Wednesday, December 12, 2018

Comments by Kenneth Blatt, MD

Showing 39 of 39 comments.

  • Hi Rachel
    I enjoy your posts and please call me Ken. I agree with you. The sources of our despair come from many wells. The APA has a major initiative to “reach out” to all faith based organizations and spread the gospel according to the APA thereby bringing in more people to become patients. The motive is to “end the stigma” by declaring “mental-illness is a brain disease like any other disease” so we should not discriminate and send those we’re concerned about to the doctor. In effect this increases otherness and fear and discrimination only increases. We all suffer in our own ways. We all have the same needs for sustenance and human connection and kindness. I’d rather be in the coffee shop talking to another alongside of me who can listen than facing a psychiatrist who is behind a huge desk while he/she is on the computer and writing out a prescription.

  • I support all the efforts people are making to change, reform, get rid or even destroy psychiatry. For me Peter’s article speaks of another possibility to address human suffering. Psychiatry survives because it has medicalized human suffering and frightened if not terrorized the populace. When there seems to be no where else to turn for what appears to be “madness” psychiatry will survive. Psychiatry will wither on the vine like most other movements that are antithetical to the human spirit of liberty and growth. For me I wish to deprive psychiatry at the source. If people who are suffering have others to turn to, others who are not afraid of being with someone in their suffering who doesn’t have to fix, cure, advise or make better; psychiatry has fewer patients. If we truly believe that love, empathy, engagement, community, persistence can heal then we have within all of us the power to effect change. We don’t have to wait. Everyday we have the opportunity to assist if allowed. It is for US to change from believing(not on this forum but in the public) others called professionals, are the authorities regarding human suffering. That is where the madness truly lies. We are responsible to care for ourselves but not in a vacuum; but also for each other and build healing communities. Psychiatry only exists because of our collective failure(albeit supported by psychiatry) to see human suffering as given in the human condition and that it is our responsibility to tend to each other and not abdicate our own inner powers to heal and to contribute to each other’s healing. There are now many alternative kinds of communities developing around the world addressing this. I am doing my little part in getting these messages out to the public. I am grateful for all those here who share with such passion their desires for change.

  • Psychiatry lost its mind decades ago. Now it is addicted to the biological model to help explain all human distress. Like all addictions psychiatry and other mental health professionals avoid the immense pain of true engagement with another. All the psychiatric drugs, all the alphabet soup of “trauma informed manualized therapy” approaches, all the pseudo science are the professionals avoiding the exquisite discomfort of being with someone persistently over time in their distress, in their world, in their suffering. without knowing what particularly “to do” at any given moment.

    Thanks Noel for consistently raising these issues. There are those who will continue to pursue this art of engaging others to co-create safe spaces for healing and collaborative growth to occur. Your voice and teaching will provide support to those seeking this healing path.

    Ken

  • Hi Shaun
    These are the really tough situations persons like yourself and many others face in the public mental health system. There are no easy or definitive answers to such an exquisitely complicated dilemma. How to maintain the dignity of this human interaction when one person (you) have been given (by the state) the power to “take control over” another person i.e. deprive the other of his/her liberty. First to clarify: In my state CT a non MD clinician only has authority to write a paper directing first responders to transport the person to an ER for a “psych eval” by an MD who then has authority to involuntarily hospitalize the person. Perhaps not much distinction for you since control is still taken from the other but you are not ‘forcibly committing someone to hospital per se. OK not much difference I know.

    I have ben in this situation many times; it is always incredibly hard. For me I hope maintaining the dignity of the relationship even with its terrible unequal power differential mitigates the harm. I stay with basic principles. What is the context I find myself in? I don’t decontextualize the situation as almost all of psychiatry does by labeling and diagnosing. So I join with the other in the dilemma that brought us together. I listen as best I can to their pain if they can talk with me about it that has led to us being here in this moment. I acknowledge and validate the awfulness of the situation and ask how we might move through it. What is it they want? Many times the person feels so frightened they wish to be “safe”, do NOT want to die, but not live without hope and with all the hurt. They might then be receptive to an offer of services or not. Either way I can justify leaving without effecting any other intervention without “fear” of liability. This liability issue is more my myth than reality. As long as I have seen the other, formulated an impression with consideration of options and risks, I do not have any liability. I am not responsible for the outcome but for my assessments and considerations.

    In the system I believe liability is used as a cover for one’s anxieties and fears as Sera has clearly described in her piece. Also I have to face the other clinician’s disapproval. Their client may remain “suicidal” leaving the clinician having “to hold and be present with” someone’s overwhelming pain; no easy task.

    Every situation is unique. But having some basic principles as a guide has helped me through these arduous times. Hope this is helpful.

    ken

  • Hi Sera
    Wonderful and moving. I often have the same dilemma about sharing another’s story. That you did is so helpful to hear how you struggle being with someone persistently in such emotional pain. For me it is “the struggle” staying with another over time without an agenda other than listening, being curious, validating and witnessing. Henri Nouwen a Jesuit priest who once trained in psychiatric hospital in the fifties wrote a piece that I posted on a bulletin board in my Center at work. It stayed up for months my hoping it would be widely read. I offer it below:

    “When we honestly ask ourselves which people in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing, and face with us the reality of our powerlessness, that is a friend who cares”

    Sera thank you for caring about David.

    ken

  • A wonderful exchange between Noel and meremortal! Thank you both for engaging in true dialogue to reach common ground; an example for all of us. The common ground stated so beautifully is that we as a society have decontextualized human distress by calling our experiences “mental illness”. By avoiding what for some of us is central i.e. early life experiences including all kinds of childhood adversity, abuse and neglect is not new. For centuries the admission that childhood abuse exists appears to make an inroad then disappears for another 50-100 years. Let’s not forget Freud’s first theories of childhood sexual abuse in his times. It’s just so painful to look at ourselves, our flaws, faults, injustices and traumas from generations.
    I call to all your attention Ophray Winfrey’s segment on 60 minutes around Mar 11, 2017. Afterwards she was interviewed by CBS Morning Show (both of these are on You tube). She said her story on childhood abuse transformed her life. She used the words of the hearing voices movement and others that Noel refers to “”don’t ask what is wrong with me but what happened to me”. Ophray referred to this phrase as transformative for her. “It changes the way I see life, the way I see people’s behavior. It changes the way I will run my school in South Africa”. She goes on to say “I want to stand on the table tops and shout this out for all to hear”. Ophray making the connection. Experiences are meaningful and not to be denied.
    So my charge to all of us here; can Ophray Winfrey lend her voice to the cause she says transformed her? How do we reach her to ally with her?

  • Thanks for lifting our spirits about your successes in life. I would add , if I may, to your credentials a role model for others. My hope, in the near future in your community, there will be an opportunity to volunteer as a peer mentor in an alternative system. Imagine if all those like yourself who have “survived” the current mental health system seek to participate in a new way in an alternative way of being with others in emotional distress.

  • Thanks Richard and BPD. I believe am I much aligned with both of your views. I am not a proponent of the medical model for those who struggle with emotional and or extreme states.

    I think the issue for me is not being as sensitive to the power of the words medication/drug. Although at times these can be interchanged as both of you note; it is not addressing the overall context of their use. It is true medication connotes pathology or disease and is used to “treat” such.

    I am on the Board of Advocacy Unlimited (AU) a peer run holistic wellness organization. We are developing a non medical approach to be with others that will provide safe spaces to journey through their crisis. We are not “treating” others. If some require “sedatives” (an old word) or tranquilizers provision will be made as well as other drugs that might be helpful in the short term.

    Actually I realize (with your insights) my use of the term medication is contradictory to the philosophy I maintain and could be confusing and doesn’t advocate for my position. BPD’s comment about using some psychiatric drugs is not necessarily harmful depending on the context is especially helpful.

    Thank you for raising my sensitivity to this important issue.

  • Thanks Stephen for your comment. Unfortunately what you describe happens far too often and change is too slow; but we persist, advocate and pursue change as each of can until a new paradigm prevails.

    You say passionately

    “Of course people would never take these drugs if they were told about the shrinkage of their frontal lobes, weight gain, chances of diabetes, dying 20-25 yrs. sooner than they should, possible heart attacks, sexual problems, akathesia, being cut off from their emotions and feelings, and all the other multitudes of things that can happen”.

    Well it’s not that simple. After the immediate crisis passes most allow me to gradually taper and accept other supports available in our program. But some do not. Why? They are terrified about a crisis happening again. The loss of control, the fears, the confusion and the trauma of forced inpatient stay is too fresh in their minds. They are young and the long term effects “won’t happen to me. Now the medications are working so let’s leave things alone”.

    Our outpatient program is available to young adults from age 18-25; 7 years to be with us if they choose less too of course. Thus there are many occasions to review the situation. Most allow a taper but some do not.

  • Thanks Lucy. I have read your work and appreciate all that I have learned from you.

    In so many ways the UK is some years ahead of US introducing alternatives to the community. People here should know you are amongst the leaders there. I am trying to introduce here in the center concepts you write about.

    I see you reference the BPS site and your work. I use the recent BPS report “On Understanding Schizophrenia” and videos for a course I teach in the community regarding alternatives approaches being with people in extreme states. Thanks again and I look forward to more learning.

  • Hi BPD
    I know you have a passionate belief about the “drug vs medication” designation. I hear this and believe I understand your point.

    I’m not there yet. I struggle with this issue. It is not all black or white for me. In the dictionary “drug” and “medication” are synonyms. So I understand you know that. Your point is similar to the one I was making about diagnosis; the inherent meanings of words mean different things to different people.
    What I believe you are referring to is the verb not the noun. That is “to drug” a person is to cause harm and induce a state of being not sought (my view). So in your view psychiatrists are drugging people leading to the harms you write about often. I believe this does happen far too often.

    Now I’m actually having an insight. I guess I believe when I am prescribing a “medication” I am only doing this with the others consent AFTER I fully inform him/her of the indications, value and RISKS both short term and long term. Sometimes a person’s immediate discomfort is so painful and other possible relief (supportive empathic people) is not available ( think why we need Peer Respites) a medication with my continued support (usually not enough) might be indicated at a low dose for a brief period of time. In this context (for me context is always crucial) I don’t believe I am drugging a person. Yes I believe I am using a psychiatric drug but not in the context of insulin. The media needs to be educated around these issues of course! As well as many others regarding alternatives to standard care.

  • Hi BPD
    No it is not a violation of the client’s privacy regarding sharing this kind of information i.e. “diagnosis” in the team. However the issue of confidentiality is a complex one on treatment teams with multiple disciplines including, therapists case managers, recreational and vocational and occupational counselors and MD.
    How does communication flow? How is information shared and with whom are but a few of the questions that bring up issues around authority, power, favoritism and a host of dilemmas. Perhaps for a later article.

  • Thanks Nick and good luck completing your dissertation.

    Psychiatry has decontextualized lived experience. Phenomenology was a central part of the field years ago. Unfortunately it became a casualty of the biological revolution. Let’s bring it back!

  • Thanks Liz. I’m glad your approach parenting your child works for your family.

    For me it is about choice. Some folks aren’t able to do as you have so that they must reach out to others. Our hope is for every community to have choices available that fits their way. Some are quite relieved to have “standard” approaches some not. If standard approach isn’t working being able to turn to something else would also be a relief. Is it no wonder that holistic approaches in general medicine are plentiful? Our goal is the same for those who struggle with emotional concerns even extreme states.

  • Hi Deena

    Thank you for sharing this with us. The “inner fire” you had then to fight for what you needed continues to simmer today. This strength and passion of yours and many amongst us will prevail through the current obstacles. Whether the “organized mental systems” will change enough in the future remains a wide open question. Some systems are trying to employ peers, have HV groups and are developing OD teams. But a system is still a system and by it’s very nature has barriers that might dilute if not co-opt the changes.
    A non-medically peer driven set of safe places for those in need is coming. There are no simple pathways through emotional crises. We can create spaces now for those who seek healing.

  • Medicated me… I believe what is a mess is not a person but the situation they find themselves in. That our emotions are intense, heavy, all over the place happens. It becomes messy when others see as there goal to control your emotions without engaging with you enough to actually do so in a helpful way. Most of us with “inner fire” will resist attempts to control us. We are then seen as more of a “mess” and more control is called upon as fears rise of the “mess” becoming “a bigger mess”; you might not remember the sci-fi 1950’s movie “The Blob”.

    This scenario is repeated often in placements for youth 13-18. An extremely difficult task to work in any such place. That’s for a larger discussion.

  • Diagnostic Statistical Manual. The 5th edition. This is a compilation of diagnostic categories created by various committees of psychiatrists staking claim to their favorite “disorders”.
    I have never believed in psychiatric diagnosis. People suffer. They can be in emotional pain. They struggle to cope with their pain and function in life. Their pain is usually in the context of current stressful situations and for some who have had traumatic childhood experiences of all sorts these “ghosts” of the past came to roust and stir up and contribute to the despair of the present. It is all so HUMAN and so COMPLICATED.

  • Thanks for your comment medicatedme. I’m sorry to hear you feel stuck in your present situation.
    From the responses so far I’ve come to use a different metaphor for the “blanket”. Perhaps the burden for some on these medications is like a “lead apron”. You know that heavy blanket dentists drape over you covering your torso and neck (to cover the thyroid I’ve learned). This lead apron is to protect us from the radiation.

    So what would it be like if we are to wear this lead apron all the time in our life? We are slowed down; can’t walk or run as fast. We are preoccupied with the heaviness affecting our thinking and mood. Although we might be protected from the outside emotional radiation=the stress of life we also don’t get the advantage of the radiation. Remember radiation is used to shrink tumors so is not “all bad” depending on how it is used.

    Belinda pointed out earlier the complexities of things. sShe also noted medications(clonidine) can have value. I agree. I am not “never medications”. I am not anti-medications. Just like the lead apron the judicious use of a “barrier” might protect ourselves from harm or harming ourselves. And the lead apron judiciously used in the context of getting x-rays contributing to our dental health; it is removed when that context is longer present. We leave the office. This is the problem.

    With the onset of the DSM and overuse of medication CONTEXT is no longer in the forefront. The medications (antipsychotics and others) are tested for only 12 weeks and then approved. Whenever a new medication is advertised a warning is given like use of these medications for more than 12 weeks should be considered
    carefully (I’m paraphrasing). The context for the original use of all the antipsychotics was in acute situations where they are highly effective for tranquilization. The lead apron in the appropriate context. But unlike when we leave the dentist and the lead apron is removed; after the acute situation a person is expected to wear their “lead apron” for much longer with consequences.
    For some (hopefully many) the lead apron can become a light blanket. Given their experiences and current life situation some bear their light blanket quite well with little interference in their functioning. Depending on their situation they might at times do without a blanket, sunny and warm times and support abound.

    Each person must have the right, the freedom and opportunity to determine for themselves what they “wear” on any given day.

  • Thanks Fiachra for your comment. I’m glad to hear a drug taper for you has been helpful. “Cold turkey” for most on these drugs/medications for a length of time ( 1+ years) is ill advised given the risk of withdrawal psychosis. Sounds like you learned from a difficult experience about that. And you had the support necessary to drop down to a reasonable dose. I wish you well.

  • Thanks Belinda your comprehensive and impassioned post.

    I agree with you there will be some despite all our “best” efforts who will not benefit from the second chances/opportunities for change and growth. This is a sad truth of life.

    For me I never know who that will be. I never know when starting with someone what the future will bring. I fall back on my basic beliefs. Until I know otherwise (which may take a very long time) I assume there is potential growth in everyone not to the same degree of course since this is unique to each individual. I try to settle in and provide as best I can given the circumstance and contexts in which I am working some optimal environment. This is extraordinarily variable depending on the setting and again even in the most optimal however defined there are some who might not benefit. So this includes a “loving, caring, compassionate, empathic, safe and secure setting even then it is “not enough”.

    So knowing this only makes it harder. Here is the uncertainty staring us in the face. The journey we begin we know will be fraught with the drama of life; the tragedies and the comedies. We don’t know exactly where we are heading, for how long and to what end. As long as the other allows me in their space and seeks to share with me their concerns I will try to be there without thought, memory or desire (Bion). To be a presence. Sometimes experienced as caring if not loving and sometimes cruel, hostile and murderous. Two human beings relating in the cauldron of mutual traumas.

    So you remind us with your vivid examples there is no love that is enough. A truth we must carry and yet put into the background somehow so we can even begin the journey.
    My hope is we develop as many “healing safe spaces” as we can so anyone seeking such will be able to come in from their cold.

  • Thanks DJ for sharing your dreams. You know it is said that change begins with one person’s dreams.

    If you are in the position of providing information relating to drugs/medications full disclosure is the ethical thing to do. That means both sides. “Tranqilizers” of some sort in acute situations for a very brief time might play a useful role to even begin an engagement. The problems starts when the acute situation begins to resolve. What then?

    Please continue to dream. Share your dreams with like minded people. It all starts from there.

  • Thanks Madcat for your comment. You must have courage to have pursued your journey and endured through all the travails. That struggle is ever-present is so but it seems you embrace it and have a perspective that promotes continued growth. I hope this is so.

    I appreciate your consideration though I don’t feel I am in an unenviable position. On the contrary I believe i can use my position to make a little contribution. That more favorable conditions don’t yet exist I have to bear this frustration and seek change as I do.

    i believe our task is to provide those we engage with a safe and secure space. Within this space to create a collaborative trusting relationship for whatever is to develop. Then it is my faith that what will come forth will be useful to the other in moving out of madness.

  • Thanks Nomadic for your comment. What you propose already exists in Sweden. Perhaps we can learn from the Swedes and develop “Healing Homes ” in US. Here is Daniel Mackler’s Introduction to his film of the same name. Just go to You Tube to view it.

    “Healing Homes, a feature-length documentary film directed by Daniel Mackler, chronicles the work of the Family Care Foundation in Gothenburg, Sweden — a program which, in this era of multi-drug cocktails and psychiatric diagnoses-for-life, helps people recover from psychosis without medication.

    The organization, backed by over twenty years of experience, places people who have been failed by traditional psychiatry in host families — predominately farm families in the Swedish countryside — as a start for a whole new life journey.

    Host families are chosen not for any psychiatric expertise, rather, for their compassion, stability, and desire to give back. People live with these families for upwards of a year or two and become an integral part of a functioning family system. Staff members offer clients intensive psychotherapy and provide host families with intensive supervision.

    The Family Care Foundation eschews the use of diagnosis, works within a framework of striving to help people come safely off psychiatric medication, and provides their services, which operate within the context of Swedish socialized medicine, for free.

    Healing Homes weaves together interviews with clients, farm families, and staff members to create both a powerful vision of medication-free recovery and an eye-opening critique of the medical model of psychiatry.

    Bonus features: In addition to the 79-minute film, the DVD contains an in-depth interview with the director, Daniel Mackler.

  • Thanks Cat for your impassioned comment. Looking at ourselves is a hazardous undertaking. All that you mention has happened and continues. Even less horrors is too much horror. But we humans, all of us, are capable of horrors and evil. And that’s not all. We will maintain our belief that those who see evil are just misled and not understanding the “good” we are doing. This for me is part of the human condition and has played out throughout the centuries.

    We are not helpless in the face of what is evil. History has shown us that change occurs through the persistent efforts of committed and passionate people. I’m prone to say sometimes; when history looks back at the practice of psychiatry from 1970 to ? (I wish i could put an end date but not yet) people will say in utter confusion and disbelief “WHAT WERE THEY THINKING!”

  • Thanks Someone Else for sharing your awful experiences. I’m sorry to hear your encounters with so called professionals were painful and harmful.

    I don’t believe in the concept of “mental illness. I believe people suffer in many different and unique ways. That such suffering got “medicalized” was an unfortunate turn in history. The medical approach became embedded in the zeitgeist and culture in a very powerful way. I believe when we are desperate, in pain without knowable ways of relief we are vulnerable to cling to those who provide answers with certainty. This is some of the origin of the placebo effect.

    For decades now folks are coming forward and saying “no more”. With new media we are all easily connected unlike anytime in history. Change is upon us. I wish I could reassure you such change will be quick; but you must know that is not so. It will be slow and feel ponderous and agonizing. None the less together with persistence (like Stephen) and hope change will prevail. I’m hopeful.

  • Thanks Stephen. You keep going back. For what ever reasons you do your persistence is a gift to those you engage with. Given all the inequities swirling around you the person you engage with has the opportunity to be with another (you) and experience your interest in them without judgment. We never know the impact we might be having simply by being available to another. A great sage once said “should you do one good deed for another on any given day it is like saving the entire world”. Those who engage with you are lucky.

  • Thanks Stephen for your thoughts. I don’t have a telescope to scan the stars. Here a shout out to Kate Crawford across the pond. She does.

    For me in this work my compass is empathic listening, tolerance for uncomfortable affects, my feelings and faith. Faith in the power of interpersonal healing. Tolerance for not knowing at any particular moment what is going on. Tolerance for the confusion around encounters with passionate beliefs differing from my own. And tolerance for the mystery taking place between two people who are trying to be with each other authentically while also being vulnerable to each other. Not easy..right!
    But when an encounter leads to deep connection love comes forth. Is there a more powerful ingredient in interpersonal healing?

  • Thanks boans for your comment and letting us see this horrible video. I cringed watching and could feel the youngsters pain and humiliation. Assaults and crimes like this unfortunately continue. We must be vigilant and continue to fight against such aggressive force used in any institution. Over the last 20 years in my state system the numbers of such tragic incidents are much reduced. Seclusion rooms and restraints are rarely used. Of course any aggression like this is absolutely uncalled for and people responsible should face consequences.

    Although not as dramatically depicted, the overuse of medications in our juvenile facilities remains a major problem. Creating safe and healing spaces within institutional settings requires leadership that is sorely lacking. But we must push on.

  • Thanks Cat for your comment.

    As many have said “we are all in this together”. The system is all of US. We are all guilty to some degree. When we are desperate we seek relief. We are in the midst of what I believe will be a paradigm change. Psychiatry has a history filled with false promises of relief from chaining people, to insulin coma, lobotomies, ECT, forced hospitalizations and drugging, to the current love affair of “evidence based models”. Psychiatry is embedded in a culture and has repeated the human story from tyranny to freedom all based on our fears of the unknown and the pressures “TO DO SOMETHING”.
    The peer movements around the globe are freedom movements. The freedom to “be mad” in our unique ways as a pathway to unlink ourselves from the traumas of our past and the chains strangling us. And as we offer alternatives and form our networks we will become subject to the same human corrupting influences ever-present to put us back in the chains. I must have faith our awareness of these tendencies might spare us such repetitions.

  • Thanks for comment TRM123.

    Never persecuted by others and never all correct and courage belongs to those dueling with their madness. I just had different beliefs held passionately in conflict with others. Our ways of approaching those in distress are for me life principles. Confronting another who holds a disparate belief is like engaging with another who has an unusual belief or in old language a “delusion”. Telling someone you are wrong in what you believe is to negate the others experience which mostly is just painful. To truly listen is to accept without condition the validity of the others experience. It’s hard. We then have to hold within us contrary notions about something very important to us.

  • Hi Oldhead
    You might know there have been many class action suits against a number of the largest pharm companies. Billions have been paid out but has not changed much. Also I believe the biggest companies are leaving the psych field to concentrate on individual genomics and cancer.
    It will take a while for the myths of biological causation of extreme states to wilt in our culture. What will speed up their demise? The alternatives coming forth spreading into society. It is happening, will continue and I’m hopeful.

  • Thanks Wayne. Change is difficult. We get set in our ways. Being with another in crisis is hard. Not only listening and engaging with another but with ourselves. We are all vulnerable. Our sense of self, our identity, our beliefs are all challenged in these encounters. We are fearful moving into the unknown and the uncertain. All these basic emotions I believe contribute to the barriers. For me it is understandable we reach for “science” , the “experts” the “medications” to relieve the anxiety, fears if not terrors we are apt to encounter. The more we allow for all these feelings and openly share them we each other the more supportive, safe spaces we create.

  • Thanks BPD for your comments. As we previously exchanged some thoughts; I agree about Rinsley’s work and others who worked in intensive psychotherapy with such young adults. Recovery or simply healing from extreme states is a unique process. Each individual seeks what fits them. For some such psychological therapies are useful not so for others. What seems essential is some means to be with another in safety with listening, trust , empathy and capacity to appreciate the others experience without judging, fixing, or advising. There are many roads towards healing. Hopefully we can provide as many paths possible to journey along.