Saturday, April 21, 2018

Comments by Ron Unger, LCSW

Showing 100 of 468 comments. Show all.

  • The recording of the webinar on this topic is now available, for free, at https://youtu.be/MO3_Odqq-7k I think Sean and his team are really on to something – for lots of people at least, I think turning toward the intense inner experiences they need to have and process, in a setting and at the time they choose, will be really effective in getting them to a place where they are no longer haunted by “disorders” that need suppression, by drugs or otherwise!

  • Hi JanCarol, I agree that this kind of work goes by different names and descriptions, including what we now call shamanic practice. I also agree with you that it offers a chance of true healing and entrance into the states of wellbeing you describe! So much different than spending the rest of one’s life trying to run away from certain experiences…..

  • Groups within society, or sometimes pretty much a whole society, can also be “out of touch with reality” and this is actually more dangerous than just an individual being out of touch, that’s something important to think about. Psychiatry is out of touch with reality when it ignores the down side of its treatment approaches. And critics of psychiatry are out of touch with reality when they exaggerate the down side of those treatments to make the issue seem more black and white than it is – for example by claiming that it’s a fact that the drugs are making people die 25 years earlier than average, when the science actually indicates the drugs as being one of a number of factors that are leading to early deaths – even if a very important factor.

    In my seminars on CBT for psychosis, I talk about how psychosis involves being disorganized and/or out of touch with reality, then I ask the students if any of them are perfectly organized or completely in touch with reality. If any answer “yes” I suggest they may be suffering from a grandiose delusion! I then introduce the dilemma, how can any of us decide for sure who is truly out of touch with reality if we are only partly in touch with reality ourselves? Then I suggest that what we really need to do is to dialogue about and investigate together different views about what reality might be, and that better approaches to “psychosis” work on that basis.

  • What most people mean by “psychosis” is being out of touch with important aspects of reality and/or being severely disorganized. Of course everyone is at least somewhat out of touch with reality, and somewhat disorganized, but it’s when it gets to seem extreme that people use the word “psychotic.”

    It’s kind of hard to argue that states of being extremely disorganized and out of touch with reality do not exist. I understand that some might like to use a different term for those states – some like the term “extreme states” – but it seems clear to most that these states of being do exist, and are worth talking about as something different than everyday states of mind.

    Some see “psychosis” as a medical problem that always implies a particular underlying medical condition. This theorized medical condition of course may not and probably does not exist – that is, some kinds of medical conditions can make people psychotic, but the fact that someone is psychotic is not good evidence that they have any particular underlying medical condition.

  • Hi Richard, what I was trying to say is that we need to accept something that doesn’t have its source in rationality, and this process may seem to be spiritual – about faith, not rationally sourced – though others might describe the same process in non-spiritual terms.

    The “validation by others” thing I agree is important, but it’s tricky. I developed my rational side in the first place in a large part so I could protect myself from the destructive side of the views of others. I was getting defined in a negative way by others, so learning to reject how they thought, to see the holes in their views, was important (just as it is important for those negatively defined by psychiatry to see the holes in the reasoning of psychiatry.) But then, if I wasn’t going to accept what others validated, what was I going to use as the basis of my understanding of world and self? It was like I had blown up the world and now had no where to stand on.

    What helped me was connecting with people who were at a similar point in their journey, and sort of making up our arbitrary starting point together. It was kind of like asserting “everything is true, we can start anywhere and make sense.” This did feel pretty spiritual to me – like rediscovering how the universe was created, out of nothing, out of the void – but someone else might have seen it in very different terms.

    I wrote more about some of these dynamics in this post https://www.madinamerica.com/2013/06/madness-and-play-exploring-the-boundary/

  • I’d like to comment on the two competing theories mentioned about the nature of the impairment of reasoning associated with “madness,” one involving the loss of reasoning, the other involving hyper-rationality detached from “the everyday world.” I would like to point out some ways these may be more complementary theories rather than competing ones, in the sense that the one leads to the other, like yin and yang.

    It might be more accurate to say that “sanity” is based not on reason, but on a balance or friendly relationship between reason and unreason, or as Marsha Linehan would put it, between “thinking mind” and “emotional mind.”

    In that case “insanity” is anything where this balance is missing. And often when there is imbalance, there is a going from one extreme to the other – so there might be hyper rationality detached from feeling; and then problems with that leading to feelings and emotions taking over, detached from rationality; and then problems from that leading to even more efforts to make “rational” distance from feelings and emotions that seem even more too dangerous to engage with.

    In my own experiences that were on the “psychotic” spectrum, it was these kinds of issues I was dealing with. I was very good at logic, but I also became aware of the emptiness of logic, and I would often quote Wittgenstein on that: “In fact all the propositions of logic say the same thing, to wit nothing.” To me that meant that everything was absurd or arbitrary, and rationality itself was an illusion. (Enter here a lot of disorganized or weirdly organized speech and behavior!)

    What brought me back to some approximation of “sanity” was something more emotional, an interest in human connection. I was particularly interested in connecting with others who could see the absurdities I saw: and once I found people like that, my interest in making the connections work made me focus more on that balance between reason and unreason that allowed me to connect with everyday life.

    It’s kind of humbling to many to recognize that our “sanity” is not based squarely on rationality, but on a mix of rationality with more arbitrary factors, something perhaps even more like spiritual revelation. But more awareness of this aspect of things would I think help us better understand some of the paradoxes around madness and some of the routes back to human connection.

  • I would like to thank Joanna for offering a thoughtful article about how we might best think about the problems that get called “mental disorders.”

    I know a lot of the focus of MIA, and especially of many of the commenters on MIA, is problems caused by those who try to “treat” “mental disorders” – and those problems are so great that it isn’t surprising some propose we would be better off if we just didn’t recognize anything like a “mental disorder” by whatever name – then there would be no efforts to “treat” anything, and no treatment induced damage!

    This approach unfortunately doesn’t work for the more severe forms of the problems that get called mental disorders – those problems can easily by themselves lead to severe life disruption and often death if not addressed in an adequate way. So playing “let’s pretend that the only kind of problem in the “mental health” field is the treatment itself” doesn’t play out well in the real world.

    We do need to continue to critique approaches that do more harm than good, but in a way that is balanced with an awareness that people do often require some kind of actual assistance with problems they have.

  • I haven’t had time to really review this in detail, but one quick comment: A lot of the basic questions suggested seem really good, but one I don’t care for. That is, “What did you have to do to survive?” This question seems to presume that the person had to do everything they did in order to survive, when in fact much of what we do in our attempts to survive may be unnecessary or even counterproductive – but still perfectly understandable given the threat we faced and what we felt at the time.

    So I’d replace that with a different question, “What did you do in your attempts to survive, and what impact did that have?” This can bring out both stories of responses that were really helpful, and ones that had other kinds of results. Some of the latter can be harder to talk about – it’s stuff we did that didn’t help our situation – but when we see it in the context of the story and the threat and what we were capable of at the time, it makes sense that we did it and also that we can act differently now.

  • I agree with Fiachra that one thing that can cause paranoia when stopping the drugs is just the rebound effect, the brain is used to the dopamine blocking effects of the drug, and with that gone, it starts over-reacting, like too much paranoia or suspicion. Of course, there’s also the problem that people can just be caught up in habits or patterns of thinking in ways that are too suspicious, the drugs dampen that down (by making everything seem less important) but then it bounces back when the drugs are stopped. So I would suggest starting to learn how to question one’s own paranoid thinking, by reading books like “Overcoming Paranoid and Suspicious Thoughts” and/or seeing a counselor who knows how to help with that – and then quitting the drugs only very slowly, so not too much paranoia comes out all at once.

  • Sometimes “approach” is a better term than “treatment” since it is more open ended. I appreciate JanCarol’s difficulty in making any kind of approach at all, with no backup. It’s easier when there is a team one can integrate with: then contact can be made, someone can connect with the individual, see more of what might be going on and what might be needed. And even if the person is so disruptive they have to be taken somewhere to insure the public safety, it would be nice if it was somewhere like I Ward, where there could be continued exploration of what needed to happen rather than just a suppression of anything “not normal.” https://www.madinamerica.com/2012/02/remembering-a-medication-free-madness-sanctuary/

  • Life is complex, and while doing forestry work really helped out at one point in my life, there was another point in my life where I was really stuck on some issues, unresolved trauma, etc. and I did find talk therapy to be helpful.

    Offering everyone, regardless of ability, some opportunity to earn a basic income would certainly undermine our current “fear of not having anything to offer the capitalist overlords” system! And that would really help resolve a lot of people’s problems, and if we had to choose between having any talk therapy or having the income scheme you describe we might do better with the income scheme, but the ideal combination if we could choose eveerything would probably still involve offering some talk therapy in my opinion.

  • Yes, it’s certainly true that talk therapy is not the best option for everyone! There are all sorts of things that might help. I think physical labor is one of the things that helped me “get grounded” – for me it was planting trees and doing other forestry work. So it was a mix of being physically active, being intimately in contact with nature, doing meaningful work and getting recognized for it, and social interaction with others in the course of the work, that had an effect.

  • I would say the idea that “psychotherapy” can help is just a variation on the idea that it can help to talk to another human being about one’s experiences.

    Of course, there are factors that might make “psychotherapy” more or less helpful than a simple conversation with a person trying to be helpful. For example, the therapist is at least usually paid (though sometimes is a volunteer) – getting paid could help the therapist be more focused and persistent in trying to help, though it could also be a corrupting influence. The therapist has training, some of which might help, and some might get in the way. Depending on the orientation of the therapist, he or she may buy into some mental health myths (or might not, and the non-therapist having a conversation might buy into myths, so it can be complex.)

    Anyway, it seems to me that it would be impossible to dismiss all of therapy as an unhelpful con without also dismissing the idea that people can have helpful conversations with each other. So maybe it would help to be less black and white about it all, and to recognize the possibility of both helpful and unhelpful exchanges. At least that’s my perspectivve, I recognize that some of your may really enjoy being harshly critical of anyone trying to offer menntal health assistance, and introducing nuance might cramp that style……….

  • Hi Maddestmike,

    I agree with you that one way we learn is to get messages that are the opposite of the truth, and then we follow them far enough to realize they are wrong, and that is how “the light gets in!” As you say, this isn’t a nice way to get to the truth, but it often works that way.

    I also think it is very tricky to talk about these topics, because words can be interpreted or intended so many different ways. I have quoted elsewhere the Discordian maxim that “all statements are true in some sense, false in some sense, meaningless in some sense…..” If we really listen to someone who seems to us to be “crazy” we may discover a sense in which what they are saying is true. At the same time, even what may be the greatest truths can be twisted into something which is very false or corrupt.

  • I agree with Daniel’s metaphor. We have to attend both to the system and the individual.

    Trauma is to some extent like a lie that gets told. If someone tells me a lie, the problem is initially the liar, but once I believe the lie, then the problem is inside me and I will also need to go through some changes to “get better.” If MDMA can help people reject lies that have become deeply embedded into them, that can be a good thing even if the person helping them is called a “psychiatrist.”

    I agree it will take more than just one thing to correct our messed up mental health system, and our messed up society, but going from a “daily drugging” model, to “use a drug at a strategic time to help create a transformative experience” model, would be a huge step in the right direction, and would be a substantial paradigm shift. (And it’s hard to see Big Pharma having much of a role, as the quantity of drugs required is minute, and already off patent.)

  • Hi JanCarol, even though at one level you are debating Richard, at another level I think you are moving toward the same point: that the separating of things can be a problem! So the idea that heaven and hell are somewhere “separate” from here can as Richard pointed out cause big problems – and even the idea that we either go to heaven or hell can be another kind of problematic separation (as opposed to the idea that we have experience of both, or that this same world can be seen or experienced as both heaven and hell, and more). Anyway, just a thought.

  • My sense is that Scott is mostly making sense here, and the criticisms are overblown!

    I see a huge difference between using a drug to essentially show someone that their brain can operate differently, and to get them to have an experience that helps them make constructive changes in a future that doesn’t involve taking the drug, compared with standard psychiatry which attempts to alter brain functioning every day.

    Of course, not all use of a drug like MDMA is likely to be transformative – but the combination of the drug with the right set and setting could I think have the potential to be truly healing. And healing, rather than daily drug suppression of the brain, would be a nice future focus for psychiatry. (Of course, if this was applied by force, it would be a disaster, and there are probably other ways to make this into a disaster, but I think Scott’s argument is just that we could take this in a good direction.

  • I would say that “love” and an awareness of oneness as at least one dimension of things is essential to healing. But there is a difference between real love and understanding of unity, and fake love for example that serves as a cover for aggression and corruption and abuse. I don’t think we should let the existence of the fake kind make us quit looking for the real stuff, instead, we just need to get better at telling one from the other.

  • I’m embarrassed to notice I had made an error in mentioning Chris Cole – it was really Tom Wootton’s Bipolar in Order work that I meant to reference! Sorry about that. I have asked the editors to correct it in the blog itself.

    Regarding the ” it’s not either or, it can be a whole range of both” comment, I very much agree. In fact, if it really is true that “the Way that can be spoken is not the true way” then whatever we speak will always be somewhat mixed up or “crazy” and if we recognize that, we might be able to be humble enough to be open to experiencing more of the truth and to seeing some truth in the different views of those around us.

  • Frank, I don’t recall me or anyone else here suggesting you should be persuaded, much less forced, to have any mental health treatment! But when you suggest all mental health treatment should be eliminated, you are advocating denying it to people who might want it and do poorly without some kind of assistance. And I don’t think you have any good argument for doing that.

    And I also don’t agree that advocating for some kind of assistance for mental and emotional problems means “medicalizing” those problems. It can rather be an open minded investigation into what the problem might be and into how it can be resolved. That might be making some kind of interpersonal change, or lifestyle change, or who knows what.

    Our current system of “assisting” is way too medicalized, and often is more unhelpful than helpful, but that just doesn’t prove that all help has to be that way.

  • Hi Frank,

    Are you proposing that no one should be paid to offer any kind of help or assistance to people who have any kind of mental or emotional distress, and who want help? It seems to me it’s one thing to say “help” shouldn’t be forced on people, or that people shouldn’t be tricked into thinking there is something wrong with them when really they are capable of getting on with things quite well without assistance – but there are plenty of people who get extremely distressed and confused before psychiatry ever gets to them – are you suggesting our world would be better if we just told those people to buck up and get on with life without any assistance? Or only with the volunteer assistance they might be able to find (which might be none, or very little?)

    I understand the “assistance” people get now is often worse than none at all, but I would maintain that it is possible to truly offer help, as we already see happening in some area, like where Open Dialogue is practiced.

    As for whether what I talked about in my post is science based – I would argue it is consistent with what we know scientifically even if it isn’t all “based” on science. After all, even the preference most of us have for being living instead of dead is not “based” on science, which has no way to define what is “better” in the absence of any assumptions about what we want to accomplish.

    I would argue the science around mental difficulties does indicate people do better when we talk to them in an open minded way about what might be the meaning of their experiences. And research also indicates that people who do recover are more likely to feel that what they went through led to some kind of transformation, not just a return to a state before the “disorder.”

    I don’t like religious dogma, but I do think spiritual language is one way of talking about realities that we all face, even those of us who don’t like spiritual language. And, thinking about how people who are talking very different from us may still be talking in some kind of way about something that is real is absolutely key to bringing respect for human differences into the mental health field.

  • I guess my perspective is that we do best when we are open to seeing there may be a problem within ourselves (unless we happen to be perfect?), and also when we aren’t too quick to think the problem is necessarily in ourselves or all in ourselves, and when we can join in social action to right wrongs, etc.

    As for your notion that psychotherapist are all avoidant of facing injustices, I wonder what you would make of my friend Chuck Areford, who has risked his job to be an outspoken critic of neuroleptics even decades ago when that was harder to do, and who more recently has been found week after week out in the rain organizing street protests, rush hour resistance https://rushhourresistance.org/

    I do agree that as a group, therapists tend too much to avoid speaking out about injustice. But over-generalizing doesn’t help – we also need to acknowledge those who move in the right direction.

  • I’m certainly not suggesting that we should quit paying attention to all the harmful things that happen that push people into psychosis. What I am suggesting is that within the process of the people who get diagnosed with psychosis, there is more going on than just the damage – there is also a person in there struggling to heal, and it’s in that struggle that the spiritual stuff happens. These “spiritual” experiences can be the foundation of a transformed and renewed life. If we can see and respect that, then I think we can be much more effective in helping people than if we just jump in and assume that everything that isn’t “normal” is pathology.

  • Hi Richard,

    Well, I always give myself mixed reviews, so I’m fine with you giving me one as well!

    For one thing, there’s always way more to be said about this kind of topic than can be said in any post of limited length, so there is always a lot left out. So I agree for example that I didn’t say anything about vulnerability to cults and such, and I agree with you that is a factor (though I did speak of the more general danger of bad ideas moving in when one has rejected the existing order and when one is really open, and being overly influenced by others like cult leaders is just one of the possibilities there.)

    I was aware that I could have said more about Dawkins and that perspective, but again, limited time, I decided to skip it. But here are a few of my thoughts. You mention that as you see it, there are there are “two separate definitions of “spirituality.” One is the unscientific belief of a spiritual world separate from the material world (God, Heaven, Hell, The Devil etc.) Another definition involves a search for meaning in life outside ourselves in various higher forms of human connectiveness, perhaps including in group efforts to transform the world into a better place.” But I think lots of other interpretations are possible. For example heaven can be thought of not as a literal place, like Disneyland, but as a dimension of consciousness that is possible when one approaches or understands existence in the right way. And this dimension of consciousness may not be very accessible to the “rich man” who relies instead on his riches to feel OK about things.

    I actually mentioned Satan only in the context of a story about Jesus that we have been told, so I don’t think what I wrote implied that he was necessarily more than possibly a hallucinatory/dream figure that someone named Jesus might have experienced when he was going through an extreme state of consciousness. But I do think Satan, like heaven, can be understood as an aspect or dimension of consciousness or a metaphor for a dimension of consciousness, so I would argue against anyone who would frame everything that has been said or written about Satan as nonsense.

    I do agree with you that religion is often fixated in distorted and dogmatic views that create great suffering, and psychosis for many may be an attempt to reverse or heal from that suffering. I do think that narrow minded religion is a threat not just to individuals but to the survival of the human race.

    As for why people like myself identify as God when we are in an extreme state, I could offer a few reasons. One is simply that this is a valid way of viewing our identity which we are rediscovering, an identity in which we are one with all of existence – for a coherent discussion of that perspective, see The Book, On the Taboo Against Knowing Who You Are, by Alan Watts https://terebess.hu/english/AlanWatts-On%20The%20Taboo%20Against%20Knowing%20Who%20You%20Are.pdf Another reason is that we are sometimes in the process of recreating the world by looking at it differently: we are all gods in the sense that we create our own worlds, and framing it that we are God helps bring attention to this proces.

  • I’m not familiar with Chris Cole’s perspective on psych drugs. But what I have appreciated is his perspective that the mood swings become not a problem when they are seen as providing parts of a bigger picture rather than something that either is taken too seriously (and dominates one’s point of view) or is seen as something that has to be eliminated (which is more the psychiatric perspective.)

    Mood swings may be more like voices: not a problem in themselves, but can be a problem if one’s relationship with them has problems. Like with voices, the problem may be usually either with giving them too much power or with focusing too much on trying to get rid of them (which in a backwards way also gives them more power, takes them too seriously.)

  • In my post I mentioned the webinar, “Recovery-Oriented Cognitive Therapy: Resiliency, Recovery & Flourishing” presented by Paul Grant and his team. The recording of that is now available at https://www.youtube.com/watch?v=YzyP7beP1r0

    I think it’s worth watching! They are advocating for a very humanistic approach, and talk about the need to change the whole culture around mental health treatment, and some practical ways to get a start on that. One thing they comment on is how “quiet” treatment centers become when the emphasis is on suppressing “pathology” and how they should and can be very lively when the emphasis shifts to how to help people more toward their aspirations.

  • Hi Tireless, am I correct in hearing that you believe there are problems with my views and so I need to change, but yours are definitely without any problem and no one should ask you to consider changing anything about them? Just asking. (Unfortunately, many mental health workers come on with the attitude that they are “sane” and don’t need to change, while the other is “insane” and does need to change: maybe you are just trying to turn that upside down, but I think the opposite of one mistake is often just another mistake.)

    Regarding your assertion that “psychotherapy is wrong because it is profiting from the suffering of others” – are you asserting it is wrong for anyone to be paid anything to try to assist people who are having psychological distress, because that would be “profiting?” Are you also opposed to anyone being paid to assist people who are having physical distress, like a doctor attending to a broken arm? Where do you draw the line at what is unacceptable “profiting?”

  • I think we are more likely to be able to come together and do well when we are open to the idea that we all have problems and probably need to change in some ways. So that includes the mental health system, families, social systems, and individuals, including but not limited to those who are diagnosed.

    And it does certainly often help to talk about it. Psychotherapy is just one way to talk, not always necessary, but can be helpful in my opinion. I can certainly understand wanting to ban bad psychotherapy, but I can’t see a reason to want to ban all of it!

  • Hi Sam, I was referring to voice hearers themselves “calling the bluff” of threatening voices that pretend to be able to do big harm if the voice hearer does not comply. That can often be important to help the voice hearer. Relationship, compassion, love, that stuff is all needed too – and it’s easier for the voice hearer to offer that once they aren’t terrorized by the voices!

    In some ways, working with voices is like working with children, or just other family members in general. Both boundaries and love are needed.

  • Hi Someone Else, I agree with you that we don’t have proof that telepathy doesn’t exist, so it always could be possible that it exists and a real person could be using it to communicate threats! But what we know for sure is unhelpful is believing that a voice belongs to someone external who can and will carry out threats, in the case when that is actually not true. Quite a few people have experienced being intimidated by threatening voices, and only once they learned to “call the bluff” of the voices were they able to regain control over their lives.

  • Are our thoughts “real or imagined?” That’s a good one!

    How about the answer that they are “really imagined?” Because imagination is itself a real thing!

    I do think there is such a thing as believing voices have a reality that they don’t have – like believing that voices belong to real people that can kill one’s whole family if one disobeys a command. But the opposite belief, that voices have no kind of reality at all and don’t provide any useful information at all, is also very unhelpful.

  • We know that antipsychotics work by suppressing dopamine, and we also know that dopamine is the brain transmitter most associated with anticipating something. That means it is associated with both hopes and fears, so suppressing it will suppress motivation along with things like grandiosity and paranoia. (Of course it gets complex, since some people who were overcome by paranoia might be more motivated to do everyday things once they are less paranoid, etc.)

    Richard Bentall reported the way they tell it a drug has antipsychotic properties in a rat. You train the rat to anticipate that if it hears a certain bell, it will be shocked unless it moves to another spot. Then if you give it a drug that has antipsychotic properties, it will quit responding to the bell (in anticipation of the shock) though it will still respond to the shock itself.

    I think if more people were aware of what these drugs do, they would be used much less frequently, in lower doses, and for more limited periods of time.

  • Hi Someone Else: I share your disgust for those who cover up pedophilia and the damage caused by it, for example those like NIMH who still pretend to not know that childhood trauma and abuse is a possible cause of psychosis down the road. But I don’t share your conclusion that everyone involved in mental health is part of the cover up, because I know quite a few people who are involved in that field who work to increase awareness of the problem. Of course, many of those have been abused themselves, and so they carry that fire, that sense of outrage, that doesn’t let them be easily shut up.

  • I resonate with what you are saying, highfellow! I like you sometimes wish I were more like others in some ways, but then at other times I really appreciate my differences. If I can remember that my differences have value even when I am wishing they weren’t there, and also remember that there might be value in the way others are even when I am feeling happy to be different from them, then maybe I can find some kind of balance. (Of course too much balance or moderation isn’t good either, as in the old saying, everything in moderation, including moderation!)

  • My entrance into becoming a counselor was different than most – I participated as an activist with MindFreedom for many years before I went to graduate school and then started working in the field. So I already had an awareness of how corrupt things could be. And I had the good fortune to be hired by an agency that did counseling but not drugs, and had leaders skeptical of drugs (the first time I heard the DSM compared to the Malleus Maleficarum (the book used to “diagnose” witches) was in a presentation made by one of the leaders of this agency to all the staff.) So I haven’t had the kind of pressure you experienced. I did work for a few years just part time at the county mental health department, where there was pressure to fit in with the medical people – but I deliberately bucked the pressure and gave them a hard time, till they decided they didn’t need me working there anymore.

    In another post, Will Hall wrote about how we have to do something about corruption if we are ever going to have the big changes we need. Pressure on professionals to go along with faulty views if they want to keep their job is just another kind of corruption.

  • I think it is important for a movement to both celebrate its successes as well as notice its failures, and I think it’s way overgeneralizing to say simply that we have so far failed.

    There are lots of people who have regained control of their lives due to help from our movement and the messages that we have promoted. These are real people with real success. That success should be counted, even though we know it is only a small minority that have been helped so far, and in many ways the oppression we fight is just spreading.

    I would agree that the bigger changes will require political change as Will indicates. But while I think we should see and work with how our movement links up with larger ones, like the one to get big money out of politics, I don’t think we should just give up all our mental health reform organizing to, say, focus exclusively on the money issue! A better approach I think is to present our issues as being just one of many where corruption is leading to bad outcomes.

    Getting the big money out of politics is also something that people have been working on for a long time, also not with great success! But if these efforts ever do succeed, it will be because the public notices the vast areas of corruption and the damage it is causing. Activists in our field can help by increasing awareness of corruption in our field, while also doing our best to bring a better approach wherever we can.

  • Thanks for writing about this. I practice and teach CBT, and I’m ashamed to have this kind of practice associated with CBT! It does violate some important principles, starting of course with the fact that CBT is supposed to be practiced by collaborating with the person receiving services, and with the aim of helping that person achieve that person’s goals, not the goals of the therapist or psychiatrist. It’s also supposed to be about helping people arrive at balanced thinking about a topic, which means exploring the positives and negatives of a given course of action – rather than deciding in advance what to promote!

    I think some professionals have become so convinced that the drugs are necessary, that they see any impulse to quit drugs as being completely irrational, and so they feel entitled to do whatever they can to get people to persist in taking them. As Noel Hunter pointed out recently, too many professionals spend way too little time considering that some of their own opinions may be wrong, irrational, etc.

  • Since 2013 the use of opiates has increased all over the US. Is it possible that this, and not legalized pot, might be behind any increase in teen use of opiates?

    Maybe instead of making recreational pot illegal again, so sacrificing tax revenue, turning the recreational pot market over to black market people, and then spending lots more tax money to arrest and imprison people (and you have to add on the massive social cost of harming the people who are imprisoned) – maybe instead of that idiocy, we could actually spend a little money helping protect teens from abuse and helping them find something better to do than use drugs? Remember rat park http://www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park

  • You wrote that “These findings underscore the impact of early onset of marijuana use on executive function impairment independent of increased frequency and magnitude of use.” Well no, they don’t. You are jumping ahead of the actual evidence.

    The problem is that the experimenters didn’t just randomize kids into those who were going to smoke early and those who wouldn’t smoke: instead, they worked with a group who self selected to smoke or not. And a contrary hypothesis would be that those who decide to smoke a lot are those who already are likely to have the brain differences you mentioned. The marijuana itself may have nothing to do with it.

    I seem to recall a study where it was found that kids who smoke marijuana were more likely to have been sexually abused, and the sexual abuse itself may be what often led to brain changes that then led to vulnerability to psychosis. Other kinds of trauma, and factors in addition to that, could also be at play. I’m not saying we should rule out the possibility that pot is itself causing serious problems, it’s just that we shouldn’t jump to that conclusion, especially when there are so many people ready to ruin lives in another way, by throwing people in prison for the crime of using or selling substances not provided by psychiatry.

  • Chuck, if the experience of taking pure THC is so terrible, I’m sure we don’t need laws to keep people from doing it! One of the nice things about having pot be legal is that people can know about the balance of THC and CBD in the strain they are buying, so they are more likely to get the experience they want.

    Of course, it’s also possible that some people will enjoy the same drug that another person hates. People don’t all react the same to a substance.

    I would agree that it makes sense to discourage pot use in adolescents, and that at least in some cases, pot use can contribute to psychotic experiences (I had that happen to me when I was a teenager.) But it is not clear that pot on average is making more teenagers psychotic – see articles like https://www.scientificamerican.com/article/can-marijuana-cause-psychosis/ We need a balanced approach to this topic, not one that exaggerates problems and then advocates for arresting and imprisoning people to “solve” those problems (without ever considering that there are huge costs to labeling people’s choices as criminal and locking them up.)

  • I find all the concern about the potency of the drug to be a little lame. In the past, people had to smoke a lot of pot to get really high if they wanted to – and they did, when they wanted that. Now people don’t have to smoke nearly as much. Smoking less seems good for the person’s lungs. The idea that high potency equals danger seems to rest on the idea that people will get way more high just because it is more potent – as though people have no ability to regulate how much they smoke, or otherwise ingest.

    Like any drug, we need to hear about the bad as well as the good about pot. But for too many years, we have had lots of hype about how bad it is, and all this concern about dosage sounds like more hype to me. (For example, the hype that pot use leads to other drugs. In regards to opiates for example it seems more likely that pot use leads to less opiate use – https://www.nbcnews.com/health/health-news/legalized-marijuana-could-help-curb-opioid-epidemic-study-finds-n739301 )

  • I like Mark Twain’s comment: “Let us consider that we are all partially insane. It will explain us to each other; it will unriddle many riddles; it will make clear and simple many things which are involved in haunting and harassing difficulties and obscurities now.”

    I agree with Sera that there are problems with calling Trump mad: but there are also big problems with not noticing he is in a sense mad! So I don’t have an answer to offer, maybe we just need to have a dialogue that won’t have a solution.

  • Jolly Roger, I think I will choose to leave this dialogue, as you keep making lots of assumptions that don’t relate at all to what I see happening, such as your claim that therapists always stand with and make excuses for abusive authorities.

    But before I go, I would like to say something in response to Masson’s statement you quoted, “The practice of psychotherapy is wrong because it is profiting from another person’s misery.” Would you say the same about a doctor who helps people with broken bones? After all, the doctor would have no job were it not for the misery of those with the broken bones.

    My point would be that if what the doctor or therapist do actually helps with healing, then their practice is worth something.

  • Jolly Roger, it sounds like you must have had some pretty terrible experiences of “psychotherapy.” I wonder though if you ever consider that perhaps some others have had very different experiences, and may have been helped by therapists?

    I think you are making a false conclusion when you suggest that if injustice is the cause of problems, then there shouldn’t be any focus on helping the individual change.

    In the case of physical trauma, we know that’s not the case. If my arm is broken during an assault, that’s an injustice, but I also need to work on changing the state of my arm, because there is now a problem with it. And the problem with my arm doesn’t go away even if the injustice of the assault is fully recognized and those who assaulted me are punished or apologize and reform themselves or whatever.

    I think mental and emotional trauma is often the same. It starts with injustice and abuse, and we do need to recognize that, but also we need to create the conditions for healing within the individual, and in the experience of many of us, a good therapist can be helpful with that.

  • Tim, I don’t think anyone here has proposed saying that people taking drugs can’t be counted as being engaged in recovery! The discussion, instead, was always about whether or not it made sense to say they were “fully recovered.” I objected to that only because it implied that such a person was done with recovery, and being done or finished with recovery of course implies that one couldn’t possibly recover any more, which would imply that there was no possibility of ever recovering more to the point of being able to get off the drugs.

    By the way I don’t believe in rating people as somehow “better” or “worse” because of the degree of recovery they have achieved. There’s a lot more to life than recovery from specific problems. A person may have been in an accident, and still walk with a cane, and so they aren’t “fully recovered” from the accident but they may be making amazing contributions to the world not being made by others who were never in such an accident or who were but are now indeed fully recovered. The same with particular mental/emotional injuries or difficulties. I agree with you that “mad diversity” is complex, as is human diversity generally, and there is so much about the value of each human being that is unrelated to whether or not they have “fully recovered” from any particular problem.

    I understand that people relying on drugs to stay stable etc. may decide it isn’t worth the risk and the effort to try and get off the drugs. I can’t tell them they are wrong, because I don’t know if they are wrong or right. But what I do know is wrong is anyone telling such people that we know they have gotten as far along on the road to recovery (or healing, if you prefer that word) as is possible, when for all we know, it really is possible for them to go further, if they decide that matters to them.

  • I found myself agreeing with everything that was said in this post!

    One way of conceptualizing psychosis is to see it as the mind’s attempt to turn to confront things that seem to the person otherwise too much to face. This seems to be “loosing one’s mind” because at first one cannot have a coherent mind in relation to those things (which might range from childhood abuse that was never integrated to facts about existence that no one in the culture seems willing to face.) But if people are supported, they can often find a way to face what were formerly overwhelming aspects of existence in a coherent way.

    One reason this process is so hard for our society as a whole to grasp, is because we can’t really support people in this process without acknowledging that there is a lot out there that most all of us have not learned to face directly……

  • Hi Daniel,

    As I see you respond to these comments I start to understand your thinking better. If you are talking about recovery as meaning just finding a way back to having a place in society, then it does make some sense to say one can be “fully recovered” and still taking some psych drugs.

    But the distinction still seems clunky to me. To use an analogy to something physical, I’m imagining a tennis player who suffers an injury, which gets bad enough that she can no longer play. Using terms the way you are using them, one would say that she was “fully recovered” once she could return to the game without impairment, whether or not she was still wearing a brace or needed regular physical therapy etc. to keep functioning. But one would only say that she was “fully healed” when no such supports were needed.

    I don’t think though that most people make such distinctions between “recovery” and “healing” – instead, the terms get used more interchangeably. And if people want to make the kind of distinction you are making, they use a few more words: for example, our imagined tennis player might say “I have made a full recovery in terms of my tennis game, but I can still only function at that level if I wear a brace…..” This both outlines the progress that has been made and describes what is not yet “recovered.”

  • I think there is indeed a big paradox in looking for a “cure.” When someone believes they have an illness that makes them fundamentally different than everyone else, then they will seek a fundamental change in themselves to fix or “cure” or eliminate the problem. But if there really was no fundamental difference in the first place, then there will be no way to make this fundamental change, and the person will just feel stuck being “ill!”

    The only way out of this is to give up the search for a “cure” and look for ways to get on with life while being the person one is. So instead of getting rid of one’s paranoia for example, one might look for a way to live with it and not take it too seriously, to balance it with other thoughts and feelings. Eventually one might find that the paranoia is still present in some form, but is no longer interfering (but maybe is even being helpful some of the time, helping one avoid being too trusting.)

    A lot of the problem with mental health treatment approaches is that they get people focused on getting rid of parts of themselves or reactions within themselves that they have learned to frame as “illness” – when a better approach might be to just accept those parts and reactions while experimenting with relating to them differently, so that life can proceed. Once people do that they might discover that they aren’t fundamentally different than other people at all, that we all face that task for example of having paranoia (and reason for paranoia!) yet also the need to keep paranoia in check, and we all can recover from temporary losses of balance in managing this, even when that loss of balance has been more extreme.

  • Hi Frank, I get it that “heartbeats of hope” could come across as sappy, but I think Daniel Fisher sometimes emphasizes emotional stuff because in the past he was around people who convinced him emotions and feelings were something to be eliminated and pushed away, and he only put his life back together once he made space for emotion and feelings. He’s very aware of how affect is central to our existence, and I don’t think he’s wrong about that – Michael Cornwall emphasizes the same thing.

    I agree with you that “resolve” is sometimes a better word, but “recovery” does have a wide meaning as well. One recovers not just from illnesses but also from traumas, and one can recover after losing one’s balance, etc.

  • Yes, recovery is a tricky concept, especially when you include the idea of “vulnerability to relapse.” Some people would say that if you have had a mental breakdown or had been caught up in addiction, then you should always consider yourself to be more vulnerable than the average person, always “in recovery” rather than recovered. But as Ron Bassman has pointed out, this may not be true in particular in regard to mental breakdown or crisis. He noted that as a result of his recovery from two episodes of psychosis, it was possible that he had learned a lot and gotten stronger in various ways that actually left him less vulnerable to future episodes of psychosis than was the average person. The same could be true of some people who had previous trouble with addictions.

  • Hi Steve, I very much agree with you that it is difficult to determine exactly how many of the early deaths that bad psychiatric practice is causing. That issue is open for debate. But my point is simply that we shouldn’t talk as if we know that psychiatry is causing all of them, when we have reason to believe that some early deaths would happen even if psychiatry did not exist.

    And I agree with you that corrupt psychiatrists will try to paint us as extremists whenever we criticize them. My point there is simply that we shouldn’t make it easy for them by making claims we can’t back up with facts.

  • A few more points:

    In response to FeelinDiscouraged: I don’t feel any need to always get along with psychiatrists. I was fired from one job for repeatedly criticizing them, and where I work now I was recently attacked by a psychiatric nurse as being a danger to my clients because I’ve attacked his belief that he can know that some people need to stay on drugs.

    To Uprising: I do believe that anytime we express views that are more “radical” than are justified by the facts, that we are being a liability to our movement. I think just as we insist that psychiatry should face facts, we should also be willing to do so.

    And samruck2, yes, you are correct that I see myself aligned with Whitaker, being critical of bad psychiatry or opposing psychiatric corruption, but not being opposed to any thoughtful and restrained medical assistance with mental or emotional problems.

  • Michael, if you really are at risk of coming across to people as an irrational fanatic, and then if I point that out to you, I hope you can see that’s a friendly action. Much as if you were at risk of driving off a cliff and I pointed that out, it would be a friendly action, an effort to help you out. I’m trying to save you from going over the cliff, because I support the main drift of what you are doing, and I don’t want you to lose your credibility by making claims you can’t back up. You have enough claims that are solid, why not rely on those?

    By the way, in response to FeelinDiscouraged, I agree that educating the public is more doable than educating most psychiatrists. But still, it takes having some credibility, which is easily lost when we put forward supposed “facts” that are easily disproved.

  • Richard, we probably just have to agree to disagree here. You aren’t convincing me of anything. I know that sometimes it is important to condemn something as both harmful and useless – as it was with the Vietnam war. But that model or metaphor doesn’t fit everything. Sometimes those who imagine themselves the “vanguard” go overboard and lose credibility as they start making attacks that go beyond anything that can be justified. Then the whole movement that “vanguard” is part of is weakened. That’s my view, and I don’t imagine it will shift anytime soon. I hope some of those reading these comments will be able to take my points into account and will become more effective as a result.

  • Michael, in his comments for example, made points about how patients are dying at dramatically high rates under psychiatric care, and he even explicitly said he sees the deaths that happen when under the care of psychiatrists to be “wrongful deaths.” I actually agree with Michael that many of these deaths are due to bad treatment, my point is simply that it is wrong to suggest that they all are, when many people who are having severe mental crisis would die earlier than usual even if there were no psychiatrists.

    There are certainly plenty of wrongs being practiced by mainstream psychiatry, and ignoring of evidence for wrongs, we don’t need to be exaggerating to make our points.

  • Richard, I’ve already stated that my interest is only in defending psychiatry against unfair attacks, not against the fair ones. And you are right, this does have something to do with my interest in appearing credible as an educator – but I also want to convince as many of the contributors and readers here as I can to also frame arguments so as to come across as credible, rather than as fanatics making irrational attacks! My interest is in seeing us really persuading people (not just the choir members) and causing change to be made, and that does require coming across as credible in my opinion.

  • Hi Seth,

    I very much agree with the idea of holding psychiatry responsible for all the things it is guilty of, many of which you list. I am simply opposed to charging it with offenses that it is not guilty of. I think this weakens our case overall. All psychiatry has to do then is refute the false charges we have made, then use the fact that these false charges were easily refuted to imply that all the other charges are also baseless.

    We are much better off focusing on the issues where we are clearly right, and where psychiatry and the mainstream mental health system has been clearly wrong!

  • Michael, are you saying that if psychiatrists lie and say psychosis is a medical illness when it isn’t, then it is OK to hold them responsible for every early death, even though we would expect many of those with psychosis to also die early if there were no such thing as a psychiatrist?

    It seems to me that you are dodging the question of whether or not it is OK to leave the impression with readers that psychiatry is to blame for all of the early deaths of those diagnosed with “psychotic disorders” etc. As you know, I very much am in favor of blaming them for SOME of these deaths. But if we are ever to get beyond preaching to the choir, we need to use arguments that we can back up with facts, we need to avoid sounding like we are exaggerating anything. Blaming psychiatrists for all of the early deaths plays well for the MIA audience, where most (with good reason) are angry with psychiatry. But it doesn’t hold up when looked at critically, so it makes your argument unlikely to carry beyond the “choir.”

  • Michael, it seems to me your post would be read by most anyone as blaming psychiatrists for the 25 year early death rate, which you call “obscene.” Would you agree that it comes across as blaming them for that?

    My point is simply that we should take care to only blame psychiatrists for what they are actually responsible for, and no more. Your article was about the stupidity of psychiatry, and what they are to blame for. When figuring out how much psychiatry is to blame for early deaths, it’s really irrelevant whether the early deaths are caused by some physical or organic process, or something else; the key question is just whether and to what extent psychiatry is to blame for them. I think it is clear that most anyone reading your article would think you were blaming psychiatry for all of the early deaths, while I think the evidence would indicate they are only responsible for some of them. Do you agree or disagree?

  • I certainly agree with the main point, that mainstream psychiatry with its disease model shows a lack of good sense or judgment.

    But I would also point out that good sense or judgment are not so easy to come by when we are facing something that seems threatening.

    Terrible experiences are threatening to people, and so they often lose their good sense or judgment and become mad (or become fools, as the medieval expression had it.) Those faced with madness feel threatened, and often lose their good sense and judgment, and embrace destructive dogmas like the medical model.

    But it doesn’t stop there: because people who feel threatened by the foolishness and destructive power of psychiatry don’t always show the best “sense and judgment” either.

    One way this comes out is exaggerating the wrongs of psychiatry, which has the unfortunate effect of reducing the credibility of our movement.

    Michael, you wrote that “….psychiatry stands alone among all other medical specialties with a death rate of psychiatric patients that has them dying 25 years sooner than the average life expectancy. And this obscene death rate is for so-called diseases — such as what wrongly gets called schizophrenia — that have zero lethal, physical or organic risk.”

    Really, “zero” lethal risk for the kind psychic turmoil that gets called “schizophrenia”? It seems to me that this is actually far from the truth. Without any help from psychiatry, madness can lead to suicide or extreme or risky behavior of many sorts that can lead to early death. And those who become mad are often people previously subjected to childhood abuse, which we know puts people at risk for an early death from a huge number of ailments.

    I think we come across as much more credible and effective when we “only” blame psychiatry for contributing to the early death rate by pushing dangerous drugs that often aren’t needed, rather than blaming them for all the deaths when that accusation is easily refuted.

    I think we all have important truths to tell, but we can only manifest “good sense and judgment” when we also watch out for our own errors and seek to correct them, rather than dig in and defend them. Michael, I know that you in particular have important truths to tell! I hope that all of us, the “mad,” the psychiatrists and mental health workers, and those who critique psychiatry etc., will find the space to slow down and notice errors, so we can all come to really practice “good sense and judgment,” qualities that are not easy to find!

  • Bonnie, I want to notice that in your last comment before this one, you agreed that some medical assistance could be of use for some people who had mental and emotional difficulties, but then stated this could always be done just as well by a general practitioner. I refuted that notion, and explained why it would make no sense to ban doctors from specializing in this area.

    Now, instead of attempting to refute my point, or alternatively acknowledging that I was correct, you are just redirecting attention to another flawed argument, which is the notion that all of psychiatry rests on myths and misrepresentations.

    Clearly, “mainstream” psychiatry does rely on such myths and misrepresentations. But you aren’t just calling for abolishing the sort of psychiatry that relies on such myths and misrepresentations: you are calling for abolishing all of any possible psychiatry, all of any branch of medicine specializing in helping people with mental and emotional problems. For this argument to make sense, you have to give us a reason for society to stop any group of medical doctors from specializing in helping with mental and emotional problems even in a well informed and humble and humane way: and you have clearly failed to provide reasons to to that.

  • Hi Oldhead, you may imagine that the psychiatric people I talk to sometimes “fear and loathe” antipsychiatry, but I’ve been in these conversations, and it’s obvious to me that the term is one they see as making someone easy to dismiss, like calling them a Scientologist or a flat earther or a racist. What they have a much harder time dealing with, what they can’t easily dismiss, is someone who has a clear focus on what’s wrong with particular psychiatric practices and who can articulate why these practices are harmful.

  • Hi Julie, I think you are right that for most people, the only “help” they might actually need from a psychiatrist is help getting away from or free from any kind of psychiatric intervention!

    But there are other kinds of stories. People can get into terrible mental states, or even end up dead due to mental and emotional distress, without ever encountering the mental health system, so we can’t blame that system for all the terrible problems people experience. And sometimes people actually get pretty well informed non-medical help with mental and emotional problems, and are still stuck in some terrible states. And sometimes people who are stuck in those ways actually do find some help in psychiatric interventions.

    This may be rare, but if it happens even once or twice, that implies that abolishing all of psychiatry would be a mistake, as it would make that kind of help impossible. So it makes more sense to simply call for abolishing all of the corrupt or misguided parts of psychiatry – that can be done without denying anything to people whose story is different from many MIA contributors, and who actually might benefit from something that could be called “psychiatric.”

  • Bonnie, I want to notice that you are no longer claiming that any possible good work done by someone calling themselves a psychiatrist “is not medical in nature” – I’m glad you are abandoning that flawed argument which you offered earlier.

    But it seems you are now falling back onto another flawed argument, which is the idea that while medical methods may sometimes be helpful, we should nevertheless abolish any attempts by anyone to specialize in offering medical help for mental and emotional concerns, and seek to make sure that any such help will only be offered by medical doctors who have no special expertise in this area!

    I do understand the sentiment behind the above argument. If a specialty is corrupt, and mainstream practitioners within that profession have beliefs and practices that routinely cause great harm, then one is likely to do better going for help to someone who is not a specialist.

    But really what is needed in the big picture is simply the elimination of the corruption, not the elimination of the specialty.

    It should be noted that people routinely get lots of terrible “help” from general practitioners as well as from psychiatrists. A non-corrupt psychiatry, like any good specialty, would seek to sort out what is truly helpful from what is not, and would guide general practitioners in becoming more effective in helping, and in stopping doing the harmful practices. It would also be seeking to understand more complex questions and possible interventions that may be beyond the grasp of general practitioners, as in the work being done by the doctors in the mental health excellence article I linked to above, where they were finding and treating metabolic problems that contributed to very serious depression. I know, this sort of thing is currently rare, because psychiatry by and large is currently very corrupt. But it is possible, and the possibility of any specialized medical help for people with mental and emotional problems means that any call to completely abolish such specialized help will inevitably come across as fanatical and illogical, and as an overreach. It’s a much stronger position to simply be against “bad psychiatric practice” which can be understood to include most all of what mainstream psychiatrists do (including believe in the DSM.)

  • Hi uprising, I encourage you to notice that I’m not saying that helpful medical approaches by psychiatrists are common, just that they are possible, and happen sometimes. There are some psychiatrists who are very interested in what’s coming out about gut bacteria and our emotional functioning for example. I know that bad or even despicable practices are much more common, I’m just saying, let’s focus on opposing what’s bad and avoid saying that every medical thing psychiatrists do is bad, when that isn’t true.
    Oh and by the way, alcohol is actually a pretty poor thing to prescribe for sleep. It does help people get to sleep briefly, but then makes sleep worse.

  • Bonnie, I think your argument rests on an assertion that it is impossible for a psychiatrist to do anything that is medical in nature that truly helps people with mental and emotional difficulties. If this were true, your position would be logical, but it clearly isn’t true.

    It is for example a form of medical help when a drug is prescribed that helps someone sleep when that person has been spiraling deeper into a “psychosis.” it’s a medical kind of help when people get assistance with getting gut bacteria back into balance, or when people find out about medical conditions that may be contributing to mental and emotional problems, or in the sort of work described in this article http://www.mentalhealthexcellence.org/cut-off-bereft-nervous-system-may-eat-away-will-live/?omhide=true And that’s far from a complete list of possible medical sorts of real assistance.

    What I’m saying is that the abolitionist opinion is easily attacked is because it is logically flawed. It seems you can only defend it by making assertions that themselves are flawed (like that no one is ever helped with a mental or emotional problem via an intervention that could be legitimately described as medical.)

  • Bonnie, I noticed your question to those who aren’t ready to identify as antipsychiatry: “What is stopping them from taking an abolition position?”

    I could offer you a couple of my own answers. One is that I think identifying as antipsychiatry is actually a much weaker position than identifying as critical of bad psychiatric practice. I notice for example that when I critique psychiatrists or those who support bad practice, they usually immediately want to label me “antipsychiatry” – they like doing that to critics almost as much as suggesting that critics might be a Scientologist!

    The reason they like labeling critics as “antipsychiatry” is that it makes critics appear to polarized in a dogmatic or thoughtless fashion, rather than someone with a reasoned critique.

    For example, for any member of the general public, all they have to do is think of any problem a psychiatrist might legitimately help with, and then to them an “antipsychiatrist” sounds like someone who would mindlessly try to prevent this help from being offered.

    I agree with you that being “moderate” on every issue is not correct, and that it makes sense for example to simply be “anti-racist.” But some psychiatrists do sometimes help people in a non-oppressive way, so psychiatry in general is not something so thoroughly bad as racism, even if it is largely terrible.

    Being critical of bad (well, most) psychiatry is a much stronger position: one is only taking a stand against something harmful, and one is clearly grounded in a concern to prevent harm, rather than some dogma or fanaticism or overreach.

    I critiqued the abolitionist view this post: https://www.madinamerica.com/2016/05/psychiatry_slowed_down/

    I wonder, what stops you from recognizing the weaknesses in the abolitionist view?

  • Thanks Helen for sharing these stories. I commend your strength in being able to continue to work in circumstances where such obvious truths are so routinely discounted, with horrible effects!

    I look forward to a time when it will be routine for everyone who works in the mental health field to understand the possible impacts of trauma. I do think better education is one way to move toward that goal; and related to that, I’m happy that it’s now up to 495 people enrolled in my online course, http://recoveryfromschizophrenia.org/working-with-trauma-dissociation-and-psychosis/ Now only maybe tens of thousands more people to reach…….

  • Frank, I agree with you that we have much to learn about how what are now usually called “mental health” issues were handled in simpler societies. But in many ways these approaches were not “simple” – they were embedded into stuff like spiritual or shamanic practices that we have mostly lost touch with these days, or that we have only the most superficial understanding of. And I also agree with you that caring can exist outside of any organized “mental health” system approach – but a problem is that when people go into extreme states, they very often disconnect from or lose their ability to access the conventional kinds of relationships that involve caring in our culture. People can get very isolated and do very poorly. Just letting that happen is not a solution, just a different kind of problem. We need real solutions, and such solutions, like Open Dialogue, will inevitably draw on the best of our current system while rejecting the corruption etc. that defines so much of what is happening now.

  • Richard, I think our disagreement stems around what we are calling “the mental health system.” I am, I believe, thinking in broader terms than you are. To me, anytime a few people join together for a coordinated approach to helping people in distress, you have a bit of a “system” of care. And when someone forms a Soteria house, or a system of Open Dialogue in an are like Tornio, they are part of the “mental health” system, just a better part of it. (And these approaches draw on some of the better parts of mental health care that have been around for awhile, as Open Dialogue drew on psychodynamic and family therapy approaches, and that illustrates that future improvements are likely to build on the best of what we already have, rather than on rejecting everything we currently have.)

    I think if we are ever going to succeed, we need to focus our language and focus our attacks. You may be clear in your own mind that when you call the mental health system “rotten to the core” that you aren’t attacking all the counselors and even some psychiatrists that are out there doing good work. But don’t expect this is going to be clear to anyone else. It sounds like you are attacking everyone. It’s better I think to attack just what is bad practice: I agree with you that bad practice is what is dominant, but we need to be careful not to lump the good bits in with the bad.

  • Richard, you write that “Of course people need supports of various kinds, but these will not, and cannot, be anything remotely related to what currently exists.” Really? So for example one kind of support that currently exists is that people talk to other people about what is going on in their lives – do we really need to eliminate that, or anything remotely relate to it?

    One of the most dysfunctional aspects to mainstream approaches is the frequent oversimplification of complex human realities. I don’t think we will fix things by offering oversimplifications of our own, especially not ones that insult all those who are currently trying their best to do what helps and stop what hurts, and who are part of the better side of what currently exists in the form of supports. (Calling such people and their networks “rotten to the core” is probably not the best way to win allies.)

    Perhaps you could fill us in on how you imagine this complete dismantling of the system, that allows for absolutely no “danger of some of the totally corrupted elements infiltrating any new types of support systems that emerge to replace it” will work. Will there be a ban on anyone who currently provides support from working in the new system, to prevent any “infiltration?” Or maybe we could just ban anyone who has ever read a book or even thought much about “mental health” from providing such support, since maybe they too are corrupted by bad ideas related to current practices?

    I do share your disgust and horror at most of what is going on in our field. But I’m urging you and others who are reading this to attempt to be strategic in how you channel that disgust, so that we can avoid driving away potential allies and can work toward changes that are actually possible, instead of pining away for a day of perfect dismantling and starting over completely fresh that will never happen. And I know I won’t reach all of you with this appeal – but hey, if I get some of you thinking, that’s an accomplishment. I do celebrate partial victories!

  • Hi Chrys, thanks for sharing your story, and giving us an overview of the complexity of some of what you and your family have been through!

    I definitely do hear clearly from some people such as yourself who say that they have found psychoses and altered mind states to be positive and useful, and the only real negative has been coercive and misguided treatment. But I also hear from others who have found their own experiences of psychosis to be very destructive to themselves and to people around them, without any redeemable side that they could find. How can we reconcile those two views?

    One is to observe that not all states called “psychotic” or simply “altered” are the same, or have the same effects. A second observation is that any state is in large part what one makes of it, and some people may simply not yet have discovered how to avoid destructive effects, and how to make something constructive, out of their “psychotic” experience.

    A simple example might be someone hearing a very domineering voice telling them to kill themselves. The person who collapses in the face of it and attempts or succeeds in killing themselves in response will not do well. But another person may experience something very similar, but manage not to be overwhelmed and to maintain some curiosity, and end up learning something both about their own strength and their vulnerability as a result of the experience.

  • Hi Frank, I would very much agree with you that a corrupt or misguided system can easily be worse than no system at all. But that is very different from saying that the best solution is to not have any system whatsoever! Those seeking reform are looking for a system that is likely to help rather than hurt, and that’s what makes the most sense to me. We need reform that is quite radical, not just bandaids, but I would hate to see our movement organize around the notion of getting rid of any system of caring or helping.

  • Richard, I hear your call to completely eliminate the mental health system, which you are sure is a higher calling than just reforming it.

    So here’s a question.

    When people have very severe psychological distress and confusion, do you think that possibly they might be in need of forms of support that are a bit different in some way from the forms of support that are available in general to everyone……or not?

    If you would propose that nothing special is needed, I would propose that you are being naive. More likely you will suggest we do need a bit different of an approach to people who are in extreme states, and that this approach needs at times to be organized – but you just don’t want to call such an organized approach a “mental health system.”

    I would say you are kind of like a person that wants to get rid of the government rather than reform it, and who claims this is absolutely necessary – but really this person also know we do need some way of organizing ourselves and managing things, it’s just that they don’t want to call anything that isn’t corrupt a “government.”

    Any system or organized approach to helping people in psychological distress can be reasonably called a “mental health system” just like any medical approach to supporting recovery in such cases might be called “psychiatry.” So I think it’s kind of foolish to talk about eliminating such categories completely, when it is clear we need something along those lines, just not the corrupt versions we have today.

    Anyway, I should also thank George for writing his article, I hope to hear more from him!

  • Thanks someone, I appreciate the dream you share. Sorting out what might be of value in confused states that go outside of convention, rather than assuming it is all garbage, is really the key thing that is needed here I think. And if we do that, we are I believe also less likely to treat people like garbage. Rather we would collaborate with people in figuring out what might be helpful in their experience, and how to put it to use.

  • Hi Richard,

    I think some caution is needed in discussion about “magic.” Certainly one can think of cases where people delude themselves into believing they have special powers when they don’t. But life and consciousness are very complex, we don’t fully understand it all, and people are able to come up with new ways of doing things that at least seem like “magic” to others. And much of what is often described as “magic” may be perfectly functional within the psyche, where what is believed to be true often becomes true – after all, the placebo effect, which is basic “magic” is one of the strongest effects in all of medicine!

    In the video I linked to, Ingo talks about how in his tradition, they would test people to see if they really had the “magical” or paranormal powers they claimed, or if they just thought they did. Even if you imagine that Ingo couldn’t have really have passed the test he claims to have passed, you might at least endorse the idea of keeping an open mind, but testing, which is what he proposes.

    I would also be cautious about framing madness as “a coping mechanism.” I would say instead that madness involves attempts at coping. Sometimes these coping methods only seem to work, but really make everything worse. Sometimes they really work in one respect, but create huge problems in another dimension. Or they worked for conditions at an earlier point in our life but they aren’t working now. And sometimes stuff just seems “mad” but it really works great – those are actually moments of brilliance, not madness!

    We get to mastery when we really have good perspective on what works for what problem, and we apply that knowledge in the present in a way that works, and when we find ways to avoid solutions that create bigger problems in other dimensions. Of course, we are all very limited in our areas of mastery – if humans were really competent, we wouldn’t be destroying the habitability of the planet!

  • I appreciated the comments about witchcraft! I think we have a lot to learn from traditional understandings and ideas about spirits, or what seem to be spirits. “Discernment” is one really key thing – deciding when to be open to something, and when to focus more on boundaries.

    Our mental health system is all focused on resisting any influence from spirits or what seem to be spirits or voices, it’s all about putting up walls, with “health” being imagined as having walls so impervious that it is impossible to even notice that anything exists outside the walls! But really that is kind of dead. Better to have both boundaries and some openness, with discernment, as LavenderSage describes.

  • Thanks AuntiPsychiatry, for your comment! I have been a fan of your work for a long while, and I really like the cartoon you linked to.

    I don’t think it’s entirely impossible though to explain the “madness to mastery” concept to those who haven’t experienced “madness.” I have given classes on spirituality and madness, attended by mental health professionals, who at least seemed to grasp the general idea. Of course these were the more open minded ones already who had been willing to sign up for the class!

    Lots of others of course may be way too closed. They never seem to notice that being closed minded is part of being “delusional,” and this could mean their own views are in need of some revision……

  • I think the work you are talking about of noticing more about yourself so you can relate your experience to your wife’s is a key step left out by many who work in the mental health field! Without that kind of self awareness, it’s hard to help people who already feel “different and defective” to see more options.

    As we become more self aware, we see our own ability to go into various altered or extreme states – even if we don’t always go there. I think this leads to the reduced sense of difference that you are talking about.

  • Hi Sam, thanks for sharing about your family’s struggle, and your own struggling with the “concept of ‘gaining mastery’ over something that is inherently dysfunctional.”

    I would suggest reflecting a bit about what you might be defining as “inherently dysfunctional.” While I would agree that any abuse someone suffers can reasonably be called “inherently dysfunctional” I think the things people do to cope in response are more ambiguous. Dissociation for example in the right context, and done in a way that matches the context, is a useful skill, not a dysfunction. It is only dysfunctional when done in a way that doesn’t match the context. Of course, if your wife is still caught up in using dissociation or being dissociated in a kind of automatic fashion, that often causes trouble for her, then it might really be dysfunctional in her life currently. But it’s also possible she may gradually learn to have mastery over that process, and find she can eventually benefit by being more able to see herself or to be both parts and a whole, compared with the average person.

    One analogy I think about related to trauma and discovery is a story of a pirate who kidnaps a child and takes that child to an island somewhere. This is very traumatic and disruptive. But now let’s move forward 20 or 30 years. Maybe the pirate is long gone, and the person who had been kidnapped now voluntarily lives at least some of the time on the island, and enjoys it immensely, as the island offers features not available in the homeland. He or she is also able to travel and go back to the former home, visit family etc. (or maybe family has also moved to the island.) In other words, what had been something discovered within a traumatic experience, might become an asset later, once the person has been able to overcome the traumatic aspects and get to a place of choice. (While a more rigid approach to “recovery” might say the person has to come back and live in the former homeland in order to “recover” since living on the island is part of the “disorder” associated with the trauma, or kidnapping.)

    Anyway, I hope that makes at least some sense……

  • Hi Kindredspirit,

    I would like to comment on a couple points you made…..

    I think some of James’ examples were not about something that was causing any immediate distress, but something that would likely lead to distress if the person kept doing or believing it. So believing vodka helps with homework may even be true the first time one tries it (particularly if anxiety was getting in the way of the homework) but continued reliance on the vodka may lead to disaster, and extreme distress. Such possibilities might be worth talking about……

    In my experience, I have found that it is often very important for people whether or not they think a belief is literally true, though even when they think it isn’t, they may still have the problem with a strong feeling that it is true such as what you describe.

    If one thinks it is literally true that swarms of bees will come out of the AC vents, one will have no good reason to even contemplate driving the car. So a first step might be to get to where one knows intellectually that this is not going to happen. Then there remains the problem of how to face the feeling that it is going to happen. I end up talking with people about how this can be hard but is often very liberating work – learning that one can do things even when strong feelings are warning against it. I can use examples from my personal life, like when I was still terrified of the dark but was old enough to know an empty room that was dark was not dangerous, etc., and so I was willing to venture into the dark room despite my fears. Often people can recall their own examples of times they successfully faced such feelings. And it can help for people to imagine they have a part of themselves that does believe the fear, and to talk to that part in a soothing way, while also refusing to give into it if that part cannot present good evidence for the existence of actual danger.

    Obviously all this kind of work is only likely to succeed in the context of a friendly and respectful relationship. But within such a context, curiosity about what may actually be true, and an interest in challenging possibly inaccurate beliefs, can play a vital role.

  • Thanks Steve. I think this all gets tricky because of the way things can go wrong in more than one direction. So we can go wrong by being too sure we are “right” as you emphasize. But we can also go wrong in some situations by being too passive, and not emphasizing the way we may be right in an important way “I think the truth is that the rat poison will kill you!” So we have to approach each situation with some sensitivity to various ways of going wrong, in my opinion.

  • I want to appreciate James for bringing up this important issue! He certainly didn’t address it perfectly in my mind, but just pointing out there is a real issue there is an accomplishment.

    Sometimes it can come up in a very graphic way. If someone holds up something that looks to me like rat poison and says that it is a medicine that will cure them once they drink the whole bottle, I might have a real hard time helping them without trying to modify their belief! (The same might be true, in a less urgent way, if the person is holding up something that looks like Risperdal, and says that it will keep them healthy if they just take their prescribed dose for the rest of their life.)

    I believe that at times it is quite possible to help people without seeking to modify beliefs at all. Actually many people who are doing fine in the world hold beliefs that psychiatrists think are delusions – one study found that 10% of the general population hold more “psychotic beliefs” than do the average psychotic inpatient! So sometimes we can just help people learn to handle life better while continuing to hold their belief.

    But often other approaches are needed, or can help. When I teach CBT for psychosis I suggest thinking of 4 ways of helping, with helping people find ways to handle life better being just the first. The second involves reviewing with people how they came to have the belief, which can both create understanding of why things looked that way to the person while increasing understanding of why it may look differently to others with a different history. Third involves working with what may make the person vulnerable to having the belief: so if the person can be helped to feel better about themselves, they may not need so much to have a grandiose belief, or if a person learns to handle worry better, they may not be so likely to take worries as definite realities. Finally, it can sometimes be helpful to actually review evidence with people – for example, what is the evidence that suggests that the Risperdal really will keep you healthy for the rest of your life, versus what is the evidence that maybe not?

    There are so many individuals and so many stories, so there is no one way of what works or how to approach things. But if we aim to be respectful, and if we are aware we don’t know it all and that some of what we think we know may be wrong, we can have good conversations and often figure things out in a good way.

  • Berezin writes that “I am opposed to the taking of all psychoactive drugs…” I wonder if that includes caffeine? I personally am not at all opposed to all use of psychoactive drugs, what I am opposed to is people pretending to be helpful and then offering (or sometimes forcing) drugs that are actually harmful to people in the circumstances in which they are offered. That’s something a little more complex.

    Speaking in very general terms, the problem with most psychiatric drugs is that they function to suppress something, so you have to keep taking them to keep whatever it is suppressed, and then the suppression gets in the way of emotional development in the long run. Or something like that. Psychedelic drugs have their own dangers, but their striking effects are around what they release rather than what they suppress (so they can often have profound effects when used only once.) How what is released is handled is then profoundly important, which is why I wouldn’t trust the average psychiatrist to have anything to do with the administration of these drugs. Helpers in this field would need a different kind of ethic.

    Society in general has been scared of psychedelics, because they tend to send people out of their conventional mind, rather than restrict or numb mental functioning as most psychiatric drugs do. But healing often does require getting out of the conventional mind, it requires going to places that look mad from conventional viewpoints. And while psychedelics are not the only way to do this, I think they could have their place if used with some wisdom.

  • Thanks to those who have already criticized Berezin’s post: the post itself seems unfortunately far from a thoughtful analysis of this complex subject.

    It might be worth bringing up a large study done a few years ago looking at the mental health consequences of doing psychedelics, outside of any “mental health” setting. Here’s what they found:

    “21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems.” That’s from Psychedelics and Mental Health: A Population Study – http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0063972

    Anyway, that’s kind of hard to reconcile with the notion that psychedelic use will create hospital wards “full of psychedelically induced schizophrenia” as Berezin suggests.

    The truth may be much more complex. In random use of psychedelics, some people may have healing experiences that save them from otherwise going mad: others may go mad and end up in the system. With proper guidance, outcomes might be much more positive. Of course, if “guidance” is left up to those currently running the mental health system, there could be huge problems! But it would be nice to see a more thoughtful analysis of all the issues involved here.