Tuesday, March 2, 2021

Comments by Ron Unger, LCSW

Showing 567 of 567 comments.

  • Megan writes that diagnoses do not “reflect anything in reality” and that “In any other industry, the word for using a name for something that does not actually exist in order to get reimbursed by insurance would be fraud, right?”

    I disagree with that, up to a point. The person coming to see the therapist is typically doing so because they have some kind of real problem. It is true that the diagnoses themselves are not “real things” – the actual problem is unique and involves a complex interaction between the person and the systems in which they are embedded – o the diagnoses might best be understood as somewhat or sometimes very misleading labels that get put over real complex problems.

    Anyway, since something real is going on and because help for the situation should arguably be paid by insurance, there isn’t anything like fraud going on. I think we need ways of talking about that which acknowledge that mental and emotional problems can be real even though labels and much of the “help” offered is unhelpful: otherwise we come across as advocating for a colder society where it would be harder for people to reach out for help of any kind, and might seem we are lacking interest in finding the kind of help that would truly be helpful.

  • When I referenced finding “the meaning” I meant finding the kind of meaning that is common in a society or in those who consider themselves “sane.” I think there are many other varieties of life affirming meaning to be found.

    Regarding the contention that we should never categorize anyone who has been abused beyond the general category of abuse survivor – I think that isn’t quite right, because people find themselves in different states post-abuse. Some continue to be highly distressed by the abuse lives on within them, while others find or perhaps are helped to find ways of making sense of what happened that leave them free to focus on moving their lives forward. That’s an important distinction to talk about, whether you do it by talking in terms of DSM language (with all its flaws) or some other, hopefully more nuanced approach.

  • I came at this a bit the other way around – first I got my MSW degree and started working, then I started posting stuff online, including my own story!

    I haven’t been hassled about that, but I have an especially friendly work place.

    I think it’s important to note that the code doesn’t say we will never post information about ourselves online, just that we will be aware it has an impact that may be unhelpful. But if what we are posting can also be helpful, we can definitely justify doing it despite the fact that it could also cause a problem.

    And it’s true that what we post might make some people not willing to work with us. But knowing that doesn’t mean we have to shut up. I’ve seen something as simple as my posting something in my office about available support for LGBTQ people make someone not want to work with me, because they then perceived me as LGBTQ supportive. But that doesn’t mean I was wrong to post something.

    Anyway, there are lots of contradictions to think about in social work ethics, even without bringing peer work into it. The whole thing about attempting to be some neutral clinician doesn’t sit that well with what social workers also sometimes like to think they are, social justice advocates!

  • Thanks for this article. Very powerfully written – I was especially impressed by the paragraph about the woman who had been raped by her father, but preferred the option of being numbed by drugs to trying to work through the experience. In a way that is a metaphor for the state of our whole society – we would rather numb out the painful or disturbing bits, rather that let each part have a voice and figure out how to fit it all together, and how to heal.

  • Steve, I don’t know about you, but I don’t usually put a lot of effort into changing something I’m doing unless I think there may be something “wrong” with it, something that is leading to less than an ideal result.

    I certainly do agree though that the goal should not be some presumed “normality” especially since, as David Oaks likes to point out, normal people are destroying the planet.

    So if we don’t want to tell people that they are wrong and should think like others do and value what others do, what should we tell them?

    Should we tell them that however they think, and whatever they are valuing, is completely right?

    That has its own problems, because the way the person is thinking or processing or valuing may be setting the person up for difficulties and distress down the line, or may be heading them towards harming their loved ones, etc.

    I think the best therapy approaches this as a kind of inquiry or dialogue, exploring possibilities, it does accept that people will have to decide for themselves but doesn’t presume that those decisions will always be for the best – instead it is constantly questioning.

  • It seems like most of those who have commented on my comment emphasize how people should be able to work out for themselves what is “disorder” or not. I would agree with that – I would also point out that “post traumatic stress disorder” is generally not a label that people have forced on them, it’s usually a case where someone knows they have a problem and the PTSD label connects the problem with the trauma that happened earlier.

    I agree with Steve that it is important that people get the message that any disorder may be temporary, rather than some “judgement of insufficiency” that is not expected to change. And there is a problem where some people (professionals or not) just expect PTSD to last forever. But that isn’t inherent in simply saying that the person has troubles or a disorder that are a reaction to bad things that happened to them.

    I didn’t see anyone respond to what I think is a more crucial part of my comment, where I pointed out that if we get too caught up in denying that there may be anything “wrong” or “disordered” in someone’s reactions, we may actually be harming them by making them more helpless, by convincing them that their troubles are just an inevitable result of what happened to them, and there is no possibility of them changing their reaction to something else and so getting more control over their lives.

    I would argue that we have to watch out for people doing things they think will be helpful, but that backfire, at each stage of the process of reaction to trauma. For example, when people experience trauma, they might feel threatened by thoughts about what happened and try to push them out of their mind, but this may backfire when the thoughts pop back in later in the form of flashbacks and they get caught up in an endless war of trying to suppress thoughts and memories. Professionals may then try to help, but at times their drugs or other approaches will backfire and make things worse. Then those critical of professionals may jump in and try to make things better – but there can also be problems with how they put things, especially if, as I have pointed out, they make people feel their reactions to the trauma are the only reactions that are possible for them.

    This may seem a little complex and tricky, but I believe (as a trauma survivor who had to work through my own disorder, as a therapist, and as a critic of our mental health system) that this is just the nature of the territory.

  • I think we can go too far in trying to emphasize how reactions to trauma are normal, and trying to deny that there is anything problematic about them. The problem that is caused by doing this is that people might start thinking that their reactions are inevitable, and there is nothing they can do to change them – which means they are stuck with them. We’ve just induced helplessness.

    If a hurricane hits my house, it throws stuff around, stuff isn’t where it would have been. So it’s a normal reaction. But it’s also fine to call it disorder. Calling it disorder reminds me that it doesn’t have to be that way, it can be rearranged into order again, I don’t have to leave things the way the hurricane left it. Trauma can be that way too – it throws everything around, or we throw ourselves around in trying to cope with it, that’s normal, but they way it leaves things is a disorder when it comes to trying to go one with life, so there’s some need to reorganize.

    I agree with Paula though that huge problems come when we assume that disorder means illness means the person needs drugs or some simplistic one size fits all “treatments” that don’t address the full spectrum of people’s humanity.

  • I appreciate this article, and all of Joanna’s work. But I’m bothered by one sentence: “Further follow-up studies show that people who take long-term antipsychotic treatment for psychotic episodes have worse outcomes than those who do not (e.g. Moilanen et al 2016; Wils et al, 2017).” The problem is that the Moilanen citation doesn’t seem to support that assertion: instead, that article suggested a mixed result, and reported that people who stayed on antipsychotics with no drug-free periods were the ones with the best scores on the Social and Occupational Functioning Assessment Scale [SOFAS].

    Anyway, if the data really is more nuanced, I think we would do well to reflect that in our statements, so we can so to speak take the “scientific high ground.” Any thoughts about that? Am I misreading anything?

  • We definitely need to abandon simplistic models of “mental health” I have often stated that “stability is a false god of the mental health system.” When we are facing a big threat, like climate change, the last thing we want to be is stable overall, and just keep on with business as usual. But we do need to be stable in some ways, so we don’t fall apart and can take wise action.

  • I like the observation that some of these statements, like the “it’s not about you” may be helpful if they are said by someone with less power than a therapist.

    I am a therapist, and I’m aware that it’s important to be careful about what I say! One thing that helps when one is in a professional role is to say things more tentatively, as in “I wonder if it may help to think that it isn’t about you, or that at least much of it is not about you.”

    This makes it easy for the person to reject the idea if it doesn’t fit. Also it helps if the therapist asks if anything they are saying doesn’t seem quite right, and acknowledges they may say things that don’t fit for the person and asks to be informed when that happens.

    Regarding moderation, I much like the Oscar Wilde version: “everything in moderation, including moderation!”

    And there is the tricky matter of the sense in which any statement is understood. I like the Discordian saying that “all statements are true in some sense, false in some sense, and meaningless in some sense…..” We don’t always know how our statements will come across, so we have to be aware they might come across quite contrary to what we intended.

  • Climate change is certainly one big reason to question the idea that “positive emotions” are necessarily good! I think of the Katrin Meissner quote: “It scares me more than anything else. I see a group of people sitting in a boat, happily waving, taking pictures on the way, not knowing that this boat is floating right into a powerful and deadly waterfall.”

    Still, there are lots of “mentally unhealthy” responses to climate change. One is just denial – refusing to know, even when we have reason to know. Or people are aware it’s happening and are traumatized, and they respond by trying to avoid reminders of it, watch the news less, etc. Or they despair and use drugs or other distraction.

    Whether it’s mutual aid, professionals working with individuals, or public health efforts, we need to be aware it’s a tricky balance to find a constructive approach to big challenges. It’s not about trying to just be happy, or squashing the “upsetting” emotions, but it is about finding a way to not be demoralized and shut down by the threat and finding some kind of positive path.

  • Hmmm, I think this is a complex topic. I would agree that I wouldn’t want mental health professionals doing things like deciding who can run for political office, but I do think they may have opinions worth considering (to the extent that mental health professionals know anything at all – many of them seem to know less than the average citizen!) I would rather hear the opinions of people like Bandy Lee rather than have them shut up by the Goldwater Rule – though they are just a perspective. Regarding mass delusions, I think they are a kind of public mental/social health issue – I’m not sure what the best treatment is, but I sure hope we come up with something good before we exterminate ourselves!

  • I’m not sure where you are getting this idea that counselors can’t bill to help child abuse survivors. They definitely can, whether they call the resulting problems “PTSD” or some other diagnostic category.

    And while some counselors cover up abuse (and some are even abusers), many others are very active in increasing awareness of the dangers of child abuse and of the needs of survivors.

    In fact, some counselors have been too willing to believe that their clients were abused. They have asked leading questions, been too sure that even dreams of abuse were the beginnings of recovered memories of abuse, or they’ve been willing to completely believe even fantastical tales of abuse (where supernatural things happened, for example.)

    I work as a counselor, and I know that these issues are not always black and white. Sometimes people do not have clear memories, and it is necessary to just hang out with the uncertainty. I have seen things like someone over the course of weeks start to remember that a certain family member abused them, then get uncertain about that, then recall it as a different family member (all without pressure from any other family members, who were not told about the memories.)

    False memories are not impossible, but it is also terrible to just assume that something is a false memory when it may be quite accurate. Counselors may not be able to know for sure what happened in particular cases, but they can be trained in ways to interact with people about their stories and their memories in ways that are sensitive and respectful, and help people on their own search for what is true.

  • You make some good points. Here’s a little of my thinking:

    Having everyone believe the same thing can create social cohesion within a group: “we all think Trump is going to save us from an elite group of pedophiles and cannibals!” So why do some people come up with their own unique beliefs? I think it’s also for the purpose of cohesion, but that of cohesion within the person. When people are confused and distressed, they may organize internally around some weird belief, and having that internal coherence may seem more important than whether or not they match up with anyone else.

  • While judging only some beliefs as “rational” is indeed problematic, failing to do so also causes problems, often ones that are more severe.

    By “rational” I mean “in proportion to.” So a “rational” fear would be in proportion to a threat, while an “irrational” one would be out of proportion to the threat. We can also have “irrational” lack of fear, as when people aren’t bothered at all by the threat of climate change, etc.

    People do indeed have “different realities” in the sense of different perceptions and different maps of what is going on. But these perceptions and maps apparently exist inside a world that has effects on us whether or not we believe in those things to start out with: so people who think Covid is a hoax can still die of it.

    This especially becomes a problem when we need people to take collective action, for example, to stop systemic racism, Covid, or climate change. We need some way to respect the fact that no one has an absolutely correct perspective, and everyone needs some slack to make sense of things for themselves, while also pushing people to “face facts” that may be essential to survival and to social justice.

  • In this article they talk about people’s “mental disorders” but it might make more sense if they just talked about people’s mental and emotional troubles. Because Steve is right, if you are going to take a “transdiagnostic” approach, you don’t really need the idea of diagnosis. I think it makes more sense to try to understand the complex factors that might have pushed someone into some kind of trouble or other, and then also look at what might be changed to help them reverse some of the trouble and become less distressed. The diagnostic categories don’t much help with that, and often just confuse people or lead to discrimination.

  • Well, if the article only said what you are saying, I wouldn’t have any problem with it. I definitely agree that if the therapist comes off as insensitive, as unwilling to listen to what the person is dealing with and suffering from, and if the therapist makes it sound like all of the problem can magically be solved, it won’t go well!

    Situations where we have to let go of controlling some things and focus on what we can still control are often situations of loss – like when we have to let go of trying to put out the fire and just control what we can, which might be getting out of the house before we burn up too. In such situations, there is real loss, but focusing on what one can control is still an important way to reduce losses.

    What bothered me in the article was when it made much stronger statements than you made, such as when it was asserted that “Telling individuals to stop focusing on “what they can’t control” is not only gaslighting, it’s inaccurate.” I get it that Megan wanted to critique therapists who might be suggesting that their clients pay no attention to broader social factors that cause oppression, but I think trying to figure out what you actually can control is also important for social activists – we are always trying to figure out where it is we might actually be able to make changes, and to avoid beating our heads against walls and getting nowhere!

  • It seems to me that being either positive or negative can get overblown, or “toxic.” The tricky thing is to be just as positive, or negative, as what fits the situation! And we are always trying to figure out exactly what we are up against, especially when the threat is something new, like Covid 19.

    As for trying to focus on what one can control – it seems to me that is basic to any kind of problem solving, it’s not part of “toxic positivity.” It makes sense even in very “negative” situations – so for example one might be dying, but decide to focus on what one can control, like sending a kind message to loved ones. I do get that it may be annoying or wildly inaccurate when someone else is telling you what you should think you can control, but that’s another issue.

  • Hi Steven,

    It’s great to hear about your continued work! There is so much that needs to be changed, but community organizing like what you are doing does open up cracks, through which some people will escape from oppression, and through which some light will get in.

    And thanks again for having me speak in your church, on the topic of When Minds Crack, the Light Might Get In: A Spiritual Perspective on Mental and Emotional Breakdown – https://recoveryfromschizophrenia.org/2017/12/minds-crack-light-might-get-spiritual-perspective-mental-emotional-breakdown/ (The whole talk is available at that link.)

  • Hi Fiachra, thanks for posting the link to the video! And thanks for joining us for the webinar itself. I hope lots of people do check out the video and then try practicing what Rufus talks about. You are right in a sense that there is nothing too mysterious about how to help people with troublesome beliefs – but we do have to unlearn a lot of what is conventionally taught about them, as well as to overcome what are pretty natural impulses to just get more rigid in response to encountering beliefs that seem to us seriously wrong.

  • Yes, I think that’s why it’s so important that we start training professionals differently! People should be able to turn to “the system” and find that it is helpful. I’m reminded of someone Daniel Mackler interviewed who lived in the area where Open Dialogue is practiced – this person compared the mental health system with the system which delivers water to each house: reliable, of good quality, and available when needed!

  • Yes, I think that move from less helpful “delusions” to a more resourceful creativity is something I experienced in my own life and that of close friends, which I wrote about in https://recoveryfromschizophrenia.org/2013/06/madness-and-play-exploring-the-boundary/ and in https://recoveryfromschizophrenia.org/2016/09/how-psychiatry-almost-stopped-burning-man-a-story-of-hell-and-liberation/

  • I agree with you that a psychotic break is a natural reaction, though it may have very unhelpful aspects. In that way it is like other natural reactions: for example, I might see a spider, jerk my head back to get pull away from it, and in doing so bash my head into something behind me. Quite natural, but also painful! Regarding antipsychotics and psychiatry: my sense is that not all use of antipsychotics, and not all psychiatrists, are the same. For example in the article I talked about one person’s interaction with a psychiatrist, where at first the person felt just like a target for the psychiatrist’s drugs, but when the psychiatrist talked respectfully they were able to form a collaborative relationship. I suspect there may be times when antipsychotics may be helpful to a person, at least for a bit, to help the person avoid over-reacting when they don’t have a better way to do that. Though I believe in always looking for a way to do it without the drugs wherever we can.

  • Hi Fiachra, I think you make some good points.

    Regarding the “two types of delusions” thing: I’ve noticed something along the same lines, that some express fears, while others are more an attempt to counter fears and make things seem OK or even great. Though it is also true that the emotional meaning often gets mixed. For example I asked one guy who was constantly bothered by and scared of people who seemed to be constantly monitoring him, how he would feel if that stopped or if he found out it wasn’t happening, and when he really thought about it he noticed he would feel unimportant and alone. So the belief in being monitored was both organized around fear and his hope of being important enough for someone to pay attention to.

  • Thanks for this great article on a difficult topic! A few thoughts of mine about that:

    I think there is a danger, not just of psychedelics being framed and used in a narrow way that just reinforces a dominant and too-narrow culture, but also in them being used in a way that is too open, or open to the wrong kind of dynamic.

    That perspective fits with that of many traditional understandings of Spirit generally – that when we open up to Spirit, things can go in a good way or a bad way, which is why it is good to have helpers nearby, a positive connection with community, that helps sort out which way to go.

    There are people right now using psychedelics in ways that totally fit with capitalism – as documented in articles like https://www.ft.com/content/0a5a4404-7c8e-11e7-ab01-a13271d1ee9c . There are people using them in some very dark ways – as Charlie Manson used to – some of that is documented in this article https://www.psymposia.com/magazine/lucy-in-the-sky-with-nazis-psychedelics-and-the-right-wing/ And there are people who are using them skillfully to promote healing, and to look outside of cultural forms which are clearly too narrow.

    Anyway, I think we need to be aware that the outcome from increased use of psychedelics is very much dependent on how we go about using them and integrating that use.

  • Great article! Some thoughts:

    Carl Jung was aware that there really isn’t any limit to what we might find in as we go deeper beneath consciousness. (First there might be our subconscious, then our personal unconscious, which is understood to be deeper, then Jung thought we could encounter the collective unconscious, which includes all of the mental forms which are possible for us, and contact with all sorts of characters who are “not us” but part of what we can access in our minds.)

    Of course, that relates to the idea that “mind” is not really something that has clear boundaries – in some sense there is just one mind.

    And any kind of creativity requires stretching in some sense beyond what we previously have know as our selves – because what we previously thought of as our self hadn’t done or said what we are now creating.

    I think many writers find the process is often more like being dictated to, at least at times. Your process seems more so than most, but not an entirely different kind of thing.

    Lots of us in dreams find there is something very creative in us that is very different from our conscious mind. For example, I know nothing about making music, yet in my dreams I have sometimes heard very impressive music that did not seem to be anything I had heard anywhere: it seems that my mind had composed it. Too bad I could not recreate it while awake!

    Leonard Cohen has written about the sense of not being the writer, for example as in the following lyrics from “Going Home”:

    “I love to speak with Leonard
    He’s a sportsman and a shepherd
    He’s a lazy bastard
    Living in a suit
    But he does say what I tell him
    Even though it isn’t welcome
    He just doesn’t have the freedom
    To refuse
    He will speak these words of wisdom
    Like a sage, a man of vision
    Though he knows he’s really nothing
    But the brief elaboration of a tube”

    Anyway, I really agree with Russel Razzique when he says the function of the mental health system should be to help people with any distress they may be having without dismissing the spiritual or creative value of what they may be experiencing – the point should be to help them find ways to hold on to what is valuable in their experience while reducing the trouble it is causing them. If they find a way to do this, then it no longer makes sense to consider them as a person with a mental health problem.

    Last year I put together an online course “Addressing Spiritual Issues within Treatment for Psychosis and Bipolar” https://www.udemy.com/course/spiritual-issues-psychosis-and-bipolar/ which is my attempt to convey this message to the mental health field….

  • Hi Sam,

    I certainly appreciate your not wanting a therapist to decide how you should be organized or exactly what you are supposed to be, or making you be something without your consent. And I know that different words resonate differently for different people, so I appreciate that “fragment” doesn’t resonate well for you. I’m not sure there are any perfect words: but I do know many people did things to cope when they faced trauma that are no longer working for them months or years afterward, and the idea that change is possible, especially change toward what feels to themselves like being more “whole,” can be liberating. I know that was true for me

  • A few years ago the local Christian college was trying to both have a counseling program and refuse to respect the rights of LGBT students. But lots of the local agencies decided they would not accept interns from that college till the policy changed. It did. But it does take people standing up and refusing to go along with stuff.

    I have also heard of really dysfunctional psychology or counseling education programs. I went to social work school, it was mediocre but was at least mostly friendly and relatively reasonable.

  • Thanks for this article, connecting the DSM fiasco to some deeper realities that are hard to write about!

    I think the notion of “dialogue” is so important in mental health, because it allows for multiple viewpoints, which are necessary to address complex and contradictory realities.

    One tricky thing is that we do sometimes need to go from dialogue to action, and as you also point out, “Complex, contradictory things or identities do not have impetus and are more conducive to stasis than progress.” Especially when we feel threatened, we feel like we need to decide what is right, and it needs to be something simple we can act on!

    The way this is dealt with in Open Dialogue is to let ideas for action emerge out of the dialogue, and to avoid coming up with big plans – instead, just decide what to do till the next meeting. And to deliberately hold back on drastic actions, like taking so-called “antipsychotic” drugs.

    In Zen they talk about “not one, not two.” There is always a dialogue between our complex/contradictory totality, and our ability to stand up for an be something specific, this and not that. It would be nice to see that more appreciated in the mental health field.

  • 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 https://www.stillharbor.org/anchormagazine/2016/11/11/the-healing-of-narrative-an-interview-with-lewis-mehl-madrona . Or you could check out this talk, which includes a lot about using traditional stories to assist mental health recovery https://www.youtube.com/watch?v=qS-km545WbM

  • 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 https://psychosis2.files.wordpress.com/2018/10/ten-ideas-think-differently-about-psychosis-1.pdf

  • 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 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.

  • Hi Ed, thanks for your comments. I agree with you that it’s very unfortunate that more people aren’t interested in really relating to people with “psychotic” experiences. I think our culture, and especially those in charge, want everything to be easily understandable and digestible, with appropriate boxes for everything – so a model that puts a label on people and then matches them with the appropriate pill is much more comprehensible than one that says there might be meaning and something worth listening to in even “crazy” talk!

    Fortunately there are at least some who are interested in this kind of psychological work. If you haven’t already, I suggest you check out ISPS, the international society for psychological and social approaches for psychosis. the US chapter’s website is http://isps-us.org/ and they will be having a conference in Portland OR this November.

  • I’ve been told by some others, after I wrote this article, that ACT does go further than I suggested, and could involve reflecting on some truth that may be within disturbing feelings etc. I don’t doubt that they are correct. But I would point out that common ACT metaphors are presented in a much more black and white way, as when people are just instructed to essentially ignore the behavior of the “passengers on the bus” while thinking about where to drive the bus.

    I would contrast that with the way people in the hearing voices network tend to talk about as a preferred way of handling voices. There the emphasis is more explicitly on having a dual method: there’s a time both for listening to the voices and a time for not listening (and when they are listened to, they don’t need to be taken literally – just as one may listen to a child, and “hear” that the child needs a nap, which wasn’t what the child literally said.

    So what I’m thinking is that if ACT would be more explicit up front about how both strategies are needed at different times – and if it would provide examples of how trouble can also be caused by getting too carried away with NOT listening to disturbing thoughts or feelings – then I would find it a more complete model.

  • My apologies, it turns out my post told people that non-professionals could enroll in the two online courses for free until 3/29/17, but then didn’t give the links for that! They are CBT for Psychosis at https://www.udemy.com/cbt-for-psychosis/?couponCode=SCHOLAR_SPRING_2017 , and Trauma, Dissociation and Psychosis at https://www.udemy.com/working-with-trauma-dissociation-and-psychosis/?couponCode=SCHOLAR_SPRING_2017 .

  • Yes, I’ve followed the thinking and strategies used in Acceptance and Commitment Therapy, and I use some of it. I wouldn’t though frame it as “modern CBT” but just a new “wave” of thinking and practice, sometimes bringing in genuinely new and helpful stuff, and sometimes only managing to sound new because of the way it distorts discussion of what came before, and sometimes even a bit shallow and not so helpful!

    Anyone interested in more about my thoughts on this might want to check out an earlier post of mine, “Acceptance and Commitment Therapy for Psychosis: A Valuable Contribution Despite Major Flaws” at https://www.madinamerica.com/2013/09/acceptance-commitment-therapy-psychosis-highly-valuable-contribution-despite-major-flaws/

  • Yes, I guess I could have said that better – I meant that people are sent to psychiatrists not to receive understanding, human connection, and exploring together, but rather just to receive pills, as you guessed.

    Bertram Karon is certainly one of the more important people in the history of therapy for psychosis! He wrote the book “Psychotherapy of Schizophrenia: The Treatment of Choice” and did research showing that experienced and motivated therapists could get better results with therapy and no drugs than conventional treatment could get with drugs. A recorded webinar with Bertram is available at http://isps-us.org/webinars.php (bottom of the page)

  • I agree with your points John. I’m in favor of noticing all the ways people can possibly be helped, and even when one way seems “better” I want to stay curious about how it may only be better in some circumstances and not others.

    It would be great to see mental health systems start seeing lived experience of psychosis as a plus rather than a minus for all mental health positions! At the same time, I hope we keep paying attention to all the factors that are involved in truly being helpful, and notice how it is indeed possible for people with lived experience to be unhelpful, and vice versa (and also having lived experience of some kind of “madness” is not the same as having lived experience of exactly what someone else is going through – we can notice similarities, but it is never the same.)

    And I think it helps to understand that we are all a bit mad, and for professionals who haven’t been overtly “psychotic” to still talk about their crazier experiences, perceptions, doubts, etc. As humans we are all peers in not being quite sure what true sanity is, and being on a turbulent quest to figure out what that might be. If we can meet on that dimension, their is hope for us.

  • Well, most grand visions are pretty hard to put into practice, and do require a lot of luck. but every now and again, progress does happen! Getting even some people to change their understanding then opens doors that some people slip through, even though the masses may still be stuck. Civil rights work did change social attitudes around racism some, even though it’s still a huge problem. So, maybe work for change, but don’t hold your breath?

  • Hi Nomadic,

    I certainly agree with you that just changing how one thinks, without taking action, and dealing with conflicts, is not going to work! But I “think” it is also a mistake to believe that changes in thinking have no role to play. Coming up with new strategies and perspectives about how to handle conflicts is often very helpful! If that makes sense to you, then maybe it also makes sense that at least some talk with others aimed at developing new thoughts or strategies for life etc. might be helpful and not harmful?

  • Hi Kayla, I agree change is difficult, but it does happen here or there. Sometimes someone in an organization starts to listen and opens things up, other times enough of the public might take an interest in pushing organizations to change.

    By the way, I encourage everyone to check out this pamphlet produced by the Felton Institute about trauma and psychosis. http://felton.org/wp-content/uploads/2016/11/Trauma-Early-Psychosis.pdf or this one on diagnosis http://felton.org/wp-content/uploads/2016/11/Diagnosis-Early-Psychosis-UPDATED.pdf

  • I don’t have any reason to believe that the authors of the NAVIGATE Family Manual were any different than those listed, but it is always possible that ghost writing was going on.

    I do know that the whole biochemical imbalance myth is super convenient for pushing people to quit asking questions and just take their drugs, and I suspect it’s that convenience that causes this lie to still be featured within the NAVIGATE program.

  • Thanks Matt, for all the points you added.

    Regarding the “blame” thing – I guess I’m wary of bending over backwards to avoid using that word. If there’s a car wreck, we understand it makes sense to figure out who was to blame, even if we still understand it was an accident, and we aren’t condemning anyone as being a terrible person. Going too far out of our way to avoid being blaming just makes it harder to make sense of what happened and how to prevent it in the future. On the other hand I do agree it makes sense to be compassionate also toward those who made mistakes that led to problems.

    And yes, I certainly think NAVIGATE is more influenced by big pharma than by the child molesters, though on this issue, their interests line up pretty well! I did start to write a little about that, but it didn’t make it into my final draft.

  • Yes, it is discouraging. But I think it’s something we have to watch out for: there are organized forces that don’t want to hear anything new and that will pretend to be humanistic and forward thinking while hiding at their core the same old toxic slop.

    And then there are organizations that will take in some of the more progressive viewpoints but just kind of mix it in with various kinds of misinformation. For example EASA, Oregon’s early intervention program, will admit that trauma can contribute to psychosis, or that anyone can possibly experience psychosis under the right conditions, but also portrays psychosis as definitely a medical condition, suggests that “schizophrenia” can cause psychosis (rather than it just being a label used for when something causes psychosis and other problems over a certain period of time), etc. See http://www.easacommunity.org/what-is-psychosis.php

  • I think the idea that “there is no right and wrong way to perceive reality” can be sorely tested when people start taking actions based on really different views of reality. If someone decides for example that in their reality I am a demon who needs to be killed, I may have some complaints. If a bunch of people decide that that what I believe to be the greatest threat to humanity is really no threat at all, and so they take power and organize action that I believe will vastly accelerate that threat to humanity, I may see a problem with that as well.

    So I think there really are dilemmas that occur. Certainly it makes sense for professionals to be less sure of themselves than they are in the standard mental health system, and to open a space for multiple perspectives where possible. In Open Dialogue, they try to create a space where big decisions can be put off, while different ideas about what is objective and what should be done can be discussed. I’m all in favor of that, but I’m not in favor of thinking that different views of reality don’t have consequences – it seems to me instead that at times differences in views can lead to very dire consequences, which is why it is important to create a space where other views can be heard and things can be sorted out in a wise way.

  • I can simply say I have talked to young people who were depressed who didn’t seem to have a distinct pattern of emotional abuse by caretakers. That doesn’t mean of course that the caretakers were perfect, just that they seemed average, both in my estimation and in that of the young people themselves. Of course, young people can have emotional challenges created by many other kinds of misfortune, bullying at school, and all sorts of other mistreatment, as well as the fact that more sensitive young people are more deeply affected by the emotional sicknesses and abuses perpetrated by our society as a whole.

    I haven’t done any studies myself about the overall percentages who have had what kind of experiences, so I won’t try to estimate what percentage has had or not had emotional abuse by their primary caretakers. I just know I wouldn’t support the idea that it is 100%. I think people’s lives are more possibly complex than that, and we should be interested in getting people’s actual story rather than making fixed assumptions that may not be true.

  • I agree it is not always clear who is the “bully” and who the “victim” – but as a practical matter, we might have to try and decide, with the only other alternative being to let the bullying continue, throwing up our hands and saying we can’t do anything because we can’t hope to understand what is going on.

    One of the dilemmas in life is that we can’t fully understand human relations and other important matters, they are too complex (whether looking at them from the outside or the inside) – and yet we do have to make decisions about what to do, guided by the best understanding we have.

    To address this, we might act when we see an urgency to do so, but then humbly step back into something closer to what Alex is calling unconditional compassion. So one child appears to be beating up another – one might intervene to stop the beating, but then attempt to understand both children, and the situation, from that place of deeper compassion. Similarly, one might have to actively oppose a voice (with a person) or a political group (within a society) but then also turn toward that same voice or political group with compassion, an interest in getting to know other perspectives and unmet wants and needs, etc.

  • Regarding the two headed monster of the prison system and the mainstream mental health system, I would note that both are rooted in a desire to control whatever is disturbing. So when control is overemphasized, then such systems become very oppressive.

    With mental health it’s a little more complex because many people are seeking help from it not to get control of others who are disturbing them but to get help to control stuff about themselves which seems out of control. So some people come in seeking drugs or even asking to be hospitalized.

    Regarding the value of contemplation: when issues are complex, there is some danger in just jumping in with action that isn’t thought out – such action can often inadvertently feel the problem itself. So I believe there is a place for finding a spot of calm or even doing nothing for a bit, which then allows us to act from a place of clarity and thoughtfulness. But it is also important to act swiftly enough, and so the best balance of contemplation versus rushing to action varies by situation.

  • Thanks Steve, for your comment! I agree with you that the issue you are talking about is very important. Not every depressed teenager has been emotionally abused by caretakers, but there is some kind of story to their distress, and we certainly need to be curious about that rather than simply proclaiming they have a “depressive illness” or “biochemical imbalance!”

  • Yes, it was a great story, thanks Caleb for sharing it! Regarding the fear of another episode: I like what Ron Bassman said about vulnerability to future episodes. He said, if I remember correctly, that when people really come to understand what they went through and what it took to recover, that they often become less vulnerable to a future episode than people who have never been through one. Because they know the territory and just what to do if they start slipping into anything. So it’s good to keep that in mind as a possibility.

  • Hi Frank, I would tend to agree, most of history is full of examples of groups of humans acting in a way that is far from “sane” or especially far from “wise” – but lots of us are fearing we will soon see new lows in this country that go far below what we’ve seen in our lifetimes.

    As for what is wise, trying to describe it is itself tricky. In some ways for example tolerance seems to be a virtue, but in some cases it isn’t, as in tolerating lies and fraud, tolerating rape and child abuse, tolerating human rights violations in the mental health system, etc. So wisdom is often seen as closely related to “discernment” or knowing where to draw the line in regards to tolerance…..

  • Hi Richard,

    I think you may be reading things into my brief sketch that I didn’t intend. I don’t find myself having any sharp disagreements with your comments, so we may only differ in nuance. I like you see a need for both dialogue and confrontation. And I share your desire for a society that exists for all, not for the advantages of some over others.

    Compassion and fighting have an interesting relationship. It might be compassion for a vulnerable person for example that causes one to confront and battle with someone who threatens that vulnerable person. That’s one level of compassion. But once we are successfully defending the vulnerable person, then we might notice it might also be important to have compassion for the person who threatened the vulnerable person – what was going on with that, what were the misguided wants and needs that led to the threatening behavior, how can we make peace with that person? At least, this makes sense if the threatening person is a member of our community or even our family.

    And at some point, we do have to be one nation. So it doesn’t work to just confront, we have to also pay attention to what is going on underneath, even if that isn’t the first thing we do. Just like a person with terrible voices might have to first learn to resist having those voices take over, but later learn to also have compassion for them and relate to the underlying needs that the voices represent.

  • Oldhead, your comment only makes sense if you ignore the fact that people have lots of problems with things that might be called mental health difficulties, even before they ever encounter any “treatment” or “mistreatment” by the mental health system. Lots of people seek help, and they aren’t crazy for looking for help, because they really are having trouble. Further, they do sometimes currently even get help, for example by good counselors, or doctors that might help them with a physical health condition related to their problem, or whatever.

    We wouldn’t be talking about alternatives like Soteria and Open Dialogue if people hadn’t experimented with various kinds of incremental change. Soteria for example evolved out of alternatives that were first tried within mental hospital wards, and Open Dialogue evolved out of family therapy and psychodynamic approaches.

  • While you are correct to point out the large barriers to incremental change, the problem I see is that the barriers to revolutionary change are even bigger! So it’s easy to call for revolution, but not so easy to make it happen.

    There could though be incremental changes that then set us up for bigger, revolutionary changes. So instead of seeing it as either/or, it would be more of a both/and strategy.

    For example, we need to have smaller “alternative” programs get started within the current system, just to create the awareness of what is possible and to test out how to really make it work. And then we need to build support for such things, so people actually see the need for the revolutionary changes you talk about.

  • I think Masson’s reasoning is a good example of how one can reach an apparently hard and strong conclusion by defining the meaning of things a certain way, even though the range of possible meanings is much broader and the hard conclusion being made is not justified.

    While you report that he defines the task of therapy as being “to change people” I believe better therapists see the task more as being to help people consider where or if they want to change themselves and to help them see options for doing that.

    To do this, therapists do bring in or draw attention to other viewpoints, not just their own but also those of others. This sort of dialogue creates a sense of options about how to look at things, but it remains the individuals choice what to go with amongst those options.

    Therapists are not lawyers or cops, nor a good substitute for them. But I have found them useful for myself at a point and I often see good therapy being helpful, even though the potential for it to to practiced abusively also remains a reality.

  • Very well said, you made a lot of very important points, clearly, with few words! And you tell a compelling story.

    The sticking point though in getting action is probably is that you are asking legislators to “second guess” people seen as medical doctors, and that’s a bit taboo in our society. I wish someone could come up with a way to overcome that – the best I can think of is to gather more dissidents within the medical profession, so legislators would feel they have at least some “doctors” on their side!

  • Hmmm, I agree with the first part, that to be really healthy we do need to feel our feelings, and to really hear from all of our psyche, or in Open Dialogue terms, “let all the voices be heard.”

    And I guess I agree all 4 of the things you cite MIGHT get in the way. Psychiatry and the more oppressive forms of religion do indeed routinely get in the way. But when therapy is good, I don’t believe it gets in the way. And while bad notions of recovery can get in the way, by creating a narrow sense of what people have to “get back to,” the wider idea of recovery I think is still important and helpful – people in our current mental health system are still too likely to be seen as stuck with problems rather than able to “recover” from them.

    In Law’s story, he himself first identified himself as having mental problems, and sought help with them. He didn’t of course seek to be locked up, not talked to, and injected with mind numbing drugs, but he did have a problem and was seeking help. That’s pretty common for people. The key thing is that we learn how to provide help that is really helpful, that leads to people “recovering” on their own terms, as Law was able to do. Anyway, that’s what I’m working for.

    Thanks for commenting, and thanks to all the others who have expressed appreciation for this post!

  • It is indeed “maddening” to have the system label as “delusion” thoughts which are actually quite “evidence based” such as the notion that neuroleptics are, at least to some extent, poisons, and can lead to death.

    But, to keep on the “high ground” I do think we need to avoid making claims we can’t really back up. So whenever someone on MIA says that the drugs are what’s responsible for people in the public mental health system living on average 25 years less, I think it’s worth reminding everyone that the drugs are not the only cause of the early deaths, even though it appears likely they play a huge role. (Poor people who have extensive trauma histories tend to die earlier even when not exposed to these drugs!)

    We sound more dramatic when we claim the drugs are entirely responsible for the problem of early death, but we also risk sounding biased and unscientific, out of touch with what is actually happening. Let’s just keep the attention on the fact that the drugs do shorten many lives while on average reducing chances for recovery – that is damming evidence enough.

  • Hi Richard,

    It seems we are on the same page with this one!

    One flaw I would see with “coping mechanisms” is just the “mechanical” emphasis. But that term also has some advantages as you suggest. Whatever term we use, the key thing is to recognize the way the same sort of response can help up to some point or in some situation but then not when things are different.

  • Hi Ragnarok,

    I think your point about how people can develop coping mechanisms for their own coping mechanisms that they are having trouble with, is very important! It suggests something which I think is true, which is that we can develop layers of such problems. None of it is well described as “illness” but it can be a mess. Still, it’s discerning what is what, and what is truly helpful in what situation, that helps sort it out.

  • Certainly it makes sense to focus on prevention – but it also makes sense to help those who have already been hurt etc. For example it makes sense to try to prevent kids getting broken bones, but you don’t put all the dollars into prevention and neglect the kids who have the broken bones already.

    And even if we make our families and schools and society more functional, I think some people will still have problems. Life is tricky, for example some kids get hurt even when they play on reasonably safe playgrounds. We are somewhat chaotic systems, breakdowns can happen, but we put ourselves together better when we can see purpose in all the different parts of ourselves.

  • My rough definition for “psychosis” is that it means being out of touch with what others call reality, and/or disorganized, in a way that causes serious problems. Of course we are all somewhat out of touch with what others see as reality, and somewhat disorganized, so none of this is black and white. And a person can be out of touch with what others see as reality, but more in touch than many others with something that may be very important: so it’s sometimes complex.

    I hear your argument that we should just give up the word psychosis, but those of us who are trying to be helpful to people with such issues need some way of talking about these kind of problems. Some use the term “extreme states” or “madness” but those don’t have super precise definitions either. In a way I think it’s good the term isn’t very precise, because in reality each person’s experience and problems are unique, there’s always a lot to explore.

  • Hi oldhead,

    In my line of work – as an “outpatient” mental health counselor, I tend to see people who voluntarily seek out psychiatric approaches because that’s the only way they know to deal with what seem to be the “symptoms” that disturb them. I try to show them that a different way is possible. I do think the problem starts with the way people are taught to understand what is disturbing them, though there’s all the misinformation, and lack of information, that they get about the drugs on top of that.

  • Hi Naas,

    Thanks for sharing your experience!

    I think change is most likely to happen if we both notice good behavior, and good approaches, while we also criticize bad. One problem with just being a fundamentalist “anti-psychiatrist” is that then it’s impossible to recognize and support good psychiatric behavior (at least not without contradicting one’s anti-psychiatric principles!) As I’ve said elsewhere, I think it makes much more sense to be just opposed to bad and oppressive psychiatric practices, then there’s no contradiction in supporting good psychiatric practice.

    It’s just not true that all psychiatrists think they are treating “diseases.” Some of them are aware that much of what they see are just human reactions to life difficulty that are complex, and they see psychiatric drugs as a tool that might be useful in a sparing way to help people deal with these difficulties. And fortunately, those who practice well also learn how to help people get off the drugs when they aren’t needed anymore.

  • Hi Oldhead,

    I really out to get my photo for MIA updated, it is certainly misleading – still it shows me in my 50’s, and I’m 60 now, so not so young!

    My history opposing most of what we call psychiatry goes back to the 70’s. But I was inspired in that mostly by psychiatrists, especially Ronnie Laing, also Szasz to some extent, and older figures like Jung. And also my sense that standard psychiatry was the very opposite of what I needed when I was in crisis.

    I met David Oaks in the early 80’s, and we’ve collaborated on and off ever since. My only involvement in the mental health field until the later 90’s was as an activist protesting the system. But I decided to become a mental health worker so I could help develop alternatives instead of just talking about how they should exist.

    So my sense of resisting psychiatric oppression probably comes out of that history – I never saw the criticism of psychiatry offered by people like Laing as separate from the survivor movement, they were just different points of resistance against what was wrong.

    So I don’t think my perspective is naive – I’ve been doing this for a long time, I just think that positioning myself as opposed to bad and unhelpful psychiatric practice is a much stronger position than being “anti-psychiatry” in general.

  • Hi Steve, I think all the steps you suggest, including “revolution” of a sort makes sense – but your idea that incremental change is impossible is proven wrong by the fact that some psychiatrists are already changing their practice. That is incremental change in action. I’m not saying I think it will be enough, though, which is why I also like your other ideas.

  • I agree there are more unknowns than knowns, but still a lot to know. And these drugs don’t just affect the brain, they do a lot to other parts of the body. And a big part in being expert in prescribing the drugs would be knowing how to talk to people about them, especially how to talk to people who are in various kinds of crisis or extreme states. So there’s lots that your average MD would probably not be great at.

  • Did you see me somewhere generally recommend neuroleptics for “psychosis”? I think not, I would prefer to see something like the practice of Open Dialogue, where most people can be helped without any use of those drugs. But not every experience of psychosis or extreme states is the same, not all cases respond to even highly skilled help, and sometimes a bit of emotional deadening or drug induced indifference can help people come out of some horrible places even when nothing else is working. It would be best of course if the drugs can be used only very short term, and even better if we get improved ways of helping so we never need the drugs at all, but we aren’t there yet.

  • It’s true that someone who isn’t medically trained can know a lot about the drugs and possibly offer helpful advice, but things do get weird in the way these drugs affect people sometimes, it still would be great to have people who had full medical training and could understand some of the complexities. Again, not that most of our current psychiatrists do, just that they should.

  • I think the complexity of the way particular psychiatric drugs affect particular individuals is actually a good argument for having people who really study that and specialize in understanding what is possible and how to work with it – I’m not suggesting your average modern psychiatrist does anything like that, only that there is reason to have medical specialists who do try to figure all that out. Your street dealers or witch doctors (who may have their own area of expertise, not to knock them) are not going to have that expertise about psychiatric drugs.

    And yes, I do agree with Gotszsche, that we would easily be better off with no psychiatric drugs at all, than with them being used the way they are. But I’m not proposing we continue to use them as we are: I’m proposing we have some kind of medical specialty that uses them very sparingly and “slowly,” only when there is a strong need and when other things aren’t working.

  • There was a day when most doctors delivered babies without washing their hands in between, and many fatalities resulted. One guy bucked the trend and noticed hand washing worked better (they ignored him and he ended up in an insane asylum!) But his bucking the trend didn’t mean that “real doctors” were people who failed to wash their hands in between deliveries: instead the exception became the rule as the importance of hand washing was eventually recognized.

    See http://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives

    So that’s my argument for paying attention to exceptions, and then teaching others the better ways, I suspect that will be more effective than just condemning everyone, including those who are doing a good job or might do so in the future.

  • Oldhead, you seem to be stuck in believing that all psychiatrists believe or propose that they are always treating diseases, even when they have no real evidence of that. But that’s not true: some of them know they are often just offering some medical interventions into what are actually very thorny problems people experience which have social, personal, and existential or personal dimensions, and which can be disabling or overwhelming. These problems do exist and offering to help with them is not fraud. Nor is it fraudulent to notice when physical health conditions seem to be leading to mental and emotional difficulties, or vice versa, and to have ideas about what to do about that.

    Actually it just takes one exception to show that a rule is not an absolute. What would be good to do is to make what is now exceptional into something common, and to define much of what is now common as malpractice.

  • I think we have to get beyond overly simplified statements such as “in today’s world Psychiatry does in fact equal multiple forms of oppression then “slowing down” psychiatry is still means preserving oppression.” Actually any number of things go on under the heading “psychiatry” in today’s world, much of it quite bad and oppressive, and some of it quite helpful. Many of our movement’s heroes have been psychiatrists, and they continued to practice psychiatry as they critiqued the bad psychiatry they say going on all around them.

    In general, being against bad psychiatry makes way more sense than simply being “against psychiatry” in my opinion. I think taking a sledgehammer approach makes our whole movement look uninformed, uncritical and insensitive – really the reason I argue this point is I want to see us coming from a sounder position.

    It’s easy to say one doesn’t need a psychiatrist to prescribe drugs for a limited period of time – but to find a medical person who say can really talk to and understand someone in an extreme state, who knows not just the drugs but also a lot about the alternatives that might work, who can resist the panicked relatives and maybe the panic of the patient who wants more drugs right now enough to move with caution, while still making wise choices to prescribe when that makes sense – that isn’t going to be your run of the mill doctor.

    Sure, it makes sense for all doctors to know something about this, there’s all kinds of things doctors should know something about. But we have specialists for a reason, and its because when problems become complex and the simple stuff isn’t working, it helps to meet with someone who knows a bit more.

    I know today’s psychiatrists usually aren’t the sort of specialist I’m talking about, but some of them are, and we do have reason to have a specialty like that.

  • Hi Richard,

    I think you are mistakenly concluding from my failure to list all the forms of psychiatric oppression, that I am unfamiliar with them. I’m pretty familiar.

    And I made no reference to simply “slowing down” oppression. Instead, the reference was to slowing down and being more cautious with things like the use of drugs, or concluding that some medical problem was/is contributing to some mental and emotional difficulties.

    Do you really think that all use of drugs for mental and emotional difficulties, at any point, is a mistake? Or that it is always a mistake to conclude that medical problems can be causing or contributing to mental and emotional problems? If these sorts of things sometimes are not mistakes, then it makes sense to slow down in the way I’m talking about.

    I don’t agree that advocating that some doctors be trained in how to work well with people in extreme mental and emotional states is the same as attempting to legitimize the ultimate scientific separation of “mind and body.” Sure it would be nice to think that all doctors could be trained to work well with these issues, but I don’t think that’s very possible or practical.

    I agree that there are so many ways the “train” of psychiatry needs to be reversed, but I’m also trying to notice the positive tasks which are medical in nature that some individuals are trying to carry out. I think these issues are worth talking about, even if I have to go against the MIA mainstream in order to assert that!

    I’ve never been very good at sticking to the mainstream……..

  • I’m not so convinced that the government is always unhelpful. After all, Soteria was a government sponsored intervention, Open Dialogue is government sponsored in Finland, and here in Oregon where I live, the government pays for people to go see counselors who are often helpful, no drugging or belief in “mental illness” required.
    When people get in big trouble and can’t take care of themselves, the government does often get involved. I’d just like to see that happen in a good way, not that it’s easy to make that happen.

  • Uprising, if you knew me very well, I doubt you would accuse me of “trying to preserve psychiatry at all costs!” Most of my comments on psychiatric practices are extremely critical, and I have no problem saying that I believe psychiatry as it exists is doing more harm than good. But if we are to be effective as critics, we need to come across as thoughtful, not simplistic and dismissive, so that means also being willing to consider where something like psychiatry might possibly do some good.

    And as I said in my blog post, I would be fine with eliminating psychiatry, and then starting over with something new. But I do think we would need some kind of medical specialty to accomplish the objectives I outlined. General M.D.s cannot be expected to know enough to carry out those objectives well in complex cases. I think anyone, including Hickey or Burstow, who might want to argue that we don’t need such a medical specialty, to be convincing would have to show a better way of accomplishing all those objectives – something I haven’t yet seen in all the comments so far.

  • Hi Oldhead,

    I hear your contention that psychiatry as a whole is necessarily built on fraud: I just disagree with you.

    I would agree that mainstream psychiatrists base what they do on beliefs that are really delusional or fraudulent: the whole notion that problematic reactions to life events are “illnesses” or “brain disease” and that psychiatric drugs correct “chemical imbalances” is wrong, and harmful to believe.

    But psychiatrists like Sandra Steingard don’t subscribe to those beliefs, so there’s no need to follow such beliefs or anything fraudulent in order to be a psychiatrist.

  • I agree that more tolerance of human differences would be helpful, but again that is an issue that goes way beyond psychiatry. Sure, psychiatrists have been the agents of a society that didn’t want to or know how to tolerate differences, but if that same society didn’t have psychiatrists to turn to, then they would turn to someone else to handle the “problem.” Of course, prisons are sometimes turned to now for that reason, they aren’t so great either.

  • I think most or all of the psychiatric drugs can create “paradoxical reactions” which are the opposite of the intended effect. So it’s not as though the average non-psychotic person becomes psychotic in response to them, usually they become just more passive and tranquilized, but yet it is possible that psychosis is the result. Obviously, being aware of such possibilities and watching out for them is something we should expect from anyone prescribing such drugs, even if that is currently rare.

  • Hi Frank,

    I didn’t much into the use of force in this article, but I think the force question goes way beyond psychiatry itself. If we decided psychiatrists shouldn’t be in charge of mental health, which I think would be a good idea, there would still be the social/legal question of what to do when people seem due to their “extreme states” that they are a danger to themselves or others.

    Regarding your assertion that we would be better off with nothing like “slow psychiatry” – I wonder what you would propose instead, to address the issues I identified that “slow psychiatry” could help with?

  • I hadn’t heard of this BCAA approach before, it sounds intriguing. I agree it’s a problem that money doesn’t go into investigating stuff like this. One thing I would like to see is a tax put on the sale of Big Pharma drugs, that would then go to pay for research into stuff that can’t be patented, and that is more likely to actually lead to health.

  • Hi Someone else,

    I agree with you that mainstream psychiatrists are oh so far from being wise in the use of drugs! But I don’t think that’s because they want to make people more mad – rather the problem is more that they just believe what the greedy drug companies tell them, and they focus on the way that drugs seem to help people in the short term, without ever asking about what happens down the road.

  • I agree, resorting to drugs should best be seen an admission of the failure at this point of other strategies, and we should always be looking for ways to come up with better alternatives that won’t fail, so drug use can be minimized, since there is no evidence it is a good long term strategy and even using them short term creates a risk of long term dependence.

  • I think a good “slow psychiatrist” would themselves be a great ally in helping people escape from any need for psychiatric intervention! Trying to prescribe the minimum dose, or no dose when appropriate, and guiding people in looking for alternatives first or switching to alternatives even if/when drugs are used at some point, would all be tasks taken on by someone who was truly slow and cautious about psychiatric intervention.

  • I agree it what I am proposing would stretch a bit the common definition of what is medical. But it is medical in that medical training would be helpful in doing things like understanding the effects of drugs and their potential toxicities etc. Certainly they should be able to suggest any substance that was likely to help with particular issues, as you say with no illusion that the substance directly treats the illness, but with the notion it creates a drugged state of some kind that may be strategically helpful in coping at least for a while.

  • I should mention that I don’t think neuroleptics correct “psychosis” in any direct way: rather they usually induce a state of relative indifference, which then has the effect for many people of making them experience the world, and act, in a less “psychotic” way. Breggin I think is basically right in saying that all psychiatric drugs are disabling in some way: but sometimes temporarily disabling some function or other can be strategic when things are going very wrong and nothing else is working.

  • Thanks Nancy, for sharing these thoughts. The bit about meditation, the default network, and dementia is quite interesting!

    I would disagree though on the bit about all psychiatric drugs being equal to placebo. That’s pretty true of the so called antidpressants, but neuroleptics for psychosis, or stimulants to help kids pay attention to boring tasks (in the short term) do beat placebos most of the time I believe, even if they are also destructive in many ways and unwise in the long term (and stimulants for kids should probably be illegal.)

  • Hi Oldhead, in the blog post itself I said one option was completely eliminating psychiatry and replacing it with a new medical specialty, while the other option was reforming it. I didn’t take a position on which was the best approach. Like you I can see a lot of sense in just eliminating psychiatry since it has so many bad practices entrenched within it, but on the other hand it’s very difficult to just wipe out one medical specialty and replace it with another. Getting more psychiatrists to practice in better and slower ways, and then pointing out the problems with the more arrogant and corrupt ways of practicing, can lead to gradual change that we can get started in right now.

  • I agree it’s going to be hard for the slow psychiatry movement to get established, for the reasons you mentioned. But why do you think it will somehow be easier to just eliminate psychiatry completely? That seems even harder, the profession would fight back, and people who want some kind of medical help and their families would be their strong allies. If on the other hand we establish something like slow psychiatry, then we can use increased awareness of the problems with traditional psychiatry and the existence of an alternative to push for change, with the support of people and families who want medical help at times but in a form that is not arrogant and corrupt.

  • Hi Alex, I agree with you it usually doesn’t make much sense, and can even be quite dangerous, to look for help from modern “psychiatry” in general. But that isn’t what I’m proposing. I’m suggesting we think about how medical people might learn to specialize in actually being helpful instead of harmful, and I’m proposing there is a role for people who want to do that, at least when other things aren’t working.

  • Mania has various degrees of intensity, and then there are complicating factors, like what kind of supports are available, the person’s willingness or ability to engage those supports, etc. I think a variety of things might work, but for all of them, sometimes they might not work. So having a “slow” cautious and informed medical person might provide another option when other things don’t seem to be working.

  • Hi Kim,

    I know reforming psychiatry or replacing it with a wiser medical specialty sounds difficult, but I believe it’s probably way more practical than attempts to completely eliminate it with nothing to replace it! It’s not like we have an “Eliminate Psychiatry” button we can just push! I believe we are more likely to succeed in persuading the public and policy makers if we can show we have a better approach that covers all the bases, with one of those being the sorts of things I’ve been writing about.

  • Hi jimg,

    It’s good to hear about your recovery! And I agree with you that we should have hospitals or other respite centers that know how to offer people an alternative to just taking drugs right away. Even if the drugs seem to help, they then create a dependency that can be hard to get away from – and of course it’s even harder when all the professionals are insisting one should never stop taking the drugs!

  • Hi Steve,

    I agree with you about how mainstream psychiatry often does little of what I talk about (though I see psychiatrists who don’t seem that far from the mainstream do a little of it.) But my point is just to identify what should be happening, and to get people talking about it. It seems likely, that unless we have some kind of huge change in the mental health field that is hard to anticipate, most psychiatrists may continue to be corrupt for awhile – but why not help some envision a way to practice that would be truly helpful?

    You mentioned that you “don’t see how the profession will ever garner the humility to admit it has misled us and choose another path. ” One possibility might be that the better psychiatrists will create their own standards of practice, and once the public becomes aware of them, a good portion of the people will want what they have to offer and so some good things will happen, even as what is now mainstream psychiatry gradually loses credibility. I don’t know how long that will take, but even some movement in that direction will be helpful to those who get better care as a result of some medical professionals starting to practice in a more thoughtful and cautious way.

  • Hi madmom,

    You make lots of good points. I do think it would help to have medical experts who really understood how to support withdrawal. Uprising is correct to point out that many current psychiatrists are more causes of the problem and know next to nothing about how to solve it, but that doesn’t mean we couldn’t use people who really did understand the issues and who knew a lot more about how to support psychiatric drug withdrawal than the average GP.

  • Hi John, I definitely agree that psychiatrists should not dominate in treatment. I meant to make that part of my post, thanks for making that point now. Psychiatry’s claim to dominating treatment has been that the whole issue is really one of medical illness, when in fact the issues are often much broader than that, ranging from social problems to the very deepest questions about human meaning and existence.

  • Yes Fiachra, I definitely think most people can get better without drugs. I really hate the drugs in general, I think hating them is a good basis for a careful practice! But sometimes people face really tough problems, therapists etc. don’t always help, even in Open Dialogue where they are really skeptical of the drugs they sometimes turn toward using them. All I’m suggesting is that it does make sense we have people who use care and develop some expertise with the drugs – very different than the approach of modern psychiatry.

  • Hi BPDTransformation,

    I would certainly agree that psychiatry as it exists is largely corrupt, and as such it is often dangerous, and people often do well to get away from it if they can. What I focused on in my post though was what psychiatry might be like if it wasn’t corrupt.

    There already are psychiatrists like Sandra Steingard who can see the corruption that exists and are blazing a trail toward practices that really try to be helpful. And they can be at times: no, a “medical specialty focused on mental and emotional problems” is not like “a trash-removal company focused on skyscraper building.” People with severe mental and emotional problems often face situations where things are spiraling out of control, and medical tools, drugs, can sometimes cool things off for a bit in a very helpful way. Finding something to support sleep when a person is manic and most drugs aren’t working is a good example.

    I agree that only a very small bit of our approach to helping with mental and emotional problems should be drugs – but we would still need people wise in how to apply drugs. Ideally, medical specialists trying to be truly helpful would know a lot about how to hold off on prescribing in most situations, or until lots of other things had been tried.

    As for whether I think mental and emotional problems not caused by medical conditions are common – I did explicitly state that “I believe they more commonly are simply reactions to difficult events or environments….” But there is stuff in the DSM that is explicitly medical, such as dementia. And many other problems described in there can have biological contributions, like lead poisoning adding to attention and behavioral problems, thyroid problems contribution to depression, inflammation with its multiple causes playing a role in depression and anxiety, etc.

    Anyway those are my thoughts in response to your post…..

  • Hi Oldhead,

    I very much agree with you that the imagined “illnesses” of the DSM are no justification for a medical specialty such as psychiatry. But I’m asserting something different, which is that there might be value in a medical specialty that doesn’t imagine illnesses, but does things like become really familiar with how drugs might or might not help with mental and emotional problems, and that also has deeper knowledge of how some physical health issues might aggravate mental and emotional problems, or on the other hand how physical health issues might result from those problems. Sure one could go to a generalist MD for such issues, but just as in any other medical area, it might make more sense at times to have someone involved who has deeper expertise in a particular area.

  • Hi Someone Else,

    Thanks for your comments. Your story is an example of how each story is unique, and real help requires tuning in to what is going on for the specific person. People get blinded by their hopes that everything will be explained by using some fixed categories! Of course, we all try to fit things into categories to make sense of them, but the more we can do so in a tentative and humble way, also noticing when our categories don’t really fit, the more we have at least a chance at those mutually respectful and understandable conversations that can be healing.

  • Thanks Alex for sharing your thoughts.

    You wrote that the mental health system perpetuates and embeds distress and suffering, by creating an appearance of having a solution but not actually having one. I think that point is spot on. Professionals often feel better when they can assure themselves and others that they are doing the right thing and offering the best services possible, but in fact, there are so many unknowns in dealing with individuals that it is impossible to be sure of this. And being “sure of oneself” when one is headed in the wrong direction does not have a good prognosis.

    People who work dialogically on the other hand don’t pretend to know, instead they engage in discussions that explore what might be happening and what the different views about it are, and if that doesn’t work, they are willing to consider they might have gone about things in a way that was wrong for that person. It’s a much more humble approach, but ultimately I believe more effective on average.

  • Yes, I didn’t get into the problems with existing “treatment” approaches in this post, I figure there’s lots of other coverage on that!

    Though I think you (and some others) exaggerate when you blame the mental health system for all of the disparity we see in lifespan outcomes for the diagnosed versus not diagnosed. For one thing we know that people who’ve been traumatized, and who are poor and disenfranchised, are already likely to have shortened lives: see http://www.scientificamerican.com/article/childhood-adverse-event-life-expectancy-abuse-mortality/ and http://www.nytimes.com/2014/03/16/business/income-gap-meet-the-longevity-gap.html?_r=0
    So even before the mental health system gets to many, they already have a few strikes against their longevity. Of course better forms of treatment might reverse some of those effects and help people live longer instead of add on things like metabolic disorders and heart irregularities from drugs, along with reinforced hopelessness from excessively biological theories about what the trouble is……

    I think we are in agreement though about the central role dialogical approaches could make in moving toward a better system.

  • It sounds like an important study, but it’s kind of scary to see it set up to look at a period of only 2 years. As I recall in the Wunderink study, after just 2 years it looked like the maintenance group might have been better off, with significantly fewer relapses. And it might be even more important to have more than two years to show positive results of guided discontinuation for a group that had multiple psychotic episodes in the past. So I really hope the study is extended past 2 years, or else I fear it may possibly become a study that could be used to support maintenance treatment…..

  • Hi Someone Else,

    I do agree with you about the point that when people make believe people have an “illness” called “schizophrenia” that has little or nothing to do with what happened to them, that they are often participating in covering up what happened.

    It’s sort of as though someone came in with broken bones, and we identified them as having some kind of broken bone illness, probably caused by genes for bad bones. If they person had just been beaten by a gang, it would turn all the attention away from the gang. (Of course, we also couldn’t conclude that the presence of broken bones meant someone had just been assaulted, as broken bones can have other causes, and sometimes biological factors do play a role in creating vulnerability to broken bones – just ask David Oaks!)

    To stretch the analogy further, even though in the case of the gang assault, the real problem is with the gang, once the bones have been broken, the victim of the assault is in need of assistance, they do now have something wrong inside themselves. So then we need a kind of intervention that will promote long term healing, not just short term suppression of symptoms at the expense of making the long term worse. That’s a tricky area in many fields, and I don’t think the problem is just that psychiatry is sometimes corrupt, it’s also that it can be quite difficult to take the “long view” when immediate distress and confusion is intense.

  • Thanks Noel, for your excellent response to the hype around that study. Your thinking seems very clear, and it’s so sad to say that this sort of thinking is still rare!

    I had been working on a post about this same subject, I won’t post it to MIA because I think it mostly just covers the same ground in a less thorough fashion, but some of you might want to check it out, it’s “”Schizophrenia Breakthrough” – Or a Case of Ignoring the Most Important Evidence?” at
    http://isps-us.org/blog/

    One thing I touch on in that article is to point out that the NIMH is still pretending it is “unknown” what kind of psychosocial events might contribute to a later schizophrenia diagnosis – despite everything we know about childhood adversity and psychosis! It’s a scandal on the scale of the Catholic church hiding the facts about sexual abuse by priests!

  • One article on families you all might want to check out is THE REHABILITATION OF PSYCHOANALYSIS AND THE FAMILY IN PSYCHOSIS: RECOVERING FROM BLAMING by Brian Martinadale. It’s available at http://tinyurl.com/j3kd58h

    I like for example the distinction he makes between punitive guilt, which is not to be encouraged, and reparative guilt which can be constructive. Then there’s also a bit about projected guilt…..

  • Hi Someone Else,

    I agree that much of the current mental health system is the opposite of what is needed. But I think you paint an exaggerated picture, especially when you suggest that it’s obvious that the drugs are making things worse. Actually it takes a bit of detective work to see how they often make things worse – on the face of it people are more likely to notice ways the drugs seem to help, to calm down people who otherwise seem at extreme risk because of their agitation for example. And when people stop the drugs, that’s often when really severe problems pop up. Noticing that the drugs can make things worse over time (and that for some people, they make things worse even in the short term) takes some more attentiveness to detail, and noticing how things can be tricky.

  • Hi Alex,

    I would agree with you that most of the dominant practices in the mental health field are about as sick as you describe. But I do work in the system and I see good things and practices and people here and there as well, so it isn’t monolithic.

    so I am all in favor of condemning what’s wrong with the system, and I think it’s great when people tell the stories of what went wrong (and even better when people really listen, which isn’t often enough.) But I’m not in favor of just condemning everything about it, because there are those bits of it that involve people actually being helpful, here and there.

  • I don’t think anyone recovers just thanks to any system, because a lot of the work is done by the person and also people get help from families, friends and other kinds of allies.

    But I have heard stories where people did credit the mental health treatment they received as being pretty appropriate – and they were people now off drugs and in control of their lives. Of course, they had also encountered somewhat better practitioners, who didn’t peddle lifetime dependence on drugs and treatment.

  • Hi John, I noticed you said you were finding something “odd” about this discussion – I hope you didn’t think anyone was trying to minimize abuse when it happens or fail to acknowledge that it frequently is involved in causing later mental disturbance.

    I am a big fan of the work of John Read and others who have done research clearly showing that abuse, and especially extreme abuse, puts people at high risk of later having problems such as “psychosis.” Once course I teach is on trauma, dissociation and psychosis, and I’m currently working on making that available online.

    But I think what people are saying is that we can’t just assume that parents or other family members have been abusive. There are other kinds of events that can lead to “madness.” So it’s all about getting the actual story as best we can, and then figuring out what people can do starting from now to possibly make things better, including dealing with past traumas if that’s part of what happened.

  • Thanks Sa, for your kind words about this post!

    As for whether helpers can go wrong if they approach people with compassion, humility and an open mind, and then really listening to what they are saying – well I think these issues are so tricky that it is still possible to go wrong even with that approach, but at least if one has that attitude one is more likely to notice when one goes wrong, to apologize and then be willing to try something else!

  • I agree with you, Someone Else, that we need to talk about and understand the way the mental health system and other helpers can put “mad” people into binds and double binds, often without realizing they are doing so.

    But I think it’s also worth recognizing that it often isn’t easy for helpers, and they experience their own binds and double binds. For example, a helper may want to support autonomy in someone, but notice that everything they do to help the person get more freedom is used by the person to harm themselves, say by street drug use or moving toward suicide or other destructive things.

    I also think to work with these issues it’s important to appreciate nuance, and to notice when people and systems may not be all good or all bad. So while I think our current system is very flawed, and further flawed by the way it often avoids any discussion of those flaws, I also know many people who find various parts of what it offers helpful at various points, so I think it’s best not to paint with too broad a brush.

    Of course, I understand there are also individuals who have received nothing but harm from the system, I’m not arguing with those stories and I think we need to learn from them, it’s just that I also don’t want to assume that everyone’s story follows that trajectory.

  • Thanks Donald, for pointing out the complexities that emerge when different children have different needs. So parents might do things that would work fine for one kid, but those practices may be harmful for another one. It makes sense that we all parent imperfectly, and things can go wrong in so many ways. Normalizing that can help open up space for discussion of what people need right now and what people can do to help.

  • I agree with you that abuse comes in many forms, and can be hard to detect. And then there are also bad things that happen that are more like accidents, where people are trying hard to do the right thing but make mistakes and so fail to meet the needs of people they love.

    I don’t agree though that abuse is always followed by “mental illness.” I think there is a certain amount of luck or happenstance involved – sometimes kids get abused but then bounce back, they somehow get what they need to work through it on their own.

    Going through abuse is like going through a war – likely to result in injury, but some people come back OK. While some people take a stroll in the park and come back with a severe injury! Life is tricky……

  • There are different ways to talk about it, but the issue of responsibility for what happens in madness is a tricky one.

    On the one side, people can get caught up in guilt or blaming others for things in unhelpful, simplistic and polarizing ways. But on the other side, people can get caught up in trying too hard to make sure no one feels responsible, so instead a presumed “biological illness” is blamed. The unfortunate thing then is that now attention has been directed away from the possibility that people could learn to take responsibility for themselves and for their impact on family members in a good way, and instead people feel helpless to do anything other than take pills or ask the family member “did you take your medication?”

    There is a middle way, that is curious about what can be done while also avoiding unproductive blame…..

  • Hi Frank,

    I agree with you that the way these drugs are pushed is despicable, and that they often kill the elderly in particular, and that sometimes when people seem to be dying from something other than the drugs it really is a result of the drugs indirectly. But with all that said, I still think if there were no antipsychotic drugs, we would still have a problem where people with severe psychological problems would be dying early to some extent. And I just think we will have more credibility in the long run if we don’t overstate our case, if we come across as balanced and careful. Because then they can’t discredit us as uninformed fanatics. I think our cause is much too important to make ourselves into easy targets.

  • Hi Al,

    I agree with your main points, they are important ones.

    I just wanted to nag you on one detail however. I noticed you repeated the claim that antipsychotics take 25 years off people’s life. I think it’s long past time for us to stop saying that, because the evidence isn’t there. Yes we know that some studies find people diagnosed with “major mental illness” dying 25 years earlier, and yes there is some reason to think that antipsychotics may be causing part of that problem, but there are also many other factors that likely contribute, such as suicide, smoking, illegal drug use, poverty, social isolation, etc. And there are even studies that show that amongst people diagnosed with “schizophrenia” that people who take modest amounts of antipsychotics live longer http://www.hopkinsmedicine.org/news/media/releases/study_use_of_antipsychotic_drugs_improves_life_expectancy_for_individuals_with_schizophrenia
    http://schizophreniabulletin.oxfordjournals.org/content/early/2014/11/24/schbul.sbu164.full
    (maybe that’s just because they are more tranquilized and stay out of trouble, or maybe because the studies are flawed – see
    http://www.behaviorismandmentalhealth.com/2015/06/01/neuroleptic-drugs-and-mortality/
    for a look at the flaws in one of those studies. By the way, it would be nice to see someone publish a critical look at all these studies and try to draw some conclusion from them.

    Anyway, I just think we look thoughtless when we repeat a statistic like “the drugs cause people to die 25 years earlier” when it doesn’t have good backing, it makes us sound more like dogmatic zealots than people with thoughtful points of view. And I know you are a thoughtful guy who has some really good insight into a lot of this stuff, so I want to see you come across that way to a wider audience.

  • But Richard….we as a culture have decided that mental problems are a medical illness. And no one but doctors are supposed to have oversight over medical illnesses, if anyone else tries to take any control, they are basically practicing medicine without a license, which we all know is very bad. So, there’s no way any government agency, at least any agency not entirely staffed by doctors, can in practice question any decision made by doctors concerning any mental or emotional problem!

    I’m guessing that was a key part of the bind you were up against……..

  • One thing I find fascinating is how the same experience can be terrifying or awesomely good depending on how it is interpreted.

    The same loss of meaning, lack of boundaries, dissolution of self and the world that can be seen as so terrifying and hopelessness inducing to some, can also be experienced as liberation and as the divine by others, or by the same person at other times. Isabel Clarke does a good job of writing about this, see my review at http://recoveryfromschizophrenia.org/2011/07/madness-and-mystery/

    So while I am all for empathizing with people that they may be experiencing something as truly awful, I’m very wary of viewing the awfulness as objective – because that cuts off the possibility that the person can learn to interpret it differently.

    Or, as I’ve put it elsewhere, if we go too far in trying to avoid “trivializing” or “romanticizing” psychosis, then we instead “awfulize” it, and that keeps people trapped, because now they think something truly awful is happening to them, and this makes it less likely they can become open to the possibility that they are simply experiencing a dimension of reality or a perspective on reality (and the perspective in which “meaning” and “self” is seen as illusion is useful in some ways even as it is threatening in other ways.)

  • I think there are lots of clinical people who think of “serious mental illness” as brain disease – it allows them to think they are doing the right thing when they focus all the efforts on getting the person to think of themselves as permanently defined as ill and keeping the person on drugs forever etc.
    At least that seems to be the way it works in the US! I have heard the US really stands out in that way, so I agree with you on that part.

  • Hi Paris,

    I think a natural extension of your concepts would involve talking about how family members who see their young son, daughter, or relative “go mad” are put into a bind themselves.

    That is, at that point if they pull back and simply respect the autonomy of the young person who is psychotic, they may allow disaster to happen. But if they jump in and try to save their relative, they easily fall into doing intrusive things that can be damaging and interfere with finding autonomy. It’s very hard at that time to find a middle ground.

    And the mental health system itself often falls into these same binds, and fails to find a middle ground.

    If the young person can be defined as “mentally ill” and not capable of handling life in a truly autonomous way, then this solves the bind – except that the person’s identity is left damaged. But then it is declared that this is simply “truth” so any damaging by labeling and by imposed definition is denied.

    A better approach is to appreciate the bind and the way it really is unsolvable, then we can talk about a variety of possible approaches (none of which are complete “solutions”) and at least figure out something to do today. That of course is what’s done in Open Dialogue…..

  • My comment above has a typo, I meant to say John Read is an expert regarding the effects of “childhood adversity” not “diversity.”

    To BPDTransformation: yes, the alien explanation is a pretty good one! It’s so much simpler than trying to sort out all the complex politics and motivated blindness which might otherwise account for how otherwise intelligent and competent humans could overlook so much!

  • Yes, it seems lame the way that this is being reported as though it is a surprising finding. But what is even more lame is that in many corners, it’s still taken for granted that if mental or behavioral issue is found to be related to a brain difference, that is being taken as proof that the issue is evidence of a “biological brain disease.” So anyone who thinks in that way would have to be “shocked” to find out that talk therapy can miraculously reverse this “brain disease.”

    John Read (an expert regarding the effects of childhood diversity on later mental/emotional problems) says when he goes to conferences with lots of “brain” people he sometimes finds himself getting up and asking questions like “what is the brain for?” and “Of what use would be a brain that did not change itself in response to the environment?” Because so many of them seem to talk and think about the brain as though it is an organ that exists in disconnection from its world.

  • I like a lot of what you have to say, but I think you would have a stronger perspective if you included a bit more nuance.

    For example, you wrote that “The thing is, our bodies don’t make mistakes.” I’m not sure that’s true. For example, what about auto-immune disorders? Also reactions like fear and anxiety often very much involve the body, yet they can definitely be mistaken, people can react with lots of dread to things which really aren’t dangerous.

    I would agree with you though that our bodies are amazing, and that simply classifying reactions as “wrong” often ignores what may be right with them. And drugs are a very poor way of trying to correct things – they are more like a sledgehammer, when we do better to engage with our emotional reactions, to listen to them and process through both what may be right and mistaken about them.

  • Hi David,

    There’s an interview with a psychiatrist in Mackler’s Open Dialogue film, where she talks about what a relief it was to have to give up that act of pretending to know what was going on, and what the person’s problem was! Instead, the new way was to show up and elicit various views or voices about what might be happening, and reflect on those views. I do think a lot of what is wrong about our current system is just the difficulty we have in “not knowing” which then shuts off exploration.

  • Well, I certainly wouldn’t rely on Dr. Pies to provide a “balanced view” of psychiatry! And I don’t mean to suggest we should avoid looking at any of the darkness. Basically though, my suggestion is just to balance being critical with being willing to see when/if particular psychiatrists have good intentions (whatever effect those intentions have) and also being willing to notice when/if things psychiatrists do are actually helpful in specific situations.

  • Someone wrote me privately and pointed out I had written a little about fear of madness previously, in my post Personal Steps toward a Revolution in Mental Health Care http://recoveryfromschizophrenia.org/about-ron-unger/personal-steps-toward-a-revolution-in-mental-health-care/

    Here’s the key paragraph on fear of madness from that post:

    “The sense that the journey could be positive kept me from developing an excess fear of madness. Research suggests that such fear typically contributes to madness itself (Hirsch and Jolley (1989)). One reason for that may be that the fear contributes to increased emotional arousal which in turn creates more “symptoms,” and this increase leads to more fear, etc., in an a vicious circle. Another function of the fear of madness is to shut down curiosity and the willingness to explore divergent perspectives: but while such curiosity may have a dangerous side when it leads a person into exploring “mad” ideas, it also is vital for preventing getting stuck in “madness,” as that same curiosity is required in order for a person to look critically at his or her “mad” thinking and eventually to transcend it.”

    Hirsch, S. R., & Jolley, A. G. (1989). The dysphoric syndrome in schizophrenia and its implications for relapse. Br J Psychiatry Suppl(5), 46-50.

  • Hi boans, I guess if the general public had no way to get aggressive toward mad people, and if all they were going to do was get anxious, there might be hope for your “poetic justice” to work out. Unfortunately, that fear of madness gets channeled into things like support for the Murphy bill in the US that promises to increase forced treatment while taking funding away from real alternatives. So the paradox is that when society starts having a more unbalanced or “mad” response to madness, it is the “mad” themselves who tend to suffer (and of course such suffering will just be interpreted as more evidence that madness is a very terrible thing, by those who don’t want to see any negative consequences to their own attempts to “help.”

  • I would argue for attempting a balanced understanding of psychiatry as well as of madness. I think there is lots of evidence of psychiatrists really trying to help, and in some cases of psychiatric practices and drugs probably really being helpful to some people for at least a short period of time, while also there is of course lots of evidence of misinformation, bad practice, and harm. And much of the harm seems to come from people who apparently have good intentions but who have believed misinformation (produced either by error or by entities happy to lie for profit.)

  • I think a key problem is that when we fear something too much, then we don’t look very critically at what is supposed to be saving us from it. So when psychosis is feared too much, it’s hard to look critically at the drugs that are supposed to be saving someone from it, then no one notices when the drug itself may be having very bad effects. A balanced look is harder to accomplish, but creates an opportunity to make wiser decisions about when to use any particular substance or not.

  • Hi Naas,

    I appreciated your article. It makes me think about how experiences that seem terrifying and destructive, such as some of the blind rage you felt, can actually be healing if we touch on them but don’t let them totally take us over. If we just suppress such experiences or see them as sick we can never make the kind of deep progress that you document.

  • Hi Alex, I think you are seeing some need to choose between your “authentic voice” and being thoughtful and reasonably considerate of the humanity and perspective even of people who you oppose for important reasons. What I’m suggesting is that it may be possible, though tricky, to have both.

    As for the process of gaining allies, it is quite possible to gain allies and do important work, while speaking honestly, even before the revolution is completed. Sera for example does great work alongside others with the Western Mass recovery learning community, and they wouldn’t be able to do what they do without knowing something about getting allies.

    One way to keep up one’s spirit in this difficult work is to notice the ways our work makes a difference to many people even before we can change what dominates in the system as a whole – though of course we want to change that too.

    Anyway I think I’m going to withdraw from this conversation now, so I don’t repeat myself too much, and so I can get on with other projects…….

  • Hi Alex,

    I agree with you it is important that people both honor and express their emotions. And I agree that “professionals” shouldn’t be authorities about what should get expressed or not.

    But as activists, it makes sense that we pay attention to what is effective and what isn’t, especially in getting us allies, as we can’t succeed without them. My sense is that those who are most effective are able to combine things like their own feelings and legitimate anger, along with thoughtfulness and respect for the humanity of the people they disagree with. That can be tricky to do, but at least in my opinion, it’s a trick worth trying to learn.

  • Hi Alex and Frank,

    When I referred to those who are “less polarized” I mean those who don’t have such firm opinions say either for or against what psychiatry is currently doing. They are the people we might be most able to draw to our side as allies, that is, if we get better at communicating our concerns.

    Being balanced doesn’t rule out being angry, but it does mean learning to focus our anger toward what is actually wrong, and not just attacking whatever seems associated. Martin Luther King was actually great at that kind of thing: he was no doubt angry about, and he attacked, racism and injustice, but he didn’t demonize his opponents, he conveyed that he saw people as human even when they were advocates for things that were really wrong.

    So yeah, it is about power, but until we can get a lot more allies, we won’t have much power. And to get allies, we need to come across as thoughtful and balanced, not just angry. Anger by itself is too likely to come across as just a tantrum, or even as more “mental illness.” Our cause is too important to let down in that way.

  • Hi Katie, and others,

    I certainly agree that it is important to be aware of the way people who have abused power are often happy to paint themselves as victims in order to avoid taking responsibility for harm they have caused. I did address this in my comment, where I noted that it is “all too easy” for this to happen.

    But that reality doesn’t negate the other reality which I spoke of, which is that there can also be some bad consequences if we fail to see and respect the humanity and vulnerability in the person or people who we see as causing harm. (Katie, you used the example of children: I think it’s much easier to work with bullies for example when we see them and let them know we see them as people whose needs deserve respect, even if we also are firmly demanding they start meeting those needs in less destructive ways.)

    I think we would all be well served by working on our ability to have balanced dialogue, where we demonstrate ability to hear and respect all the voices. I think this is important not so much so that we will be “nice” to the people in power, but so that we will come across as balanced and thoughtful to the people who are less polarized, and so we will be able to attract allies and convert some of those who are still muddled but leaning our way. Because we need a lot more allies, if we are ever going to have the power to really change things!

  • Hi Sera,

    I agree with a lot of what you say, especially the importance of listening to people’s descriptions of how they have been hurt if one ever wants to have a productive dialogue.

    But I think you might be able to do a bit better of a job of also trying to look at this through the eyes of the other party, to see how things might look and feel to Alice in this case. For example, about the “aggressive attacks” thing – while Alice didn’t in her comments explicitly say she was aggressively attacked on MIA, I think she would be right to describe some of the comments by some of the commenters that way – for example one comment suggesting her film was “utter bs” and pure stigma comes to mind. The tone of some of the remarks is pretty hostile, not dialogical.

    I think this is a very tricky area, because it is all too easy for people with power and privilege to claim that they are being hurt, or reverse discriminated against, or whatever, and to use that as justification for staying with and/or reinforcing the system as it is.

    But when we claim that the only rights and the only pain worth talking about are those of people who have been denied power, we create a climate which feels very unsafe for the person who has had power, because it’s kind of like being in a car that has no breaks – there’s a feeling that things are shifting but they are being given no way to stand up for themselves if things shift too far and they start being the one who really being hurt, misunderstood, having their reality denied etc.

    It’s a tricky balance to both keep in mind the ways the power balance has to shift, while also being willing to talk about those who have had too much power as human beings with needs and rights that we can also sympathize with – but I think it’s worth trying to do so.

  • Thanks for your well written story!

    I’m one of those people who went through something like the experience you did, but without the getting thrown in the hospital part. Still, one common factor that was really essential was always having at least one person I could talk to, to whom my experience made some sense (even if during one year that person was on the other side of the country!)

  • Hi Sera, I think sometimes people have positive intentions, but are also in reality doing harm, and are closed to feedback about the harm they are doing, because they are so sure they are doing good!

    That’s kind of maddening to deal with, but in those cases I think it is still helpful to recognize the positive intent. This can lead to a softening over time, or maybe lead to others who are a little more open to feedback being willing to engage with us, because we come across as friendlier, less polarized.

    People often hear voices that have positive intent despite in reality doing a lot of harm: I think it’s helpful to recognize the positive intent in those cases as well. It can set a foundation for interacting more compassionately and lead to eventual change.

  • I know the two filmmakers, Alice and Lois, and I respect their intentions both to create dialogue about mental health issues and also their intention to create mental health services where people try to talk to and understand those experiencing “psychosis” rather than just drugging them. But I think we need to distinguish between a positive intention to create dialogue and methods used whose results may be to actually suppress or appear to discredit some of the voices that most need to be heard.

    In order to strengthen our movement, we need to find ways to simultaneously make alliances with as many people as we can who have positive intentions, while also drawing attention to the way just having good intentions doesn’t guarantee good results, and sometimes the results obtained may be really bad. Having discussions like those are tricky, but in the long run I don’t think there is any substitute for learning how to have them.

  • Thanks for sharing your experience of this meeting, and your observations on dialogical practices in general!

    It seems so important to bring more than one perspective to the work we do. In fact much of the value of “new” psychological approaches may be simply in their being new and different: if they ever become dominant, then they risk becoming the latest rut or monologue, and we need some other perspective to challenge them, or we are stuck……

    I also think it is great that you are honest about the patience this entails. That’s probably one of the greatest challenges in bringing this practice into our culture, which lacks much patience!

  • I find the issue of whether or not this topic belongs on MIA kind of interesting. One of the key components of “madness” is making associations that others feel aren’t appropriate. But it’s complex, because other kinds of madness come from failing to make associations that should be made.

    That’s why it’s often debatable what is truly mad – should we stay “appropriate” and keep a narrower focus, or are there important reasons to break out of the silos and bring some important ideas together? There is no fixed answer to such questions – it all depends on the exact circumstances.

    As disaster seems closer, it does seem more “mad” to just go about business as usual, expecting others and other forums to address the crisis. “We just arrange chairs, we are responsible for adequate seating, others deal with problems like the threat of the ship sinking……..” So I think it makes sense in these circumstances to sometimes look at the connection between mental health issues and our coping, or not, with what threatens humanity as a whole.

  • Thanks bpdtransformation, I think you are talking about some important dynamics. Let me say a little about my take on it.

    I think the process of “going mad” is something like having a revolution in the mind (of course, there is also counter-revolutionary process as well.) The revolution happens in the first place because the existing order had been oppressive or ineffective (which could be due to anything from parenting problems, social problems, or reactions to past trauma), and the revolution aims to improve things, though of course also has its own excesses.

    It is tempting for outsiders to see the disorder caused by the revolution as being the problem, and to intervene on behalf of suppressing the revolution by any means necessary. That’s what our mental health system usually does, though this approach as you say does repeat traumas and reinforces an order of things that really does need to be shaken up in order for health to emerge!

    It is trickier to just be with the chaos, to be unsure exactly what is right, but to be with the different factions within the psyche and to support the emergence of a process that can bring them all back together again in a possibly more open and less oppressive system.

  • A few more thoughts about this:

    Usually we think of healthy as what’s “normal.” But if normal in a culture becomes acting in a self centered way that leads to the destruction of countless species and the ecological stability upon which future generations depend, then it’s pretty hard to call that “healthy.” Maybe we should give it a diagnosis, call it a particular mental illness?

    Then we have the people who enter into the kind of turbulence we call psychosis. They might go even further off track, but also new ways may come out of that turbulence that lead toward a less self centered way of being in the world.

    Traditionally, we call that turbulence itself “illness”

    Vomiting is not pleasant, and too much of it for example can lead to death from dehydration or something, but it can also be part of recovery for example from having ingested something poisonous. Simply suppressing vomiting in such cases could be destructive rather than helpful. Could it be that psychosis is kind of like vomiting, a process that has its dangers but can also be useful in coming back toward health?

    We might wish that people would be able to go straight from noticing problems with “normality” into positive creativity and cultural transformation. Sometimes, it happens that way. But often it doesn’t: people initially often make mistakes and flounder, they may even seem to be “drowning” in that ocean that Campbell talked about (the one “psychotics” drown in, while the mystics swim…..”)

    But at that stage, are they sicker than the “normals” or possibly at a risky but possibly productive stage on a journey of recovery from a pathological “normality?”

    In many areas, we want to have the creative accomplishments with none of the mistakes that tend to happen along the way. But if we try to hard to eliminate any mistakes, we end up suppressing the accomplishments we want as well. I think that’s where we are with psychosis.

    So if someone can be just successfully creative or mystical, our culture accepts that, or even appreciates it. But if someone is working out how to be successfully creative or mystical, and is making errors on the way, we call them “ill” and try to shut down the whole process they are engaged in, rather than attempt to help them learn to do it with more finesse, and to not put too much weight on new perspectives till they are tested, etc.

    So I would agree that it isn’t madness that will save the world, but taking a more nuanced perspective on madness, and treating it as part of a process of wild experimentation and/or groping toward what will possibly save the world, could be exactly what we need.

    I think it’s sad that there are very few places in our mental health system where these sorts of questions are asked and discussed. I’m happy that people like Paris are asking the questions.

  • Hi Norman,

    Therapists berating their clients for not adopting to the therapist’s style sounds like a pretty terrible practice! That’s certainly inconsistent with the ideals of CBT, which emphasizes collaboration, exploring together.

    I don’t think I’d go as far as you though when you say that “one should always attempt to make the therapy fit the client and not the other way around. ” I do think there is room for what’s called “socializing the client into the therapy model” which involves teaching how it might work, giving reasons to try something that may seem counter-intuitive, etc. And when a client thinks something isn’t going to work, it can be important to explore why: they may just have a misinterpretation about what is being asked. But this whole process should never feel harsh or pushy.

    I suspect the problem may be that when therapists (and their supervisors) are too sure CBT is the best or the only way, and even more so when therapists have a narrow interpretation of what CBT is, then they are sure the only thing to do is to push more forcefully when the client resists their initial efforts. Having less certainty is important if we are going to be collaborative – an issue I plan to write about more in the near future!

  • Thanks Paris, for this illuminating article! When the “normal” people are destroying the world, we certainly do need more experimentation with something different, and we certainly also need to get better at supporting people as they go through this wild experimentation so they are less likely to crash or get stuck somewhere nasty.

    I will be a fine day when our society can learn to see “psychosis” as being simply “possibly dangerous exploration” rather than as something unambiguously bad and an “illness.” Then we will really be able to support people in a way that is non-stigmatizing and which helps people access what might be positive in the experience while avoiding hazards.

  • Hi Saul,

    I think you are right that there are real limits to just challenging depressive thoughts, though I think there can be some benefit to it, especially when one doesn’t see it as an attempt to “replace the negative thoughts with positive ones” but rather to come up with balanced thoughts that admit what is true in the negative thoughts while also noticing what is also true that allows for possibility and hope.

    There’s also some interesting stuff out there on how getting into a state of depression can actually facilitate problem solving of a certain kind, see http://www.scientificamerican.com/article/depressions-evolutionary/ Of course, like other evolved states like fear it doesn’t always help us solve problems and may create way more than it solves, but it can help to see it as having at least an intended purpose, if an unconscious one.

    But behavioral activation is often at the core of getting out of depression, and your website which you linked to has a cool approach to that, thanks for sharing!

  • Hi Richard,

    I never explicitly said so in my blog post, but I do agree with you that CBT can be all 3, part of the solution, part of the problem, and not really anything distinct from other methods.

    CBT is a tool, that can be used in different ways. People may be encouraged by the system to only use it to make the box they are locked into more comfortable (“adjustment”) but it can also often be used to help get out of the box.

    As far as the change from within/change from without argument, the answer I tend to endorse is that we need both.

    I spent years working for change from outside the mental health system before I became a worker within the system. (Living in Eugene along with David Oaks, I was influenced by his leadership, and I started attending protests, writing editorials, and speaking to groups.)

    But I noticed it’s hard to convince the general public that things can be any different if we don’t have living examples of things being done differently. To get that happening, we need those alternatives happening around the edges or within the cracks in the existing system. When the general public see those efforts working well, it becomes easier to convince them it’s the mainstream system that needs to go.

    I’ll look forward to hearing the story you are planning to tell, and I’m sure there are lessons to be learned from it. But while I have certainly had my own stories of frustration, I’ve also seen positive things come from working from within, so I don’t plan to give up my efforts anytime soon., and I hope others don’t either. And I suggest also working for change outside the system…….

  • Hi sjdelgado168,

    It’s true a lot of my focus was on the value of CBT for psychosis, partly because I think that is a key area where CBT can be part of the solution, and partly because that is what I practice and am familiar with. But quite a bit of what I wrote applied to CBT in general, and addressed prior critiques of CBT in general, so that’s why I wrote the title the way I did. I’m sure there’s much more I could have written, and I also thank all the commenters like you who have contributed to the discussion.

    As for how I would answer the question that Fiachra asked you – I think psychosis can arise out of attempts to cope with intense anxiety. To give a very condensed example: a person feels frozen in anxiety and indecisiveness, then gives up trying to sort out exactly what to do and develops a powerful “voice” or belief in other messages that say exactly what to do. For a bit, the anxiety is resolved, but then following the voice or messages may lead to states that get diagnosed as psychosis.

  • Hi Richard, I’m going to try to respond to your points in the same order you made them….

    I disagree with your assertion that the practice of CBT is somehow tied to believing in an Idealist perspective. Good CBT recognizes we are always embedded in a situation and that our own behavior in turn affects what situation we are in. CBT does notice that even when we are stuck in a certain situation, we have options in regards to thinking about it differently, and which option we take will affect how we feel and behave etc., but that’s something we can see as true in practical sense whatever our basic philosophy. (I’m more of an “opposites arise mutually” kind of guy, I wouldn’t express adherence to the materialist or idealist viewpoint……)

    I agree with you that with any method, it is important to look at how it is being used. I also did write in my post that I agree CBT is too often being used to simply promote “adjustment” but I also argued there is nothing in CBT that requires it to be used that way. In other words, the problem can be seen as not inherent in the tool, but it the way the tool is being used. It isn’t necessary to throw away a tool when it is being misused, but only to change practice. Exactly how to build bridges between social justice work and individual therapy is a big and important topic, not just for CBT but for psychotherapy in general.

    When I look for how CBT can be part of the solution, I look for what is best within it. I pay attention to people like Tony Morrison who for example is doing some great work showing that therapy for psychosis can be helpful to people who don’t want to take medications. I am fully in favor of attacking crappy CBT, but I would suggest attacking it as being bad CBT, not rejecting possibly good ideas and good practices just because a bunch of bad therapists and bureaucrats distort those ideas into something unhelpful.

    You made a claim that if therapists used the “strict CBT guidelines” in each session, they would “be often ignoring the needs of the person seeking help, and often harming that person if they failed to be trauma informed or deeply aware of the oppressive nature of the world we live in.” I don’t agree. Check out for example the Cognitive Therapy Scale – Revised at http://www.ebbp.org/resources/CTS-R.pdf – that’s a scale used by many to rate whether or not good CBT is being practiced. Key parts of it relate to being collaborative, interpersonal effectiveness, eliciting appropriate emotional expression, and getting feedback on how it’s all going. That’s hard to do while ignoring people’s needs. It also does ask that the history of the problem be addressed, which suggests that failing to be trauma informed wouldn’t work. And there’s also an understanding by CBT trainers (at least the ones I went to) that it’s sometimes best to not do things asked for by this scale if there is something about the client that makes it be inappropriate at a given time.

    Regarding your idea that therapists need to be activists, I encourage therapists to be activists but also think therapists can do some good without being activists. Good therapy itself can be a real service. And I definitely don’t believe we have to wait until we can somehow overthrow the entire mental health system before we help liberate anyone! I would like to liberate everyone from whatever is oppressive, but if I can only liberate a few here and there, I believe that counts too. And I think real revolution in the mental health system is more likely to happen if we first open up more cracks in the existing system, bringing in methods that really help empower people in a healthy way. I think good CBT can be part of opening up such cracks.

  • I agree that grief is important, and any therapist who sees it as just “negative thoughts” is one to stay away from!

    The way I think of grief is as a process of sorting out what was lost from what still remains. Some people do need help while they are grieving, because they fall into a pattern of thinking that “all is lost” rather than just facing clearly exactly what was lost while still being able to see what remains. When we lose someone important to us, we have a loss that will never be made up to us, it will always be there as a hole in our life, and seeing that may be negative but it is also accurate. On the other hand, there may still be important people and opportunities for love and joy in our life, and finding a way to see that as well is part of the balance that good therapy, including good CBT, aims for.

  • Hi Andrew, I think the emphasis on thoughts that you highlight is maybe the core of “cognitive” work – the notion that we are always interpreting things, that our interpretations have key consequences in regards to how we feel and behave and so in our situation, and that we can change those thoughts or interpretations of things and end up with a very different result.

    There are of course hundreds of schools of therapy, and lots of them do in one way or another also consider the possibility of changing thinking! But CBT is probably more explicit about that possibility, and emphasizes more how simple changes in thinking can have large results.

    CBT as a whole includes looking at inter-relationships between thoughts, feelings, behaviors, and also life situation and physiology. A key practice is mapping out how these are currently related, and then imagining how changing one variable could change the others. Usually we think of thinking and behavior as the two things people can most easily change, with changes in those then impacting other variables. In practices like compassion focused therapy, which is often integrated with CBT, the therapist may also teach people how to deliberately evoke compassionate feelings which then influence both thoughts and behavior – it’s all an integrated web of relationships.

  • Hi Norman, I certainly agree with you that the last thing we need is therapists who don’t know how to relate to people are who are sure that having a few CBT ideas makes them a superior therapist!

    At the same time, I have met therapists who know how to be friendly and empathetic with people, and yet they have no ideas to offer people about how to actually help them with their difficulties if being friendly and empathetic proves insufficient. I’ve also met people who went to therapists like that and found the whole experience very frustrating, the therapist was very empathetic about how it felt to be as stuck and distressed as they were, but had no ideas about what they might do differently to make it go better. Ideally we have therapists who can relate well and also help people try different things, which I think is what you were saying about therapists who can use multiple modalities to meet the needs of the people they serve.

    One area I would slightly disagree with you on is where you said that “empathy and in-depth understanding of a person is always an aspect of good therapy.” I think it is sometimes possible for people to be helped by a therapist who doesn’t yet understand them very well, sometimes just sharing an idea or somehow prompting a different way of looking or acting is enough to trigger change in the right direction. (Sometimes even reading a book or watching a video is enough to get people to change in a good way!) But good therapists can go deeper as needed, and if CBT is being taught in a way that interferes with therapists learning to do that, then that’s a big problem.

  • Hi Michael

    I think sometimes opening up to the ideas of others, expanding the tent, is a way to make progress. But then sometimes we notice there’s just too much nasty unhelpful stuff in the tent, and it’s time to clean house.

    So it’s hard to say that all appeals to allowing a “big tent” are misguided. Like another commenter on this post, I very recently found myself arguing for a “big tent” of sorts, diversity of views, etc., in another context.

    I guess what I’m saying is that i do like diversity of views, but not when they are grossly insensitive and foolishly dogmatic, like portraying certain people as “the mentally ill.” Then I start seeing the point of shrinking the tent.

    Speaking of diverse views, I see how much you like quoting Lieberman. My personal favorite Lieberman quote is this one: “As someone who has worked with thousands of schizophrenic patients, I can assure you that they are just as likely to betalked out of their illness as they are to be bled or purged out of it”

    Talk about a “big tent” – inviting him to an ISPS meeting was as great an idea as inviting a KKK leader to address a civil rights rally. After all, shouldn’t the KKK have rights too?

  • I think psychosis can be understood as often an extreme version of everyday problems (though it can a also of course be a side effect of some medical or drug problems.)

    “Normalizing” is a method used within CBT for psychosis, to help people understand how their psychotic experiences may be understood as on a continuum with everyday problems, even if toward an extreme end of that continuum. For more on that approach, check out https://www.madinamerica.com/2014/07/normalizing_psychosis/

  • Thanks Tim! It’s good to see you writing in this forum. I especially liked your paragraph:

    “More and more the health and lifestyle message informs us of a parade of different methods, medicines, and machines for achieving amazing results with minimal effort in almost no time at all. The idea that life can be tough is barely a whisper above the beguiling roar of life as a never ending party where people who are normal are relentlessly chirpy, agreeable, and successful.”

    I’m sure the problem you appear to have with all those chirpy people can be resolved with some kind of pill or other. Please contact your doctor……

  • Hi Carina,

    My thought is we don’t really have a choice about whether or not marketing affects our field. It will no matter what. If the leaders in Open Dialogue allowed anything at all to be called “Open Dialogue” then a likely result would be that many things would be marketed and called by that name which did not follow the Open Dialogue principles and which did none of the difficult work you are talking about. This would eventually convince most everyone that Open Dialogue itself was worthless and it would be abandoned.

    Daniel has expressed concern that even with the name being controlled, there will still be programs called “Open Dialogue” that don’t follow the principles. That’s still possible, but at least we have people trying to bring those principles into reality and keeping them real (and trying to do so in a way that fits the culture into which they are applying them – the leaders in Open Dialogue are very aware of this concern.)

    It seems to me that the fears of damage being done by trademarking the name are being overblown. Worst case might be that someone develops a program that really follows all the Open Dialogue principles, but those who control the trademark refuse for some unknown reason to let it be called Open Dialogue. That wouldn’t have to stop the program: it could justify itself in terms of the principles it was following, and the likelihood of those principles being effective, rather than justifying itself in terms of the “Open Dialogue” name. It’s the principles and their effectiveness, after all, that we really care about.

    I for one really appreciate all the thoughtful efforts of people like Mary Olson to bring Open Dialogue into wider use. Unless we see them making some truly major mistakes, I don’t see the point of getting all critical about their strategies in doing so: I think our efforts would be better put into supporting them and/or other programs that have some promise of bringing really constructive change.

  • Hi Carina, I’m not sure I understand why there would be a problem “dealing with” other programs or people who independently invented and practiced many of the principles. It seems to me they could continue calling what they do what they have always called it, or if they wanted they could use the proposed term “dialogical practices,” or the term Sandy suggests, “needs adopted approaches.” I don’t see why they would have any need to suddenly start calling what they are doing “Open Dialogue” in a case when they weren’t actually following all the principles of Open Dialogue. Am I missing something?

    Regarding Daniel’s concern about people doing what is “legally branded” Open Dialogue but not following all the principles – that would be quite sad, if indeed it is happening. As I recall the practice of holding back on using antipsychotics follows from the principle of “tolerance of uncertainty” which includes “avoiding premature treatment plans.” That’s one of the principles I like the best…..

  • I went to the first Open Dialogue training in the US that happened in New Mexico, with Mary Olson and Jaakko Seikkula, and the issue of how to define Open Dialogue was discussed. There was concern that lots of people and/or agencies would start calling things “Open Dialogue” when really most of the principles would not be followed, so they wanted to restrict the use of the term to practices that actually followed the principles.

    It was suggested that practices that followed some of the principles but not all of them might better be called simply “dialogical practices” to avoid confusion.

    I basically support that notion, I think it’s great that people describe what they are doing as accurately as possible, and I don’t see harm done if people who are practicing in a way influenced by Open Dialogue, but not really following all the principles, are asked to use a different term for what they are doing.

  • Hi Sean,

    I think lots of us on MIA try to figure out what an ideal mental health system would look like, but we also are busy figuring out how to help at least some people within a less than ideal system. For example, I help people who are capable of making it to and getting something out of outpatient counseling, usually one hour a week or less. Probably like the two week interventions you do, that works well for some, but of course not for many others – we need a system with sufficient constructive options to possibly reach everyone.

    Getting back to my own story – it certainly was fortunate that I had an interest in psychological stuff – I took an interest in psychology prior to my own “extreme states.” And it was fortunate that I really liked to read (a habit which I developed as my way of coping with oppression), and that books by people like Watts and Laing were prominent in the bookstores, so it was easy for me to run into them. I just consider that a kind of luck rather than a sign of my “advanced development.”

  • Hi Sean,

    I’m pretty sure that anyone who would have checked me out as a late teenager would not have tempted to see me as being in any sense of the word “highly developed.” And that was the age I was when I started having the experiences I wrote about, losing my sense of self and sense that anything had any fixed meaning.

    I grew up facing abuse at home, and very extensive bullying – always being one of the very most picked on kids from elementary through sophomore year in high school at least. I had very little experience of having friends, I was very repressed and ashamed of my sexuality, and while I had good verbal intelligence, I had extremely little worldly understanding or street smarts, I didn’t know how to be emotionally honest with anyone, I was desperately trying to fake being OK so that others would accept me.

    So how did I get through my experience in a constructive way, so I can look back on the whole thing as a positive experience? One is I didn’t get subjected to people who made me scared of my experience (whether or not someone is scared by this kind of experience is not all just about them, but about how others convince them to view what is happening.) On the positive side, I had one good friend who was a bit more developed than me who was going through something similar (and a second on-the-edge friend who conveniently engaged with me shortly after I alienated the first one), I had access to lots of written material from people like Alan Watts and R D Laing who helped me see hope it could be a positive journey, and it was a forgiving time socially – the early 70’s, when being a “freak” was considered cool. And of course, lots of dumb luck, along with whatever inner strength I did have.

    By the way, I’m definitely not a fan of Ken Wilbur’s hierarchical distinctions. I’ve always felt they were more useful in making Wilbur feel advanced and clever than they were at reflecting reality. I think Wilbur just couldn’t stand the notion that all our advancements may actually not make us any better or more advanced that anyone else in any ultimate sense – that maybe the truths we discover at the peak of some spiritual journey are just things we forgot when we were infants and first started to develop a “self.”

    From a more limited everyday human perspective, though, it does of course make a difference what kind of resources we have when we go through death/rebirth and touch the Void on the way through. I would argue, partly based on my own experience, that this isn’t just about the resources within the “self” but also in the person’s support system, culture, etc. And of course, within one’s mental health system, if one is thrown into that. Our current mental health system frames the whole experience as simply illness, thus increasing fear of it, then of course turning around and framing the fear itself and the reactions to the fear as evidence of how terrible the whole experience is, never recognizing the circularity. We obviously need something better.

  • I think it’s wrong to blame psychiatrists and other professionals for their pattern of explaining behaviors as being caused by the label they make up for that behavior. They can’t help it: this is clearly a symptom of “Circular Reasoning Disorder” and that’s why they do it. I’m not sure what the treatment should be, but maybe if we talked to the drug companies they could find something for it?

  • Hi Bob, your link is not working, at least it isn’t working for me…..

    Here’s a different link though, about some research done where the researchers pretended to have a test to show if a depressed person had a biochemical imbalance or not

    Those who thought they had been found by a test to have such an imbalance did not experience any less self blame, but did become more pessimistic about their condition, saw themselves as less able to regulate their mood state, and less able to benefit from therapy – http://www.ncbi.nlm.nih.gov/pubmed/24657311

  • Hi B,

    I’m on the same page with you regarding the importance of being humble enough to see there may be lots of truth in things people are talking about that may be literally untrue, but still carrying lots of meaning.

    If you think about it more deeply, most of the spiritual traditions had some teachings about the truth going way beyond what could be put into words – which we might understand as indicating they knew the truth was not in the literal meaning of their words. Later people who come along and declare their words meaningless because they aren’t “literally” true are showing their ignorance in more ways than one. And the same goes for mental health people who assume there is no truth or meaning at all in things diagnosed people are saying which obviously aren’t literally true……

  • Hi Audrey,

    I think the bigger picture is that for some people like you the drugs don’t seem related to the “negative symptoms” which for others the drugs definitely cause them to get worse, while for others they may even get better on the drugs – with an “average” effect that the drugs don’t seem to make “negative symptoms” worse or better. I think it does make sense for everyone to pay attention to the actual effect of the drugs for themselves.

    One thing I suggest people experiment with is instead of thinking of the “negative symptoms” as being part of an illness, is to think about them as possibly related to things like confusion and demoralization. If people start noticing when things seem just a bit more clear, when some inspiration, hope and other affect emerge even a bit, and support that in a good way, then the “symptoms” can fade.

    By the way, if “one thinks of negative symptoms” as related to confusion and demoralization, it becomes easier to explain why the drug effects on them could be so variable. For some, the drugs will suppress the things that have been confusing and demoralizing them, and the “negative symptoms” will decrease. Others will find the drug effects themselves to be confusing and demoralizing, and will have “negative symptoms” increase. For others, the two effects will cancel each other out, there won’t be any noticeable change one way or the other.

    For more on a psychological approach to these problems, you might start with https://bbrfoundation.org/discoveries/aaron-beck-reducing-schizophrenia%E2%80%99s-negative-symptoms

  • Hi Noel,

    I certainly agree with you that it is hard to be clear about complex matters in brief comments on a blog! And in a case like this where I had a disagreement with a couple of things, it’s hard to also convey that I agreed with the vast majority of the things you were saying, even though I did try to communicate that.

    You wrote in your latest comment about how before a person can learn to question his or her beliefs, he or she must have a reason to question them. I would agree with that – but sometimes it’s the consequences of holding the belief that are so severe, which makes a person think of questioning them. So it may actually be focusing on how the belief causes problems that gives the person incentive to question it.

    You also wrote in your latest comment that “At no point anywhere have I said that “never” should beliefs be considered problematic.” OK, but you did write that “The main point of the whole article is that beliefs themselves are not the problem- it is what they represent.” It was the “beliefs themselves are not the problem” part that I was responding to, which seemed to me to imply that you were saying was that we shouldn’t think of the beliefs themselves as ever being what was problematic, even though I get it that you really didn’t intend that.

    So I doubt that things are perfectly clear yet, but this is my attempt to clarify……

  • Hi Noel,

    From my perspective, I can’t accept what you said in the comment above is the “main point” of your whole post, which is that “beliefs themselves are not the problem- it is what they represent.” Sometimes it seems to me beliefs themselves are a real big problem, they lead to people taking actions that have really big consequences, so it seems misleading to suggest that beliefs are never “the” problem, even though it would also make sense to be curious about what is behind them.

    And sometimes people’s recovery stories have a progression that involves learning to question “delusional” beliefs BEFORE the person learns to reflect on what they might mean. For a public example, think of Eleanor Longden, who first learned to question the belief that her voices were real beings outside of her that had the power to do things like damage her family: after that she learned to reflect on what was going on psychologically behind the voices. I’ve also seen plenty of people who made progress by learning to question their beliefs (but that of course is different than having someone try to force that concept into their head.)

    I also wanted to point out that you seriously misread me when you thought I was saying that “a belief is somehow less destructive because culture, or a large group, agrees with it.” What I did say was that a “belief that is established in a culture is in some ways less likely to be risky, as lots of people have already tried living with it and have gotten on OK.” That of course doesn’t mean that it isn’t also possible that sometimes beliefs will form within a culture or subculture that are quite terrible – you mentioned the Nazis, I made reference to people with beliefs that could lead to planetary destruction (David Oaks refers to Normalgeddon) – there the problem is, assuming climate science is accurate, that we can all collectively get away with being wrong in a very bad way for a long time until the consequences catch up to us.

    I liked a lot of your perspectives on beliefs, you had some good angles, but I think sometimes coming at it from some other angles also makes sense. When I cover this in the seminars I do on CBT for psychosis, I emphasize finding the angle that works for the person, which may shift over time. And I emphasize it as a collaborative investigation, not one person forcing a belief on another.

  • Thanks Noel, for another good and thoughtful article!

    I do think though it might help to point out that psychiatrists see delusions as something more specific than the definition you used, of “a fixed-false belief.”

    Here’s a definition from http://www.medicinenet.com/script/main/art.asp?articlekey=26290

    “Delusion: A false personal belief that is not subject to reason or contradictory evidence and is not explained by a person’s usual cultural and religious concepts (so that, for example, it is not an article of faith). A delusion may be firmly maintained in the face of incontrovertible evidence that it is false. Delusions are a frequent feature of schizophrenia.”

    In other words, they only call it a “delusion” if you came up with the idea yourself, or at least if it’s pretty rare. This allows them to overlook all the “fixed false beliefs” that people maintain in the face of the evidence, that are consistent with one’s culture or subculture (at least if that subculture is established enough to be recognized as such by one’s psychiatrist.)

    There is a bit of logic to that approach: a belief that is established in a culture is in some ways less likely to be risky, as lots of people have already tried living with it and have gotten on OK. It also allows the psychiatrists to get along with all the powers that be, no matter how irrational, and to focus their attention on those who are creative enough, and deviant enough, to have come up with unique beliefs.

    While there is value to mental diversity in general and while psychiatry should be criticized for usually failing to recognize that, I do think there can also be a problem with just accepting all the diversity of beliefs, since some can be really destructive. “I think so and so is an enemy alien and must be killed” can be a destructive belief, etc. And group beliefs such as “we can all continue doing X behavior and ignore the science that says this behavior is making the planet unlivable” can be a big problem if the science is in fact correct.

    But often, what is most needed is to just take the time to listen, explore the sorts of factors you write about, in a gentle and respectful way, etc.

  • Thanks for this fascinating post.

    One of the huge problems with our mental health system is the way it claims what might be called, not “knowledge of good and evil” but a very similar “knowledge of health and sickness” – and it is sure that conventional ways of knowing are entirely healthy, while other ways are definitely sick.

    Just changing this one thing, and going to a place of not being sure, of considering that there might be value, alongside the danger, of looking at things in other ways, does a whole lot to change the relationship between the person with anomalous experiences and those around them, as you found out. And the chances for the person to then increase in self respect can then be immensely helpful.

  • Thanks David, for your thought provoking post. As for the claims made by tusu, I don’t really agree, but I do think they touch on an important issue.

    I believe there is a difference between hearing voices etc. and having contact with the spirits in a helpful way, and being troubled by voices and spirits. But I think cultural research has found a pattern about how in many cultures, signs of shamanic crisis, which indicates destiny to be a shaman, can be things like babbling confused words or being tormented by spirits. In other words, people with a tendency to have these kinds of experience might first run into trouble with them, but then be helped to handle them successfully, so they can use their talent of going into altered states to help the community instead of suffer from it.

    I have talked with a Native American spiritual leader i know, he agrees that in his tribe, there was no concept of people who were the equivalent of what we call “psychotic” long term, though there were people who ran into trouble with the spirits, and people who had more of a tendency to engage with spirits. The main difference seemed to be that people in the community had ideas about how to engage in the spirit world and could help prevent people from getting stuck in long term problems with “spirits.”

  • I would like to suggest that “collaboration” is only a good word when the project that one is collaborating on is a good one! When it is something destructive, (like providing drugs that the best evidence suggests are likely to make things worse) then any such collaboration can be simply evil.

    I think too many people in the mental health field value being agreeable with the establishment over and above acting on their responsibility to notice when people are being harmed. I’m happy that Bob Whitiaker is “defensive” or “oppositional” or however you might want to label it, and prefers calling out bad ideas to “collaborating” with them.

  • I fail to see how withdrawing a report that will be quite helpful to at least some people could be the right thing to do at this point. It seems that an alternative solution would be to revise it to include up front an apology for not including or linking to very much on the cultural front, and then aiming for producing another report that would include the elements you are talking about.

    As for what may have caused the failure to be sufficiently broad, the failure to address issues of cultural diversity etc. in the first place: I think it’s common in all kinds of social justice movements for initial steps to be taken by people who may be more privileged in some way (like middle or upper class woman banding together to support women’s rights) – initially just organizing at all is so overwhelming that issues of broadening the discussion to include more cultural/class etc. perspectives gets neglected, and only comes later. Obviously, we need to move along toward that broader approach, but I think we are better off doing that with the angle of “expanding” the report and the movement, rather than getting caught up in attacking it or various pioneers for not having been broad enough at the beginning.

  • Thanks Philip for bringing up these critical issues!

    One sentence in your post was that ” It may be a paradigm shift but it is one that is of little or no relevance to 14% of the British population. ” I think I would argue though for a more nuanced view. The “Understanding Psychosis” report supported a paradigm shift toward taking into account people’s actual lives, their experiences of adversity, and did identify that cultural and spiritual issues can be important, without going into detail. Just taking that perspective is a very relevant step toward better mental health care for cultural minorities, even though it is also correct to argue that it won’t really make much of a difference unless we also take the next step and try to understand in detail what those actual issues are for specific cultural minorities, how they play out, how mental health workers can best help, etc.

  • Yes Fiachra, I think you are right, we could save billions, plus avoid a lot of misfortune, if we figured out how to help recover instead of just endure chronic troubles (some of which are caused by misguided attempts at helping.)

    Of course we could save even more if we quit “helping” people who don’t need help at all, as TitA proposes. One problem with a system that uses force too readily is that it also resists even discussion of the possibility it might be making mistakes – a more collaborative system would be happy to discuss such possibilities, which then would also allow for fine tuning, dealing with ambiguous areas where a person might need help in some sense, and actually be doing really well in other senses, etc.

  • Hi Frank, I should make a couple of points.

    First, ISPS is not a psychoanalytic or psychodynamic society, even though it was founded by people with that orientation: currently the group includes people who come from a wide variety of orientations, anyone who advocates for stronger psychological and or social approaches to what we call psychosis can find a place in the group.

    Second, there always has been diversity in the psychoanalytic/psychodynamic community about the whole “biological” thing. People like Bertram Karon, who was involved decades ago in research showing that psychodynamic therapy can work better than medications, have emphasized trauma and reactions to difficult life events rather than anything biological.

  • Thanks Peter, for stepping forward enough to get your well described points out to so many people!

    Some of us don’t face much criticism because we usually don’t get our views out to a wide enough audience to really bother the guardians of the status quo, but it seems you did make it far enough to encounter some hostility – good for you!

  • Hi Noel, I guess I should have said where my sense of “many” was coming from – thing’s like a number of people on the Dissociative Disorders Listserv who have expressed a lot of interest in the Hearing Voices Network and its approach, and the interest I’m getting here in Eugene OR among trauma therapists who have signed up to attend a seminar I’m doing on “Trauma, Dissociation and Psychosis” this Friday. And Jennifer Freyd at the UO (also editor of the Journal of Trauma & Dissociation) has been inviting me in to speak in her classes every year for a long time on that topic and she has been very supportive.

    I’m not saying I don’t also run into the other kind of trauma professional, those who are adamant that the emperor of schizophrenia is fully clothed and any competent professional can see the clothing, and on such a basis distinguish it from dissociative disorders……

  • One way of trying to protect people from oppression is to say that they don’t really belong in the category of those being oppressed “Why this person is not a witch, the real witches are over there!”

    For a long while, many of the trauma and dissociation professionals have been protecting their clients diagnosed with dissociative disorders in this way, “they aren’t insane or psychotic, they are having understandable reactions to what happened to them, the real insane people are over there – those with schizophrenia!” They have used this same defense to protect their line of work, which is offering psychological help to people with dissociative disorders.

    To then say that there often is little difference in what happened and what is happening between those diagnosed with dissociative disorders and those diagnosed with schizophrenia seems to undermine this whole line of defense and justification. So confusion about how to handle all this may account for some of the strange silences…..

    I think it’s also worth pointing out that many important people in the trauma and dissociation field are becoming very willing to talk about dissociation within the experiences of those diagnosed with “schizophrenia.” I think it’s a field in some flux, where getting discussions going is quite important…….

  • Thanks Sandy, I really respect your engagement on this difficult topic and your honesty.

    Like you, I thought David was not accurate when he stated that “most practicing psychiatrists, if pressed, would choose to replace or discard any existing treatment or intervention save one: the power to impose a treatment or intervention.”

    In my experience, psychiatrists are happy to be able to replace coercion with other things like for example simply being able to persuade people to accept treatment.

    I think it is wrong to focus on coercion as the ultimate problem here: because really coercion and the giving to psychiatrists of the power to coerce is just an effect of something more essential, which is the fear of madness and the fear of possible harm to the mad person themselves or to others, and to some extent fear of harm to the social order, as a result of madness.

    I think what is really needed is finding ways to help the public fear madness less, and to see the ways that coercion (and drugs) are often counterproductive rather than helpful, and to help them see that there are better ways to respond to madness and distress.

  • Hi Steve,

    I certainly agree with you that these are not scientists looking for the truth, but instead technicians aiming at making drugs look good so they can be marketed, who are simulating science for that purpose! There should be a name for someone in a career like that – not a very nice name…..

    People are being told to stay on hazardous drugs for life when it is difficult to show that those drugs are better than placebo in getting their intended result for more than a few months – the concern should be about the welfare of the recipients of the drugs, not about trying to create a “successful outcome” for the drug in the study……

  • Hi Aubrey, this is a truly horrible story – I think the only thing more horrible though would be for you, its author, to end up either dead or re-hospitalized after being identified as a danger to yourself by the mental health system due to them framing your fast as “mental illness” – especially since we need your strong voice to stand up for justice!

    Of course, I also understand the impulse to not back down, since that would feel like other times you had to back down, many of them terrible. So I really hope the system does the right thing – I already wrote my email – but I also hope whatever happens you will still be here next year and the ones after, using the power of your life to protect children, rather than your death!

  • Rossa, you seem to be alleging that my comparison of global warming with child abuse was an attempt at “thought control” – I think you totally missed my point, and are accusing me of something absurd!

    Child abuse is bad because it hurts children: global warming, assuming the science is real, will massively hurt our children and grandchildren through huge disruptions of the livability of the planet http://thinkprogress.org/climate/2012/10/14/1009121/science-of-global-warming-impacts-guide/ . My point is simply that when the hurt to vulnerable people seems bad enough, it starts to seem worth bringing up even if it is “off topic” or might hurt the coherence of a group.

    If the global warming threat is real and too many people do “prefer to look the other way” and then billions of people get hurt or die, and society gets so disrupted that mental health care is the last thing on people’s mind, then all of the politely setting aside the topic of global warming so we can get on with trying to change the mental health system will seem in retrospect to have been a huge mistake.

    I think even those who are adamant that it isn’t a real threat could agree with the above “if then” statement. Their argument would simply be that the first part of the statement isn’t true, so no worry about the second part. In the end though, it will be a physical situation not a political thing that can be simply argued about.

    So I hope you can agree that, from the perspective of someone who believes the climate science is roughly accurate, global warming is at least as serious as a threat as child abuse, and it’s understandable that people who see the world this way are uncomfortable about being asked to stop talking about it for the purpose of forming solidarity around other issues.

    As for myself, I am often willing to stop talking about global warming so I can focus on topics like transforming our approach to mental health, but I’m not always so sure that I should be doing that…….

  • Duane, my point was just that what will really count in the long run will be the physical reality, whatever that will be, not the number of climate scientists (or mostly non-climate scientists in the case of your 1000) who have opinions one way or the other.

    At this point I’m (mostly) not trying to debate global warming or not, just calling for more understanding of why some people find such issues to be so important that they will want to break out of established ways of thinking and talking in order to address them. But hopefully I’ve said enough about it, I’ll sign off now unless something really new comes up……

  • Hi Duane,

    I would point out that what will happen in the future as a result of human activity will be a physical reality, not a thing that can be compartmentalized into only the world of politics. If it hurts our children, that will be real hurt, not just a “left or right” political opinion. And the hurt won’t be avoided just by not talking about it.

    I hear you believe it isn’t such a big problem, or that it’s too complicated to make into something important. I just hope you can hear that there are others who disagree with that assessment, and then maybe you can follow why to such a person, what our society is doing does look like child abuse, and is worth talking about even if it upsets people or is seen as out of order.

    I was trying to touch on a bigger theme as well, which is how those designated as “mad” are often breaking out of what others think the order of things should be, often because the established order itself to them often seems to be, and may actually be, a bit “mad.” Which is what David is getting at when he talks about “normalgeddon.”

    Of course, people will have disagreements about when breaking out of established order is really helpful or not, but I think it helps if people can at least understand the motivation of why some people want to do that.

  • Hi Rossa,

    While I think you make your points pretty well, I think essentially you are arguing for a kind of compartmentalizing strategy.

    I think a key dilemma in our existence relates to, when are we better off compartmentalizing, versus when are we better off breaking down the compartments and joining issues together, even though this causes some problems?

    I definitely do think it often makes sense to set many issues aside or compartmentalize in order to come together around common ground, like changes needed in the mental health system. But coming together in these ways can also cause problems, if we minimize issues that really are important in order to do so.

    I’m sure that if child abuse was happening at your church, you wouldn’t accept that those who opposed it should be quiet about it at church because speaking out might split the congregation. Instead, you would see it as such an evil that you would encourage everyone to come out against it, and to not mind if those who refused to see the child abuse as a problem got alienated in the process.

    I think a good argument can be made that human caused global warming is a kind of child abuse. We take care of our comfort and profit and pleasure now at the expense of later severe distress to our children and grandchildren. Should people like David shut up and go away to only then talk about it with people who feel like listening?

    I don’t think there are easy answers to these questions, about compartmentalizing or not, etc. I could argue both sides of the issue, so I don’t think it’s easily resolved. But maybe if we understand the difficulty in resolving it we will be able to understand those who argue either side of it, and we may also better understand madness, which is often about struggling with issues that are near or even definitely impossible to resolve.

  • Sorry I’m getting back to this late – oldhead, you wrote that “You inadvertantly make the pont that when people get any real help within the system it is an aberration, i.e. the help is received in spite of the system rather than because of it ”

    I don’t think that is consistent with what I was saying. Certainly to provide real help, people have to go against the mistakes and the corruption within the system. But the system is more than its mistakes, and coming out against the entire system suggests one is against helping people find housing and jobs, is against paying anyone to listen to and spend time with a troubled person, against the reasonable things the system does or at least tries to do some of the time.

    It’s easier to mark things as totally black or white, but much of the real world isn’t laid out that way……

  • Hi Fred,

    I think David Oaks’ reasoning is more nuanced than you suggest. He is certainly very wary of attempts to “reform” without being radical enough – which is why he always calls for a “non-violent revolution” instead. But he certainly hasn’t maintained that there can’t be value to people doing progressive kinds of work even within the existing system.

    People’s experience differ as far as how much help versus abuse they feel they received within the system – partly I think that’s because the mental health system is not a monolith, it is different in different places, and as operated by different individuals. And people at the receiving end are also all different, with some being helped by what others resent.

    I hear that perhaps your experience was 99% abuse, maybe 1% help. It would be nice for our society to have a way of helping people in crisis that led to most of them feeling 99% helped, maybe only 1% mistreated (we will never be perfect!) But obviously we are a long way from that.

  • If you read a lot of people’s recovery stories, told by themselves, you will often find that they received important kinds of help from within the mental health system, by people who were going against the grain a bit and providing real help instead of the more common kind of “help” that makes things worse.

    So I don’t buy the idea that no one can provide help within the “mental health industry” or the idea that all peer support paid for by the system is useless. Yes saying it is useless sounds dramatic and clear, it just happens to be more dramatic and clear than is the truth.

    At the same time, I totally agree that we need people organizing outside of the system, to protest the violations, abuse, misinformation, and generally stupid ideas of the system, while not having the “conflict of interest” of also being part of that system. Of course, such organizing isn’t going to have the funding that “Alternatives” has.

    And we shouldn’t ignore the fact that there already are some national conferences happening that are pretty independent – MindFreedom organized one this year. NARPA just had its conference earlier this month.

    I don’t know if any of those conferences involved protests though. By the way, I was at that little protest against electroshock across the street from the Alternatives conference in Portland in 2012. David Oaks made it happen, he would never let the opportunity slip by to have a protest when he could! He’s still sometimes involved in protests, I even marched with him today here in Eugene, but that protest was about stopping global warming…..

  • While I am definitely against exaggerating any differences between people who get diagnosed and people who don’t, I also think we are better off noticing that at least usually there are usually differences in the behavior and state of mind of people who tend to get the serious diagnoses and those who don’t (even if these are potentially temporary differences.) I don’t think it makes sense to call this “othering” people – otherwise, noticing any differences in people’s behavior or state of mind could be called “othering!”

    I think instead of insisting that everyone is just the same all the time, we are better off trying to figure out the best ways of responding to people when they are in different states of mind, so we can perhaps be actually helpful instead of hurtful.

    I would assert that it is not just a “trope” to notice a connection between madness and creativity, though that connection is complex. I think there are lots of ways of understanding madness as often involving attempts at creative solutions to problems, and this allows us to understand it on a much more human level than as just something going wrong, or an illness.

    Here’s another article that reviews some of the science about associations between madness and creativity, with suggestions for future research: “Leveraging the “mad genius” debate: why we need a neuroscience of creativity and psychopathology” http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.00771/full

  • Hi waynem,

    I actually think either intra-psychic or interpersonal instability can be either seen as a horrible threat, or as something to be celebrated, depending on lots of factors.

    Lots of people are very threatened by their own intra-psychchic instability, and will check into the psych unit or seek out more mind numbing drugs whenever it starts to happen. They may have gotten into serious trouble with it before, and they don’t have much sense about how to accept some instability to maintain that “edge of chaos” kind of state. (People may also call the “internal police” on themselves when they start being less stable, and kind of shut down, resulting in what psychiatry sees as “negative symptoms.”)

    On the other hand, it is perfectly possible for instability to be celebrated and embraced within cultures that make a place for it. I wrote some about that in https://www.madinamerica.com/2013/06/madness-and-play-exploring-the-boundary/ – Sascha recently wrote about a connected subject, https://www.madinamerica.com/2014/09/burning-man-bellevue-hospital/ I think many traditional/indigenous cultures also had ways to tolerate and celebrate psychic instability that were quite powerful.

    So fear of instability is not inevitable at an interpersonal level, and some cultures or subcultures can handle it much better than others……

  • Hi B, yes, I think it probably happens a lot, people fight back like that against the drugs, but that fighting isn’t recognized as an attempt to restore one’s liveliness, instead it is seen as “part of the illness.”

    I also think that kind of “fighting back” is part of why people often go out of balance dramatically when they quit drugs suddenly. They are used to being in that “fighting back” kind of mode, then when the drug is withdrawn, there’s nothing to push against and they go way out of balance.

  • Yes, I think it is a key point that the professionals can’t predict who is going to recover, and they don’t know for sure how people are going to do on drugs versus off, so this supports the idea people should be able to choose for themselves.

    I do think it’s worth mentioning that there is no good evidence that the drugs are making people die on average 25 years earlier. Diagnosed people have lots of reasons to be dying earlier, from smoking to suicide to low income to living in areas where everyone dies on average a decade or more early (yes they can predict who will likely die early just by zip code.) Drugs are apparently a factor in early deaths, but I think we lose credibility when we keep repeating the 25 year thing when we can’t back it up with evidence that the drugs alone account for the whole 25 year difference.

  • I agree that “It is important for those [diagnosed] with schizophrenia to see themselves as normal.”

    I believe professionals need to be trained to help people see themselves that way: my post “How Can Professionals Learn to Reduce Fears of Psychotic Experiences Rather Than Emphasize Pathology?” at https://www.madinamerica.com/2014/07/normalizing_psychosis/ links to a free training on how to talk to people in a way that encourages this.

  • Open Dialogue practitioners don’t see themselves as treating “mental illnesses” in the patients. They don’t see psychosis as something that happens “in” particular people, but more as something that happens in social networks, in exchanges and relationships, which may of course involve abuse but also other kinds of problems. And instead of thinking they know exactly what it is, they see their goal as getting people talking and communicating so that dialogue with multiple views can be created about it.

  • Hi Someone Else,

    I really love your instructions about what to talk about with psychiatrists: “Never discuss anything of a spiritual nature with psychiatrists, nothing philosophic, nothing creative, and maybe even nothing more complicated than “all real life problems are caused by chemical imbalances in people’s brains.” ”

    I think the problem you are getting at comes not from the average psychiatrist being stupid, but rather they’ve seem people experimenting with being so far outside the box, in ways that often cause severe problems for themselves and others, that they see their job as re-imposing the box on people’s thinking in order to avoid further problems, and in their short appointments they are looking for any evidence that the box is not completely intact, in case they might need to do something, prescribe more drugs etc.

    Of course that whole way of operating ignores the fact that we need people thinking and experiencing outside the box, and that real recovery doesn’t mean giving up ever doing it but means learning how to be a bit safer while doing it, getting the right kinds of support in doing it, etc.

  • If “psychotic symptoms” are not disabling or leading to illegal behavior or severe distress, then it starts becoming possible to argue they shouldn’t be called “psychotic” at all.

    My nutshell definition of “psychosis” is that it means “being out of touch with “reality” and/or disorganized in a way that causes problems. So if a person is still able to handle reality OK, and is reasonably relating to their own needs and to the rights of others, then they might be having an alternative way of being in contact with “reality’ or an alternative way of being organized, but it isn’t one that requires any kind of “help.”

    Of course it gets way more complex than that. Often people get pushed into psychiatry not because they are having real problems but because others are scared that they might be – Eleanor Longden’s story of getting started with psychiatry is a classic version of this. And once one has been identified as being “mentally ill” then people tend to be less tolerant of “alternative ways of being in touch with reality or of being organized” because they worry this will just lead to something bad if it hasn’t already.

    One thing we need from a good mental health system is caution about rushing in to “help” when things may be going OK, albeit differently than “normal.”

  • One thing I miss in these MIA discussions is the voices that would stand up for the status quo! It’s actually important to hear those voices – sometimes they are correct, they point out something about the status quo that may be worth saving, other times they are wrong but are still valuable because they give us all experience in responding to them.

    So since no one else is offering anything, here’s a defense of the status quo and of antipsychotics that my own mind came up with, tell me what you think…..

    In summarizing Harrow’s 20 year data, Sandy had written that “At 2 years, 74% of individuals in group 1 [those who stayed on drugs over the whole period] had psychotic symptoms, as did 60% of those in group 3 [the group that quit drugs by 2 years and stayed off]” and she noted that this difference between the two groups was not statistically significant.

    When I first read that, I took it to mean that the two groups could be understood to be having roughly the same degree of a hard time with their “psychotic” experience. However, thinking about it more, I realize someone could argue that the group that was still on antipsychotics might be a group that really had much more serious problems with psychosis on average, and they only seemed to be having about the same level of problem with psychotic experiences because most of their psychosis was being controlled by the drugs they were taking.

    So the better outcomes over the next 18 years could have come from a tendency for those with milder psychosis to show recovery, while those with more serious psychosis at two years were much less likely to recover. If this is true, the difference in outcome could have nothing to do with the antipsychotics making the psychosis worse.

    Anyway, just a thought. I believe it’s important we look at all the possibilities, so we don’t just become an echo chamber for our own perspectives.

  • Hi barrab,

    I agree with you that it is a big problem when psychiatrists convince themselves and others that they know what is going on when they don’t. That’s why I think one of the big innovations of Open Dialogue was just to have the professionals admit they don’t know what is going on up front, instead they say “we don’t know, that’s why we are here to talk about it.” And they always want to hear more than one view about what might possibly be happening.

    I do think psychiatrists have a reason to tell people to be on their drugs forever that goes beyond their ego however. What they see over and over again is people who stop their drugs and then end up in a terrible condition. It’s not surprising they think the best way to stop this is just to convince people to never stop the drugs.

    I think what we have to communicate is that it’s more complex than that: that part of the problem is that they drugs create a dependency on them, that people have to be educated about coming off slowly and with support, and that there are important long term advantages to getting off the drugs even though it is quite risky in the short term.

  • Hi Someone Else,

    The points you make are extremely important. While lots of people experience less psychosis in the short term as a result of the drugs, and only have the drugs lead to more psychosis is the long term, others like yourself experience a beginning of psychosis or increased psychosis right away.

    I know a young woman also put on antipsychotics for reasons other than being psychotic, who then while on the drugs started seeing, hearing, and feeling physically touched by dead people!

    Unfortunately as you suggest, too many psychiatrists are only familiar with the typical response to drugs, and don’t consider that there are always some people who respond in atypical ways that may be completely the opposite.

  • Thanks Sandy, for referencing all your other great posts! I did think your letter was especially important, maybe because that word limit made you boil your points down into an incredibly succinct argument.

    I actually wrote this post for my blog, so people who just read that would be exposed to your ideas, and wasn’t sure it was worth posting on MIA, since you had already covered the subject pretty well. Kermit though thought it should be posted here, because it is such a key topic. Scary, but so important.

  • Hi Jeffrey, Sorry to hear about the permanent problem you experienced. The possibility of that kind of thing is yet another reason to avoid using these drugs wherever possible.

    I don’t think we know precisely how often damage is permanent versus temporary, but we do know permanent problems are not uncommon, and that fact should make our system much more cautious than it is.

  • Hi Robb3, I agree with all your ideas, with the exception of the last one. I think existing systems would have to be reformed quite a bit to do things like make a strong effort to help people with psychosis without medication.

    Our psych hospitals for example are organized around the idea that it isn’t really necessary to relate that much with the person experiencing psychosis, rather, the idea is to just kind of watch them as they get large quantities of drugs put into them, and then notice when they are “stable.” Lots would have to change to make these hospitals into a place where people felt connected with in a good and healing way.

  • I think a key difference is that freed slaves tend to do quite well on their own, absent active sources of oppression like the KKK, while people with severe “mental health” issues commonly have serious problems in their lives even before psychiatry intervenes, problems which can easily result in terrible outcomes all by themselves.

    If we fail to make note of such things, we may feel more adept at making statements of condemnation toward psychiatry, but we will also be seen as totally out of touch by the general public, which won’t exactly help our movement.

  • I think there are real problems with the comparison to slavery. Slavery of course existed entirely for the benefit of the slave holders, and was obviously harmful to the slaves. Psychiatry is much more mixed.

    It is not difficult to find people who are sure they have been helped by psychiatry, even by forced treatment. In some cases we could argue they only thought they were being helped while really they were being hurt, but in other cases we might find that people do seem to have gotten real benefit.

    In any case, I don’t think we get anywhere by being oblivious to the ways psychiatry is unlike slavery in that it usually is at least trying to help, and we need to be much more overt about proposing meaningful alternatives to current psychiatric practices before we can expect much momentum behind any efforts at change.

  • Thanks Michael, for a thoughtful article. I hope you aren’t put off by all the critical remarks! Obviously there are lots of fans of Szaz here, and I think they may be talking too literally your assertion that Szaz “failed.” Obviously if he had completely failed in having his voice heard you wouldn’t be writing about him here – he wouldn’t be important enough to pay attention to.

    While I have found Szaz helpful at points, and I agree especially with his point that mental conditions should not be assumed to be medical in the absence of good evidence that this is the case (like a stroke or Alzheimer’s) I also think Szaz might have been more helpful had he been a little more Epicurean, and striven to be more moderate.

    For example, I met Szaz only once, while I was staffing a booth alongside David Oaks. The two of them began a conversation, and one thing I recall from that is that Szaz had little respect for the Hearing Voices Movement. In general I have seen that kind of thing as a flaw in the way Szaz approached things – all the emphasis seemed to be on critiquing how our society deals with confused and distressed people, with little attention to what might work better.

    I know that those who have been seriously hurt by the existing system, many of whom are commenters here, often see eliminating the power of that system as a first priority, and so would have no problem with Szaz’ critical emphasis. The problem with that though is that there are way more people worried about what to do about distressed and confused people than there are people worried about how the existing system has flaws and often hurts people, so unless we can address both issues at once, we aren’t likely to get the broad support we need to really change things.

  • Hi Stephen,

    I think you are correct that the “chemical restraint” of a person is a good description of what happens in many situations. But there are other kinds of situations. I see people outside of hospitals, and some of them have never been in a hospital, and yet so many of them choose to keep taking antipsychotics. Some of these people are even relatively well informed. I don’t think the “chemical restraint” language quite covers those cases, unless one talks about it as the person using the drug to restrain themselves in a way.

    So while I like Phillip’s posts generally and I agree he is a “good man” I do think he went overboard with his statement that “They are chemical restraints with no medical qualities whatsoever. ”

    I think at this point in our state of knowledge, a wise doctor would keep antipsychotics on hand for use in certain limited situations, as the Open Dialogue people do, and contrary to what Phillip is suggesting.

    On the other hand, I would agree with those who would say we would be better off if antipsychotics could be made to not exist, because I think they are currently used so often in harmful ways as to outweigh any positive uses they might have.

  • While I think the issue of toxicity in “antipsychotics” and their use as restraints are both important topics that need much more discussion, I also have a little critical feedback here about the way those issues are discussed in this post.

    You seem to suggest that “real drugs” to treat a “real illness” would never be toxic to the person in and of themselves, when the right dose is prescribed. I don’t think that’s correct. Lots of chemotherapies for example are toxic in and of themselves at any dose, though it is hoped they are more toxic to the cancer than they are to the rest of the person.

    While “antipsychotics” have a toxic effect on people, for many they do have a stronger effect suppressing the part of the person that the person themselves wants to suppress, such as a disturbing voice. This often makes people appreciate the drugs.

    Certainly when “antipsychotics” are forced on people, we can talk about chemical restraint, but it does get trickier for example when people decide they want the antipsychotic drug. In this case, it is kind of about a person using the drug to restrain themselves or part of themselves, which is more complex. An then in many cases an extra layer of complexity is that they only chose to voluntarily use the drugs after being coerced into using the drugs first, and then the drugs themselves may be making the person more compliant and even subservient to other who want them to take the drugs.

    Anyway, I think we need to find ways of talking about these issues that don’t exaggerate our points, so we come across as balanced thinkers instead of just partisans for an extreme point of view.

  • Hi Mark,

    I’m curious how you would justify your statement that ” it appears that the black box warnings on antidepressants for adolescents did lead to decreased prescirptions, but also to higher suicide rates among adolescents” Did you not read https://www.madinamerica.com/2014/07/real-data-no-increase-suicides-following-black-box-warning/
    or did you find some reason to disagree with that? If the latter, could you share your views?

    By the way, I do hope you continue to engage here, and don’t feel too pushed away by people who feel you aren’t radical enough. I think it is important that we sustain dialogue between a diversity of views, examining the evidence for each, so we don’t just become an echo chamber for certain dogmas, some of which might be disconnected from the facts.

  • Yes, this is a positive angle to take on a thorny problem.

    I knew a couple angry/isolated young men when I myself was that age. One was a good friend, the other more an acquaintance. The friend would sometimes contemplate shooting up crowds of people just to express his alienation (this was kind of a new idea back then!) The acquaintance actually bragged once of taking a random shot at someone in a pickup truck going by, for no good reason. Both these young men matured without real problems, but they had come close to big trouble.

    I was also an isolated young man at times, but not with the shoot-em-up style of thinking.

    I think young guys like this need to meet up with a culture that can see them as having value in all their eccentricity and different-ness. They often don’t want “help” or “mental health treatment” but they do want connection and respect. If we found out how to connect with them in a good way, I think society would strongly benefit, not just by reducing violence but important other ways.

  • To E.Silly and anyone else who gets to the page that says “Start Here” and then can’t get further: you may have a problem due to having an an old browser, or maybe it’s because you have turned off javascript or cookies, If it’s due to an old browser, it could be fixed by getting a more current browser.
    If you need more help than what I am providing here, you could try contacting Julia at [email protected]

  • Hi Rossa, I would say this course was really designed with professionals in mind, but it is certainly open to service users, ex service users or survivors, family members, or whoever.

    That’s also the way I have taught a lot of my in person seminars, and lots of diverse people have found them interesting and helpful. So thanks for your interest, and do pass on the information!

  • I agree that for some people at least, marijuana can cause psychotic experiences.

    I can tell a tale myself that illustrates that effect. When I was in high school, I started hanging out with a friend who really really liked to smoke pot, starting in the AM and then at noon and at breaks, with the really serious smoking starting once school got out. After I got going in that style myself for a few weeks, I recall attending a party, where of course we smoked pot. At some point during this affair, I started to realize that the conversations I was hearing people have in my head were actually very different than what the people were actually saying, which I could still tune into if I really paid close attention.

    this was very weird and disorienting. Fortunately though I came up with a normalizing explanation – I decided it must be the pot, I hid the weird experience I was having from others so they wouldn’t think I was crazy, and over the next few days or weeks the experience faded as I smoked much less marijuana, and tried very hard to pay attention to what people were really saying instead of the dialogue in my imagination.

    With that said, I think the overall relationship between marijuana and psychosis may be quite complex, and there definitely are people who report that smoking pot reduces distressing psychotic experiences, and there’s even a substance in marijuana, CBD, that would probably be being tested right now as an antipsychotic if there wasn’t the problem that no one can get a patent on it.

    So I think we need to increase awareness that marijuana can cause problems for particular individuals as suggested, and we need to get better at helping people in a constructive way when they have those experiences, but I don’t think re criminalizing marijuana will be a helpful step. Putting people in prison causes horrible human and social costs, without much benefit. So I’m for awareness, not prison…….

  • I certainly don’t think I need to get into documenting the harm done by reparative therapy, as information about that is pretty widely available. It should suffice to say that any therapy that widely relies on telling lies to vulnerable people as a core part of its practice is not worthy of the name “therapy.” Wikipedia by the way has an entry for reparative therapy that covers the “pros” for the therapy as well as the cons – it’s clear that the “pros” are pretty pathetic in my opinion.

    Yes, some people who are strongly motivated by religion can learn to give up their primary attraction for the same sex, and can even learn to enjoy, to some extent, opposite sex interaction, at least for awhile, and probably only if they are somewhat bisexual to start out with. That shouldn’t surprise us – after all, some people can give up sex entirely for their whole life if it is important to their religion. This isn’t at all evidence of a change in sexual orientation, only a change in sexual practice, based on religious belief. A therapy that only aims to help people be aware they have such choices is not problematic. Reparative therapy is problematic because it starts with lies about being able to change orientation, then follows up with more lies aimed to make people feel worse about their orientation, and other forms of pressure aimed at taking away choices rather than helping people be aware of their choices.

    I think johndoe is quite wrong when he blames gay people for being “enforcers and bodyguards” of biological psychiatry, just because many say they were “born that way.” The problem with biological psychiatry is that it takes differences between people and then describes them as illnesses and attempts to eradicate the difference, instead of noticing how people might learn to live well with the differences. That’s why many in the hearing voices network take the gay liberation movement as a model for what they want to do for voice hearers – not insist that voice hearers are the same as everyone else, but rather insist that voice hearing is not an illness, and people can learn to live successfully while still hearing voices. Our movement doesn’t depend on insisting that people don’t have differences, only that these differences should not be labeled by outsiders as pathology based on being different, instead we need to work to understand what different sorts of people need in order to be healthy and then relate to them based on that.

  • I too am sad about this decision by the Unitarian Church. I have participated in Rethinking Psychiatry events and I have found their organization to be quite helpful, if imperfect like all of us.

    I do think this event could be a cause for taking a moment to reflect WHY an organization that otherwise is very much into human rights would have a hard time with an organization looking to improve human rights within mental health, and generally why mental health oppression seems harder to battle than most other forms of oppression.

    I believe the biggest factor is the way there are really various kinds of oppression in the mental health field. There are the forms of oppression that frequently lead to mental health problems in the first place, though this is often not seen. Then there is the oppression from the mental health problem itself – the problem for the individual and for others close to the individual. Then there is the oppression caused by poorly designed “treatment.”

    A key problem is that when we push back against oppression caused by treatment, lots of people out there in the world think we are attacking the very thing they are hoping is going to save their loved one and their family from the second kind of oppression, that caused by the mental health problem itself. So naturally they oppose us.

    I think we need to find better ways of talking about how we want to address all these forms of oppression in the best way……this might help us make more friends, which we desperately need.

  • Hi travailler-vous,

    I certainly never said there was no problem with all the sorts of various abuses practiced by government sponsored mental health systems that is so well documented by all the people writing in here on Mad in America.

    But while many bad things come from such government excesses, I don’t think we can make everything better just by taking all the power away from the government. That’s kind of like noticing police brutality and abuse, and thinking one can correct everything by taking all the power away from the police – ignoring the way brutality can happen without governments, and the way governments and police departments, if run correctly, can actually act against brutality.

    I think some have a sort of religious belief in government being the source of everything bad, and a dogma that says stopping the government will make everything better. From that point of view, when a traumatized and confused adult goes to see a professional who promises to be helpful, but then manipulates them into sex, or into hating themselves, no wrong has been done, because it wasn’t done by the government. I don’t subscribe to that religion, and attempts to convert me are unlikely to succeed.

  • To cannotsay2013: Thanks for clarifying the nature of our disagreement. I definitely don’t buy the notion that the source of the oppressiveness of various mental health interventions is the involvement of government, even though I would agree that governments can be part of the oppression. And I don’t agree that any kind of oppression should be allowed between initially consenting adults.

    I say initially consenting, because people can easily fall into a pattern of continuing to consent because of the nature of the mental health oppression itself. In reparative therapy, it might be the self destroying nature of the therapy that leaves the person without the will to leave. In the case of psych drugs, let’s imagine a person persuaded to take a drug which then itself takes away the ability to evaluate the effects of the drug, and if the person is kept on it, oppression can continue with no ability to resist. Under your scheme, this would be perfectly legal, even if the person was made into a complete zombie forever who had no ability to ever again question what was happening to him or her.

    I think government has a role in outlawing varying kinds of fraud and abuse, and what’s important is just to get it correctly identifying what is fraud and abuse. I don’t expect you to agree, but I thought I’d explain my own view a little more.

    One other point: psychology certainly involves beliefs, but it involves beliefs about things that can be tested, for example about what leads to distress and disability or not, even if these issues are so complex that what the tests mean remains controversial. It’s not like beliefs about what happens to your soul after you die.

  • To cannotsay2013: In general I agree with the rights of adults to do what they please, make their own mistakes, etc. But I don’t agree that mental health professionals should be able to do whatever they please. For example, even though adults generally have the right to have sex with whatever consenting adults they please, therapists at least in many states can be arrested for having sex with their clients, and I think that’s OK. Because offering therapy and then seducing people is so often harmful. Pretending to offer therapy and instead offering abuse and lies, as reparative “therapy” does, is similarly abusive.

  • Hi Rossa, when I say “unambiguously poisonous” I mean exactly what I say. Not like homeopathy, which might use a highly dilute poison that actually doesn’t harm. “Reparative” therapy basically focuses a poisonous force, the hate of parts of society for sexual differences, and lies about them, into an intense relationship that pretends to be helpful but turns the person against themselves.
    There may be people who don’t like psychotherapy, but most often people seem to be helped, with a small minority being worse off. Reparative therapy is quite different: pretty much no one “helped” and a long trail of intense psychological damage. It is itself a potent form of abuse, and should be recognized as such.

  • I really don’t agree that people should be able to sell stuff that is unambiguously poisonous as therapy (whether it is a chemical or a psychological method) and the data on reparative therapy is so bad it is clear it has no benefit but incredible ability to damage.

    I want to thank Peter for clearly and bravely writing about his abysmal experience, and I hope we can all support changing laws so experiences like that quite a bit less likely to occur.

  • Thanks Paris for this coherent view of how to approach people with really different beliefs! I think the bit about the importance of noticing when beliefs impact needs was well written and addresses a really important issue.
    I have heard of research showing that the majority of the population holds at least one belief that psychiatry believes is delusional, and that 10% of the population holds more “delusional” beliefs than does the average “psychotic inpatient.” Obviously, these people are not all in need of being “helped” to make their beliefs more normal! So it makes sense we need to be careful to only offer help when it is truly needed, and to then do our best to insure it is really helpful and not destructive.

  • With Karen Taylor’s permission, I am reposting a conversation between her and I that started on facebook in regards to the post above. It touches on some very important issues. (For those of you who don’t know, Karen Taylor is very active in the hearing voices network and hearing voices training, and she is also the wife of Ron Coleman, who is even more active in that field.)

    Karen Taylor: Hi Ron It may interest you to know, that most of the early CBT in psychosis learning was done by psychologists who regularly went to the manchester hearing voices groups when Ron C was there and took the self help techniques and turned them into a therapy. This is why there is similarities but also why there is animosity as lately there is a feeling that you have to be a psychologist to do this work with voice hearers which is bullshit as it originated as self help in the voices movement. People have always gently challenged each other over their belief systems the respect is in accepting the persons answer if they dont want to think about it from another view point, but most ideas are not fixed but fluid dependant on what is happening in the persons life. One researcher who used Ron’s working with voices book came to the conclusion that his workbook was based on CBT, in fact it was the other way around the book predates the CBT in psychosis papers, also voice dialoguing was a natural part of the hearing voices groups and something some voice hearers have always done. Keeping alive the history of the HVN movement is important and necessary to make sure it is not colonised and sanitised by professionals which is what has happened to every other consumer movement breakthrough. This is not to say that professionals who work in this way are not needed or wanted but that they must not own this stuff as their own work and then exclude self help and peers from using these techniques themselves.

    Ron Unger: Hi Karen, Thanks for this important note, including the historical bit! I share your outrage at the idea of professionals taking ideas that come from places like hearing voices groups and then claiming them as their own and saying others shouldn’t try them! As far as what I heard in the Turkington training, he didn’t say much about where ideas he shared came from, and he also didn’t suggest anyone needed any particular training to try the various ideas, other than of course an understanding of the ideas and the methods themselves.

    Karen Taylor: Psychologists like Richard Bentall & people like Doug Turkington will be the first to acknowledge how important the groups and voice hearers were to their learning, in person. Richard is a great supporter of HVN and Ron C has shared the platform with Doug at many events. It is the professionals who have read the CBT books and done some of the training who sometimes pontificate on who can and cannot then use these techniques. I remember Ron talking about being at a psychosocial intervention conference where a professional was talking on running hearing voices groups -and the training needed to run it-he didn’t know Ron C who got up to ask him if he would be able to run a hearing voices group -the guy said “have you done our training” to which Ron replied no he hadnt the person then went on to say no he wouldnt be able to do it, at which point Ron told him who he was and how many groups he had run with out training and why he was entitled to run a group -his lived experience . This is the danger as the spread of CBT grows peers will be told they dont have the skills to engage in this work.

    Ron Unger: Thanks Karen, for the added information. I think you are right about the tendency of many professionals to want to claim that things can’t be done without professional training, even though they were started by people who didn’t have such training. I have seen this reaction for example when I taught about voice dialogue – some professionals in the class expressed a belief that only highly trained professionals should attempt such things, even though I let them know about how the method has been used successfully by non-professionals. I would say though that this isn’t really a CBT kind of perspective – one of the merits of CBT is that it is usually taught as something anyone can do, it is put in self help books and such, professionals may be trained in applying the methods and helping people with them but the ideal is that people learn to do any methods themselves and make the professional obsolete. Maybe one thing we need is a guide for how professionals can work cooperatively and without arrogance or “colonization and sanitization” of practices that come out of the consumer/self help movement.

  • Yes, I think it is important to understand that psychiatric drugs often have effects opposite of what is intended and also often opposite to what is the most usual effect of that particular class of drug.

    I would say that neuroleptic or “antipsychotic” drugs in general do tend to reduce hallucinations overall, yet I know one young woman whose only experience of clear cut hallucinatory experience happened while taking antipsychotics. And it wasn’t just moderate hallucinations either – instead she was hearing, seeing, and feeling the touch of dead people.

  • Thanks Jonathan, for your comments and feedback. Regarding Turkington and how different he might be from “mainstream” CBT for psychosis – I think it is harder to be more central to CBT for psychosis overall than Turkington has been, so I think he is a very representative face of that approach.

    At the same time, there is still the problem of less well trained CBT therapists (especially ones who have some CBT training but not really in CBT for psychosis) who as you say “still function within the framework of a DSM psychiatric model where extreme states are pathologized and seen as permanent markers of illness.” Turkington did complain that even when he trains people to do things like inquire into stories of possible trauma, he checks back and often finds out they aren’t doing it. So there is a big problem with people slipping back into the psychiatric mainstream approach, of just explaining away everything as “illness.” That however is not what CBT for psychosis is really about.

  • Hi AngryDad,

    If Turkington did give a reference for the atypicals aggravating command voices, I didn’t get it written down. Sorry about that. His point though was that such voices are on a continuum with basic OCD, and the reason they sometimes increase such voices is the same reason they can induce more OCD. I found at least a bit of documentation of the latter effect when doing a quick Google search, for example look at http://ajp.psychiatryonline.org/article.aspx?articleid=172890

  • Thanks to everyone who has commented so far.

    I definitely agree with the people who point out that the current system is full of problems, and I know that some people will be much better off if they just get away from it and anything that looks like a mental health system – because they don’t now have need for any specialized form of “help” and in some cases never did, and were just dragged into the system because of someone else’s worries.

    On the other hand, we as a society do need some kind of response for when people and social systems are very seriously distressed and/or confused. And there is often a lot of very hard work involved in providing such a response in an adequate way, so expecting this to all happen for free, that is, without some kind of “professionals” being employed, is not something I see working.

    If we are going to have people paid to help out, whether they are “peers” in the sense of having had severe difficulties and/or psychiatric labels and treatment, or whether they are just fellow human beings who want to help out, then there will be the question of how they are taught to understand things and to provide that help. I’m hoping to be involved in helping such education take a good direction, towards helping people find their core humanity and ability to heal, rather than feeling more stuck due to dysfunctional attempts to provide assistance.

  • Hi Bob, While the fat lady sang for me a very long time ago on the question of whether long term antipsychotic drug use is generally a good idea, and while I think it is clear that the preponderance of the evidence is pointing to long term antipsychotic treatment being overall detrimental for most people, I still wonder if I could convince a more skeptical person that this latest study carries much weight of itself.

    The question I raised earlier was whether it could be reasonable hypothesized that the people who tended to incline toward long term problems anyway got quickly put back on drugs when they tried to quit, while others who were inclined toward recovery managed to stay off drugs when they quit them, resulting in the use of drugs being just correlated with worse psychosis rather than causing it.

    I don’t think the bit about prognostic factors really answers that question, because one might expect that within the group with better prognostic factors, some would still be individually inclined toward more long lasting psychosis (within group variation), and some not so much, and if those individually inclined toward more long lasting psychosis then got steered more toward staying on drugs, then you would get a result much like Harrow got, but it wouldn’t be due to the drugs causing the problem.

    If I knew that the group being off meds at 4.5 years consisted of the same people as those off meds at 2 years, then I think the case for the drugs being detrimental would be strong as you suggest. But if the group off meds at 4.5 years consists partly of people who were off meds at 2 years, and partly of those who were on meds at 2 years but who tended to be doing better and so managed to safely get off by the 4.5 mark, while those who were in the medicated group at 4.5 years consists partly of those who were medicated at 2 years, but also partly of those who were not medicated at 2 years but then relapsed and got put back on medications, then the meaning of the better results at 4.5 years might be very different – if might mean perhaps just a tendency for those who tended to do poorly to end up on drugs, with that being much better sorted out at 4.5 years than at 2 years.

    So I agree with you there are lots of other reasons to think that the drugs do increase problems for people in the long run, but unless I’m missing something, I don’t think I could put the kind of weight on this study that I could on something like the Wunderink study, where it is hard to argue that it was anything other than the reduced medication that led to the better functional outcomes. (In that study the group on less or no medication didn’t have less psychotic symptoms, they just were more than twice as likely to recover in other ways – which might also lead people to questioning if the drugs really do increase psychotic experiences in the long term.)

    Anyway, I’d be happy to hear about any holes in my reasoning, I’m just trying to sort this out in my own mind, so I can be sure of where I’m coming from when I communicate with possible hostile audiences.

  • Hi Hermes, I can definitely see how to argue for all the conclusions you have made, especially about the study showing there is something wrong with the conventional view of “schizophrenia.” But I know Whitaker was trying to go further than that with it, and I still have unanswered questions about that.

  • Hi Bob, forgive me for not having read the recent Harrow article in full, or I might have already figured this out, but here is the question I worry will come up if I try to cite the article as being definitive:
    I am imagining that people who believe more in “antipsychotics” will say that probably what happened was that those who were having better outcomes anyway tended to get off drugs successfully (while those who tended not to be having better outcomes might have tried to get off drugs but usually got put right back on them after they did poorly off them.) Also, they might ask if the people who were off drugs 10 or 20 years later were really all the same people as those who were off drugs at 2 years, or was it the case that some of those off drugs at 2 years went downhill and got put on drugs, while some of those on drugs at 2 years did relatively well and got off drugs – so that over time, there was a filtering so that those who tended to be doing better for whatever reason showed up in the “off drugs” category.
    In other words, they will say that it isn’t that drugs worsen outcomes, but those with worse outcomes tend to be the ones that end up on drugs over the long term.
    Is there a way we can prove that this explanation can’t be correct? If we can’t disprove that explanation, then the “fat lady” will have to hold off her singing for a bit longer, much as we might wish to hear her voice.

  • Hi Joe, The study that I referred to, which was discussed on the NEC site, was a study that was done quite a while ago, comparing long term recovery rates in 2 states, one with a psychosocial rehabilitation program, and one without. That study could be taken as evidence that in Vermont at the time (Vermont was the state with the rehabilitation program) people were getting services that did significantly increase their chances of making a recovery. I won’t comment on the federal grant you mentioned, as I’m not familiar with it.

  • Hi Stephen, regarding your comment about how I would propose dialoguing with the system when the psychiatrists won’t engage: I agree this is a huge problem, as psychiatrists tend to avoid invitations to talk. But I think we are often taking part in a dialogue even when they don’t show up. For example, here in Eugene Oregon, we have done things like get editorials printed in the local paper, and we’ve formed something called the “Opal Network” that brings together consumer/survivors, family members, professionals and interested members of the public to talk about mental health issues and watch films, etc. (This network has as part of its mission to support the consumer/survivor voice, so we definitely don’t let professionals dominate.)

    Psychiatrists don’t show up at these meetings, but I think they hear about them, and get influenced by those who go. Once a psychiatrist responded to one of our editorials with an editorial of his own, we responded back: later that same psychiatrist joined MindFreedom! See http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/areford-neuroleptics for some details on all that.

    David Oaks found a way to dialogue with one of the leading psychiatrists in Eugene: he got on an airplane, and the guy was sitting next to him! He reported they had a decent conversation.

    So anyway, it is tricky, but I think we do better when we follow some of the attitudes of Open Dialogue, which includes the notion of attempting to “speak as a listener” which means to show that you have listened to even absent voices as you speak. I think this includes trying to speak in ways that show we are trying to understand what may be the perspective of psychiatrists, even when we think it is misguided. By then coming across as balanced rather than shrill, I think we have a lot more chance to succeed, even though it is still very difficult to make progress.

  • Hi Stephen,

    I think there may still be some value in these programs that are being called “peer” but that don’t live up to the ideals – the main value being that they bring people who have been on the receiving end of treatment into the system as workers, and I do thing that shakes up some perspectives and practices, while of course still failing to meet many of the objectives that IPS for example was designed to accomplish.

    It might be a name thing – just hiring people who have been on the receiving end of treatment to work with mental health agencies should be given a different name, so it could still be considered a possible positive small step forward, but it wouldn’t be confused with a more progressive step like IPS. My thought anyway…..

  • Hi Joe, I would agree with you in that as far as I know, we don’t have any systems in this country which are really informed with the best ideas we have about recovery.

    But I wouldn’t say that there has been no value at all to the various recovery initiatives, flawed as they may be. Rather, these may help some people somewhat, just as the older “psychosocial rehabilitation” programs were useful to some. For research demonstrating that, I would point to the comparison of long term recovery rates in Vermont, which had a psychosocial rehabilitation program, and Maine, which didn’t. Vermont outcomes were significantly better, which suggests the programs did make a difference for quite a few people. See http://www.power2u.org/evidence.html .

    Of course, you may be right that some just use the word “recovery” and don’t do anything different – and I’ve also seen people being told they had “recovered” when they were totally dependent on the system and medications for every aspect of their lives – that’s a real betrayal of the hope for recovery!

  • Hi Alexa,

    I think what really bothers a lot of people is that it may be that many, most, or all of those who are in that “bottom group” that you refer to, could really be helped to be in the “middle” or “top” group if we gave them better forms of assistance.

    If you read Rai Waddingham’s story for example, you will notice that for years she seemed to “need” medications, and 20 times went back to the hospital when she tried to quit. That is, until she was ready to quit and had better help, then she did so successfully and is doing quite well.

    Currently our mental health system tries to avoid short term risk by telling people to just assume they will always be ill and always need medication: this actually discourages people from even trying the things they might have to do to actually recover.

    I think we would do better to tell everyone that as far as we know, recovery is possible for them, we can’t guarantee it but we can help them fight for the kind of recovery they might want, if they are already on drugs then we don’t know when or if it would work best for them to get off those drugs but we will help them think through what might be reasonable risks to take and things to try, etc. I think that would work much better than just deciding that some people will inevitably linger in the “bottom third.”

  • Unfortunately, people being a danger to themselves is incredibly common when in states people call “madness” or “psychosis” – not just being deliberately self destructive, but also being destructive because of being so out of touch with “reality” – like thinking cars are a hallucination and so driving into them or walking in front of them.

    And psychiatrists often think drugs will help stave off other kinds of destructive effects – like help people not lose their housing or not do things that will make family and friends refuse to associate with them.

    We can certainly do a better job of making believe that psychiatrists are pure evil if we ignore such things, but I don’t think we will do a better job of understanding them or of making sense to the general public if we ignore the scary side of madness, and the way the damaging sides of mental health treatment often arise out of a not entirely unjustified fear of madness.

  • Hi Duane, you make some very categorical statements, I think the reality is more complex. There are many people for example who are happy to have been locked up at points in their madness, and who believe they wouldn’t be here if someone hadn’t stopped them from doing what their madness was pushing them to do. There are also of course many people who find psychiatric drugs to be a better alternative than anything else they have found up to this point.

    Obviously, I share the concern that in the long run the drugs can often make problems worse, and so many are locked up and traumatized by use of force when a more humanistic system could reduce that risk without coercion and could make drug use less necessary.

  • Hi Fiachra, I understand that stories like yours are way too common. Psychiatry needs to realize that having good intentions about wanting to help, or even showing an appearance of helping in the short term, is not enough. It needs to pay attention to what really works in the long term, and it needs to notice when efforts to help in the short term are disabling as you found them to be, or otherwise problematic.

  • Thanks Hugh! You bring up really important points. By the way, the term for “refusing to acknowledge one’s disease” is “anosognosia.” I think refusing to acknowledge problems can itself be a problem, but what is often missed is that something like “anosognosia” applies also to things like people not noticing the problems being caused by their psych drugs (an issue Breggin has explored) and even more importantly, a mental health system can be said to suffer from anosognosia when it fails to notice the way its dogmas and its treatments are causing huge problems.

  • I think it’s important when critiquing psychiatric approaches to keep in mind that they are attempts to respond to what appears to mental health staff to be, and what often is, something worse than the “treatment” approaches that are used.

    If someone came into your home and sprayed everything with water at a high velocity, you would rightfully accuse them of being hostile and needlessly destructive. Unless they did that in response to your home being on fire, in which case you would think of them as the fire department and you would thank them gratefully. Unless, that is, they had failed to notice when/if you had a good chance to put out the fire with a much less destructive means, then you might still see them as trying to do good but think of them as over-eager, possibly misinformed, etc.

    Madness is the equivalent of the fire in this metaphor. Madness like fire has its good side, but it can also be incredibly destructive, usually just to the person themselves but also fairly often to others, when not contained in a good way. Psychiatric methods of attempting to contain madness are both somewhat destructive (like spraying a home with water) and in the long term ineffective (because drugs just immediately suppress, but then prolong, the problem) but I think we will dialogue better with the mental health system and with the public in general if we understand that they often arise from that sense of an urgent need to restrain an immediate threat.

  • Thanks Rai, this is a really great story, well told, and the “relationship” metaphor is awesome.

    I also like the way you described how convincing it can be about the “need for drugs” when there are multiple episodes of getting off the drugs in a haphazard way and then just ending up back in the hospital. In the past in seminars I have used Rufus May as an example of someone with a number of relapses before he got off successfully, but it seems you went through the revolving door quite a few more times – I will probably be telling your story in seminars in the future!

  • Good article! One thing I hadn’t read before was that DSM IV-TR actually mentioned that brain changes associated with “schizophrenia” may result from the use of “antipsychotic” drugs, but this reference was deleted from DSM 5, even though more evidence now exists indicating that such changes may result from the drugs. The DSM 5 also deleted a reference to the fact that antidepressants can cause akathesia, which can lead to suicidal behavior. The only purpose for removing references like this that I can think of would be to promote drugs and insure that clinicians don’t think too much about possible problems with the drugs, even though these issues are crucially important.

  • I wasn’t trying to say I knew for sure that marijuana has no link to causing psychosis, only that one should be cautious about assuming it caused the kind of brain changes being discussed in the article that started this conversation.

    I would say based on my own experience that smoking pot can definitely cause at least brief psychotic reactions in some people, because that happened to me in high school. I had a friend for a bit who really wanted to smoke pot every available opportunity, I did this with him for a few weeks, it built up to a point where I was hearing voices. I did figure it was the pot, I backed off on use, the voices quit, and I was fine.

    I do agree with Jonah that bad treatment by the mental health system can make things a lot worse, I was lucky enough to not have that problem. I also think it makes sense to discourage pot use in teens, but not to the extent of having a “drug war” about it, which damages a lot more people in other ways.

  • I think this study should be interpreted with caution, because it’s more complex than they say. The brain differences commonly, but not always, seen in people diagnosed with “schizophrenia” are also commonly seen in people abused as children. And people abused as children are more likely to become heavy pot smokers. So much or all of the brain differences may be due to things like abuse and trauma, not the marijuana – it’s just not clear.

  • I think the excessive focus on dopamine is misguided, but the general idea that psychosis involves extreme reactions to stress and difficulties in living, with additional problems resulting from the reactions to one’s reactions, or counter-reactions, seems sound to me.

    Curious, and sad, that in the otherwise broad list of possible causes of “schizophrenia” these somewhat biologically oriented writers can still not bear to include childhood trauma and abuse in their list of possible causes. Maybe recognizing that would violate their “religious” beliefs?

  • I agree with you that the average person doesn’t think much about these issues, that’s why we have to pay attention to what comes across to them very quickly when we use certain words. Torrey is not being stupid when he accuses us of being “anti-psychiatric” – he is good at PR, and he knows how this term helps make us look like unscientific extremists. There is no reason to play into his hands by using the language that he and his allies would prefer that we use.

    I would also make the point that if we want to resist a system that too easily thinks in categories, it doesn’t help to adopt a term that implies for example that we are against all psychiatrists, when really we are only opposed to the practices of the vast majority of them!

  • I think among those making comments I may be the odd person out here, but I think it is more strategic to simply be “anti-stupidity, anti-abuse, anti-lying, anti-greed and anti-coercion” rather than specifically “anti-psychiatry.” The reason not to be “anti-psychiatry” is that people in the general population then think you are just opposed to people with medical degrees doing what they can to help people with mental or emotional problems, it sounds like you are against “psychiatry” in principle for some religious reason or maybe it’s your private obsession, or maybe one psychiatrist hurt you and now you are against them all because you overgeneralize everything.

    If on the other hand you say that you are against abuse, dishonesty, coercion etc. and the problem is that the vast majority of psychiatrists (but also a large number of other mental health workers and even politicians etc.) are currently taking part in those problems, then people can better understand what you are saying, and they see you as sticking up for values they can relate to.

  • Thanks Richard, for drawing out those parallels! I agree that there are similar dynamics present whether the voice is “heard” as though physically present, or is just a more metaphorical “voice” that speaks in favor of a particular direction, such as participating in an addiction.

    In regards to the addiction voice, you spoke about a need to “consistently and permanently defeat it in on going internal arguments.” While I agree with you that there may be a need to consistently and permanently defeat the idea of relapsing into destructive drug use, just as people may need to consistently and permanently defeat the idea of making suicide attempts, I think there are problems with seeing this as a need to defeat the voice itself.

    Another way of looking at this is that when part of the psyche proposes use of destructive drugs, or self harm or suicide, it is attempting to meet some kind of need. So if we look to really understand a voice or part of the psyche, we can find that unmet need and then actually find a way to ally with the part of the psyche that had previously been trying to get that need met in the “dysfunctional” way. In other words, set healthy limits with the “addiction voice” – such as absolutely no use of a drug one can’t handle well – but then get to know the deeper concerns of the voice and find healthy ways of addressing those concerns.

    Of course, many people will heal fully without ever noticing themselves finding anything positive behind their “addiction voice.” The reason that can happen is that they only recognize part of their psyche as an “addiction voice” when it is asking for the drug: if the person becomes able to learn about and meet the underlying needs in the healthy way, then it will seem that the addiction voice has just faded away even though it may in some sense still be present but is now proposing different solutions to meet its needs.

    So I think the deeper levels of peacemaking with voices is most important to know about when the voices themselves are more differentiated, because it is then we are most likely to get into trouble if we simply focus on defeating the voice rather than understanding it and taking its needs seriously.

  • Thanks Rufus, I think this is the most well written summary of these issues that I have ever encountered! I really appreciate the way you have “tread carefully and acknowledge the intensity of people’s experiences” while also opening up a picture of what’s happening when problems occur to include everything from the social environment to diet.
    You wrote that:
    “In my experience, for example, renegade parts that have sabotaged the person’s dreams are not easily forgiven and given a new role in the psyche. Even though the person may logically understand that a part has sought to protect them in the best way it knows, they may still resent the damage they perceive the part has caused. If the person does not want to give space to a part of themselves they are angry with or ashamed of this need to be respected. We need to feel safe and acknowledged before we are willing to make peace with parts of ourselves we may not want to recognise, or still see as our enemy.”
    This is a tough part. We need to exploring to find ways to create respectful dialogue between parts of a person which have been hurt and the parts which are seen as causing the hurt (which of course have often been themselves hurt in the past, as Eleanor Longden is good at pointing out); we also need to be finding ways to create dialogue between people who have been hurt by the mental health system and the people who work in and support that system. I think many of the same issues come up in both efforts.

  • Mjk, As your gofundme site points out, conferences can be very expensive if you have to attend from out of town! But millions of people live within a reasonable train ride from this conference, and might want to and be able to attend for much cheaper.

    I’m also working on ways to get more conference kinds of events happening over the web, that will be accessible without travel or other big expenses – I hope many of them can be free for people who don’t need educational credits.

  • Somewhat along the same lines, here’s a link to a discussion that considers how psychiatric diagnoses share the characteristics of “defamatory statements”:
    http://www.behaviorismandmentalhealth.com/2013/09/05/are-psychiatric-diagnoses-defamatory-statements

    These issues are complex though. I was having a discussion yesterday with a guy who is now capable of seeing beyond his diagnosis, but he still looks back on the day he accepted his diagnosis as a change for the better. The reason is that until he took his diagnosis seriously, he was instead taking “delusional beliefs” seriously in a way that was ruining his life. The diagnosis gave him a different perspective on what was going on. What we need to do is get better at “ceremonies” that help people shift perspective without the destructive aspects of diagnoses.

  • I liked the article, it made lots of great points, though the issues are complex enough I understand it certainly isn’t perfect. Still, I’ really pleased that Joanna is a psychiatrist carrying the dialogue into psychiatry, and engaging the public as well. I don’t agree with the idea of completely getting rid of psychiatry – I think it makes sense to have people who specialize in figuring out how medical approaches might be used to wisely support recovery from mental and emotional problems – it’s just that the profession needs to admit that these problems are not primarily medical and they have to be able to be humble about the possible role of any medical approach and to acknowledge their own uncertainty about what is really going on, as do psychiatrists within Open Dialogue.

    I certainly think it is incorrect to claim, as PC did, that the gay rights movement didn’t talk to psychiatry. In fact, they took this talk right into the psychiatric conventions, and that’s a primary way they applied pressure to change. Before that, there was research done about how homosexuals could be well adjusted mentally and emotionally, that really did a lot to change how people thought.

    In our case, we aren’t going to be able to show that those identified as “mental patients” are in general “well adjusted mentally and emotionally,” but what we can show is that the experiences psychiatry tries to suppress, like hearing voices, having extreme emotions, altered states, etc., can all be part of the lives of people who are leading positive lives (either “well adjusted” or “creatively maladjusted”) and so the objective of a mental health system should not be to suppress “different” experiences, but to help people find a way to positively relate to their experiences without suppression. I think we need to take that dialogue to the public, but at the same time take it into all corners of the mental health field, into all the professions.

  • Duane, I strongly support being dramatic in ways which are consistent with the facts. (After all, I worked with David Oaks on various dramatic protests over the years.) What I oppose is exaggerating the facts in order to increase how dramatic we are: and I oppose that specifically because our issue is too important for us to be discrediting ourselves with such exaggeration.

  • I doubt there is an article by Healy that documents the claims you report. I tried a Google search for those authors and year of publication, and found only the article “Psychiatric bed utilization: 1896 and 1996 compared” which is not about mortality.

    Meanwhile, people on MIA should be aware that this issue is murky enough that there are even people making the claim, supported by at least some evidence, that antipsychotics used moderately reduce mortality, see http://psychcentral.com/news/2012/11/02/antipsychotics-boost-life-expectancy-of-those-with-schizophrenia/47056.html

    John Read is a person critical of treatment as usual: he was a co-author of a review that found some role for antipsychotics in increasing mortality, but certainly not responsible for even most of it: see http://www.researchgate.net/publication/26290191_Influence_of_antipsychotics_on_mortality_in_schizophrenia_systematic_review

    I think the argument against antipsychotics should be that they have three strikes against them: they are often subjectively experienced as oppressive, they have negative effects on physical health and mortality, and their continued use reduces the likelihood of recovery in the long term. I think we can argue all that based on science, we don’t need to make dramatic claims which we can’t back up with science.

  • Thanks Nancy for clarifying your remarks. I think maybe I should clarify a little where I stand with the death thing.

    Back in 2006 I put together a report based on the Association of Mental Health Directors report that presented the statistic of people dying 25 years earlier, you can view the PowerPoint for that presentation at http://www.healingattention.org/presentations/unger07.ppt The slides go into some detail to tease out how much of the 25 year earlier mortality may be due to the drugs: while it seems much of it is due to the drugs, it’s pretty clear that not all of it is.

    I know it is pretty common in our movement to hear people make the claim that the whole 25 year earlier death statistic is due to the drugs, but this is the kind of careless talk that makes us sound unscientific and uninformed and easy to dismiss for all those outside our movement who know we are being inaccurate. I want to increase awareness about the facts so that we can be more effective when we try to influence people outside our “choir.”

    Defenders of the status quo love it when we over-state our case so much that they sometimes even accuse us of doing so when we haven’t. For example, a friend of mine, Chuck Areford, wrote a column in a local paper about the death rates. He was then accused in another column written by a psychiatrist of being uninformed about the science and of recklessly claiming that all the early deaths were due to the drugs. I then wrote a rebuttal to that, clarifying what Chuck actually said and adding more facts, providing evidence that the science was on our side. You can read the whole exchange at http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/areford-neuroleptics

    My point is that we can only come off as the people to listen to if we are careful with our facts. Making extremely dramatic statements that are easily disproven by our opponents will only make us easy to ignore.

  • I think it is important to emphasize that the drugs cause many deaths, but also to keep our balance and not pretend the drugs cause them all. It can be tempting to think that we can win just by escalating how dramatic we are, but if we just do that, we end up looking like we are all about the drama, without having any well thought out points to make. I know we all wish there would be an easier way to push for needed changes, but I don’t think there’s any substitute for making the effort to address the facts in a balanced way. It’s the facts that are on our side, if it’s just about drama and distortion, the other side can always outshout us.

  • Yes, like Ted said.

    One point where I would differ though, I don’t think though that we should be claiming that psychiatric drugs are “documented to shave at least 25 years off the lifespan of anyone who is captured.” Yes, it is documented that people in the US who are in the public psychiatric system are typically dying that much earlier, but the drugs are not the only cause of the early deaths, even though it appears likely they play a huge role.

    We sound more dramatic when we claim the drugs are entirely responsible for the problem of early death, but we also sound biased and unscientific, out of touch with what is actually happening. Let’s just keep the attention on the fact that the drugs do shorten many lives while on average reducing chances for recovery – that is damming evidence enough.

  • Hi Eleanor, welcome to Mad in America! My only fear in having you here, is that you substantially raise the standard for eloquence in blogging……

    My favorite quote from your recent interview in the Guardian – you also said something similar in your talk – was the following:

    “Probably the most important insight was when I realised that the most menacing, aggressive voices actually represented the parts of me that had been hurt the most – and as such, it was these voices that needed to be shown the greatest compassion and care. Which of course ultimately represented learning to show compassion, love, and acceptance towards myself.”

    It is so interesting that our modern mental health system focuses on suppressing or “getting rid of” the very parts of people that were most hurt. It should be no surprise that the result is typically just ongoing problems, ongoing “psychic civil war” to use your great metaphor.

    Anyway, welcome again to our community!

  • It sounds like great research, and I like the way you think about it. I’ve been very interested in the spiritual dimensions of “madness” and the way it can be tricky to separate what is helpful or “spiritual” from what may be unhelpful or “mad.” One way to deal with that problem, obviously, is to give drugs that suppress that whole dimension of human experience…..

  • Thanks for the reference to Juli McGruder’s work. The notion of madness as involving both “challenges and blessings” is certainly more balanced than most of our “mental health treatment.” Unfortunately, when the mental health system is unbalanced, it contributes to problems for the person, but then any additional problems created are just seen as “part of the person’s illness” rather than as the fault of the system.

  • Thanks Rossa. Obviously, there are some potentially very serious sides to madness – getting lost in it can lead to death or lifetime disability – but in order to notice that, we don’t have to blind ourselves to the other sides of it. I think we do best when we take a complex view, seeing the risks but also the other sides, such as the way it might contribute to development, or how it illuminates the uncertainty we all face as we attempt to make sense of a world that itself is at least partly mad.

  • Hi Alexa, I agree with your point that in general actual friends are in general of more value than therapists who are doing nothing other than being friendly, though there are some exceptions. One is if a person doesn’t have friends they can trust to talk with about certain subjects: then having a therapist to talk with about those subjects can make a huge difference. Sometimes the problem is that within a given culture, too many people don’t know how to function as a friend in relationship to certain events, in that case the most important skill of a therapist might be to just continue to engage in a friendly way in relationship to experiences lots of people might over-react to.
    Oh, and thanks for the feedback about my website – I’m glad some of the content was helpful to you!

  • Thanks for explaining very well the hazards of “too many questions” and too little caring for the person being asked the questions, and welcome to Mad in America as a blogger!

    One fine point I would disagree with you on though concerns the value of CBT for psychosis compared to “befriending therapy.” Despite the success of befriending therapy, and the fact that it sometimes, as in the article you linked to, shows as good a result as CBT for psychosis, I think it is important to note that when looking at all the studies overall CBT for psychosis appears to have a benefit in addition to befriending. See http://www.apa.org/pubs/journals/releases/pst-49-2-258.pdf for one summary of the data.

    I recently heard Doug Turkington, one of the lead CBT for psychosis researchers, talk about some of the studies comparing “befriending therapy” with CBT for psychosis. He said lots of things happened in the befriending therapy that weren’t at all planned by the therapists, who were just trying to create a friendly relationship. People would do things like decide to explore trauma that happened in their past, trauma that hadn’t been dealt with at all by the mental health system up to that point. This demonstrated how people sometimes really know what they need, and therapists just have to let the person take the lead so that the healing can happen.

    There are other times though that people really want ideas about what to do about what is troubling them, and they are really disturbed by therapists who just want to listen and have little to offer! So I think the best therapists have flexibility and really try to figure out what the person wants and is ready to benefit from – they have ideas to offer, but also know how to simply be a listening friendly person when that is what is likely to work.

  • Hi Ross, if you want a well known person who has written on his CBT work and very vocally opposed biopsychiatry, check out Richard Bentall, Doctoring the Mind: Why psychiatric treatments fail http://www.amazon.co.uk/Doctoring-Mind-psychiatric-treatments-fail/dp/0141023694
    I also practice CBT and am active in opposing biopsychiatry. The British Psychological Society that just issued a broadside against psychiatry is heavily involved in CBT, and they were proposing using CBT type formulations, which take into account people’s stories, as a replacement for “psychiatric diagnosis.”

    Richard, I thought your blog post was really unfair to CBT. I would agree we always need to be looking beyond the limits of any particular “system,” CBT included, but CBT is nowhere near as limited and simple minded as you painted it to be.

  • Morias, you wrote that you thought Alison Brabban should have come to the conference to learn and not to teach, but I think she was invited there as a presenter, so we can’t blame her for wanting to teach what she knew after she was asked to do that! I didn’t really try to judge her by the short bit I saw in the video. In general I do think professionals should be interested in learning from the Hearing Voices movement, but I also think this field is complex enough that people in the hearing voices movement can also learn a thing or two at times from open minded and compassionate professionals, and mostly we need dialog where we can share our understandings, compare differences, and help each other understand more.

    I thought your bit about voices and trauma made a lot of sense, and it really isn’t different from the more progressive CBT understanding. Well, one point of minor difference might be that your comments could be interpreted to say that voices inevitable make a positive contribution to people’s healing: I think people in CBT would be more likely to see voices as contributing to healing only if the person interprets and relates to the voices in the right way: other interpretations and forms of relationship with the voices can send a person spiraling into more trauma and disorganization. But that’s really not a viewpoint at odds with the hearing voices movement, since both CBT for psychosis and HVN see lack of ability to relate successfully to the voices, and not the voices themselves, as the problem.

  • Morias, I think CBT for psychosis uses the term “vulnerability” in a common sense way as something that may or may not be permanent, though I would agree that in the mental health field, it is more common for people to use it with the “delusion” that they are talking about something necessarily permanent. I don’t think that means we need a different word, vulnerability is a good word in a lot of ways, we just need to be clear how it should be understood.

    You ask “Is voice hearing a cause of stress or a way to deal with deep-seated underlying stress caused by a history of trauma?” I would think that for many it is both. Ways of coping with trauma frequently cause unintended consequences that amplify stress rather than result in successful coping – one of the strengths of CBT is that it recognizes the possibility of such non-linear effects.

    I don’t think there is a problem with people who haven’t heard voices helping people who do hear voices explore coping options, as long as they do so in a humble way, paying attention to whether they are helping or not. After all, just having some voice hearing experience is no guarantee of understanding another person’s experience that may be different in important ways….

  • Hi Joanna,
    I think the better forms of CBT seek to collaborate in exploring what beliefs, thoughts, and approaches might be most helpful, and that is similar in some ways to what might happen in a Hearing Voices Group. So it isn’t about the therapist deciding what is most helpful and telling it to the person they are supposed to be helping. A good CBT therapist is humble: he or she might have ideas about what might work, but also knows those ideas might be wrong for particular people or situations, and knows people have to decide for themselves.
    I have heard about some of the limits in what NHS would fund in the UK, and the CBT therapist I talk to over there was pretty upset about that herself. I don’t think it’s fair to blame all of CBT for the limits put in place by funding sources.

  • Hi Morias, I certainly agree that the Hearing Voices Movement and CBT should not try to be the same thing, but they can work really well together – people can participate in both at the same time with each reinforcing the other, there doesn’t have to be any contradiction.

    I disagree with your analysis of the role of “vulnerability in two ways. I don’t agree that vulnerability is necessarily permanent, and I also don’t agree that vulnerability has to be thought of as just a defect.

    Early trauma does seem to make people more vulnerable to psychosis, but people can also work through trauma and resolve it, and eventually that person may be even less vulnerable to psychosis than others. Good CBT does take an interest in helping people do this (though I’m also sure you can find lots of crappy CBT that doesn’t!)

    Various kinds of sensitivity or tendencies to be creative or imaginative can also increase vulnerability to psychosis, at least until the person understands well how to work with those differences. CBT for psychosis emphasizes “normalizing” and helping people see how otherwise positive qualities might also increase vulnerability can help with self acceptance as well as practical learning about how to handle oneself in the future.

  • While I agree for example that it is important the the Hearing Voices Movement maintain its independence from professional efforts and that it continue to focus on emancipation and challenging professionals and psychiatry, I also think this article over-simplifies some key issues.

    For example, while CBT uses the vulnerability-stress model, it does NOT assume that vulnerability is genetic – instead it definitely is interested in the possibility that vulnerability may come from difficult or traumatic early life experience, and it is very interested in understanding the role of such experiences.

    I would also argue that it is very untrue to state that CBT never challenges psychiatry. One small study was already completed by CBT therapists showing that CBT can be helpful for people who choose not to take medications for “psychosis” and a larger study is now underway: this explicitly challenges the psychiatric notion that medication is a pre-requisite for helping people with psychosis. By proving that people can get better just by experimenting with the way they think and act, such studies can be helpful to our movement generally.

    I understand many of us are rightfully wary of professionals, and there are reasons to continue to be appropriately wary, but let’s not be so wary that we overlook potential alliances or so wary that we inaccurately represent research and approaches that could be helpful.

    Rufus May has called for a dialog between CBT and those whose knowledge comes from experience. I’m someone who has my feet in a variety of worlds, including practicing and teaching CBT, and I’m interested in that dialog. I hope to get a post up about it in the near future, going into some more detail on what I think might be some helpful perspectives regarding these issues.

  • I definitely agree that deceptions in mental health are not a monolithic conspiracy, except for those within companies like Eli Lilly, which are more organized and fit the classic definition of a conspiracy. In the wider arena, the problem is as you say, corruption, combined with simplistic thinking by people who really want to help but can’t imagine that what seems to help in the short term may actually be making everything worse.

  • I would argue that getting eighty some percent of the public to believe that “mental illnesses” are definitely caused by known “biochemical imbalances” with psychiatric drugs as the best option for treatment, is the result of a very successful conspiracy. Lots of people had to plot behind closed doors and agree on how to put out misinformation disguised as science, they had to sideline critics, etc. They did a great job, though over the years, the holes are more apparent to the minority that might be paying attention.

    Conspiracies to make money are extremely common, but I still think they deserve the name, when they involve massive planned deception and ultimate harm to the public.

  • My thinking is, if they find a biomarker commonly associated with depression, they will give the condition a special name. If you come in and have depression but don’t have the biomarker, they will just tell you you must have another kind of depression for which the biomarkers aren’t found yet, and they will treat you anyway.

    So what about all the people who will have the biomarkers they find but not the condition that is supposed to go with it? For example, they have the biomarkers for that “special kind” of depression, but aren’t depressed? Well, the biomarker will indicate they are at risk for depression, so they can be treated too!

    Just this morning I found out about a proposed biomarker for “schizophrenia” which can be found by taking tissue out of one’s nose. It is already being proposed that those who have the biomarker but who don’t seem to have schizophrenia can be considered to be “at risk” and so treated. See http://www.medicalnewstoday.com/articles/259854.php or http://www.ncbi.nlm.nih.gov/pubmed/?term=neurobiology+of+disease+shomron

  • I agree they are setting themselves up for failure if they are to be held to the standards they are holding up – but what I think they are way too devious to just fold when they find they can’t really do it! Instead they will do things like their old routine where they find certain biomarkers are a little more common statistically in people who seem to be having problems of a certain sort, and they will decide that is a definite marker of a certain illness even though it isn’t, and the press will totally let them get away with it. Anyway, I guess it’s wait and see….

  • To the inarticulatepoet: the “targeted individual” website was interesting to look at. I have certainly met people who felt they were “targeted” at this level. Some of the persecution experienced would have to involve large numbers of very well coordinated people, while other parts of it would have to involve technology that doesn’t exist according to what is commonly acknowledged. An alternative explanation, more likely from the viewpoint of “common sense” would be some combination of the person being biased to look at information that confirms their suspicions, and perhaps dissociated parts of the person that actively manipulate incoming information to reinforce perceptions of persecution. Whatever causes it, it is certainly a scary kind of world to live in…..

    As for the biomarkers thing, I think they really do believe they will find something substantial, but the will to find something is so strong I believe they will “find” things, or exaggerate the evidence for things, even when they are really not successful. And they will spend a fortune in the process, if they can get their hands on it at least. It will take lots of critics to continually point out the flaws in their new clothes!

  • Yes, the historical documentation of the existence of some very dark conspiracies is certainly one reason we can’t just assume that all conspiracy ideas are incorrect! Colin Ross wrote about having people come into his office and complain about being experimented on in very weird ways, all of which sounded like definitely delusional reports until he heard that the CIA had been actively experimenting on people in his city (see http://www.rossinst.com/military_mind_control_book.html ). Which then didn’t “prove” that the CIA was responsible for those people’s complaints, but it did raise interesting possibilities.

  • Darby, I think a key point for many is that mental health disability should NOT be thought of the same was as one thinks of being blind or an amputee – because one doesn’t generally have a chance to “recover” say from having a leg removed, but one does have a chance to recover from a mental health crisis. It’s the keeping alive of the hope that the crisis and the related disability does not have to be permanent that many people really have valued in the concept of “recovery.”

    Of course, there are always more wrinkles than one can document on how such words and concepts are used. One interesting such variation is the way some consumer/survivors saw how “recovery” was used by people who definitely do have permanent disabilities – these people used the word to mean getting one’s life back, despite continuing to have the disability. Moving into the mental health field, this was taken to mean getting back to a full life, despite having a “disability” due to hearing voices for example. Of course mental and emotional differences are less easy to categorize than physical differences, and many people discovered that once they learned how to have a life despite the voices, that the voices could became more of an asset than a disability, so it wasn’t clear any actual disability was persisting!

    I do think it’s important that we see the inadequacy of words to define our lives, and that we feel free to explore other meanings that might work better for us, but also keep in mind that in other situations or for other people, those same words we rejected may work really well. When it comes to language, I’m more with the Discordians – “All statements [and so each of the words] are true in some sense, false in some sense, meaningless in some sense…..”

  • While I fully the identification of the problems with seeing people as “always recovering” instead of living, I find the word recovery to still make a lot of sense in some other contexts.

    Recovery definitely doesn’t imply that one must accept that one was ever ill – one can just as well “recover” from trauma or any other life disruption. And as others have pointed out, even if one is sure there was no disruption before the mental health system came along, one can “recover” from the damage done by the system. The word has a lot of uses, and I’m not aware of an adequate substitute. (“Escaping” sounds like going somewhere away from the problem, which certainly doesn’t define how people deal successfully with many problems which are only handled well when faced directly, not “escaped from.”)

    While the mental health system has done its best to co-opt the word recovery, and make it mean still being a mental patient needing drugs etc. but one “in recovery” and staying out of too much trouble, I think the notion of “full recovery” is still quite threatening to that system, and needs to be talked about more. Full recovery logically means not needing treatment anymore, back to living a life, leaving the system behind. Stories of people who have fully recovered are still unknown to many, and can have a revolutionary impact on people when they are shared.

  • It’s important to note that Open Dialogue only operates in the far north of Finland, which is not where most of the population is. So much of the mental health system in Finland is still pretty bad. The Open Dialogue approach emphasizes going out to people in their homes and community, not dragging people into hospitals. If they do ever get scared enough of what someone is going through to force hospitalization, I’m sure it’s still way less frequent than in most parts of the world.

  • Jonah, you wrote that “I realize the “mental health system” is largely a collective of governmental operations, designed for the purposes of administering ‘social’ control; hence, the “mental health system” is really all about maintain the status quo — at best.
    From that point of view, I feel it’s terribly naive of him to expect the “mental health system” to embrace *any* kind of revolutionary spirit, ever.”

    I can certainly understand your skepticism, and I agree it is difficult for governments to nurture anything like creative maladjustment, or independent thinking, etc.: but sometimes they do, at least somewhat. Open Dialogue for example is a government run program, though not run by our government, yet it does a great job of supporting the voices that otherwise don’t seem to have expression and bringing them into relationship. It’s the kind of thing that even if we could develop it more widely, it would be crushed during periods of global upheaval etc.

  • While I’ve dropped out of the discussion of whether global warming is a scam or not, I thought I would contribute a bit to the discussion of corporate power and bias, and how to understand it.

    There’s a difference between corporations which would only be motivated to do something if they believe something is true, and corporations which have a strong financial motivation to pretend to believe something is true even if/when they know it is not.

    Corporations like like “Google, Apple, Amazon, Microsoft or Bloomberg” are not set up to profit from a belief in global warming: they are active on the issue only because they find the evidence for global warming persuasive, and if they found it disproven, they would be motivated to spend their money elsewhere.

    Fossil fuel companies on the other hand can make their profits only if society doesn’t take global warming seriously, and so they have strong motivation to lie. Piles of evidence that global warming is real and dangerous mean nothing to them, because their billions in profits depend on not seeing the damage they are causing. Just like tobacco or big pharma.

    I agree that in fighting for mental health reform we need to seek allies among conservative folk who typically don’t see big corporations as the enemy, but I think we can do that by emphasizing common ground, and we don’t need to blind ourselves to other social problems or corporate abuses in order to do that!

  • Sandy, thanks for your thoughtful post!

    One of the factors I have never seen addressed in studies about the supposed problems resulting for longer “durations of untreated psychosis” (DUP)is the problem of un-equivalent groups.

    That is, when we catch people early on in psychosis, we may be seeing a group which contains a number of people who are likely to recover if simply left alone. When we look at people who have had a longer duration of psychosis, we are looking only at people who failed to recover, a sub group that may have less positive an average prognosis.

    I believe I could have been diagnosed with psychosis when I was a young man and yet I got through it fine without psychiatric help: my friend and fellow MIA blogger Michael Cornwall, and many others, have had similar experiences. Too often, mental health professionals think professional help is required for any kind of recovery, and fail to notice that many people manage recoveries without its help and that many kinds of professional intervention may be more likely to get in the way than to help.

    Anyway, I think it is curious that the possibility of the short and long duration of untreated psychosis groups being different doesn’t get addressed, when it may play a key role in how the statistics come out.

  • There’s been a connection noticed between lead and ADHD, but even more between lead and crime rates – see
    http://www.motherjones.com/environment/2013/01/lead-crime-link-gasoline

    Unfortunately though, while crime rates and lead in the environment are now falling, ADHD diagnosis continues to soar! Anyway, I think there probably are more connections than we can easily know between environmental problems and mental/emotional concerns.

  • Hi byder_58, I work as a therapist helping people who are seen by others as having “mental illness” though lots of us wouldn’t call it that. I’ve had my own issues, lots of my family members have spent time in psych hospitals, and one brother committed suicide. So like many on this site, we aren’t strangers to the topic.
    In answer to your other question, I think lots of people would see being suicidal as a kind of maladjustment, a failure to adjust to one’s world. At the same time, I wouldn’t usually see it as a “creative maladjustment” because in most cases there are lots of better options than killing oneself! I hope that makes sense to you.

  • I’m not surprised James Lovelock decided he had been alarmist – he was the one who thought we were quickly headed for a planet where only the polar regions would be habitable. But others who made more mainline predictions find they haven’t been alarmist enough – see http://www.scientificamerican.com/article.cfm?id=climate-change-worse-than-expected-argues-lord-stern

    With that said, I’m going to end my participation in this discussion of whether or not global warming is a scam, because it doesn’t seem to be getting anywhere. Your claims don’t hold up, but you seem to respond to holes in them being pointed out only by making more claims, or repeating old claims without even noticing they have been refuted, and it seems this could go on forever.

  • One point about the Nobel Prize winner in physics Ivar Giaever – he was quoted in 2012 – after making the complaint you referenced – as saying the following:
    “I am not really terribly interested in global warming. Like most physicists I don’t think much about it. But in 2008 I was in a panel here about global warming and I had to learn something about it. And I spent a day or so – half a day maybe on Google, and I was horrified by what I learned. And I’m going to try to explain to you why that was the case.”

    see http://www.skepticalscience.com/ivar-giaever-nobel-physicist-climate-pseudoscientist.html

    This is an obvious case of someone stepping outside his field, not really bothering to do his homework, and then expressing strong opinions and getting a lot of press for it.

  • First, I want to make it clear that I certainly don’t think anyone has to have any particular view on anything to be a “MIA community member in good standing” – other than maybe have a concern for finding what is truly helpful for mental health, since that is our focus.

    But in the long run, if we do dramatically alter the earth’s climate, that will mess up a lot of people’s mental health, as well as physical health of course. Meanwhile, the question of how a society makes sense of evidence we may be undermining the conditions needed for our own survival relates to many key mental health issues in the present.

    You seem offended that I called what you are doing “denial” yet you blatantly called global warming a “scam” – if that’s not denial of its existence, I don’t know what you think fits the definition!

    And while you argue you are much more “scientific” than I am, I find your attempts at science to be as superficial as those made by biopsychiatry, where grand conclusions are drawn from limited fragments of evidence. For example, because air temperatures were modestly below what had been predicted as most likely over a period of a few years, you want to conclude that global warming is disproved – even though the air temperatures were still within a zone that had been predicted as 10% likely, and even though there was an obvious explanation for why those air temperatures were a bit low – the existence of La Niña meant cooler air would be expected in much of the world, even as the oceans and the earth overall continued to heat. It seems to me that if you really cared about science, you would be more cautious about claiming to have disproved global warming using evidence that does no such thing.

    You also claim that predicting the weather is easier than predicting long term climate effects – but in many ways the opposite is true. We can be unsure about the weather tomorrow, but be very sure that the average temperature in summer will be warmer than the average temperature in winter; we can also be sure that the average temperature on a planet with high CO2 will be warmer than the same planet with much less.

    Like Jonah, I enjoy questioning orthodoxy, but we also have to be careful about assuming that “orthodoxy” is necessarily wrong, especially when our future depends on what we decide. Instead, I would argue that we need to think things through carefully, and pay attention to where collective thought processes are getting corrupted by profit driven bias, or short term thinking or superficial analysis.

    Anyway, that’s my personal opinion, again, no one has to agree with me to be welcome at MIA…..

  • I hear you have your opinion, and that you aren’t interested in changing it: but it seems to me you are holding it more like religion than science, you aren’t very interested for example in the links I provided that show that the sources you provided have all been thoroughly debunked!

    I think I can make a strong case that disbelief in human caused climate change and belief in bio-psychiatry arise out of the same dynamics. In both cases one has special powerful and wealthy interests that benefit from biasing the information, and one has a public that seems to benefit in the short term from going along with the special interests. In bio-psychiatry, there is the fact that in the very short term, the drugs seem to provide relief the quickest. Climate change denial also makes us more comfortable in the short term: we can all go about our business without any interruption. Unfortunately, the long term effects of bio-psychiatry and of climate change denial are both quite dire.

    And if anyone does start worrying that maybe we are destroying living conditions for our children and grandchildren, there are always drugs for that…..

  • I agree that consensus is not proof that views are correct, but if you want to argue that a consensus is wrong, it’s worth finding some good evidence to believe it is wrong. Whitaker did a great job of finding evidence that the consensus around psychiatric drugs was wrong, and when people attempted to debunk him, they couldn’t come up with real data to attack him with, so they had to resort to just trying to badmouth him, or play dirty tricks. Whitaker had paid attention to actual science, and his critics had little ground to stand on.

    The situation with global warming is completely different. Those who attack the consensus get way more attention than they deserve. But all of their attacks have been well discredited in the ways no one was able to discredit Whitaker, by looking at actual studies and science – for example, in reference to Richard Lindzen who you mentio, see http://www.skepticalscience.com/news.php?n=1319

    True, people who believe in climate change can get paid in academia, and maybe even get extra funding from some groups that care about saving our ecosystem etc. But people who disbelieve in climate change can also get paid in academia, and they can get way more attention than their shoddy attempts at science deserve, and they can get special funding from climate change denial groups supported by fossil fuel companies. So what could possibly account for the emergence of a consensus in favor of climate change, if as you claim, the science doesn’t actually support it?

    The truth does matter, and a lot depends on what gets believed, whether the field is mental health or climate science. So I encourage everyone to look behind the superficialities, and do your best to discern who is really communicating clearly about what can be scientifically known and who is not, either due to simple mistakes or perhaps due to craven allegiance to corrupt special interests.

  • To Cannotsay2013: I didn’t write this article to get in a debate with people who want to deny the threat of climate change, so I’ll redirect you to http://www.slate.com/blogs/bad_astronomy/2013/03/18/global_warming_denial_debunking_misleading_climate_change_claims_by_david.html which does a great job of addressing and debunking the claims at the link you provided.

    Big pharma profits off bio-psychiatry, and fossil fuel companies profit off climate change denial. There are no comparable, powerful “special interests” that would have any investment in biasing science toward belief in climate change. The very notion that there is a conspiracy to promote false beliefs in climate change is comparable to the belief that scientologists are behind all criticisms of psychiatry: it’s a cover story to keep people from looking at what’s really going on.

  • Jonah, I’m sorry you couldn’t make it to the seminar! But Adrian says he will work to bring me back next year, so there could be another chance…

    I follow Rufus May’s work very closely, on his blog and on youtube, and I borrow from it within my own approach. Also I want to say I’m really happy to see Rufus posting on Mad in America so more people will hear about his work – I was bugging Kermit just the other day to persuade Rufus to post hear, and it appears that worked……

    I suggest that everyone should check out the youtube videos Rufus did about mindfulness and voices, at http://www.youtube.com/watch?v=hNp-7DT2u8E and part 2 at http://www.youtube.com/watch?v=SARayODS_90 – great work!

  • Hi Marian, I think you make a good point. It is very tempting when we see harm done to a particular person by the label “schizophrenia” to attempt to rescue the person from the label, saying “this person does not really have schizophrenia” leaving of course the implication that there are others who really can be accurately diagnosed as having a condition called schizophrenia that has nothing to do with their life history!
    The problem with this strategy is that it is unfair to all the other people so labeled, who also need to be protected from the presumption that they have an illness that has nothing to do with their life history, or their own creative attempts to deal with that history (which may have inadvertently made things worse) or with the efforts of others to “help” them (which also may have inadvertently made things worse.)

  • Thanks Alice, for posting your thoughts on this. It’s great to see you are one of the people speaking out.

    I think we need to expand the discussion to address the question of why more psychologists, social workers etc. aren’t speaking out. Many of these people are in private practice, there is no one to fire them, yet they keep quiet.

    We really need a lot of voices speaking up and supporting each other if big change is to happen.

  • Thanks Oryx. This was refreshing to read!

    One of the more difficult paradoxes you touch on is the way we both have to stop noticing “difference” in a way that isolates people with labels and destructive “treatments” but get better at recognizing difference in a way that allows us to reach out a little bit extra to people who need it, to be sure they are included and connected with.

  • I thought a key sentence in the article was this: “Kirmayer documented how feelings and symptoms that an American doctor might categorize as depression are often viewed in other cultures as something of a “moral compass,” prompting both the individual and the group to search for the source of the social, spiritual, or moral discord.”

    I think in general our medical approach tends to deny the possibility that our emotional states might have meaning, and that this is making our whole culture increasingly socially, spiritually, and morally ignorant. I think this would be a problem with any culture that tried to deny the possibility that emotional states might be an indication of important issues that need to be resolved.

    I say “might” because sometimes our emotional states do have more to do with physical problems, maybe our sleep was off or we are withdrawing from some substance or something else, but often they point to bigger issues outside of ourselves, and when we are trained to not notice that, social problems just fester while those who sell us drugs or whatever prosper.

  • One argument that might go beyond the choir is an economic one – pointing out that since they can’t accurately predict who among the “mentally ill” will become violent (or even who among the “apparently normal” are really both “mentally ill” and violent) then they would have to lock up many millions of people to make a real dent in just that portion of violent crime that is committed by “mentally ill” people. That wouldn’t be cheap…..

  • Thanks for this post! It was interesting to see that the top ranked service was talk therapy – something offered by parts of the system at least, but also de-emphasized by the parts of the system that have been taken over by the “medical model” or “disease model.”
    I think therapy could rank even higher if more therapists were really trained to understand mental health issues in an open minded way, and to support a variety of ways of being mentally and emotionally well: currently there are still way too many therapists who push ideas about “mental illness” and “needing to be on medication” etc.

  • Corinna, I am so glad to hear you are working your way through this successfully! I agree with Jonah by the way that your writing about the “trap” is really important. Psychiatric explanations make people feel defective, that they have an “illness” that others don’t have. But if people can see that the “trap” or potential vicious circle is really out there waiting for anyone who might fall into it, and furthermore that we don’t need to keep falling into it once we know how it works, then people will feel much more able to regain control.
    Anyway, that’s the kind of stuff I talk about in the mental health education that I do.

  • Metalrabbit, I think you make a good point, that madness becomes scarier the more we feel that the system is planning to provide “help” that will be scary and destructive. If we had a system of helping that offered kindness and choice and which wasn’t arrogant, then it would be much easier for people to make their peace with “mad” experiences.

    mjk, it makes sense what you say that the threat of possible re-incarceration makes it harder to work on recovery. But getting your life and independence back may be more possible than you think. It might help to read a lot of stories of people who have managed to do it, to expand your sense of what you might be able to do and of what might work for you.

    It should be easier, I hope the work people are trying to do here will take hold and future generations will be less oppressed…..

  • Hi Jonah,

    I certainly agree with you that the categories are stupid, and when I teach counseling or practice it I suggest paying attention to stories and experiences, rather than categories. We still need language that notices commonalities and differences in various kinds of experiences however.

    And yes, I was talking about a society’s need to decide when and where free help should be provided. Because when people are “mad”, they frequently don’t have money. Also, they frequently need more than just therapy – whether that is an Open Dialogue team or a Soteria house.

    And the free therapy idea, while nice, has a problem in that a society would need some idea of how to decide what was “real therapy” versus just talking to someone, else people could form friendships and meet every week with one person getting paid to do it as the “therapist.”

  • These issues do get a bit complex to address in short comments, but I will try to take a stab at it!

    Our society is currently organized around the notion that problems can either stem from a medical or mental health “disorder” or “illness” or whatever, in which case the person deserves “help”, or the person’s problems are just their own problems in living, and they should figure out how to solve them themselves.
    There are those who think they are “helping” people by supporting the notion that they really do have a validly diagnosed disorder and need assistance, and then there are those who think they are helping people by declaring that diagnosis is a fraud etc, in order to save people from misguided help and stigma. But in the latter case, there is the problem that if only diagnosed people deserve help, and if one no longer has a diagnosis, then no help is available, and the person may really need some kind of assistance!
    A middle ground kind of position would be to see people who realistically were in need of some kind of assistance as being worthy of help, though we would want to find better language for describing what it was they needed help with, and what sort of help was likely to be helpful, etc. Obviously, this varies by individual, but we would need some kind of concepts and categories. It doesn’t really work to just point out that everyone needs help, because even though that is true, there is also the fact that some people need forms of help that others don’t, and we need ways of talking about that, so we can get the right help to the right people.
    By the way, I agree with Jonah that the “Kraepelinian divide” should go, but at the same time, we will still need language to talk about the differences and variations in what people are going through, even when we understand they have their origins in complex reactions to and interactions with life problems and cannot be understood separate from that.

  • Emily, I was writing about “we” meaning “society” or something like that, so that’s why I was using the “if.” I don’t have any problem myself (check out my other writings) with framing the problems that usually get diagnosed as “schizophrenia” as having to do with interactions, and as being certainly much more complex than any medical model.

    What I was trying to point to is the way that society currently sees people as deserving “help” if they have a medical problem, and not deserving of it if they just have “problems in living.” If society just said that the problems of those diagnosed with schizophrenia were not medical, and didn’t change anything else, then for example lots of people not ready or able to work would be cut off disability and wouldn’t be seen as eligible for any other kind of assistance, which could cause problems.

  • One of the tricky bits around this whole issue is how we are to structure offering assistance to people, if we admit that the medical frame really doesn’t work. Western cultures have such an idea that the “individual” should be able to handle, by themselves, problems in living that aren’t medical. Framing “madness” as medical allowed society to direct resources toward “helping” though the errors in the medical model often resulted in more harm than help being provided. If we switch to framing it as non-medical, we will have to work to build a frame that says there should be organized help for people encountering some of the more difficult problems in living, and then make sure that “help” is really appropriate. This may take some work on changing cultural ideas about what an “individual” really is, and what social responsibility is…….

  • Thanks Seth, for this inspired post!

    I think many of us are struggling with how to talk about these huge subjects: massive social problems, individual trauma, madness in the sense of being lost, and also the redemptive flip side, the mad discoveries, creativity, and/or spiritual transformations etc.

    One problem is just trying to find words for it all. It’s confusing that we use the same words for the process of falling apart or being broken, and the discoveries that can happen when we have been “destroyed” and yet we are still there, the redemption, (redemption is a spiritual word,though some people experience it and don’t use spiritual words at all…..)

    We definitely need people exploring outside the cultural blinders, whether they get there by falling through cracks or being pushed outside by trauma and abuse, or set out on deliberate adventures. At the same time such exploration is dangerous, both to the individual who may in their disorientation be deceived into seeing as salvation something which is deadly, and to the society, which may be harmed by misguided “mad” individuals or which may be influenced by “prophecy” that is more harmful than helpful (“spiritual” visions are not always helpful in this world!).

    An idea from older societies is that visionaries need to be encouraged, yet also supported and protected, and the support and close connection to the community makes such exploration safer, it helps people interact with “the good spirits and not the bad” or generally helps people come to a better perspective.

    I think we need both individuals who know how to support their own visionary process, and a society that knows how to support and protect visionaries and especially young people who don’t yet know their way around. This will help us have more access to the helpful side of madness, while protecting us from the deceptions and darkness that are also associated with it

  • Thanks Will, for bringing some real “insight” to the APA, for sharing your thoughts here, and for your great keynote at the Alternatives conference.

    Just one thought about a tricky point: rather than say that psychiatric drugs have helped a lot of people, I often say that these drugs appear to be helping a lot of people, and may actually be helpful to some of these people in the long term, though I also don’t want to ignore the fact that the evidence seems to show that many who seem to be being helped are probably more hurt than helped when the long term is considered.

    That takes a lot more words to say, but it highlights the way drugs are likely to trick people into thinking they are being helped when they really aren’t, and it suggests that people might want to think hard before accepting superficial evidence that someone is being “helped”. At the same time, it takes an open minded sort of position, acknowledging that drugs may sometimes be a good choice for some people, even though it is hard to figure out when that may be.

  • Thanks Jack, for this account of the hunger strike.

    As for the best possible subject for another hunger strike, I suspect “involuntary commitment” would not be the best. Not that it isn’t a worthy topic, it’s just that any change on this would come slow, involve lawmakers, and have to overcome huge resistance by people who fear what might happen if people weren’t being committed. It’s not the kind of change a few hunger strikers could pull off, in my estimation.

    I think what hunger strikers can do is embarrass the establishment by pointing out where “the emperor has no clothes.” The biochemical imbalance thing was a good example of that – the public imagined there was proof of such a thing, but there wasn’t, and the hunger strike exposed that.

    One issue I think could be profitably highlighted by a future hunger strike is the issue of evidence for the long term effectiveness of the major tranquilizers aka neuroleptics aka “antipsychotics.” The public imagines that this evidence exists, but it doesn’t. A hunger strike could ask the establishment to provide evidence for the long term effectiveness of these drugs that is more substantial than the evidence they are harmful: they would not be able to do this, and that could make them look very bad, especially if news releases also focused on deaths due to these drugs, more and more kids put on them, etc.

  • Hi Paris,

    As you know, I am very sympathetic to your model, especially to the idea that madness involves a process of experimenting with different ways of looking at the world in a fundamental way. I was happy to see you summarize your model in this blog post. I think “nutshell versions” of theories can be very important in influencing the ways people think, so I wonder what you think of the following summary I wrote this morning:

    What we see as madness is typically the result of a process of experimenting with different ways of understanding or looking at the world, and different ways of approaching the world and of behaving, that don’t appear to be working out well to either the person or to those around him or her, and in which the person seems to be entrenched – either unwilling or unable to change.

    It may seem strange to associate madness with a process of experimentation, when so many who are labeled mad appear caught in repetitive patterns, and they don’t seem able to experiment with ways of getting out of those patterns. But this avoidance of experimentation can be understood as also the result of having experimented and then suffering from the result, and fearing that more experimentation would lead further into the abyss. Fear of madness, fear of one’s own creativity and imagination, becomes a key part of the madness.

    Society manifests its fear of madness by supplying antipsychotic drugs, and these drugs themselves inhibit experimentation, and keep people stuck in repetitive patterns. They seem to “work” when they keep people from doing further experimentation that causes trouble, but they also inhibit the continued experimentation that is needed in order for the “lost” to find their way to a pattern that works, to recovery.
    I think this summary is consistent with your model, while maybe going a little further to explain some of the patterns we see in “chronic psychosis” and in “negative symptoms.”

  • Thanks Steve, I appreciate your positive feedback and that of others who have written here!

    In cognitive therapy for psychosis, a key method is called “normalizing.” That’s where you try to help the person understand what they are going through as just a possibly extreme example of stuff everyone goes through, you look at how it makes sense given what happened to them, etc.

    In my classes on cognitive therapy for psychosis, I explain that what happens in the mental health system is often the opposite, which we could call “abnormalization.” Experiences the “patient” has are seen as very different than those of “normal” people, are given different words and completely different explanations, so much so that it is hard to see any connection. This is not too helpful in working toward healing and understanding……

  • Hi Jeffrey,

    I can imagine how horrible it must be to feel drug induced problems that you then have to hide to avoid more drugs! That in itself is a great argument for why we have to teach mental health professionals to actually listen to people and hear what their choices are, rather than just impose “solutions.”

    I hope though that you start seeing options in life other than hiding in your parent’s attic! You write well, and I’m sure you have other strengths also. If you work at getting back into life, then when your parents die you will be competent to handle things and to stay out of the mental health system.

  • I agree that drugs more often interfere with therapy and with recovery than help. But I suspect there are some positive uses of them. Especially for example when lack of sleep is making the mind unable to function: drugs that induce sleep can really help. That’s why the one kind of drug they give right away in Open Dialogue is stuff to help people sleep (but not anti-psychotics – those are reserved for times when nothing else works after a number of weeks.)

  • I suspect it is more complex – that both mental health problems, and the drugs, can cause impairment. Which is why sometimes drugs seem to “help” with the impairment, and sometimes make it worse.

    What I think is key to recognize, and what our system should be working toward but isn’t, is ways of getting to where one neither has the mental health problem nor is taking the drugs. I suspect the currently reported study may be too narrow, they might try looking for example at a form of mindfulness meditation that has been found to help people in general with developing the part of the brain involved in emotion regulation, see http://www.medscape.com/viewarticle/765894

  • Hi David,

    Unfortunately, I doubt I will make it to this event myself. I’m often stuck watching the DVD’s later – fortunately some of the key talks are often available at Working to Recovery
    http://www.intervoiceonline.org/3085/news/congress-dvd.html

    Hearing voices is certainly not unique to a diagnosis of schizophrenia. They are common in bipolar, depression, PTSD, dissociative disorder, and for many people who don’t ever go see a psychiatrist because their lives are going just fine. But it is a problem in our culture that people assume hearing voices means trouble, and often means “schizophrenia” as opposed to remaining curious enough to notice whether the voices really are causing problems with the person or if the person is capable of handing them. And if the person isn’t capable of handling them, we should be teaching them how, rather than assuming they will always be incompetent.

  • Here’s some more information related to the conference and some other Hearing Voices events, from the Working To Recovery newsletter:

    “Intervoice Congress
    Firstly we now have the official booking form and Congress information designed and ready. Hope you like the cover design, I personally love it. To view it CLICK HERE

    “Bookings are coming in swiftly, so please get your booking in. We would love to have 500 people at this 25th Celebration of the hearing voices movement.
    A range of different types of accommodation are available – and can be found by CLICKING HERE

    “If you are coming from abroad and staying you might be interested in the four day voice dialoguing course, Talking with Voices, we are putting on at Hebden Bridge in Yorkshire from 1st – 4th October with Dirk Corstens, Eleanor Longden and Ron Coleman. We still have a few places left. For more information and booking CLICK HERE

    “Travel from airport to Intervoice
    If you are looking for travel arrangements from the airport to the venue in Cardiff. A group from Denmark who are attending the Intervoice Congress have booked a bus and are inviting people to join them from Stanstead airport to Cardiff. Details Below:

    “Stanstead Airport to Cardiff – Tuesday 18th September 2012 – Departing around lunchtime.
    Cardiff to Stanstead Airport – Saturday 22nd September 2012 – Departing in the morning – Arriving around lunchtime

    “The more the people on the bus – the cheaper it will get!
    If you are interested in booking a place on the bus – Please Contract Trevor Eyles – [email protected]

    “Marius Romme & Sandra Escher in conversation – last 25 years
    Don’t forget to purchase a copy of Marius Romme and Sandra Escher in conversation about the last 25 years of the hearing voices movement. These are wonderfully relaxed interviews by both of them, carried out by Paul Baker. This DVD would make great training materials or just view them for personal interest.
    For more information and to purchase CLICK HERE http://workingtorecovery.us2.list-manage.com/track/click?u=d147865e18c59aada52ed2c88&id=928a33f69a&e=fc8a505fa8

    “USA Tour with Ron Coleman
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  • A hallucination is often defined as Wikipedia currently defines them, as “perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space.” So I think “voices” can often fit this definition, despite the fact that they may be at times more organized and thoughtful than the voice hearer, and despite the fact that “hallucination” is often seen as a put-down sort of word, since it has been so associated with the medical model.

    I definitely agree with you that a voice with “it’s own rich, distinct vocabulary and grammatical structure” cannot be considered to be “just a disease” as it obviously is much more than that. But it is still possible that the person is hearing whatever is going on as a voice, rather than just as his or her thoughts, because of an illness of some kind. For example, some people start hearing voices as a result of breathing changes at high elevations, and I knew one person whose voices seems to be intensified by oxygen deficiencies she had as a result of an illness. And I heard a story of a woman who developed voices which told her she had a brain tumor: when she told the doctors that they were kind enough to humor her and did a scan, found out she did have a tumor, after the operation the voices said goodbye and that was it!

    So I guess I’m saying, it can be a little complicated. But many or most voice hearers seem to be hearing voices more in response to life difficulties instead of any real illness. These are the people whose problems are more likely to be resolved if they face and learn to understand the voices and what is underneath them, rather than chronically avoid them or try to drug them away.

  • There are actually a lot of great stories of voice hearing in extreme life threatening situations, that confirm this idea that the voice hearing phenomena can save our lives. See for example this review http://hearingvoicesnetworkanz.wordpress.com/2009/07/12/the-third-man-factor-by-john-geiger/

    Fear also evolved for a reason, but it can also ruin our lives when we have the wrong relationship with it, especially when we think we have to always avoid feeling afraid. What we need to do instead is to learn to that the feeling of fear is not something we need to avoid, it’s just that we have to sort out when this feeling is telling us about a real danger and when it is just likely a false alarm. With the latter approach, fear itself no longer dominates our lives. I think people can change their relationship with voices in the same way.