cross cultural traditions outside of the standardized modern Western psychiatric model. Thanks for your words.

  • I’m not really sure you have looked at that site and those reports I mentioned at askapatient.com….heres the link again…

    http://www.askapatient.com/viewrating.asp?drug=20639&name=SEROQUEL

    These aren’t just a few people- there are hundreds of reports in here of serious and adverse effects. Not just a few, or even a small sampling- a significant percentage of folks report very poor reactions. What do you think about some of these reports?

  • How about something cheaper that gets straight to the point. AskaPatient.com. Take a look at the testimonials of people who have been taking the drugs themselves. Since this post is on seroquel, lets take a look at the 1346 ratings it has been given… http://www.askapatient.com/viewrating.asp?drug=20639&name=SEROQUEL

    There are certainly a number of folks that extol its benefit- but literally hundreds and hundreds of folks that describe horrendous reactions to this drug. How many people are told that this is the type of experience that could very well happen for them…here is a sample…

    “All Delusions, hallucinations, sleep, dry mouth, weight gain, overactive libido, mood swings Over confidence all side effects. I am 100 days free of this dangerous drug”

    “This medication did not really help me at all with my problems and it very possibly may have completely killed my reproductive function. I am currently waiting to find out if my body will ever recover, it has caused me to gain weight, develop breasts, varying levels of sexual dysfunction, it has damaged my blood sugar levels, and I may have completely lost the ability to procreate. There are over 10,000 law suits filed against AstraZeneca for things like this and I may be another soon, I implore you to research the rare and serious side effects before taking this in my experience worthless and dangerous pill.”

    “Just a bad over prescribed bad drug Went cold turkey, it cost me my life, it destroyed friendships, prescribed to shut me up, this drug is used as a catch all for any ailment, I would not recommend this for anyone, I’m working through insomnia and angst for not researching this drug, nothing will ever have me take this drug again, did not dose down did not tell my doctor, just left it along.”

    “Within days of taking this drug I developed Spasmodic Torticollis. Was in severe pain and still recovering the damage of what this drug did to me.”

    These are not just a small sampling. Reviews like these are extremely common there. Your thoughts?

  • Hey Rossa- I think Castaneda really made it tough on himself by presenting his experience as a first hand narrative. If he had just explained things as a deeply imbedded anthropologist he wouldn’t have caused himself so many problems.

    But…I think there is quite a bit of value in those books- and he very much popularized the idea of examining experience from a non-ordinary, non-linear perspective. This influenced a lot of folks who have been interested in seeing our experience outside of reductionistic ways of examining life.

    This can be really important for people going through extreme states because the process is often very non-ordinary/non-linear. So- not trying to trash. But I am acknowledging what many other people will say when discussing Castaneda and his works. On an academic level, he lost his good standing. But his willingness to deeply explore and describe these complex experiences deserve admiration, and certainly they have helped many people understand their own process better.

  • Yes- I am afraid Bipolar waking up is right. Casteneda has been dismissed as fiction, though he borrows from a lot of anthropological literature and first hand accounts. This is one of the problems when talking about this sort of thing. It can be easily dismissed. That’s too bad, because there is tremendous wisdom inherent in these ancient practices.

  • Hey Rossa- Yes I wrote a piece that was up on Monica’s site- Beyond Meds and can be found at my site here- http://www.hearthsidehealing.com/madness-possession-and-transformation-a-personal-narrative-of-healing/.

    It talks about my personal experience going through “madness”, my experience of possession and healing. One of things I wrote fits here as well…

    “When I look back at that experience now I wonder a few things. On a certain level, I could see the whole experience as imagined, a part of the process of psychosis, a grand delusion. And from a scientific and logical perspective that seems rationally true. But from a different perspective, I see how the descent into darkness and then coming through a horrific and torturous experience through the help of a healer and plant medicine is a story that is as old as time. We are walking in a world where treating madness through the use of double blind study proven antipsychotic neuroleptics is the main accepted form of treating “mental illness.”

    What is challenging is how easily these conversations can drift into feeling “new Agey”, assembling indigenous cultural perspectives into a modern formulated “shamanism”- created almost entirely for white and privileged people. This is a fair critique- but I would also suggest that by dismissing these ancient traditions, we have exchanged them for a rationalistic, scientific and reductionist way of working with madness that is deeply flawed and often far more dangerous.

    One of the most interesting things that have been happening lately is a very strong interest in exploring healing with Ayahuasca, a South American hallucinogen. This medicine has been used entirely in unique tribalistic contexts but numerous Westerners are exploring and finding great healing through ritual work with ayahuasca. There has been quite a bit of talk on CNN (just google) about returning veterans feeling completely zombified by psych drugs for treating their PTSD, and a number of them have traveled south to take part in ayahuasca ceremonies that they describe as being tremendously transformative.

    I think we need to be careful, but open, to these wider possibilities for healing.

  • Hey Alex, I think by scientific rationality, I’m mainly talking about the gold standard of double blind studies. Frankly, I think the idea of something needing to be proved by a double blind study is often ridiculous. How do you use a placebo for the warmth of the sun, the kindness of a stranger, warm home cooked food, a cup of warm linden tea- all things that have obvious merit for improving wellbeing.

    Shamanic techniques are fairly impossible to verify as something repeatable and verifiable s effective under the classic double blind scientific paradigm.

    But I would say…bah. There is a long history of using these techniques in many settings with good anecdotal support. But there are many complexities in bringing that wisdom forth. One of the main problems is cultural imperialism, appropriating another culture’s healing forms. A second problem is that some of these forms just don’t translate to many modern people. They often involve culturally unique cosmologies, spirits, deities, etc.

    But…I still think its something we should deeply explore as shamanic/spiritual techniques of working with people in deep distress is a time honored tradition and one that I have personally seen as effective.

  • Very interesting post Natalie.
    I think we tend to get lost in our cultural assumptions about mental distress and its etiology. Most are influenced by psychiatry and the DSM and others are influenced by psychological thinking. But we tend to relegate non-western approaches to being superstitious, magical and non-scientific.

    This is strange because most of the world does integrate a lot of these tools for helping people in crisis that are often effective and merit deeper examination. I think its important to separate out traditional systems of healing people such as Traditional Chinese Medicine, Ayurveda and Unani-Tibb from more tribalistic and religious practices. The former have developed countless tools for helping people in crisis such as acupuncture, qi gong, herbalism, yoga, massage and dietary advice. Though these are lumped in with “New Ageism”, they are simply traditional tools that have thousands of years of historical, anecdotal and empirical efficacy.

    Shamanic, spiritual and religious tools are more complicated because they do rely on a willingness to forego scientific rationality. As you mentioned, concepts like possession, out of body experiences, shamanic healing, ritual and ceremony are common to many indigenous cultures throughout the world. Deriding these tools for being superstitious and magical is somewhat amusing when we offer an alternative (psychiatry) that has led to an epidemic of worsening mental health.

    I think the challenge is that these tools don’t easily translate well into cultures based in scientific rationality and modernity. But they do hold an important place for many indigenous and religious groups throughout the world. Even if one were to consider them metaphorical, they help allow for a community to embrace and help in the healing process for someone who is in deep distress. These techniques are ways for the community to come together and offer hope and care for someone who is experiencing extreme distress. Frankly I’d like to see a whole lot more of that than a drug based approach to distress.

  • Interesting- I have always wondered about the thinking of psychiatrists for prescribing multiple meds in such large doses. I will give an example of someone from a while back who was receiving 800 mg of seroquel, 2 mg twice a day of xanax, and 120 mg of celexa. This is for someone diagnosed with depression- no psychosis. She says the seroquel was for sleep.

    I have always wondered how doctors simply pick and choose meds- subjective preference, research, etc?…and what leads them to high dose polypharmacy. Is there literature that supports it?

  • Sandra interesting about effectiveness range being around 3.5 mg. I regularly see people in the community and in my practice who are prescribed at least 20 mg of haloperidol a day and a few times as much as 40 mg. The effect is very noticeable with muscle rigidity, akathisia, anhedonia, tics, etc. Horrible. I have almost never seen someone prescribed less than 5 a day, and it is often paired with other antipsychotics.

    so yes, conservative dosing and much less poly pharmacy would go a long way to mitigating extra pyramidal side effects. That would be wonderful to see.

  • Ya Hermes,

    I know that risperdal is now available generic and that was one of the first (the first?) atypical to be marketed….so that is indeed cheaper. I know that the cousin to Risperdal…the Invega shot…is pretty pricey. Add it all together…hospitalization, expensive drugs, regular med checks, etc….leads to busted mental health budgets.

    Drug based “therapy” is stealing money out of the hands of community services.

  • ya Duane…some of these drugs are indeed very expensive…Abilify I think is the most but so is Geodon and other newer “atypicals.”. Big Pharma has made a fortune marketing these drugs as wonder meds that are far more safe and effective than older antipsychotics such as Haldol and Thorazine. But of course we are now learning about severe metabolic problems, weight gain, diabetes, heart disease, etc, associated with the newer drugs.

    So some say the answer is to return to those cheaper older neuroleptics that were horrifically damaging. Like you say Duane, hopefully the sheer cost of drugging enormous swaths of population will force the hands of those who manage State Budgets to rethink this approach to mental health.

    If longitudinal studies showing poor outcomes and long term health effects doesn’t change the debate, perhaps financial budgetary burdens will convince people to make significant changes to reduce drug based treatment strategies.

  • Excellent analysis Bob and thanks much for the in depth examination of these issues. I have long felt that the sheer expense of the medical/disease model of “mental illness” is the Achilles heel that will eventually cause it to have to radically change. The cost of not only employing high priced doctors and nurses in acute and outpatient settings, but also paying for very expensive pharmaceutical drugs, is becoming untenable in many counties and states.

    You mention the cost/effectiveness of antipsychotics. There seems to be a push towards using the older “typicals” such as Haldol and Prolixin, not only because they are much cheaper than most atypicals, but because some research is saying they are just as “effective.” Of course this ignores the severe extra pyramidal side effects and potential for long term neurological disorders of the older antipsychotics. So will we trade more expensive drugs such as seroquel and zyprexa with their known metabolic side effects, for older antipsychotics that cause Parkinson like symptoms?

    How about what we do what you suggest…shift monies to much more effective and cheaper ways of helping people… Community and peer supports with increased available housing?

    Thanks for your words Bob.

  • On a deeper note, I think the key issue to resolve is why we have shifted towards 20 percent of people (in America) taking psychiatric drugs. A back of the napkin estimate would mean that 60 million folks are taking drugs for emotional distress. They are not generally getting these drugs from psychiatrists. They are mainly getting them from their GP. I don’t think many of them are interested in whether they meet a DSM-V diagnosis. They want relief from symptoms, and doctors, the AMA, the APA and pharmaceutical companies are saying that drug based therapy is an evidence based and generally safe way to manage distress.

    If we want to get to the heart of the matter, the question becomes less about psychiatry and more about the role of drug based amelioration of emotional suffering in modern society. There are many culprits, and that includes us as a society that wants a quick fix to complex emotional pain. If we want to unwind this “epidemic”, we have to not only point fingers at the medical establishment and Big pharmacy, we have to choose as a society to employ healthier methods for working with our distress. We have to not only choose a slower, healthier path, we have to acknowledge the role of systemic racism, classism, poverty, food politics, industrial agriculture and quick-fix thinking at the root of our suffering.

    These are complex problems not easily solved by

  • Thanks to Bob and Allen for debating these deeply important issues. I want to address Allen’s piece first.

    I applaud Allen for directing a lot of his critique at “Big Pharma” and their advertising and marketing efforts. Yes I agree that this is absolutely important to address and reform. However, Big Pharma would not have the power to influence without the help of the APA and the DSM. Without the DSM, Big Pharma marketing would not be able to wrap itself in the cloak of scientific legitimacy. Truly the two are wedded and Big Pharma would lose much of its power to influence if the DSM was seen as lacking scientific underpinnings.

    As tothe role of medication. Again I applaud Allen for recognizing that overmediction is deeply problematic. However he differs in that he would reserve medication for those that are acutely psychotic. Strangely I would agree but not for the reasons Allen may say. Sadly once a person has become habituated to antipsychotics I would guess the leading cause of psychosis is due to med changes and abrupt tapers. Because of this the humane thing to do is to suggest returning to taking psychiatric drugs as a way of curtailing florid psychosis. This does not imply that a person is essentially “mentally Ill” or needs meds for some chemical imbalance…but simply needs a safer and slower taper off very potent drugs. I would also reserve the use of drugs for short term care as we are already seeing that long term use are leading to worsening prognosis and health. I think it is key that Allen acknowledges this.

    On the third point I think Allen is addressing a really important point. We have shifted from having around a half millions psychiatric hospitabeds in the 50s to having around 50000. Hospitals are generally turn mills to get people in distress back out the door. Prisons have taken up the role of long term “care” which is abysmal and torturous. Both options are awful and we need to revamp better possibilities for those in distress via humane non medical respite, housing first, community outreach, and non medical wellness programs designed to offer healthy non-drug options for helping those in distress. What I cant abide is Allens support for outpatient treatment. He must know that these drugs cause worsening prognosis and physical health. Why support their use as any form of “care”? I would hope Allen would become a leading critic in disavowing this practice understanding what he knows from longitudinal studies done by Harrow and others.

    Anyways, though I disagree with you on a number of matters I appreciate you taking the time to debate and discuss these issues.

  • Wonderful work Sandra…and work that I wish was replicated by many psychiatrists. and I love the idea of fully monitoring weight, and also adding other concerns such as blood pressure, blood glucose levels, metabolic panels, etc. This should be standard practice for any doctor putting a patient on an antipsychotic. The tapering process is often complex, with lots of stops and starts, reinstatement, cold turkey experiments, complexities of poly pharmacy tapering, med changes, etc…very hard to track exactly, and I really applaud your efforts.

  • Bob this is wonderful news…and a very smart way to change the standard of practice for prescribers as well as forward the conversation about long term implications of psyhciatric drugs.

    Eventually I think mainstream media, APA and those taking these meds will have to catch up to the implications of the Harrow and Wunderink studies (as well as other studies on other classes of psych drugs) and this is another way to press the issue.

    Thank you to all who are taking part in this.

  • Sounds like a great program Bonnie and Julia. Thanks for talking about this. At the farmers market I helped start, we initiated a program to give matching dollars for folks with food stamps for purchasing locally grown fruits/veggies. Examining food politics and poverty is really key to this discussion.

  • Oh…you asked about prisons. I think far greater attention should be placed on prisons as well as hospitals. The stat I quoted above says there are 350,000 people with mental illness in prisons and about 35,000 in hospitals. MIA needs to shine a serious spotlight on the immense crimes being committed in the penal system.

    We need to create centers for people to experience psychosis without the threat of mandated treatment.

  • Hey Noel. Thanks for your thoughts.

    I think we are all in agreement that

    I think you raise some key points and I see you are in agreement with Ruchard and others when you say…

    ” I completely agree with everybody who has brought up the issue of breaking the law; if a person breaks the law, then they should learn to deal with the consequences. Not doing so, and creating some alternative “treatment” avenue because somebody is “sick” is probably the biggest impediment to getting past #1 the association of violence with “mental illness” and #2 the learned helplessness of those who have been so misfortunate to end up in the system.”

    I just want to ask how you would look at things given this example. A man is in his home going through some delusions that his parents are aliens and they need to be killed. He actively starts hitting and attacking them. Police would likely be called…but where should he go? Does he deserve to be tried in front of a court and put in prison for this episode?

    How about if someone is on the street with command hallucinations telling him to break into a house and find a Bible? What should happen if they do that? Prison for breaking and entering?

    My hope is that we can create centers where people can go that do not require psych drugs and the person can work through their episode without having to be criminalized for psychosis. But right now we are left with really poor options.

    Many of these folks end up in hospitals because we have not created an alternative non-medical infrastructure. They come and so do people who have a history of being predatory and assaultive. At rare times I have had to protect vulnerable people in that setting from people who have a criminal background. If you call the rare instance of defending vulnerable people “abusive” I wonder how you would approach helping and defending them? I have already said cops won’t put down their guns to come in…so how do you work with those situations?

  • Ugh…these threads get so mixed up…here is where I was hoping that comment would land…

    Whoops…I should have said police are not allowed in any other Portland hospital units. I have seen them in the ED escorting a patient here.

    But really…you say if I am not part of the solution, I am part of the problem.

    If the solution means cops in hospitals, I don’t want to be part of the solution.

  • Hey Richard…back for a brief mo before off to the hills to dig up some Oregon grape roots…

    Per your questions…

    1″What world are you living in? Police are involved ALL the time in matters of ‘force’ and violence in psychiatric hospitals. Don’t police frequently “escort” aggressive people (in psychological distress) into locked psych wards on a regular basis?”

    No. Police are not allowed on our units because they carry guns. They are not allowed in any other portland hospital either. At my hospital, they have been asked to remove the guns and all other tazers and weapons and they laugh at the suggestion.

    It’s the main reason I could never support police being allowed in a hospital setting.

    2 “And when (or if) a psychiatrist or nurse is struck or assaulted by a patient on a psych ward are you telling me that you don’t believe the police are called and that person is prosecuted?”

    Police are almost never called because these cases are never prosecuted. The reason is they are deemed “mentally ill” and not responsible for their crime as a legal matter. That could be a thread of its own.

  • AA, thanks for your comments.

    Richard,

    I’m still not sure you understand my position on “force”.

    I am against the use of force in the form of the courts and doctors mandating treatment. By the way, this issue…not the issue of whether to use force in extremely dangerous situations…is the key sticking point in the public arena. Kendra’s law and AOT are the principle methods of using force and should be fought vociferously. We have a legion of opponents to our side on that view. NAMI, Torrey, Murphy, etc.

    I am against the use of coercive force for offering people psychiatric drugs without fully informing people of their perils. Advertising, doctors lectures, misleading information, 5 minute doctor appointments are all subtle but pervasive forms of “force” that we need to oppose. Again, there are a legion of opponents to this view from the AMA, APA to Big Pharma.

    But you have zeroed in on a very narrow use of the force…and magnify it to imply that I support all force. This couldn’t be farther from the truth. I am fundamentally against the “wrongful use of force”. Any survivor story here strikes me as a blatant abuse of power. I am against any blatant abuse of power.

    But you take it a step farther Richard. You demand that force never be used….no matter the circumstance. Or that matters of violence be handed over to the police. I just have to fundamentally disagree.

    Like AA said, police intervention has gotten a lot of people killed. I will fight you or any others who try to suggest that hospitals should now have police involvement in matters of violence.

    Instead. we need humane workers in hospital settings and in the community who understand how to use deescalation skills and will do everything humanly possible to avoid force.

    And yes, there are cases where people step over the line and start inflicting damage on others. That is unacceptable and force is obviously merited. By abdicating force, one would endorse the traumatization of vulnerable people. So of course there should be force in those situations. How could you argue otherwise? But it should be used extremely rare and abuse of power should be fought vociferously.

    In any event, I’m busy today….gonna do some work, enjoy the family and brief windows of sun so I won’t be back to reply. But I hope you and Jonah, and all else here have a good day. Take care,

    Jon

  • gardenlisa,

    That’s a hard path to walk. And it’s esepcially hard if you don’t have a lot of support. So much of the time folks are isolated in these situations. That’s wonderful that he was able to wean off the anti-depressants and anxiety meds and that he was seeing a naturopath. Zyprexa, and all the antipsychotics can just be horrible to quit.

    Sometimes the family member will take a lot of the anger/pain/confusion out on the parents and the rest of the family. Is there any way to bring someone in outside of the family to encourage him to start doing healthy things…clean, shower, eat?

    You asked about recovery…at some point his neurochemistry will adjust to being completely off zyprexa and that process is really helped by nutritious food, rest, good sleep. As an herbalist and someone who works with people withdrawing off psych drugs, I second Fred’s ideas of offering good supplements too but it sounds like it’s hard to interact on this level.

    Sometimes people experience prolonged discomfort, neurological disorganization and extreme states for quite a while after withdrawal. Recovery can look uneven. Having family members and friends around who are supportive and offer unconditional love and care is vital. It sounds like you are playing that main role and it can really burn people out…it’s really helpful to do a lot of self care so you can help him.

    Anyways, hope you and your son find a way through to a better place…

  • Man….really challenging. One thing is that I would hope you are getting some support for yourself because that is really hard stuff you are going through.

    I was saying before, I try to steer people away from hospitalization as much as humanly possible…but if he is truly talking about death wishes against the family that is scary stuff. I know people who are fundamentally opposed to psychiatry who have brought family members into a hospital setting because of the fear of violence. It’s a very hard decision to make.

  • Whoops…hopefully this will find the right place…

    Richard,

    I am trying not to twist your words. Here they are…

    “Nigel, I am very worried about your situation. Because we don’t yet have safe alternative programs for people in your situation if you don’t calm down now and continue to act aggressive or violent, we will be forced to call the police. This will be our only available option.”

    Forced to call the police is another term for…using force. And it’s somethng I see folks here repeatedly trying to wriggle out of. Though you say you don’t support force ever…is just not true. You support allowing the police to use force in these rare extreme conditions.

    That is not abolition of force.

  • Richard,

    I am trying not to twist your words. Here they are…

    “Nigel, I am very worried about your situation. Because we don’t yet have safe alternative programs for people in your situation if you don’t calm down now and continue to act aggressive or violent, we will be forced to call the police. This will be our only available option.”

    Forced to call the police is another term for…using force. And it’s somethng I see folks here repeatedly trying to wriggle out of. Though you say you don’t support force ever…is just not true. You support allowing the police to use force in these rare extreme conditions.

    That is not abolition of force.

  • Hey Jonah,

    For you, and anyone else who is interested…this is a good write up of the national statutes that were codified back in the 70s.

    http://careforyourmind.org/the-right-to-treatment-and-the-right-to-refuse-treatment/

    Here’s a key piece of the article:

    “It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.

    Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital. But a person admitted involuntarily, due to danger to self or others, cannot leave, at least not right away. However, despite having the authority to keep the patient in the hospital, the professional staff cannot treat the person against his or her will, except by court order.

    The concept of a right to refuse treatment was built on basic rights to privacy, equal protection under the law, and due process. In other words, involuntarily hospitalized patients still have a right to decide what happens to their bodies.”

    Now again, I honk horrible abuses take place where folks are “treated” against their will, or a flimsy excuse will be made to give a shot. Many folks can attest to brutal experiences in a hospital setting.

    What I aslo want to warn someone against, anyone who thinks about hospitalization…is that “right to refuse” will go away if the person goes to a court hearing and the judge decides to commit them. That means anyone going into a hospital is gambling that they will not be committed and then treated against their will.

    Civil Commitments have gone down rapidly in the last few decades and are now mainly reserved for folks who are deemed “psychotic” and a danger to self or others. But anyone entering a hospital should think hard about that possibility of commitment and it’s one of the main reasons I try to steer most folks away from hospitalization if at all possible.

  • Again- really really hard real world problem there gardenlisa…with no easy answers. One of the things I hear right off the bat is that he went cold turkey off psych meds- which can really cause severe complications and disorganization for anyone…but especially for those prone to extreme states. Even if it was 3 months ago- that may still be causing ramifications. However, I would not be as concerned with CT causing permanent harm. 7 years of drugging can indeed train the brain to be habituated to those drugs- and then when someone quickly cold turkeys off them…it can cause a hell of a lot of problems.

    There really is no easy solution. The main problem with hospitalization is the very distinct possibility that he will not just be held-but then taken to civil court and be committed. At that point doctors can choose what drugs and at what dosage they want to prescribe psych drugs. He also faces the possibility of transfer to a State Hospital setting and indefinitely being caught up in the system.

    At the same time, in a hospital setting he may decide to take a psych drug voluntarily and then hopefully stabilize and be released- and this time with the goal of tapering slowly and carefully off the drug.

    The best option- like you say- would be a place where he could recover without facing the possibility of being forced to take psych drugs.

    Hard stuff…I hope your son will improve and recover in time.

  • Hope this comment makes it to the end of the thread line here :).

    I think we need to be very clear that there are a lot of different types of aggressive and violent behavior and there is no clear line saying that anyone who is aggressive/violent should be dealt with by the justice system. You call that “enabling.”

    I have worked with countless people who act extremely aggressively in the throes of psychosis. But once the psychosis has passed they are no longer violent or aggressive.

    I also have worked with people who are predatory and violent by nature.

    I think its key that we separate out these two separate populations. In the first case, I think it is highly troubling to turn over every aggressive and psychotic person over to the justice system. The humane thing to do is to give them space until the psychosis passes. If you call that enabling…so be it.

  • Really tough questions hearsbirds. I think a few things have to be examined with that incident. Why were hospital staff negligent in allowing an obviously violent person in a shared room with a vulnerable person? Why did they not look in on this vulnerable person regularly? There is obviously a lot of negligence going on with that hospital and there should be justice in that case.

    The questions I have would be- what state of mind was that violent person in? Were they going through psychosis or paranoid delusions that led to this attack? Or was the assailant simply predatory and predominantly lucid and clear in thought when she attacked?

    If its the second case, I have no problem with handing that person over to the justice system. In the first case, that’s a lot harder. Violent people who are “mentally ill” tend to go to forensics wings of state mental hospitals. They then get “treated” which generally means being forced to take loads of neuroleptics. Would the assailant fair better in a prison setting? Doubtful…but both are awful places to end up.

    What should have happened is that a potentially violent person should have been somewhat isolated from vulnerable people and been monitored very closely. My hope is that if the violent impulses were related to psychosis, that those impulses would fade as an episode of psychosis passed. But if those violent impulses were related to underlying aggressive and predatory traits, my hope is that person would be transferred out of a hospital setting as soon as possible.

    The problem comes that people who both aggressive and psychotic- often get court committed and end up in State hospitals. As other people mentioned, this is a horrible type of vague “sentence” with no fixed end. Forced treatment with neuroleptics is the norm. So many would say prison may be better for those who are likely to be committed. But as I described in the link above, prisons are overwhelmingly brutal to “mentally ill” inmates.

    My hope would be that we pass laws to end the right of doctors to force treatment. In that case, someone may be detained for violent and psychotic behavior, but not required to take meds.

    These questions you bring up are complex and very challenging to answer. In my heart, I don’t believe we should treat every aggressive and psychotic person as a criminal. However, in this case, and with the severity of the crime, the assailant needs to be isolated from vulnerable people for a long time.

  • In reply to Jonah at 6:46…

    “Each time I was “hospitalized” against my will, it would come ultimately as the result of my being falsely accused of being a danger to myself. And, each time, I’d be forcibly drugged. Never was I committed by a judge.

    Jonathan consistently fails to acknowledge that this happens.

    Perhaps, in Jonathan’s “hospital” setting, people who are viewed as ‘suicidal’ are treated with the relative degree of respect that he’s describing, but why does he generalize?”

    What you are describing is against the law Jonah. From Wikipedia…

    “Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without a person’s consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual’s objections. These are typically individuals who have been diagnosed with a mental illness and are deemed by a court to be a danger to themselves or others.”

    To be “treated” against your will without having been seen by a judge is a violation of 1975 law. And that law does not go far enough. No one should ever be involuntarily treated….period.

    But the reality of your experience, and many many others, show that many hospitals have been routinely abusive and it looks like in your case they flouted that law.

  • I also have to check in with this statement here Steve…

    “But even so, the same thinking applies: even if you decide it is OK to detain a person for self protection, it should not take away their right to consent or refuse medical treatment, in particular, the drug-based pseudo-”treatments” that are usually enforced on every detained person in the psych ward.”

    People who are suicidal are generally never “forced” to take a drug based “treatment.” You can only be forced if you have been committed by a judge and it is very rare for a suicidal and non-psychotic person to be committed.

    However, suicidal folks are coerced by doctors into taking psychiatric drugs without full informed consent and without presenting alternatives- something that is seriously wrong.

  • Hey Richard- I wanted to reply to these words here…

    “Here is the best I can offer in a very difficult dilemma for anyone working inside the system.They (the distressed person) should be told ahead of time what will happen if they are violent or threatening violence. They should be pulled away from harming some one else. They should be offered support, consolation and compassion. If they are so aroused that they cannot calm themselves (with this kind of support) then they should be offered short term use of sedative drugs (such as Benzos).

    If none of this support or offer of drugs works then they should be told that if they cannot control themselves the police will be called to intervene. They should never be forcibly drugged or contained in a psych ward against their will; the short and long term harm FAR exceeds other alternatives.”

    This is the real meat of the matter. I totally agree with the first part, and I think you’re right that just creating a space to vent, rage, receive support and just listening can be really powerful. I once was in the ED when an enraged 350 pound man came out into the hallway screaming and demanding to fight me. He had scars from bullet wounds and knife fights and looked totally scary. I told him I didn’t want to fight because he’d crush me. I told him I was scared of him but I’d be open to hearing what he was going through. After a while he stopped screaming, calmed down and told me about his life, which was incredibly hard and sad and painful. That was all that was needed in that moment.

    The part where we disagree is the police part. There have been times when police wanted to come in and talk with a patient with a criminal history and we said that they could not enter with weapons of any kind. They refused. I just can’t support the use of police tools for dealing with really precarious and potentially violent situations.

    You ask about me making a stance against forced drugging and forced hospitalization? Lets start with the first. I absolutely oppose forced drug “treatment.” But you are talking about forced drugging in violent situations. I will say, as I have said before, I will only support the use of it in the rarest of circumstances when all other measures fail and other individuals are threatened with trauma. I don’t think supporting police involvement means you don’t support force.

    As to forced hospitalization?

    In general I agree with Steve here that…

    “I’ll say as I have before that there is no reason that detention of a person for acts or threats of violence has to be coupled with enforced treatment.”

    Right. People are only forced into mandated drug “treatment” after they have been committed. This should be abolished. No one should be forced to take regularly scheduled potent neuroleptics.

    I don’t think that has to mean a hospital but I would far prefer a non-prison setting for deescalation of someone who presents as psychotic and aggressive.

  • Hey Richard…ok thanks for your reply.

    So yes…everyone has a right to defend themselves. We’re in agreement there. I think what might make this more clear is describing in real terms how to work with people who are violent.

    Many people here, we’re abused. Force was used against them needlessly and horrifically. I will never support that. But you also say that force should Never be used. I just don’t get that. Let’s talk specifics.

    If someone who is labeled “mentally ill” is attacking a vulnerable person, would you intervene…and how?

    You mainly suggest that police and the prison system should manage all violence, even if it emanates from someone who is psychotic, confused and delusional. I just will have to disagree. I don’t see hospitals as a panacea where nothing bad happens. hospitals are deeply problematic and I see that from an inside perspective. But I will agree with Allen Frances that the level of brutality committed against the “mentally ill” is overwhelmingly horrific. The use of extended periods in solitary confinement is routinely used as a way to “manage” the ” mentally ill.” They are regularly beaten by guards and tortured by other inmates.

    I think this comes down to my fundamental question. If you oppose force, why do you support police and the prison system for working with the “mentally ill”?

  • Thanks Richard for your piece. As I have been the prime person involved in this ongoing debate for the past year, I’ll try to respond. At the same time, I know a number of us have gone round and round on this issue and at some point it may just be better to refer to previous discussions.

    First off, I want to look at the term reformist…which you argue against. When I say I am reformist, that doesn’t mean I don’t think some aspects of psychiatry should be abolished.

    I believe that there should be a complete abolition of mandated treatment with any psychiatric drug. That is an untenable position and I wrote about that in this article here… https://www.madinamerica.com/2013/12/homelessness-hospitalization-compliance/

    I also support the abolition of ECT, even voluntary. While some people say they have been helped by it, the level of suffering that it has caused should require this procedure to be shelved…permanently.

    But the term anti-psychiatry, or abolitionist…is far too general and global for me. It implies a complete cessation of all aspects of psychiatry, which not only seems impossible, it doesn’t even seem desirable. There will always be people who seek out psychiatric drugs, even if it is in the tapering process. I don’t believe that should be abolished.

    What I do believe is that there should be far more available information about the perils of psychiatric drugs available to the consumer. There should be curbs on advertising, paying doctors to promote psych drugs. There should be impartial longitudinal studies of drugs that are not run by pharmaceutical companies. There should be a curb on prescribing psych drugs just as there have been curbs on opiates due to the potential for damage.

    Finally, I think instead of funding NIMH “silver bullet” genetic research, I think our tax payer monies would be far more wisely spent on increased services for the poor, homeless and disenfranchised through “Housing First”, respite centers, holistic alternatives, changing agriculture subsidies to promote fruits and vegetables, etc.

    Ok- so lets get to the meat of the matter- where we disagree…

    Force.

    You say that you don’t support any force…whatsoever. Not even in rare or extreme cases.

    I really just can’t agree that that is a reasonable view. I think you are mainly talking about hospital situations but lets look at how violence or how the threat of violence is handled in society today.

    Generally, people who are acting in an uncompromisingly threatening and violent way are managed by police through the use of tasers, nightsticks, beanbag guns and handguns. There are police trained in how to work with people labeled “mentally ill” who are able to help deescalate folks without the use of force but often these types of incidences end in the use of one of the types of “tools” I just mentioned.

    If a person is deemed criminal, they end up in the prison system. Right now more than 350,000 people with “mental illness” are in the prison system. There are about 35,000 in state hospitals. We have shifted from hospitalizing the “mentally ill to jailing them. In the prison system, any sort of violence or threat of violence is met with brute and overwhelming force. For a brief overview of how these folks are treated…here is an article…

    http://www.nytimes.com/2014/07/14/nyregion/rikers-study-finds-prisoners-injured-by-employees.html?_r=0

    At Rikers, 40 % of the 11,000 inmates are deemed “mentally ill.” Besides beatings and frequent injuries to “threatening inmates”, isolation is one of the main ways of using “force” to manage “illness.” Long term isolation is known to make people go increasingly “mad.”

    When working with the “mentally ill” population, overwhelming force by police, and in the prison system…is commonplace, and often brutal.

    OK- so lets shift to the hospital system. I think its key to first talk about how the hospital system has changed over the past few decades. 50 years ago there were over a half million hospital beds. Now there are about 50,000 while population has doubled. The long term hospital model has been dramatically reduced in favor of the prison system for managing “mental illness.”

    Richard, as you have written, you don’t support force at any level in these settings (and I assume other settings). But we are challenged by a fundamental question- how do we work with someone who is actively trying to harm another vulnerable person. My first take on this is, all people working with this population need to learn skills to work with highly agitated folks without responding with force. Deescalation skills are essential, such as building rapport, listening, offering comfort measures, food, TV, a radio, a phone, a place to be angry and vent, to even throw things and tear up a room without intervention.

    The problem comes when a person does not deescalate and becomes increasingly intent on hurting others. Often the act of putting hands on and moving the person to a quieter area to calm down helps. But occasionally, rarely, it doesn’t. Even this level of force is controversial. Putting hands on someone who has been traumatized, especially sexually, can be increasingly traumatizing. Keeping a person in a physical hold or mechanical restraints can be deeply traumatizing to some. Isolating a person for a period of time in a state of extreme agitation is also traumatizing. Giving a forced shot of a sedative is traumatizing. There is no good answer at this point.

    But the alternative is to allow that person to inflict damage…to severely traumatize another person. And that is where I draw the line…and where I am willing to defend the use of mechanical restraints or a forced injection.

    What I will not support, is making this a legal matter- turning this over to police and their tools, or to the prison system and its ways of managing force. There is no easy answers in the face of these rare circumstances. My goal is to make this type of encounter extremely rare. And in the hospital where I work in- it is rare.

    But I acknowledge in other hospitals, it is likely not rare and far more draconian. One of the best ways I have seen for reducing the use of force in hospitals is by requiring hospitals to document every incidence and then publicizing the results in the media. Hospitals that use force commonly will be pointed out and should be severely criticized and humiliated into changing their policies.

    So…Richard…I understand your desire to support an all or nothing abolition of force mindframe. I do support the abolition of mandated “treatment”. I don’t think we will come to agreement on the issue of how to work with violent individuals but I do want to acknowledge that we are largely in agreement on most all other issues. Thanks for your words.

  • Wow- I just want to say- thank you for sharing those words. Sometimes spiritual practices can unearth a lot of deep and traumatic inner work. I think this is especially the case with sitting meditation. That act of simply sitting and observing can allow the rawest and deepest unconscious terrain to open up which can be truly frightening and hard to manage. I have known people who have had profound psychotic/spiritual experiences from spending prolonged periods in meditation. It can indeed dissolve gates of perception so that a lot of extra hidden information comes in.

    I tend to steer people towards more gentle movement based practice (yoga/tai chi) if there is a propensity towards extreme states as that can often help mediate and ground that rippling “hurricane” energy that can suddenly surface.

    I really loved this last paragraph of yours…so poetic…

    “I don’t run anymore, I stumble. But I stumble because she is with me now, that broken part of myself. We are tethered together by love and fate, like two sisters in a sack race. My life is very different, but I will never leave her side again. I dropped straight into hell to get her back and I will never walk until she can walk with me. I will never begin to run until she can keep up.”

  • Har har!

    But seriously…how hard is it to understand that psych drugs won’t cure homelessness, poverty and the stress and perils of modernity? How bout we spend our hard earned tax dollars on “housing first” and respite centers that serve nutritious meals with staff that can provide support and care?

    Even if we found a magic marker for a “mental illness”, how would that ever translate into the need to take a drug that has long term health consequences and poor longitudinal outcomes?

  • Hey first off- Sandra- thanks for your counting work in this area.

    I read the Insel piece…I think its great that there are leaders in the field who are really acknowledging some of the deep problems with psychiatry and are willing to “atone” for some of the failures. My only problem is that Insel seems to really believe in the “magic bullet” method of helping people win distress. By that I mean that he really wants to direct NIMH into deeper reductionist pathways to find “markers” and underlying genetic etiology for illness patterns…and therefore create a scientific way of matching treatment with illness patterns.

    This seems remarkably short sighted and diving further into the rabbit hole of trying to develop a more “scientific” diagnostic framework. For someone who wants to atone for the failures of psychiatric “paternalism” and hubris, this seems like continuing down the same road of trying to reduce and medicalize complex psychological states.

    Anyways- thank you for continuing to share your journey.

  • Yes there is a lot of controversy Chris. When yoga first came to the West, there were only a few main teachers and styles (Iyengar, Desikachar’s viniyoga, Ayengar). As yoga has become incredibly popular, many different styles have bloomed, and many have become focused on the physical portion of yoga and eschewing the Hindu yogic philosophy. Power yoga and Bikhram come to mind. Most Americans don’t want to study Sanskrit, mantra, deeper levels of pranayama (breathwork), vegetarian diet, and are simply looking for a good workout and stretch.

    I honestly don’t think there’s anything too wrong with that though there are issues of yoga being commodified, watered down, and removed from its spiritual roots. At the same time, the practice itself can be very rejuvenating for anyone, without a need for delving into intricacies. I think we can get caught up in who is doing a “truer” form of yoga.

    Credentialization is also an issue. Some folks call themselves a yoga teacher after a few weekend trainings. Others gain a certificate after long study that doesn’t just examine the physical (Hathaway) part of yoga but delve into the deeper wisdom of yoga. My one friend who became a teacher was required to read the Bhagavad Gita.

    I do think it is important to have a strong understanding of the ethics of teaching/practicing yoga( yamas and niyamas), Patanjali’s eight fold path, basic yoga philosophy, as well as a strong understanding of body mechanics, the asanas, etc.

    Anyways, interesting to look into.

  • Yes for anyone interested, please review that whole discussion. When all other measures fail to deescalate, I will defend the safety of other patients from violence. I think mandated forced “treatment” as well as ECT should be abolished. However, I will not choose police, padded rooms and straight jackets as Jonah has. Beyond this…jonah I’m sure will have a long amount of words to say about me…please again refer to the discussion below the article Jonah referenced.

  • I don’t think there is a single definition, but certainly some of the key things that I see that are red flags are yoga teachers touching students without asking, pushing people too hard and not encouraging a safe place for people to take rest, be still, etc.

    I would also say that a gentler, restorative type of yoga can often be helpful for a disturbed nervous system. There is a lot of yoga geared towards athleticism such as ayengar, power yoga, gym yoga…that can work well for some folks but be too invigorating and overwhelming for others who are trying to restore.

  • Douglas….sorry to hear you are going through a dark time again. I remember meeting you in May and just felt such a warm and connecting presence from you. I’m sure you bring that to the people you work with…and because you are so open about your experience it helps many fathom the suffering they are going through.

    Anyways, sending you good thoughts your way to get stronger and to move through this challenging time.

  • it just seems like common sense that one drug with a likelihood for side effects, combined with another drug with the likelihood of side effects…will compound the potential for adverse effects. Then add more drugs and increased dosages…I don’t need a study to know what will happen.

    But it doesn’t surprise me in the least that this hasn’t been studied.

    As an herbalist, I am constantly confronted by the fear that an herb will interact poorly with a psych drug. There are indeed contraindications…but I have rarely heard of severe complications. On the other hand, adverse side effects of drug drug interactions are commonplace but are rarely highlighted in news stories, or seen as necessarily bad…just need to adjust the meds.

  • Good news…but this needs to go further. No one should be required to take any drug as part of their “treatment.” And certainly no one should be required to take a drug that causes long term physical disability in the form of obesity, diabetes, heart disease, metabolic syndrome, neurological deficits and worsening potential for psychosis (as noted in longitudinal studies). Period.

  • Meaghan- its wonderful that you are teaching and have been working through past trauma with yoga. Yoga was really helped me when I was at my darkest and opened a doorway to feeling stronger, more vibrant and healing somatically and spiritually as well as physically.

    I’ve explored a number of yoga styles and sometimes I am attracted to a vinyasa flow style of yoga, sometimes towards a more restorative yin style yoga. I have lately been exploring kundalini yoga which really focuses on the breath but can be far too activating for me at times.

    I would love to see more teachers who specifically work with people suffering from stress due to trauma. Certain poses and asanas seem to bring up emotional pain and emotional release that can be hard to incorporate and process at times. Having more skilled teachers who can honor people in those states of transformation is deeply important.

    Thanks for your words.

  • Sorry to hear your son is “relapsing” frequently. You mentioned gut absorption problems…perhaps due to eating poorly for a long time. Psychiatric drugs can also cause cascading deleterious effects on the digestive system. Serotonergic agents can lead to complex vague ailments such as Chrohns disease, IBS, fibromyalgia and a host of autoimmune related diseases.

    This can lead to serious challenges in absorbing nutrients and is one of the reasons I steer away from pill/capsule based vitamin and mineral therapies. When the digestive system is compromised, the body will not properly absorb the nutrients found in those supplements.

    Shifting towards a long term plan of deep nourishment can improve things dramatically. Monica really outlines that work at her web site “Beyond Meds”.

    At the same time, “relapsing” can be due to so many other factors not related to nutrition…environment, stress, relationships and the many pressures of modernity.

    Anyways, I hope that your son feels better and gets stronger. Best wishes to you.

  • It’s a good point, and one that Daniel didn’t fully touch on. Traditional psychotherapy was based more on insight, awareness and working through childhood fears and trauma as a way to develop healthier ways of living in the world. Some of this exploration went to ridiculous levels with meeting multiple times a week over years.

    Modern therapy has shifted towards approaches that are much more oriented to accomplishing goals and changing behavior such as solution focused therapy, dialectic behavior therapy and cognitive behavior therapy that are aimed at actual achievable and measurable changes.

    In many ways life coaching takes this modern tack of helping people to develop ways of living that are healthy and help the person meet challenges and ” actualize”. The “coach” is less of an authority and more of an encouraging and supportive friend who helps the person meet his or her goals in life.

    A lot of the move away from depth insight oriented therapy came from a feeling that it was wasting a person’s time and money and not helping a person make achievable healthy changes in life. I think there is some merit to that argument but I do think it can be deeply valuable at times to explore the roots of fears and suffering, often rooted in early childhood dynamics…essentially….to go “deep”. By understanding these deeper shadows, a person can come to a greater understanding of their full self, and try to untangle some of the knots that have made them suffer.

    Anyways…Daniel… it would be interesting to hear your thoughts on the philosophical differences between life coaching and the broad array of therapy styles.

  • Interesting piece Daniel. As a licensed professional counselor, I often feel that the whole system is a game, where you have to jump through hoops, spend enormous amounts of time and money to receive a degree or license…when all that really matters is the level of genuine care, empathy and authenticity a person has in connection with another person. How can that be “licensed”? Not to say that education doesn’t matter. But much of modern mental health education is steeped in the medical model.

    I think you touch on some really important points such as licensed folks being beholden to diagnostic codes for billing purposes. In my practice that simply is the way to have insurance pay for the therapy. The actual diagnosis, it’s veracity and importance to therapy sessions…is zero. A diagnostic code simply will not explain the deep and complex narrative of human experience.

    But on the other hand, that billing code is really essential. Very few people can afford ongoing care at 70, 100, 150 bucks an hour. But a much larger group can afford a copay of 15- 25 bucks a session. And that, sadly, is the bottom line. The system is geared to supplement licensed folks with insurance money to offer the lowest cost care to the most people.

    .

  • hi Bonnie and Julia. Thanks for contributing to MIA. I also think that nutrition is a key to greater mental health and I see how the Standard American Diet (SAD) contributes to deteriorating physical health but also contributes to severe emotional distress. Downing Big Macs, microwave TV dinners and 72 ounce Mountain Dews is going to make even the most mellow person feel unstable. If you have any susceptibility to extreme states, the modern diet can promote severe disfunction.

    That being said, my first tack would not be towards supplementing diet with nutritional additives (vitamins, mineral supplements) but would be towards

    First: avoiding processed and refined food and returning to a whole foods diet.
    Second: cooking from scratch as much as possible, with an emphasis on nutrient dense foods.

    As an herbalist, I promote supplementation, but I am very nervous about what I call quick-fix herbalism…the idea that we can just take supplemental vitamin, mineral and herbal pills and just feel better. This seems like just a replacement of one form of drug therapy to another form of pill therapy that promises resolution of symptoms.

    Instead, I think we have to be honest and say that it takes work to become more emotionally and mentally resilient. It takes time in the kitchen, cooking real food. It takes effort to avoid buying food at 7-11. It takes time to slow down and begin the process to deeply nourish yourself.

    I also acknowledge that deep nourishment with nutrient dense food can’t solve it all. Working through trauma, examining social conditions, relationships, where a person lives and where they work, are all part of a complex puzzle.

    In any event, I appreciate your words and I hope I don’t sound too critical because I really support examining the relationship between diet and mental health and that is important work to do. Thanks much!

  • “Evidence based practice” is really at the core of the problem here…the idea that a few randomized control studies done in a short period of time can truly show us efficacy of a psychiatric drug. Not only are the harmful health ramifications ignored, the Wunderlink and Harrow studies have shown us that the longitudinal effects of neuroleptics actually show a decrease in efficacy. This should be front and center in our understanding of treatment protocols but has been conveniently dismissed.

    So we are left with whatever big Pharma tells us is “scientifically approved” and “evidence based”.

    Of course very few trials of non-drug alternatives are undertaken, so evidence based practice omits an enormous range of treatment modalities. We are left to take their word for it. I’ll pass.

  • Thanks for your post Sandy. I think a lot of what you say points to the complexity of helping people in severe crisis and psychosis. I have worked with people who were significantly helped by psych drugs and people who feel irreparably harmed by the treatment they received when psychotic.

    I think Truth in Psychiatry really affirms the type of care I would prefer to have for myself…lots of supportive round the clock care from loved ones, therapy and access to benzos for sleep. I would also add to that someone to cook really nourishing food and provide supportive and calming herbal teas.

    As you note on the post, once someone is on neuroleptics for a period of time, the tapering process can be really challenging in the best of circumstances. For some, they are able to significantly reduce or come off the drugs without significant problems. But for many others, tapering presents enormous challenges, even if done slowly.

    That is why if at all possible, I would personally feel better about taking intermittent doses of psych drugs as needed for periods of severe crisis and not continually. At the most, I would prefer taking a very low dose of only one neuroleptic for a short period of time.

    Sadly, the subjective nature of psychiatry allows for a very wide range of treatment protocols and I have continually seen people with psychosis prescribed multiple high doses of meds that lead to numerous health and wellbeing complications. I have also seen people’s meds radically changed, stopped and started, upped or reduced radically, all with severe ramifications.

    I guess all this is to say…I work with people in severe crisis and psychosis quite a bit in private practice and in a hospital setting. Once the drugs and multiple cocktails have been started, it starts a pathway that is very hard to get off. I envision a way to offer psych drugs that doesn’t lead to habituation and then the roller coaster ride of withdrawal psychosis, increased dosages and meds, hospitalization and rehospitalization ad infinitum.

    Is it complicated? Very. But we can do way way better. Thanks much for all the care you put into your thoughts and words Sandy.

  • First of all- man- that sounds harrowing madmom. I’m glad you came out of it without any serious medical issue and had a good circle of support to help feed, support and take care of you until you got better.

    I am hearing that story again and again from people going through mental health crises. A circle of support is created to offer nurturance and help a person through the worst part of an acute crisis. But like you I think of the mass groups of homeless and disenfranchised that don’t have those options and that don’t have adequate respite, don’t have a place to turn to. And like you say, they can’t even rest on the damn grass to take a nap and recuperate. They may be dealing with coming on and off of psych drugs that are making them more confused, more addled, more confused by neurological tics and tweaks brought on by the very medicine that is supposed to “heal” them.

    Some come to the hospital and stay a couple nights, only to be discharged quickly with meds they are likely to stop soon, with worsening effects. Some become angry, lash out, end up picked up by cops, taken to jail.

    I like your idea of just creating oases where people can rest, heal, find shelter and safety in a public area. Sometimes, people just want to…lay down.

  • Yah good questions- and I think this gets to Ted’s comment too. Right now, all States are looking for solid ways to cut costs. I think this is the essential argument to pitch- The medical model of crisis care is too expensive to sustain. We can save states money if we divert people into much less costly avenues of care. This means facilities primarily staffed by peers and therapists with back up medical support for those needing to stay/return to meds.

    Here in Portland, I have been getting wind of a massive new project that will likely happen and Steve- and other Portlanders- you may be interested in this. A number of the hospitals, including OHSU, the Legacy system and Adventist, are considering partnering to take over the old State hospital (Portland Oregon State Hospital- P.O.S.H) and move all their hospital beds into one facility. They are doing this because all these hospitals are losing money and desperately want to outsource their beds to a different facility.

    Now more than ever, we need to martial discussions aimed at our political representatives to make the case that we need much cheaper, more humane and and more effective models of crisis care. I plan to be talking to a number of representatives and hospital administrators in Portland to pitch the idea of ramping up diversion centers that are based on Recovery, not rapid medical stabilization. This will save the State and City money and will be much more caring for those who want alternatives. Win win.

  • Interesting point someone else. I know in Portland emergency departments, the ED doc often slaps a hold on someone simply out of fear of liability. This creates an enormous amount of unnecessary holds that are often dropped the next day. they don’t have the right to make someone take regularly prescribed drugs until a person has been civilly committed. But then they can choose whatever course of meds they would like. That is far too much power for a doc to wield.

  • Hey Steve. I agree that I don’t want anymore psychiatric beds. But I do feel that we need more respite beds along the lines of Second Story and other peer based recovery centers. Torrey has really galvanized popular opinion towards supporting Outpatient Treatment. My worry is that he and others may galvanize a new movement towards increasing status quo psychiatric beds. We need a different type of respite bed for people in crisis.

    Deinstitutionalization has led to a massive emptying out of hospitals. But we are now left with prisons becoming the defacto holding grounds for people labeled with mental illness and they are being treated horrifically.

    We need more safe options for people in crisis outside of hospitals and prisons.

  • Hey- great reply- and yes- I think there needs to be a lot more dialogue between “those of us who have experienced altered mental states and Mental Health professionals.” And yes, the power balance needs to be shifted away from MDs when it comes to these key issues.

    What amazes me is that we only have 10 percent of the amount of people in hospitals since 1955. We have outsourced some of this to outpatient “treatment” programs in the form of periodic neuroleptic shots, but by and large we have shifted to a model of spotty meetings with prescribers and crappy housing if you are lucky. Hospitals are generally a place of churning people in and out as rapidly as possible.

    In many ways, the anti-psychiatry movement is winning the battle of radically reducing commitments and eliminating the hospital model simply due to the financial burden and costs of caring for people in crisis. The problem is that people still go through severe crisis without adequate respite.

    I am increasingly seeing “circles of support”, where friends, family and loved ones will do round the clock care for someone in crisis. The problem is that this only works for folks with a strong social network.

    Thanks for your good words.

  • Fair enough- I think a lot can be accomplished without needing crisis beds at all. In many ways this is why deinstitutionalization happened. We decided to try and help people in distress in the community where they lived. However, this led to an industry of assigning people as disabled with 700 dollar checks to pay for substandard housing and crappy food.

    And by radically cutting crisis beds from 340 per 100,000 to 17 per 100,000, we have left little room for crisis facilities when people are in extreme states. For people who are homeless, or are in dangerous situations, or who want round the clock support we need a better model of care. My argument is that we may need beds…but they need to be significantly different from the type of beds we have now.

  • I agree that I would like to see a radical reduction in the use of “medications” that tend to lead to further chronicity. The problem is that many people coming into hospitals have already long been taking psych drugs. Simply stopping prescribing the drugs cold turkey is inhumane at that point.

    I would go to the root of the problem and address how we work with people in first states of psychosis. If we don’t jump to a drug based model of initially treating psychosis, we would radically reduce the potential for long term illness and the need for chronic hospitalization.

  • Oh…I saw I didn’t address your question of locked wards. This is a pretty broad topic and probably one deserving its own thread but let me start with a story.

    Recently I have been working with a number of suicidal people and we have discussed the possibility of hospitalization and I gave them a clear understanding of what to expect. They would likely be placed on a hold (have to stay in a locked unit) due to being “a danger to self” and would likely stay no more than 3-4 days. They would receive prn benzos for anxiety and sleeplessness and the doctor would prescribe one or two drugs to take daily.

    And..that’s about it. A social worker would make a cursory plan for following up with a provider. These folks would not be taking these drugs so that part was useless. The only thing that a locked unit could provide was the ability to keep them safe for a few days by not letting them hurt themselves. For the folks I worked with, they felt secure enough to not want to go through hospitalization.

    But, I do know folks who are natural minded, and who hate psychiatry, who have chosen periodic hospitalization and its locked units. I have also known people who are in such an extreme state that they have become intrusive to the point of scaring people, or violent towards their family, etc. I support a limited amount of locked units for these cases.

    What I do not support is a doctor ever having the right to force a prescription of psych drugs on a person. This only happens when someone is civilly committed and it should be abolished. There is far too much power in the hands of doctors who should not have the right to require someone to take drugs that damages health and shortens lives over the long term.

  • Really good questions Russerford…and well worth examining carefully. I think it’s important to acknowledge that there is a population that comes to hospitals that have a history of violence, predatory behavior and ways of acting that are intensely intrusive and frankly scary to many people.

    I think it’s even more important with this group that it is stafford primarily be non-medical staff. There is no need to pay a nurse 100,oo0 a year to work with someone in an extreme state. It would be much smarter to have well trained peers and therapists who understand how to listen well, support a path of recovery, provide comfort, and help de-escalate any one who becomes threatening or abusive . I absolutely think that we could develop primarily non-medical units for a wide variety of people.

    In terms of violence…In the hospital I work in, the use of restraints is rare…perhaps once every other month due to someone being very violent. This…or even less..should be the norm. And this is in a place that takes perhaps the most highly acute patients in Oregon with long histories of assaultive and violent behavior.

    I also understand that many people in distress are already taking medication and will likely need continued medication. Units can have adjunct doctors and a limited amount of nurses to provide those drugs. But the emphasis should be on Recovery…not rapid medical stabilization.

  • I tend to agree. But Torrey has proven to be one of the most politically influential mental health “experts” in the country. His organization…the Treatment Advocacy Center has developed a lot of the language for onerous Outpatient Treatment programs. If he, Jaffe and others, are calling for a massive ramp up in psych beds, there needs to be a fair bit of rebuttal.

  • Outrage at horrible hospital conditions definitely helped lead to deinstitutionalization. This was especially the case in the 60’s and 70’s. But I would say that financial concerns have really been the main cause for the deep cuts in beds in the last 10-20 years.

    In essence the medical model system of managing mental health crisis is dying not due to social justice concerns, but because it is too damn expensive.

    We can create models of respite care that are far cheaper and far more humane. I think this would also help a number of people avoid the extreme peril of jail and prison based mental health “care.”

  • I definitely agree that housing is key to this process. Ultimately a lot of the issues surrounding crisis care has to do with economic injustice, classism and a lack of adequate housing. At the same time, there will always be a need for respite for those in crisis. I think we can look to peer respite centers as models of the type of care that we should offer more of…and I believe we should divert much of the money we spend on really expensive medical model “care” towards scaled back facilities that are for more centered on giving people a place to ride out extreme emotional distress without a drug based approach.

  • Interesting counterpoint and one that I am guessing most folks supporting the “status quo” would suggest. I’d beet rested to see how folks who have delved I to this study would respond.

    I’ve said it before but I would love to see folks like Jaffe, Torrey and many folks from NAMI post and occasionally author pieces here. It would certainly broaden our conversation and lead to more substantive debates. I would also love to see pieces written by NAMI advocates…but hopefully without a string of conversation ending posts.

  • I again have to take exception to the idea that Hippocrates and the Ancient Greek physicians primarily promoted strong “neuroleptic” herbs for treating emotional distress.

    Like most traditional systems of healing such as traditional Chinese Medicine, Unani Tibb and Ayurveda, Ancient Greek medicine stressed the importance of allowing the body to naturally heal from emotional and physical distress through a healthy diet and lifestyle, a good environment and the appropriate use of herbs and food.

    The main philosophy of Hippocrates was Vis Medicatrix Naturae…essentially saying that the human body has a natural tendency to heal itself and physicians should simply assist in that natural healing process.

    Essentially the Ancient Greeks, like many traditional societies, emphasized nourishment, not allopathic dramatic intervention.

    We would do well to examine these traditional systems for helping people experiencing emotional distress instead of relying on the shock and awe system of mental health treatment that we employ today.

  • Hey Ron- I agree a lot would have to change- but as someone who works in a hospital setting I have seen drug prescribing habits change. There has been a strong movement away from prescribing opiates and now there is movement away from prescribing benzos (though this is sadly being replaced by antipsychotics).

    I don’t think its an enormous leap to shift towards a very low or no dose model, or intermittent model of prescribing for people going through initial episodes of psychosis. As these studies are indeed showing long term harm for long term use of antipsychotics, it would indeed be best practice and evidence based to try and limit their use, especially in the beginning when someone is not habituated to them.

    Once someone is habituated to antipsychotics, it can become extremely hard to shift gears. In the hospital I work in, I see many people return over and over again after they have stopped their meds cold turkey. Thats not the best time to try and taper a person off…and they likely need to start the drugs again so they don’t have horrendous withdrawal effects.

    The time to be extremely cautious with these drugs is in the beginning. If we can shift to a very cautious approach with people who are just starting to experience psychosis, then we may not create entire generations of folks dependent on antipsychotics at risk of iatrogenic psychosis when they stop.

  • Excellent piece Ron, and thanks much to Sandy for elucidating these studies. I have o agree with Robb3 that I think the best approach would be to avoid starting antipsychotics at all if possible. We too easily jump to starting people on these drugs if there is a hint of psychosis. I believe it is quite possible that people will go through a period of instability and periodic psychosis that may naturally run its course. During extreme states it may be wise to offer the intermittent use of psych drugs as calmative and hypnotic agents…but it’s when we get into the long term use of these drugs…all of them…that we run into trouble.

    I also think we could app,y the “intermittent dose” idea within the existing mental health framework. Why start people on heavy neuroleptics and cocktails when they are hospitalized? Mainly it’s due to fear of violence or to encourage rest and sleep. But this first step of heavy tranquilizer ion sets up a very difficult road if the person wants to later come off the drugs.

    For those in long term treatment, these studies show it makes strong sense to avoid long term usage. However, this can be extremely difficult to do for many folks…and the withdrawal off antipsychotics can engender destabilization and psychosis.

    I think we need to be much more adept at encouraging doctors to taper folks off antipsychotics in the shortest time possible and to develop tools and supports for people going through that process. At the same time, I want to honor that there are many people on antipsychotics who feel the risk of tapering off them is just too great and they wish to remain on them. Because of the strong risk of tapering, it would be smarter to not start regular use in the first place.

    Thanks Ron and Sandy!

  • Hi Michael,

    Thanks for your thoughtful essay and for presenting this to the APA. I am not strongly familiar with Epicurian philosophy so this was an interesting read.

    I do want to mention that I felt like your thesis didn’t ring completely true for me in terms of the three schools of thought. You mention (and dismiss) the shamanic/tribal approach as obsolete- though that is an incredibly common way of interacting with “mental illness” throughout the world to this day. But I think you also discuss the Hippocratic model of mental illness somewhat poorly. You say…

    “In 5th-century BC Greece, Hippocrates introduced a new explanation—the medical model, which attributed mental abnormality, again as inferred from behavioral deviance, exclusively to natural bodily causes. Hippocratic healers believed in humoral imbalances in the brain, and sought to correct them through the use of neuroleptic drugs, forcibly administered if need be, and confinement in the clinic.”

    Like most traditional systems of healing- including Ayurvedic, Unani-Tibb and Traditional Chiniese Medicine, emotional distress is often described in terms of elemental or humoral imbalance. However, none of these systems- including ancient Greek, generally promote correcting them through “neuroleptic drugs, forcibly administered if need ne, and in confinement in the clinic.”

    Hippocrates actually promoted the idea of vix medicatrix naturae…the idea that man, if given proper nourishment, rest and a healthy environment, will naturally return to a state of balance. Herbs and foods were often offered to help remedy imbalance and bring someone back to a greater state of emotional and physical health. The notion of “dis-ease” was seen by the ancient Greeks and most other traditional societies as a temporary condition that could be essentially alleviated by proper nourishment.

    This is really quite opposite to the modern “disease-model” which posits that strong drugs fix underlying permanent illnesses that are rooted in genetics. One posits nourishment and gently encouraging the body’s own healing processes and one posits allopathic intervention with strong neurleptics that supplant the body’s own natural ability to heal.

    Though Szasz rightly focused strongly on the inherent flaws in the modern day disease model of mental illness, I think we would do well to look at how the ancient Greeks and traditional societies often tend to work with people in emotional distress- primarily through the model of nourishment and not dramatic intervention.

  • Thanks David for your post and supporting Marcia. In my conversations with her, she has always been incredibly enthusiastic, kind, supportive and deeply passionate about this work. She has worked countless hours and been a true bridge builder so it has been sad to see her treated poorly by some folks.

    I also want to honor your call for Unitarians to address this immense takeover of the mental health field by psychiatry. When 20 percent of Americans are labeled mentally ill and are using drugs to manage emotional distress, something has gone deeply wrong. As a Unitarian who has attended the local Portland church many times, I was very frustrated by the break between the UU and RP. I am very glad that Steven up in Vancouver has been willing to call attention to these pivotal issues.
    There are many Unitarians who wan to examine these issues, build a place for non-violent dialogue and create deep systemic change. Thanks for all that you do David.

  • Great post Peter and thanks for joining the conversation. I agree we have shifted to medicalizing and pathologizing much of human experience and then primarily relying on psych drugs to “fix” the problem.

    I think much of the shift has been due in large part to economics. Many people labeled with chronic “mental illness” only get to periodically see prescribers and a case manager. Medicare doesn’t pay for individual counseling for these folks but will happily pay for a haldol decanoate shot, etc.

    I think some of the key to this is to shift to peer based free “counseling”, similar to the 12 step path but not based on a disease DSM medical model.

    I also agree with Wiley here that the physical experience of distress needs to be looked at as well, that emphasizes nourishment over drugs.

  • I feel like this is one of the only places where I see people talking about depression and suicidal feelings without mentioning the need for “treatment.” I have to say I feel less depression than anger right now Sera…anger that Williams’ death is being used by many to push more people to “get help”. I put both those terms in quotes because generally all that really means is to take psych drugs. Occasionally it means seeing a counselor but that is less and less.

    I see people bringing up the same refains that depression is an illness; that it is a chemical brain imbalance that can be corrected by “meds”; that people who are depressed need to get treatment from a doctor. These views are repeated over and over again throughout the web. It is so pervasive that it reminds me that alternate views, such as yours and mine, are very outside the mainstream, and are frankly very unpopular.

    A while back I was talking to a friend who had become profoundly anxious, panicked, confused, sad and overwhelmed. Someone could call that state “Major Depression.” She felt like hurting herself. She was strongly considering hospitalization. I told her that she would likely receive benzos while in hospital, a prescription for antidepressants and then discharge within a few days.

    Instead, we developed a circle of friends that could be with her for a few days. We offered her cups of herbal tea, massage, some flower essences, good home cooked food, support. Within a couple days she felt much better and was no longer suicidal and “clinically depressed.” I wish we could recerate that experience for anyone going through a dark time. I get that that is not possible for all people.

    But at the core of me, it frustrates me that the meme of “getting help” and “treatment” has been comandeered by doctors who’s only solace thay can offer is a drug.

  • Monica…such an amazing story. I wish it was posted on every doctor’s office…especially those who prescribe psych drugs frequently. Thank you for sharing such a deep, harrowing and devastating experience so clearly and openly. many of the clients that I work with in private practice refer to your story as giving them hope for their journey.

  • Hey Corey…

    Yes the system we have in place…is to offer meager “benefits” that include just enough money to live in a depressing tiny apartment and just enough to buy unhealthy crap food which makes you more depressed and anxious. And yes, see your prescriber every two months for your 5 minute check in and take your meds so we can keep you on the dole.

    A horrible and deeply unhealthy system. Yes it would be great if that could be augmented by truly healthy offerings in the way of fresh food, yoga, a gym membership, etc. we choose to leave people isolated and drugged. And when they stop taking drugs because of the horrible side effects, the withdrawal effects send them back to the hospital for a very expensive “retreat.”

    I think the main way to address this is to examine the bottom line…money. Every county and State is stretched thin by their mental health care costs. We need to show that heavily medicating everybody leads to increased disability and then costs the government more. And yes, offering alternative programs, social clubs, gym memberships, healthy food, etc…will lead to less “decompensation”.

    Just drugging people and then sending them to live in shitty cubicles to eat top ramen the rest of their lives is a recipe for an unfolding disaster.

  • There are a lot of parallels here with many modern medical drugs as well.

    I remember recently seeing an ad for Pepcid AC. A guy was sitting down at a diner eating a huge philly cheese steak. After polishing it off he looks…uncomfortable. So he reaches down and grabs the Pepcid AC. Then? All smiles.

    How bout just not eating the whole damn philly cheese steak? And if he takes Pepcid AC long term he may develop kidney problems.

    In so many cases of anxiety, depression, panic disorder, insomnia, etc….lifestyle issues, habits, previous trauma, diet, etc…should be addressed before any prescription. But people see the ads, see how it’s been normalized, and go for what they think is an easy fix, though it often leads to longer term complications. Doctors easily abet the practice and the AMA/APA justify it via bogus “evidence based” research.

    I think it’s deeply important to ring the bell of alarm on “Philly Cheese Steak medicating”. I still think getting psychiatry out of the hands of general practitioners is one main way to do it.

  • To the second paragraph- I think its fair to say that psych drugs cause damage- though we do need to be careful about talking about the diference between taking 20 mg of prozac for 20 years and taking a combination of haldol, zyprexa, lithium and xanax for 20 years. There is a continuum of harm here. So by inevitable long term damage we have to talk more specifically about which psych drugs in what combos, etc.

    To the first paragraph- Yes it should be said- and I have said these drugs cause harm frequently- but I also acknowledge that many people seem to find relief and feel helped by drugs. I have known very “natural minded” folks who have taken mood stabilzers with a full understanding of their damaging effects, and have felt helped by the drugs. So be it.

    Though we may find fault with it, many people are willing to take the health trade off for what they perceive to be a psychic/mental distress improvement. Saying all people who take drugs(in any dosage and combo) will experience “significant to profound organic damage, coupled with disempowerment and stigmatization” is not quite an accurate statement to make. But I think it is fair to focus strongly on the perils of these drugs and to help educate the public to their severe complications.

  • I think this is really the epicenter of the “epidemic”. Wierdly, I almost think that It would be smarter if only psychiatrists could prescribe psych drugs. then GPs would be forced to refer patients to a psychiatrist for “meds.” Because there are so few psych docs compared to GPs it would create a massive bottleneck that would effectively act as a shut off valve for the vast over prescription of these drugs.

    Just as GPs have to refer patients out for renal issues, or for cancer, a requirement to refer out “psych” patients might slow down the rush towards medicating all of society for normal human emotional distress.

    Just a thought experiment really.

  • Well yes- I agree a lot of people are self-medicating due to the challenges of modernity in general- but they are being abetted by the medical establishment. There has been a 400 percent rise in the prescription of antidepressants since the 80’s- and this is mainly happening in GP’s offices.

    They have become far too comfortable handing out psych drugs with impunity.

  • What is interesting is that many of the street drugs that we call out as being particularly “evil” such as heroin and cocaine, are in many ways relatively easier to withdraw from than many of the psychiatric drugs. Though withdrawal from heroin can be temporarily horrendous, the worst of it is over within a week or two. Not so with psychiatric drugs such as benzodiazapenes or antipsychotics that can be truly harrowing to try and quit. For many it takes months and sometimes years to get off these drugs and some never succeed.

    At the same time, I do acknowledge that many people report feeling tremendously helped by psych drugs and I believe them. If they feel helped and not bothered by side effects and concerns of long term health effects then all power to them. I don’t think it helps our cause to criticize people who have found help from a drug, even if we feel that drug is generally harmful.

    The problem comes when the idea that 20 percent of Americans have a “mental illness” and are prescribed “medications” becomes normalized. What the hell happened there? Does anyone really think that 20 percent of us need to take pharmaceutical drugs to regulate emotional distress? And if not, how do we turn back the clock on this massive abuse of prescribing power?

  • At Jonah 5:49- Not a straw man…reality as we know it today. Today if someone develops a psychosis and becomes violent, you are left with choices…today. If this happens to a loved one or a friend, you are left with choices….today. And the choices we have when things get out of control…are bad. Maintaining ideological purity goes out the window when you are confronted by a tough situation.

    You say- well then lets pass laws against tazers. Would you also suggest that we ban the use of guns, bean bag guns and nightsticks for police officers? These are the weapons of choice that police use for dealing with violent people.

    Again, you are outsourcing how to work with people who are violent and “ill” to police and are de facto endorsing those types of methods of working with that population in the name of purity.

  • The larger question of whether jail or hospital is a better option for someone is an important one to address. I agree that in jail at least you get your court date, your right to prove innocence, etc. whereas it’s a crapshoot if you go into a hospital and are psychotic and at times violent.

    You could end up committed and then sent to state hospital, remain in a weird limbo of not having committed a crime, then get mandated to take drugs (AOT), and be placed under state authority even when you are “released.”

    That all needs to be seriously addressed and reformed, and “treatment” in the form of mandated neuroleptics needs to be ended…now.

    But we weren’t really talking about that. We were talking about how to deal with psychosis/violence in the moment. I want to be clear that since you have asked me not to use euphemisms like force (I’ll call it forced drugging), I would ask you not to use euphemisms like “police” and instead call it forced electro-shocking.

    At this point, we cannot remain pure by simply pawning off the problem of how to manage these difficult cases by off sourcing it to police via electro-shocking and jailing someone for being “mentally ill.”

  • I’m sorry Jonah, if you truly feel that police should be involved in these cases where violence is occurring you are indeed de facto suggesting that you support police measures for dealing with violent individuals.

    In the case above you suggested that hospital staff should forcibly restrain a patient experiencing psychosis and is violent…and wait until police arrive, have them remove all weapons and then transfer the person to a police car and then to jail.

    First of all, that violent individual needs to be taken out of hospital restraints and placed into handcuffs and then transported to a jail while in a highly agitated state while police remove all their weapons and tazers. That is just not a likely or realistic scenario for police.

    Again, when you support police involvement in these cases you cannot be evasive and say you don’t support electro shocking.

    I’ll give you an example of something that happened a few years back. A man was in the ER and was experiencing profound psychosis and then rushed out into the hallway and attacked another patient. I was nearby but before I could arrive I saw a policeman in the ER tazering that man. One of the other tazer lines also dropped the other patient at the same time.

    What does one do in that incident? It’s complicated, dangerous and fast. But simply saying you are against one thing begs the question of what the alternative to forced drugs would be in its absence. And sadly, that is the alternative. I don’t support either but I do acknowledge brutal choices at times.

    Tazering or jailing someone (and then drugging them) who is in the throes of severe psychosis and violent is not the better option in my book…but all options suck if deescalation has not worked.

    .

  • Just a little further, I know you are a stickler for language, and are pretty focused on wanting to paint me as “pro forced drugging”, I would ask…

    Are you pro-forced electro shocking (I.e.tazering)? I know you are not but by suggesting police should be involved in these cases you are de facto agreeing to the idea of “treating” mental illness/violence with electro-shocking.

    I am as much pro “forced drugging” as you are pro “forced electro shocking”… Which is not at all. but I do acknowledge the hard choices that have to be made at times. We need to work on making sure these choices have to happen a little as possible.

  • Hey Jonah,

    I do t think we can go much further with this conversation as we have somewhat gone round and round on it. I’ll just say this. yes…in rare cases when all other measures have been tried to try and deescalate…When conversation, space, food and comfort measures have been offered; when listening, allowing for strong and intense emotions to be expressed, and a person is still threatening or engaged in strong harm to other patients and staff…I support forced drugging.

    I know that you…and many others don’t support that. You have suggested police should be involved when violence happens. I completely disagree. If given these horrible choices, I will choose a forced drug over tazers and bullets. By saying you support police involvement, do you support using 50,000 volts of electricity to subdue people who are violent and “mentally ill”? Do you support police drawing guns to threaten those who are violent and “mentally ill”? These are the awful choices we are left with.

    I will always support having staff who are trained in making sure this type of choice happens very very rarely. But ultimately, these choices do have to be made. I will fight hard to see they happen as rarely as humanly possible.

  • I also agree with Jonah on this in all regards and hope your piece can be published by MIA so we can discuss some of your ideas further. Thanks for joining the discussion.

  • “Qu’ils mangent de la Prozac.” Couldn’t let that pass…perfect.

    Yes great post Wayne. In a hospital setting a substantial amount of people come in who are homeless and are hoping for a social work referral to better housing. But they get a prescription for psych drugs instead…that many stop taking once they are out the door within a few days.

    Let them eat Prozac indeed.

  • I do agree that there is a lot of glorification of shamanism without understanding the complex narratives that go on in many cultures. I lived in Ecuador for a while and worked with Ayahuasceros- Quichua Indians who used the hallucinogen ayahuasca for healing/ritual work. In my work with them I took part in some of their ceremonies and learned some of the complex cosmology.

    A lot of their medicine was based on a syncretic belief system that incorporates folk herbalism, Catholicism and native jungle animism.

    In the healing ceremonies I took part in the ayahuascero would transform into forest creatures while singing “plant songs” and blowing “healing” smoke on participants. The ayahuascero seemed to be able to tap telepathic and psychic information about participants that could appear uncanny.

    They also believed that a lot of illness was caused by evil ayahuasceros sending invisible psychic “darts” at people. So yes, there are complex and sometimes dark underbellies to tribal societies that we in the West tend to overlook. We also tend to appropriate and simplify to a great extent. At the same time, this should not negate the importance of exploring non-linear, “transcendental” ways of healing. Will’s article points to that.

  • Hey yes Chris…

    I think you may be referring to “moral treatment”, the idea of offering sanctuaries for people in emotional distress through a combination of rest, manual work and time in nature/gardens. A wonderful idea. I would also love to see increasing systemic non-medical respites for people in crisis.

  • Hey Chris and Uprising. I think in a lot of ways the polarization between reformers and abolitionists is really not that great and is more of an academic exercise. Chris …just as you say, those who fought for the end of capitalism and were socialists were likely happy with progressive reforms such as the end of child labor, the 8 hour work day, safety reforms, etc, etc.

    I place myself in that camp. I want to look at each issue and work towards making on the ground change in each area that needs to be reformed. One example is the vast over-prescription of psych meds. Right now 20 percent of Americans are on psych meds…a massive explosion in this area over the past 30 years. We can change this through a number of ways- legal law suits against drug companies who neglect to inform people about the health problems associated with the drugs. We can reduce prescriptions through educating people about their horrible long term effects. We can reduce prescriptions by encouraging doctors like Sandra S. to speak openly and frequently about this issue, etc, etc. Its achievable.

    Less prescriptions means less people tied into the pharmaceutical system and movement towards a goal of using alternative methods of helping people in emotional distress. Achievable change.

    The goal of ending the prescription of psychiatric drugs…is not achievable. Focusing on that goal marginalizes us and leaves with…no change.

    Uprising, I’m not sure that shifting towards just letting MDs prescribe psych meds instead of psychiatrists furthers this movement. Already, the lion’s share of psych meds are prescribed by general practitioners. I think this is actually a huge part of he problem. In small 15 minute conversations, a doctor who has had little expertise in mental health offers psych meds that have long lasting ramifications. They tend to not encourage counseling, alternative holistic tools and certainly most of them are not versed in effective tapering methods. I would love to see that practice marginalized.

    So really I see abolitionists and reformists sharing many of the same goals and focusing on our differences is not really productive.

  • Thanks for sharing this Will. So many indigenous cultures embrace a spiritual way of perceiving “madness” and healing that often involves prescribed rituals, Healers/shamans, herbalism and “other world communication.” Often someone becomes a shaman/healer after experiencing an internal crisis/breakdown/spiritual emergence.

    It is deeply challenging to work within this “shamanic” context without either appropriating other cultures or making up our own rules. This is why many who are interested in this work are either dismissed as colonialists or New Age dilettantes. That is sad because this type of work is truly powerful and potent with meaning and transformative power.

    When I experienced some of my deepest psychosis/confusion/emergence, a healer/shaman was able to profoundly assist me in my walk back to a healthier place. Instead of pharmaceutical medicine, she led me to wilderness medicine, tree and plant medicine, spirit medicine. In time that helped me find a good road.

    Indigenous and shamanic healing will never be tested using double blind studies. But it has been used worldwide for helping people through profound “psychotic” and “mentally ill” states. We need to take a stronger look at what these indigenous cultures have to offer.

  • Thanks Sandy for your post. In my mind I fall into the reformist camp because ultimately I am interested in systematic here and now change that improves lives for people in emotional distress. I prefer to strategically look at areas that the public is likely to agree on (such as systemic overmedication) and chip away at these areas rather than wait for some global eradication of the profession of psychiatry…which I think is highly unlikely in the short term.

    At core, I am a pragmatist. I would rather see psychiatric prescription patterns becoming much more cautious. I would like to see the use of force and restraints used only in rare cases of violence. I would like to see strong non-medical alternative systems in place for people who are looking for them. I would like to see doctors focused on how to properly taper someone who desires to be off psych drugs. I would like to see greater education and awareness of the long term health problems associated with psych drugs. I think this is all….possible.

    What I don’t see as possible, or even desirable, is the abolition of psychiatry. There are far too many people who want psychiatry as a choice. Far too many people who feel aided by psych drugs, or feel too challenged to withdraw off them to eradicate psychiatry. They should be offered that avenue, all be it with far more caveats and education around the perils of that path.

    Right now there are over 100,000 iatrogenic deaths per year due to the practice of modern medicine via drugs and surgery. I don’t support the abolition of modern medicine either but I also support the strong reform of all of medicine, not just psychiatry.

    Thanks for your words Sandy.

  • Congratulations on being able to taper off all those drugs Aria. Man…ten mg of Xanax for anxiety. That just sounds overtly abusive. I work with a number of people who are coming off and I see the absolute hell people go through. And having a doctor discount your akathisia as “nervousness” is simply malpractice. So sorry you had to go through that.

    Any tips for those who are going through a similar process? What helped you the most?

  • Hey Stephen,

    Yeah- I think if we want to really address “Mentally ill violence” we should look at a very big word in the psychiatric field- non-compliance. God, what an awful word by the way. I don’t have access to pull up the figure right now but I have heard that up to half of people are “non-compliant” with any medication, psychiatric or otherwise. Somehow I imagine non-compliance rates are even higher with neurleptics because of the horrendous side effects.

    But let’s just say half.

    So in a hospital, a clinic or a doctor’s office, someone is handed a bottle of neuroleptics that they are supposed to take every day. These are heavy tranquilizers. And they become quickly habituated to them. Maybe stay on them for a few weeks, a month or two or longer. And then maybe half of them say, nah- these are awful. Dump em. Stop taking them. And then…

    Everything goes to pieces. The withdrawal effects are a nightmare for most folks and tend to cause psychosis, espeically for those who have been susceptible to extreme states. And then some of them get suicidal and violent. “Its the illness” some say. Hell no. You take 300 mg of seroquel a day for a few months and then stop suddenly. See what happens. I’m guessing I would go fully ape shit.

    And maybe they become violent. “Its the illness you see.” No. Let’s address the real issues- Iatrogenically caused violent tendencies.

  • I also agree that I would love to see those folks post here. Man…that would be awesome…but only if a lengthy and sustained dialogue/debate could take place free of ad hominems and calling them out as evil, the enemy, etc. Then a wider public could really see the different views on these issues in a clear way and make their own decisions.

  • I agree they should not be considered “anti-depressants” but I do think its important to differentiate halucinogens from psychiatric drugs. On the one hand, psych drugs are relatively new, are industrially made, are often prescribed for daily use and tend to cause long term health problems.

    And on the other hand, the traditional use of halucinogens has been used as a spiritual, ritualistic and healing tool cross culturally. They are generally used infrequently, in a community setting and are not “prescribed” for regular use. They have been used to “treat depression” and “mental illness” in different cultures, but only in the context of that traditional society.

    I don’t see them as particularly addictive but they are definitley dangerous for some people to use due to their highly psychoactive and potent effects. At the same time, I really doubt the ability of the mental health system to use these drugs in any helpful manner.

  • Hey just to chime in. First…excellent post. How we define success is often far too narrow.

    Also…Steve…just to say I went to Evergreen and had an amazing experience. It is truly a very unique place of learning. I designed much of my academic path and studied a combination of things that I doubt I would have studied elsewhere (field botany, genetics, herbalism, ethnobotany, pharmacognosy, biochemistry). I hope your youngest enjoys it as much as I did.

  • Hi Mark,

    I think it’s great that you are addressing the issue of “mental illness” and social isolation as it relates to violence. I also want to say that though I disagree with you on a number of points, I’m glad that you are here and saying your piece.

    Though I agree that social isolation plays a large role in decreasing mental health and potential for extreme distress and violence, I think we have by and large created a system that promotes that isolation. In the last couple decades we have embraced a system that generally treats people in severe emotional distress with heavy neuroleptics. As Robert Whitaker has brilliantly pointed out in his books, the se neuroleptics contribute to worsening mental health and an increase in those on disability. Those on disability then receive small monthly stipends (often between 700-1000$) that is just enough to cover living in a small “SRO”, essentially a tiny apartment.

    Those on disability then tend to go on and off their meds due to the horrible side effects, then cycle in and out of hospitals due to the withdrawal effects of these drugs. Some who experience this merry-go-round become increasingly isolated and violent. The iatrogenic potential for violence due to either the drugs, or the withdrawal off these drugs is something I don’t see you generally address. And yes, add that to social isolation created by forcing people to live in tiny apartments with occasional monthly “check ins” with a provider and you are creating a cauldron ready to boil over.

    So before examining outreach programs, peer support, 12 step, etc….let’s examine the system that folks are steeped in. We don’t need to mop up afterwards. We need to fix the system that is broken itself.

    Anyways, thanks for your words. Even if I disagree with you I really want to see your posts here. It helps further the conversation.

  • Interesting Boans. I know back in the 60’s Leary, Alpert and others did extensive reserch into the use of halucinogens for therapeutic purposes. It led to Leary becoming somewhat messianic, being booted out of Harvard and then starting a movement to “tune in, turn on and drop out.”

    In a lot of ways, the use of psychedelics helped spark a revolution in exploring the “Self”, depth psychology as well as non-religious spiritual pursuits, metaphysical consciousness, etc.

    Some of that was undoubtedly good. Esalen comes to mind as a place that was influenced by this psychedelic revolution. At the same time, there was a dark side to that as well. Halucinogens can lead to extreme states that can precipitate long term psychosis for some. Leary himself acted as a pied piper of this revolution but also caused a lot of people to just get high without much personal effort. There was also a lot of narcisism involved in the wider drug culture that exalted personal freedom, even at the cost of personal health, family and interpersonal obligations.

    I also agree when you say:

    “I do believe that if mental health professionals wish to study the effects of hallucinogens they should go ahead, and they will fail miserably. Why? Because they see the parts, but not the whole.”

    Exactly. A reductionist and scientific exploration of this subject will by definition miss the big picture and larger holistic and global effects of these very interesting drugs.

    Your first question: “Is it really devoid of spiritual and cultural context though Johnathan?”

    The experiences that I had on halucinogens were undoubtedly heavily spiritual in nature even though I didn’t take them in a ritual and culturally defined context. So certainly, powerful spiritual transformations can occur no matter the situation. But I think these drugs aren’t generally seen this way by most folks. Maybe I’m wrong there. They stimulate intense, complex, often confusing and totally overwhelming experiences…but I don’t know how many folks interpret those experiences in a transformational way. But in the context of indigenous traditions, they tend to always be used in a “spiritual” context centered around the native cosmology.

    Anyways, interesting stuff…

  • Har har!

    Seriously though…

    The use of ritual halucinogens for healing purposes has been part of numerous cultures for ages- Ayahuasca ceremonies of the Quichua Indians in the Amazon, MesoAmerican mushroom use, Peyote rituals in SouthEastern America, etc.

    I totally understand the use of these “psychedelics” within the context of tribe, culture and specified ritual. I am more leery of psychologists or medical professionals offering some industrial derivitave halucinogen as a way of “developing insight”, having a “breakthrough”, etc.

    The use of psychedelics in this way is devoid of larger integrated spiritual or cultural context and seem on a level of taking any manufactured drug to affect a cognitive or behavioral change. In this way, they can be misused and abused like any other drug.

    When I was a younger man, I had a few personal experiences with halucinogens that were life changing, including an experience with an Ayahuascero in Ecuador. I get that they can have a deeply transformative potential. At the same time, I don’t want the medical or mental health establishment any where near adminstering these agents. Engaging with sacred plants is not something that should not be comandeered by mental health “professionals.”

  • I also totally agree that there is a strong relationship between the agri-industrial and pharma-industrial complex. The agri-industrial complex has promoted the use of processed forms of soy and corn that have led to massive health problems related to obesity, metabolic and inflammatory health issues.

    I believe this intense focus on monocropping and marketing processed foods has contributed to the demise of our collective mental health as well. If I downed a few (mostly soy) McDonalds cheeseburgers, some fries and a 32 oz. high fructose corn syrup coke every day for a few weeks, not only would I get fatter, I would get increasingly anxious and depressed. I might develop symptoms of ADHD like restlessness and difficulty in focusing. I might develop insomnia.

    And then I may go to a doc to say I don’t feel good lately. Pretty tired and depressed. Well, try some…Zoloft, Paxil, Valium, Xanax, etc etc.

    Neat trick.

    Conspiracy…as you say? Probably not. But man…This little merry-go-round sure has fattened some coffers.

  • Interesting Sandra. The other day I was talking with someonoe who had been in prison and he described how inmates liked to snort crushed the antidepressant wellbutrin. Apparently it gives a short lasting cocaine like high when snorted. The prison warden apparently was trying to crack down on this. It kind iof made me laugh…

    Snorted Wellbutrin powder- “Bad Drug”
    Orally dosed Wellbutrin- “Medicine”

    Hmmmm.

  • There’s a lot to look at in terms of the nutrition/mental health connection. At the same time, for the lion’s share of people I think underlying poverty, classism and lack of adequate housing and support systems trump diet.

    At the same time, we have created a global food system based on creating obesity, inflammation and disease- both physical and mental. Transforming the psychiatric industry requires also transforming the global food industry to stop poisoning us.

  • Pot indeed works in weird ways- I have worked with people where pot was one of the main factors in instigating a psychotic episode and I have worked with people where pot was the best tool for eliminating manic episodes. Its a complex plant with numerous constituents that can be both relaxing and stimulating, psychoactive and tranquilizing. I think it depends a lot on potency, how frequently it is used, personal biochemistry as well as “set and setting.”

    Inmy practice I am more likely to see people stimulated into psychosis by synthetic canibinoids…nasty drugs known as “Spice” and “K2”.

  • Hey hold on.. I’m not familiar with his blog. Not trying to pile on. Really genuinely interested in his thoughts. I get that he personally is against overmedicating patients. And I also said that he may himself be a careful provider.

    But somehow we have got to a place where 20 percent of Americans are being psychiatrically medicated. Significant portions of foster kids and kids in general are being medicated. this…to me…seems inherently abusive.

    So I am looking to Joel’s thoughts on this. How can that change? How does he think that can be changed in his profession? How did this happen?

    I would frankly prefer if there were more folks like Joel here so we can have a broader conversation…even if we completely disagree.

  • Joel again I think you are looking at this on a microscopic level. I am asking you to look at the situation from a systemic level and I’ll ask you again…

    Do you think 20 percent of Americans should be taking psychiatric drugs?

    And if you’re answer is no, then let’s examine how this massive systemic abuse is taking place.

  • @ Joel July 14, 6:58

    You suggest that there are places where greater abuse is taking…sure…I agree with you…I’m sure there is.

    But the scale with which psychiatric drug prescribing is happening is simply immense. let’s take that 20 percent figure. Out of 300 million Americans that would mean 60 million Americans are taking psych drugs prescribed by doctors. Do you really believe that 1/5th of Americans need to be on drugs?

    And if not, then some form of wide scale enormous abuse of practice is happening.

    You may deny it in your practice…fair enough. You may deny it in the practice of others you know. But somehow, an immense over drugging of modern society is happening because…doctors are widely and unnecessarily prescribing these drugs, often causing grave harm to many individuals.

    Would you agree that wide scale abuse is happening?

  • Joel,

    I appreciate you coming here and talking with us. When David Healy speaks of doctor’s abuse, it is not a simple straightforward abuse where a doctor knowingly hurts a patient. It is abuse that comes from not providing adequate information, not warning the patient of the health dangers of psychiatric drugs, not explaining fully how challenging withdrawal can be.

    Abuse happens in quiet and banal ways when doctors see someone for a few minutes and then prescribe them a drug, or set of drugs that can be addictive, damaging and for some…debilitating.

    This “quiet” abuse is rampant. When 20 percent of Americans are taking psychiatric drugs, something has gone deeply wrong and I hope you would acknowledge that. I don’t personally believe there are many doctors that are knowingly and overtly “abusing” people. But I do believe that by their negligence, by their willingness to ignore iatrogenic illness, by their use of personal power to influence people and prescribe potent pharmaceuticals, they are indeed causing grave harm to many many people.

    I don’t know you. I don’t know how you practice. But I do know that doctors need to take a long soul searching look at their prescribing patterns, and to look at the damage that they are causing. I hope that you stand at the vanguard of those doctors pushing for sweeping change.

  • Though I agree with you Dan that there are genuine biological issues that people have that can lead to emotional distress – you mention …”heavy metal toxicity, fungus and microbe infections, essential mineral depletion, unhealthy damaged gut flora unavble to screen out toxins and make essential nutrients”- I don’t see orthomolecular high vitamin dosing as the answer…and I have to agree with Francesca below that simply exchanging industrially manufactured vitamins for industrially manufactured drugs is not a good answer.

    I also really agree with Donna below that “psychiatry preys on (…) those suffering emotional distress from typical human problems like domestic, work, school abuse/bullying/mobbing/rape and other human cruelty that can lead to post traumatic stress that can do a number on the body/mind as well.”

    I think a lot of holistic practitioners (acupuncturists, naturopaths, herbalists, nutritionists) really are focusing a lot of effort on examining how nutrition and the modern lifestyle leads to emotional distress. Simply shifting away from the Standard American Diet (S.A.D.) to a more whole foods diet would do far more in my mind than mega dosing vitamins.

    But really even dietary concerns are secondary to the most essential needs- good housing, safety, reducing environmental and social stressors, etc.

    We also have to acknowledge that not all suffering needs to be tranquilized and medicated. Again – as Donna puts it so well…

    “There are natural disasters, loss of loved ones through death or divorce, job loss, monetary loss and countless other misfortunes that can lead to human suffering. Sadly, psychiatry has robbed all of these normal human reactions to loss and medicalized and stigmatized them so they can profit from the suffering of their victims as they plotted when they sold out to Big Pharma in the 1980′s.”

  • Jason- As you can see plainly from this thread and the members of Rethinking, these folks are far from being a “Front” group for Scientology. They are passionate, inclusive, and willing to do an enormous amount of volunteer work to make things better.

    I call on you to apologize. I call on you to apologize to the members of Rethinking Psychiatry who have been damaged by these false claims.

    If you are truly friends with the ministry at the UU, let them know that you made a mistake and were unfairly harsh in your accusations.

    For all the good work that you do in the community, these types of false accusations will make you seem less reasonable and less credible. They will make you seem mendacious and vindictive.

    I know all the good work that you have done protecting innocent people from injustice. In this case, I call on you to reflect, think about your words, and think how they are causing needless damage to good people who are also fighting to protect people from injustice.

  • Portland Rethinking Psychiatry took money from Scientology? Not as far as I have ever heard- on their website they specifically state…

    “We are a fully responsible and autonomous entity, independent of any other organization. As clearly stated on our web site: We accept no funding or control from, nor do we promote any religion, other organization, government entity, corporation, or drug company.”

  • This is the larger issue. Tactics. Strategies. “Getting a seat at the table.” Politics. How we come across, the affiliations we keep…makes ammunition for those who oppose our views. I absolutely understand the bottom line is that we are trying to reach as many people as possible, and if opponents…or in this case…folks I see as allies…use the “Scientology” ammunition to discredit us, then we reach less people. Less change happens on the ground, etc.

    At the same time, where do you stop? Do you angrily usher out any person who is a scientologist from the room? Do you avoid all contact, event cursory? How about other controversial groups? Hard core libertarian conservatives? Strong advocates of natural medicine? Angry protesters willing to be confrontational with the psychiatric industry?

    I mainly agree with Bob that we have to be politically smart to protect reputations and for the sake of reaching more people. But I am concerned with losing inclusivity, splintering into factions (as is the case here) that don’t listen to each other.

  • Out of an enormous site filled with the posts of thousands of people, MIA has absolutely no overt connection to CCHR. However, there have been posts here by writers who have connections to CCHR but are not promoting that group. Bob, you mention Sheila Matthews There is also John Breeding, also a CCHR award winner and a previous board adviser.

    And this is very similar to Jason’s argument…that a cursory connection to CCHR is enough to paint all of Rethinking as a “Front” group. Absurd.

  • An amazing piece Steven. Thank you so much for posting it here. As a Unitarian who was profoundly disappointed that my Portland church has distanced itself from this movement, I am deeply grateful that there are other congregations and ministers who truly understand the need for sweeping change.

  • Thanks for all the comments here folks. I wanted to add that (like Steve said) the Vancouver BC Unitarians are very much supportive of our aims. The folks there are outspoken in their desire for radical reform so I don’t want to take this one case as indicative of all Unitarian churches. Steven Epperson and Diana Girdansky are doing powerful work up there to change things.

    I do think that these issues can be pretty confusing for folks on the Left. Many of them have avidly been promoting more access to mental health “treatment” for the poor, the homeless, etc., and are clamoring for more hospital beds. They see this as a civil rights issue to offer more “help” for those in need.

    Our message is that the help they, or anyone, is getting, often does not serve people well and can in fact damage them quite a bit more. Those on the Left who are allied with us have to separate that idea out from the idea of governmental “support” for those in need. It can be quite a leap, especially when there is disinformation to discredit reformers as being stooges of scientology, or anti-scientific, etc.

    I think the challenge is always going to be how to channel much of the justified anger coming from survivors as well as the evidence of modern mental health care malfeasance, into productive long term changes.

  • Hi Douglas. Thanks much for this piece. I have to agree that much of today’s “mental illness” can be attributed to modernity. We have become increasingly fractured, living alone or in isolated family units, often disconnected from meaningful work or sense of place.

    Also, just as a sedentary high stress indoor lifestyle with a diet of processed foods, sugar and caffeine has led to an epidemic of obesity, metabolic disorders and chronic illness, I believe that modernity has also led to a large increase in symptoms of depression, anxiety, and increased the propensity towards uncomfortable extreme states.

    Instead of addressing the perils of this relatively new lifestyle (past 100 years), we are mostly using strong pharmaceutical drugs to try and cover up these symptoms. The drugs themselves often lead to worsening health and disability.

    Though few would like to live in a tribal setting such as the Kaluli, we would do well to examine why they are more mentally and emotionally healthy. We should address why we have become so disconnected from one another, our bodies and our environment.

    By the way, Douglas. I just met you at the Rethinking Psychiatry symposium in Portland in May. You gave me your book. It was a pleasure to meet you. Thanks for the good words here.

  • Uprising…I hope this comment is in the right place…and I’m sorry I don’t have the time to fully respond to you…but I want to thank you for your really thoughtful post. That’s definitely the kind of conversation I hope to have here…

  • Uprising..

    I am not trying to make bogeymen out of anyone who “doesn’t support forced drugging.” Its strange that you would think I am bullying people when I am by far and away the minority on this issue on this site (at least by commenters that post.)

    And fr5ankly, pinning me as “pro-forced drugging” is pretty strange. I would fight hard to make it as rare as humanly possible. I think the use of “forced drugging” has been horribly and overwhlemingly abused.

    But I acknowledge that there are ciircumstances that are really really challenging. Someone coming into the ER who has a long history of assault who is experiencing psychosis and then becomes intensely threatening is an example. If deescalation doesn’t work, there are very few options.

    Call cops, who come with guns and tazers? Subdue the person and restrain them…indefinitley? Until they calm down? What if they don’t calm down and attack and hurt people every time you release your hold?

    These are really challenging circumstances. But…I totally support your right to the view that chemical restraints should never be used. I understand that especially for those who have suffered through it, it seems unimaginably abhorrent. I agree. But I also think tazers and bullets are abhorrent too. I will just have to disagree with you in these rare cases.

    However, I am guessing that we agree on 90 percent of other issues related to critiqueing psychiatry and developing alternatives.

    I guess my hope is that we allow for varying voices…even vocies we profoundly disagree with…and not just see them as the enemy…but as people we can engage with, perhaps find common ground…or at least develop an understanding of their thought process.

    I am not trying to shut down heated debate, or passion. And by the way, I do not find the position of opposing forced drugging extreme…at all.

    But I will strongly disagree with folks who want to end psychiatry- overnight- without a strong set of alternatives in place. Anyways, hope you have a good night.

  • Hey Malaika…thanks for coming and sharing some of what you thin with us here. As someone who works both “on the outside” and in the system, I agree with you that changes can certainly come from both places.

    We have a need to fundamentally transform the mental health system while also creating strong and realistic alternatives to the system. That is going to take a lot of voices and I appreciate you adding yours to the conversation.

  • Yes, I have taken part in restraining individuals who are being given IMs when they have become violent. I have said that before. But I have never said I have done this as any form of “treatment.” But I will protect other staff and patients from people who are being violent…

    As a last resort after every other intervention has been tried. In the hundreds and hundreds of interventions that I have been involved in, I have almost always been able to help someone to deescalate. Sadly, there are cases where that just doesn’t work.

    I would never, however…support using straight jackets.

  • Yes Donna. I have been a patient of biopsychiatry. I have gone through my own process of psychosis/spiritual emergence in my 20s. I was given medication that made things way way worse so I stopped taking the drugs. I consider my experience of biopsychiatry mild compared to some of the horror stories I have heard.

    My experience simply was the blasé normal case of going to a psychiatrist, having a 10 minute conversation, and then being prescribed a drug. The drug made me feel truly out of my body, panicked and suicidal. I think in many ways it’s very lucky that I did not tolerate it and that I did not go back to ask for a different one.

  • Indeed a game between mental health services and police/jail. If no major crime is committed, and a person appears psychotic, they are usually brought to a hospital ER, even if they have a history of being assault ice and dangerous.

    Recently, a man who had been in prison for a number of years for numerous crimes was brought from jail to our ER because he was “decompensating”. He then proceeded to attack ER nurses, injuring one by kicking her hard in the chest.

    Really challenging cases and ERs have really crappy ways of working with people in these situations. Restraints? Forced meds? Then what?

  • Hey, certainly the question was rhetorical, and really not meant as an actual question. I am certainly not trying to say you have no right to oppose the system. I’m not interested in you “shutting up.” But it was made to illustrate that there are shades of grey, confusing issues that are hard to examine.

    Just to share some background, I work as a therapist and an herbalist in a private practice. I often help people come off psychiatric drugs. But I also work very part time in a hospital setting.

    I don’t work in the ER, or in the really acute units of the hospital anymore. I generally work in the unit where voluntary patients go who are depressed, suicidal, etc. I spend quite a bit of my shifts just talking to folks…well mainly listening.

    But in the past I worked with many hundreds of people who were going through some type of psychosis. For the vast lion’s share of those folks, the issue of violence never came up. And in almost all the cases that I worked with people- simply listening, offering support, food, a safe place to vent and be angry was all that was needed to help folks in distress to feel better.

    But there were times when we received people who truly were predatory, had histories of being assaultive, of having been in prison for many different types of crimes such as rape and murder. Some of these folks could become violent, attacking not only staff but often other patients. The justice system is not interested in these cases because they are “mentally ill” so they don’t go to jail.

    It is deeply challenging to know what to do in these cases. You ask, where were the cops? Personally I would never want anyone with a loaded weapon anywhere near someone who is going through psychosis and is also potentially violent. That just doesn’t seem like a great option. Certainly peer respites are not an option. Sending them back on the street seems harsh. Pretty complicated.

    But man, these are extreme cases. I am willing to examine these extreme cases because I think its important to do.

    But it seems like a lot of effort is going on to discredit anyone who is not a strict abolitionist here. And that saddens me…because I think there are a lot of people who are open to the message of deep, systemic changes to the mental health “system.”

    Anyhow, I’m sure you’ll come back with something that further tries to argue with me…and I’ll listen. But I would prefer it if you could think of me standing right next to you talking to you, having a cup of tea or a beer. I’m not out to tear you down, shut you up, or anything else. Anyhow…out for now.

  • I hear you. But for those who are on meds, and may take years to taper off them; and for those who want to take psych meds intermittently- as in a benzo or even an antipsychotic occasionally, there is still a need for a prescriber. Certainly it doesn’t have to be a psychiatrist. It could be a nurse prac or a regular GP, but the prescription of psych drugs will still need to go on in some form.

    I am for shifting to a deeply cautious approach to prescribing meds, but I don’t think its realistic or even desirable to want a cessation of all psychiatry.

  • The funny part is that we agree on most everything. We agree on the need to create alternatives that are effective options for people in distress. We promote peer respite, Hearing Voices Network, publicizing a much broader understanding of the perils of psychiatric drugs, eliminating forced outpatient treatment, litigating against pharmaceutical companies who cause iatrogenic damage and deaths, etc, etc.

    But the language of the debate can sometimes shift to all or nothing. No psychiatry or radical reform of psychiatry. Complete abolition or systematic reform. And if you’re on the wrong side, look out.

    Thats sad because our true mission is to shift the public debate in favor of examining these important issues. And that requires ongoing conversations, often with people we disagree with. Bob Whitaker speaking at NAMI, or to a group of psychiatrists in Texas comes to mind. Will Hall speaking to the APA also comes to mind. Crossing difficult lines to have uncomfortable conversations is key.

    My hope for this site is that we could have more of these challenging conversations with people who truly disagree with us. I think of the term NAMI mommies, used almost as an epithet here at times. I have serious problems with NAMI and how it promotes a drug based way of managing emotional distress. But I think it is deeply important to “cross the lines” and have deeper and less angry dialogue with “NAMI mommies”, and others that we disagree with.

    Through those respectful conversations, openings are possible. Change is possible. At the least, a greater level of understanding is possible.

  • Duck a simple question?

    This one?

    To “start a campaign to get anyone who works in a “mental health” setting to take a pledge to nevere ever engage in any forced psychiatric procedure, and to allow this to be put on the internet and subject to commentary by those who have been subject to that person’s “care”? Sound fair?”

    I will fight for making sure that any type of “force” is used as rarely as humanly possible. I am happy to work towards that reform. “Force” should be reserved for the most challenging situations when all other deescalation skills have been tried but the “patient” continues to be violent.

    But since I a answered your question, please answer mine. Since you are opposed to all psychiatric hospitalization, will you pledge towards taking home a large angry man who is deeply confused, going through a profound psychosis, threatening and with a history of assault and rape when they come through the Emergency Room doors? (This happened a few days ago.)

  • Oldhead,

    I am not interested in arguing with you. But no one here gets to set an agenda that abolition of all psychiatry is the only way to change the system. If you choose to define the fight in that way, that is your choice. But there are others that choose to see change in a different way. I don’t believe in purity tests, and in large part that is what I see turning people off from this movement.

  • In many of the settings I have been in, I have seen the notion of a diagnosis as an afterthought. The doctor sees the patient, sees some symptoms and then prescribes drugs. Big mood swings…mood stabilizers. Psychosis…anti-psychotics. Depression…anti-depressants. Then some diagnosis is written up later. The classic one is schizoaffective disorder, or as one psychiatrist out it…”the garbage can of disorders” because everything possible is in that term.

    Different doctors give different diagnoses for the same set of symptoms. I think many of them just want to make sure they are paid and generally pick one of the biggies so that insurance covers it.

  • .I hear you when you say that aiming for reforms can easily lead to watered down mushy dead ends. At the same time, I think only shooting for the whole enchilada (the end of psychiatry) can lead to a whole lot of frustration as well.

    Anyways, thanks for the conversation Richard.

  • Hey Richard.

    You suggest a revolution…

    I agree. To me the revolution means creating alternative structures outside the psychiatric paradigm of “care”. My hope is that eventually these alternatives would supplant, or at least radically diminish the influence of the psychiatric model.

    But in the mean time, we have a n enormous complex system that keeps churning along. I believe that we should examine how to reform it to better protect the welfare of people who are “in the system.” I guess I would liken it to making sure McDonalds cooks its meat properly. I would prefer that McDonalds doesn’t exist…but while it does, I will fight for workers to gain a better fair wage, fair labor practices, etc.

    So I guess I am confused most by your last paragraph-

    You say that we should fight for reforms, but that will only end up reinforcing the status quo. Do you believe we should be fighting for reforms, or that it is just a waste of time?

  • I get that in all movements there are various parts. In the environmental movement in the 80s and 90s to save old growth forest land, there was a need for tree sitters, loud protests; as well as lawsuits and political action in Congress. Eventually huge stands were placed out of reach from logging due to bills passing in DC.

    Similarly in this movement there is a need for multiple spokes to the wheel: i.e. Angry voices, protests, media campaigns, judicial and political action.

    At the same time. I often see our group as marginalized, seen as too radical, zealous, perhaps aligned with Scientology, etc. I wonder if an excess of rage and bile turns off a large group of people who could possibly be swayed.

  • I would agree that there needs to be quite a lot of change outside of the system. Alternatives such as Hearing Voices Network, Open Dialogue, Peer Respite centers, therapists, peers and on line support for those who desire to come off meds, etc.

    I also think that enormous harm has been done to many that needs to be acknowledgeda no addressed.

    However, calling the whole practice slavery does a disservice to people who choose to take psychiatric drugs, who choose to enter hospitals, who choose to remain on psych drugs because coming off them may prove too challenging, etc. For those who choose to enter or remain “in the system”, it is key to examine how to best reform it.

    For those who have been profoundly damaged, and I work with many, I get the desire to dismantle the whole edifice. But I think we need to recognize that there are many others who will desire psychiatric “care.” I want those who seek that form of care to have the best information possible, the most support to have access to and choose alternatives. I want them to have as much power as possible for making their own decisions. And I want doctors to shift to becoming deeply cautious with their prescriptions.

    I just don’t see it as slavery. And about ending slavery. that would mean that I would tell all the people I know on psych meds that they are slaves; that their choices are simply wrong and that they should be forced to stop taking those drugs.

  • Phillip, thanks again for a great piece. To a large degree, I think this outlines how battle lines have been drawn. Those who support psychiatry talk about psych drugs saving lives, restoring mental health and decry dissenting voices as anti-scientific, shrill voices aligned with Scientology.

    The problem comes in how to challenge the modern practice of psychiatry in a way that is actually productive and accomplishes true change. this is where I differ from the abolitionists here. There are people who want to take psychiatric drugs, or feel it is too challenging to come off them. There are those who want to enter hospitals for crisis care and feel served there. For those people we will still need doctors. We will still need psychiatry, even if we personally have serious problems with the practice.

    More important to me is we lead the charge to reform the practice of psychiatry. That means making sure the “consumer” receives a more global understanding of psychiatric drugs and their effects before taking them. It means focusing on changing the prescribing patterns of physicians to be far more cautious in prescribing these drugs. It means shifting towards a greater balance of power in favor of the “consumer” and not the medical practitioner. It means creating a system of alternatives that can truly create options for people in emotional distress. It means scrutinizing the abuses found in hospitalization and fighting against outpatient treatment that mandates drugging.

    Reform is a long hard slog requiring many voices, many conversations and greater media awareness of the issues. We are already seeing a great degree of scrutiny of these issues in the last few years. Some of these voices will be very angry out of the great harm they’ve experienced. I think that these voices are very important. But when anger becomes the main tone of the conversation, it is unlikely to lead to productive outcomes. More likely it will lead to defensiveness and potential allies leaving the conversation.

    My hope is for actual realistic changes and reform that is possible rather than the complete abolition of psychiatry which I see as impossible.

  • Really good point John. There is a school of thought that says- “Hey- you didn’t have to eat at McDonalds, or buy sugary cereals, or purchase energy drinks, cheetohs and Top Ramen.”

    And while I agree that the consumer does play a small role, they are up against a sustained media advertising blitz and are selling foods that are addictive and easily purchased in stores all around you. They are also generally cheaper than whole foods such as organic produce and grains.

    Similarly with Big Pharma, there is a sustained marketing blitz to “sell” these drugs as health producing and efficacious. Learned doctors then parrot this information to the point where its very difficult for the average “customer” to examine alternatives.

    Who is at fault? For the lion’s share I would say Big Pharma/Doctors/Insurance Companies/NAMI.

  • I agree. Its more important to me that we affect actual on the ground change then to tilt at windmills talking about the complete cessation of psychiatry. My initial hope is that prescribing patterns would change, just as they have changed for opiates. In the last five years it has become increasingly hard to get prescribed large doses of opiates for interminable periods of time.

    This has been due to increasing iatrogenic damage and deaths caused by opiates. I am hoping we can see a similar examination of benzos and then a much more cautious approach in the prescription of those as well as other psych drugs.

    I think its possible that the work of Whitaker and others can especially help us to examine a low or no-drug policy for those going through a first time psychotic break

    This is not some pie in the sky fantasy. It requires patience, media exposure and publicity, as well as thoughtful dialogue…yes dialogue…with those who will actually be making the changes…doctors.

  • I agree that there is some onus on patients…but the top searches on the internet will mostly take you to sites that promote the idea that mental illness is a disease that needs “treatment” in the form of psychiatry and perhaps therapy. The leading advocacy group NAMI certainly promotes this so it takes a little more work to ferret out alternative viewpoints. Then individuals have to either take the advice of doctors and NAMI, or…people on the internet.

    But I agree that there is a certain segment that certainly know what they are choosing and understand the risks and benefits. There is also a segment that are focused on shopping for the more addictive benzos and opiates. But many of these have been unwittingly hooked on these drugs by doctors in the first place.

    Creating more places on the web for accurate and clear information about the true pros and cons of psych drugs is a really important mission. It can also be helpfuyl if this information is explained by folks that don’t “have an axe to grind” like many of us here. One good spot is askapatient.com. You can see first hand reports of how the drugs affect people with ratings for the drugs.

  • I think it’s key to examine this idea of the “patient responsibility”. In some ways there is truth to this idea. In an ideal world, all people should have a full awareness of the implications of taking prescription psychiatric drugs, their complications and long term effects on health and problems with withdrawal.

    Unfortunately, most people don’t. They are not fully informed…and that is fully the responsibility of the doctor and any pharmaceutical companies selling the product. And when a drug is shown to cause tremendous complications, that should be explained….fully. Sorry…no free ride for a doctor because well…the patient wanted it.

    A clear example of this is benzodiazapene prescription. I have worked with countless people who have become easily hooked on these drugs when they went and consulted a doctor for sleep issues, insomnia, etc. and then down the road it becomes next to impossible to quit them without horrendous long term withdrawal complications. The doc doesn’t get a free pass because…well…the patient asked for them, or because…he saw an ad on TV for Xanax.

    We have moved to a quick fix paradigm of mental health for many reasons. It’s lucrative for pharmaceutical companies and doctors (15 minute med check ins are way more lucrative and easy than 1 hour psychotherapy conversations). It’s a simple way to manage distress…stimulate and sedate. And in the short term it appears effective. (Give a manic person a boatload of tranquilizing drugs and they’ll come down pretty quick). It feels impossible to truly help people due to the overwhelming need and the lack of resources…so it is easier to do something, anything…even if that means just throwing a drug at the problem.

    But the toll is piling up. The adverse drug reactions are increasingly apparent. Those injured by psychiatry are not staying silent. The underlying suffering is not being fully addressed. Monolithic solutions to complex narratives end up feeling false…and often lead to worsening problems.

    Doc Hassman, I hope you stick around. I always appreciate hearing various voices, especially when I disagree.

  • There is a tremendous amount of debate around the exact etiology of emotional distress. Is biology involved? Is it due to environmental stressors? Diet? Family of origin issues? Socio-economics? A combination of some or all of those factors? While these issues are deeply important to examine, I believe the most important aspect to examine and critique is how we treat emotional distress…no matter what the cause.

    And right now, psychiatry has the monopoly on how we treat distress…with psychiatric drugs. That is the giant elephant in the room. Even if we learned that all emotional distress is 100 percent biological and genetic (laughable)…it still doesn’t mean that we should always use strong neuroleptic drugs to “heal” this distress.

    I think pro-psychiatry folks use this debate as a wedge issue to make us appear fringe and anti-scientific. “You don’t believe in mental illness?”…implying that we are kooks. I would prefer to switch the argument to “Do you really believe that strong neuroleptic drugs heal “mental illness”?

    Its about language. And right now the languaging of these issues are being used against us. We need to be smarter.

  • James, Thanks for contributing this piece.

    I think we can easily get caught up in the semantics of language such as the difference between normal and abnormal, health and illness, disease and wellbeing. The language that is used to discuss mental health is often political. When psychiatry describes symptoms of distress as a “mental illness”, it implies that there is a permanent underlying condition rooted in biology, and that therefore lifelong medication is often warranted.

    And I agree that we throw the baby out with the bathwater when we react by saying…there is no mental illness. Of course there are symptoms of distress that are deeply challenging to millions. Anxiety, depression, hearing torturous voices, bizarre delusions, etc. I think it is important to use different terms, such as “emotional distress”, or the exact symptoms a person is experiencing, because they do not imply a permanent condition.

    By shifting the conversation, and the “languaging”, to suggest that a condition is likely temporary and not permanent, the conversation changes completely. It implies that “treatment” does not need to be lifelong, that recovery is possible, that given enough care and attention, distress is more likely to be episodic than permanent.

    Bu at the core, I think our role as dissenters is to spend less time examining the exact etiology of emotional distress (I think there are many causes personally), and spend more time examining the ways we can help people heal when they are experiencing intense distress.

  • Interesting piece Ron. I could see how the traditional notion of CBT could clash with the HVN persepctive in that CBT generally involves confronting preconceived notions and self-limiting narratives, while HVN often involves engaging with the “psychotic” experience of hearing voices without judgement or agenda, but as a way to explore the deeper meaning of the voices.

    Turkintgton sounds very open minded in his practice of CBT and I wonder if that differs from the usual practice of CBT. He is open to normalizing these extreme states, not “catastrophizing them”, perhaps seeing them from a spiritual dimension…but he also discussed “reality testing”…a key component of CBT. You go on to say that that can actually be a key part of the healing process for some who hear voices- to see them as metaphorical, expressing true emotional experience, such as being based in trauma, but perhaps lacking in external reality.

    CBT often encourages an individual to examine and then reframe narratives. I think HVN also looks for ways to normalize and “un-catastrophize” experiecnes like hearing voices. I think the main problem is that many CBT therapists still function within the framework of a DSM psychiatric model where extreme states are pathologized and seen as permanent markers of illness. Though Turkington sounds very progressive, I wonder how many of his colleagues share his views.

    I dfefinitely see how CBT and HVN could blend and I appreciate your exploration of this interesting topic.

  • I am also a therapist who has worked quite a bit in inpatient settings…and I would have to say that what is “offensive” is giving strong neuroleptic drugs long term to people who have gone through an extreme state like psychosis and mania. If a person decides that is what they want to do, then that is their right….but each individual should know the tremendous complications inherent in getting started on neuroleptics and cocktails of drugs.

    Suggesting that “schizophrenia” is a life time illness requiring a lifetime of health destroying neuroleptics is severely problematic. There are countless stories of people who have gone through psychosis and manic states, been labeled “schizophrenic” and have been able to recover without the use of drugs. Look up Will Hall for a classic example.

    It’s not about “not trying hard enough”. It’s about creating an alternative support structure where the emphasis is not placed on intensely problematic neuroleptics. Check out Open Dialogue as an example.

    But please, don’t spread completely false information that “schizophrenia” is like diabetes and health destroying neuroleptics are like insulin. It makes you look, frankly, uneducated.

  • You know I was perusing the site “askapatient.com” the other day. Just type in a drug and read hundreds of people’s account of the drugs effect and efficacy. Such widely varying opinions. For psych drugs you get everything from….”I turned into a zombie and wanted to die everyday…” to “this drug saved my life.”

    I agree we have to honor both sides of the issue and have courteous and open dialogue with people who strongly support using psych drugs in their life.

    At the same time, it is hard to play the balance of being open, while still reporting the strong dangers of these drugs. Very challenging indeed when you see some of the harm they have caused.

  • INdeed Steve. Wish this could be understood loud and clear. Sadly, if you look through B’s youtube video and scroll through the comments, you see a number of similar comments. “I was unfocussed. I didn’t do well at school. I could never sit still. Then I took….bla bla boa….now I’m great…bla bla bla. ”

    Though I am “pro-choice” and am all for people making their owned choices on taking drugs or not, I have a very hard time with this drug. Its frickin speed. How the Hell is it ever ok to regularly dose a kid with speed?

    I see people saying…”Oh well yeah thats crazy for a 2 year old…but for my 5, 6, 8, 11 year old, etc it was a godsend.” Give me a frickin’ break. No you don’t get to give your kid speed no matter what their behavior is. You just don’t. Ban these drugs and any psych drugs for anyone under 18. Period.

  • Yup, that’s indeed part of what I’m taking about John. This movement is much more complex than say…ending slavery…or giving blacks the right to vote. Those had very clear goals in mind.

    Part of this piece outlines the complexity of this movement. I think most here can agree that everyone in emotional distress deserves more choice, more alternative options, more awareness of the ramifications of psychiatric drugs, ECT, an end to psychiatric hegemonic power, etc.

    But there is not a clear cut case for abolishing psychiatry overnight. Some people would take years to come off drugs. Some feel the risks aren’t worth it. Some want to use psych drugs on a limited basis. There are complicated questions about how to work with violent people who are experiencing psychosis. About alternatives to hospitals for people in severe crisis.

    Some of us, like Bob W. is offering a template for limited use of antipsychotics for those experiencing psychosis. Others want to abolish the practice of psychiatry altogether…today.

    There is also the element of strategy. While the vast public may not be open to abolishing psychiatry, they may take incremental steps towards reform. We have blackbox labeling today, but maybe someday there will be outright drug bans, changes in prescribing habits, greater awareness by the public of the dangers in psych meds.

    While this may sound watered down, it also would radically affect the lives of millions. Already there have been vast changes in the prescribing patterns of opiates. http://www.nytimes.com/2013/10/25/business/fda-seeks-tighter-control-on-prescriptions-for-class-of-painkillers.html?_r=0

  • The challenge of working as a reformer in the gray lands- AKA- one foot in the system and one foot out- is that you can easily feel either co-opted- or dwarfed- by the dominant paradigm. At the same time, I see the work of reformers talking to folks in the system as deeply important. Bob Whitaker talking to psychiatrists at Temple University, or speaking at NAMI…or Will Hall talking to the APA…are creating actual dialogue and introspection amongst those “in the system”. They may eventually spark real, effective change in prescribing and in patterns of care.

    My question would be, for the sake of purity- do we abhor every social worker who finds shelter vouchers for discharging patients, every therapist who walks with patients in the hospital garden, every nurse who doesn’t overreact and allows a patient time and space to be angry and “intense”?

    Do we also blame people for not being in “recovery” because they continue to take psychiatric drugs? Or because they support a family member who takes these meds? Do we blame people for going to a hospital when they are in crisis? Or taking their family members to a hospital when they are in crisis?

    Fundamental reform efforts comes in many shades. I see the need for protests, demonstrations. But I also see the need for conversations, dialogue, changing minds one at a time through increasing awareness. And many of those conversations will happen with one foot in the system.

  • Agreed Kim. Placing an age limit on the side effect of feeling suicidal in response to SSRIs seems completely arbitrary. It seems fairly obvious that the rash of increased veteran suicides was likely caused by psych med prescriptions for PTSD. With SSRIS I wonder…do suicidal feelings magically start to dissipate if you take them when you are 18 as opposed to 17? Or at 24, 30, 49?

    With people I have worked with as a therapist, the horrific suicidal feelings often come while withdrawing off of SSRIs too quickly.

    Thanks for sharing your story.

  • Extensive research into tapering and discontinuation symptoms…now that would be amazing…especially if it was done by an independent body separate from the drug companies.

  • One of the biggest problems with “Assisted Outpatient Treatment” is that civil commitments eventually end. And at that point, folks who have been placed on heavy neuroleptic cocktails may easily say “no more” and quit takingt the drugs cold turkey. They then end up back in the hospital for another trip on the merry go round. You are exactly right- the hospitals get them addicted… and then they suffer the consequences when they quit without tapering.

  • Absolutely. So many people get started on meds and then just stop them, not realizing how that messes with their brain chemistry. How many kids in foster homes cheek their meds? Spit them out? Then suffer from the ping pong effect of going on and off of them? This is therapeutic?

  • First and foremost, do no harm. Indeed.

    Doubling neuroleptics, drug cocktails, heavy withdrawals from psych meds, anticholinergic poisoning, smoking cessation drugs that lead to manic states… How is this “no harm”?

  • Great post Monica. It can be very challenging and intimidating for people to go back and talk to their psychiatrist if they have been damaged by the psych drugs. It’s wonderful that you can have an open and thoughtful conversation with the psych doc who helped you taper. It is beautiful to hear you process and explain your experience in a way that hopefully gets him to think and review how he’s treating people.

    The sad part is when doctors respond by saying essentially…”we’ll you’re an anomaly. The vast amount of people are helped by what I do. “. And indeed I think we have to acknowledge that some people do feel very helped by psych drugs. Or taking them very selectively.

    But let’s look at it this way, if you prescribed a medicine where even a small amount of people were gravely harmed…say even 10 percent….wouldn’t you want to explain that risk very very clearly? Wouldn’t you want to warn people that this is like Russian Roulette….you may get lucky and it works for you (or at least doesn’t harm you) but you may easily get unlucky and this will deeply injure you.

    And the more drugs you add to the cocktail the likelihood of getting injured go up and up. And the longer you take these drugs, the chance of getting injured becomes more and more likely. So doc, if you know that a percentage of people are like me, someone who was really harmed, do you talk about that risk to everyone who walks in the door? And if not, why?

    These are the tough questions I would like to hear answered by psych docs.

    Anyways, thanks for your words…

  • Very interesting Chaya. Makes total sense. It seems like your friend found a way to go inside, destim and create a quiet place. One of the simplest and most powerful tools for healing is to simply take rest. I sometimes see people focus on what you can do to heal by getting active, joining groups, working out, going to therapy, etc….but sometimes what people need is to get really quiet and let their nervous systems reset and heal. Hurray for idle hours…

  • Urgh- Kate- I personally hope you don’t go because I think its key to have an open conversation with everyone. I think a lot of the anger you will see here is from people who feel they were either forced or coerced into taking very strong medications that led them to feel increasingly depressed, confused, cognitively impaired with a host of long term health problems.

    I’m wondering if you would be willing to acknowledge that pain and anger from folks who have experienced this.

    My guess is that you fear that this pain and anger could lead to overturning laws that you feel are necessary, such as commitment laws and forced medications for your daughter when you say she is unaware of her delusional state. I get that.

    Right now if someone is acting in a manner that is a danger to self or others, there is a right for a hospital to hold someone and eventually to commit them if they continue to be in imminent danger. I know a number of people are absolutely opposed to this here but I am not.

    I get that someone who is acting in an extremely aggressive manner who is unable to deescalate out in the community may need to go to a closed facility such as a hospital (not a jail) for a short while. The problem I encounter (as someone who works partly in a hospital) is that all power is taken away once you have entered this system. Doctors make all the decisions once a commitment has happened. I have seen doctors put young patients on an enormous cocktail of meds. They then decide where a person will go after hospitalization (state hospitals, step downs, foster care, home, etc.) They also can require a person take long term outpatient antipsychotic injections. That’s a lot of power to have.

    Once on these drugs for a long period of time, it is extremely difficult to come off of them. So in essence, many are forced to be on strong health depleting drugs for a lifetime. Do you think this should be examined more carefully? Even if you support it for your daughter, do you think its reasonable that other people don’t want that decision made for them?

    People like Robert Whitaker have noted that short periods of psych drugs might be warranted for some people in these cases. Its the long term use that causes severe problems.

    So I get where you are coming from…you want to make sure your daughter has support and does not spiral into another psychotic episode and decide to go off of them because of people like us. But none of us advocate cold turkey. We advocate examining the possibility of lowered dosages, reducing and tapering and hopefully for many who choose this path, leading a life free of drugs that will cause long term health problems. We also advocate looking at crisis care that does not put an enormous amount of personal power in the hands of a few doctors, who can make unilateral and sometimes deeply damaging long term decisions.

    Anyways, I hope you understand that we don’t argue with personal choice. If your daughter has come to the realization that the meds are working for her and that she can manage any side effects and health complications then I think most all of us would support her decision. What we have a problem with is losing the power to choose and being harmed in the process. Thanks for talking with us.

  • Hey Kate,

    I definitely understand your concern as someone who works part time as an acute inpatient therapist in a hospital setting. There literally is nowhere else to go outside of a hospital or a jail (unless you are enormously rich) when you or your family member is going through a severe crisis like you describe.

    But because of this, the medical system has enormous power and control over the life of your daughter. They have the right (with a judge) to commit her and require her to take whatever psychiatric drugs they choose. They don’t have to inform you or ask for your consent. They emphasize taking drugs that have very strong adverse and long term effects…for life.

    We, and others here, have seen that this is simply no longer how we want things to continue. You are right that there is no easy alternative to this at this point. You, and many many others who are not interested in this type of care…are stuck. But instead of saying that we are wrong…why not work towards promoting and developing these alternatives.

    How about a hospital model where drugs are used extremely judiciously and sometimes not at all?

    How about following the successful Open Dialogue model and not starting people on antipsychotics during a first break.

    How about doctor’s encouraging a responsible taper to a level of drugs (or no drugs) that are not as harmful as massive multi-drug cocktails?

    Do you think the system as it it stands right now is perfectly effective? If not, how would you like to see it changed?

  • Interesting Agni. I personally think that most emotional distress comes from a complex mixture of previous trauma, stress, socio-economic pressures, underlying family of origin dynamics, innate susceptibility to anxiety, melancholy, altered states, etc. But when people go to a doctor, these complex narratives are boiled down to a simplistic diagnosis and prescription that can easily lead to a cycle of worsening symptoms and increasing drug prescriptions.

    At that point it’s like the chicken or the egg. It’s hard to tease out the original emotional distress from the iatrogenic damage that is being done. Hope your friend finds some peace.

  • I agree. Altostrata and her site survivingantidepressants.com are a very important resource for folks. For those who need help, please check it out. Thanks for your words.

  • No, the wrist bands don’t exist…at least not yet. I have heard from one person who is interested in making them. They were just a thought experiment born out of frustration and empathy for some of the people I work with. But we do indeed need to raise awareness.

    Usually the party line is…yes yes…we know these side effects and tapering problems exist for some people…but really the benefit is worth so much more than the cost. Really? Perhaps in sone cases but for hundreds of thousands of others?n That argument has to be fought vociferously. And one way to do that is to stand up and say “I was harmed”, or say “My loved one was harmed.”

    The focus on fast tapers by docs, while working for a select group of people, can cause severe neurological problems for many others. It sounds like you have been through your share of docs who have that specific agenda. This is why so many people have been led to these on line communities…due to the ignorance by doctors of the lived experience of tapering.

  • Agreed…we truly lack a system of informed consent. Perhaps if people watched n hour long video testimonial of people who have been iatrogenically harmed by the psych meds, there could be a greater sense of “informed” consent.

  • Mary Anne, you bring up a really key point. I mainly mentioned the Hell and isolation of tapering. But for many people there are prolonged after effects that last months and sometimes years after tapering off the drugs. Tardive dyskinesia is a classic example in which one develops permanent neurological tics, tremors and sometimes wild uncontrollable gesticulations that can be a permanent response to long term antipsychotic use. But there is wide spectrum of other symptoms such as light sensitivity, ongoing anxiety, autoimmune illness like symptoms, memory and cognitive impairment, and on and on.

    I don’t want to scare people because I truly believe that there is an enormous capacity for self-healing in the human body if given enough time, care and nourishment. But these potential effects should not be sugar coated.

    People who go through tapering and the after effects are extremely brave people. And they often go unacknowledged by wider society. Thanks for your words.

  • It is indeed astounding how easily these different psych drugs are handed out with no warning of the potential for absolute torture once going off them. Thanks for your words.

  • Hmmmph. I knew that most of NAMIs funding was based on big Pharma donations. Nice to see it spelled out. Maybe we should attend NAMI functions with black wrist bands with a symptom list written on it. Insomnia. Suicidal Feelings. Memory loss. Tremors. Weight Gain. Numbness. No sex drive.

    Perhaps it would start a conversation.

    “What’s that all about?”
    “Oh I’ve got psychiatric iatrogenic illness.”
    “Oh that’s horrible. How did you get that?”
    “Well…let me tell you…”

  • Wow. I’ve perused the NAMI site from time to time and seen things like this. But I guess I forgot how much it all appears to be an ad by a psych pharmacy company. Perhaps Ill call them up and see if they’ll add a menu bar that describes the horrors of psychiatric iatrogenic illness. I’m sure they’d oblige. Sorry…I try not to get too sarcastic and jaded but that makes me grumpy.

  • Thanks for posting Erin. So sorry to hear about your husbands descent into the pharmacological merry-go-round. When doctors suggest you are just experiencing mental illness as you are withdrawing….when you get little help from the greater community…when society has little understanding of the torture of iatrogenic illness, it can make someone feel very very alone and sad. And hopefully in time mad…and then turning that anger into activism as you say. Thanks and take care.

  • AA…yes I believe that the meds can often cause long term complications with the sleep cycle….which in turn leads to poor rest where a lot of deep healing happens. This can then lead to long term health complications. And it can all start with a doctor prescribing 50 mg of Seroquel as an off label prescription for insomnia or depression. Or it can start with a prescription of Effexor that leads to increasing manic feelings and difficulty sleeping.

    I hope you can find the support you need in an often very lonely process.

  • Yes indeed Monica. Please folks, if you haven’t had a chance to do so already, please visit Monica’s site at Beyondmeds.com and follow her through facebook. She offers an amazing amount of resources for anyone coming off psychiatric drugs. She delves into the really deep issues surrounding psychiatric iatrogenic illness, and more importantly, she provides hope for people who can often be feeling despair.

  • Yes indeed Copy Cat…if you develop iatrogenic illness from withdrawing from the drugs then its your illness, not the drugs. Catch 22. You can’t escape their twisted logic. No blame allowed, no anger, no responsibility taken.

    And yeah, like I said…psych med rehab really is an unlikely possibility because tapers just take too long. Most people would have a hard time leaving their life for a month, let alone 6 months, a year, two years.

    As to insurance companies paying for receiving support through a taper….HA…that would mean that the medical model is somehow at fault…that it is leading to hundreds of thousands of people becoming sicker…not better.

    So sorry you had to go through a torturous Zyprexa taper. Thanks for your comments.

  • Richard I entirely agree. I would guess most therapists either avoid the issue of medication or encourage it as a way of “treating” an “illness.” Many of them avoid it because it is bordering on practicing medicine and may be seen as unethical or at least out of their purview. Or perhaps they avoid it out of ignorance. Many dont understand the intricacies of poly drug prescriptions, let alone the complex issues of tapering off of these meds.

    But I believe that therapists must have a much broader understanding of this subject and act as a bulwark against the immense dominance of psychiatry in this field. Since doctors aren’t doing it, therapists should become trained in how to support people through a drug taper. They should encourage a full examination of their medication regime if the person wants to do that. As for some, they could encourage social justice as part of processing the effect of these meds on their emotional and physical health.

    There should not only be a movement by therapists to thoroughly discount the medical model but to also support alternatives to this system of “care.”

    The tight spot is that insurance companies pay for treatment of diagnoses based on the DSM V. It’s a bullshit game to make therapists adhere to a corrupt model. To truly avoid that, you would have to make everyone a private pay client. But most people can’t afford that, so some therapists play a cat and mouse of billing for a diagnosis and then completely ignoring it and going on with the real work of helping a person through their process of healing.

  • I agree that the character of the therapist and the quality of the relationship indeed matters the most. I think this is why there are a tremendous amount of new alternatives to therapists sprouting up….life coach, health coach, mentors, peers…

    How does two or three years of generally following a rote required curriculum prepare you for developing an authentic and caring relationship with someone else?

    The only difference between me and another compassionate person who is good at listening is my licensure and the many years I have worked with people. My licensure makes it easier for some people to pay because insurance covers some individual therapy. Is that a racket? Yeah. For the most part.

    I have gone to therapists and never come back a number of times who were licensed with a PHD. Their character, personal style and lack of authenticity could never be erased by education and a number of letters after their name. And I have seen therapists with no letters after their name who have astonished me with how they have helped me to develop insight and grow.

    Lets call it what is…a territorial game played out by insurance companies and certain licensed therapists to keep money flowing their way.

  • Thank you Michael for writing this piece. What stuns me is that my friends who are addicted to street drugs such as cocaine and heroin can often receive insurance reimbursement for spending 30-60 days in an inpatient treatment center (rehab) to come off these drugs. There is societal approval and encouragement for this.

    But with psych drugs? Nothing. If you want to come off, you will receive no support, no insurance based care for the process, no societal acknowledgement of the horrors that some people go through in tapering. If you have cancer, are going through a messy divorce, lost a family member…you are likely to receive quite a bit of societal support. But if you are going through a grind it out tougher than shit Abilify taper you will be met with…blank stares? Silent judgement?

    Further, psychiatric drugs are far harder to come off of than heroin or coke. They tend to require a concerted period of slow tapering to do it well, often in the range of many months or years. Rehab is an impossibility in most of these cases. So we are left with people trying to do the hard work by themselves or with the help of a few close people, shuttered behind doors, in agony that society is ignorant of, or willfully dismisses.

  • Interesting piece Eric. On many levels I agree but I side more with Andrew on this issue. If a therapist is acting within the confines of the medical system and promoting a DSM V label and treatment using medication as an “answer” to the inherent suffering that is normal to most of humanity, then I would agree that this type of therapy should be abandoned completely. On the other hand, I agree with Andrew that most of the therapists that I know do not act within that conventional framework., or indeed an old school Freudian model.

    Most spend most of the time listening, finding out “what happened”, serving as witness to human experience, with all its frailties, confusions, failures, happiness and underlying tragedy. It can be deeply challenging for a friend or family member to be a witness in that way as their own confusions, projections, worries and self-protection can easily fog the relationship.

    I easily see the issues inherent in the role of therapists. Time periods are allotted. Payment is made. A power structure is created that can feel unnatural. But the notion of free peer based service is fraught with difficulty as well as people can feel drained by helping too much.

    My essential issue with the therapeutic role is the philosophy of care. Is the job of a therapist to be simply a witness? Should there be an active role of nudging people towards a search for meaning within the pain? Should there be a goal of greater happiness? Or should there be a goal of greater acceptance? Stoicism? Buddhist mindfulness of what is? Should therapy be about teaching “skills” for managing anxiety and depression? Should it involve discussing diet, exercise, sleep patterns? Should it involve encouraging social justice? Promoting meditation? Prayer? And on and on.

    Many therapists have their own take and own philosophy of “helping” people in distress. But you hit the nail on the head when you suggest that diagnosing “depression” and trying to help people feel happier when their son is away at war, or has been killed, or their life is simply miserable does a disservice to the person who is looking for support. The goal of happiness is not really a great answer for many people in this world and aiming for an unobtainable goal can make many people feel worse for falling short.

  • I have to agree Philip and its my min argument against people who claim parental abuse.

    I’m sorry, was it the Pelletier parents who diagnosed Mitochondrial Disease? Wp did the parents prescribe the drugs for Justina? Did they perform the surgeries? If Boston’s seriously believed that abuse was occurring then they should have taken their fight against Tufts. They should hold that medical establishment at fault and file criminal changes against their doctors and surgeons.

    To critics who cry “doctor shopping”, we are not talking about how the Pelletiers searched for some Bermuda MD graduate who ran a seedy clinic. We are talking about Tufts, a prestigious medical center. How do the parents lose custody of their child and suffer through public condemnation of abuse while Dr. Korson, the MD who specializes in MItochondrial Disease at Tufts, and other surgeons escape any responsibility?

    This case is so overwhelmingly bogus that it defies comprehension.

  • Lovely to see your words here Monica. As a fellow plant lover and herbalist,, I see how powerful herbs and the natural world can be for helping people to heal.

    One of the most powerful ways that herbs can heal is by helping people to engage their five senses in the here and now. When people are struggling with anxiety, depression, confusion and negative thoughts, simply connecting to the plant world can bring one back to their center. Smelling rosemary growing in the back yard. Infusing a bath with lavender oil. Sipping a cup of lemon balm tea and really tasting it and feeling its effects. Seeing a forest full of green leafed trees. These are all ways to stimulate the sense and engage the process of healing.

    And like you said, this doesn’t mean just popping the right herbal pill. I see many people buy standardized industrially manufactured non-organic St. john’s Wort pills stuffed in a plastic bottle and hope that it will help their depression. It almost never does. This is what I call quick-fix herbalism and its an analogue to taking psych meds to fix a mental health “problem.”

    So I am heartened by seeing your words here. We need to get away from the idea that strong overwhelming drugs with powerful side effects will improve the health and well being of people in distress. Sometimes the simplest, most subtle and ordinary weeds and plants in our backyard can offer a pathway to greater happiness.

    Thanks for your words!

  • Iden, great piece and glad to have your voice on this site. As someone who works part time in a hospital setting, I see how broken our system is for those who are in crisis and in emotional distress. The lions share of people who come through the door are either in poverty, unemployed, homeless, people of color, transgendered or some combination of those.

    We take in these people with tremendously complex socio-economic problems compounded by racism and discrimination and offer them….heavy psychopharmalogical drugs. And then we send them back out the door. “Here’s your 7 day supply and a shelter voucher.” And in a few days when the person decides they don’t like how the meds make them feel and stop them? The withdrawal symptoms can spike a new round of severe distress.

    And if we commit them and for outpatient treatment? Then we condemn people to ongoing side effects such as loss of libido (castration), cognitive fog and confusion, tics, tremors and long term health problems such as brain shrinkage, obesity, diabetes and heart disease.

    You are right that this disproportionately affects the traditionally disenfranchised including the LGBT community and people of color. Essentially we are allowing tState sponsored racism and discrimination to chemically control and damage certain groups of people.

    So….I am heartened by seeing you address the deeper issues instead of this bandaid approach that can easily do more harm than good. Housing is a key issue as well as examining how the community chooses to help people in distress. This should be a neighborhood by neighborhood and city by city issue…not one overarching government law that appears to have good intentions but is actually draconian in practice.

    Thanks much for your words Iden.

  • Finally!! I’m so happy that this extremely painful disorder will now be seen as the mental illness that it is. My poor child has suffered from it for years. We thoght at first it was Excessive Grumpiness Disorder (EGD) but these reserchers have finally nailed it. So far we haven’t been able to get doctor prescribed medication for her “SCT” but now I am hoping that my 5 year old will receive Provigil. We have had to medicate her ourselves…first with double shots of espresso, now with IM Methamphetamine, and the fog finally is lifting. But I would prefer a doctor prescribes the meds than to have to buy drugs from “Snakes”- the guy down on the corner.

    I feel like I can see some hope for my little one today. Thank God!

  • Psychiatric drugs are causing some people to be increasingly violent and suicidal. They are iatrogenically engendering a violent disposition. Coupled with access to enormous firepower in a society that is increasingly fragmented and you have a cauldron ready to boil.

    There are black box labels warning about the potential for suicidality in adolescents when taking SSRIs. What happens at 19? 20? 24? 30? Do those feelings magically go away?

    The evidence is mounting.

  • I don’t think it’s off track at all. Looking at how to defeat this bill means having an open dialogue with people who support it and understanding why they do. Many of the strongest supporters are not some monolithic evil big pharma supporters. They are people who are unable to find the full support they are looking for with their family members. While you and I may disagree with them and not support outpatient treatment it’s key to examine what we can offer as an alternative. Right now outpatient drugging is being strongly forwarded in part because we have not created viable alternative structures for those in crisis. This is what we need to look at and what we need to offer if we are to convince a lot of people not to go down this road.

  • Again Kate, glad to have you here and to have your comments. I think there needs to be more comments here from people with your perspective to discuss these really hard issues.

    For some background, I’ve worked for the past eight years s a therapist in an inpatient setting in Oregon. Our hospital tends to receive people going through the most severe cases of psychosis and mania. Though I have serious concerns with different aspects of hospitalization, I also understand that it is the main established system for working with people going through severe crisis.

    You said some things I really agree with. There are many cases where someone is experiencing psychosis, is in crisis and is becoming intensely intrusive or challenging in the community. I disagree with many people here but I absolutely understand the need for an involuntary hold and temporarily staying in a locked unit that is not a jail.

    But this is where the problem starts. Doctors are independent professionals who then have very different ideas about how to “help” someone in crisis. But generally the move has been towards polypharmacy (antipsychotics, mood stabilizers, benzos, antidepressants) medication that lead to long term mental and physical health complications.

    I think the “soft” reform many of us here would like is to look at starting people who have just had a first break on a very low dose of meds, or perhaps none. There is substantial evidence that this can be more effective long term. And for those already in the system, the hope would be for tapering down or off of these strong drugs that can lead to heart disease, obesity, diabetes, Parkinsonian like symptoms and earlier mortality rates.

    Mandating and forcing these drugs on people, while knowing the likelihood of these complications simply seems unethical. However, I entirely get that many families then feel very stuck. Their kids are placed on heavy meds in hospital. Thy leave and then stop the meds, leading to further psychosis and more hospitalization. Forced outpatient treatment seems like a good answer to this.

    But as we have seen from research (and I urge you to read Bob Whitaker’s new article out called The Fat Lady has Sung), long term use of antipsychotics leads to further episodes of psychosis, the opposite of hat is commonly thought.

    Anyways, your perspective is really needed here. Thanks for talking with us.

  • Seems like a fairly open and shut case. Long term use of antipsychotics increases the likelihood for episodes of psychosis to persist. But amazingly we are moving in the opposite direction as evidenced by the latest bill in Congress. So now we have the States and Federal government actively allying themselves with a strategy (long term use of neurleptics) that has essentially been debunked as an ineffective and damaging treatment method.

    What will it take to shift the treatment strategy of psych docs? Lawsuits, mainstream media articles, patient outcry, more Thomas Insels speaking louder about this?

    The moneyed interests and inertia are strong here.

  • Kate it’s great to have your perspective on board here. I agree that there really aren’t comprehensive alternative systems in place for helping people in severe crisis, going through extended psychosis and mania. And when someone has to respond to a family member in an extended struggle who has acute symptoms, it can feel insulting to say, well whatever you do, don’t bring them into the hospital.

    I think the main point of this article is to point out the serious problems in forcing someone to take a drug against their will even while they have returned to the community. From certain family members perspectives, it can feel like needed help. But for the individual themself, it is state mandated drugging with neuroleptics that have harmful side effects, long term health implications and problems with withdrawal.

    On a more practical level, what happens after that commitment process is over? They can go right back to stopping their meds. But now 6 months later, they have become so used to heavy sedating drugs, that they are likely to experience extreme states of psychosis when they stop.

    Though I agree with you that it is basically mean to tell someone not to take a family member into the hospital when there are simply no other real choices. But it is also cruel to have the State make someone take a harsh set of drugs against their will for an extended period of time.

    My only thought on this is that even if the hospital is the only main answer right now, many people are working hard to create an infrastructure for alternative crisis care. In the mean time, I encourage hospitalized individuals and family members of these folks to act as strong advocates to become fully informed, to push back against unneeded or overezealous polypharmacy drugging, and to fight for their welfare and safety in these settings.

    Anyway, hope you add more to the ongoing discussion. Thanks for being here.

  • Great piece Sandra. I was hoping you were going to weigh in on this latest update of Harrow, et al. I agree that those who dismiss these findings do so ono the basis of calling it a “naturalistic” and not a controlled double blind study. I think those who are critiqueing this study would look for any excuse to dismiss the findings. But th evidence is mounting…Wunderkind, alterabntive approaches like Open SDialogue showing success. Insel acknowledging that long term use of antipsychotics is not effective and likely detrimental.

    But here is what I’d like to really address. Many of us would hope that those who are going through an initial episode of psychosis/mania could be treated with a no/low drug regimen and then be tapered off as stabilization improves. But this really only addresses the “first-time” population. How would you address helping those who have been treated long term. From first hand experiecne, it seems like the longer you are on these drugs, the harder it is to “come off.” And of course, it takes time, lots of time and support.

    Many of the people who have been medicated don’t have the structure, the socio-economic means, and the right therapeutic community/doctors to walk that road. I agree with you completely about the best approach for helping those who are first experiencing psychosis. I’m interested in your approach for those who have been in-system for many years.

    Good stuff…

  • This is a fairly huge piece of evidence that long term use of antipsychotics for those labeled schizophrenia is not only ineffective, it prolongs the chronicity of psychotic episodes. This concluding sentence says a lot…

    “Another factor could be prolonged treatment with partial do- pamine blockers or antipsychotics, which may produce a medication-generated build-up of supersensitive dopamine receptors or excess dopamine receptors for some or many SZ. ”

    When will this be publicized far and wide?

  • Great post Monica. As someone who works part time in a hospital setting, I have worked with many hundreds of people who have become angry, aggressive and potentially violent. It is always better if I have had the chance to make a connection with that person beforehand so he knows me and doesn’t see me as threatening. But if not I try to be real and not become fearful.

    Just a few days ago, a woman was very manic and started to throw chairs around. I knew her well and went in to talk to her. She started screaming at me loudly just a few inches from my face. I listened calmly and tried to ask questions. After a while she saw I wasn’t going to be aggressive to her and she calmed down a bit and talked to me. I could start to hear why she was so angry. I won’t go into details but what she said made sense. Her frustration and anger were very very justified, born out of trauma.

    Out of those hundreds of people I’ve worked with, almost all of them were able to deescalate. However, I will acknowledge that there are a few that are not simply psychotic and scared. There are some that are predatory towards vulnerable people, are intently looking for ways to inflict harm. Because of the setting (psych hospital) it is very unlikely that they will receive criminal prosecution. It is these few that are the most challenging.

  • Hey Francesca, somehow I missed your post. Yes, great point. If we create alternatives that are effective, widespread and cheaper than the insurance-pharma-doctor-hospital model, then we could see some real progress. I think avenues like Soteria and Open Dialogue are wonderful models, especially for “first-episode” psychosis where a person hasn’t been caught by the system and has been heavily medicated for a long time.

    For those who want a road back to a non-medical model, it takes lots of time, perseverance and support to taper down or off of meds. That is why I support a based peer community wellness and recovery template- where meetings are frequent, everywhere and free. Though “Home based models” are wonderful for supporting people temporarily, most people need a longer system of support where they live in their own home.

    But yes, I fundamentally agree. We can’t tear down the existing system without having something truly effective in its place.

  • Hey Joe, I agree with you that hospitalization is generally a holding tank, beds and meds. Its interesting to me, though, that we get many many voluntary patients and patients who return to hospitals. For some people who are homeless, it is a place to get some rest away from the street. For others, they are invested in the medical model and simply want to tinker with their meds. Some patients do feel that “doctor knows best.” And for others I have talked to, the hospital actually provides a needed respite from where and who they were living with.

    But at base, this is really all that is offered out there with a few exceptions. If there were better alternatives, I am sure that many would take a different path.

  • Good question Andrew. I think you have identified one of the main ways that will cause the practice of psychiatry to change- the legal avenue. AWe have seen a chipping at psychiatry this way – black box labeling, GSK no longer paying doctors for “educating” people, opiate prescriptions are going down…all the result in part due to lawsuits. But these are all minor, small chips that psychiatry has given up in order to preserve the bottom line.

    The main way to change psychiatry is to affect its financing. And psychiatry is financed by the insurance industry. If the insurance industry, as well as Medicare and state insurers, favored alternative models of care that were less expensive and equally if not more effective, that would cause a deep blow to the practice of psychiatry.

    However, as you know, once you have been taking psych drugs for a while, it is deeply hard to go off of them. This is where psychiatry has the upper hand. There is no easy alternative model for the millions of people currently taking these meds. Even if they want to taper down, (and a large percentage don’t), they will still need more prescriptions, more refills, more psychiatry.

    If there is one area that I think we can truly make a change it is to present the case of not starting meds. As you said, Insel has already tacitly agreed that the current plan of medicate hard and medicate for life is an erroneous model. Perhaps media campaigns showing what happens to people who are medicated such as videos of people who have experienced tardive dyskinesia, parkinsonian symptoms, obesity, diabetes, heart disease, strokes, SSRI withdrawal symptoms due to meds.

    Just as “Faces of Meth”, and anti-smoking campaigns changed people’s opinions, strong media footage and commercials could show people some of the true harms inflicted by psych drugs. There needs to be a public mind change before there can be a true change in psychiatry. Thanks Andrew for your post!

  • Thanks much travailler. You know its interesting talking about these issues with my co-workers. A fair amount of them are interested in reform, and developing new paradigms for helping people in distress. But at the same time, there is a great deal of inertia and willingness to accept the status quo, deeply flawed as it is. Thanks for your kind comments.

  • Thanks for the comments Jonathan. I agree theHospitalization model for emotional crisis needs to be seriously revamped. Like you said, medication changes seem to be the only thing really going on. Ad it’s quite bizarre to start someone on something new and then kick them out the door. “Hope that works for ya!”

    And yes the supposed watchdog agencies are fairly toothless at this point and true advocacy groups with more muscle need to develop.

    One of the biggest issues that you tak about is the public clamor for “more hospital beds” as if that will do much to alleviate people in crisis. We don’t need more beds, we need better options. Less expensive options. Options that are more effective and less dangerous to the welfare of vulnerable people.

    Last night I heard that 6 people were boarding in the ER. One was so agitated by having to wait in this space that he was being guarded by a sitter. This is functional? It is exacerbating crisis; creating the template for further trauma.

    Thanks for your good words.

  • Nettles are one of my all time favorite. I love going out and wildcrafting a ton of them in April. Huge amount of iron, mineral and vitamin dense and its what I call a “food” herb…something that many people can take daily fr weeks and months to tonify. My only caution is for people who already run hot and dry. They can be a little too stimulating for some people.

    Nettles can often be incredibly helpful for those who have been wrung out by the system, exhausted, depleted and feeling sad and fearful due to both previous trauma and the psych drugs. Also, interestingly, nettles has anti-histamine like constituents that make it useful for those prone to allergies, but perhaps to those who have been made more histamine sensitive from the drugs. Good stuff.

    And Madmom, I love the idea of drinking up your steam water after cooking up greens. Even better if you grew them yourself like you say. These drugs are incredibly depleting and the dark greens are so deeply nourishing. I really find that I absorb nutrients and vitamins way better from food and herb infusions then from capsules and pills. And if someone’s gut is not absorbing properly, liquids are really a good way to go.

    The revolution is in the backyard…

  • The histamine connection is really interesting to me right now Monica. I tend to look at the big culprits first…sugar, caffeine, alcohol, wheat , dairy and processed foods…that alone can be daunting for a lot of folks…and then if I go on to talk about exploring the histamine connection, it can be a hard sell at times.

    I personally have a strong reaction to some, but not all, high histamine foods. The big culprits for me are red wine, chocolate, aged meats and cheese and tomatoes. Hoo boy…I’m itching just thinking about these foods.

    However, I seem to do great with some fermented foods like miso and limited yogurt and i do great with bone broths. There’s a lot of experimentation and tinkering but I also notice when I’m less stressed I can handle more…like I’ve got a histamine tolerance cup that can handle a certain amount before it spills over and my health suffers.

    Anyways, I always like reading your take on this subject. Pretty fascinating.

  • Hey great stuff Chaya. I wanted to tack on a few things about herbs. I think of them on a continuum, with some of them very benign and subtle, and some that can be stronger and sometimes interacting poorly with the psych drugs and the intense sensitivities that develop. Of course everyone is really unique and for some even a cup if gentle lemon balm tea can be too much.

    In any event, the gentle nervines such as chamomile, lavender, rose, and lemon balm tend to be the gentlest and work for youth and the elderly well too. I’d also add oatstraw that many people can handle as a gentle nerve strengthener over time. Sme people can handle nettles and for others it’s too stimulating.

    Then the middle category of anxiety reducing nervines include linden, Scullcap, hops and passionflower. Some can handle these, others can’t.

    St. John’s wort is in a class by its own. It has some nervine relaxant effects but tends to react adversely with anyone on antidepressants so I tend to avoid it for those coming off.

    Then the big guns to me are herbs like Valerian and Kava. Both are strong medicine that I would only offer intermittently to very specific people who can handle their effects.

    Whole Food, herbs, sacred movement, fresh air, sunlight, friends…true medicine. Thanks for your words…

  • Hi RISN. Yes there are alternatives to the medical model for emergency care, but I don’t know if they are readily available to most folks who are in crisis. I think one of the ideas that we may have to move away from is the idea of creating houses for all people in distress.

    Though this may certainly be a great idea for those having a first time break or for people who need intensive support, there is even more need for creating broad coalitions or peers and meetings of people devoted to a non-medical model of healing and recovery.

    Many people in distress can’t leave their homes and families but need strong networks of support. I think the 12 step model of meetings throughout the country with peers and sponsors helping people to heal could be a great template for this community too.

    So yes, to alternative support houses, peer recovery centers, non-medical based peer recovery meetings, holistically minded professional support…all of it!

  • Alix, yes sadly there is little in the way of in depth conversation between docs and patients in a hospital setting. I think this is due to a few things:

    1 The payment structure. There is no incentive to talk at length when there will not be more financial reimbursement.

    2. The medical model. Doctors are generally only educated in using one tool…drugs…for managing suffering.

    3. Laziness. It’s a hell of a lot easier to prescribe Seroquel for confused thinking and insomnia than to sit and discuss a persons in depth issues at length.

    The Insurance-Big Pharma–Doctor industry have corrupted mental health care to an astonishing degree.

  • Fantastic post Sera and thank you for researching this thoroughly. To add a personal note, Recently the director of the mental health units at the hospital I work for strongly promoted all staff to attend a NAMI “walk” through downtown Portland to promote “awareness of the need to help those with mental illness.” I stated my case plainly that I would not be walking with other staff. The Director and my co-workers were astonished. Why not? Well…it took a few minutes and a lot of blank stares.

    These staff are well meaning people, as are almost everyone who works with NAMI. They believe strongly that they are doing a very important service. It’s important to discuss the facts with them without belittling them or insulting them. If I say, well you’ve essentially been co-opted by the pharmaceutical companies to promote their medical illness based model and hooking people on strong drugs to treat their emotional distress…they may get a tad…upset.

    We need article after article like yours in high profile media sites…exposing Big Pharma for co-opting and corrupting the very organizations that are meant to ave and protect the vulnerable.

  • Your english is great. Yes there have been radical changes in the way physics is understood that can be truly mindbending from a strictly linear cartesian way of examining phenomena. Scientific principles of inquiry can be really useful for examining nature and reality. The idea that a hypothesis needs to be tested and verified repeatedly to determine accuracy (vs. blind faith) is a very useful construct.

    However, the terminology of science can be bent to promote ideas and treatment strategies that are simply wrong at best and outright damaging at worst.

    The answer to this problem does not mean the abandonment of scientific inquiry. It means a reappraisal of how scientific study is done: who is conducting he studies, how the studies are shaped, and the limits to the approach of reductionistic scientific methods when they are used for examining mental health.

  • The terms scientifically researched, evidence based, proven through double blind studies…have all been used as cudgels to promote some of the worst abuses in psychiatry. Even impartial mental health research (if there is such a thing) is biased by what it wants to examine (while eschewing other templates for healing).

    When applied to physics, astronomy and chemistry, I generally have no problem with science. When applied to health and human behavior, I have many many caveats and questions.

  • Great interview. Thanks to Bob and Bruce putting this together. Essentially, I think Bob is right that intellectually and philosophically, psychiatry is in deep inner conflict. But in terms of the reality on the ground, not much, if anything has changed. And little s changing because there is enormous financial interest in keeping the drug therapy model going.

    I also want to nitpick with Bob over one point. He hopes for shifting to a model of care that is truly “science based”. I ask, what kind of science? “Science” has led us to promote drugs, ECT and outpatient involuntary treatment. If by science you mean creating truly impartial (not funded by drug companies) double blind studies of the effectiveness of different modalities, I would partially agree.

    But I would still question what “science” means in terms of mental health. The gold standard of randomized double standards to parse out a single variable to determine effectiveness just doesn’t jibe with the immense complexity of helping people in emotional distress. The holistic and deeply complex element of human nature just doesn’t adhere well to reductionistic double blind “scientific” studies.

    In any event, it’s a quibble. This post is great. Thanks for all your work Bob and Bruce.

  • Thanks for the comment Chaya. I think its interesting to examine the lines and grey areas between peer and “professional.”

    Even in peer relationships, there are a number of challenges. If someone is in crisis, it can be really challenging to be a main source of support as a peer. Boundaries can be much trickier in terms of how much time, care, and emotional attention to offer. If a peer gives away too much, they end up feeling drained. But if they give too little, the person in crisis can end up feeling abandoned and further traumatized.

    In some ways a professional relationship “solves” this because the roles are defined and compensation is given for time and attention. However, you are right that there is a natural power imbalance and a feeling of returning to the expert/patient role that was initially so destructive. And of course money makes the relationship different. It is certainly not a usual friendship, or peer to peer relationship anymore.

    Complicated…

  • Great post Chaya. I think this is a challenging topic to bring up. Is asking for payment from people who have been abused by the system just a form of continuing the abuse?

    Though there are some differences, I look at the 12 step model for drug and alcohol recovery and see how those folks work with people who are “recovering.” There is both peer based and professional level help. The peer based support is generally free (meetings, sponsors) while the professional help is not (counseling, rehab).

    I think there is a place for both in the mental health recovery community as well. If you have taken the time to develop your skills to create a template for helping people to recover in a way that improves health and well being, I see no reason you shouldn’t be compensated. Your compensation helps you to have enough to support you so you can best support many many others.

    I think part of the key can be to extend some of your services at reduced or pro bono levels for those who can’t afford it. Finding a good balance can be challenging.

    Helping people to “come off” is an incredible service, and one sorely lacking in this society. I think there is both a place for peers and people with specific skills in this area. Thanks for the thoughtful post.

  • Man….Cindi…I knew you had been through a lot- I just didn’t realize the extent of your battle. It amazes me how much extra-judicial power we give to medical “professionals.” There needs to be a case brought up to the Supreme Court to challenge the legality of violating a person’s right to autonomy, essentially jailing and drugging someone indefinitely, without being charged with a crime. It is unconstitutional. Thank you for your strength and bravery Cindi.

  • Interesting article Ron. I think a lot of this stems from a discussion of what “recovery” means. For those allied with NAMI and the current mental health system, recovery means taking daily medications, integrating into the community and being able to not have severe episodes of distress requiring regular hospitalization. Even if that means having a host of side effects from the meds and health complications.

    I think for people who are critical of psychiatry, recovery means an improvement in health and well being not necessitating large doses of psych meds. It means tolerating or even welcoming divergent symptoms such as voices or even depression as part of the human experience. It means not relying on the medical establishment for managing their well being but developing personal autonomy and finding holistic methods for improving health and well being. It means not believing in a permanent illness model of mental health. It may mean some interaction with the medical community but with much more circumspection and personal agency in those interactions.

    The word “recovery” has been easily co-opted to the point where it’s meaning is fuzzy. Obviously the folks that write this article are invested in the first model of Recovery. From there we have problems.

  • Thanks Monica for the great post. When confronted with symptoms of pain, neuralgia, and suffering that Western Medicine has no answer for, doctors have often turned to the old adage “Its all in your head.” SSD is simply another extension of labeling people who are suffering pain with a mental disorder, further branding and stigmatizing them.

    In Chinese medicine, there are myriad descriptions of Physical/Emotional illness that do not fall in line with a Western scientific explanation. Someone could have liver qi stagnation and experience a feeling of repressed anger as well as underlying toxicity in the body. Someone with “Shen disturbance” may experience a feeling of fear and depletion as well as genuine pain in the heart area due to shock and trauma. Liver wind is a description of moving neuralgia, tics and tremors as well as shaking and trembling.

    But in Western Medicine if someone shows complex symptom patterns with no known etiology, we label them with SSD. And then what? A little prozac to get them to stop worrying about all those made up symptoms? A little xanax to calm them down so their not so obsessed with worries about their health? Hmmmmphh…..

  • The Paleo vs. Vegan debate has really been raging hard for the past few years. I think its first important to acknowledge what they agree on first. They both agree that the Standard American Diet (SAD) is making us sicker and more mentally/emotionally unwell. Though a Vegan diet can theoretically include sugar and processed junk food, I think most people who talk about this diet promote eating primarily whole foods in the form of vegetables, legumes, grains and fruit. And certainly a Paleo diet does not allow for processed foods, sugar, as well as legumes and grains.

    I personally think that starting either of these diets can be very healthy depending on the person. Both have their strengths and weaknesses. Paleo seems to be really helpful for people with sensitivity to wheat and grains, helps with blood sugar balance and can impart an overall sense of vigor and calm mood. At the same time, it is also very expenisve (if you but free range and organic only) and not very environmentally sustainable.

    Veganism is much cheaper, more enviro sustainable, but some people have a problem with feeling deficient and weak after a while. The plant based diet seems to be really helpful for improving health at an organic level, helping to reverse many disease processes.

    However, some vegans also lapse into eating a lot of processed “fake meat”, peanut butter and jelly sandwiches and vegan cookies. Obviosuly this is just as bad as eating a SAD diet- just has a “vegan” spin.

    Personally, since we’re talking mental health here- I have seen a lot more improvement for people with a Paleo/Primal diet than Vegan. But I think it just requires personal experimentation to see how one reacts to each diet type. Bioindividuality.

  • Thanks as usual for your thoughts Sandra. I really appreciate that you take the time and effort to post here, even when it is likely to feel pretty uncomfortable. I really appreciate this part of your post even if I don’t agree with it fully…

    “To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it. Some of the people who comment here seem a priori against the notion of using a drug to reduce suffering. I do not share that view.”

    I know a number of people who say that drugs have seriously helped them. Even saved their lives. They get very emotional, angry, if I, or others talk about the potential negative effects of psych drugs. I get that, in a lot of cases, people feel their suffering diminish. Why interfere with that?

    I honor where people are coming from. If an antipsychotic, or an antidepressant is “working for them”, who am I to suggest they are wrong? Or should stop. However, if I am a friend or their therapist, I do keep a careful eye on whether that drug or combo of drugs are causing greater health or emotional problems. And if they are, to be careful of what doctors usually suggest, which is to change to another med, up the dose or add another med. I frankly rarely hear about doctors looking at tapering the meds, or offering comprehensive programs that involve diet, exercise, therapy, sleep hygiene and peer support.

    This is where I believe psych doctors could do a world of good. Just as doctors look at holistic programs for those with diabetes, heart disease and obesity, holistic health programs could deeply serve those suffering with emotional distress as well, and serve as alternatives to just one more drug.

    Anyways, always enjoy hearing your point of view.

  • Thanks for the comments Steve. I think there is indeed a place for integrating science and the scientific method for helping people in distress. But what is that process? As someone trained in botany and as an herbalist, I am often informed by a scientific understanding of plant chemistry and the active constituents and their biochemical effects on human physiology. This can be important when helping people in emotional distress. But it only informs a part of my understanding of herbal medicine. It is also key for me to understand traditional and empirical uses of plants as well as the unique needs of my clients. That holistic understanding gives me a broader palette to work from.

    The scientific process for helping people in emotional distress has moved towards relying almost entirely on drug “treatment.” And those drugs have been pushed by large and very wealthy companies that have the money to do extensive double blind “studies.” Is this science when many alternate systems of care are ignored because they are not “evidence based”, meaning huge sums of money have not been used to study them?

    When Science becomes bastardized as simply a tool for wealthy corporations to sell a product, then I think we need to completely revamp our notion of what constitutes…good Science.

  • Brett- I’m sorry if I took part in that and I would be sorry to see you stop posting on articles other than your own. While you and I have some disagreements, I have always wanted to hear your point of view. As I have seen from day one coming here- this site is rough. People are direct to the point of being personal at times. There are times I’m not comfortable with the level of vitriol that happens.

    At the same time, I appreciate a good conversation and examining issues that can get heated sometimes. I hate to see conversations become one sided where those who agree just talk amongst themselves. In any event, it would be sad to lose your voice. Thanks for your posts.

  • I don’t know- when I think of the word “psychosis”, I think of a temporary state of being. Schizophrenia implies permanence to me. At the same time, I get where you’re coming from with words. Psychosis is a very bland, uninspiring and generic term. There is such an enormous variety of experience placed under the rubric psychosis.

    I also personally don’t have a problem with thinking some people are prone to psychosis. I think one of the concepts in many traditional societies is that some people are more prone to altered states, having visions, hearing voices. But instead of seeing them as weak, they have often been picked out as the seers, the shamans and visionaries.

    At the same time, I don’t want to minimize the extremely confusing and torturous elements that some people go through when they are experiencing “psychosis.” I don’t want to exalt the condition into some rapturous spiritual state. For many who in the depths of severe confusion and emotional distress, the experience is deeply unsettling and scary. But instead of drugs, perhaps we could offer shelter, guidance, some empathy, nourishment and a place to walk through that space of mind with compassion.

  • I agree Duane. The term that is bandied around as all powerful is…evidence based. It’s a silencing term for any other forms of care that have not been rigorously double blind studied. Pigeonholing a category of people with vastly complex narratives into singular treatment strategies seems misplaced at best.

    There has to be an allowance for a divergence of healing methods. What works best for one person may not work at all for another.

    Here’s an example. A number of years ago I was having trouble sleeping. I decided to see a therapist who was known as a sleep specialist. When we met we talked about some strategies and sleep hygiene. Then I asked him what he thought about caffeine and diet as it relates to sleep problems. He said he had no idea about that and doubted that it mattered much. I never went back.

    My insomnia was essentially cured by paying close attention to my diet and avoiding caffeine. I probably would have been served better seeing a naturopath.

    People need different skill sets and techniques at different times. Compartmentalization and one size fits all methodologies are part of what’s wrong with modern medicine.

  • Thanks Fred. I thought it was also timely because a lot of the discussion lately has been about what constitutes “effective” treatment. I have said in other posts that I think relying exclusively on double bind “Science approved” studies have left us with…mainly taking antipsychotics. What went wrong here? Is it the fault of scientific research? The trials themselves? The huge monies invested and a corrupt psychiatric-industrial complex? Eurocentric cultural thinking?

    I think the whole notion of “science-approved” needs to be seriously reexamined.

    And I think we need to allow a great deal more leeway to empirically validated healing processes. We need to trust ourselves again.

  • Hermes, I think this is one of the sanest approaches to managing mental health, whether it is sanctioned by “Science” or not. The problem we encounter when relying entirely on double blind studies is the sheer complexity of experience that can not be reduced to simplistic controlled studies.

    How can one possibly do a double blind study that tests the efficacy of a low-carb diet, specific exercise, basic lifestyle psychology and zen meditation vs. antipsychotics? There are too many variables. There is bio-individuality. Length of chronicity of illness. Age. Community support. If the person has been on drugs or not before starting the study. And on and on.

    I think its deeply important for someone who is going through severe emotional distress to experiment with a number of ways of helping themselves. As long as those ways aren’t potentially harmful, it can be incredibly fruitful to explore ways of managing mental health that don’t involve extremely powerful drugs that are destructive to health long term. Capital S Science might not back you up…but the proof is in your own level of well being.

  • Interesting Keith. Here in the States, almost no public money is put towards individual therapy such as CBT on a long term basis. Frankly, if you are poor with only public insurance (Medicare/Medicaid) you will receive free antipsychotic medication and very occasional visits with a prescriber and a case manage. No individual therapy. Even if efficacy was shown, I doubt public insurance would cover regular CBT.

    You mention deaths and an attempted suicide for unmedicated individuals. I assume you are implying that unmedicated individuals have a higher risk of death. That is a fairly big assumption. Other studies have shown otherwise. Here’s one. http://bjp.rcpsych.org/content/188/3/223.abstract

    On the other hand there is demonstrate lee proof that antipsychotics lead to enormous health risks such as diabetes, heart disease, obesity and early death.

    Though CBT may not be the answer, it certainly does not cause an immense amount of long term health complications. If the first rule is “Do no harm”, then I would suggest the UK NHS needs to go back to the drawing board.

  • Fiachra…yes…It seems evident to me that if you could offer a model of care where people don’t remain chronically ill, that would save insrance companies and the government reams of money. We need to convince them to pay for holistic care models.

  • Thanks for posting this Sandra. I think eventually alternative models for handling first time psychosis will at least be acknowledged, if not promoted. However, as a therapist myself, I wonder about the real world application of CBT as a primary model of care. Would insurance companies pay for ongoing therapy to work through psychosis? The vast majority of people I work with are poor and have Medicare or no insurance. If they receive benefits they can see a provider once every couple months, a case manager infrequently and maybe some group therapy once in a while. Weekly one on one CBT visits seems luxurious.

    Sadly, we have moved to the ten minute drug based model of care because its easier, simpler and (I assume) cheaper for insurance companies. The only way I see this model changing is to present evidence that alternative systems such as CBT/Open dialogue can provide cost savings to insurance companies.

  • @Pablo-

    When it comes to psychiatric medications, this issue gets compounded because these trials are not longitudinal studies. What are the potential health complications that could arise from taking a drug over a period of time. Many of these studies do examine side effects, but they are only for a very short length of time.

    Finally, what is deeply problematic is the prescription of these drugs for off-label conditions. The atypical antipsychotics, which carry a wide side effect profile, are routinely prescribed by GPs for a multitude of conditions without any substantiating evidence for their efficacy.

  • I’d go further dbunker. Any company that develops trials to prove the efficacy of a medical treatment/drug should, by law, have to provide the data for all their trials (not just 2), whether there is government money involved or not. Why?

    Because otherwise, if many of their trials show that the treatment is no better or worse than placebo, they are involved in obfuscation, false advertisement and are potentially causing grave harm to anyone who buys their “product”.

    I would actually prefer that all trials are done by independent scientists that have no ties to the corporation who wants to sell a treatment.

    The results can then be published in independent medical journals. No advertising should be allowed. No doctors should be able to promote the treatment for company money. If it works, it will be made abundantly clear in the medical journals and that information can then filter down to doctors who can then make the choice to prescribe the treatment or not.

  • I have been fascinated with how different diet types affect mental health. Personally I think that it starts with shifting to a whole foods diet. My guess is that most people would find an improvement in their mental health if they simply cut out sugar, processed food, caffeine, alcohol (and for some- wheat).

    When adhering to a Paleo diet, all of these (except for caffeine) are eliminated. I have tried a Paleo diet and found it pretty hard to be that strict. When I added in whole grains and legumes I personally didn’t notice any difference with my well being. I don’t know if you are familiar with Mark Sisson (Primal diet), but his forums are chock full of people exploring the mental health/diet connection. He can be found at http://www.marksdailyapple.com.

    Anyhow, I would love it if doctors talked about diet instead of pills.

  • Fascinating bio of Insel. I’m glad that he has chosen to be a harsh critic of the DSM and its complete lack of a basis in scientific underpinnings. However, he is devoting his energies into exploring the biological underpinnings of “mental illness.” What we need to focus on is much more effective strategies for helping people who are suffering. If he truly believes that long term use of antipsychotics is not generally warranted, what does he propose as an alternative? And if he does propose other options, why not sink money into researching non-drug alternatives?

  • Phillip, thank you for your post. I agree that Family of Origin issues can indeed have a large impact on the mental health of children and can impact their adult lives significantly. I don’t think you’d find much disagreement, even from psychiatrists, that children born in abusive, or negligent families can develop serious mental and emotional distress.

    But I think we have to be careful about saying to what degree “Nurture” has an impact, especially when it comes to a tendency towards severe symptoms such as a susceptibility to psychosis, repeated manias, etc. Like MadInCanada, I have seen one family member develop psychosis while her siblings raised in the same family do not. I have seen studies of twins separated at birth who both developed psychosis at a much higher rate than the norm. To me, I worry that if we promote “nurture” as the primary etiology of mental illness, we would indeed return to a “blame the mother” period of time.

    I think the real problem is that Big Pharma has way over played the biological argument. They not only have neglected family of origin issues, but also socio-economic factors, nutritional, psychological and interpersonal factors in favor of a one size fits all argument. They have also extrapolated to promote the biological argument for all “disorders.”

    Finally, and most importantly in my mind, even if their argument that mental illness is rooted mainly in biology is correct, (which I entirely dispute), they make the deeply illogical leap to the premise that strong neuroleptic drugs can somehow “treat” these illnesses.

  • Brett- I think this issue is actually fairly complex and may not be able to be hashed out in a few posts. Let me see if this is a good paraphrasing of your post.

    1- Psychiatric meds do not correct a chemical imbalance
    2- These drugs create brain changes that can worsen people who take them long term.
    3- Drugs such as antidepressants work no better than placebo.
    4- We have learned these things through scientific research.
    5- We should use the same level of scientific research for evaluating alternative treatments.

    I agree with the first four points but I am uncomfortable with the 5th. Here is why.

    1- First, when we are talking about acupuncture/yoga/tai qi vs. psych meds we are talking about apples vs. oranges in terms of the potential for harm. I have a much greater need for efficacy when a treatment is invasive (surgery), or has potentially damaging side effects (meds).

    2- The classic double blind gold standard showing *validity* simply falls short when examining complex holistic treatments such as Traditional Chinese Medicine, Ayurveda, Yoga, tai qi, etc. These studies can not take into account the skill of the practitioner, the setting of the treatment, the interpersonal relationships, etc, etc.

    3- There are an enormous amount of things that provide relief for emotional distress (baths, sunlight, massage, family support, spiritual and religious rituals, sipping herbal tea.) Even if it was possible, it would seem absurd to do double blind studies to prove their validity. If we were to require that every treatment modality requires double blind scientific evidence, we would be left with very few modalities left, something that seems to be “throwing out the baby with the bathwater.” There are many many treatments that have empirical validity. As long as the risk of harm is low, I have no problem with many treatments that are not scientifically proven.

    4- Scientific “evidence” has been used to convince people to engage in deeply troubling therapies such as regularly taking psychiatric drugs for the rest of one’s life. The notion of what constitutes scientific evidence is put into question. Who are running the studies? What are the financial interests of those running the studies, etc? We have seen these problems when Big Pharma runs the tests.

    I think where you and I agree is when a very large claim is made for an alternative, or allopathic treatment. If you told me sipping chamomile tea cured a person of having regular manic episodes, or that a certain medication cures cancer…I want to see the scientific evidence. There is a border line, a dark line that can be crossed where alternative practitioners suggest that they can solve complex emotional and health problems with a certain treatment modality.

    So to sum up, I think we agree on a certain level. Scientific evidence plays a role when a very strong claim is made.

    But for me more importantly, it comes down to potential of harm. That potential for harm not includes the treatment itself, but for financial harm as well (spending 50,000 $ for a weekend Mayan extraterrestrial healing ceremony workshop).

    At this point using acupuncture as one modality to help with emotional distress rates very very low on the potential harm-o-meter while taking multiple drug cocktails rates very very high.

  • I’m not trying to distort Brett. Perhaps I read your post wrong. You just said this…

    “The point of my last post was to ponder the wisdom of adopting the stance that it does not matter how a treatment works if some people find it helpful.”

    Maybe I am not reading this correctly, but are you saying that it does indeed matter how a treatment works for it to have validity, or worth?

  • I’m surprised you would compare antipsychotic drugs, with their very well known side effect profiles and long term health implications, with acupuncture, which has an almost negligible side effect profile. Do you need to know the scientific basis of yoga before you engage in deep breathing and stretching?

  • Thanks Peter for an excellent summation of the major myths that are perpetuated around psychiatric drugs. Olga, I would love hear further how the Danish mental health system is responding to articles such as this. Please keep us apprised.

    One of the largest myths I have encountered is that “mental illness” gets worse iand the brain deteriorates if untreated, (myth no.10.) and therefore it is unethical not to give psychiatric drugs to people. Sadly I hear this one all the time from nurses in a hospital setting. Along with the awful chemical imbalance theory, it is the other primary myth I hear used to goad people into taking psych drugs.

    Frankly I wish it were illegal to use these myths to convince people to utterly change the course of their lives…often for the worse.

  • Hey I have to agree that is a mischaracterization. Brett thinks that biopsychiatry has serious complications due to a number of reasons. And Brett I als get that you want to make sure that any other healing modality, whether it be CBT, humanistic psychotherapy or acupuncture, has a valid scientific theory that supports it as well as evidence to prove the modality is better than placebo.

    Brett, I get where you are coming from. We disagree on a number of things but I understand your desire to offer effective models for helping people with emotional distress.

    I think we disagree in a few areas. Though I spent some time showing a number of studies that prove that acupuncture is better than placebo, I think my defense is misplaced. Like massage, yoga or tai chi, acupuncture also falls into a category of a practice that tends o make a lot of people feel better. It has enormous empirical evidence for its effectiveness. For all of these modalities, the side effect profile is tiny (compared to bio psychiatry) and if someone receives no benefit, they can easily walk away.

    So I’m baffled by Oli’s need to compare it to a cult. I would suggest its far harder to stop being involved in a cult than to tell your acupuncturist your not coming any more.

    i would also point to practices that have become very popular that originate in Eastern Mysticism. You dont have to believe in the concept of reincarnation and chakras in order to gain benefit from mindful breathing, a practice that came out of a Buddhist tradition of meditation. Likewise you don’t have to undstanding, or even like, the complex methodology of diagnosis in traditional Chinese medicine, to appreciate its good effects.

    Some things will defy the desire to “prove” efficacy via the double blind study. Hopi rituals, Native American sweatlodges, the love of a partner, the joy from drinking a cup of tea, or relaxing in a sauna. These things all help different people with their mental health. They do not need double blind studies for validity. For many, they have had experiential success.

    To define efficacy by double blind studies is to miss the vast complexity and potential for healing all around us.

    In any event, I see where you are coming from…you want people to avoid making mistakes by using tools that are ineffective, or worse…destructive. At the same time, defining successful models only by double blind studies can be narrow and destructive in its own right. It leads people to thinking that there are only a few ways to achieve better mental health. I disagree. I think there are many.

  • Hi Dru…yes your first point is really important. This is actually a critique that comes from acupuncturists. Many of them really feel that the NADA protocol is limited and not geared towards unique patients. It’s a fair critique and one that my wife (acupuncturist) has concerns about. A the same time, the NADA folks really wanted to offer a treatment that could be widely dispersed amongst non-professionals to make it cheaper and more available to those who are poor and disenfranchised.

  • We are mostly a jaded bunch here, and I would guess many people here would chalk this up to one more example of corruption in the process of making the new DSM. However, there is an obvious smoking gun here as Kupfer has publicly acknowledged his COI and (sort of) apologized for it. I would hope that the detailed information that BOM discovered does not only go to the APA but also to publications like the NYT, The New Yorker, The Atlantic, etc. More light needs to be shined on this. I would guess that the end result may just be shuffling chairs, but it can also show further proof of the serious problems inherent in modern psychiatry.

  • I hear that Stephen. I can get caught up in defending something as scientifically “sound” when in essence I agree- I don’t care either. I have seen it work countless times. It helps people. I have rarely seen a side effect and even then it is simply discomfort that goes away quickly. I do countless things that are not scientific that help me. I don’t need to know what neuronal pathway is being lit up when I laugh at a funny movie, or stretch into a yoga pose. I don’t need to know if a double blind study has approved of the massage I am getting.

  • Ok, I’m surprised that I have to link to scientific trials showing acupuncture is greater than placebo (or sham acupuncture) but here’s a few…

    “This study showed that active acupuncture was more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days.”

    http://www.ncbi.nlm.nih.gov/pubmed/15520102

    “We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.”

    “Conclusions: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.”

    http://archinte.jamanetwork.com/article.aspx?articleid=1357513

    Finally, the World Health Organization published a comprehensive review of research. You can see their publication here

    http://archinte.jamanetwork.com/article.aspx?articleid=1357513

    Many of the studies showed that acupuncture worked better than sham acupuncture. Here are some of their findings…

    “For traumas such as sprains, acupuncture is not only useful for relieving pain without the risk of drug dependence, but may also hasten recovery by improving local circulation (68–70). Acupuncture analgesia to relieve postoperative pain is well recognized and has been confirmed in controlled studies (71–76).”

    “In controlled studies, it has been shown that acupuncture is more effective than antihistamine drugs in the treatment of allergic rhinitis (111–115). ”

    “For tension headache, migraine and other kinds of headache due to a variety of causes, acupuncture has performed favourably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical nerve stimulation (TENS) (17–27).”

    But really we could go on and on. You posting me studies where it doesn’t perform better than placebo. Me posting you studies where it does. Instead I simply urge you to go try for yourself the next time you have a physical complaint (that is not so serious it requires immediate care from a doctor.). See if it works for you. No harm done if it doesn’t. For millions of people it does.

  • I’m just going to continue to have to disagree that all acupuncture studies say it is no better than placebo. Yes there are studies that show it is no better than placebo. But I could cite many many studies that show it is better than placebo. Here is a recent article pointing to a study…

    “…they found that for back and neck pain, chronic headache, osteoarthritis and shoulder pain, acupuncture works better than no treatment and better than “sham” acupuncture – done, for example, with needles inserted superficially or with needles that retract into the handles instead of going into the skin.”

    http://articles.latimes.com/2012/sep/13/news/la-heb-acupuncture-works-above-placebo-effect-for-chronic-pain-study-shows-20120913

    I could point to many many more, but I wonder why it is necessary. I would agree with you that there are a number of studies that show it is no better than placebo, but indeed there are hundreds that show efficacy.

  • Brett- I’m not sure you read the NIH conference report because you continue to say that acupuncture is no better than placebo. The concluding line in their report is…

    “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”

  • As a therapist myself Duane- I have to agree. There is a place for talk. There is a place for exploration and depth work. But I would say that talk can only go so far. When working with people in emotional distress (and often for people getting off of psych meds) there is a place for looking strongly at nutrition, lifestyle patterns, breathing and mindfulness techniques (whould those be ruled out because they have their origins in Eastern mysticism?), and yes- alternative therapies such as acupuncture.

    Talk can have its place- but nourishing and helping the body and nervous system to heal is essential as well.

  • Brett: “Scientific research may not show it to work better than placebo, or to be based on a plausible scientific theory, but there’s no denying the fact that it is greatly valued by many who enjoy its benefits. ”

    Interesting you say this- but really its not true. In 1997, the NIH (National INstitutes for Health) held a conference and an objective panel concluded that:

    “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”

    Here is one of their main findings from their studies of research…

    “…promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.”

    Brett, if you are interested in this subject you can read more at

    http://consensus.nih.gov/1997/1997Acupuncture107html.htm

  • My only question is, “Why only use 5 points when the whole body is full of points?”

    Good question Corinna. This is actually a point of controversy for NADA. They only allow training for the five needle ear treatment but many acupuncturists feel this is under serving people and that more comprehensive treatments involving the whole body should be employed. There are also some acupuncturists who feel undercut by people who have been trained as acu-detox specialists but are not trained as acupuncturists.

    My personal sense is that the NADA protocol is a great doorway to Chinese medicine and if people are looking for more, they should go to a trained acupuncturist. .

  • Thanks Peter for those thoughtful comments and thanks Vicki for writing here. As a therapist who works part time in inpatient hospitalization for adults, I have seen the shift towards faster and faster admits and discharges. I personally studied the numbers recently and saw that 25 percent of patients were discharged the next day. The vast majority were discharged within a few days, Undoubtedly they received a prescription and were sent on their way.

    As you say Vicki, this revolving door method of treatment has been really pushed by managed care and increasingly insurance companies will not pay for more than a very short period of inpatient time and are mainly paying for rapid stabilization via pharmaceutical drugs.

    While this is awful for adults, it truly seems criminal for children. Like you say Vicki, we need to look at a variety of ways of challenging the status quo, including examining regulations, class action law suits and in my mind…direct criminal negligence lawsuits. We need to take a giant step away from a pharmacy first approach…and a giant step towards a psychosocial approach.

  • Oli,

    I understand the critique that acupuncture is not scientific, because frankly it isn’t. It is based on an entirely different philosophy from western science and does not describe human health in terms of biochemistry, histology and microbiology. Like other traditional forms of medicine, it takes a holistic approach and describes health in terms of emotional, physical and energetic well being. Does this make it any less valid?

    Acupuncture and Chinese medicine has empirical validation for thousands of years. That it cannot be reduced to a simple Western scientific explanation does not eliminate its credibility. The proof is in the pudding. Millions of people are helped by Chinese medicine every day. And since we are talking about credibility, this site is in part devoted to examining the incredibly destructive practices of Western “scientific” psychiatry. How far has a reductionist and pharmacological approach achieved in helping people with “mental illness”?

    And to add, maybe you don’t know but Bob Whitaker was a keynote speaker at the 2011 NADA conference. Since the NADA protocol is essentially mainstream and paid for by insurance in many places in the country, I sincerely doubt that promoting acupuncture as one tool for emotional distress will discredit MIA.

  • Steve…it would be great to get a cup of coffee sometime.

    And yes…I’ve seen acupuncture work for so any people including myself that I get surprised when people call it pseudoscience, etc. I guess I’ve been indoctrinated by a culture where alternative medicine is pretty pervasive.

    And yeah, my wife has used it to good effect for inducing labor. Good stuff…

  • Debunking? The practice of the NADA protocol and acupuncture is widespread in many different settings now. Like i said, this is being done in hospitals, prisons, the Yale medical school, Indian reservations, the VA, etc. There is quite a body of peer reviewed literature to support its efficacy. It can be found right here…

    http://www.acudetox.com/nada-resources/15-online-resources/193-new-resource-nada-research-summary

    Furthermore, even if you want to believe this is simply a placebo effect, side effects are very rare. I urge you to take a second look.

  • Have to agree Madmom and thanks for clarifying that for me. I have seen people irreparably harmed after starting a short course of benzos and I know holistically minded people who feel like their lives were saved by psych drugs. To me it has always come down to informed choice and giving people a full understanding of what they are getting into when they start “meds”. But making blanket all or nothing statements not only feels like an injustice to many people who would be sympathetic to reform, it could indeed make a lot of people just tune out the message.

  • Excellent piece Adam and thanks for collating all these studies. And as you say, there is not only an autism link, but also a link to the risk of a host of other health complications.

    The sad part is that for some women on antidepressants who decide to have a baby, they taper their dosage so quickly that it can lead to severe withdrawal (“discontinuation”) effects, right when they are trying to be in the best emotional state possible.

  • I think about this a lot when I hang out with “societally ill”. (Sounds better than mentally ill) depressed, poor homeless people in the hospital. If only Medicaid was paying for a trip to Hawaii for you instead of sitting in this hospital and coerced to take a drug that will do nothing to help your “societal illness.”

    But really, people don’t just need the cruise, or th trip to Hawaii….they need housing, good food, a decent job, etc.

  • Where I work in inpatient psych, I would guess 90 percent of the patients are in severe poverty and/or homeless. I have heard someone derisively calling many of them “three hots and a cot”, meaning they came into the hospital voluntarily as a way of getting off the streets for a few nights. When I hear their stories, their desire for death makes sense. Most are broke, living in shelters, estranged from family often due to trauma and often dealing with addiction issues. But while I acknowledge their hopelessness and despair, I always look for the possibilities, the place of hope. So much of the despair and suffering is societal at root, and without societal changes, there is little that therapy, and certainly not psychiatry, can accomplish. These folks want solid housing, a safe place to sleep at night, a job that can earn them a decent wage, community that is accepting and caring, enough food to eat. And we offer them…Celexa? Wellbutrin? Seroquel?

  • Good points Richard…indeed, dividing out those psychiatrists willing to focus on “humane tapering regimens” would be a good strategic start. They still get paid, but they can start to unwind the damage.

    And AA, very good point too…even if a movement of psychiatrists started doing this, GPs still prescribe the lions share of psychotropic drugs.

    Advertising, alliance groups, doctor’s interests and influence as well as many people’s desire for a quick fix all make it seriously challenging to change the status quo.

  • James, thanks for your post. I would love to see psychiatrists shift from a medication/disease model of treatment to something involving holistic care, focusing on nutrition, exercise, lifestyle primarily with drugs way down the list in their toolbox. But realistically, I don’t think that’s bound to happen. Psychiatrists are paid for short 15 minute sessions and are paid highly for medication management. Full stop. Unless that basic model is changed to pay doctors highly for simply talking and educating patients, there can be no revolution in psychiatry.

    However, a very few psychiatrists are shifting how they prescribe and are suggesting tapering to a lower dose or getting off completely. This is how we can change psychiatry…emphasizing the low or no med model, emphasizing tapering if possible, avoiding multi-drug cocktails and prescribing to new patients as well as pointing them towards more holistic care. In this way, you don’t affect their bottom line….their ability to make a high salary.

    And the sad fact is…once a person has invested ten years of their life and money in education, and then is offered 125 dollars for 15 minute sessions that are based on prescribing drugs…they are unlikely to adopt radical ways of practicing.

  • Great post Will. FOR sounds like a fantastic resource for family members of folks experiencing severe emotional distress. I think a lot of parents of kids going through “first-breaks” are understandably scared and are looking to fix the problem. They are left with limited options and a societal push to medicate the psychosis away. Parents without any experience in this area are likely to trust the opinions of doctors and medical professionals.

  • Excellent post Phillip.

    When you describe how psychiatrists debate the point that there is no biochemical illness, you offer their rationale that the meds work. And then you go on to say…well…alcohol works for shyness but no one would conclude that shyness is an illness or alcohol is a medicine.

    I think this gets to the meat of the matter. How is prescribing Ritalin for the “mental illness” of ADHD acceptable, but offering them methamphetamine or cocaine is not? Why is it ok to prescribe Xanax for the “biological illness” known as Generalized Anxiety Disorder, but not ok to prescribe a fifth of Jim Beam, or some quaaludes?

  • This is a truly tragic story and reminds me of the needless killing of James Chasse, a 42 year old man labeled with schizophrenia, here in Portland back in 2006.

    After that horrible killing, the Portland Police Department changed to mandate crisis training for all police and created a liaison between police and Project Respond, a group of mental health workers trained in deescalating tense situations out on the streets. Perhaps something like that could have prevented this in North Carolina. It sounds like the third cop coming on the scene was way too gung ho and helped spark the violence.

    At the same time, cops are challenged when any person brings out a weapon. When things go south, their toolbox is generally limited to tasers, beanbag guns and lethal force via a gun. When working with people who are experiencing severe emotional distress, altered states, psychosis and are agitated, this is a really bad combination.

  • Holding a psychiatrist responsible for the suicide of one of their patients due to prescribing antidepressants? That is huge news. And I would guess that would lead to a lot less prescriptions of antidepressants by doctors in Denmark, even if they aren’t in the legal window of 18 to 24.

    I can’t imagine that ever happening in the US but who knows.

  • This really seems like a key part that is missing. Even if Open Dialogue were to take hold as a way of working with young people going through a “first break”, that neglects the vast amount of people who have already been labeled, medicated and trapped by the perils of polypharmacy.

    Though I think a movement like Open Dialogue is extremely valuable, I think there needs to be a movement in how to help people, some of whom have been on these drugs for decades. How do we unwind the damage once it has happened?

  • Great piece Mary and thank you so much for you detailed observations. You are more kind to Ross by saying he is calling for more research. In fact he seems to be trying to denigrate Open Dialogue as not substantiated by evidence and therefore not meriting any of the praise it is getting. If he had been even handed he would have simply said that the results in Finland are very interesting and we need to take a closer look/do more research.

    As a therapist working part time in a hospital setting, I have seen people put on heavy doses of neuroleptics, and then see them return again and again with increasing somatic and neurological deficits. There is a clear case for avoiding or seriously limiting antipsychotics, especially for folks having a first experience of psychosis. The areas I would want to explore with this model are

    1- How does this work in an urban environment with less social supports?

    You mentioned this in your article but I think its one of the key issues. Can this be replicated in settings where there are challenges of isolation, fragmented and underfunded supports? Here in Portland, we have the EASA program which has some similarities (though it is still based on a disease model). They contact people between the ages of 15 to 25 who are experiencing a first episode of psychosis and arrange a team to offer vocational training, life-skills coaching, 24/7 crisis services, etc. They also emphasize no, or low dose medication…but they defer to psychiatrists who often will prescribe more meds…a real failure in the set up of the program.

    2- How can Open Dialogue assist people who have been on psych drugs for long periods of time and have been deemed “mentally ill”?

    Most of these folks are on large cocktails of meds. As a number of our MIA writers have written (such as altostrata from survivingantidepressants.org and Monica Cassani from Beyondmeds.com) about the extreme challenges of tapering off of psych meds. Does Open Dialogue address these concerns?

    3- And on another level, the Open Dialogue model seems a perfect fit for state and federal governments looking for a cheaper way to help people who have been labeled with a chronic mental illness. Instead of funneling money into repeated hospitalizations, disability payments, and monies for medication management, the alternative could be helping people to return to a healthy way of life where people are integrated into the community and working at jobs where they pay taxes into the system, instead of taking money out.

    Again, thanks so much Mary, for giving us a detailed response to Marvin Ross’ critique.

  • GwynOlwyn, I would agree that marketing/advertising as well as misinformation campaigns by groups such as NAMI are much easier ways to insure profitability. Patients come to doctors demanding Seroquel for anxiety and Wellbutrin for depression because of commercials and the idea that these drugs fix chemical imbalances. The doctors are simply willing middlemen between Pharma and the consumer. It’s not like they will stop prescribing.

  • Excellent piece Maria. I agree that GSK, (and others are sure to follow this) is doing this to protect its brand image and to make sure their profitability remains high. And if it appears ethical, all the better.

    And as I said in another comment, we need to now move on towards banning advertising pharmaceuticals, and allowing companies to publicize their own cherry picked results of studies. We need to ban allowing pharmaceutical reps promoting these drugs in medical establishments like hospitals and medical establishments.

    All studies of these drugs need to be longitudinal double blind studies done by completely neutral parties and all results need to be published In journals untainted by pharmaceutical company money.

    Rebranding to appear more ethical is simply window dressing. A nice start (even its done for sheer profitability), but there’s a long way to go.

  • Ok, I expect to see you make this comment over and over again to every psychiatrist who writes here as they send people to hospitals or actually prescribe forced AOT. I will be following your comments closely with every poster connected to the mental health “system” who takes part in sending people to a hospital, every nurse and every tech. I will be highly surprised if I don’t see frequent and regular comments from you

  • Thanks Richard, for a more in depth understanding of what you feel. It’s interesting for me to explore the notion of reform vs. abolition. I agree that the profession of psychiatry is on the defensive and the critique is coming from a number of quarters. As the psychiatric system sees their flaws, some may be open to incremental change. And I agree that that is not enough. That is simply window dressing.

    But at the same time, I see a variety of voices calling for everything from absolute abolishment of prescribing psychiatric drugs to folks willing to accept a much more modified position for psychiatrists…in essence saying that there needs to be much more information given to patients; much more awareness of the perils of psych drugs before prescribing them, as well as a n acknwledgment that psych drugs are not curing a biological illness.

    So I guess my question is, does reform have to mean watered down mush that really doesn’t get to the root problem of psychiatry? Can it mean a complete sea change of the whole practice of psychiatry that truly is based on informed consent? Or is reform a nasty word, and we should be replacing it with abolition, and focusing on the abolishment of the practice entirely?

  • Hey Pat, somehow I missed this. Yes alternatives such as respites, peer directed centers, free clinics are great and I wish there was a fabric of intertwined alternatives that could really take the place of hospital settings for the millions of people that go there.

    In my own practice as a therapist and an herbalist, I work with my wife who is an acupuncturist. Often, we see people who are looking for a completely different way of envisioning healing. Our fundamental approach is towards nourishment instead of “fixing” anything.

  • Alex, I’m not sure what you mean. Do you not believe that a hospital is a hierarchal setting? That there is a power. Imbalance between staff and patient?

    On a deeper level I agree with you. Staff certainly has the illusion of power. At a core level, staff have absolutely no more power than those coming to a hospital. But the structure creates a power dynamic just as the societal structure creates a dynamic where being a white male gives one more privilege.

    So I’m not sure what you mean by “buying” into the “power thing.” I acknowledge the structural reality that creates imbalance in that setting.

  • Hey thanks Jonah, for expressing your philosophy, or creed, as you call it. And thanks for taking the time to articulate your differences from me. I think I’ve said more than enough and I’m going to take a break for a while on this one. Even though we may disagree, I feel heartened by the discussion. And as you said of me…you think I’m not a bad guy, just terribly naive…I will leave saying I just think you are a good guy…smart, very well intentioned and passionate.

  • Hey Jonah- well in terms of the Will Hall piece- really there were a lot of things he suggested as essentially “reforms” of the system, but in general I was responding to Pat about what I see as really important- and that is creating bridges between Survivors and “the system”, to broaden dialogue to try and make systemic changes.

    I guess what I appreciate is the desire on Will Hall’s part to try and create a space for meaningful change within the system while also looking to create alternatives outside of the system.

  • Ugly. Horrible and abusive. Just awful. Yes I can think of myriad ways of dealing with that better. I don’t doubt that abuses like this continue. I agree that a hospital setting is by nature a hierarchical severe power imbalance. And yet I wonder, should we abandon the millions who go through these doors? Is there a place for change without “getting it all”… meaning a complete abandonment of the medical hospital model? Should we talk to doctors who work there? Nurses? Other thereapists?

    One of the most amazing things I saw recently was Will Hall speaking to a number of psychiatrists at OHSU and talked about some of the fundamental reforms he would like to see. He has been horribly abused by the system and yet he was willing to see if changes could be made.

    Here is a video of that talk…

    http://beyondmeds.com/2013/05/27/will-hall-at-ohsu-psychiatry/

  • Hey yeah, no problem with taking a break..I look forward to your comment when you’ve had some time.

    Just to add one more comment before you respond. I get that you see a forced IM as the worst type of reaction to violence. And I agree that it is awful. 99 percent of the time staff and myself can use skills to deescalate a situation before it comes to that. A portion of my work is to try and make sure that that doesn’t happen.

    And I understand that you consider an IM the worst abuse. But I ask you to reflect on people who think being touched and “handled” is very abusive…or that restraints are worse than a shot, or that being made to stay in isolation is much more abusive. Though you may say it is at the high end of abuse, others may differ.

    I believe the fundamental goal should be non-coercive de-escalation and that all other further measures are simply awful. You say that a therapist should never be involved…and I ask…who should be the one doing non-coercive dialogue to deescalate the situation? A nurse? Some do very well, others don’t. A doctor? Sorry to say it never happens where i work.

    Or should it be people trained in listening, offering help, in not reacting poorly to very tense situations and intense emotions. And to preempt violence, you need people willing to make connection, listen, be supportive. Do you believe these folks should abandon the situation if it becomes violent and endangers others?

    So we return to the rare time when everything goes wrong, when physical intervention becomes avoidable. I wait your reply to ow to handle that. thanks Jonah,

    Jon

  • Ok it still isn’t clear to me what defending oneself using your hands means. Do you believe that police officers should only se their hands? What if someone has a weapon? What if the person is extremely strong? What if a person is attacking other patients? Defending yourself sounds nice…but it also sounds like another, more gentler way of saying using force.

    In another post I said that if all other measures have been tried, then we do use our hands…to hold people who are striking others. But what happens when you let go and they continue to strike?

  • Thanks Alex for the comment. Basically I agree with almost everything you say. The hospital setting by nature is a hierarchal setting where the staff have essentially all the power and the patients have next to none. By it’s nature, the hospital system can be enraging due to this vast power imbalance.

    As a staff member I also own that I carry this “authority” that by its nature can feel demeaning, no matter how “compassionate” I appear or how much I am open to listening.

    I would also continue and suggest the architecture of most hospitals, the idea of locked doors and seclusion areas…can lead to a deepening sense of despair and anger. And finally, I would also suggest that the psychiatric drugs themselves can lead to further feelings of anxiety, frustration and anger.

    I have seen situations where an individual is given a benzodiazapene to “help someone with their anxiety” and when it wears off the person becomes ncreasingly anxious and “edgy.” Essentially for some people, the hospital is iatrogenically engendering the potential for rage.

    So yes, agreed…on many scores. I think this gets down to…why would I stay in this environment? My feeling is that millions of people come into a hospital setting every year. This is ground zero for where those who are homeless and poor often come. In my best case scenario there would be a completely alternative non-medical setting for helping most people. But there is not.

    So here is where I disagree. You say I feel ths system can be reformed and saved because people are having discussions. No. I don’t think the system can be “saved”. If it is medical in nature it will never be saved. But, yes…I think it can be improved. And really, what is the other answer? To ignore the system? To not examine it and see what could be better?

    How can we reduce hierarchy and the power imbalance? How can we advocate for patient’s rights more effectively? Can we inform people better about the adverse and sometimes extremely damaging effects of psychiatric drugs? How can we interact better? Listen better? Use our language in a way that is less demeaning? Create a space for better alliance?

    I’n my job often what I do is listen. Listen to stories. I try and make connection to people when they are confused and feel lost. There is no great change. There is no massive shift where everything becomes better. But sometimes in those small moments of human to human connection, there is a release, a sense that a gap has been bridged. Maybe it’s through telling a joke, or offering some warm food, not turning ones back on someone who is in the midst of deep psychosis.

    And maybe that’s all there can be within a hospital. Simple small acts within a larger system that is by nature is deeply flawed.

  • Jonah, the reason I asked you to talk is that I’m tired of writing out my responses. Instead, I’d love to hear more about what you have to say on this issue in terms of alternatives. Do you want me to give concrete examples of violent behavior? I suppose I could but there are so many varied possibilities that that is very hard to do. Each situation, each person is unique.

    Ill say again my philosophy but then after that ill stop because I have repeated myself many times. But I haven’t heard much from you. I’d like to stop writing and hear your thoughts.

    Ok so…

    My philosophy is always preemptive. Violence doesn’t often come out of nowhere. Make contact. Listen. Try to respond to needs. Avoid titles and hierarchy. Be genuine. Offer a place to vent, to rage, that is safe. Offer food and drink if wanted. Give some if wanted.

    If all measures fail, and a person starts harming another person or staff, intervene with the least force necessary. Hold a person without harming the person. If possible move them to a safe place where they won’t harm others. The last, and hopefully very rare measure is to either restrain them or give a forced shot. It’s awful and absolutely a terrible thing to have to do. I don’t take it remotely lightly. But I also believe it is my duty to protect others from someone who is attacking others.

    That’s it. I really want to hear your thoughts. Please don’t ask me to give examples of emotional distress or violent behavior. I feel at this point that that is dodging. Really describe your philosophy so I can understand it.

  • Hi Jonah,

    I’ll try and answer your questions here.

    Jonah: “I was, quite basically, wondering whether the housing which you say that ‘homeless’ people who are supposedly “mentally ill” should receive, would also subject them to the possibility of being forcibly drugged; when housing administration staff might perceived threats of violence coming from certain residents, would they call for needles?

    Would they refuse to call the police — even in the cases of what you might call “severe violence”? (You say that, in “hospitals,” even “severe violence” should not bring the police.)

    Or, would you, perhaps, recommend calling the police — but only to take the seemingly threatening individual to a “hospital”? ”

    I would assume that pretty much any housing facility would not have staff on board that could respond to a violent incident and that they would call police. Police sometimes take people to jail and sometimes to a hospital setting depending on the situation.

    When police deal with vioelnce and dangerous situations out on the street, their tools are limited but often involve tazers, bean bag guns and occasionally lethal force. Here in Portland, police have paired up with an organization called Project Respond who have staff that are muich more adept at interacting with people who are severely agitated and are going through psychosis/mania.

    That relationship has greatly improved how police work with this population and there are far less reports of abuse.

    But lets get to the meat of the matter. When police bring people in to the hospital who have become violent, how do staff respond?

    I get that for you, and many many others, the idea of an IM injection is abominable. I get this. And yet for others, the thought of being thrown into a jail cell is a horrible abuse for someone going through emotional distress. For others, restraining and isolating someone is abusive. And on and on.

    We talked about the idea of having some sort of mental health advanced directive that could state…”in the event that I become violent, I would prefer to…”

    So really, you are asking some really deep and important hard questions…but I have yet to see how you would respond to someone who is in severe emotional distress and then becomes violent. What would you prefer to do?

    Finally, as to letting someone else do my dirty work? No way. My job first and foremost is to see that this happens extremely rarely. How? By interacting, making contact, listening, hearing and responding to needs as best as I can. And if someone does become threatening, I want skilled people there who can listen, help someone to find a place to vent in a safe way, to help deescalate the situation. An enormous amount of people come to inpatient psyhciatric every year. They should not be abandoned to someone who sees it as dirty work.

    So, I have tried to answer your questions as best as I can many many times. And I understand why you aren’t, and likely never will be satisfied.

    But I’d like to start with asking you more about your response to violence when someone is emotionally distressed. Perhaps that way we can have a better dialogue if you describe your alternatives.

  • “There are people on this blog who seem to think that the three goal areas I described – reducing violence and aggression, connecting with people, and reducing suffering and increasing ability ot work through suffering by making it less overwhelming are bad goals.”

    Well no- I don’t think anyone here would disagree that those are bad goals. Most of us would simply disagree with the methods of attaining those goals.

    1- “Reducing violence and aggression”- Through long term sedation of a patient with antipsychotic major tranquilizers with harmful side effect profiles? Is that truly the answer?

    2- “Connecting with people”- I think we can all agree that connecting, truly connecting through listening and seeing how someone can be of service- is a good thing.

    3- “Reducing suffering and increasing ability to work through suffering by making it less overwhelming”- OK. but again is the method of decreasing suffering primarily prescribing a drug that sedates and reduces anxiety with drugs that have long term consequences?

    Again- the goals sound great- the answers sound pretty iffy. I’m sure you wouldn’t prescribe booze to help people feel more comfortable at work. Why prescribe Valium? Or Seroquel? I’m sure you wouldn’t prescribe meth for a kid who is having a hard time concentrating. Why prescribe Ritalin?

    Are drugs (“meds”) really the answer to these problems? We agree with the goals but I’m not too sure about your logical reasoning behind attaining those goals.

  • Very true…the we have to do something and this is something therefore it is good fallacy.

    In essence I don’t really blame the doctors entirely. I really blame the insurance world that pays for ineffective (and often destructive) “care”. They have bought the 10 minute consult drug prescription model.

    If we want to change the system, we have to change the payment structure. Follow the money.

  • In many hospitals a doctor is not salaried but given a fee for admitting and doing an initial H and P (history and physical). A significant amount of people are admitted one day and discharged the next. The doctor receives a very large fee and the patient receives a prescription, or some take home meds.

    We see these folks over and over again…this is a sane health care model?

  • John and Andrew, I entirely agree. most of the folks who go through who inpatient psychiatric hospitalization are poor. When it comes to hospitalization, this is very much a class issue. These are people who often have been abused by society and dealt with trauma that compounds their emotional distress. And then this distress gets pathologized, medicalized and labeled. Drugs are used to control the emotions connected to this trauma and oppression.

  • That’s a heartbreaking story madmom. And indeed Torrey is one of the key national figures promoting this. But Oregon, along with 43 other states have willingly agreed to this. These are extremely challenging issues when it comes to parents. Doctors and the State all say this is what is best for the individual. That it is treatment. They don’t talk about the side effects and the long term health implications of these drugs.

    Voices like yours will help send a message that this is absolutely untenable.

  • Hi Jonah, thanks for your comments. OK yes, to start out with- when I said “Let’s take him for his word that these statements are true”…I was essentially saying- even if these words were true (which I agree are highly suspect), that his argument that AOT is therefore humane falls flat because long term use of neuroleptics often cause severe health effects. And yes- a number of people have written excellent articles about problems with AOT. Thanks for mentioning their work.

    In terms of the issue of violence, this is a deeply difficult subject that we explored in the first post I wrote. In answer to the question, how to respond to someone who is experiencing extreme emotional distress and becomes violent in a hospital setting?

    There is no easy answer to this. My first response would be, what conditions have led up to the violence? Is there anything staff could have done to help the person before there was violence? Did they need to talk? What are they mad about? Is it something staff could help with? Sometimes people need to have intense emotions, yell, throw things, without the need for any intervention. Allowing a person to be in a safe place to vent intense emotions does not require intervention.

    But yes, there are times, when violence occurs, that staff have run out of options. It has now become an issue of staff and other patient safety. We have a duty to protect others as well. So, what to do?

    We reached an impasse on this one Jonah, and I don’t know if we can find full common ground. I have said something that makes a lot of people deeply uncomfortable here- and I understand why it is a very hard thing to say. I support the limited use of force and IM injections when someone threatens the safety of others. Are there other options? Yes. We often try moving someone to a place of safety away from others if at all possible, but sometimes it is not. Other options? Restraints, calling police and risk the use of tazers, bean bag guns and guns. All bad.

    Like I said, I want hospitals to use force, or self-defense if you want- very very rarely, and only in the case of imminent violent danger. I want there to be community oversight so that the abuses that continue are ended. And I ask again, how do you respond to violence?

    Very tricky questions and I really appreciate you bringing them up. I think there are a multitude of reforms that could happen around how force, or self-defense, is used.

  • @Ted- I don’t know- I have actually seen improved awareness via the media. The recent story in overprescription of drugs for ADHD in the NYTimes is one case in point. There have been numerous other stories critical of over prescription and serious side effects and long term health implications of psych drugs. We have also seen a very large rift in the psychiatric community itself over the DSM5- though some of the rift can appear like window dressing. Whitaker got invited to speak at NAMI. One of the MIA writers has been elected as Board president of NAMI and someone who is a former senior attorney (Mary Giliberti) at Bazelon has been named the new executive director at NAMI. I see positive steps such as Will Hall speaking to the APA.

    Yes the Torrey/Jaffe faction are as strong as ever, but I think they, and the whole institution of psychiatry, feel increasingly threatened.

    As studies continue to point out severe problems with psychiatric drugs, I think there will be a sea change eventually.

    So I don’t see it as dark as you do. I don’t feel the movement has gone backwards. I think millions of people are seeing that something has to seriously change. Perhaps I am too pollyanna- but I do see positive steps forward.

  • This conversation doesn’t take place in hospitals, and I would guess it almost never takes place in private practice. Why? I wonder. If all the facts were laid bare, what percentage of folks would actually take the drugs? Probably a lot less. And doctors get paid for prescribing and “managing medications.” Without that, the entire funding mechanism for “mental health care” and psychiatric hospitalization falls to pieces. It’s in the best interest of the doctors and the hospitals to not talk about the severe problems associated with psychiatric drugs.

  • Your second point is really key here. You say you see symptom relief in a majority of patients and that people who are suffering are getting “better.” And the logic were to continue, then If this is the case, then what you do is…good.

    And I agree, many people do get symptomatic relief from psychiatric drugs. Benzodiazepines make you feel relaxed when you are very anxious. SSRIs often make you feel happier when you are depressed. Antipsychotics often do quell severe symptoms of mania and psychosis.

    But that is only one part of he equation and I see you ducking the other part. What about the side effects, the long term health ramifications, issues of dependence and withdrawal? Do you talk about these issues with patients so they can make a more informed choice?

    Do you talk about alternatives to drugs?

    Just a thought but….cocaine makes you feel good in the moment. Heroin relaxes you and takes away your pain. But would you ever suggest taking those drugs for dealing with pain and suffering?

  • Sera, I’m not sure if you’ll see this but I had a chance to see Will Hall’s recent talk to psychiatrists at OHSU, one of the main medical schools here in Oregon and the site of another psych unit. His talk was excellent and appeared to be mainly well received. I would love to see talks like this duplicated at all hospitals. The video can be found at Gianna’s wonderful site Beyondmeds.

    http://beyondmeds.com/2013/05/27/will-hall-at-ohsu-psychiatry/

  • I don’t think many of us here are completely “anti”. But we see a state in which doctors make no attempt to give a full understanding of medications, their potential side effects, long term health effects and difficulty with withdrawal of these drugs. Imagine two conversations. Here’s the first.

    Doc: “You seem to be having a lot of ups and downs, and mood swings. I’m going to prescribe you some Seroquel. Just take 100 mg in the morning and night. It should really help. I’ll see you in a couple months for a follow up.

    Here’s the second.

    Doc: Wow, it seems like you are really going through a lot right now. Can you tell me more about what’s happening?

    (30 minutes of conversation later)

    Doc: Well there are a lot of options to explore for trying to get more balance in your life. I’m really not well educated on a lot of them but let me steer you to a few places where folks know more than me (link to therapists, nutritional advice, holistic care, etc). If none of this really works for you and you want to explore medications I am happy to talk to you about it. Taking medications is not something that should be considered lightly. They can help some folks but they also come with a number of complications.

    Let me tell you about them (10 minutes later)

    If you are still interested in taking these medications after hearing al that I am willing to start you out on a low dose and monitor how this affects you very closely over the next few months. And if you want to get off of them at any time, I will work closely with you in doing this in a safe manner.

    So yeah- if there was more honest information, more discussion, more in depth exploration…then I think almost no one here is opposed to people making an informed choice about taking medications.

  • If we want non-drug interventions, we have to target the insurers, including Medicare and Medicaid. If we present evidence that drug interventions are worse and more costly than non-drug psycho-social support, then and only then might they listen.

  • That…is….wonderful. I’m sure its to protect their legal back, and to appear less tainted, but the end result is a good one and should be followed by all pharmaceutical manufacturers.

    No more doctors getting paid to promote pharmaceuticals.

    And now for the next big lion step. No more advertising pharmaceuticals. And then next, only neutral party double blind longitudinal studies of drugs. “Evidence” of drug efficacy by the company itself should be ignored. These neutral party studies can then be written up in medical journals without ties to big Pharma.

    Good first step though.

  • Yes its still benzo bonanza out there (love that btw) but there is much more caution for giving it out to people who have addictions issues or there is concern about suicidality. From wikipedia…

    “Numbers of benzodiazepine prescriptions have been declining, due primarily to concerns of dependence. ” http://en.wikipedia.org/wiki/Benzodiazepine_dependence

    I would guess that a lot of doctors have shifted over to prescribing antipsychotics for conditions they used to give benzos- like anxiety, insomnia, “agitation”. Maybe they somehow think this is better.

    But my question remains- if you know that the long term effects of antipsychotics are universally dangerous to health and well being- why would you prescribe them on a long term basis?

  • Mark, I work acute inpatient as a therapist and I have seen people who are suffering from severe confusion, delusions and mania “improve” on meds as well. I have seen people shift from severe psychosis to increased stability after taking meds and I would guess that the sedation from the drugs allows people to get some rest and sleep. However, I have seen many cases where people don’t get “better”, they just become increasingly sedate, quiescent, dulled.

    You say you like to improve suffering but doctors are increasingly not prescribing pain medications, because they are addictive and potentially lethal. Doctors have increasingly stopped prescribing benzodiazepines because they are addictive and potentially lethal. Both of those drug classes “relieve suffering” as you say, but they are fraught with complications. I’m wondering how you see that differently with antipsychotics or mood stabilizers. They indeed can help some people, but they come at the cost of severe side effects and long term health problems when taken regularly.

    Is a doctor relieving suffering if they are immediately decreasing psychotic symptoms, but at the cost of causing long term health problems such as obesity, cardiovascular problems, dystopia, akathisia, etc? Relief of suffering is great if it is prolonged. If it is only for a brief window and the long term picture leads to increased suffering, is it worth it?

  • Yeah it’s cool. I was just thinking about how mass movements that historically changed widespread policy generally started with progressive movements. That includes fighting child labor laws, the eight hour workday, maternity leave, ending gender discrimination in the workplace, etc. I think the needs to be a fight on many fronts…fighting within the court system, fighting in the political system and fighting from outside the establishment such as what goes on here.

    All hands on deck.

  • It’s wonderful and somewhat surprising that the Times published this, and hopefully their next piece will be about antipsychotics. My hope is that Progressives and libertarians band together to pass laws sharply curtailing the power of Big Pharma. No more advertising (especially ads aimed at kids). No more payments to doctors for lectures. No more “informational lunches” in hospitals and medical centers. No more pamphlets at educational centers such as NAMI. No more hiding studies from public view. No more false advertising presented as science. And on and on.

    We have allowed these folks to accrue far too much power.

  • Thanks for the link Sera. Hadn’t had a chance to read that piece and I read all of it, including the very thoughtful comments. The idea of survivors talking to people within the system is one fraught with challenges. For people to come to a setting which by its nature has been abusive can be extremely traumatic. And when staff appear uninterested, or worse, belittling, it can re trigger that initial trauma.

    The question becomes, is there a point? Why bother trying to affect change on a system that won’t acknowledge it’s deficits, that is highly unlikely to change, that is by definition hierarchical and coercive?

    As someone who works both on the “inside” and the “outside”, I see it fpdifferently. The are7.6 million people who go through the hospital system every year. They need allies from people like you and other survivors. They need people willing to try and change the hospitalization…not to make it perfect because I am fairly certain it could never be…but to at least make it better, to reform it one step at a time.

    For staff to have a better perception of a patient’s perspective is one such step. Getting staff to develop increased sensitivity, to understand how harmful their language can be, to understand how their actions and decisions can be incredibly hurtful if used inappropriately. That is one small step.

    I can only imagine how potentially traumatic it might be for survivors to re-enter the lion’s den. But I hope a few brave souls do so, perhaps even if it is videotaped, as a way of teaching hospital staff to develop better respect.

  • Excellent article Erik. I’m stunned that 58 percent of prescribers in NZ prescribe quetiapine regularly…mostly for off-label concerns. That seems enormously high to me and shocking that prescribers would offer this drug that so obviously can lead to severe health problems down the road.

    In recent times benzodiazepines seemed to be the drug of choice for managing anxiety related complaints. I wonder if prescribers see anti-psychotics as somehow better, perhaps because they are less “addictive” and much less chance for an OD leading to death. Perhaps that is part of their reasoning? It is hard to fathom.

  • Good question. I would love to make it mandatory for all the employees at my hospital (and all other hospitals) to experience a presentation by survivors. In fact, I would like it to be part of the standard quarterly education process where this type of information is presented again and again.

    There are talks that are non-mandatory, and frankly, I think we only get a few people coming to a talk on anything. But I will make this a very specific goal of mine here when I talk to the director. It really should be standard.

  • Really interesting reply Diana- We also practice “holding” someone and waiting for a time for severe and violent emotions to pass. I have seen it work many times. More often I have seen the power of staff taking the time to listen to someone who is deeply angry, even if they are throwing furniture and smashing up a room. The key to the process is just being with the emotion without becoming triggered, fearful or reactive. There’s a lot of power in these ways of interacting with people in severe distress.

  • Jonah, just to add to what you are saying…I think the idea of a formal declaration, or advanced directive to describe how a person wishes to be treated in the event of them becoming violent is a great idea. Some may prefer that we call the police. Some may prefer to be secluded “in a padded room” as you have said. Some may prefer restraints and some may prefer forced drugs. All are going to be traumatic but I think the idea of stating a choice is a good idea.

    Obviously this can be very challenging if someone comes into an ER and is already violent towards staff. Ai Ki Do or other forms of non-harmful physical interaction can only go so far. Eventually some sort of decision about how to interact with someone who is trying to hurt people must be made. Though you perceive forced drugging to be the most horrendous assault, others consider restraints to be worse. And certainly some consider being locked in an isolated room to be very traumatic. But I agree with you that individual choice would be a very good reform.

    On a deeper note, a lot of how you are responding to me is becoming more personal and I am going to take a break from responding. At the heart though, I truly appreciate your passion and how much you care about these issues. Thanks for the conversation,

    Jon

  • Sera, thank you for writing this and thankyou for broadening the conversation to give a deeper understanding of your perspective. What I am hearing from you is a desire for profound transformation and an abolition of a “mental health” system that has become deeply corrupted and in many ways abusive. Though we have some disagreement I think there are many areas we are in agreement on.

    I think in this conversation on force, there is sincere desire on both our parts for reform. Though you may opt ultimately for abolition of all coercive practices, hopefully we can at least find common ground on implementing some serious improvements to “business as usual.”

    One of the areas where we agree completely is that we need to abolish routine forced medication of patients who are committed. Not only is it incredibly traumatic, can lead to long term deleterious health problems and takes away people’s sense of autonomy and agency, it is also a very poor strategy for improving wellness. In essence, it is not only unethical, it is ineffective and destructive.

    In terms of incremental change, you mentioned two very positive ideas that I think should be instituted broadly. They include both monitoring the use of force as well as interviewing and investigating any use of force by staff. Just as there are formal investigations of the use of force by the police, I believe there should be independent community investigations of the use of force in hospital settings. My hope is that this step alone would make the use of force as rare as possible.

    I also agree that there should be a much larger understanding of the patient’s perspective, especially those who feel they have been seriously damaged by the system. Perhaps staff from all hospitals can be mandated to hear talks by people like yourself who can describe what it feels like to be unheard and traumatized. Raising the overall awareness of all staff to increase sensitivity to the persepctive of those who come to the hospital is key.

    I think where we have ultimately disagreed, is if there is any situation that would warrant the use of force. I don’t know if its even helpful to get into that conversation again. I am willing to talk further about that if you want. But at this time I just want to honor what you have said and to search for meaningful systemic changes.

  • Jonah, covering human history for how we treat violent people who are suffering emotional distress is a pretty broad topic. There have been, and continue to be, horrendous abuses before neuroleptics and in countries that don’t use neuroleptics. At the same time, I agree we could look at some traditional cultures such as within a tribal framework to examine alternative ways of managing violence.

    IN terms of Ai Ki Do, I agree there are a lot of ways to disable someone who is violent without inflicting violence. We practice techniques for interacting with someone who is violent quite a bit and they involve non-harmful ways to hold someone. At the same time, the question is what do you do after you have held someone? We do practice waiting, but that is not always effective.

    Physically holding someone is traumatic. Holding someone in seclusion is traumatic. Restraining someone is traumatic. Drugging someone is traumatic. Calling police is extremely traumatic. This is a choice of wrongs. But I entirely agree with Andrew that I cannot abdicate my responsibility of protecting people when someone has become violent.

    IN terms of the previous comments, hopefully some of the things I wrote and what Andrew was saying also addresses some of what you said.

  • Andrew, I’m sorry you had to make this post at 4 in the morning but as an intermittent insomniac I understand waking up in the middle of the night to mull things over. Hope you are sleeping in this morning.

    Forced drugging. A very very challenging topic. I think we have both agreed that long term involuntary drugging for “treatment” is simply not tenable and needs to be ended as a practice. But lets look again at doing this in reaction to violence. I agree that we are dipping into murky waters here and there is very good reason for some people to say the practice should end.

    The reasons for ending the practice include that it has been highly abused (as we talked about in the previous posts) and that perhaps there are better tools for dealing with violence.

    We both agree that anything and everything should be tried before resorting to engaging physically with someone who comes to a hospital setting.

    So what options do we have in the face of violence or potential violence? One of the techniques that we have used in our hospital is the practice of simply holding a person and essentially waiting them out…Waiting until they have calmed down enough so that they stop attacking staff and patients. Is it still coercive? Yes. Is it traumatic? Yes. But hopefully less so. Does it always work? No. It can be dangerous to staff because as soon as the patient is released from the physical hold they may decide to attack staff or other patients quickly. In essence it is more risky to staff members but can be a way of reducing trauma.

    So I would be interested in what ways you think we could interact with violent people in a way that less force can be utilized (again with the caveat that all other measures have been tried) than restraints or forced drugging.

    At this point I think we are on the continuum of “wrong”. Forced drugging is wrong. Restraints are wrong. Tazers are wrong. Bean bag guns are wrong. Lethal force is undoubtedly wrong. And yet we are left with tough decisions as you well know. I am very open to exploring how to make this better, but I agree with you that involving police or taking people in the midst of psychosis who are violent to jail is not a solution.

  • Hey, thanks for responding Andrew. These are by very tricky and hard things to talk about as they trigger a tremendous amount of emotion, especially in people who have been abused by the system. At the same time, I think it’s key we try to have these discussions as a way of exploring ways to both reform hospitalization as well as creating alternatives to hospitalization.

    I would especially like to see something like you experienced, a place to go for a short period of time, perhaps up to a few days, where people would stay with you round the clock in a non-medical establishment.

    Ok, to address the force issue. I think you are absolutely right, and maybe I didn’t
    make myself clear, that force of any type is not “treatment”, including forced drugging. But here I differentiate between a doctors order to mandate forced drugging for committed patients and the use of force in a violent, or potentially violent, situation. In the first case, I am totally opposed for many reasons that I stated in the op-Ed.

    As to the latter, this is a really really hard issue. I see you were conflicted and in many ways I am too. I think it needs much more exploration and I love that you outlined four large issues surrounding the use of force in your a-b-c-d. Let me try and look at each one.

    A- couldn’t agree more. It is not a therapeutic tool. And I believe it should be abolished as “therapeutic” for court committed patients. Without consent, the state is allowing drugs that have knon serious side effects and long term deleterious health effects to be administered routinely against the will of the patient. This absolutely needs to stop.

    Furthermore, forcing drugs on someone who doesn’t like them will lead to them stopping them as soon as they possibly can after being released from commitment. Stopping taking powerful neuroleptics cold turkey often leads to severe rebound psychosis, essentially dooming someone to heavy sedation and then torturous withdrawal effects.

    Finally, allowing the state to suppress and sedate someone on a long term basis is abhorrent. The state, and certainly modern medicine, should not have that right. It needs to be constitutionally challenged.

    B- another big problem. How and when to use force is a subjective decision made by nurses, security officers and therapists. The decision making process can be quick, at times arbitrary and with control in mind instead of as a protective measure of last resort.

    Imagine a situation in which someone who is drunk comes out of their ER room and starts challenging staff to fight. Sme staff may immediately see the need for restraining and sedating the patient. Anoth staff may see an opportunity for dialogue, trying to listen to the patient, offer comfort measures like food and drink. Ways to deescalate the situation. Essentially, there can be a wide variance in staff approaches to potential violence.

    C- disproportionate force. Indeed. Both B and C are what many people who feel abused rightly complain about. An overezealous security officer who handles a patient roughly. Someone who has been punched or kicked in a hospital setting. It is absolutely untenable and must be reformed.

    D- use of force in a regular basis up to a 6 month commitment process. I already addressed this but it is simply unacceptable.

    I’ll respond to the actual issue of forced drugging in your next comment but thanks for taking the time to respond.

  • Excellent article Sandra. Thank you so much for writing this piece for an influential paper like WaPo. One of the interesting things I have just read is that only about half of patients prescribed antipsychotics continue to take them. As a hospital therapist, one of things that concerns me most is seeing people taking heavy doses of these neuroleptics in a hospital setting, only to be discharged with a strong chance that they will stop taking the drugs abruptly. Without tapering, it becomes highly likely that severe symptoms will suddenly erupt, just like if anyone suddenly withdrew from a heavy drug.

    I love that you can have detailed informative conversations in your practice. I only wish that this full understanding of the costs and benefits became established practice.

  • @Jonah- You are right. People at times do get drugged with neuroleptics without a full test of whether they took recreational drugs. No question. And you are right that I should have made that clear.

    As to the language of hospitals- i.e admissions, toxicology screening, and even worse- medication, compliance insight, etc- whoowee- that deserves its own article and thread. But I agree the language itself creates barriers to effective dialogue, especially with people who are survivors of psychiatric abuse.

  • @Jonah. Routinely for psychiatric admissions a toxicology screen is administered in all hospital settings. However, you are absolutely right and I should have made this caveat…in the case where it is impossible to get a tox screen, medications are given without receving one. But the universal standard is to get one at admission.

    My point was more that even in the case of a positive for canibinoids, doctors will prescribe antipsychotics.

    By the way, I don’t support forced drugging, except in cases of responding to severe violence.

  • In those cases I absolutely agree. In the case of someone in the community trying to kill themselves? I just cannot agree that I should let that person accept their destiny. My instinctual response is to intervene.

    However, I would love to see a much more thoughtful way of intervening. How we do it now is traumatic…police cars, sometime fire engines show up. Someone is whisked away to a sterile hospital environment, etc. I would love to see a vastly improved model that creates alternate sanctuaries where people can go when suicidal.

  • @Someone Else, Yes I haven’t addressed every comment here, partially because the have been many to respond to and also I don’t want to hit the mike here.

    As to our question about how the psychiatric industry bought its power and bribed mainstream medicine in your last paragraph.

    I think Whitaker, Breggin and many others have described many of the abuses of power inherent in the system, including what you describe. You will find no disagreement from me there.

  • Maria, great post. As a hospital therapist, one of the biggest reforms I see is the need to stop forcibly medicating people who are involuntarily committed. It is absolutely untenable to make people take something over a long period of time that has severe side effects and health risks. There must be consent in any form of long term treatment.

    The rationale is that the drugs will make them better, stabilize them. And indeed for many, drugs will make a manic person sedate, will dull and muffle the interior world if there is severe psychosis. But we are left with allowing the state and medical system to repeatedly chemically alter patients, at the cost benefit of Big Pharma, an absolutely horrendous situation.

    I mentioned this in another post, but hospitals also allow representatives of the pharmaceutical industry to promote their drugs in hospital settings via free lunches where they give away cups, pens, watches, etc. They also promote their medications using evidence that they cherry pick while avoiding talk of the severe complications related to most of the drugs. Untenable.

  • Larmac, haven’t has the time to do the research on this one but it is a known fact that much of the marijuana being grown these days is much higher in THC content. For some folks, this does not create a “mellow buzz” but can induce states of altered perception, disassociation, paranoia and psychosis. I saw a recent National Geographic episode and perhaps you can locate it where a young person was tested while smoking different strains of marijuana. With one strain she reported feelings of calm, sleepiness, etc. With another strain she reported having telepathic conversations with unseen people. So really we need to be much more aware of the wide variety of experience and potential pitfalls of high potency marijuana.

    In my work Ina a hospital setting, I have not seen a lot of marijuana related psychosis, but I have seen many cases of folks who have smoked synthetic marijuana such as “Spice” or “K2”. These synthetics really seem to trigger psychosis on a much greater scale. To me these synthetics are truly a scourge.

  • Okay Jonah, ill try and address your post after taking some time to read it. There’s a number of issues you address in there so I’ll try to look at each one.

    The first one has to do with my perceptions of the reception to my piece here. I again want to state that I really don’t want to talk about individual perceptions of my character. I would much rather have a broader conversation about the topic of hospitalization.

    You bring up some really important issues that I would like to address though. You say that I make it sound like there s less “abuse” in the hospital I work in. I can’t address my specific hospital but I can say that in general there is a strong similarity to all psychiatric hospitals, the desire to prescribe drugs as the fundamental way of treating emotional distress. I have serious problem with this. It is systemic and it happens at all hospitals. Prescribing drugs with long term health consequences without fully informing patients of these consequences is a serious problem. It needs to be addressed systemically at all hospitals.

    Th piece about supporting short term medication? Only if a patient who is fully informed about the medication makes a choice to take it. Or only by force if a patient has become violent towards other vulnerable patients or staff. It is an opinion that I understand is very unpopular here. I think I addressed that mostly in above comments.

    The suicide discussion is ongoing below so I will leave that for now.

    As to whether my hospital and its staff represents some alternate Pollyanna place? No. Like everyone else, they are human. But by and large I see staff trying to interact in a way that is respectful, does not move hair trigger towards applying force and are generally interested in the well being of the patients. In essence, I work with a lot of compassionate people. Still, I will agree that we are working within a system with a core philosophy of prescribing psychotropics that is bankrupt.

  • @jonah. Thanks for the link. I had the time to read the article and the comments afterwards. Good discussion.

    In my practice as a therapist in a hospital setting, I often have long talks with folks about the desire to die. For many folks, they have experienced so much trauma, pain and suffering for so long that the urge to commit suicide seems pretty rational. Here in Oregon we have passed laws to allow very physically ill people to end their lives.

    As a side note, my own grandmother took her own life after years of experiencing extreme pain. My uncle assisted her and because of this was actually arrested and had to stand trial. This helped in sparking a death with dignity movement in Australia.

    There are layers of complications around this subject. Poverty, homelessness, racism and oppression also add to the injustice that can make some people feel more depressed. As a society, we try to apply band aids like psychiatric drugs that often compound despair.

    In a perfect world we would address these deep societal issues. We would create sanctuaries where people who are suicidal could go without having drugs pushed as some sort of solution.

    But in the end, I also acknowledge where we don’t achieve those goals and we are left in a world with few options in the face of someone wanting to end their life. Do we as a community intervene? How do we intervene if we do?

    In my work at the hospital I often listen to people who are suicidal. I have no answers but I try to hear them fully. Sometimes that is all we can do.

  • Excellent video. I was amazed to see doctors speak in a way that show they understand the severe problem and danger of psychiatric drugs. The disconnect is that they get paid primarily for prescribing drugs.

    As someone who works in a hospital setting, one of the most horrific abuses I have seen is pharmaceutical companies coming into the employee cafeteria setting to promote their drugs. I suppose the idea is that they will influence staff to promote their drugs to the doctors who will in turn prescribe them more regularly. They appear like car salesmen and come bringing lunch for all to entice people to attend. They then leave pens, cups watches, etc, to advertise their drugs. Abysmal.

  • I entirely agree that the approach of being brought to a hospital and being prescribed psychotropics as a primary approach for helping someone who is suicidal needs to be completely reformed. If a person does decide they want to take psychotropics, the decision should be deeply informed. But before that happens, in my opinion, a host of other support mechanisms and alternatives should be offered.

    But again, that still leaves me with the question…what would I do for someone who is trying to commit suicide?

  • Good points and good perspective to add to the conversation. The manner in which people are brought to a hospital due to feeling suicidal and if it should happen at all is something we all should be examining closely. When police interact with someone in the community who has made a suicide attempt or is actively saying they will kill themselves and describe a plan, there are only a few options right now.

    One is to talk to them, but allow them to continue their plan if they choose to, and the other is for police to take them into custody and bring them to a hospital, or what you have called kidnapping in your case. I have said in a previous post that this is very challenging for me. On one hand I want to defend the right of self-determination as well as privacy for anyone to make the choice they want to make as long as it does not harm others.

    But at the same time I come back to the idea if it was my friend who was making a choice to kill herself in my presence and I couldn’t talk her out of it. My instinctual emotional response is to try and do anything to stop her, including calling the police.

    As to your second point, I also see that holding someone and intervening in this way does not allow for a person to unfold their own process and retain the “dignity of risk” as you so eloquently put it. So yes, it is a further challenge to the instinctual desire of many in the community to intervene.

    And as to point 3. Yes indeed. Many folks will simply say they are not suicidal in order to leave. A very valid point.

    My question about this process is this. How would you prefer the community respond to someone who is about to jump off a bridge? Or who has seriously injured themselves? Or who are drunk and threatening to shoot themselves? Is there a place for intervention?

  • Jonah,

    By and large most all the comments have been very respectful. The anger I see from comments here and elsewhere is mostly directed towards the system. I will acknowledge though, that some of the comments accuse me of being complicit with a system that perpetrates violence and that people like me who work in hospitals do it mainly for the paycheck. I would much rather have a dialogue about the issues going on in hospitalization then what a poster said about me though.

    I hear you that in a hospital setting, there is a high degree of alertness for anger and hostility. The reason is that is it can become the precursor to violence, usually directed at other patients. That is where staff at my hospital intervene to try and create a safe haven for all the patients. Sometimes that means offering a separate place to vent, separating individuals who are trigerring each other, offering a place to talk, etc. I believe you that there are hospitals where staff react to even the slightest pretext of hostility with drugs and restraints. That has to change. It is one of the main reforms that has to happen.

  • Cannotsay…after this conversation, all I can say is that you have given me more to think about. The question of how society intervenes in terms of suicidality is very complex. And as you say, we willingly condone oth forms of very self-destructive behavior that will likely lead to early death (smoking, drinking, obesity). Yet we allow the government to intervene during someone’s very private choice to take their life.

    I think the notion of when and when not to intervene is complex. I think most interventions happen because the situation is so immediate that police have been called. Someone is about to jump off a bridge or someone has slashed their wrists and a family member called for help. On a visceral level it seems heartless to ignore a bridge jumper because I am honoring their “right to self-determination.” A the same time we allow people in my state to kill themselves if they are facing a serious disease.

    No easy answers and its a very grey area for me. The funny thing is there is an argument on the other side that we release suicidal people way too quickly in a hospital setting. Most folks who are suicidal leave the hospital within a few days. Many times its the next day. There is an immense push to get these people out the door. Most of them are in a fragile emotional condition and we give cursory advice to follow up with a provider/case manager/therapist.

    On a deeper level, I have encountered people who are so tortured by their experiences, so traumatized by their extreme emotional states or their poverty and homelessness that they regularly contemplate suicide. One of my main jobs is to talk to people in that state and explore the notion of suicide and reasons for living. Often times I completely understand the reasons why people are suicidal. Yet I work toward finding some sense of purpose, some sense of meaning, even in the face of feeling tortured and constantly miserable.

    A very muddy grey area. Thanks for the conversation and your insight.

  • Chaya…really powerful words. Thank you for sharing so deeply. Reading your words, and other articles you have written show me someone who has some very deep wisdom. Even in the midst of pain and suffering you are offering some very good heart medicine. Thank you for being here.

  • Larmac, that’s a heartbreaking story. I’m really sorry for the loss of your son. Terrible.

    To start with, I get why there is a lot of angry and hostile comments here. I expected that and I get why there is so much anger in this community. The system has been so abusive and destructive that many people want to see the entire edifice of modern mental health “care” collapse. And if I in some way represent that edifice, then that anger will be directed at me. So be it. The anger is valid.

    However, we sadly don’t live in a world of Soterias, holistic management of emotional distress and non-hierarchal crisis centers designed to allow people to cycle through episodes with humane care.

    Your situation illustrates that problem completely.

    My hope is that new models of care develop but in that time what can a family member do in this broken system? It sounds like you did your best and still it was not enough.

    Again I am really sorry for your loss.

  • @cannotsay…sorry I missed your comment. Let me try and respond. You lay out some really goods points and I will take some time to reflect on them.

    One thing though, just to delineate the difference between a hospital hold and a court commitment. The first one last a matter of days while the other tends to last up to 180 days. When I was talking about holding someone who was drunk and suicidal, it referred to a hospital hold, not a commitment. Ad again, as soon as the person clears from the alcohol, they are usually no longer suicidal and usually the hold is dropped and they leave.

    But you bring up a really valid point. Is it the governments job to intervene when people make poor choices such as getting high and then making an impulsive choice to hurt themself (or worse, what they deem are bad choices like the examples you bring up)? I will have to reflect on that one.

    On an emotional level, I can imagine a friend having a really bad night, getting high and then trying to hurt themself. On an instinctual level I would want to protect them by getting them to a hospital where they would have to stay until the drugs wore off.

    But by allowing the government to intervene in this manner, am I condoning the government to take away a person’s inherent right for self-determination. Really hard question. I’ll mull that one.

  • A very good question Sharon. Within the context of a hierarchal framework, is it possible to see fully realized reform. Very doubtful. I think its likely we need to develop completely different models of care for crisis. But at the same time, I would like to see incremental reform within the system that we have.

    But you are right, power imbalance is at the root of much of the problem.

  • My hope is that we could overhaul the system to provide alternatives to hospitalization. However, at this point, we are left with few options in the community when people are under severe emotional stress. I believe there should be an alternative to jail when someone is confused, becoming aggressive with disorganized thoughts. Respite houses will not take people unless they feel they are mostly “stable”. How do we bridge the gap and create sanctuaries for people to cycle through disorganized states in the most humane manner possible?

  • @cannotsay: in my entire time as a part time therapist in a hospital setting, I have only seen one person civilly committed for being depressed. For the vast majority of folks who come to us depressed and suicidal, they leave within a few days. There is no forced drugging.

    The bigger issue for me is that here folks often are prescribed strong anti-depressants without a full ne’er standing of their scope of efficacy, side effects, long term health issues and challenges around withdrawal. To me it is more an issue of informed consent. He consent part is often their, but not the informed part.

    As to supporting government imposed paternalism, I hear that critique, and I am in no way defending the current state of mental health care. We need an overhaul.

    But right now, if a friend was drunk and started slashing their wrists, I would want them to get to a hospital. After getting sober, most of the people I meet do not want to kill themselves. Is it paternalistic to put them in a locked ward? Yes. And I would like to see alternatives. But that day or two can help many people change their minds and is worth it to me.

  • I agree with your view that there should be no coercive psychiatry. When a person first comes to a hospital due to a hold, they have the right to refuse medications. Only a small portion, perhaps 5-10 percent go through a court commitment process. Only after they have been court committed can they be made to take medications. I have serious ethical problems with doing this. I agree.

    But as to those who “misbehave”, I have to disagree. If someone in the throes of severe psychosis and paranoia has become assault ive and violent, he last people I want to see are the police. They tend to not be trained in how to work with this population and generally use tazers or lethal force in the face of violence. I would prefer to help them move through the state they are in until they have become calmer. I just dont believe that folks who are violent while psychotic should not have to go to jail.

  • @Tom. Yes this is the core of the issue…what justifies the use of force. And I think in many cases still today in many hospitals, the use of force comes too quickly, and without enough time to allow for deescalation. For me the decision to use force should only come as a means to stop someone from being truly violent. By that I mean physically attacking patients and staff. It does not mean yelling, cursing, being verbally abusive, etc.

    But these are warning signs…times to intervene and talk with the individual. Perhaps they aren’t getting this needs met. Perhaps they are frustrated with their care, or perhaps they just need to express a lot of rage and anger. That does not require any physical intervention. But it does require close attention, especially if it looks like it could rise to the level of violence.

    Unfortunately as we all know, there have been and continue to be horrendous abuses. And because of this, we need a much higher level of scrutiny for how we interact with patients. The decision of when to act and how to act in the face of intense emotion and violence is key.

  • Thanks Wayne. It is a slippery slope, and one that needs to be monitored very carefully. It is interesting the fine line between incarceration and psychiatric care for those who are emotionally distressed and acting dangerously. I agree in many circumstances we should do better than jail. We have enormously high and excessive incarceration rates.

  • Very challenging to be respectful and compassionate if someone is directly assaultive. I much prefer working with hospital staff and we simply do not allow police to come in to the picture. The tool bag for police officers is very narrow and they tend to have much less training in how to help someone who is experiencing psychosis and is aggressive.

    While meth and drug induced aggressive states from meth and alcohol are not uncommon, I am often more concerned when we receive people from jail or who have an extensive criminal history. It becomes that more important that staff develop good skills in interpersonal communication and deescalation.

    As for suicidality, this is a tough one for me. We get many patients who have been suicidal or have made a suicide attempt. They are placed on a hold for a short period- meaning they have to stay in a locked facility. Often within a day or two, most of these folks leave as they are no longer suicidal. I think it makes sense to have a place that can act as a sanctuary for people who are in extreme distress and are not thinking clearly. By taking a day or two to reflect, they often change their minds. Is that a service, or a harm to someone who is contemplating suicide?

  • Ok, yes we will just have to disagree. But let me explain a little more. In our setting, we do see it as a very rare but acceptable only in extreme circumstances. I don’t see it as “part of treatment.” We do prepare for it by going through extensive training on how best to physically interact with a violent person. The most immediate training is how to use interpersonal skills to deescalate the situation. But, there is also training on how to protect yourself and the individual without inflicting pain or injury.

    The alternative, unfortunately, is to call the police. And the tools they use to interact with violent people is the use of tazers, bean bag guns and lethal force. I would much prefer our staff to interact with a violent person than the police.

    So yes, unfortunately, the process of interacting with violent people is part of the system. It requires attention and training.

  • Sharon, thanks for your direct honesty of your personal experience. I fully agree with you that there have been and continue to be, extremely over zealous, harsh and cruel ways of “managing behavior” in hospital settings. And because of this, the entire system of care is deeply flawed. And I also agree that I would prefer an entirely new philosophy for helping people in emotional distress and crisis who need support.

    When you say I say some of the hospitalization process “can be good”, and you diverge…I just have to say I disagree. I believe the process of care for people under intense emotional distress needs to be radically overhauled. At he same time I do acknowledge the need for respites of care, sanctuaries for people to come to. And in this setting, sometimes violence happens. How do we prevent it? How do we care for those who are extremely aggressive and are hurting other patients?

    If all other measures have been tried, such as listening, offering food, comfort measures, offering space…and the person still is deeply aggressive and violent, how would you respond?

  • I totally agree with the “ounce of prevention” strategy. Listening, getting food when people are hungry, giving people support, not waking up manic people who haven’t slept for days just to take their blood pressure, etc.

    And yes, hospitalization by itself is traumatic for many…so you are compounding trauma on top of the trauma they have already experienced. That is why I hope for a much better model for helping people who are in severe mental and emotional crisis.

    Cameras. I get it. It adds to the level of trauma and can easily heighten paranoid states. The justification is to make sure people aren’t hurting themselves but it does seem excessively intrusive.

  • Thanks Sera for your comment. Let me try and respond as best I can. To start out with, my piece is a critique of hospitalization as a process rooted in the disease model of mental illness. I have strong concerns about pharmaceutical drugging as a primary tool of treatment. I have strong concern with the power imbalance and hierarchal nature of hospitalization. I have strong issue with coercive treatment without full understanding of the side effects and long term adverse health effects of psych meds. I don’t support long term involuntary medication.

    But let me try and address your two main concerns with my piece.
    1- the support of very limited use of medications/sedative drugs in the face of violence.

    If, as you say, it is part of the “menu”, then it becomes easier to use this method of interaction. And I certainly believe that is happening in many hospital environments. Harsh, hair trigger staff exist in many places and there are many stories of people who can attest to that. It is simply untenable to use force to control a patient unless under extreme circumstances. So what are these circumstances? Severe violence towards staff or other patients.

    I completely agree with your statement that I could change my wording to ….”sometimes the options on our menu fail and we get stuck. ” But the reality is that we have to be prepared for the possibility of violence, respond to it as best we can…but above all we need to make sure both staff and patients are protected from violence. How can we do that?

    The best way I know is to spend time making alliances with everyone in that setting, offer them support in a way that reduces the potential for anything like this happening. And if someone does become angry and aggressive, use all the skills possible to try and help that person and meet their needs. Perhaps they need space. Perhaps they need food, or they need to vent, or they need to pace. Whatever it is, allowing a space for them to be “intense” without reacting poorly is key.

    However, there is a time when the situation tips over and a patient becomes severely aggressive and violent. I cannot abdicate the rights of other patients and staff to feel protected as well. How to solve an unsolvable situation?

    It really is a no win situation. I know there are many many people who have been treated abysmally with unnecessary force in harsh and cruel ways in a hospital setting. Perhaps for many, it is just too much to ask to allow for some very limited use of force. I get that. But I would hope you see my perspective as well.

    My question to you is, what would you do if someone became extremely violent towards you or other patients in your setting?

    And hey, I will try and answer the suicidal question in another post….this one got a little lengthy.

  • “Torrey seems to be rooted to the idea that if the brain is involved then the environment is never implicated. This outdated conceptualization isolates the workings of the body from its environment. Just today, I was reading about research that demonstrated the debilitating effects of poverty on cognition. ”

    This is a very salient point and one that I don’t always see addressed; the influence of poverty on mental illness symptoms. Where I work as a therapist in an inpatient hospital psychiatric setting, I see thousands of people a year who come in with psychotic symptoms. The lion’s share of these folks are deeply impoverished. Because most of these folks are on disability they receive a paltry sum to pay for necessities. Many are homeless, malnourished, living in substandard housing and dealing with the stress of trying to survive.

    In this context of perpetual poverty and trauma, many people suffering from severe mental illness have worsening and increasingly debilitating symptoms. Its hard to imagine separating socio-economics and environmental factors out and simply calling mental illness a “brain disorder”.

  • Kelly, thanks for your article. As a therapist and herbalist, I constantly see the need for an examination of lifestyle and one’s “toxic environment” as you put it. Unfortunately there are many barriers to working with people on this level. At a base level, insurance companies are geared to pay doctors for medication management, not for lifestyle counseling. Sadly, not only doctors, but patients as well, have a quick fix mentality.

    I would love to see “mental illness” treated in the same way as obesity…as something that requires a lot of time, care and attention to treat. It requires attention to diet, sleep habits, relationships and inner belief systems. No simple fix.