Thursday, September 19, 2019

Comments by Ron Unger, LCSW

Showing 100 of 529 comments. Show all.

  • Hi Oldhead, like you do I imagine, I find the way that word “appropriate” is used is mostly very obnoxious, where someone is claiming the right to tell someone else what they should be doing and what is OK or not!

    What I was referring to, and what Aristotle was referring to I think, is more about what works to accomplish goals. As an example, let’s say I love someone, but they do something to offend me. If I just tell myself “anger is good, let them see my anger!” I may show anger in a way that makes my partner feel unloved and even decide to break up. Which was not what I wanted! But anger expressed more skillfully and artfully may leave my partner still feeling loved, but also understanding what the offense was and how it upset me. Does that make sense?

  • I agree with the criticism of the “anger is a secondary emotion” claim. I agree that anger is as valid as any other emotion. However, I also think that for any emotion, it can help to get in touch with the wants and needs that are behind it, and it can also help to review the evidence for whether it is really justified, etc.

    I like Aristotle’s saying on this: “Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.”

  • Hi Derek, I appreciated the nuances you were able to articulate as you told your story!

    As an active member of ISPS though, I was disappointed to hear about the negative side of the experience you had with that therapist.

    I wonder if you would generally agree with the following: that the good side of many schools of psychoanalysis is their interest in deeper meanings and relationships, while the problematic side is the way they typically gives way too much power to the professional?

    I am told that there are branches of psychoanalysis which attempt a kind of shared exploration and consciously try to avoid this “power over” kind of dynamic, but I am less familiar with those.

  • Steve, I think you are jumping to a conclusion that this study doesn’t support, when you say the study suggests the treatment has no positive effect. The study’s outcome could also be a result of the treatment having positive effect, but insufficient positive effect to prevent all of the suicides that might otherwise result.

    It’s very hard to convince people that forced hospitalization never has a positive effect, when there are so many stories of people who were about to kill themselves, but got hospitalized and in the hospital quit being suicidal and then got out and weren’t suicidal anymore.

    what many of us wonder about though is the bigger picture. Is it possible that the dragnet of forced treatment pulls in many more people who wouldn’t have committed suicide if they hadn’t been hospitalized, but who as a result of the trauma of forced treatment, do end up committing suicide? I think we can agree that we need an answer to this question, but I don’t think we yet have data that can answer it.

  • While this is interesting, I don’t see it as convincing evidence that forced hospitalization leads to more deaths (or even as proof that forced hospitalization doesn’t save lives.)

    The problem is, this study doesn’t seem to have a way to rule out the possibility that those who were forcibly hospitalized were a group that had gotten to a place, pre-hospitalization, where they were way more likely to kill themselves, and so hospitalization may have reduced the suicide rates but wasn’t effective enough to prevent all of the suicides.

    A more effective study would randomize acutely suicidal people to either get forced hospitalization, or simply be offered treatment on a voluntary basis. Then we could compare outcomes between the two groups. This would be a difficult group to get approval for (since those who believe in forced hospitalization would see it as unethical to not forcibly hospitalize people who seemed to be at high risk of suicide, while those who are opposed to it would see it as unethical to do even as part of a study like this.)

    Anyway, I just want to see all of us on MIA being careful about our logic, and to avoid convincing ourselves we have proof of something when we aren’t quite there yet.

  • Thanks Anita – you tell your story very well, and I’m happy to hear of your work to bring more understanding to others!

    My only reservation about the way you frame your story is that by saying you were “misdiagnosed” with schizophrenia, this suggests that there are others who fully deserve this diagnosis! And it’s also true that, according to the DSM, if you did have enough of certain “symptoms” to match the checklist, then you did qualify for the diagnosis – the DSM doesn’t actually say it’s a misdiagnosis if the cause is trauma.

    I think it’s better to bring attention to how labeling something “schizophrenia” is just a way of not trying to understand what is really going on. Not everyone who gets this label is responding to a distinct trauma, but they still have a story and deserve to have people try to understand it rather than just have it all attributed to an imagined “psychiatric illness.”

  • Lewis Mehl Madronna is a Native American doctor who has thought a lot about how to bring indigenous wisdom into healing practices. One interview with him is at . Or you could check out this talk, which includes a lot about using traditional stories to assist mental health recovery

  • Steve, thanks for your comment about the diversity of what therapists do. That matches what I’ve seen.

    A couple comments though. You said the goal of being “normal” is abhorrent. I would agree with you if we were talking about trying to be “normal” overall, because that is both usually undesirable and impossible, but I do see some value in helping people figure out how to regain “normal” abilities they may have lost, or never had to start out with. So somebody might not know how to engage with random people in a friendly way, or how to experience “normal” physical affection without feeling freaked out, and they want to be able to do that. It makes sense that a therapist might join with them in working toward such a goal.

    I know when I had some really different mental experiences, I often had to struggle a bit to regain “normal” kinds of things I used to be able to do. But I definitely never had the goal to overall become normal…far from it!

    Also, I think it is possible to work as a therapist and still piss off psychiatrists. I’ve done quite a bit of that, and I only got fired once from a minor job. But most therapists don’t do that openly, for example lots of therapists used to tell David Oaks they agreed with his criticisms of psychiatry and would talk to their clients about the problems with drugs, but they wouldn’t speak in public. Maybe some avoid it because they are intimidated, but it seemed some were just too shy about speaking up in public in general….maybe they needed therapy for that?

  • There is a middle ground between solving a problem for someone and leaving them to solve it for themselves, and that is to collaborate with them in solving the problem, but encourage them to do the part of the problem solving that they are able to do, and teach them the rest as you go. So instead of rushing in with the solution, you ask them to get going on solving it, then only when they get stuck you maybe help out a bit, but also with an eye to helping them learn how to get to their own solution next time.

    I would definitely agree with those who would say the more we can get people solving their own problems without the help of therapists, the better! But I would still suggest having therapists available for when that isn’t happening.

  • Hi Steve, I’m not clear on how what you are trying to say is different from what I said. I certainly never said people can’t be or shouldn’t be proud of surviving adversity of various kinds! But pride is still something to be used with caution – for example I may have survived an adverse situation by learning to be very distrustful, but if I’m too proud of my habit of distrusting people, I might never work on “recovering” from that, and starting to notice more when some people might be worthy of trusting. That’s where discernment comes in, in my opinion.

  • My point was not that people with mad pride never want to change their lives or themselves, but rather that people don’t want to change what they have pride in. So if a person is always proud of how they do things, they won’t acknowledge (and recover from) mistakes that they make, they will be proud of them instead.

    I think what people need instead is discernment, sometimes being proud of their actions and reactions even when society might call them mad, and sometimes working on recovery instead. I know that’s a little tricky to explain, it’s not a fixed answer, but it is what I think works best.

  • Thanks Annette, I appreciated hearing about the complexity of the experience of you and your family, and how participating in Open Dialogue was helpful.

    As you might have noticed if you read my recent blog post, I’m trying to re-educate professionals to be willing to talk in an open minded way about experiences that are seen as spiritual – and not to assume that all experiences that are off the beaten path are detrimental.

  • Larry, I’m having a hard time following what you are saying.

    Are you trying to say for example that you think I’m wrong to propose that feeling fear, or being organized by the emotion of fear, can sometimes be helpful?

    And then, whether or not we agree that fear can sometimes be helpful or not, it seems you are asserting that people can just freely choose what to feel by altering their beliefs? While I would agree that beliefs do influence emotion, the process of changing beliefs is not so straightforward. For example I might know that I could feel more content if I could believe that our society is headed toward a completely wonderful future, but then find I have a hard time believing that is true.

    I think a lot of people feel fear for example, and would like to choose not to feel it, or not to feel so much, and have no idea of how to go about making such a change. Or they try, and what they try actually makes it worse. So it often isn’t simple.

  • Hi Julie, I think Oregon, maybe especially Eugene, may be a better place to be poor and looking for a therapist. I for example work mostly in a non-profit agency that sees mostly people on Medicaid, some on Medicare. People on Medicaid don’t have to pay anything themselves. We do have to diagnose people with something, but we try not to diagnose people with anything they find unacceptable, and most of us at least don’t believe that diagnosis is useful beyond putting people in a category so the insurance company can make sense of it (one of the cofounders of the agency has openly compared the DSM with the Malleus Maleficarum, the book that was used to determine who was a witch.)

    One other thing: as a therapist I try not to tell people what their problem is – the idea instead is to explore what’s going on together, and see what the possible avenues for change might be. But if people don’t have the ability to change their external situation (however problematic), then we usually do end up exploring what they might change about themselves, either how they see things or how they behave or both. Because I think as humans few of our problems are “all external” – we have to decide how to respond to our situation, and we seldom find the perfect response right off the bat. It takes experimentation, and what is needed changes over time. People come to therapy usually because they want to find better ways of responding to their situation. And one possible response of course is working to get into a better situation, where that is possible!

  • I certainly agree that it’s bad for society when the idea is spread that only professionals can be helpful – really, effective interpersonal support is something that should be woven throughout the fabric of society. I do think though that it makes sense to have people who study how to be helpful in situations where everyday supports or unpaid supports are not working.

    As for Soteria, it was a collaboration between people who did have some professional training and people who did not, professionals like Loren Mosher and Voyce Hendrix did a lot to set the frame for what was done there. Open Dialogue uses people with a high degree of training (training that is different of course from what is mostly offered in the US).

    Professions can be a source of both good and bad. Professions can get corrupt, and it’s really important that they get criticized and this corruption is brought to light. I still see value in them however. They are like governments, they sometimes need to be overthrown, but then you find yourself still needing a government.

  • I certainly agree that often people do find effective ways to help themselves all by themselves. It’s just when they can’t find a way to do that, or even more when they stumble into ways of trying to help themselves that inadvertently makes things worse, that they may need external help.

    I don’t agree that everyone who turns to external help will lose trust in themselves and their own ability to solve problems. Often, when we watch someone help us, we figure out what they are doing and realize we could do it next time for ourselves. I know some people do become dependent and some people especially some professionals encourage dependency, I don’t agree with that, but it is not inevitable.

  • Yes, it is very unfortunate that healing has to occur regarding what was offered as “help.”

    I do think it is interesting though that the way people try to help themselves can also turn out to be unhelpful. For example someone betrayed by important people in their lives might withdraw from society in an attempt to protect themselves, but as a result their life might fall apart and they end up not having any social support etc. It can be overprotection that causes damage, which in some ways parallels the way the mental health system can think it is protecting people but do way more damage than help.

  • Hi manymore, I’m glad you are finding your voice, and you are speaking up!

    It is certainly worth questioning what “being lost” as an individual means, especially when we live in a society that has overall lost its way and seems bent on destroying its own future.

    But it does seem to me that some people do get lost in ways that can even be life threatening, even before any bad treatment becomes part of the picture.

    Regarding “first episode psychosis” treatment, I’m not opposed to it, if it’s done well. Open Dialogue is for example an approach designed to make early intervention, they try to respond within 24 hours of an initial report. Of course, a very important part of what they do is try to hold off on using “antipsychotic” drugs. I don’t know of any early intervention programs in the US that make that attempt to hold off on using “antipsychotics” but there are some that do attempt to keep the doses low and at least some of the time will suggest that people try reducing or coming off the drugs after they have been stable for a while (this sometimes happens in Oregon for example.)

  • I think my comment might have disappeared for a moment, but it’s up there now right below your original comment.

    I agree with you that mental and emotional problems often get exaggerated by the mental health system, but I think that if we had no mental health system that there would still be some mental and emotional problems, some of which would be extremely serious or disabling all by themselves. Certainly we are all entitled to our humanity, but part of being human means we have tricky brains and live in a tricky & often traumatizing world, and we sometimes need help, and sometimes from helpers who have to know more than the average person.

  • I agree with you that there are no “bad emotions” in the sense of emotions we should never have, but I don’t agree that people have trouble with emotions only because therapists see a problem! It’s so much more complex than that.

    Take fear for example. In many ways it’s a great emotion to have, it can save our lives, push us to avoid danger. But people can get in huge trouble with it, when fear is overgrown people can become afraid to leave their home, afraid to interact with other people, their lives can be ruined. All that can happen without ever going to a mental health professional or taking a psych drug – that’s why I think people are really dreaming when they imagine there would be no “mental health” problems if there were no mental health system.

    At the same time, it is an unfortunate truth that for many people, their problems were not so big before they turned to the mental health system and got “help” that made things way worse.

    I would like to imagine a society where, when people have been traumatized or when they run into other sorts of mental or emotional problems, they can turn somewhere and get help from other people that is really helpful. It’s in some ways a simple dream, but I don’t think we can ever get there if we keep imagining that bad “help” is the only kind of problem out there.

  • As I read the comments it seems that some may be getting distracted from my main points because of not relating to the term “mad” which to some might mean believing in “mental illness” which you don’t.

    I think it might then be helpful instead to think simply of being different, or especially extremely different, perhaps in ways that seem to cause problems.

    When we find ourselves being different, we have to decide, do we want to try to recover from these differences, to try to be more like others so as to avoid any problems or disruption that seem associated with those differences, or do we want to accept and even be proud of our differences, and ask others to accept us as we are and to adjust to accommodate the way we are different?

    To use a simple example, let’s say I am being way more fearful about an upcoming event than is most everyone else. If I think my fear is reasonable, and I think everyone else is just being overly bold, I might accept or even be proud that I am perceptive enough to have that fear, and I would want others to also accept and accommodate my fearfulness. If on the other hand I think my fearfulness is going overboard, I might try to recover from it, or to overcome it.

    The key thing I am proposing is that we really need both strategies, sometimes working to change ourselves, sometimes rejecting the idea of changing, being happy with ourselves as we are. Trying to rely exclusively on just one of these strategies, and always rejecting the other, is unlikely to lead to a successful life.

  • Someone Else, I think you bring up some important concerns, though I’d encourage you to also consider that others may have other experiences.

    So it is really important that mental health professionals acknowledge that “antipsychotics” can for some people actually cause them to hear voices etc. At the same time, the much more usual pattern is for these drugs to quiet voices at least somewhat. Of course, this quieting is itself not necessarily a good thing…..

    One way of making sense of that is to think of the voices as messengers, that let you know something is going on that needs to be dealt with. So for you, the voices functioned as messengers that you were reacting badly to the drugs, and needed to get off them. For others, the voices may be messengers about underlying distress for example about past traumas, and the drugs create indifference around that past trauma, which quiets the voices – but only as long as the drug is taken, and it keeps the person from engaging with the parts of themselves that have continued to be distressed by the trauma. So it may both de-escalate a crisis and also prevent healing.

    I don’t agree with the assertion that the mental health system needs to be completely overthrown in order to address child abuse. Rather, I would say there are parts of it that need to be overthrown, while in other parts of it, there is really a lot of knowledge and expertise about how to help people recover from abuse. I’d hate to throw all that out.

    I do think we would do well to throw out the DSM. A lot of people would say, well, then you have to throw out modern mental health care, because it is “based on” the DSM. But I think a lot of it is based on something much more simple, which is simply that a lot of people are feeling stuck in states of distress and would like some kind of help getting out of it. To many professionals, the DSM is just a way of putting the distress into a category so the insurance company will be happy – then the real work of figuring out what is going on with the person, and how to work toward change, begins.

  • The idea that emotionally traumatized people “don’t have anything wrong with them” and that the focus should all be on social issues, social justice, is an interesting one.

    It’s the exact opposite of the psychiatric idea that the problem is all inside people, with no social justice issues at all!

    I am proposing that the truth, as with physical trauma, is somewhere in between.

    In the case of physical trauma, it would be quite weird if someone claimed to have had serious physical trauma, but then not to have had, even for a while, (before it healed) something wrong with them or with their body.

    I think it is also true of emotional trauma that an event that doesn’t create something bad or wrong within a person is not much of a trauma! That doesn’t mean the injury is necessarily permanent, and some injuries are healed without special assistance, but as with physical problems, some may stay unhealed till the right assistance is received.

    Of course, there is no guarantee that what people offer as “help” will truly be helpful – sometimes what is offered makes things worse. Figuring out what is truly likely to be helpful is an important goal.

    I really get how rotten a thing it is to tell an emotionally traumatized person that the problem is all inside them, and that there was no problem with what happened to them or with whoever caused it!

    But I also think it can be disabling to emotionally traumatized people to tell them that the problem is now all outside of them, even while they continue to be miserable. And what if their abusers are now dead, and if there is now no way to seek justice? At this point, something inside may need to change to relieve the misery, and it’s the idea that people can do internal work toward healing, and get help doing that work if they need it, that provides hope.

    That’s not to say that there isn’t also something to be accomplished by helping people get in touch with the sense in which they have always been completely OK, the sense in which the trauma didn’t affect them. In IFS, mentioned elsewhere in these comments, there is the idea that we all have an undamaged “Self” that, if we learn how to bring it forward, can help us heal or unburden the parts of us that have been messed up by trauma. So it’s complex, but I’m hoping we can talk about the complexities so we might have a chance of actually helping people who are caught up in stuff that often isn’t real simple.

  • Hi dfk, I agree with you that the internal family systems approach is a very similar approach to the one described in these videos.

    And PacificDawn, it sounds like you are saying no one should offer therapy, because that makes it sound like there is something wrong with the person who was hurt, while all the attention should go to social justice issues etc. I see that as wrong – like saying that no doctor should sew up wounds or set broken bones of those who have been beaten up, because the real problem is with the assailants. It seems more reasonable to both help people who have been hurt AND to attend to the social justice issues, prevention of more harm, etc.

  • While I think it is true that a lot of psychiatrists base their practice on the idea of “real mental illnesses” as described in the DSM, I don’t think they all do. Some see the causes of mental and emotional suffering as often much more complex, usually involving social causes, etc. They don’t want to try to solve everything with drugs, but they do seek to offer a drug, or medical, intervention that might in some cases be helpful for at least a limited period of time. Do I have to be against their work, just so I can say I am truly anti-psychiatry? Or can I say that maybe there would be a small role for a medical specialty helping out in mental health, even after all the lies and corruption gets scraped away?

    I know the latter is heresy to many of you, but I would propose that the reason psychiatrists love to paint all their critics as “antipsychiatry” is that being antipsychiatry is actually a much weaker position than being focused on what is wrong or corrupt within psychiatry. They love to face the weaker argument, because it does come across as extremist, and it’s kind of sad to see so many on MIA rush to paint this weaker position as being the stronger one.

    Anyway, I’m afraid if I keep responding to comments I may just repeat myself, so I don’t think I’ll respond more unless I think of something really new to say…..

  • I understand the need for decisive action! But I really contest the notion that “being more extreme” is always helpful in getting there. I think instead it very often backfires.

    For example, let’s say I know someone, “X,” who often does very dangerous things. If I tell others “I am against everything X does!” it is certainly more emphatic than just being against the dangerous things X does, but it is also more likely to come across as me just having a grudge against X. It backfires, makes me look bad instead. I’m much better off just focusing on being against the dangerous stuff X does.

  • Rachel, I think you and Kindredspirit make good points about how projecting, or mischaracterizing the opposition, plays a big role in our polarized society. For one thing, if our opposition is some irrational extreme, then that’s the only reason they don’t like us, it couldn’t be anything wrong with us! Paranoia in this sense can make us feel better about ourselves (and I agree that psychiatrists often do that.)

    One reason I prefer the critical psychiatry stance to the anti psychiatry one, is that it’s harder for psychiatrists to demonize. “I’m not against anything a psychiatrist might do or so, I’m only against the harmful things they might do or say.” This “middle ground” stance brings focus to what’s important, which is what is or isn’t harmful.

  • I’d like to offer some defense of “middle ground” kind of thinking! Though I agree very much, it’s a terrible idea to look for the middle ground say between MLK and the KKK. That’s because MLK himself was a middle ground kind of person. The true “middle ground” might better be seen between white supremacy and a (hypothetical) black supremacy. Curiously, when current white supremacists talk about “white genocide” they speak their fears about how if white supremacy no longer prevails, that white people then will be oppressed. We need to articulate how there is a possible middle ground, where skin color doesn’t make people better or worse, it’s still hard for many people to believe that is possible.

    We live in an increasingly polarized world, that is tearing itself apart and neglecting the future. I think the way forward is to get better at identifying and moving toward something like what I am calling the “true middle ground” or point of balance. That’s what we need for mental health, ecological health, political health etc.

  • Hi Eric, thanks for this article, I think it makes a lot of sense! I think this role of “investigator” is already being taken on by those who are shifting to developing a formulation rather than a diagnosis: a formulation is a map of what’s going on and of possible routes to something different. Therapists can collaborate with people in developing such maps and in going through the process of change. But “investigating” sounds more understandable, less like jargon, than “developing a formulation.”

  • Thanks Will. This is a very deep and thoughtful essay! I really appreciate the way you addressed your own mistakes, and the way fear of facing our own mistakes can then make us more fearful of calling out something that is wrong in others.

    And it’s also important that we find measured ways of calling out the failings not just of our enemies but also of our close allies. This requires something other than black and white thinking – we don’t want to trash people who are otherwise doing good work, but we also don’t want to just get silent when real damage is being done by people who otherwise are doing good things.

  • Hi Peter, thanks for writing up this summary of your impressions from the ISPS-US conference. I was also there, and I do agree with you that it was an interesting intersection of professionals with people sharing and drawing from their own experiences.

    One difference in my reaction: I didn’t see as much conflict as you did between the views of the professionals and the people with lived experience.

    For example, you defined Beck’s approach as seeing problems that need to be fixed, rather than seeing persons with whom we need to connect. But what I saw was that Beck’s approach was all about connection. They talked about how they had been working to come up with an approach that would work for the most aliented people – as they put it, to help the person in the corner who won’t communicate with anyone, and who has been disconnected for a long time. Their approach was all about trying to build connection with that person, and then supporting that person in connecting with others, and Beck specifically said he believes in being person centered, not symptom (or problem) centered.

    Of course, Beck’s approach didn’t come out of thin air: he and his team admit it came about largely by listening to people with lived experience in the “recovery movement.”

  • Well, if you are talking about trying to get all of the mental health system to repurpose or reframe words, that indeed is a daunting task! But what I was referring to was just that it is easy for someone like me to use the word “recovery” in a way that makes clear I don’t assume it is an illness that someone is recovering from, or that they will always need to be “recovering,” etc. I guess what I am saying is that I don’t want to see us make “recovery” a bad word just because the system has figured out how to misuse it. I see it as a word that can still be helpful, and I believe our energy would be better spent insisting the word be used in its more helpful sense, rather than opposing its use at all.

  • Yes, that really is one of the worst problems of mainstream psychiatry – robbing people of their story, diverting attention from criminals and social dysfunction and instead directing the attention toward imagined brain defects which psychiatry then pretends to treat!

    By the way, one really cool poster that people can print out to paint a more accurate picture about trauma and “psychosis” is at

  • I’m sure you are right that most are currently thinking of it as “recovery from an illness” but it’s pretty easy in conversations to make clear that one is thinking in broader terms. I think it’s important to remember the ways the word “recovery” can be used constructively, while also of course balancing that with awareness of its limitations.

  • I’m glad you acknowledged that perceiving “recovery” can be a step forward for people told they will always be “sick.” I think it’s crucial that we don’t reject a word that is often so useful in helping people take that crucial step, even as we also explore its limitations and traps.

    And I would disagree with one thing you said about the term recovery – that it implies we must have been “sick” in the first place. It doesn’t. “Recover” is a broad word in the English language. We recover our balance, we recover from a shocking event, we recover from all kinds of things.

    We can even “recover” from something that is overall good – like I might recover from the chaos caused by doing a home remodel. I think “madness” can often be like the remodel – we lose functionality for a while, but we also might go into some kind of transformation that makes things better in the long run. An exclusive focus on “recovery” suggests that getting back to some status quo is the only objective, but refusing to talk about recovery can leave people feeling like it is understood they can never get back things they once had that they really would like to return to.

    I like the notion of the hero’s journey – it includes the idea that we have to leave “normality” to do some crucial things, but then there is a return stage, or a “recovery” stage as well.

  • Yes, the idea that one approach will help everyone should be declared quite dead! But I think there is value in having a diversity of approaches, then people can find something that fits for them at a given time and place.
    Steve, I wonder if you watched any of the video? If you did, can you see how someone like John might be more ready to help someone after learning something like Process Work?

  • Hi BigPicture, sorry if you were waiting for a response, I didn’t think of anything to add to what you already said, at least nothing without making a longer post than I might be ready to do! I think you make some good points, many of them along the lines of what Alan Watts used to talk about when he said that sometimes you have to go out of your mind, to get back to your senses.

    And I agree about the post hypnotic trance thing. Going into at least a different kind of trance gives you at least the awareness that some other kind of processing is possible, even though it doesn’t tell you what “being truly awake” might be…..

  • Hi Steve, I agree with you that much of what is taught in standard approaches is either not helpful or is actually detrimental, but I don’t think that all attempts to educate people in how to help is useless – a good example is the Open Dialogue program, which relies a lot on education, though part of what they educate is also humility and staying uncertain! I think we need to work on sorting out what is helpful and what isn’t.

  • Lots of professionals were trained to think that talking with people about their “psychotic” experiences would just make them worse, so if they believed that, it’s not surprising that they would think that people who hear voices shouldn’t go to a hearing voices group. But it’s also so ridiculous – it shows the impact of bad ideas, that can make the whole mental health system quite mad, and not in a good way.

  • I’m glad you found the article liberating! I hope you watch the video too, I think you will find it much more helpful. And I know it is hard to get practitioners to change, but I think it is worthwhile to keep chipping away at it, just getting a few to change can make a big difference to the people those practitioners work with. And once enough change, the balance may shift and the current model of mostly mistreatment may come to be seen as the monstrosity that it is.

  • Wow, I really like your phrase, about how spirituality is looked at as a “decorative garnish on a plate of pharmaceuticals.” I may quote you on it. It really captures the way I’ve seen spirituality be approached by the mainstream, when it even approaches it at all! It’s like a frill people might be allowed to have as long as it doesn’t interfere with them properly attending to the main course, the drugs and suppression.

  • Thanks for your story. It’s curious the bit about realizing you (and others) were God and then trying to talk about it – this was easier for me as a young man when I started thinking the same way, because that perspective was more talked about at least in the “hippy” subculture. Writers who were popular at the time, Alan Watts and Baba Ram Dass, for example, had some good ways of talking about it.

    In the hearing voices movement they say hearing voices is only a problem if you don’t know how to handle it. I would also say that thinking you are God is only a problem if you don’t know how to handle it and relate to others from that perspective. If mental health professionals understood this, they would be better at really helping people instead of just trying to squish perspectives they can’t understand.

  • Thanks Sarah! One thing I really liked about the article is your analysis of how the special confidential relationship of therapy actually backfired for you and left you feeling worse about yourself.

    I think ideally, any therapist, or even anyone who is going to have some kind of confidential helping relationship, would be trained to recognize the possibility of this kind of dynamic and ways to overcome it.

    I do think there is a time and place where people want or need a space to talk confidentially about things they can’t bring up elsewhere, but ideally they get help finding ways to then get support elsewhere – either because they learn how to frame their issues in ways they can share with the others already in their lives, or they learn how to find people they can share with (if the current people in their lives are too judgmental.)

  • I also don’t find value in distinguishing “healthy depression” from “clinical depression.” “Clinical depression” too often just means a depression that the clinician is unable to, or too lazy to, understand the cause for!

    But I do think depression is kind of like fear: sometimes it is really helping us, and other times it is more based on misunderstanding, exaggeration, etc. So I might be depressed about my relationship or job or even my whole way of being in the world, and that might be helpful and realistic, because there might be something terribly wrong with my relationship or job or way of being in the world, and I need to slow down and face that and let it sink in so maybe I can find some other path. Or maybe I feel everything is depressing, but it really is just an irrationally dark view, and what I need to do is to question my dark thoughts and see the value of jumping back into life without making any big changes.

    A key thing here is that it shouldn’t be clinicians deciding which is which: people have to make these decisions for themselves, though clinicians can collaborate with them in doing that, or facilitate thoughtfulness about it. It helps to have a clinician who isn’t too sure that the only thing needed in each case is rosier colored glasses to look at the world through……

  • Thanks Annette for sharing your experience, and I hope you do write more as a blog post! I had something similar happen – experiences and time spent exploring perspectives that psychiatry sees as psychotic, but making sense of it as a process of healing and transformation. I think there can be real dangers in going through this kind of process, and it isn’t the same for everyone – some people go to deeper and more intense places than I did and need much more support to navigate it safely – but many more would get through it successfully if we aimed more at exploration and working through, not suppression.

  • Hi LavenderSage, it’s true I wrote this blog without addressing any possible spiritual perspectives. But I didn’t mean to rule them out. There is for example the view that the self is an illusion – so it doesn’t really make sense to say something is part of something that doesn’t exist! Or there is the view that we are all one – so anything or any being we encounter is really part of us, equally so whether it seems to be “in” us or “outside” of us. What is key I think is not quibbling over different ways of conceptualizing our own identity or that which seems to be outside of us, but rather of seeing the possibility of establishing relationships that respect both what might seem like our “self” and what seems like “other,” whether or not that seems to “others” to be inside or outside what we “should” – according to them – be seeing as our “self.”

  • Hi Bradford, I think I see it as a bit more complex than what you are suggesting. I think there are a range of possible ways humans can get into troubles or confusion, that they are on a continuum with extremes possible, that is we can have a panic attack and be sure we are about to die, be so depressed we can’t get out of bed for days, or be so “psychotic” that we believe and experience outlandish things (as when my friend David Oaks thought the CIA was making his teeth grow.) These sorts of problematic mental states existed before the DSM came along, but what professionals did was to make committees to divide it all up into neat categories, and then they started talking in weird ways, like saying that the person’s “schizophrenia” made them believe or do certain things, which then took them off the hook from having to try to actually understand what might have happened to the person and what they might be going through to get them to think or act that way.

  • One way of thinking about it is that voices and thoughts exist on a spectrum. At one end we have stuff that is distinctly a “thought” – there doesn’t seem to be any hearing component to it, and it seems consciously willed. At the other end are experiences that are distinctly “voices” – one may hear them so distinctly that one has to look to see if anyone is there, and they are definitely not consciously willed. Then there are various kind of in between experiences – which some people might call thoughts, and some might call voices, with no clear distinguishing line.

  • Thanks for the comment, and for the perspective on the Metamorphosis story – there really are so many different ways of interpreting things, and so often reality is too complex to be captured in any one of them. Which is why, in Open Dialogue, they are so dissatisfied when only one perspective on things is on the table! They always want to bring in more, since dialogue is impossible if only one view is present.

  • I agree that the “psychosis” does communicate, usually in a disguised way, what the problem is, and taking drugs to suppress what is happening often gets in the way of sorting out what it’s all about. That why I think it makes sense to only use drugs when people can’t find any other way to head off some immediate disaster, drugs should not be the cornerstone of treatment.

  • I agree, when people do manage to get “less psychotic” and the problem seems to be just dissociative, then they are often told that they never had a psychotic disorder or “schizophrenia” to begin with. But somehow the fact that a mistake was obviously made in that case never gets them thinking that maybe the whole conceptual scheme, with its clear diagnostic separations, could be a mistake……

  • I would agree with you that the goal of identifying people with specific categorically distinct disorders is a fantasy! But the notion that people can have serious mental and emotional problems with which they can use help is not a fantasy. Rather than diagnosis, I much prefer trying to map out what might be going on for a particular person, or making a “formulation” of the problem. This can be individualized, but also draw on general knowledge of the kinds of problems that people often experience with different kinds of mental phenomena.

  • Hi Someone, I didn’t mean to suggest that I was assuming that “psychosis” is always something organic that can’t be approached with understanding and therapy, I just meant that this is a common assumption in the mental health field! What I was trying to suggest is that it often reflects just a further degree of alienation from one’s own experience, an alienation that often begins, as you suggest, with childhood trauma.

  • The recording of the webinar on this topic is now available, for free, at 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

  • 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.”

  • 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

    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 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

    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.