Monday, August 10, 2020

Comments by CraigWagner

Showing 7 of 7 comments.

  • Liz,

    “It’s by no means easy to go the no-drug route in a society where families like mine have no support….”. Absolutely. It is hard on many levels: emotionally, financially (most are not covered by insurance), logistically (traveling out-of-town to find supportive practitioners), even conceptually (who and what information do you trust?). It’s easy to think, “the doctor says drugs, what do I know”? I admire your clear-headedness to question a drug solution and experiment with non-drug treatments.

  • David, thanks for the good thoughts. Like you, I think conventional psychiatry is horribly broken.

    Like many on this site, I have struggled to figure out how to maximize my personal impact in a mental health environment where much is severely broken. Where to place personal bets? I think there are three primary options: 1) vigorously work to change these broken systems from the outside 2) try to change the broken systems from the inside, 3) ignore the broken systems and create afresh hoping the old systems will die from Darwinian disuse.

    The existing mainstream psychiatric systems are entrenched, rich and strong. Sun Tzu will tell you that mounting a frontal attack against a stronger opponent is fraught with difficulties. We in MIA are experiencing that difficulty in spades as we hear from many people who post that people don’t see change despite our efforts. But I think we are at least changing the conversation and must continue.

    I’ve decided to straddle options 2 and 3. For option #2, I’ve looked for the good within NAMI and the APA and tried to make that good better. I think it is short-sighted to fully demonize both organizations. If we do, we become as close minded as those we hope to change. For instance, the NAMI family-to-family training puts a heavy focus on drugs as the therapeutic solution, but offers good material on self-care, communication, the downsides of drugs (yes, they spend ample time talking about that) , etc. I’m not in a position to change the courseware to reduce its drug-centricity. It will continue to be taught regardless of what I do. What I can do is respect the people in the local NAMI affiliates who are trying to help (I would go to war with some of them), respect the parts of the training that doesn’t talk about drugs (which is most of it) and gain their trust so that they allow me to augment their training with non-drug information. So that is what I do. And that non-drug part of the material is always very well received. If I screamed at NAMI for their drug-centricity, I couldn’t get in the door because I refused to respect what they do. My screaming would result in harm – in the form of not getting information to people in need – to the very people I’m trying to help.

    For the Psychiatric APA, I volunteer with the caucus on Complementary, Alternative and Integrative Medicine. These are psychiatrists who are vigorously trying to help people with non-drug options. They are trying to change their flawed organization. These are admirable men and women who have found their chosen profession in dramatic disrepair and are trying to do something about. I’ll support these contrarians.

    But my major focus is #3. We need talented and caring people who can simply define and execute in a new way and don’t give a hoot about all the flaws in psychiatry. A great example is Open Dialogue. They have found a strong solution for first episode psychosis and they are just doing it. They are healing at a dramatically impressive rate. They are publicizing their success. They are moving their success around the world. They are ignoring mainstream psychiatry and mainstream psychiatry can’t do anything about it.

    The end game that I think is possible is this. We as mental health “consumers” must shift demand. We need to understand that alternative practitioners (psychologists, naturopaths, integrative psychiatrists…) are where the healing is at. We need to flood their practices with people. As we do this, they are going to hire more PAs and talented practitioners to expand their practice so the supply of the right kind of practitioners increases). To the greatest extent possible we should simply ignore mainstream psychiatry (unfortunately, you can’t under court ordered treatment and if you go to the ER).

    In order to get people to ignore mainstream psychiatry, we need to change their consciousness, helping them understand that there is a far better answer. So my goal is to change that consciousness and shift demand. You bring down the wrong thinking of the Psychiatric APA not by overpowering it on a frontal assault, but by starving it of oxygen.

    David, as you suggest, it is important to work outside the mainstream. At Safe Harbor, we focus on primarily the proven biomedical (food allergy, nutrition, toxicity, pathogens…) that can cause mental health symptoms and are decidedly un-mainstream. My book is decidedly un-mainstream too. So we’re birds of feather there.

    At a larger level we need to shift the balance of power between the two APAs. From an outsider’s perspective, the Psychological APA has the right solutions, but doesn’t have the power of the Psychiatric APA. The Psychological APA lacks the badge of MD, so people think practitioners of the Psychiatric APA are the true “experts”.

  • KIP, Overall the evidence is not compelling. Some studies show promising but inconclusive evidence for rTMS for depression, but it has not been shown to be effective for OCD, PTSD or SZ (2005, PMCID: PMC2993526). The 2002 Cochrane meta-analysis of 16 rTMS trials for depression found no strong evidence of benefit from using rTMS—“although the small sample sizes do not exclude the possibility of benefit.” (http://goo.gl/Ea9sBY). A 2015 Cochrane meta-analysis of 41 trials for SZ found insufficient evidence to support or refute the therapeutic use, noting that overall quality of evidence was very low, due to risk of bias (http://goo.gl/34zSX8).

    Although not extensively studied, I think of greater promise are tADS (for OCD), tDCS (depression and SZ) and CES (depression and anxiety). All are inexpensive in-home devices.

  • Knowledge is Power (like your handle)

    Yes, EMDR, meditation, mindfulness, music, journaling, meaningful social interaction and many others are effective – they all have their place in that broad clustering of 27 non-drug options. A number of people have been helped with Emotion Freedom Technique as well. Good to hear your consensus with Matt on BPD – I had not heard that perspective before.

  • Matt, cool, thanks for the links on BPD. Time for me to inhale more research.

    You touch on a point that I think is vital here… “From reading most mainstream material, you would think drugs should be 70-80% of the treatment for serious distress”. The research supports using a much wider menu of options than drugs. Fortunately, the number of practitioners who are embracing non-drug approaches is growing.

  • David, thanks for the link – interesting material there, and the interactive graphic approach lends itself to a much more nuanced representation than the 2D grid can represent… There are a lot of different ways to represent the mass of approaches. I strove for one as simple as I could make it without sacrificing too much nuance.

    Certainly the psychosocial therapies reduce symptoms, and do it well. The distinction I was trying to highlight is that the psychosocial/biomedical therapies have a much stronger ability to strike at causes than do drugs. In the process, they relieve symptoms. In general, the diagram hopes to show that we should work as “high” in that diagram as possible. First, do as much tier 1 preventive as is reasonable. If symptoms, exist then look to tier 2 psychosocial/biomedical to strike at causes. If that isn’t enough, consider things in the tier 3 “symptom relief” category to address the residual symptoms not addressed by the restorative approaches. And all the while, avoiding excess tier 4 intervention. Realistically, we’re often doing things in all 4 levels simultaneously.

    You raise the interesting point about “competition” between therapeutic approaches. In reading the literature, I do sense a “competition” between the two APAs. Hopefully we can evolve to a point where all of these therapies, including drugs, are seen as available options where the benefits, warts and unknowns of each are clear. I think that is the vision of integrative mental health..

    I volunteer time to (not employed by) the APA caucus on Complementary, Alternative and Integrative Medicine (CAIM). These are talented psychiatrists working to mainstream many of these non-drug approaches. They use the three big terms for this body of therapies (“complementary”, “alternative”, and “integrative”). I think I agree with you, “alternative” is the one that carries the most negative overtone.

    Good interaction, thanks for the insight.

  • Amen. Canada, Australia and some of Europe seem to be leading the charge here. Interestingly, the legacy of orthomolecular does live on in the U.S. through the lineage of Hoffer to Pfeiffer to William Walsh (www.walshinstitute.org). There is a directory of Walsh-trained practitioners at their site. Walsh’s Nutrient therapy is based on earlier orthomolecular approaches: nutrient imbalances, food allergies, hormonal irregularities, gut/digestive imbalances, heavy metals, etc. Walsh extends that foundation to consider epigenetics, oxidative stress and more. In my personal situation, we live near the border and we ended up in Toronto to find an orthomolecular practitioner.