Showing 100 of 101 comments.
I agree completely with all of this, sad as it all may be. Thanks oldhead.
I appreciate your comment and think you point out something very important. I tried to explicitly say that I was not making assumptions about him, personally, because we do not, in fact, know anything about why he was so unhappy. What I was trying to say, and perhaps did not do a good job of, is that we need to actually ask WHY. That question so rarely gets asked – instead, it becomes about “mental illness”, which explains absolutely nothing. We as a society need to ask the hard questions about why a person suffers as they do. I also suggested that this could possibly be an opportunity to bring to light a very serious issue that NOBODY talks about. My intention was to provide a possibility of what could’ve been at play so as to simply consider that there are reasons why people kill themselves. My sincerest apologies if in the process I did the very thing I was trying desperately to avoid. It certainly was not my intention. You are right – we do not know what he went through or why he suffered so. I just wish we, as a society, would be daring enough to ask.
I hear your pain CryAngerNow. There are definitely some discussion forums here and on Facebook where you at least can communicate in solidarity with others who know your struggle all too well. It is difficult to find a safe space where your anger can be tolerated, and even more difficult within mental health services. You are more likely to find such tolerance with a psychodynamically inclined clinician, but it sounds like perhaps what you need is anything BUT another clinician. Another option, too, is EMDR, since there is less talking or relying on the person but rather a technique that many find helpful. My suggestion, though, would be to find comrades either in person or online that share your pain. There is much healing in shared experiences and comradery. Perhaps not the most helpful response, but, then, that’s the problem isn’t it? There are so few answers.
I’m sorry to hear of your family’s struggle. There are some forums on this site where you might have some discussion with other family members that could be helpful. There is a place called Advocacy Unlimited (http://toivocenter.org/) that is an excellent resource in CT, though I’m not sure they can help with crisis situations. It might be worth reaching out to them, though, to see if they have any suggestions or possible referrals. Unfortunately, I do not know of any other resources in CT. You might also look at ISEPP’s website (psychintegrity.org) for clinicians in your area.
Best of luck to you,
This is an understandable response and good question. I am particularly partial to the poisonous nature of SSRIs because while, yes, all drugs carry enormous risks and can create harm, especially with long-term use (hence what I mean by ‘fully informed consent’…people should really know this before deciding to take them), these drugs have little-to-no benefit whatsoever. They are all risk, no benefit. Also, unlike the other drugs they are frequently prescribed like candy and people are regularly told that they are harmless (I’ve never heard of a doctor claiming that lithium or benzos or neuroleptics are harmless). I do think drugs of all kinds can be helpful for some (I know I like my glass of wine or a nice pint in the evening) and people should not be judged for using what they will to get through tough times. Maybe I should re-word my statement to “except for SSRIs bc they are poison sugar pills. Hope this clears things a bit.
Thank you kindly littleturtle – much appreciated
Would you deny that people experience crises? Would you deny that people are in pain and in need of help – not necessarily from a professional, but in connection with another human being? Perhaps such crises might be defined as emotional, spiritual, psychological, traumatic, existential…whatever words you use, they will never do justice to every single individual. The point is that the folks in this film were, indeed, in crisis and needed connection in some way. Nobody is promoting the mental health system here or curing anything, in fact that’s the entire premise of the film. Certainly, I am not dismissing individuals’ suffering – quite the opposite. So apologies if in any way it is perceived otherwise.
This is really interesting, thanks for sharing. I now need to read up further on St. Francis
I’m sorry you are so frustrated, Sam. I will not get into an argument with you about who is more knowledgeable or who has the more privileged perspective and what I do or do not value. You have no clue what my experience is or is not or what I do or do not understand and I’m not going to defend myself to you. I listen to everything that is written here and have been open to all that you and others write – this does not mean I have to write about it myself or do research on it. Nobody is without bias and nobody can ever understand another person 100%. We don’t even understand ourselves 100%. And your idea that an individual cannot allow themselves to be known unless someone else does the telling for them is a curious one. I do hope that you find someone to validate and hear your words better than I seem able to here. With respect – Noel
Ah, yes, if we are talking about hearing a from or about people who reject mainstream psychiatry…well, that’s pretty rare no matter what population we are talking about! Thank goodness for this site. I was thinking more about NAMI, for one, and also the fact that clinicians and researchers are often family members (though this is not widely known in any official way, but there have been a few studies). There are also numerous books and blogs out there along the lines of “How to live with a partner who has X” (try searching for specific things, not diagnoses, for instance,unless it’s narcissism or BPD which seem to be quite popular). And, I do know that several people have done doctoral dissertations on such a topic (and that’s just in my area during my time in school!). If I come across something specific, I will remember and I’ll post it here.
Hi Sam –
Even 3 years later, I do still read every comment that is put on my articles. I thought it better to respond here than to the email you sent.
It is wonderful that you have been able to find meaning and a framework that works for both you and your wife. I know you put much energy into trying to understand and help her in her struggle, which is admirable. At the same time, this frame is not necessarily the same for everyone who has similar experiences. In fact, the idea of multiple selves appears to be, from a neurological standpoint, one that is universal – so, the idea of “fusion” or “integration” is one that, personally, does not resonate. I have found that using parts work is extraordinarily helpful for most of my clients, whether considered as “dissociative” or not. I only say this to make the point that your perspective is, of course, entirely valid and important…and also, it is one among many. Your story is important, and you should not shy away from making it heard in ways that help others feel connected to you.
I do think SOs have a perspective that is most important and does offer an alternative to that of the professional. The perspective of the family member, more generally, actually is quite celebrated and heard often. There is definitely a place for it.
And also, it is not the same as a first-person perspective, which happens to be my interest and is actually quite rarely heard or valued in its own right. What we see from the outside is not the same as from the inside, and is often clouded by one’s own internal experiences and needs.
So, while I do not dismiss your perspective and find it to be incredibly important, it also is not something I, personally, want to write about or research. The first-person perspective deserves a spotlight of its own and my focus on it is not meant to invalidate the perspective of others.
There are many researchers out there who are more interested in a family member or SO perspective, and those are the folks you need to seek out if looking to have your voice heard in a more formal manner. Otherwise, trust that your voice is heard and appreciated by so many both here and on your blog. The 2 commenters who responded so quickly to you are evidence of how your voice gets heard and has great meaning to similar others who need guidance and/or support.
Thank you, everyone, for your comments. I appreciate the stories shared, the debates had, and the varied issues that arise that I hadn’t even thought of when writing. It’s always interesting to me how one person can be angry that I went to far with an issue while another can be equally angry that I did not go far enough – this is the beauty of humankind. Differences are what keep us strong and always learning – so, again, thank you all.
Thank you to the editorial staff and Bob for putting together such a lovely tribute. It is very sad, indeed, and such a difficult loss to process. I believe Matt to be a great example of a person whose anger and “righteous indignation” (as mentioned by Louise) allowed him and so many others to survive and have hope. I think of this when I consider how odd and important it seems to be for mental health professionals, specifically, and society, more generally, to get people to stop being angry. Let us not stop being angry. Let us not stop fighting. Let us reach out to each other when we think we cannot make it another day. And let us be inspired by Matt’s drive, vision, and bravery.
For what it’s worth, I, too, think the term ‘psychosis’ is highly problematic and prefer to use terms such as “emotional crisis” or “spiritual crisis” or “altered state” or whatever the heck else seems appropriate for any individual situation. I struggled with how to write this article, however, without using the term and without going off on tangents regarding terminology. For purposes of reaching a larger audience, I stuck with psychosis. But, all points taken in this regard and all points I agree with. Thanks for bringing them to light.
That is a huge other piece, markps2. The extreme lengths the mental health goes to in order to get rid of anger and condemn those who are actually angry (and so often for very good reason). Very frustrating. It, well, it makes me angry.
The_cat, this is precisely the thought I was having and have been repeatedly having for several months. Which is why I had to write something. It’s mind boggling isn’t it???
Thanks for the link, Matt
Thanks, Richard. Thanks for elaborating on these points re: religion. And oldhead as well. Totally agree.
Sadly true, lily, sadly true. They just aren’t at the forefront of hatred in the way Muslims and “mental illness” is these days. There are also many other groups I didn’t mention, such as LGBTQ, for instance. Too many. Way too many.
Hi Matt – I have written elsewhere about psychology as our modern day religion and hope to do so more in the future, perhaps in the form of a book. Szasz has written a book about the matter as well. I think that psychology provides many what religion does not: the answers to the dark side of human nature under the guise of science. Just as God and the priest once replaced our fathers so too now does the psychiatrist and therapist.
I hear your frustration Borut. For the record, I do not classify people and find it unscientific and inhumane to do so. I’m sorry you feel that I wouldn’t waste my time responding to you… I try to keep up with all comments made and would be sorely disappointed in myself if I ever got to a place where I felt people weren’t important enough to listen to. Wishing you all the best – Noel
Thank you for this. It resonates on many levels and is wonderfully written! boy, I’d love to sit down to a coffee with you one day. You say you’ve given up on innovation and changing the world, but your ability to express your experience and touch others as you surely have here defies this. Though you have found, perhaps, what is right for you, I also hope that you never give up. You are not alone.
Thank you all for commenting and for the discussion. I think it’s good that not everyone agrees and that individuals with different perspectives have taken the time to comment on this site. Looking at the world, at our families, at ourselves with nuance and openness is painful and difficult for all of us – there is a reason that people do not wish to question the status quo regardless of the topic at hand.
To clarify, though, for some who seem to find upset with my article- nowhere do I deny that individuals suffer, sometimes intensely, in the ways that a bipolar label might describe. Nor do I deny that there are complex and interacting factors that contribute to the way any individual experiences and deals with the world. Nothing is so simplistic and linear to say X causes Y or we wouldn’t be having these disagreements in the first place.
Can psychiatric drugs cause mania? Absolutely. Is all mania caused by psychiatric drugs? no. Can childhood trauma and chronic stress cause extreme emotions and manic states? Absolutely. Are all emotional experiences such as this caused by child abuse? No.
Further, there is a big difference between chaotic and dysfunctional family dynamics and other “life stressors” and non-relational trauma. Big differences. Plus, I don’t know what “normal” is. Is it being able to witness the most horrific behaviors of mankind in war and go on about your life as if the world is still good and nothing happened “normal”? I wouldn’t be so sure about that. Is normal not being able to consider evidence that contradicts your views or to question authority and the status quo? Maybe it is. In that case, I am proud to not be normal and hope that I never become so.
This article is brief and is based on solid research. I do not deny that temperament, complex life circumstances, drugs, and other unknown factors cause the troubling experiences often labeled as bipolar. But, like my analogy to the headache suggests, it is important to spend time understanding what is causing these experiences instead of relying on the idea that the experiences are caused by the experiences.
Again, thanks to all for this conversation. Happy New Year.
Thanks, Matt, that is the precise argument I was trying to put forth. I also put forth this argument to the Boston Globe folks in person and we see how far that went.
I wonder what the studies were in the 70s? That actually is quite interesting and something I’d like to look into further. Of course, in the 70s you didn’t have the DSM. At the same time, “schizophrenia” was a huge category that was almost automatically given to black civil rights fighters, which would amplify the violence statistics not the other way around. I’m curious.
In any case, the overwhelming evidence states pretty consistently that “mental patients” as a category are more aggressive and violent since at least the 90s (which is as far back as I’ve ever gone in my research). Do any search and you will find this. Here is one such recent review: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000120
They state in conclusion: “Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis.” This is standard and what you find almost anywhere.
The concession that is given is that this increased likelihood is small when factoring in substance abuse, “mental patients” are more likely to be victims than perpetrators, and that the increase is limited to certain categories (i.e., “depression” would not be included). Torrey is the first to claim “violence”, so I find it hard to believe that he said there is no increased risk. I would guess he alluded to the idea that they are more likely to be victims and that the incidence is quite low. And, of course, that more crime is committed by non-“mentally ill” people than those with labels. Maybe this is what you are referring to?
Oldhead, I agree. My Master’s Thesis was entirely on the preposterous definitions of “aggression” and “violence”, especially on inpatient units. But, statistically, that is all, there is a strong and consistent correlation between diagnosis (particularly PTSD, antisocial personality disorder, substance abuse, and schizophrenia) and “aggression”. Now, I am the first person to say that this involves entirely circular logic…if one is aggressive they are likely in some kind of emotional distress and so therefore mentally ill and so therefor more likely to be aggressive because they are mentally ill. Mental gymnastics aside, when arguing that efforts to decrease violence are not going to be effective if they keep doing what they’re doing I cannot sit back and say “Well, people with diagnoses aren’t more likely to be violent” because this isn’t true; simply looking at the evidence/statistics, there is a greater likelihood. Though, they (we) are also rarely, if ever violent and that’s the real point that needs to be made more than any other. And being reactive and oppressing everyone with a label just because a few are violent is precisely what is happening. This whole subject matter is a large part of the argument and can’t just be ignored because we don’t like it or because it is, fundamentally, illogical and based on ideological fallacies.
Thank you for your comment. Individuals with particular diagnoses are, in fact, statistically more likely to be aggressive and/or violent than the general public. They also are, statistically, more likely to be victimized than the general public so this is not a pointless comparison. No, not all individuals who are diagnosed and are violent are reacting to psychotropic drugs (though, of course, some are). The most likely to be violent are individuals with substance use issues, regardless of other diagnoses.
In my original article (though it got edited out) I made a snarky comment to the effect of “individuals with a PTSD diagnosis are more likely to be violent…shall we then lock up all veterans, child abuse survivors, and rape victims just in case they might one day hurt someone?” Violence is used rhetorically as a reason for locking up folks who are deemed ‘psychotic’ or unruly, but violence is most often perpetrated by your average everyday citizen. It cannot be ignored that individuals in emotional distress are, indeed, more likely to become aggressive; rather, what needs to be highlighted is that there is no “illness” causing the behavior but rather reactions to things like poverty, oppression, abuse, and other trauma and that these factors need to be the focus of any efforts to decrease violence in our society not further oppressing, abusing, and traumatizing people.
I am assuming that the moderator will delete some of the very disturbing comments left in the middle of the night, but in the mean time I wanted to express my deep sadness at the anger and verbally violent assaults that do nothing but perpetuate suffering. Disagreement, debate, and even scorn for that with which you disagree is where learning and progress can stem from. Suggestions for others to kill themselves or otherwise is vitriol that is emblematic of cruelty. I know that when I write, my foremost intention is to bring awareness to the oppression and violence that many experience, be it ethnic minorities, religious minorities, those in poverty, and/or those who have grown up in abusive or severely dysfunctional family environments. Telling such individuals that their reactions to such life experiences or expressions of pain and sorrow are sure signs of illness, psychosis, or the need for death saddens me to my very core. Where does such hate truly stem from?
I am reminded of a study conducted several decades ago wherein a group of monkeys was put into a cage and, essentially, trained to beat any monkey who climbed up a ladder (see here: http://www.wisdompills.com/2014/05/28/the-famous-social-experiment-5-monkeys-a-ladder/). Over time, each monkey was replaced by a monkey who was not conditioned to become violent over something so silly as climbing a ladder. But, then, he was beaten when he dared to climb that entry point to food and learned his lesson quick. By the end of the experiment, all the monkeys would beat a monkey going up the ladder, but had NO IDEA WHY. They did it because everyone else did it and it had been done to them. This is how hatred and violence spread. But, things don’t always have to be that way. Compassion is difficult, particularly for those we are told to hate (and that includes people who attack viciously for no apparent reason), but it is possible. I hope we all can keep working towards expanding these holes in our hearts.
Thank you, Icagee, for this very powerful statement. It moved me and I hope it moves others.
Thanks, Matt, for the link to an interesting analysis. It made me think of John Read’s studies demonstrating that “poverty” is not in an of itself the catalyst for emotional distress and experiences that get labelled “psychotic”, but rather “relative poverty”…ie inequality. It seems that the need for justice is embedded in our DNA.
Actually, to be quite concrete, “insanity” is a legal term to determine guilt or innocence based on someone’s ability to know the difference between right and wrong. It is used colloquially in this article as a term used in everyday language. Like many terms in psychiatry/psychology, people have assumptions about the meaning behind a term as it is generally used until one really sits down and breaks it open only to find that it means nothing at all. At the end of the day, it seems we are all insane depending on who’s doing the judging.
I would like to clarify that this piece is not about “Trump vs. Clinton”. It is a much broader reflection, particularly in response to some very disturbing behaviors rising up among American citizens. We are told that “insanity”, “madness”, “psychosis” is an individual problem due to faulty biology yet I really wonder how this can ever really be defined. That is the question I ask in light of what is happening right now in the world. And, yes, Matt – John Read’s statement is quite fitting with the very idea of what I’m trying to express here. Thank you all for your comments and thoughts.
I just wanted to thank all the folks who have commented for really digging into the issues and demonstrating the difficulties involved, particularly when one’s pain has the perception of negating another’s. Thank you for your support, but, more importantly, for so many of you (and it seems new faces) for sharing your stories. Once upon a time, that is how we were educated: stories.
I’m sorry to hear of the difficult situation with your husband. Perhaps it’s best if I had not qualified or asserted in any way that someone’s suffering may be greater than anothers’. It kind of does go against the entire premise of what I was trying to get across. Suffering is human, universal, and too many of us are invalidated and ignored for the pain we carry. Some cannot let go of the past because they never were heard and so cannot hear others in the present. Suffering certainly begets suffering. And, I agree that we are responsible for the consequences of our actions regardless of what has happened to us or how we may suffer.
Maybe, somehow, one day, we all might find a way not only to have compassion for others, but to have compassion for ourselves. For some, that can be an even greater task.
I wish you all the best and hope that things improve for you soon.
This is lovely, thank you for sharing
Thank you for adding a very important piece to the topic. “Trauma” definitely includes attachment disruptions, and really can simply be defined as anything that overwhelms one’s ability to cope. This means something very different to a 1-year-old toddler than it does to a 40-year-old. Sounds like you’re doing some great work!
Thanks, Darby! And, I’m so used to people calling me “Nicole” that I stopped even noticing long ago. You are in good company 🙂
I agree completely and similarly have found this to be frustrating. It’s like no matter what you say or what evidence you put forth, people will continue to hear “illness” and “brain disease”. The link I put in above under “brain disorders” (http://psychintegrity.org/wp-content/uploads/2015/08/White-Paper-Brain-Scan-Research.pdf) was a paper I wrote with a colleague that covers a lot of this (but, it’s also really long and boring).
Great job once again, Jay.
I am sorry to hear of the struggles your family has gone through from conceiving to your more recent problems with your son’s emotional distress. When breakdown occurs in the family, it is always a painful and confusing experience for all involved. And, though it may be hard and shocking to be asked about potential child abuse, it’s nowhere near as hard and shocking for the identified patient to not hear it, seeing as how more often than not the answer is “yes”. I ask if you could identify where in my article (or any article I’ve written) you find any statement alluding to the idea that chronic stress and/or childhood trauma = child abuse? I do not insinuate this, and this would not be true. However, the rates of childhood adversity and the factor of chronic stress as causal precipitators of severe emotional distress are not my opinion, they are fact. Of course, there may be a very small percentage of sufferers who do, indeed, have some sort of disease process that can be attributed to environmental toxins or some other unidentified infection, but there is little evidence for this and would be impossible to parse out so long as we continue to deny the evidence as it does stand because of the difficulties in facing it. Not to mention that if there were an infectious toxin to be found for some individuals as causing emotional breakdown, this would no longer be a psychiatric issue (as seen with syphilis, encephalitis, tumors, Alzheimer’s, and other organic diseases).
Lastly, it is often the case that no overt abuse or economic hardship is present, but rather problematic family dynamics stemming from intergenerational trauma and/or parental distress interact with certain sensitivities and temperaments that result in an identified patient breaking down and, in some ways, holding the pain of the entire family. Do I insinuate this is the case for your family? I do not know you and would be embarrassed if my words were taken as such. But, when we talk about “normal” families, I do have to say that nothing is ever as simple and rosy as it appears on the surface. Looking within and exploring the pain within one’s family can be intolerable for many. But, there is almost always meaning behind one’s “symptoms” and more often than not they are situated within the context of the family system.
Regardless, the data demonstrating a clear causal relationship between childhood adversity, chronic stress and psychosis cannot be ignored because it is some people’s opinions that it doesn’t make sense or is too painful to consider. Your situation may be different, but it does not serve to negate the greater picture. At the end of the day, I genuinely wish you luck on your family’s journey and hope you all find healing sooner rather than later.
Hi Peter Dwyer, thanks for commenting. This study was based on comparing individuals diagnosed with schizophrenia with a control group that was not diagnosed as such. There are no population-wide studies evaluating this gene and, in fact, the authors state that the difference was so small that it would not justify testing in the general public. Therefore, I do not have an answer to your question. But, if, as I suggest, the gene variant is due to environmental stress, then any of us are prone to developing such a variant under the right conditions.
And to this question: “a 0.25% increased risk with for those carrying this variant, when the overall population risk is 1%, would mean that this variant is associated with 25% of the risk of “schizophrenia” in the general population.”, no this is not correct. All one can say from this study is that, statistically, the variant may be associated with an increased risk over the 1% risk of .25…that’s all.
Hope this helps
My point, which as I read it here is not quite explicitly clear, was to say that the suggested brain abnormalities in the prefrontal cortex noted by Sekar et al., could easily be explained by having experienced severe childhood abuse and being taken into custody as a child. The behaviors, such as hostility and lack of impulse control, cited by some of the other studies as directly associated with more severe childhood adversity are also those associated with the prefrontal cortex. Your question as to why I used the word “traits” instead of “behavior” can only be answered with “you’re right”. Sometimes it can be difficult when interpreting research studies to not inadvertently use their language. This was my mistake…it should read “behaviors” as it’s just more accurate and without judgment.
Thank you for your kind comments. I really hope people will read this and it can get spread far…the one-sided publicity has just got to stop!
Thanks, Edward 🙂
I’m copying and pasting what I wrote in a listserv recently:
While this study (and the NY Times coverage of it) is an important step in the right direction, I would caution the blanket endorsement of it. The “therapy” consisted of psychoeducation of family and patient of the nature of “disease”, how to cope with “symptoms”, suppression of “hallucinations”, and other standard non-depth, non-exploratory “therapy”. One comment posted on the website rang true to me…it referred to the fact that the 2 groups differed not just in the administration of “therapy” but also in dosage of drugs. This commenter suggested that perhaps the effect of better outcomes (itself relative) was due to the decreased dosage of drug and had nothing to do with “therapy”.
Note: I am not completely knocking this report because it is a step forward, but it also reinforces the “need” for drugs, the need to accept an illness model, and the suppression of experience, which for many is not conducive to recovery.
I received a message from Sandy Steingard, MD, whom many here know, after she had some difficulties signing in to MIA. I thought it important to have her point raised here. With her permission, I am sharing our following dialogue….
Hi Noel,… While I agree with most of [your blog], I was intrigued by the part where you say something like it is no help that some people find the current system helpful and “deny their trauma.” Isn’t that a slippery slope in which you do to those people – denying their own “truth” a what you feel has been so harmful to others in the system. Isn’t it at least possible that there is great heterogeneity and that indeed trauma plays a variable role in people’s lives (meaning for some there is no discernible major trauma) and that for some the medical model is helpful? ….Take care,Sandy
Hi Sandy, That’s strange that you can’t sign in…would you mind if I copy and paste this dialogue into the comments? I ask because I think you bring up an important point. This is a complex issue that is not done justice in my one flippant sentence.
I have posted in other blogs my personal reflection on “trauma”. I think that the insistence that there has to be some major event or abuse in someone’s life to justify the distress they may be experiencing as an adult (or else it is, indeed, a “disease”) is harmful and disturbing. When I speak of “trauma”, I am referring to a reaction of the brain and body, the subjective…what is “traumatic” to a 3 year old may be unnoticeable to those around him. I actually have come to loathe the word “trauma” because of it’s political tone and connotations. I should use adversity and dysfunctional family dynamics. That may more precisely reflect my meaning.
I think that it is our duty and our moral obligation to tell people the truth and not lie to them because it makes them feel more comfortable. We know that DSM diagnoses are not valid and we know that at this time there is no evidence to support the supposition that a disease process is taking place. If people want to believe that, fine. But we should not promote that just because it makes things easier and more comfortable. As a therapist, I do make an effort to get past some people’s entrenched belief that they have a disease because it is virtually impossible to get them to find a sense of agency and a sense of being a whole, valuable human being otherwise. I don’t argue, but i do ask people to entertain the idea that life circumstances may contribute to their distress and let’s discuss it. Otherwise, why be in my office in the first place? Of course, sometimes the only reason some go to a therapist is because it is required in order to continue with the psychiatrist, or because they just want help coping with their “disease”. In these instances, I do the best I can to lightly challenge while also respecting one’s ideological beliefs.
I have yet to do much digging or searching to uncover childhood adversity and/or dysfunctional family dynamics that very clearly give reason to the particular way a client is suffering. I feel it would be unethical to ignore this and not challenge one’s beliefs about their unrelated “disease”. At the same time, I fully accept that one may need this belief or that it is helpful in some way to them. As with anything (like believing that I am a piece of garbage, for instance), firmly held beliefs must be respected and challenged in a balanced and individualized way.
I don’t know the approach other authors here take, but, for me, I find writing on MIA to be such an excellent opportunity to receive feedback and learn to better articulate my thoughts. On that note, I thank you both, Richard and BPDtransformation, for challenging me and pointing out processes that perhaps I wasn’t even aware of.
Yes, I agree, this piece is pessimistic, and it is because that is how I feel. I once was naive and believed that the system could change because it was full of “good” people and if they only knew the evidence then they would want to do right by it. There are definitely people within the system, many of them on this site, who are trying to swim against stream, but I have completely lost all faith that the system can change. My belief is that it must be replaced by a completely different system, preferably headed up by people with lived experience, but that such a system may also fall prey to corruption and authoritarianism if not protected against.
In no way, however, does this mean that we should resign ourselves to defeat or lose sight of the bigger picture…just the opposite! Within the system, let’s try to do less harm. At the same time, let’s use our energy, resources, and voice to create change outside of the system. Let’s change the minds of the general public and start ignoring the ideologues in the system. Let’s change the minds of lawmakers who are not funded by pharma or NRA. Let’s change the minds of our peers so that they believe in themselves and believe that their voice is more than giving lip-service to “illness” and “meds”. We spend so much time and energy trying to fight the voices within this system and I do not believe for one second that it will do us any good outside of the choir. So few are willing to hear anything, especially if it invokes any feeling of guilt or helplessness in the professional. It is demoralizing and sucks the energy out of people like a leech on a bloody rag. BUT, we all are prone to be this way too and we should always keep this in mind.
And, of course, there absolutely are people who are different, who will listen, and change can happen! But, I do not believe it will happen in the system. So, on that point, I disagree with you Richard. Yes, a harm reduction strategy should be short term…in the hopes that the system will cease to exist.
Hmmm, I have failed indeed if I have given the impression of “settling”. Such a thought does not “settle” well with me at all, for I am the last person to suggest such things! My suggestion is that I do not believe the system can be reformed…I am a full-blown abolitionist at this point. At the same time, I believe that any system, peer or otherwise, that replaces what we have now best note these human tendencies because good intentions are not enough. And, while I fully believe that those who have been there must take back their power and revolutionize, my other point is that we must take a “harm reduction approach” in the mean time (and that is stolen from addiction work). What are the least-worst options and how do we at least decrease the overall harm being done until something better is in place? Just saying “no” to any services won’t work either because some people do need help. This is my point.
And, as for the dichotomy, I agree that science and ideology cannot be so easily separated. But, for purposes of strategically fighting for change and revolution, one must know what they are fighting against. We can speak up about the science til we’re blue in the face (and many of us are that blue), but until we realize that we are fighting ideology then we will lose. We are fighting the church of psychiatry, not science. It’s like trying to argue creationism versus evolution with some religious believers. There’s just no point in trying to argue using science in this regard. Ideologists will not listen, they have shown us that too often. And, my article is trying to demonstrate why that is. But, I perhaps created a false dichotomy in doing so.
In any case, thank you for your well-thought out response. And, for the love of cookies, let’s never settle.
Here, Here! I second your comment.
Indeed to all…yes. I will simply respond by quoting us:
“While brain research is certainly interesting as an academic exercise, and may, in fact, provide us with some interesting ideas for effective interventions, the consequences of the search for “disease” in the brain cannot be ignored. These include: skewed research funding, biased treatment preferences, and clinically harmful assumptions and prejudices. Though brain-based initiatives for understanding human behavior should have its place, limited funds need to be redistributed in line with current research findings.”
Thank you for the constructive criticism and the areas you point out. I wonder, though, if you read past the introduction? All of the quotes you pulled were from the first page and a half…thereafter I do believe that we address most of the concerns you point out and go into greater depth regarding each of the vague statements made throughout the introduction.
Also, in response to the comment regarding B12 deficiencies- I think it is important that any person suffering strange emotional experiences consider their nutritional and medical environment in the case where this may actually be the main contributory factor. However, in most cases where there is complex psychological issues at play, such as in psychosis, a simple B12 shot is not going to “cure” everything. The majority of cases where people are in extreme distress and experiencing altered states can, indeed, be considered problems in living resulting from developmental disruptions. This paper was not designed to tackle that subject in depth, as it is a HUGE topic, but I would suggest reading the cited references throughout our paper to glean a greater idea of why this conceptualization is “great”. Also, you could refer to some of my earlier blogs on this site concerning psychosis and trauma.
You are definitely not alone. The loneliness you speak of is all too familiar, as is the solace found here and in similar other places. Perhaps you will check out ISEPP (as recommended by Al Galves) and make it to Boston in October…if so, make sure to say “HI!” As for your comment about “schizophrenia” being the so-called condition you are least familiar with, that happens to be the area that I focus on the most (you can see some of my posts here). I am happy to share any resources you might be interested in, just send me a message. In any case, I wish you luck on this difficult journey. It is one that is worth travelling.
I just wanted to say that when I first decided to go to grad school and get my doctorate in clinical psychology I did it precisely because of some of the things you have experienced. I consider myself a peer, first and foremost, but could not stand the idea that I would be patronized, belittled, used as a pawn, or told “what do I know” just because I didn’t have the formal schooling that the doctors did. Sadly, as I am nearing the completion of my training, I can say that no matter what setting I am in (outpatient, hospital, school, etc.), I still get treated this way. If they can’t dismiss me as a student (who couldn’t possibly know anything), then instead it’s much worse: I am oppositional, over-emotional, refuse to learn, etc. My personality is called into question. Every review I’ve received thus far says the same thing: “Works great with patients, not so great at being a professional”. They try to use me, as a psychologist, to coerce patients and see therapy or just being with a person as ridiculous and a waste of time. My ambivalence in continuing down this path is parallel to yours for the same reasons. It has nothing to do with your position, and everything to do with making people uncomfortable. But, if folks like us always left, then what????
At the same time, I also agree with what MadMom brings up: once a person’s paycheck relies on honoring the status quo, it is nearly impossible to maintain one’s integrity. Alas, this is the bane of my own existence these days.
Thanks. While my tone and statement was more a sarcastic observance of how society reacts (a reaction that is utter and complete BS), I can see how it would read in a horrible way. Words can be interpreted so many ways…further reinforcing my point of the importance of strategy! I appreciate your observance
I’m sorry for your pain. Nobody deserves this. Let’s hope we can change things…
If there is one thing that I am good at, it is contradicting myself. I think I’m nearly as frustrated as you and am just trying to throw out ideas. But, I actually agree with everything you say here! Thanks for all the work you do, Ted. You are among many who have long inspired me.
I agree with almost everything you say. I’m enraged and so sick and tired of people disparaging me because I’m “argumentative” or “combative” even when I’m trying to be “nice”! At the same time, I stand by my assertion that psychiatrists are not evil and that just screaming in the streets will not get us anywhere. But, my whole message here is that being nice is even worse. I think my argument is that we need to play a smarter game. Use our anger more wisely. Smart campaigns using images and playing on the same emotions that people like Murphy are playing on. How can we be strategic? Just yelling in the streets will only further frighten the public, not garner us support. How do we work together wisely? I don’t have the answers, but we need to figure it out pretty fast.
This bill honestly terrifies me deep in my bones. I believe the first thing we can do about it is to really put it in people’s faces the dangers and human rights travesty that will result. And like Ted says below, to make the wider public aware instead of just the choir. Maybe putting up flyers with my imagined picture on it all over your town? Kidding. Sort of.
The way I see it (or at least what I tell myself) is that you cannot be silenced unless you allow yourself to be silenced. I pay a price for refusing to be silenced, but I refuse nonetheless…
Thanks for your comment Jessica, and thank you for all the work you (and others) have put into this effort. I look forward to working with you more going forward and to all the exciting new roads you will lead us down!
Thanks, madmom, I think you pointed out the one thing I was missing from my report: Family. There were so many family members there, and to also have folks like you walk out with some added hope is quite beautiful. I wonder if you came to the HVN townhall I was sort of moderating? In any case, so great to hear that your family benefited!
Thanks for reading. I agree completely with what you say here. I briefly looked over your thesis, and it seems quite interesting as well as informative. From what I gathered, we share much in our way viewing distress.
Best of luck to you and your own journey…
I’m sorry to hear of your struggle, and even sorrier that it seems to be the norm and not the exception. Interestingly, the author of the link you provided is the same person who frustrated me to the point of writing this article in the first place. I do have hope that things are slowly changing (there will be a new post to this effect soon), but I don’t think that most of us in this generation will benefit much from it. The only solace is finding peers and like-minded professionals who can support you, even if they can only be found online. And meditation. Learning to honor yourself and your experiences even when no one else will. I wish you all the best…
Sa, your assertion that this passage sounds like “negative symptoms” was precisely my point! This is an area that I am very interested in exploring further, but have not yet done so. Your suggestion to elaborate on it in another post is well-received…I should have time in a couple months to sink my teeth into that challenge and I hope when done it might elucidate something interesting. Thanks for the comment!
Thank you for adding this important piece to the equation. Yes, the subtle dynamics that leave a person confused are extraordinarily powerful and rarely recognized. I think in large part they go unrecognized due to the fact that most mental health professionals engage in that very same “crazy making” communication that leaves one in a never-ending cycle of chaos and confusion.
First let me thank you for your bravery in posting a blog that I think you knew would stir some anger and create a bit of controversy among the readers here. Personally, I appreciate your position as a person who is attempting a sort of middle-of-the-road approach and who challenges the point of view of many while also seeing some of the reason for such views to exist in the first place. Complacency and dogmatism, indeed, can be highly problematic. The number of comments and long discussion generated by this article, I think, is a good thing even if it is frustrating for some Although we have discussed before the fact that there are some pretty fundamental philosophical disagreements between us, I genuinely appreciate finding myself challenged and forcing myself to try to understand where you are coming from so that I might broaden my own perspectives.
Having said that, I agree with some of the previous comments that it appears as though you are almost dismissing and minimizing the argument that so many “anti-psychiatry” advocates stand for. I have felt this before with you, and I think some of the comments here clarified this feeling for me. Just because a position is “extreme”, that does not mean that it lacks nuance or complexity. In fact, I think I am in full agreement with Ted that psychiatry cannot be reformed any more than slavery. This is not because I am thinking in black-and-white terms. Sometimes, an extreme position is entirely rational. The assertion by you, and some other commenters, that MIA, its authors and its readers, neglects sociopolitical and ethnic problems is, to me, an unsupported criticism. I know that every article I’ve written has largely included this and has never commented on medications at all. So, I can just take myself as a prime example that this criticism is not quite accurate.
As for Whitaker’s arguments, I don’t know. Yes, socioeconomic factors play a large role, but then, the 80’s was one of the first times that our current disability program existed and that a huge recession hit…but we did not see the numbers that we see today, and the major spike did occur at the same time as the boom of SSRI’s. Of course, I think most people who read this website and certainly Whitaker understand that correlation cannot be equated with causation. But, the trend is certainly an interesting one that needs to be taken seriously.
You mention the concurrent rise in disabilities due to back pain, etc. Someone mentioned the NY Times article…and I agree that the medical model in this sense is just as problematic as it is in psychiatry. I work as a personal trainer. I have gotten into full-blown arguments with some clients begging them to wait before taking a pill or having surgical interventions…and all but one time did this result in the disappearance of back pain. In fact, several clients were also able to get off other “medications” as well. I think we need to look at another factor that is often ignored in the argument about drugs on both sides….It’s not just the direct effects that drugs exert (though this is an undeniable problem…dementia, lethargy, etc.), but the context in which the distribution of drugs lives. If a person goes to any kind of doctor in this day and age, it is unlikely that he or she will take the time to get to know the person, understand the full context in which “symptoms” developed, work with the individual to change his or lifestyle (including decreasing stress, nutrition, exercise, finding meaning in life, working through past trauma, etc.) or take the time to withstand pain while more naturalistic measures are incorporated. Instead, a distant, detached, and expert stance is taken and a drug is prescribed. Even before the drug is taken, we have separate body and mind, we have taken out the factors of caring relationships, and we are jumping to a quick-fix to solve everything. This is a societal problem, not just one of psychiatry.
Drugs have helped people cope with all kinds of issues since the beginning of time. Medications save lives, drugs help us live them a little easier. When discussing psychotropics, we need to discuss them in this context. Of course some people find them more helpful then others. I like to have a beer at night…I don’t know a lot of other people that enjoy a good beer like I do without needing to get drunk. But is that a medication? Does that mean that somebody else should be forced to drink alcohol because it helps me to de-stress at night?
These issues cannot be minimized. But, I also agree with you that the larger context must also be of great importance. The society we live in today is sick. RD Laing, Foucault, and others have written in great detail about the relationship of so-called mental illness with society, yet they are on the fringes and also seen as extreme. The topic of mass incarceration also cannot be separated from discussions of mental health, in large part because of the problem of involuntary hospitalization. If we reformed our penal system, which would require reforming a society built on fear-mongering and vengeance seeking, and started understanding that people who commit crimes and act in anger are in just as much pain and in need of just as much love and “help” as those who get labeled as “psychotic”. People who advocate for involuntary treatment often are just as guilty of discrimination as the rest of us, because their fundamental argument is that some people “deserve” “treatment” and others are just somehow “bad”. Not to mention that the labeling of someone as criminal or mentally-ill serves the purpose first and foremost of marginalizing, blaming, and dismissing.
I realize I have written way too long of a response. I love that you consistently have this affect on me. You are not easily dismissed…but you sure do push some buttons. That is a good thing.
I agree with you that we all have different temperaments and sensitivities to life that “predispose” us to certain reactions. In this particular article, I am trying to make the point that psychosis is a very understandable and common response to trauma (as it is defined by society) yet is almost always ignored to the detriment of many. On the other hand, some people may have different sensitivities to life and need not experience some overt traumatic event to breakdown under the pressure of our society. In my opinion, and it is only that, society is what is crazy and people who are sensitive souls are prone to break down when overwhelmed by the sickness of our modern world. While I agree that some may be more predisposed to react in particular ways or have greater difficulty with the world as it is, personally I do not view this as an illness or weakness. I find that an illness perspective lends itself to helplessness and hopelessness. I might ask how can a person like yourself find use in your sensitivities? How can you honor the unique qualities that set you apart from our sick and traumatizing world? Even if one accepts that an illness is in fact at the root of such difficulties, there are places and environments where a more subdued and sensitive character is valued. In any case, I really appreciate your comments and wish you all the best on your personal journey.
Thank you for your thoughts. I agree with much of what Ron has said. Though it may not be clear from my article, when I claim that much (not all) of what we consider to be “negative symptoms” are iatrogenic, I’m not necessarily referring to neuroleptics. I’m referring to the profound hopelessness, helplessness, and confusion that gets instilled the second one enters “treatment”. Having said that, I also tried to explain how apathy, lack of motivation, confusion, the mental fog, feeling like a “vegetable”, etc., can be explained through depressive and dissociative processes…thereby giving support for my assertion that perhaps psychosis can be understood through a trauma framework rather than a medical illness.
However, I also understand that many do view their experiences as a disease. I respect your (and anyone else’s) right to view things that way. My goal is simply to suggest that there might be other ways of looking at such experiences.
Thanks again for your thoughts and comment…
Thank you, Danielle, for you comment. I’m so happy to hear that maybe you might find a bit of validation in anything I’ve thrown out there. At the end of the day, that’s really what’s most important. Thanks for reading.
I think maybe I understand a little better what you are saying, Ron, but perhaps may still be misreading you a bit. It’s always tough sometimes to engage in a complicated dialogue in relatively brief typed out comments. I will say that from what I am hearing, I can’t help but feel that you are way oversimplifying both my blog and my response to you. That is unfortunate, and I’m not entirely sure how to respond to that. But, I will try to respond to what I do think I understand you to be saying…
I would venture to guess that nobody’s progression through healing and growing is quite so linear as to say, well first X happened and then Y and then Z. Usually it’s an interwoven process of all 3 and the rest of the alphabet too. As for your examples with Longden and others who learn to question their beliefs…Yes, of course. But, one must first have a reason to question their beliefs. Everyone’s individual process is different, and not really something I touched upon anywhere in this piece. On the other hand, if I come to a person with whom I do not understand and/or agree with, I cannot just step in and tell them to question their beliefs. Collaboration on learning ways to challenge one’s beliefs usually comes through many, many, many steps combined…again it is not so black and white and linear. And I’m guessing that it rarely happens until either some basic level of understanding and trust has been reached between people, or the person has become so beaten down by the process up to that point that “compliance” becomes a top priority. Even a cursory enough belief to say “this represents something, but I don’t know what yet” is giving some understanding to the why, rather than just saying one has a “delusion” that must be gotten rid of because it is a “symptom” of a “disease” and has no meaning. I’m pretty sure you are not approaching your clients in such a manner, so that point is kind of moot.
My last sentence, “At the end of the day, really, all any of us can do is our best to hold our beliefs lightly and be wary of what we think we know, while respecting and trying to understand that which we don’t” I think makes it pretty clear that I think we should all challenge ourselves to be wary of our beliefs and engage in reality-testing. I think where we may just agree to disagree is that it appears you are saying there really is a difference between a “psychotic delusion” and what the rest of humans experience. This is where I say, it is the internal world, the rage, the fear, the worthlessness is the “problem” and what is difference. The process of forming a belief system around that is a normal human experience. We all have delusions. We all need to challenge our rigid beliefs. We all need to question our actions, particularly if they might cause someone harm, before blindly engaging in them. At no point anywhere have I said that “never” should beliefs be considered problematic.
Also I just wanted to add to Alex’s comment…who cares what anybody says? The main point of the whole article is that beliefs themselves are not the problem- it is what they represent. No matter who you are. And if you have violent or rage full tendencies, those will find an expression in other ways if a belief is just suppressed or forced to be agreed to as wrong. If I believe that somebody is an alien and needs to be killed nobody is going to convince me otherwise. But why do I believe this? That is the point. Who is this person? What would killing an alien mean for me? Just telling somebody that aliens don’t exist might turn you into the alien. And then a shot of haldol is sure to follow…
Thank you for your kind words Steve!
Thanks for your thoughts Ron. I went back and forth on a lot of things, and ultimately decided to not directly touch upon the cultural mentions in the DSM because, quite frankly, an entire other essay could be written about that. The rest of the definition you quote, however, is in line with everything I outlined in the beginning. A personal belief that is not subject to reason, continues to be maintained in the face of incontrovertible evidence (as if there is such a thing) that it is false, etc.
I must disagree with you, on your comment that there is a problem with accepting diversity of beliefs. There is a difference between what I’ve said here (accepting that people have beliefs that serve a purpose, and trying to understand that purpose and help to ease their pain and suffering in order to help bring about change) versus what you are implicating (accepting that people have beliefs that are destructive and just leave them be and do nothing about it). There is no choice…no matter who you are, you will never convince a person their belief system is false without first accepting and understanding how that belief serves the person. They might humor you, but they will not just change their belief.
I also quite adamantly disagree with the idea that a belief is somehow less destructive because culture, or a large group, agrees with it. The Nazi’s had a pretty big cultural support system throughout the world. So did slavery. So does the DSM. So does the idea that poor people should just learn to work harder. So is the idea that bombing the heck out of the Middle East is somehow going to make the world safer. I’d say these are pretty destructive beliefs that our society here in America has supported and have led to probably at this point billions of deaths. So, no, there is no logic to the idea that if a group believes it, it is somehow “less likely to be risky”.
In any case, I always appreciate your thoughts, even in the rare case where we seem to disagree!
Thank you, Richard. I really do appreciate all your thoughts (and your blog too!)
Thank you for your comment, Ted. It is dangerous and painful to think for oneself. I think it is the people who are able to stand strong and do so anyway that bring about the justice we do have in this world.
Thank you for sharing your story. Sadly, it is a common one…it sounds, though, like you’ve come to a place where you are able to believe in yourself and not be swayed by the “experts”. I wish you well on your ongoing journey…
I would agree with you, Truth, except that those who treat so-called dissociative disorders are working with individuals known to enter into altered states deemed “psychotic”, have anomalous experiences deemed “psychotic”, and who accrue numerous psychotic diagnoses. Yet, these particular researchers/clinicians spend a great deal of effort saying well, these folks are just “psychotic-like” (a whole section in the DSM-5 is dedicated to this logic) without anything beyond ideology to back up such claims. And, they also fight for folks with that epithet of a label BPD to be included (a noble effort few other professionals are willing to engage in), while specifically excluding the “real psychotics” of “schizophrenia”…
I actually wanted to add something because I realize that my response might give the impression that I disagree with you, and I do not. Sorry for the long comment, in advance.
You state: “But I think we need to attend to the many ways in which these states arise, are experienced, addressed and in many cases resolved: The heterogeneity of etiology, phenomenology, effective care and course.”
I agree completely. My problem with all of these terms (which I ranted on a bit in a previous blog) is precisely because these experiences are so unique to each individual. I wish that we would just talk about specific experiences and not syndromes or medically-sounding processes that we have no actual proof exist or even any agreement on what they mean. We need to accept humanity for its uniqueness, and treat every individual as an individual (and I mean this regarding everyday life as well as in professional work). It is human nature to try and group people together and categorize them based on some superficial similarity. This same argument can be made (and has been) about race; one similarity does not make anything else similar, necessarily, beyond that one similarity. Because you hear voices and I hear voices does not mean that our experiences are the same, came from the same place, or will be worked through in the same way. It takes effort to move beyond boxes and treat people as individuals.
My point is that, with all of this in mind, I also think it is imperative that we assume first that there is meaning in said experiences. The meaning is individual, and is usually associated with trauma, but healing can be found through so many different ways. Even if we couch it in trauma, this is still true. It’s about going on a journey together.
Thanks for your comment. I would agree that it is important to attend to the numerous ways in which one might become overwhelmed and distressed. My problem with the term “dissociation” is precisely because it leads to the sort of assumptions as you appear to make here. Dissociation is a term that is used in every field of study to mean, quite simply, a sort of disintegration or separation. Mental health professionals use this term politically to mean “trauma”. The problem with this is that the term “trauma” is an entirely subjective, human term that has no objective reality to it. What is traumatic to one person is not the same as it is to another, and what is traumatic to a baby is not what is traumatic to an adult. For instance, I sited above research showing that attachment disruption (which may not have any relation to “trauma” as we define it) is far more “traumatic” than is physical or sexual abuse by a non-caregiver. To define what is and is not traumatic, and what is and is not “bad enough” to have an extreme reaction to is where the civil rights issue comes in to play.
Having said all of that, I do not believe there is any one “cause” for the distress that humans experience. But, I do believe that all forms of extreme distress, including, and probably most especially, that which we call “psychosis” is always a meaningful response to overwhelming circumstances in life and is a natural human attempt to adapt and grow. Whether or not an outsider considers these overwhelming adverse life experiences to be legitimately traumatic or not is not really the point. How the person who is experiencing the distress frames his or her experience and makes meaning out of it is the point. Most often, the meaning is couched in experiences of trauma.
A conference dedicated to trauma and psychosis sounds awesome! Until that happens, however, ISPS in New York (March 2015) will have a good amount of focus on the subject. I know that there is upset regarding some of the speakers, but I think overall it will be a good balance. And, it is the only organization that I know of that really does justice to the subject, even if it is not always a central focus….
Thanks Wayne, I agree with everything you say here. If you see my previous posts you will see I’ve argued these very same points using the very same resources. Clearly we are on the same wavelength….
How I wish I could be at ISEPP tomorrow! I look forward to hearing how it goes!
Jennifer Freyd is one of the most amazing women I have come across! I’m so happy to hear that she has been supportive. Yes, many, in fact most, dissociative disorder specialists are interested in HVN and accept that hearing voices are dissociative. This can be credited to the brave and pioneering work of Andrew Moskowitz. But, nonetheless, voices are considered “pseudo-hallucinations” and still completely unrelated to “schizophrenia”.
I would really love to hear about how your seminar goes this Friday….
Ron, as usual I agree….mostly. The only part I might digress is where you say “many” people in the trauma field are “very” willing to discuss this. I would definitely say “some”, and you and I are very familiar with at least “one” (who is also on my dissertation committee), but I think “many” is a stretch. Getting discussions going is EXTREMELY important. I guess that’s why I want to come up with as many reasons as possible for why I see reactions like what I describe here. The more understanding we have, the more we can figure out how to create a more open dialogue without this fear.
I don’t wish to comment specifically to your situation, as I am not able to work in depth with you one-on-one to understand the complexity of your particular dilemma. Having said that, “conversion disorder” refers to experiences where individuals suffer very real, very frightening, and often very disabling physical problems that are entirely psychologically based. The most common of these might be when when someone experiences a seizure that is not due to an actual neurological problem, but rather is a result of psychological conflict. It doesn’t make it any less real, it’s just that the basis of it is different. Similarly, one may experience chronic, excruciating pain that is very debilitating yet nonetheless has a psychological basis to it. Many “real” physical problems, like heart disease, chronic pain, and digestive issues have a very large psychological component that interacts with the physiological. It’s one reason that mediation and yoga are so effective with these problems….
Thank you for sharing and your suggestions. I take very seriously all the comments I get on this site. Often I think that moving to the UK might be the answer, but then people like you come along to remind me that the grass is not always greener…
I’m so sorry to hear about your struggles with your daughter. You say that: “Just one worker can do so much good for a patient by showing through words or actions just a tiny bit of empathy or solidarity” and I would agree that this is extremely powerful. I would also suggest that just one mother can do the same. Your caring and support and willingness to discuss her traumatic experiences and validate the difficulties she is experiencing now should not be considered small. I’m sure that you are making a huge difference in her overall ability to possibly heal, even if you never know it directly.
All the best…
Not an unrelated “soapbox” rant…quite to the point. I’d add “borderline personality” to the top of the heap, though, for prejudicial labels that allow professionals to write them off. A travesty in many regards.
“It seems that there are “taboo” topics that you don’t find out about until you say something “wrong” and encounter the silence of denial.”
Well, now, isn’t that the truth! It’s just a shame how often that seems to happen. I agree with you that there is a strong possibility that professionals are worried about being attacked themselves. It is a horrible feeling and not one that many are willing to tolerate.
Oops, I need to figure out how these comments work. My response to you is below….
First, I would kindly ask you to please point out where in my comment I said that defending vulnerable people is abuse. I’m pretty sure I stated pretty clearly that your argument was akin to that used by abusers. Not quite the same thing. Additionally, when somebody is physically attacking another person, the legally sanctioned “force” is called self-defense. This means you physically remove the person. This does not mean it is ok to inject mind-altering drugs into a person pretty much ensuring that they will act violently again the next time they get upset. You can also remove the person from the situation. This does not mean it is ok to restrain a person to a bed.
Anyways, I think part of the problem where perhaps you and I disagree is that you seem to believe that there is some distinct “mental illness” that is clearly, objectively, and definitively identifiable that also gives people a pass to act in violent ways. Forgive me if I have misunderstood you. See, I might ask in response to your specific dilemmas a different question. What about the man who believes that he must kill his rival drug dealer in order to maintain respect. For him this means survival. Is he delusional? Or does he deserve to be treated abusively by the prison system? If the answer to that is yes, please do explain further how you make this decision. What about the woman who kills her husband because he cheated. She firmly believes that he had taken her life away, a death in and of itself. Is she delusional? Who gives somebody the right to say that one person deserves abuse while another does not? And why is your person delusional and these 2 individuals not?
Nobody is arguing that alternatives are not necessary. However, that is irrelevant to this conversation, particularly since it seems that you would sanction using force in these alternatives if the situation called for it. Simply, though, to actually answer your question as to whether or not the people in your scenarios should be tried in a court of law and sent to prison, I say yes. It is unfortunate that when people suffer immense emotional pain and suffering that horrible consequences may follow. But, if we had a prison system where everybody was given the opportunity to heal, work through their emotional pain, and learn new ways of coping with that pain, then that is really where we might start to move forward as a society. But saying that the horrors that exist in prison are somehow justifiable for some, and that the horrors in the hospital are somehow justifiable for some is, quite frankly, terrifying to me.
Hi, Richard, thank you for a wonderful post.
I wanted to comment on the issues raised by Jonathan and some of the responses. My apologies, but I could not deal with figuring out the appropriate spot within the threads, so I just am making my own comment here. Anyways, I have read everything on MIA that Jonathan has written regarding this topic. As a person who works in a state hospital, I can understand the concerns and the very real problem of dealing with violent behavior. There have been moments in reading his blogs that I question my own beliefs. This current blog and all the responses, however, has finally allowed me to feel secure in my very firm belief that there is never, ever, ever, any justification for psychiatry to have the legal right to use force. Period.
I completely agree with everybody who has brought up the issue of breaking the law; if a person breaks the law, then they should learn to deal with the consequences. Not doing so, and creating some alternative “treatment” avenue because somebody is “sick” is probably the biggest impediment to getting past #1 the association of violence with “mental illness” and #2 the learned helplessness of those who have been so misfortunate to end up in the system. I have nothing to add to this.
Jonathan’s argument, I now realize, is akin to saying “well, the police abuse worse than use, so what we do isn’t so bad.” I grew up in an abusive home, and this was exactly the same tactic used to get me to believe my parents when they said they were not abusing me. I call BS. If the law were to change, as it should, and all use of force was deemed illegal, then the system would adapt. The system would learn new ways of preventing the violence in the first place (i.e., actually listening to people before they get to the point of resorting to violence). Those instances where somebody assaults another is an instance of breaking the law. Period. This leads to my second point.
The prison system is also abysmal. Both systems need an overhaul. Imagine a prison system that actually treated ALL of its inmates humanely? Jonathan, are you arguing that only the “sick” should be given that opportunity? That somehow it’s ok that “those other criminals” get the crap beat out of them daily and thrown in solitary for months at a time? We wouldn’t have such a crime-ridden society and such extraordinarily high rates of recidivism if we had compassion for the individuals being incarcerated in the first place. In Sweden, they do not live in such a retributive society; their criminals are exposed to real rehabilitation and compassion. And guess what? They have the lowest rates of recidivism in the world to the point that they have closed many of their prisons. EVERYONE deserves this opportunity.
We live in a society that is short-sighted and cannot see beyond the immediate future. If the laws were to change, there surely would be immediate chaos and sad and unfortunate consequences. But, the system would adapt. And, in the long run, people would no longer be traumatized by those benevolent souls who dedicate their lives to “helping” people. Frank Blankenship’s statement above regarding the Nazis is pretty accurate in this regard. Change is hard. But, it is absolutely imperative.
Thanks again Richard for a great piece.
Dear Angry Dad,
I’m so sorry to hear about the experience you have had with your son. The anguish you must feel is very palpable-it brought tears to my eyes to read this. Unfortunately, America (where I am) isn’t any better, and neither is much of the Western world. I do hope you find some healing for your family.
Wishing you all the best…
Someone told me this quote today:
“The river does not break through the rock through power or force, but rather through gentle persistence”
At the risk of sounding trite or strange, perhaps we just need to be rivers.
First, I want to start with apologizing for perceived “innuendos” that left anybody feeling like I was admonishing them harshly. It genuinely saddens me to think that I might have upset people who I consider my (virtual) allies, even if we don’t know one another. If you see the final sentence of my comment, it states very clearly that I am talking to myself just as much as anybody else. That is because I am used to being in the position of being told that I am “attacking” when I become impassioned and upset at what I perceive as an affront to my very being…which is also as a “survivor”. I get it. My comment was a plea for reflection, particularly in relation to someone who is willing to dialogue, not an accusation.
Second, I want to reiterate the point to my comment that everything else was centered around…that is, how do we get people to listen and really help change to happen? My suggestion was that in order to get people to listen we have to be willing to welcome those who may not fully understand but yet are curious and open. And by welcoming, it requires giving someone a little bit of the benefit of the doubt.
Lastly, nothing of what I said was to shut down the debate. I actually learned quite a bit from some of the comments correcting the mistakes found in the original post and some of the personal anecdotes that went with it. Rather, I am pleading for, yes, a less violent approach to doing so. Perhaps my choice of words were harsh without my tone and context being apparent (and perhaps that is the case for others on here as well!). It’s just that there are more respectful ways of debating that don’t lead to humiliation of a person trying to honor a leading figure of this movement (even if his efforts were clumsy in some ways).
I too am upset. But, to be very clear I did not say that people cannot be upset for that would indeed be preposterous. On the other hand, attacking someone (which is beyond upset) who appears to genuinely be trying to dialogue because I perceived justified anger gets none of us anywhere.
This comment is more geared to those participating in the discussion, rather than so much to Professor Fontaine. I read this article not having any idea what to expect, and kind of excited to actually learn something new (I know most nothing about philosophy). Professor Fontaine also prefaced the entire thing by saying this was a speech given to the APA…so, I also had my guard up as I read through. Like many of you, I found some things offensive, but I also found many others enlightening. The thing I was most impressed by was this man, who is not even a mental health professional, had the courage to give a presentation about a figure whom is most reviled by the very people Fontaine is addressing, and he did so in a room and time slot that really is quite insulting and humiliating. He attempted to bring to light an issue that those in power were ignoring, and asked his audience to take a moment and reflect. There are very few, very few indeed, who have the courage that Professor Fontaine does to do this at an APA convention.
Professor Fontaine may not be aware of the extent of the issues discussed on this site or that people have first-hand experiencing. And, yes, his speech has many errors in it due to using secondary resources or no resources at all (shamanism), and his tone is, at times, terse and dismissive. But, it is clear from his exploration and the questions he asks that he is curious and skeptical of the mainstream mental health practices and stigma that so many people must deal with. And there were very interesting historical and philosophical ideas that he explores that could really inform us from a “let’s learn from the past” kind of place. For that alone, he deserves respect, not an attack. There is a lot of anger around here, certainly justified in many respects, but to lash out at someone and accuse them of wrong doing without listening to his stated intentions is itself abusive and oppressive. This is what happens in the cycle of violence.
There is another author on this site, who I will not mention, who is consistently offensive and has made it very clear that he doesn’t care what anybody thinks. Perhaps he deserves the anger and backlash that is rampant here. But, Professor Fontaine has admirably responded and tried to dialogue in spite of the attacks. Maybe we can give him the benefit of the doubt and discuss the problems in his narrative from a place of respect? And, perhaps we can also acknowledge that there were many interesting and important things within the narrative that are very much in line with the thinking of most at this site. There is constant discussion about “how do we instill change?” Personally, I believe that the first step is to not push away those who are curious about and sympathetic to what we might have to say. It’s not always easy to do, but we still must try to be aware and not react out of anger.
Oh, and just as an FYI, I’m speaking as a person who is talking to myself just as much as anybody else right now….
I find this to be incredibly sad and disheartening…yet…not surprising. Your ability to forge through in spite of the less than desired support is truly amazing. Don’t stop. I’ve come to reason that if you can reach just one person, then the entire struggle is worth it.
Welcome to MIA- I’m sure you will find many helpful things at this site. Personally, I do not believe that anybody can be “helped” until said person is willing to help himself. So, I applaud your efforts to help yourself!
Your concerns about the posting policy are understandable….but I am pretty sure that not a single author pretty much anywhere will complain about a comment that is “simply praising an article”. I know I sure don’t mind 🙂
I’m pretty sure that the policy is in regards to the occasional times when heated discussions or comments made in the heat of emotion turn into personal attacks against somebody instead of constructive debate.
Anyways, good luck on finding some resources around here…
Thank you angelaursery for your comment.
You ask some great questions that I hope I can provide some clarity to. So…
First, you asked about the trauma vs. trauma and dissociation field. The trauma field does consist of specialty areas related to war trauma, sexual trauma, developmental trauma, etc. There are also researchers and clinicians dedicated to the dissociative disorders. So, you’re right, although I used the terms synonymously, there is a distinction that should be made. Particularly because not all trauma scholars believe that dissociative disorders exist (this is from personal knowledge, I have no citation to provide you).
Second, you asked about written materials that provide examples of how trauma specialists (including, but not limited to dissociation specialists) insinuate a demarcation between real trauma disorders and schizophrenia. Because I want to avoid challenging any particular person, researcher, clinician, etc., I am hesitant to provide specific resources. But, if you read books about dissociative disorders, guidelines, or specific articles discussing “psychosis” vs. “DID”, for instance, this insinuation will be there. Many are likely to discuss the problems associated with the schizophrenia label, but few question the validity of the diagnostic system itself, the biomedical understanding of psychosis (or bipolar or any other category), or the brain disease rhetoric. You will be hard pressed to find a dissociative specialist who does not believe that there is a brain disorder called schizophrenia, and who will say that DID is trauma-based, while schizophrenia is biologically based. Of course, without any evidence to actually back this up. An interesting example of an exception to this, and an article that discusses this very problem at length is “Schizophrenia, Trauma, Dissociation, and Scientific Revolutions” by Andrew Moskowitz
The biggest example of the line in the sand can be found looking at the DSM- Dissociative disorders are not in the trauma disorder section, but they come right after with the caveat that they are “closely related” and there is an explicit message in the first couple of paragraphs stating that it is understood that trauma is at the root of these disorders. The psychotic disorders are nowhere near this section. Also, any dissociation organization will tell you first and foremost the importance of getting psychological testing in order to obtain an official diagnosis, and part of this process is ruling out “real psychosis”. Yet, there really are no objective differences between dissociative psychosis, other psychosis, schizophrenia spectrum…it’s definitely a topic that could warrant another piece.
Your next question is one that I don’t think I can adequately answer. The focus on discussing dissociation and schizophrenia was because this is the biggest area of confusion and contention between different schools of thought. While there are many other psychiatric labels often given to a person who might meet criteria for DID (such as depression, which is almost universal in this population), none overlap in the same way or have the same level of disagreement as with these 2 categories. Depending on how you define it, dissociation is an aspect in almost any major category. But, there are no weird efforts to say that someone who has mood swings that might meet criteria for bipolar disorder has “mood-like swings” in DID. This is the baffling logic, though, when discussion psychosis and DID. They might argue that such mood swings exist due to “alters” rather than “real bipolar”, but it just isn’t the same level of effort or disagreement. There is an entire page or so in the DID section of the DSM dedicated to describing the difference between “real psychosis” and “DID”, which is based on the rhetoric I have mentioned in the blog piece. There is no effort such as this to demarcate DID and, say, bipolar (although there is for DID and borderline, but that’s another discussion). Perhaps I will take your suggestion and write another piece about dissociation’s relationship with other various categories (just none have the controversy that these 2 do and the near impossibility of clearly saying how they are different).
You also asked if I believe the broken-brain model is correct for psychosis. I’m not clear where I have given this impression, and I hope you can let me know so I can fix it! I do not believe this is true for any DSM category, except for dementia and Alzheimer’s…because there’s actual clear evidence that this is true. And, so these disorders are really under the realm of real medicine not psychiatry.
Lastly, regarding “many political, ideological, and financial reasons” the links between childhood trauma and psychosis are so often ignored”- I left this alone largely because it is an entirely different subject, and also because most who visit this website already hear enough of these reasons in other posts. Perhaps, though, I will write more on this eventually. I appreciate your thought-provoking questions.
Thank you all for your supportive and thought-provoking comments. I wanted to respond to a couple of statements regarding what constitutes “trauma” and the idea that certain things are clearly “traumatic” while others are a “stretch”. The overall point to what I was trying to discuss in my post was that psychiatry, specifically, but really all of society needs to stop defining another person’s experience based upon their own values and experiences. “Trauma” is something different to everybody. What is traumatizing to one person may or may not be to another, but to insinuate that there are certain things that somehow cannot be considered traumatic is horribly invalidating to the person who is suffering already. One may very well have a much more severe traumatic reaction to words and non-verbal threatening dynamics (particularly if they are a child) than a person who has a great deal of familial, societal, and financial support might have to a brutal attack like rape. These terms are problematic for the very reason that this discussion has started to take. People suffer, and they do so in different ways. I implore those reading this to step back for a moment and try to stop putting your ideas onto someone else’s experience, but instead to try to validate the suffering another might have had. Dismissing someone’s suffering because in your mind it is not “traumatic” is to do the very thing that so many of us on this website complain about the psychiatric system doing. Sometimes when change is what we are seeking, we must first look inside ourselves to find that change.