Thursday, April 27, 2017

Comments by Steven Morgan

Showing 19 of 19 comments.

  • This:

    “More detailed knowledge of clinical interventions will be needed so that peer specialists know when and how to support individuals in treatment. For example, Hendry explained, research has shown that when an individual is receiving DBT for a personality disorder, peers must have enough knowledge about the phases of DBT to avoid “getting in the way.” This can occur when the individual’s therapist “withdraws,” leaving the individual “alone” to face challenging situations as a means of developing essential distress tolerance and emotional regulation skills. Peers who recognize the phases of DBT treatment can adapt their interactions with the individual in ways to support the therapeutic goal.” –

    Is disgusting.

    Thank you, Sera, for once again speaking truth to power and keeping the flame alight.

  • Thank you Iden, Sera, and Earl for taking the time to write this thought-provoking piece and publish it here. There is racism in this movement, and I’m all ears for how to participate in undermining it. So, thanks for the suggestions, and for the consiousness-raising.

  • Hey Bob,

    Here’s their response (on the article page under supplementary statements):

    Some Methodological Issues: A Supplementary Statement from Drs. Pierre and Pies:

    Our commentary cited six studies of “quality of life” (QOL) and antipsychotics (AP) that involved a placebo control (Hamilton et al, Nasrallah et al, Beasley et al, Leucht et al, Witte et al, and Isitt et al). All these studies found an advantage for AP use vs. placebo, with respect to improving QOL. Like all studies, the ones cited have limitations and methodological shortcomings, and we carefully qualified our conclusions as “provisional”, pending more long-term placebo-controlled studies.

    Some critics argue that APs make patients with schizophrenia worse (or even cause “brain damage”), but then simultaneously invoke the speculative notion of “withdrawal” to explain away the results of the studies we have cited, arguing that these studies did not use “true” placebo groups. But if APs actually make patients with schizophrenia worse, then discontinuing the AP ought to make patients better. Conveniently invoking “withdrawal” to explain why, in fact, patients with schizophrenia who are taken off APs do not usually get better is contradictory. (To critics who respond, “Oh, we concede that antipsychotic medications may be helpful in the short term, but they make things worse in the long term,” we would reply that there are no convincing randomized controlled data, either on the basis of relapse frequency or quality of life, that demonstrate that antipsychotics worsen outcome in the long term. As the Sohler et al study concluded; i.e., “Our study did not support the hypothesis that long-term treatment with antipsychotic medication causes harm.” [Am J Orthopsychiatry. December 14, 2015]

    Critics also confuse two uses of the term “withdrawal.” One use means, “stopping or discontinuing a drug.” The other refers to withdrawal syndromes, such as the kind experienced when a patient is suddenly taken off a barbiturate or opiate, and experiences shivering, diarrhea, hallucinations, seizures, or even death. There is no such documented “withdrawal” syndrome associated with discontinuation of antipsychotic medications—even sudden discontinuation–except for generally mild and transient cholinergic rebound symptoms, such as hypersalivation, cramps, or diarrhea. These are usually seen within a few days of stopping the AP; are usually mild and self-limited; and rarely need clinical intervention (In rare instances, they are easily managed with anticholinergic medication). These short-term symptoms are quite distinct from a relapse of the illness, which typically occurs 1 or more months after stopping the medication. Thus, the notion that the placebo groups in the studies we cited did worse because they were “in withdrawal” and not “being treated for withdrawal” is completely unsupported by any empirical data.

    A “true placebo group” is a group that is given a placebo—period. There is no other definition in the medical literature. It would require an individualized, patient-level analysis in order to demonstrate that any particular patient taking the placebo was “in withdrawal.” We are not aware of any such data. The notion of a “supersensitivity psychosis”, as invoked by some critics, remains only a speculative and theoretical possibility—not, to our knowledge, one confirmed by any biological study (PET, fMRI, etc) of the brains of actual patients.

    Finally, while all studies, including the ones we cited, have methodological limitations and potential biases (e.g., pharmaceutical company sponsorship), we have yet to see critics cite a single controlled study, using standard measures of QOL, showing that quality of life improves for patients with schizophrenia when they are no longer taking their antipsychotic medication.

  • Hi Bob, great article. I took the leap of signing up for Psychiatric Times and publishing this comment on their article (hope it stays up):

    Greetings Ron,

    First, disclosure: no one put me up to writing this commentary.

    I believe the “journalist critics” you’re referring to are Robert Whitaker, who has written several books critical of psychiatry and who publishes on https://www.madinamerica.com. If that’s so—and please correct me if I’m wrong—your conclusion that these critics haven’t “spent a single hour with a grieving or distraught family member, who has seen a loved one decompensate into a life-threatening psychotic relapse, after stopping medication” is inaccurate. I’m wondering: did you ask him or other “journalist critics” about this assumption first?

    I’m glad you acknowledge that people other than psychiatrists should weigh in to help “narrate recovery stories”. Here you are, verbatim: “We would add that, in addition to families, mental health workers of all kinds – counselors, social workers, nurses, and psychologists to name a few – share a privileged position from which to observe and facilitate the recoveries of our patients. All of our voices—not just those of psychiatrists–are vital in helping to narrate those recovery stories.”

    What I notice missing from your list are peer supporters who have lived experience and work with others going through hard times, and also people who have recovered (or not) and who aren’t “mental health workers”. I’m curious, why? It seems to me that the people who have actually gone through the experiences that land one in psychiatric treatment would be the most valuable group to dictate the terms of “recovery stories”.

    I was in psychiatric treatment for four years for so-called major mental illnesses, and I’ve been out of that treatment for 9 years, during which time my life has significantly improved due to many intersecting factors, one of which has been my rejection of the recovery narratives that psychiatry propagates. Under your terms for what qualifies as having a voice in whether the antipsychotic drugs are effective or not, thankfully I’m in: I indeed spent 8 years in human services (and now 3 as an educator in the mental health world) and a lot of hours with persons, families, friends, and strangers who are having bewildering experiences, sometimes predicated by having just withdrawn from psychiatric drugs. For the record, I’ve also swallowed or been shot up with over twenty different brands of these, but again that doesn’t cross the threshold under your rubric. I’m curious, have you tried the psychiatric medicines? I’d say from my firsthand experience as both a “consumer” and a “witness” (that you appear to value), most psychiatric drugs are doing more harm than good.

    I also spent a lot of time stealing expensive psychiatric articles from online journals that I accessed by posing as a student at Dartmouth. I spent a year combing these through, first with an interest in what had happened to my “chemical imbalance” since I was no longer taking psychiatric drugs and was feeling fine, and later getting hooked into the the mass cover-ups, biases, collusions, and unethical treatments that Whitaker documents in his writings.

    Now, you’ve just published a case for antipsychotics here by citing two studies. And like most of the studies I encountered in my non-professional reading of the scientific literature, these studies are flawed to a point of absurdity. Whitaker provides you a rebuttal here: https://www.madinamerica.com/2016/09/confessions-of-a-trespasser/

    I’d like to ask, if indeed Psychiatric Times will publish here my non-conforming comment: will you please address his criticisms of those two studies?

    Cheers,
    Steven Morgan

  • Hey Sera,

    Thanks so much for writing this intriguing analysis and starting a wide conversation. I’ve made it through a lot of comments, but wow, it’s turning into a novel on here! Good sign.

    I want to raise an issue that has been troubling me lately, and hopefully not fly too off-topic. I’m still working out my thinking on this, so I’m all-draft here.

    Here it is: I have a problem with acknowledging “human rights”. From my understanding, the idea of human rights has been historically wedded to religious ideas of creation. Hence, “inalienable” rights ascribed by our “Creator” in our constitution. To me, there are no inherent human rights. We’re born alongside all kinds of other life forms in an infinitely complex and connected world of competition, co-existence, and collaboration. I think what gives us rights are our social institutions. Not protects them, but actually grants them. In other words, I don’t believe we are born with a right to exist on this planet. Any life-form survives by death of another, so it’s always felt a bit awkward to me that “human rights” would be something that would be inherent just by the fact of existence, while every other life form would lack the same honor. Even animal rights activists that talk about natural rights that belong to both humans and sentient animals still rely on cherry-picking which forms of life deserve to be protected and which deserve to killed for that protection (in other words, the corn was once alive, too, and so was the bacteria on the corn, and so on). To me, we don’t all have an inherent “human right” to food, for instance, merely because that “food” requires death (and where’s its “right” to life?), unless we’re accepting that humans are somehow ascribed to be the privileged species on Earth. I do, however, believe that we have a “civil right” to food.

    So, I bring this point up not just for nit-picky reasons. My preference is to think of “civil rights” instead of “human rights” because that keeps the focus on the thing that can actually grant them–civil institutions. In other words, it’s a political orientation as opposed to a species one. It brings me back to believing that we are all creating the social forms that are making this reality possible. I think what ultimately creates change is advancement in civil policy, as least insofar as we exist in our current landscape of nation-states. So, thinking of a “civil rights” movement propels me to question the institutions that make all the -isms possible and functional, whereas thinking of a “human rights” movement leaves me feeling–though I certainly know this is no one’s intent who advocates for them–that humans are somehow the entitled species on this planet.

  • “This field is going to have to get past the idea that there will be a perfect pill for these disorders,” Insel says. What’s needed is a deeper understanding of the brain — the genes, the molecules, the circuits that go awry in some diseases, he writes October 10 in Science Translational Medicine. It’s much harder to fix something if you don’t know what’s going wrong.”

    Oh boy.

  • Thank you for this insightful, dots-connecting, well-articulated piece of writing.

    Today at Starbucks, I picked up a gingerbread cookie to read the ingredients. There he was, smiling happily. Frosty joy. There were at least twenty ingredients, many of which I cannot pronounce; he must be a constipated gingerbread man.

    It’s amazing – and entirely alarming – what goes into our bodies. Mine has begun a process of fighting back, against itself, and it seems the more people I talk to about this, the more I meet who are experiencing the same. No doubt that digestive health fuels so-called mental health. I’m hoping that its corollary – digestive illness fuels so-called mental illness – will start to be a part of the conversation.

  • Hey Richard,

    These are good thoughts, thank you. I pretty much agree with you. My initial response came on a day of staring too long at things I hardly understood!

    I’m mostly a believer in the scientific method. I do think, however, that people can be ideologically rigid about the efficacy of science in proving ultimate reality. I think form matters, sometimes as much as content: i.e. “The Medium Is The Message.” I believe the form of scientific studies lacks something imperative. You’re right that good science writers can bring emotion to it, but still, there’s this assumption in data that the truth lay bare. “Numbers Don’t Lie.” But they do!

    Also, I want to underscore what I mean by this statement: “The stuff is important, but only because the bad guys have used it as gunpowder, so we have to flank ‘em.” I don’t believe there’s an inherent need to understand the mind scientifically, and certainly not it’s so-called health. While I want to give this a little more thought, my first reaction is that literature, dance, movement, sex, taste, aggression, flow, dreams – all of these are better suited towards understanding the mind. The call of crows outside my window in the morning, and my observation of them: I feel like that captures the mind in a way that coefficients simply cannot. So, alas, I think we only need to acquaint ourself with the scientific literature because it’s a prized tool in our society – thus it has power – and unfortunately, it has often been used against us. But I don’t think that means it is ultimately valid. It’s just some people will listen more to charts than chirps.

  • Hey Laura,

    Thank you. And I’m glad as well to be connecting with you and others around here. I’ve been in my local cave; it’s nice to peek out again.

    “I sometimes find myself in moments of intense self-doubt, wondering whether I can trust my gut and my thoughts, or whether maybe, just maybe, I’m really at root just a self-destructive, self-sabotaging, less-than person with a deep-seated “death wish”

    Yes, the imprints of psychology run deep. I was thinking last night about how a lot of psychology posits everything as a deficit against perfection, which then creates the illusion of endless growth (kind of like Capitalism with its GDP). Measured against that, one is always inadequate.

    God, I’m so sorry you had to do the ink test, and that people interpreted your experiences as “death wish” and the like. So much interpretation!

  • Hey Richard,

    Thank you. Yes, real science is good. But man, there’s still something about it that is so isolating. I’ve been revisiting some scientific literature lately, and it just reads like concrete. All those words and numbers and symbols and processes and charts, all in black and white. No color! The stuff is important, but only because the bad guys have used it as gunpowder, so we have to flank ’em. But after a day staring at that shit, I have to flush my head in the toilet and hang upside down like a bat all night to ensure blood flow.

  • Thank you, Anonymous.

    I’m actually still angry about that Grof/Kornfield incident, even though it happened 4 or 5 years ago. I hope my anger at it never turns to forgiveness (like all those pretty models predict), for it keeps me aflame.

  • Hi Emily,

    We’re going to start our development with cues from the original Soteria and build from there. Yes, there will be lots of good alternative books, good food, things to do, creative tools to pick up, people to connect with, plants to grow, and so on.

    I don’t know if anyone will be given chores or schedules. That can be a bit of the ol’ medical model if one is not careful. I think we want to learn from folks as much as we hope to impart. I see Soteria-VT as a mutually learning project with folks who come there. The original Soteria would “start from scratch” with each new person, and I hope to keep to that here. We want to try and soften down any models or approaches inherent in the programming, and by that, I mean, to remain creatively doubtful that we know all the right answers.

    As for blogging again, perhaps. I’m blog-naive at this point in my life. Other work I’ve done if you’re interested can be found here: http://www.vermontrecovery.com/writings.html

  • Agreed!

    This: “They stamp their prejudices all over their brain scans, couch their ‘findings’ in impenetrable, polysyllabic terms, and expect us all to prostrate ourselves at their hallowed feet.”

    When I first started reading the science of psychiatry, I was completely lost, particularly when referencing neuroscience. It’s amazing to me how distant the language of so-called mental illness feels. It’s hard to think carefully on something that one cannot pronounce.

  • These are great thoughts.

    I do want to note that I don’t discount the possibility that behavior can hypothetically be correlated to biology in a 1 – 1 perfect manner (though good luck to those trying to make such maps!) But alas, I’m not sure that tells us anything important. It’s like saying the Mona Lisa has a faint smile because the pixels of paint that make it up are slightly slanted upwards. The most troublesome aspect to me of modern biopsychiatry is its disinterest in the abstractions and stories that compose a life.

  • Yes, I was reading Szasz when I first started composing this essay a couple of years ago. Hence the appropriated title!

    I don’t know how I feel about Szasz’s positions on incarceration and freedom, but I do know I agree with his analysis of mental illness as metaphor. It’s a shame his work is often dismissed.