Friday, November 27, 2020

Comments by David Ross, MEd, LPCC

Showing 473 of 473 comments.

  • Thanks Michael!

    I’m not sure why we’re bothering with these half-measures. Mandatory monitoring of ALL citizens is what’s needed. The “Citizen Safety and Tranquility Act” will soon require all of us to take our neuro-behavioral monitoring pill. Expect agents of the state to spot check all of us and read our “levels.” Any readings outside established norms will trigger an approved treatment algorithm designed to return the individual to pre-determined behavioral, emotional and cognitive functioning.

    Soylent Green is people my friends.

  • How could this be? Never in our history have more people been diagnosed with a “mental disorder” and prescribed psychotropic drugs. The drugs are given out like PEZ, diagnoses are available in under an hour and you know ‘Brave New Brain’ has been in print for over ten years. Anti-stigma campaigns are all the rage, along with white tee-shirts sporting black block print. I ask again, how could this be?

    Are we ready for a paradigm shift yet?

  • I’m sure you’re using hyperbole, but even so, let’s do it for 368th and 400th time if that what it takes to dispel the delusion! This is a primary belief in the NAMI curriculums taught to families and law enforcement officers via CIT trainings. My experience, like others, is that it continues to be a pervasive message needing rebuttal. I’m glad though that in your experience your not hearing it. Maybe progress is being made?

    Thanks for the book and your review Phil.

  • Yes exactly Jobos. As you can see from their qualifications at the end, it seems there’s all kinds of things that can influence volume of brain structures. I would add that these things are not static and interact with each other in ways we just don’t know. It doesn’t seem to stop them from giving the impression to the general public that they “know” something though.

    “Fourth, apart from disease-related biological factors, numerous confounding environmental factors can influence the volume of brain structures, including fetal hypoxia,50 nutritional and hydration status,51, 52, 53 exercise,54 medications,11 smoking,55 cannabis use,41 social isolation56 and the stress associated with severe mental illness.57”

  • I agree Someone Else – most of my discussions with “professionals” get stuck because they cite all the “credible research” that shows how safe, effective, good, etc. the drugs are. Or how convincing the brain imaging “research” is. Trying to have a conversation about the studies themselves, who conducted them, who funded, how were they conducted, etc. usually gets me no where. I appreciate MIA continuing to help us think critically about these supposed scientific studies. Bob’s latest book does this very well in my opinion as he writes about the various “guild” interests.

  • “My concern is how much of the society on drugs can any country sustain?”

    Unfortunately Jill I think we’re going to find out. I recently finished Bob’s latest book and there seems to be an intransigent ethic among those either directly/indirectly involved in the drug prescribing business. Looking forward to your next post

  • Richard, I don’t agree with your characterization but I get your point. We disagree on this one. I haven’t seen the problems you cite or are cited in the NY Times piece. The MAT program we have utilizing the Drug Suboxone has been useful for many (but not all) of the individual’s in the program by their report. Again, this is a MAT program which means the drugs aren’t given if the treatment isn’t occurring. And the goal is a two-year taper. This is different from a Methadone maintenance program or poorly run MAT program which do exist. I’m all about getting “upstream” and preventing the problem in the first place but give me some additional programs you’re aware of that are showing better results than MAT using Suboxone for persons currently trying to get off opioids.

  • Richard, I think they are part of the solution for some people. I think MAT is actually a good thing as it emphasizes that the drugs are secondary to the treatment, which is the way we’ve seen it work. Not everyone tapers off after two years and it is a difficult process but many do and report that there lives are better for the experience. Thanks for your thoughts.

  • Yes, I don’t think anyone responding is saying anything differently on that. My point is that there are MAT programs that are well run and the persons in them are reporting success in getting off all opiates (within 2 years) and back to living the life they want to live.

  • Jill,
    Thanks for this. I have to say, I’ve got a slightly different take on this. We’ve funded a M.A.T. program in our county for about 10 years now and have seen more advantages than disadvantages.

    To be clear, there are different ways to operationalize M.A.T. and some are horrible and I wouldn’t recommend. The reason I can agree with the M.A.T. label is that, done correctly, the medication (We use primarily Suboxone) is only given when the person is involved with treatment. From a very practical point of view the drug (Suboxone) allows the person to “not feel sick” and they’re able to participate in treatment, able to work, go to meetings, able to do any number of “socially necessary” things. This information comes from over a hundred client interviews. A successful program however has to have a great working relationship between the prescribing physician and drug/alcohol treatment team. This is something that is not always happening. We’ve not seen the issues you describe of complications with persons on the Suboxone but also abusing other substances (alcohol) though I don’t doubt that happens.

    In keeping with medication optimization principles, folks are started on the lowest effective dose (so they don’t feel “dope” sick) for the shortest amount of time. Most folks are titrated off by two years. Our county, like our State and other States is facing quite a problem with opiate abuse/dependence. M.A.T. is the most effective approach we’re aware of. It’s certainly not perfect and not everyone does well but we’ve yet to encounter a more effective option. If anyone knows of one – please suggest.

    We certainly need to do more on the prevention/education end of things. Getting rid of Pharma’s direct to consumer marketing might help. Teaching the benefits of pain, both physical and psychological, may be helpful so we’re all not so inclined to immediately suppress discomfort. Pain is after all a message sent by our bodies. Listening might not be such a bad idea.

  • Early Childhood Adversity (abuse, neglect, etc.) is a huge component largely overlooked but starting to get more attention.

    For me, the bigger question is replacing “ADHD” with any of the DSM labels.

    So, “How Should We Understand the Link Between “Schizophrenia” and Early Death?” “Bi-polar” “Depression” etc.

    And when will we see more and more studies showing the correlation between early use (5-6 years of age) of psychotropic drugs and premature death?

    Thanks for the piece Dr.

  • Phil – I’m a little confused. Are the author’s suggesting that “antipsychotics” have protective capacities? They extend life when compared to people who don’t take any drugs or take “too much.”

    Thanks,
    David

  • What was the suggested treatment for people being given psycho-stimulants like Adderall, Ritalin, Concerta, Vyvanse et ct ? I’ve a thought: Stop prescribing these brain damaging drugs! For those persons already affected by long-term use of these drugs perhaps the research will provide a way forward to lessen the damage wrought.

  • Registered,
    I understand what you’re saying but my comments were trying to take the argument back to Phil’s piece. Being able to “see” “real symptoms” is NOT the same as being able to see a virus. Since the predominate view is a medical/disease model of mental illness – Phil’s point is very important. That individuals experience real distress is not in question. What is in question is that psychiatric labels are real in the same way that medical diseases are real. I believe that was the author’s point.

  • This is great stuff and I encourage readers to check out Chapter 4 in David Levy’s book, ‘Tools of Critical Thinking: Metathoughts for Psychology, Second Edition’

    “To name something isn’t to explain it.”

    The Nominal Fallacy and Tautologous Reasoning has been and is the bedrock of the DSM endeavor.

    I can’t resist one last quote. “Words are so important to us that if we can find, formulate, or invent a special name for something, we easily fool ourselves into believing that we have explained it.”

  • Did you notice the asterisk at the end of the Pies piece?

    “*In my view, the Web site of “Mad in America” is particularly abusive toward psychiatrists, though it is far from the worst of the bunch. ”

    I think some MIA readers will take that as a challenge Dr. Pies! What do you mean we’re not the worst?

    I was interested in Pies’ comments about migraines and “painful tic” He says, “the history of medicine is replete with well-established diagnoses which, on their initial description, were of unknown etiology…” but eventually a “bona fide disease” is found. I think that’s a pretty accurate view of many of the professionals I speak with. They genuinely believe a “disease” exists but our science is just not sophisticated enough yet to provide the objective measures to “settle the matter.”

    In the other piece, the ending asterisk talks about Dr. Robert E. Kendell and the notion that “disease” should be seen as a “global characteristic” Wow! Not sure how that would be helpful for anyone to be seen as a “diseased person” versus having a “diseased brain.” I mean they’re both really bad terms but a using disease to refer to the “living human person”?? No bueno my friends.

  • The drug will indeed impact you. As has been pointed out to you before but you were dismissive, if you were to adjust the dose to your weight you would indeed feel the same drug effect your child does. The chemical imbalance theory has been disproven for many years now. These drugs are NOT correcting any imbalance in your child they are actually creating a brain imbalance (brain damage) that he may never recover from. Let’s hope and pray you keep him off these brain disabling drugs and the brain has enough plasticity to recover from what was done.

  • I think your responses, and there are many, are very instructive. For you, and by extension your child, ADHD is real and what you’re doing is “right” You’re just not persuadable at this point of any other view. If any of those organizations had actually proven the existence of ADHD I’d agree with you but they haven’t. They’ve agreed that people who act in a particular kind of way should be given a particular label and particular drugs. They can’t point to a blood test, an MRI or other imaging test (pre drug of course) to verify the existence of this so-called disease. I feel bad for you because you’ve been so misled by Pharma, Psychiatry, Schools, and who knows else and it’s your child who will pay the ultimate price for your decision. I know this probably isn’t penetrating but I’m obligated to try!

  • Check it out for yourself but many would say your son is in fact “hyper stimulated” but that stimulation is not expressed externally (through observable behaviors) but internally (in the brain). The brain is so overly stimulated only very limited affect and functioning is possible – judged by teachers and parents as “better” The brain is actually incapacitated to some extent by the stimulant.

  • I’m still waiting for the reports showing the increased mortality rates of persons started on psychiatric drugs as children. There are several studies examining adults dying on-average 20-30 years earlier. What kind of future should a 10 year old expect when started on drugs like these? Will he/she even see their 30th birthday? I’m sure the FDA knows best.

  • So what are we to make of this? Are they both right? Both wrong? One right one wrong? Some other variant? If seems to me that there’s no “bullet proof” study. There’s always someone, usually someone who has a different opinion, who presents arguments of why the study or study conclusions are flawed in some way. It leaves us scratching our heads saying, “what can we believe?”

  • I do appreciate the debate but I think it’s hard for Allen to be objective about the APA and his contribution to the mess we’re in. The DSM IV was his baby and he’s acknowledged that it “created” several “epidemics” including ADHD, Autism and Bipolar.

    I do agree with him about the direct to consumer marketing piece. Bob mentions that it would be a good “first step.” I think it would be much more than that and would love to see it happen. It’s hard to over-estimate the impact on “the story of mental illness in the US” these commercials, articles, billboards, etc. have.

  • Ron,
    Appreciate your perspective. I’m wondering if we would be better off to explore alternative drugs to replace the so-called anti-psychotics? In the same way I would imagine we are exploring alternatives to chemotherapy drugs. Can the “benefits” some people receive be achieved by a last harmful drug? Or, can they be achieved by a non-drug option?

    David

  • Thanks for putting this into words because Phil’s articles hit me the same way. His writing style is concise and clear and he exposes the word games being played.

    But the drugs work…

    Is the clarion call of so many. In what way do they work? For whom do they work? At what cost do they work?

    Good stuff Dr. Hickey.

    David

  • Hmm. SSRIs block the reuptake of serotonin leading to increased amounts of the neurotransmitter in the cleft. How they do that is a little more involved and outside my expertise! Again this gets back to the theory that an individual is somehow lacking enough serotonin so if they introduce a drug to disrupt the way the brain is working producing an increased amount of serotonin…well you’re just all better!

    Except…that’s not what happens for many many people. As to your other question, in my opinion these dangerous drugs shouldn’t be given to adults let alone children with developing brains.

  • I’m not a psychiatrist Someone Else so this may be way off – but I think from the quote you cited that the theory was there was too much serotonin present so they were trying to create a serotonin blocker (antagonist). Seroquel is a serotonin antagonist and Risperdal is what they call an inverse agonist for serotonin which apparently means it binds to the same receptor as an agonist but produces the opposite response as an agonist (quasi-Antagonist). This last bit is above my pay grade!

  • Thanks for this piece and for what you’re doing Sandra.

    I also work “in the field” and am faced daily with the challenges of how to make large and substantive changes in a system without alienating those that you need to work with to bring about the change. It’s taxing stuff but people’s lives are on the line so it’s worth it.

    Best,
    David

  • Both these ladies are powerful speakers!

    Thanks for your kind words and I’m encouraged that you also have a local conference that is making a difference. It takes time to change a culture, even at a local level, but if we’re persistent, I think there’s a real possibility for lasting reform.

    For me, one of the real strengths of MIA is and can be the connecting of like-minded people in this country and around the world. We learn from each other, support and encourage each other and have each others back when necessary!

    Thanks again for your efforts,
    David

  • I think Bob hit this one on the head. Nancy was THE authority in the so-called ‘Decade of the Brain” her books, The Broken Brain and Brave New Brain were pointed to as “evidence” of the biological underpinnings of so-called mental illness. Her acknowledgement, however grudging, that the drugs cause brain shrinkage (aka Damage) is a big deal because of pedestal she’s been raised to by those espousing the bio-reducio-absurdum view.
    D

  • Compare, “I am saying it is founded on a wrong appreciation of the nature of things.” with “It remains a very useful book for other purposes.” And you get some appreciation of this “transitional” time that we’re in.

    Like Insel’s statement of a couple months ago, we see again the equivocation that is going on within the field. The first statement can’t be readily harmonized with the second. Because if the first is correct the second is not. “Other things” is not defined and a bit misleading. The DSM has a stated purpose, namely the identification and classification of so-called mental disorders, so if it’s foundational assumptions are wrong (as I believe them to be) it isn’t “very useful” by definition.

    Insel said very much the same thing but was forced in to equivocating by saying we should keep using the DSM even though it’s not valid because there’s “nothing better” out there.

    As we move through this transitional period I look forward to less equivocation and more honesty.

  • Michael,
    Great piece.

    I’ve been in many meetings trying to stop involuntary outpatient commitment legislation in Ohio and when I mention utilizing the approach you write about, the scoffing and dismissiveness is palpable.

    Those pushing for IOC can’t or won’t find it in their hearts that being kind, gentle, caring and patient with another human being is, in itself, therapeutic. You see, to them, that’s too simple and therefore too simplistic to be considered as an intervention.

    For many, a prejudice exists towards those they/others label as “mentally ill” They perceive these labeled people to be potentially violent, lacking the will/ability to “get better” without the use of coercive measures. They embrace the use of tranquilizing drugs because the person can be reduced to a semi-conscious state (That’s how IOC is perceived as “working” in the NY Times piece).

    This is a difficult debate and I know it’s going on across the States and elsewhere. Thanks again for reminding us and others that the solution need be no more complicated than treating our fellow humans humanely.

    -David

  • Thanks so much Jennifer!

    I don’t want this to get lost in all the discussions about the need for moderation. But what just happened between Jennifer and I is incredibly important (IMO). She has good resources that people in our county desperately need and thru MIA we were able to connect and hopefully bring those resources (in this case Family Education) to our town. This IS part of how things change.

    My hope is that NAMI ‘Family to Family’ curriculum’s will be replaced, phased out, eliminated by alternatives like what Jennifer describes all over the country.

    If we can start to change the basic assumptions of the conversations we can see real change. Thanks again Matt, Kermit and Bob for MIA.

    D

  • Jennifer,
    We are looking for something exactly like this to support family/friends. Our Board (funder) would likely make funding available if it’s consistent with our mission, vision, values.

    Is there any way I can review a summary of the content for each lesson? While I’m fairly sure we would agree with the information, it’s something I’m going to have to do before making a recommendation to our Board. Please contact me [email protected] if this is possible.

    Our need came about because we were not at all satisfied with the NAMI ‘Family to Family’ curriculum. We offered to work to change the information to be more accurate but our offers were not accepted. I’m not sure local NAMI chapters have the latitude to change key portions of the curriculum.

    If we can move forward on this and start with the next cycle in September, I’d be more than happy to do a report out via my blog on how things went in Ashland County.

    Thanks Jennifer,
    David

  • Thanks for posting. Not too many comments yet, maybe everyone at MIA gets this and I wouldn’t be at all surprised.

    Unfortunately, this runs contrary to the mainstream myth of the benefits of stimulant drugs. They’ve longed been thought of as “study drugs” or “focusing pills” and parents, teachers, etc. have been bombarded with these “truths”

    When constructing a “Pluses” and “Minuses” chart for deciding whether to start these drugs or start your child/ren on these drugs, I hope parents and others will see that the “Minuses” column far outweighs the “Pluses” column. For additional information on this topic see the ‘Related Posts’ section above.

    David

  • I’ve watched two of the Szasz You Tube videos and found them to be very interesting. I haven’t noticed any insults other than when a psychiatrist tried to make a point about Szasz and scientology. I know these things get edited and if you were actually there Joanna, I would defer to you.

    Besides that, Szasz is really very coherent and the questions from the audience are great! Some of my favorite quotes:
    “First you have to abolish slavery and then you work on freedom.”

    “We don’t have cancer laws!” In response to the existence of mental health laws.

    “If you don’t inform yourself, you’re a dead duck!”

    “Careful decision maker in a free society”

    “It’s word magic!”

    Welcome back Joanna!

  • Thanks for this idea Matt. I should have remembered Jacqui’s blog of some months ago. I re-read her piece and the responses. It generated a pretty lively debate. There may still be some benefit of another piece.

    Couldn’t help but read the recent (today) WSJ article on Stimulant drugs and academic performance. I know this one can generate a blog!

    WSJ Piece: http://online.wsj.com/article/SB10001424127887323368704578593660384362292.html

  • Last night on The Learning Channel (TLC) part of Discovery Network, there were two one-hour programs on “Born Schizophrenic.”

    It chronicles the life of a five year old child diagnosed with Schizophrenia, her parents and sibling.

    I could not watch the entire program. It was just too disturbing to me. I point this out because the Discovery Network is very well known and I’m sure many will have seen or will see this program.

    In the context of this discussion, how do we dialogue with the people in this story? The parents, children, physicians, etc.?

    This will NOT be an easy thing.

    Link to the program:
    http://health.discovery.com/tv-shows/psych-week/videos/born-schizophrenic-janis-world.htm

  • Stephen,
    I like what you’re saying but I’m not sure whose doing it this way? Can you point me to some systems/states/counties where people in the system but not of the system are helping others in the system? Are these helpers volunteering their time, energy and efforts or is someone paying them? Is this model faith based and/or affiliated with so-called Peer Centers?

    Thanks,
    David

  • Thanks for the links. I was very vigilant in casting my vote and actually saw my printed ballot to ensure my vote was cast correctly. There did appear to be some…let’s call them irregularities in some precincts. Sigh.

    There are 88 counties in Ohio and the vast majority voted for Romney. However, the 12 or so that went for Obama were the most populous and that’s what carried the day.

    D

  • You’re absolutely right, talk therapy is far cheaper than drugs in the short term and long term. Insurance companies would do well to consider that before approving life long courses of drugs for invalid (according to Insel)diagnoses. Especially in light of all the evidence we have that alternatives (talk therapies, nutrition, exercise, etc.) are just if not more effective and again much cheaper. Now it’s important to note that many people might believe results from talk therapy take too long as compared to the drug effects they realize rather quickly. I think that’s a legitimate observation. I would like to think with good and accurate information, most would choose talk over drugs but that won’t be true for everyone.

    D

  • Thanks for your comments above dbunker, you are on a roll! Good stuff. I am definitely NOT a doctor. My LPCC credential is just the nomenclature Ohio uses to denote an independently licensed clinical counselor.

    I’ll talk to Duane about throwing “chum” in the water!
    😉

    David

  • Jonah,
    Thanks for your thoughts and your queries about 1) the psych meds and 2)lack of counseling. These are not easily answered. I can tell you that Nouthetic Counseling is not a proponent of psych drugs. Here’s a brief piece by Adams on the issue:

    “The use of psychotropic drugs, on the other hand, inhibits the body from functioning as it should. It is that use of medicine that we deplore. Mood changing drugs affect a person in such a way that the benefits of pain and other unpleasant feelings are not realized. Discomfort was designed to call attention to some underlying problem (organic or non-organic) so that it might be dealt with. One would hardly want to desensitize the nerve endings on his fingers because he has found that touching a hot stove hurts. If he did, the first he would know of the fact that he was resting his fingers there would be when he smells meat cooking! To desensitize these nerves, in the long run, would cause serious damage to the body. As an alerting system and warning device, then, pain is a friend. We do not believe in masking such pain by drugs.”

    In short, Adams doesn’t buy the chemical imbalance myth but what he does buy is actual organic conditions if they exist (i.e. brain damage).

    Your second query is a tougher one to answer and I won’t pretend to be able to answer it fully or completely. I can only add that people don’t seek counseling for all kinds of reasons. Cost, time commitment, don’t think it helps, bad experiences (personally or family/friends), stigma, culture, etc.

    I think the church can do a far better job of counseling their own members and STOP sending them out to secular authorities. Jay’s group and others are trying to help churches do this and train up counselors within the church to handle the increased numbers of people receiving counseling.

    If you have time, check out some of Dr. Adams’ writings under the “Resources” tab.

    Best,
    David

  • Thanks Duane. I hear you about not throwing the baby out with the bathwater. I’m no fan of drugs. You’ve read enough of my comments to know that. Unfortunately, counseling approaches based on say a moral relativistic philosophy can do harm, IMO, just a different kind of harm than drugs.

    All the best,
    David

  • Duane,
    No space to answer above. Yes, to answer your question, but it depends. It depends on the beliefs/assumptions undergirding the counseling approach. I’m a firm believer in Nouthetic Counseling, for instance, because I believe in the foundational beliefs behind it.
    http://www.nouthetic.org/about-ins/what-is-nouthetic-counseling

    I can’t say the say for other psychotherapies (Behavioral approaches, Rogerian, Psychodynamic, REBT, etc.)

    Feel free to contact me thru my email if you have additional questions on this.
    Thanks Duane,
    David

  • “Ross, Psychology itself is Humanism”

    Bingo!!

    Beliefs undergird any “ology” or “ism” and the belief structures undergirding psychology have led us to where we are today. I would argue that, given those beliefs, we couldn’t have arrived anywhere else.

    Change, real change, involves a change in beliefs and this is far easier said than done. That’s why It’s more likely for help to come from outside the current paradigm from other disciplines rather than from within.

    Good stuff dbunker.

  • Quote from the story: http://news.yahoo.com/tiny-electric-current-makes-others-look-better-111523142–abc-news-tech.html

    “It’s worth noting, however, that the experiment also demonstrates just how vulnerable the human brain is to seemingly trivial external forces. Two milliamps is practically nothing, yet it produced a measurable effect. So it doesn’t take much to make a difference.

    “Very small imbalances in your brain chemistry, which is related to brain electrical activities, can cause big problems,” Crib said.”

    Which is why drug based “solutions” are so incredibly dangerous. We know so little about the incredibly complex brain. I continue to call for humbleness, caution and care. “Helping” may be hurting as Nijinsky so eloquently said.

    D

  • Oh that Brand is funny! At the 5:30 mark he says, “Thank you for your casual objectification. I’m glad that it’s positive for you.”

    This is a great example of a brilliant comedian being on the show with a bunch of asses. They have no reference for Brand. In their groping to come to terms with what is so foreign, Brand pokes fun and, in my opinion, is very clever. “Lose the ring Mika, its doing nothing for you” That’s precious.

    I love when creative genius meets average (Joe).

  • Movies and Metaphors are a favorite of mine and as we’ve discussed before, Avatar is chock full of them.

    The Red Dragon is a ripe one! I like the concept of Jake and the Dragon so much because it’s a mutual process of acceptance. Jake needs to work within his abilities to “capture” the Dragon but ultimately it’s up to the Dragon to “allow” itself to be tamed. And at a very basic level both understand this. It’s in this understanding by Jake that he takes another step forward in understanding this very different culture.

    I didn’t know if you’ve returned from Thailand or not, but reading some of your other comments it looks like you have. I hope your visit there was helpful and meaningful for you. Also, don’t know if you’ve noticed but there seems to be a growing contingent of Aussie’s on MIA! I think that’s great.

    Best,
    David

  • I appreciated your interviews Barry. You presented the evidence for your point of view convincingly. It’s nice to read your perspective on the gathering as well as Bob’s.

    I’m heartened that you believe your group was “heard” and that, generally, there was agreement “that the child cannot be reduced to a biological description and that love, family, culture, and spirituality were key elements in any therapeutic approach.”

    Also, thanks for posting the presentations.

    Best,
    David

  • I agree with that Duane!

    I think what I appreciate most, both in those interviews and this written piece is Dr. Moncrieff’s communication style. It is clear, even though discussing complex issues. It avoids excessive “jargon” that typically confounds rather than clarifies. It’s reasonable, measured and fact based.

    I appreciate the post and your ongoing efforts Dr. Moncrieff. You’ve said for years that these drugs are not harmless substances. They produce drug effects (because they’re drugs!) and some of those drug effects will be perceived by individuals to be advantageous while others will experience drug effects that are life-threatening and harmful. Informed consent has been discussed quite a bit on this site and that means being honest about what these drugs actually do, not what some wish or want them to do.

    D

  • I too thank you and the other speakers for all your efforts. I think the absolute collapse of the chemical imbalance myth has shown some of the drug proponents for who they really are. Proponents of drugs. Period.

    I think many believe that we, as a species, are “better” on drugs. Sure we may not know exactly why yet, but the answer is just around the corner. Will the drugs produce undesirable effects as well as desirable effects? Sure, but you have to take the good with the bad no? It’s a kind of willful blindness Bob. They “have” to believe that we can be better under the influence. We can’t possibly negotiate all the richness and challenge that life affords clean and sober.

    No, the un-medicated life is not worth living.

    D

  • Batesy,
    I also enjoyed the Avatar meaning. I’ve been meaning to ask you if you had a chance to watch/read the book entitled “Cloud Atlas” While the critics were lukewarm, I absolutely loved both the book and movie, though for different reasons. I think you would enjoy either if you haven’t had a chance to read/watch them yet.

    David

  • Clip 2 includes an interview with Barry Duncan who introduced an interesting concept that might appeal to many of us here at MIA. Barry found the Vatican’s involvement in this effort of pushing back against the drugging of children so important because the church has the power to “push back” against the efforts of Big Pharma. Many blogs and comments have focused on this point. It’s a big challenge to go up against Big Pharma with an alternative message since they have, for all practical purposes, a limitless funding and dissemination stream for their point of view. Mr. Duncan see’s the church as one institution that, if it adopts similar views as those espoused on MIA, could effectively be a foil to the drug industry.

    Interesting idea.

  • It’s nice hearing from you Batesy! I hope all is well with you and your family.

    Your question is a good one and I have to say, unfortunately, no mainstream TV (NBC, CBS, ABC, Fox, CNN, MSNBC)or print (NY Times, USA Today, Wash Post, Wall Street Journal) that I’ve seen. There’s plenty of coverage from secondary sources. Maybe it’s forthcoming?

    I’m relying on MIA for posting the live streams which I appreciate very much.

    All the best David,
    D

  • Thanks for posting. This is just one piece confirming what many at MIA were saying months and months ago. This was an inevitable result of the DSM 5 and, sadly, it’s only the beginning.

    I’m curious to read from our international friends, is off-label prescribing legal in your countries? Do physicians get this dangerous latitude in prescribing medications for conditions that the medication has not been approved for?

    D

  • Seth,
    I’ve appreciated the opportunity Bob Whitaker has given me to blog and anticipate at MIA. I want to respect Matthew’s direction to us and have an avenue to continue our discussions if you’re interested. My alternative email is [email protected] and I’m willing to continue our discussion outside MIA. I value your perspective, it’s different than mine, but that doesn’t mean we can’t learn from each other.

    Thanks,
    David

  • Seth,
    I do appreciate your acknowledgement of the “redneck” remark. I can tell you that it is very offensive to those it’s used to denote.

    I don’t want to quibble, but it bothers me that you continue to claim that I called you “anti-Christian” in my original comment. I’ve read my comment several times and I don’t get where I said that and I know that wasn’t my intent. I was asking you to be sensitive to Christians with differing views, not to imply you weren’t a Christian but to say that not all Christians agree on doctrine. I think that’s pretty clear in my statement and would love it if you could point to where I said that or said anything about your political views, your ethnicity, etc. Your original outburst was, I think you will agree, a bit much. I would like to get to the discussion piece, which is far more interesting.

    I know many Lutherans, Baptists, Presbyterians that hold with the biblical view of radical corruption, which is a consequence of original sin and the fall.

    You asked for sites so I would direct you to the Lutheran Church – Missouri Synod. They have a fairly exhaustive history at: http://www.lcms.org/page.aspx?pid=415

    One of the more well-known Baptist preachers who hold to the biblical view (note, not Augustinian view as Augustine, in the reform faith tradition, was nearly interpreting scripture faithfully not “creating” new scripture)of original sin and the fall is John MacArthur at Grace to You: http://www.gty.org/

    Another in the Presbyterian line would be the PCA or Presbyterian Church in America. There site with a listing of doctrinal beliefs and history can be found here: http://www.pcanet.org/

    There are several reformed church organizations this is just one: http://www.prca.org/prc.html And of course a myriad of independent churches.

    R.C. Sproul is an easy read and has a nice concise piece here: http://www.the-highway.com/fall_Sproul.html on original sin.

    Now, I listed these sites with their corresponding history and beliefs for your perusal but I’m not sure where that gets us?? I don’t think MIA is the place for doctrinal debates and, let’s be honest, you really think I could change your point of view or you could change mine? You’ve said you come from a more liberal Christian perspective, I come from a more conservative one. Don’t you think that’s fine for the sake of discussion on MIA? I’m not here to convert anyone, nor make claims on one view being “better” than another. I’m just asking for a bit more care when describing other faith traditions including those at MIA with no faith tradition. This has been my point from the beginning.

    Now, in addition to all that, the point you made about Freud, his avowed atheism and the notion that he replaced religion with Psychiatry. That’s absolutely correct in my view and a critical point. Many churches have been trying to take back the arena of counseling from the so-called professionals ever since. There was immense pressure for the church to let the “experts” handle things when problems of life, and yes, “sin” were re-cast as “mental illness.” Now brace yourself cause I know this is radical stuff, there is quite a lot of effort to return to what is called nouthetic or biblical counseling. Jay Adams is probably someone you know who’s spearheaded this movement with his book ‘Competent to Council’ back in 1970. A great website for more information can be found at: http://www.nouthetic.org/

    Now I imagine you won’t agree with a lot of what’s said, but I’m trying to raise awareness of alternatives out there that fit for many folks.
    Thanks again for your response.
    Best,
    David

  • Seth,
    That is my point, I, as well as others, have a differing view of Christianity than you. It’s not about having a “better” position as you suggest. Many believe that the Augustinian position is a correct and orthodox position as it’s consistent with scripture.This has been carried forward by Luther, Calvin, Edwards, et ct and can be found, most notably, in our current Protestant Reformed faith and among other denominations.

    I made an argument for not calling people “rednecks” who have a differing view than you on religion. You’ve yet to address that or apologize as far as I can tell. If you aren’t willing to even consider that your statement was, at minimum, insensitive how can we have an honest discussion?

  • Donna,
    I appreciate your comments. I disagree with them however.
    I too don’t want to get into a lengthy discussion on biblical interpretation but when the Bible was talking about the Sun moving around the Earth it was using phenomenological language. This has been understood from the beginning.

    I never made any of the claims of having the “sole” truth. You’ve made this up! You claim I’m “glib” regarding misogny? Where on earth do you get the right to make such false accusations? Wow. I guess I need to stop as this is NOT a productive discussion.

  • Duane,
    I do agree with you and I think many of us do want many of the same things when it comes to psychiatry, the care of others, etc.

    I’m also hoping that MIA can be a respectful place where differing views on faith can be respected. This site is NOT about religion but it comes up often both in blogs and in comments.

    Again, I’ve commented on what I thought were insenstive remarks and while I don’t expect everyone to agree with me, I feel I have the right to make my voice heard on this.

    Broad statement of “facts” about religious faith traditions is always going to be a tricky thing, I think it best to try to avoid them if possible. For example, Catholics belive this or Christians believe that are problemattic due to variations of traditions within those two broad religious faiths.

    I didn’t think my original request was too extreme. I’m a little surprised by the responses.

  • Your charge of “defensiveness” is simply not true and I can only guess you say this as a tactic to try to keep me or anyone from stating a differing views? I asked for increased sensitiviy regarding making statements about others faith traditions. That’s not “defensive” nor is it “disrespectful”. If you take the time to re-read the comments made I think you may see that they very well could be offensive to those with differing views. By saying I’m “disruptive” when I ask for sensitivity begs the question on who is trying to suppress who here.

  • Your charge of “defensiveness” is simply not true and I can only guess you say this as a tactic to try to keep me or anyone from stating a differing views? I asked for increased sensitiviy regarding making statements about others faith traditions. That’s not “defensive” nor is it “disrespectful”. If you take the time to re-read the comments made I think you may see that they very well could be offensive to those with differing views. By saying I’m “disruptive” when I ask for sensitivity begs the question on who is trying to suppress who here.

  • You state that the Adam and Eve story of the bible is a myth and most “educated” people know that. Well I do consider myself “educated” and, along with many, don’t view the Adam and Eve narrative as “myth”

    I find this whole section rather offensive:
    “I have done some research on the Bible and not too many take every word of the Bible literally today since studies have exposed a lot of it as far less than the “word of God” for sure including lots of tailoring by later Christians especially in the N.T. Of course, people hypocritically cherry pick when they want to attack gays, but never mention the parts that advocate handing over daughters to be raped in the O.T., etc.”

    Millions do in fact believe that what is in the bible is in fact the inspired word of God. They don’t believe that it has been “tailored” So an attack on the truthfulness of scripture is attack on the character of God. That some people “cherry pick” scripture or misinterpret scriptures meaning can’t be challenged, but that in no way negates the truthfulness of scripture accurately interpreted. I’m not sure what point you’re trying to make with Lot and his daughters? When the angels came to Sodom? Surely, Lot’s behavior regarding his daughters and offering them up to the crowd is sinful. Are you making the point that the bible says it wasn’t?

    I’m not too sure how “dirty tricks of the Patriarchy” and “misogynist Church fathers” would be interpreted by our Catholic friends, or how it contributes to further conversation on the subject.

    I didn’t notice your response to an earlier comment of mine. Thanks for that and I did notice your apology awhile back but thought we were “done” with that thread. Nope, not harboring any resentment on this end.

    I guess I’ll end in a similar way to what I said to Nijinsky. I’m not sure you realize it, but when you make sweeping statements about what you believe to be true of Christianity or any faith tradition, you have to understand that there’s bound to be people who disagree with your statements and may see them as so far from the truth that they amount to being offensive. Again, I’m just asking for a bit more sensitivity when it comes to differing faith traditions on MIA. I need to do better myself so please don’t think I’m exempting myself from this. I can do better and should do better in responding to those with different beliefs than my own.

  • Nijinsky, I just disagree. I think what you’ve just written is extremely disrespectful, because millions don’t believe it to be true. When you characterize any religion falsely, as I believe you’ve done, and make false claims about it’s teachings, you disrespect that faith tradition.

    My original objection to some of what Seth/Donna were saying was it wasn’t very respectful of those with other beliefs (so-called fundamental Christians in this instance).

    I’m asking that the atmosphere at MIA be more tolerate of all religious faiths, including those with orthodox or fundamental beliefs and for those with no beliefs whatsoever.

    I ask you to re-read your comments to see if there’s a possibility that they could give offense. I’ve reported several of the comments made on this thread and await the results.

  • Seth/Donna,
    I would ask that both of you review your recent comments as they relate to Christians and Christianity. I don’t know if it was your intent or not, but the language and tone you use is disparaging in my opinion. There are Christians on MIA like myself who are just as passionate about eliminating/reforming a broken and dangerous system as you are. I just ask for a bit of reflection. Thanks.

  • I appreciate your response Joanna. Therein lies some of the challenges of MIA (in my opinion). We have very passionate people on different sides of these issues. Allowing for all these disparate points of view to exist here in a respectfull way is to be commended. But what then is our message? Is it a message of the majority (tier 1)? A message of the minority (tier 2)? A message that all messages are equal in their “messageness”(tier X)?

    No, we don’ have anymore Guinness! Damn holidays.

  • By that logic:
    -Some people have found detainment with forced treatment helpful;
    -Some people have found ECT helpful;
    -Some people have neuroleptic cocktails helpful;
    -Some people have found Psychiatry helpful;
    -Some people have found (fill in the blank) helpful

    If all truths are equally valid, what are we promoting at MIA? Are we pushing one version of the truth at the expense of others? Are we rightly critized for being arrogant, narrow-minded and intolerant? And if all truth is true aren’t we guilty of intellectuall dishonesty?

    Back to grill my brats are burning!

    D

  • I can’t deny that there are a core group of folks that seem to spend a LOT of time on MIA! We need to embrace our addiction. You know, DSM 5 actually lists “Caffeine Withdrawal” as an illness… can “MIA Withdrawal” be too far behind? When is that DSM 6 coming out?

  • Thanks for posting. In a way this goes back to what Szasz was arguing. He actually wanted to stick to established definitions of words so that a concept, like mental, couldn’t rightly be said to be “Ill” or “Sick” since concepts aren’t actual things.

    Simalarly, when pressed to explain why human distress is determined to be disease/illness, proponents have to fall back on this distinction or re-definitional view. Distress by definition isn’t disease or illness although distress may accompany these.

    This is a foundational assumption. One’s view on whether human distress is a normal part of the lived experience or something that should be viewed as illness or disease will shape your arguments and points of view for this entire debate.

  • “Argh!” Could mean so many things 😉

    I’ve not written a blog on my efforts in Ohio around this issues as yet. Primarily because most people I talk to about it look at my funny and what to know what I county I work for again. That’s why I was so excited about your comment. Anytime I run across someone else who “gets it” on this topic, I feel affirmed!

    I think time, will help in being successful in Ohio and hopefully in other states. We just continue to try to educate the community about the impacts on recovery of approaches including drugs vs. not. The one and only Courtenay Harding has agreed to speak at a regional conference we host this year. Her work on the Vermont Longitudinal Study is a classic and will hopefully persuade some folks.

    The implementation of the Affordable Care Act might also offer a chance to speak directly to managed care entities in way we’ve never had before.

    I’ll certainly try to keep everyone posted on my successes and failures as I try to learn from both!

    Thanks,
    David

  • “My question is how do we convince the insurance companies that demanding that people be on medication is actually more expensive to their bottom line or is this a useless endeavor?”

    That’s exactly right AA, exactly right! I’ve been trying to make this point in Ohio for some time now. In Ohio and other States there is a treatmet model de jur called “Health Homes” Jack Carney has blogged on this here at MIA.

    Health Homes are designed to treat both “mental illnesses” and primary care issues (real illnesses) at the same time by the same team of staff. What’s driving this model, in many states, is the desire to bring down costs (both mental health and primary health) for persons diagnosed with “severe mental illnesses.” For many, the primary health problems are the RESULT of psychiatric drug interventions. The weight gain, lethargy, amotivation, tardive dys, etc. All the drug effects mentioned quickly at the end of those adverts on TV.

    So we’ve created a whole new approach to dealing with an issue, without really dealing with the issue. Now that’s madness!

    Insurance companies and other payors should be a receptive audience to the messages of MIA. Stop using/paying for “illnesess” based on an invalid classification method (DSM); stopy paying for interventions (Drugs) that will cause long-term outcomes to be far worse (and expensive) than non-drug interventions (which are far cheaper in the long-term).

    Best,
    D

  • What a refreshing article!
    Thanks for the link cannotsay.

    They don’t even mention Insel’s admission but this initiative will gain further validation (ha!) with the curtain rising on the fallacy that is the DSM process.

    Interesting times.

  • Similar to how the original PAMI/NAMI groups became co-opted by Pharma/Psychiatry, I do see the trend towards using the word “Recovery” as an entree to mischief by those not really interested in a person’s well being. Those that do this are sly and many of the consumer/survivors are vulnerable which makes this practice particularly distasteful.

  • I think the fact that Insel is the current Director of such a high profile governmental agency makes this a possibility. Typically, expert witnesses get called by both sides to negate each other, but he is a unique voice. Maybe the defense will call Biederman! Just joking.

    You may have read/heard the story recently of the IRS admitting that they unfairly targeted “tea party” organizations for audit during the last election cycle. When these complaints were originally made, everyone laughed and called the complainers conspiracy nuts and “Preppers”

    Moments of honesty from our Government anymore seem to be few and far between. I know Insel has another angle, he definitely wants to continue to pursue a diagnostic system with biological assumptions of so-called illnesses in view.

    Maybe we need someone like Jim Gottstein, or another attorney to weigh in cannotsay. I believe a case could be made that the assessment tool relied upon to render a diagnosis has been shown to be invalid therefore negating the diagnosis and any subsequent action taken because of the diagnosis. I’m not sure though. I like the idea of “hijacking” or working within existing systems to change/dismantle them. I get a chance to do that daily!

  • Again, we have to ask, how are these drugs getting through the FDA? To be fair, the FDA Director from 2000-2007 had concerns about the drug being prescribed “off-label” to children, but that raises another issue. How is it that the FDA can balance their stance of: You can’t market the drug off label, but you’re within your rights as a physician to prescribe it off-label?

    Why do we allow physicians to give these drugs to children when the FDA has not approved them for this use in this population? A drug is dangerous enough AFTER getting approved by the FDA. Using it off-label increases the danger exponentially.

  • White elephant and pseudo concern are spot on!

    When I read the story for the first story I was sure someone else had been fooled by The Onion. But more and more outlets starting reprinting the story and then I started hearing it on television/radio outlets.

    How many more Rebecca Riley stories need to happen for the FDA to recall these dangerous drugs?

  • I guess I have a slightly different take than 1boring.
    I don’t think it’s been clearly said, prior to the Insel blog that someone at Insel’s level of leadership views the DSM as not valid (meaning not true, untrue, false, off the mark, inaccurate). It may have been said in cloistered meetings but the general public and “system” were largely unaware.

    Second, I have to wonder about the collusion of the APA and NIMH when Insel makes this announcement so close to the DSM 5 launch. Is his announcement likely to increase or decrease sales? It’s one of the APA’s top money makers, so the timely doesn’t seem ideal if massive sales are in view.

    Finally, Insel doesn’t claim the new direction of classification will be ready for use anytime some. A decade or more for practical applications. I’ve read another account (NY Times) where Insel walks back his initial comments by saying the DSM system (even though it’s not valid) is the best we have and we should keep using it until something better comes along. I found that very disappointing if not surprising. How can we say the best we have is something that isn’t valid? How can untruth be the best we can do? Don’t we all deserve better?

  • Nice piece, it includes some related links to stories also worth reading. Thanks for posting.

    While many others have been making the same assertions for years, I wonder if Insel’s admission will “tip the scales” towards more widespread acknowledgement that we have a problem regarding so called mental illnesses.

    It’s important to note that the DSM is not a-theoretical (regardless of claims to the contrary). By saying the DSM is not valid, it also implies that the theory/theories underpinning the DSM are not valid and further, the assumptions underpinning the theory/theories are not valid. Again this has been said for many many years. If you start with mistaken assumptions you’re most likely going to end with a mess. The computer expression, “garbage in, garbage out” comes to mind.

    Fascinating development.

  • Looks like Kermit posted this response in the news section and folks are commenting there.

    The response doesn’t really disagree with Insel’s assertion that the DSM is not valid. In fact, the response seems to confirm reliability but not validity which is what Insel stated.

    Dr. Insel has, using his blog postings, over the last year or so declared that the chemical balance theory is far too simplistic and shouldn’t be used anymore. And now says the DSM is not valid. That’s quite a year for Dr. Insel!

    There is no replacement for DSM because reductionistic biomedical conceptulizations will never capture the complexity and wonder that is the human brain. Any so-called replacement from the “establishment” will most likely be lacking. I’m incredibly curious to see what, if any alternatives, will be proposed in light of Insel’s declaration.

  • Official APA Response to Insel’s announcement:

    : FOR IMMEDIATE RELEASE
    Erin Connors, 703-907-8562 May 3, 2013
    [email protected]

    Tamara Moore, 202-745-5114
    [email protected]

    Statement by David Kupfer, MD
    Chair of DSM-5 Task Force Discusses Future of Mental Health Research

    The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

    This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.
    – A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.
    – Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.
    – Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.
    – A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.

    DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

    Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

  • Official Response to Insel from the APA:

    FOR IMMEDIATE RELEASE
    Erin Connors, 703-907 8562 May 3, 2013
    [email protected]

    Tamara Moore, 202-745-5114
    [email protected]

    Statement by David Kupfer, MD
    Chair of DSM-5 Task Force Discusses Future of Mental Health Research

    The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

    This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.
    – A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.
    – Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.
    – Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.
    – A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.

    DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

    Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

  • I agree Duane. I commented on the original news post on MIA but maybe more commenting is necessary.

    Drawing from Wiki, let us tease out a bit more what Dr. Insel about the DSM not being Valid. Why does the DSM’s lack of Validity matter? What is Validity anyway?
    Validity:

    “In science and statistics, validity is the extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world. The word “valid” is derived from the Latin validus, meaning strong. The validity of a measurement tool (for example, a test in education) is considered to be the degree to which the tool measures what it claims to measure.

    In clinical fields, the assessment of validity of a diagnosis and various diagnostic tests are extremely important. As diagnosis augments treatments, medications, and the patient’s life, it is extremely important to know that when running diagnostic tests that clinicians are truly testing what they intend to test.

    It is generally accepted that the concept of scientific validity addresses the nature of reality and as such is an epistemological and philosophical issue as well as a question of measurement. The use of the term in logic is narrower, relating to the truth of inferences made from premises.

    Validity is important because it can help determine what types of tests to use, and help to make sure researchers are using methods that are not only ethical, and cost-effective, but also a method that truly measures the idea or construct in question.”

    Wiki also supplies a nice graphic for those, like me, who enjoy a visual. Remember, Dr. Insel stated that while the DSM has reliability (consistency) it lacks validity. So when you look at the diagram below (not sure if will show up here), you will see that the DSM quite literally “misses the mark”.

    The admission by Dr. Insel can’t be understated in my opinion. He’s lifted the curtain and exposed the sham underpinnings of our so-called mental health system. I do wonder and worry about what might rush in to fill the vacuum. Will something else fill the vacuum with this admission? Is this not the opportunity folks at MIA, Mindfreedom, NEC and others have been waiting for? A chance to say, “There’s a better way. A more human, caring way.”

  • “RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning.”

    Now this poses an interesting question.

    Dr. Insel has acknowledged our current system of diagnosis is not valid, but a presumbably more valid (or precise) system is a decade or more in the future.

    So what does that mean for the current practice of diagnosing and treating so-called mental illness? Should people continue to do something that isn’t valid just because a valid alternative doesn’t exist yet? Why should insurance companies pay for treatment based on diagnoses that the nation’s Top Doc has declared fradulent?

    Pandora meet Dr. Insel.

  • “Wouldn’t you love to see the Pope – on Prime Time – condemn the practice of elevating Atheism to a degree course in Medicine?”

    That’s well said and in my opinion true. The Church (generally — always some exceptions) has progressively abdicated its role and responsibilities as it pertains to problems of living over the last 100 years. Counseling the flock on the challenges of living a Christian life has always been the purview of the Church and, for the members of their congregation, an incredible help. Telling members of the congregation that the Church can’t help with their problems anymore and directing them to the atheism of Psychiatry is…well, not good.

    Time will tell the impact of this meeting, but I like that a discussion is happening.

  • I appreciate your thoughts Darby, I think I wasn’t clear since there are two threads by different bloggers about basically the same issue. I’d like to see the SSI/SSDI process change, because you can’t get the disability benefits without the diagnosis piece. That diagnosis, is as you say, based on mental/emotional state, but without a DSM diagnosis AND evidence of mental/emotional states interfering, I’m not familiar with people being approved. Maybe they do, It’s just not been my experience with the attorney’s and judges I’ve worked with. As an aside, your work in Ohio continues to be built upon. Trauma Informed Care is becoming much more prominent in our State. Thanks for that!!

  • My understanding is that the definition is as you say, “physical (read medical) problem.” I’m open to hearing from others on this as well, but it would be news to me if another view, like a social model, were in view when disability is determined. After the fact, because the person has a disability (medical problem) they’re also a “protected class” legally and can’t be discriminated against.

  • I’m with you Sera, but, as you say, if you’re not recovering because you were never ill, you were just dealing with the problems of living like everyone else. And if you’re not “ill” or in recovery for “illness” than in our current system, you’re not eligible for certain governmental “assistance” like Social Security and Medicaid. All this to get to the challenge of so-called mental illnesses being grounds for disability. Bob talks about the astonishing rise of persons diagnosed as mentally ill receiving Social Security/Medicaid benefits. Don’t get me wrong, I’m happy to get rid of the idea of normal human distress as illness but I’m not sure how that plays out in our current society. If Bob’s stats are accurate, changing the conceptualization of mental illness to normal human distress would make millions ineligible for their current assistance. How would their needs be met and by whom? Thanks for the post.

  • I think this is an important piece Al. Your clarity regarding the assumptions we make shaping what happens afterwards is critical and often overlooked. Whatever one’s orientation to helping someone else, it’s important to understand: 1) What they believe about the nature of life struggles/distress 2) What they believe about their role in helping others to be and 3) What they believe about how to help others.

    There’s been a fair amount of discussion of moving away from using the term “Mental Illnesses” and replacing it with some variation of “Brain Disease” or “Brain Disorder” I’m curious to see how that works. How many of our current DSM diagnoses would survive if Neurologists applied the same diagnostic criteria as they do to Parkinson’s or Syphilis?

    A construct like “mental” can never be actually seen, measured, examined. Therefore it remains a blank canvas for the powerful to invent/create “diseases” (see forthcoming DSM). A brain however can be seen, measured and examined, however, as you caution, faulty assumptions about what the brain is seen to be doing (assumptions) can be harmful.

  • This may have been mentioned already Sandy, but your conclusions are very consistent with the Medication Optimization principles established in Oregon a couple years ago:
    http://www.femhc.org/Portals/2/Foundation%20Documents/Medication_optimization_in_the_service_of_recovery.pdf

    For me, the constant refrain when trying to work with prescribers is, what can they do instead? If not drugs, than what? Advocating with physicians without a well thought out alternative strategy, ends in frustration all around. I believe many physicians are eager to hear about alternatives because they aren’t comfortable prescribing these drugs, but what are they? An effective/immediate referral process for these alternatives from the physicians offices to something else is typically required to get “buy in.”

    D

  • Good catch mcoma, I forgot the number of the bill changed when the new session started. S.B. 43 is the current bill in Ohio. My understanding is that there have been some hearings but little else. I’ve been in contact with a gentleman from Disability Rights Ohio and their organization is trying to push back on this really bad idea. FAQ sheet here:
    http://www.disabilityrightsohio.org/news/disability-rights-ohio-creates-faq-senate-bill-43

    I’ve been able to provide them with several articles (e.g., Lancet piece)because of the passion of people at MIA. Jack Carney has done particularly good work in this area.

    Best,
    David

  • Thanks for this.
    I’ve been following this issue for some time and the early Lancet publication seems to be persuasive but some folks will still deny its conclusions. Senate Bill 350 in Ohio continues to be debated and information like this is helpful in trying to defeat the legislation.

    D

  • “The molecular and cellular underpinnings of psychiatric disorders remain unknown; there is broad disillusionment with the animal models used for decades to predict therapeutic efficacy; psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials”

    Yep.

    Interesting new “Click to Edit” feature!

  • To Jonah’s point above (a good one), one of the many many advantages of not pathologizing normal human suffering and distress is that it broadens the base of who can be a “helper.”

    Since all of us experience varying degrees of suffering/distress, we all have some capacity, if we choose to develop and use it, to help others.

    It seems to me we will always have need of “real doctors” to ensure that real biological conditions are not the cause of a persons distress or suffering. The Wall Street Journal did a piece on this a couple years ago: http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html

    So how do communities begin to develop a capacity to help others who are experiencing suffering and distress? Should basic guidance like eCPR be taught more widely? Probably. Can we have community education on becoming “trauma-informed?” Should we set up support groups like Mother Bear? http://www.motherbearcan.org/index.php/aboutmbcan-1.html
    You bet.

    There are many discussions on MIA that help outline how we might all collectively move forward to develop caring communities of people, not “professionals.”

    David

  • “For myself, I no longer grant a psychiatrist the authority to define me nor alter my consciousness with powerful dependency forming psychotropic drugs.”

    Thanks for this Emily, it reinforces a point I’ve been trying to make, to limited success, for some time now. No doubt you had someone/s in your life that were supportive of you and cared about you. Being empowered to make decisions about your own life has to be a cornerstone to health no?

    Best,
    D

  • Belinda,
    Lot’s of good stuff here. My only clarification is regarding Supported Employment. I’ve seen this in practice and it makes a huge difference. The way you describe it though isn’t Supported Employment (SE). The goal of SE is competitive employment, so-called regular work just like everyone else, NOT sheltered workshop settings. If folks are saying they’re doing SE and placing people in sheltered workshops doing piece rate work, they’re not doing SE. Having met the pioneer of this model, I can tell you he views SE as an alternative to medications. If more people were involved in meaningful activity, there would be far less need for meds or counseling or “the system”

    Some of the other psychosocial approaches can be helpful to many but they have to done in a context of recovery, informed consent, an appreciation of trauma, culture, etc. Supported Education for example can help those who want to either finish high school or go on to college or develop a trade. This can be just want some people are looking for.

    Thanks,
    D

  • I appreciate that Altostrata. We’re tracking percent reduction of scripts written pre/post education and offering an on-site referral. While I hope for 100% reduction, every script NOT written may be saving a life.

  • AA,
    I think these are good thoughts.

    I wanted to say your take on the primary care physician piece and their comments ring true here in Ohio. We’re not calling it an anti primary care doctor movement ( it does have ring to it 😉 ) but what we are doing at least in our local county is a concerted effort to get into primary care physicians offices, especially pediatricians, to do some basic education and encourage them to refer people out to non-drug based help rather than starting them on medications. Most of the primary care doc’s don’t feel comfortable anyway with prescribing but they have to respond to the person in front of them, so we’re trying to give them better options.

  • Thanks for sharing your story Mary Anne. I hope that you find much support, encouragement and information here at MIA. I think the community that’s forming has a lot to offer.

    All the best.
    D

  • Alexa,
    If only the States took the opportunity you describe.
    For Ohio, Sequester will mean about a reduction of $668,000 in Mental Health funding and $3.4 million in drug/alcohol funding. Most of this will get “absorbed” at the State level. They will not fill positions and stop projects that haven’t already started, etc. We’re not expecting any reductions in services this State Fiscal Year, maybe a bit next year. I’m not sure who are State officials consulted on what to cut versus what to invest in. As you say, we need to invest in recovery and less “treatment as usual.”

  • This is a great story Lyn and one, in my current professional capacity, I have the great good fortune of seeing on a regular basis. Your conclusion is absolutely correct. The historic models of stabilization, take your meds (be med compliant!), go to your groups is not only costly in the fiscal sense it robs people of their lives. Our current approach to working with persons with emotional distress must be scrapped and replaced with recovery focused, trauma-informed approaches that stress meaningful activity (for many this includes competitive employment). Thanks again for sharing!

  • One of the scariest articles ever posted on MIA. While there is some acknowledgement of problems, it reads as if the new DSM will just throw more fuel on an already raging fire. Of course the fire is consuming people we all love and care about.

  • “By the way, I’m not a woman.” Priceless.

    I remember the first time I read a Cledwyn comment, I literally sat up in my chair and said, “Now this person has command of the Queen’s English!”

    I continue to be impressed by your literary style, your substance and passion for what you write.

    Best,
    David

  • Donna, no I’m absolutely NOT saying anyone doesn’t have the right to feel the way they do. I did not say nor intend to imply that. I don’t seem to be communicating my point very well. I’m not saying people don’t have a right to feel something, I’m saying we should feel empowered to know that we can manage our own feelings. I’m sure you would agree that feeling as if someone else has total control over your emotions would NOT be a pleasant thing. If our emotions are held captive by another we’re all in real trouble no? Hope you reconsider with the clarification I have given.

  • You make some great points Donna and I agree with most if not all. I must not have been clear. I think each human being has a capacity and a responsibility to manage, as best they can, their own emotions. That’s of course made extremely challenging in some of the instances you describe in your response. No argument. But I don’t think you’re suggesting that the goal shouldn’t be to gain as much management as is possible, regardless of part/current trauma of one’s emotions. Correct? I was responding to a blanket statment that people were “made” to feel a certain way. Hope that helps and I appreciate your thoughts.

  • I’m very grateful for MIA’s continued postings of news/blogs on this subject. We’re still in a fight in Ohio to curtail this abuse and I know several other States struggling with the same/similar issue. Information like this helps to “make the case” for improved services and/or improved conceptualizations of helping persons experiencing emotional distress.

    Info on the fight in Ohio against I.O.C. can be found here:
    http://www.disabilityrightsohio.org/news/disability-rights-ohio-creates-faq-senate-bill-43

  • Thanks for this Szasz link cannotsay.
    At about the 31 minute point, Dr. Szasz makes a good point, one of many, that may have some bearing here. With the emergence of “Right to Treatment” there has come this belief by the State that it has a right to use coercion and violate your civil liberties. Szasz makes the point that this is due, in part, because we’re not talking about voluntary contracts between two people where money is exchanged for goods and services. So, if we insist on a “Right to Treatment” and the person doesn’t have the ability to pay for that treatment thru a voluntary contract, the State seems more than happy to treat, but under its own terms which include coercion. So how do we go about reforming this when there are many individuals who just can’t afford “treatment” via private contracts? Some States have piloted programs when State subsidy funding are giving to individuals for treatment “of their own choice” But these projects always have stipulations that prevent true freedom of choice. It’s a thorny but important topic.

  • I think you have a great point here Poet. Concordance (agreement) seems a fine term to be used between two equals who have agreed to something. So, in this case, if the physician and person involved with services agree that medication is something worth trying, what’s the best way to describe that, after beginning the medication, the person is taking the medication as directed? Surely we can do better than ‘compliance’

  • This is a nice, concise summary Bob.
    Two years of talks? It’s hard to believe it’s been that long but our next Ohio RSVP Conference is coming up in Sept. You spoke there two years ago and the buzzing hasn’t stopped.

    Medication Optimization principles, an increased wariness in industry funded publications/studies and a push for alternative responses to persons struggling with emotional distress are all ongoing efforts kickstarted by your visit.

    More ideas are in the hopper to get the “MIA Brand”in every State and, why not, across the pond.

    So when’s the next book coming out? 😉

    D

  • I don’t find the information you’ve shared to be “vital to many people” but you may be correct. I think the information I’ve shared is vital to many people as well, but I don’t expect you share in that view.

    I don’t believe the orthodox Christian faith is abusive. Certainly there have been abuses of power within churches of all different faith traditions over time. This is a reflection of the sinful people who make up the church, not the sinless God we worship.

    “…made to feel” is an interesting topic if you’re willing to discuss it further. I would argue that the individual has the power and responsibility to manage their own feelings, as best they can, and that a belief that their feelings aren’t their own or can be controlled by others through words, actions, behavior, etc. can lead to all kinds of issues. I’m open to differnt views on this, yours included.

  • I enjoyed this story! It’s not that far from reality is it? That’s what makes it so funny and sad. The folks at the Onion are pretty good at this kind of thing and have “fooled” many main stream news outlets over the years. They recognize the need for many to believe in a certain narrative. They construct this narrative, push it to its limits and see what happens.

  • I wish there was a way to discuss religion and faith on MIA Duane that could be useful, but I just don’t see how it’s possible. The forum just doesn’t seem to lend itself to this extremely important topic. The exchange we’ve had here is another example. Jinks has beliefs which may be 180 degrees different than my own. We’re both entitled to them but the chance of “common ground” is not likely. So both Jinks, you and I are all non-comformists in the sense we will not conform to truths that we believe are falsehoods. We refuse to accept authority from those not worthy of it. All hail the non-conformists and anti-authoritarians!

  • N- you’ve articulated your beliefs and I’m sure you would allow me and the millions like me to have our own, different beliefs. Regenerate/Unregenerate are biblical terms. They differentiate between those whom the Holy Spirit has changed their nature and whose nature has not yet been changed. These is no similarity to that concept in the way Mr. Levine’s article uses the term. I don’t feel the need to challenge the statements you set forward other than to say, you don’t have an understanding of orthodox Christianity (which is fine) and this isn’t the forum to engage in education on that subject. I’m always amused that people don’t think the Lord judges. Yes, he judges and he judges with eternal verdicts. The gospel is translated from “good news” because it shows the way to escape God’s judgement. Sinful man is absolutely desparate to believe in a God who doesn’t judge, but Christians should never be complicit in agreeing with that lie. God judges.

  • I think you’ve raised very good points Nathan and Darby as well. One thing Cindy mentioned that I notice regularly is the subject of reimbursement rates.

    -A decision is reached that certain “services” or “interventions” are preferred more than others.

    -Reimbursement rates are then established to make providing the approved services/interventions more advantageous to the provider (note, this has nothing to do with what the person in distress might desire!) and less preferred services/interventions less advantageous.

    For example, if the reimbursement rate for one hour of counseling was the same as or greater than one hour of psychiatric, what would happen? What if peer support was valued at the same rate as counseling? As psychiatry?

    Reimbursement rates create a business model that predominately poorer individuals can’t escape.

  • Million of Christians don’t share your “Satan myth” myth. Lucifer, before the fall, was light in the sense that he reflected the glory and majesty of God. But, for those with different, including no, faith traditions, this all seems silly. And it should. How often did Jesus say, “For those with ears to hear, let them hear.” This was code for, some of you who’s natures have been changed will understand what I’m saying, but for those who remain unregenerate, this is nonsense.

    Great piece by Bruce as always.

  • I work in a rural system and the numbers cited above are typical. I’ve never, ever heard/read of a physician being paid $70 an hour. I just can’t understand that assertion. I guess come to Ohio!

  • Yes, the regress here leads us back to termination of the pregnancy or, better yet, the forced sterilization of high-risk breeders. This hateful language/attitude has been documented in Robert’s book, ‘Mad in America.’ Many readers will be surprised to read that eugenics was first an American idea and several States passed forced sterilization laws. These laws were repealed after WWII but this had less to do with a shift in attitude towards the “mentally defective” and more to do with the horror/outrage of the concentration camps.
    I share the authors concern with the increase in so-called mental health prevention efforts. We’ve seen how the DSM 5 will make “early diagnosis” easier. Many of you have seen/read the reactions in the media and elsewhere after Sandyhook, “If we could just have gotten to them sooner…”
    The day may come where we’re encouraged to start taking our meds before trying to have a baby. Surely, we can combine our contraceptives with psychotropics for a more efficient delivery system.

    *This response contains some sarcasm.

  • Maria,
    I like the graphics so much I would like to use them. Are they copyrighted? Is there a process to use them as part of Suicide Prevention activities here in the States?

    Thanks for all you do,
    David

  • I believe this observation to be true Duane. I’ve been asked in my professional role to write/comment on MIA so I’m not at liberty to engage as I’d like with some of these issues (religion and politics, what else!). I think it is fair to say that a bit more tolerance for those in the groups you list with the beliefs you mention are in order but I’m probably skating too close to my limits. You’re not alone. Best,
    David

  • We tend to agree on things Duane, but I admit I’m a big fan of Charles, especially in his role on the “Special Report with Brett Baier” show.

    He’s by far the most interesting and knowledgable “talking head” around. He also encorporates a bit of humor in his comments which I appreciate. I think we should give Charles and all media the appropriate amount of respect and credibility. When I do that, I find them more humorous than frightening. It’s those that don’t think critically about what they read, see and hear that scare the hell out of me!

  • I’m so glad you mentioned so-called early detection Morias. That concept is indeed gaining more and more traction here in the States. The new DSM V will certainly provide “support” for this damaging idea, thru its introduction of “pre-psychosis, pre-depression, and pre-dementia” This shift will effectively get us all and get us while we are young. I have to admit, some days I’m less hopeful than others. I do appreciate Bob, MIA and all the participants here. Still, I have to wonder if we’re going to make a difference in the face of massive forces arrayed against the changes we’re advocating for. Pessimistically optimistic? That just might be right!

  • I agree with a lot of what you write here Morias. Let me give you a real and current situation in Ohio. The governor has proposed increasing Medicaid coverage to 138% of poverty. This is not a position embraced by most members of his party. Many of the governors public statements about why it’s a good idea to expand the coverage is to include people with “mental illness” who would otherwise be a threat to society. I’m afraid that some go the “mentally ill people are violent and dangerous” whenever they’re looking for cover for risky decisions.

  • Not being a neurologist, let me ask: Are the mechanisms of action between certain psych drugs and violence clearly established? If so, what are they and how were they established?

    There seems to be more and more reporting of the relationship (causal? or correlational?) between these drugs and violence and as a non-medical person, I’m just curious of what the mechanism is and where I can read about it. Thanks.

  • This is great news! I’m glad I mis-understood earlier. I will pursue what is necessary for our State to secure Medicaid/Medicare waviers of this type. I know this already happend in the DD system, but a diagnosis is necessary to be eligibile. That’s where I’m curious, if they don’t use Diagnosis to determine who is eligible for the waiver they must be using…what? Hospitalizations? So-called “functioning” Incarcerations? I’ll let you know what I find out. Thanks again for your time.

  • “there’s just no free lunch with medication treatment.” Almost as catchy as “luscious lipids” but certainly as true.

    Let me stretch medication to mean drugs and suggest this is one of THE central discussion points of our time. Introducing drugs into the human body, any drug, produces effects. Have we become so careless as to overlook the negative effects for the “positive” effects? Is life so unbearable that the benefits outweigh the risks? Can we be just a bit more careful and cautious when using drugs? Just a little? Can we be a bit more skeptical that by “adding Abilify” things will finally get better?

    Thanks for the post.

  • Thanks for your response above Amy. I appreciate your efforts. I should have been more specific in my first response but it looks like Jack picked up on what I left out. Medicaid, Medicare and Private Insurance. Those are the plans I’d like to see abandon the DSM, ICD, DC-03R, etc. Local levy or foundation funding gives us great flexibility but if those big three above ever changed their stance on coding it would be a significant.
    Thanks again,
    David

  • Amy,
    Tell me more. I couldn’t find anything online about the service-based billing system you mention. Some of us in Ohio have been wanting something like this. Typically, Managed Care entities have insisted on Diagnoses as a way to gauge the level of benefit they will pay for. If a diagnosis isn’t used, what would be their basis in authorizing services? What type, for how long, etc. I’m very interested in this so I hope you respond.
    Thanks,
    David

  • You’re passionate Maria and boy do we all need that in this struggle. Thanks for distilling this down and, I’m not surprised, we agree. The organic causes you mention in addition to substance use, including things like lead poisoning, have to be ruled out before considering other possibilities. Beacuse, as you say, Neurologists, real doctors, know that there are a myriad of organic conditions that mimic so-called psychiatric symptoms. I also agree that I haven’t personally seen/heard Bob spend a lot of time on this aspect. Thanks again for sharing

  • Maria,
    I appreciate the time and effort you put into your responses. Unfortunately, you’ve said so many things I can’t possibly respond adequately to even half of them! I don’t know how to proceed without unintentionally giving offense. Most of what you say I agree with. I read the interview you referenced and found no inconsistencies with what Bob has stated elsewhere. I personally agreed with his statements. Scientology is just one very prominent organization that has been demonized by mainstream psychiatry and Pharma. There are many others who speak truth and are minimized, ignored, etc.
    I like the different views on MIA. I don’t find it confusing that there are so many different messages and points of view being expressed. I think people are just very individual and our searches for ways to help each other are very individualized. There is no monolithic “WAY” to solve the current mess we are in in my opinion.
    I boil down a lot of what Bob espouses to a simple fact: The benefits of psychiatric medications have been grossly exaggerated and the risks greatly minimized. In a nutshell, I think that’s what Bob and many others are saying. What to do next is difficult, exciting and confusing. I hope you keep posting as your point of view is one of many I find helpful as we try to create a caring response to those experiencing distress.

  • Maria,
    Thanks for responding. Dr. Torrey’s review had a lot of information in it, not just the quote you provided. Bob did a lengthy rebuttal on his blog here. Surely you agree that some of what Torrey said was viewed as factually correct while other portions were not correct? I think we all celebrate truth, so to the extent Torrey’s review was truthful, great! It’s not an all or nothing proposition. I’m not sure how to approach your last statement. You assert Bob IS inconsistent and can provider “many examples.” I feel the need to defer to Bob, Kermit or whomever to decide whether this is the proper forum to dialougue about Maria’s assertions. Maybe if you gave just one example of how he is inconsistent, we can start there?

  • We often talk about the need for good withdrawal protocols for these drugs but Dr. Gupta’s comments make me wonder about induction protocols as well. These drugs aren’t benign, otherwise our bodies wouldn’t go through the compensatory responses in an effort to maintain homeostasis. There seem to be challenges with starting, stopping and maintaining over long periods of time which begs the question, “Is it best not to start at all?

    Thanks for posting this.

  • I’m not a Whitaker apologist, but I do consider him a friend. You seem to be insinuating he’s not consistent or sincere in what he’s been saying and we should all watch/listen to him closely for heretical behaviors.

    I’ve had the discussion about shortened life expectancies with Bob and heard him discuss it with others. He’s outraged that mainstream media and systems of so-called care don’t take this data seriously. Bob is also tracking studies that show the shortened life spans for those beginning these drugs at younger ages, 4, 5, 6 years old. He’s not happy or making “jokes” about that either.

    I think you must have misunderstood the context of his comments because I can’t imagine Bob ever making a joke about the ravages of long-term psychiatric drugs.

    Of course Bob is mortal and makes mistakes so someone has to stand behind him and whisper “Memento mori” lest all this acclaim go to his head! I guess that’s you Maria so thanks too.

  • While this two-part summary has been useful, I would encourage readers to reference the full report. There are so many important points made. If you are currently working in the “community mental health system” I would encourage and challenge you to bring this survey up in your next clinical staff meeting or individual/group supervision meeting for discussion.

    This survey is not inconsistent with the Smith & Glass meta-analysis of 36 years ago (Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist,32,752-760). An individual’s expectations when coming in for help and the characteristics of the person(s) in the position of helping are far more important than counseling theory/technique. The great news, well at least from one point of view, is that years and years of formal training are not necessary to be an effective helper to someone experiencing distress/problems of life.

    When I look at the survey, I don’t see too many services/interventions requiring an MD, PhD, or Master’s Degree with independent licensure. We all have the capacity to be an effective support/help to someone else. We always have had. It has taken a truckload of money and messaging to convince so many that that is not the case anymore.

  • Your voice has been a welcome one Sandra. I’m glad to read that you’ve benefited from your association with MIA. We’ve benefited from your insight, passion and honesty.

    Happy New Year!

  • “ Do you think schizophrenics or bipolars can recover and wean themselves off anti-psychotics.”

    This question you pose is very important. I can confirm that when I ask it of professionals, I most often get the answer you describe, which has lead me, and the folks I work with to do more. After asking this question of so-called professionals, so-called consumers, teachers/educators, members of the general public, other social serving organizations and the faith community we then need to follow up with more accurate information. We know this is going to take some time in our small community but we feel like it has to be done. So many people are laboring under a false/untrue conceptualization of problems of living/emotional-behavioral distress. Thanks for your thoughts Seth.
    D

  • Good stuff Faith. We cannot underestimate the influence of media. I’d like to think it works in multiple ways. Meaning, if we have what we would deem “positive, hopeful information” about the mental/emotional distress all people experience that that would get equal coverage. We’re not there though. We can only keep trying.

  • “Why send messages of hopelessness when they are so often untrue?”

    Why indeed. Cui bono? Who benefits from these messages of hopelessness? The person hearing the message? Seems unlikely in most cases. The person delivering the message? Intentionally or not, we have to acknowledge the “job security” of telling someone they will require our services…for the rest of their life! Does the pharmaceutical industry, APA and other groups benefit? I think we know the answer. How about the broader culture? Does the broader culture somehow benefit from knowing that those who act “differently” can be identified/labeled and “treated” for life?

    I think the results of the survey also speak to the incredible resiliency of survivors. In the face of multiple messages designed to influence them, they don’t buy it. People recover in spite of the help they receive. What would happen if we actually gave them what they wanted?! Shock. Horror.

  • I’m always amused by those internet “tests” that, regardless of your score, indicate physician follow-up. The only difference is how fast you’re told to run to their office! You’ve rightly discovered the money behind the exercise which explains things. That physicians offices get paid by how many of these “assessments” they can get patients to complete was a new, and disturbing, wrinkle to me.

    Nice piece. Pithy.

  • I think Ron has hit on something here. At least in the States, many would agree with Ron that if extreme states of distress or less extreme states aren’t framed as “illness” or “medical” than many will not be involved in “helping” Of course a lot of that help isn’t helpful, but there will be more of a “pull yourself up by your bootstraps” mentality if distress is successfully reframed as not/non-medical, not an illness. Interesting point Ron.

  • Jack,
    Thanks for this two-part series. As I’ve commented before, we face a similar struggle in Ohio where NAMI, with support from TAC (Torreyites) are seeking to expand existing IOC laws in the State. There’s been a good deal of pushback from a variety of groups and for that I’m grateful. It’s an ongoing struggle as you know and we need to remain vigilent. I’m not sure how to convince the general public that experiencing strong emotions isn’t a “disease” and doesn’t render you incapable of making decisions for yourself, even decisions that, with the aid of hindsight, you wouldn’t necessarily make again. To think that during any of your bouts with a down or depressed mood, someone should have stepped in the make decisions for you, afterall you were experiencing strong emotions! Who knows what you could have done. I don’t know how we do it. We seem to be living in a society that increasingly frowns upon strong emotions.

  • I’ve noticed the same thing as Emily, that the general public has been far more receptive to recovery, reducing/eliminating drugs, the idea of trauma and that “labeling” is not helpful.

    This was great perspective Corinna. Many don’t get a chance to run in the same circles you do so thanks for sharing what happens at “these places”!

    David

  • I do Athena! I really enjoy the different “voices” on MIA. Cledwyn’s is certainly unique. Of course my own personality and preferences factor in here, but I just really enjoy his comments, insights and above all the humor. As someone who values humor, I appreciate that we can seriously discuss difficult issues without being devoid of mirth. Life without laughter seems a pretty incomplete thing to me. Thanks for commenting Athena.

  • “The concept of anosognosia performs the dual function of circumventing the obdurate psychiatric heretic and camouflaging the sheer injustice of psychiatric coercion and violence.”

    Your talents are being wasted on this site if I’m the only one who notes this brilliant statement.

    An artist must have an audience.

  • From a slightly different perspective, take heart Bob. If Torrey weren’t attacking you, Sandy and MIA we would know we weren’t doing enough to speak up and challenge the status quo.

    You should take it as a compliment that he feels so threatened about what you’ve written and said and what’s going on at MIA that he lashes out in such an emotional and irresponsible way.

    Before I write anything, I consider my “W.W.T.S” bracelet. What Would Torrey Say? If I think he will start to froth, I know I’m on the right track!

  • Sorry I wasn’t more clear. The “risk” or “trick” has to do what jeopardizing our State funding. We just need to be mindful not to do that, while still promoting reform efforts. For example, in most states Medicaid will pay for “Psychiatric Services” that service is typically conceptualized as the providing of psych meds for a DSM diagnosis. If we also include psychiatric drug tapering, and promote that we offer the tapering program, but still bill the same code, “Psychiatric Services” we should be able to survive an audit, but we’re “hijacking” services to fit reform efforts rather than how they were originally conceptualized. We don’t want to put our Board or our contract agencies at rist of a State/Federal audit, but we don’t want to put our residents at risk of dangerous drugs! Reforming a bureaucracy from the inside is challenging stuff, but we’re up for it in Ohio. Sorry I missed you at NARPA.

  • I appreciate the passion Emily! I work for a governmental agency responsible for providing a network of services to folks, regrettably, diagnosed with so-called mental illness and addictions. We have a Board structure of 18 persons who are ultimately responsible for making decisions, thus the mouse in my pocket. I say regrettably because I don’t find value in labeling of this sort.

    There is a bit of careful consideration needed because what we would be doing is creating a system that deters people from another system we’re supposed to be promoting. Also, we can’t treat everyone the same. We have to ensure that all options exist for folks after informed consent is provided. For example, we can’t refuse to offer psychiatric services.

    I think what you will see with Laura is someone trying to actually make a change in how we currently function as a system. I see her as kindred spirit in this regard. I think it’s important to note that change looks different and can come from different perspectives/directions. My focus is making changes at the level I work at and have some limited influence. Laura makes change where she’s at, et ct. We need everyone to push for the changes we’re talking about here at MIA for it to become reality.

    I understand that change does seem to take too long. It probably does. I feel like we’re doing a lot to make things better here in little old Ashland Ohio though. Thanks.

  • Laura, great piece.
    We’re considering a fairly risky and unorthodox approach that is consistent with your observations here. Simply put, we’re considering a network of “resource people” name not fully agreed upon, whose primary job would be to keep as many people out of the traditional community mental health system by linking them with other support systems/resources that are less harmful. It’s a prevention approach, where we’re preventing the harm caused by a broke system.

    As you might imagine the details of something like this are tricky and need thorough study, but we can’t just keep doing what we’ve always done and expect something different to happen. Preventing a DSM label, preventing harmful drug prescriptions, preventing disability due to a “mental illness” preventing the notion that “you can’t work” and “you have a chronic illness” seems like a good place to start!

  • Yes, I think we all agree on this. The point was just about the research, some research for some people that is suggesting irreversible damage due to these drugs. Just another bit of information to be included in the “informed consent” someone should receive before making a decision.

  • You’re absolutely right Alexa. And I’m planning to “lift” a bit of Dr. Steingard’s blog on anosognosia to do just as you suggest. Thanks for your thoughts, I’ll keep everyone posted. Legislators in Ohio are similar to around the country in that everyone seems to be waiting for the results of the November elections. Then, lame duck sessions start all over the place and that can be a dangerous time. Those senators/rep’s who are on the way out can sometimes be swayed to support issues they wouldn’t have if re-elected or if their party was still in power. What was that quote, “May you live in interesting times.”

  • I’m a bit uncomfortable stating the obvious, but you’ve read Whitaker and others and know that for some, there’s sometimes no complete return to the way things were, biologically, pre-drug. I hope that’s not your situation, but for many it is. These drugs can cause permanent damage. Very dangerous, thanks for sharing.

  • Alexa,
    It’s the latter. They’re misapplying the term “anosognosia” to give them cover to force treatment including medications, or else face incarceration. The current law does allow for IOC but it’s pretty restrictive. A so-called “high bar” has to be met in order for a judge to order it. Their clarification would significantly lower that bar to further deprive people of their civil liberties. We simply can’t incarcerate people because we feel uncomfortable around them.

  • Thanks for your kind words Emily and getting my sense of humor (definitely an acquired taste I’m told).

    Your words, “mis-spent life” resonated with me. I can’t think of anything more violent than crushing someone’s dreams. I see this happening all too frequently when professionals artificially impose their own prejudices and limitations on those they’re supposed to be helping. “Oh, you can’t work.” or “You can’t go to college,” “You can’t start your own business” “You can’t get married and have children” “You can’t own a home” On and on it goes. Thankfully, some, like Anonymous, have the “fill in blank here” to ignore/refute the limitations others seek to apply to them, to keep their dreams alive and realize them. Unfortunately, not everyone can/does overcome these dispiriting comments.

  • Emily, I can understand your outrage. I wanted to paste the letter directly as it came from NAMI Ohio to help MIA readers understand what we’re up against. I’ve had several in-person face to face meetings with these people and they really do believe the three options you mention. The additional option they espouse and tell families all the time, is a lifetime of psychiatric medications, in an apartment, no ability to work, dependent on the “system” And, get this, they think they’re being compassionate and caring and I’m the one putting lives at risk by blocking efforts to increase Involuntary Outpatient Commitment. It’s mindboggling and I’m often dumbstruck myself after these meetings. That’s one of the many reasons MIA is important to me. A river in a time of dryness, A harbour in the tempest . Wait a minute those are U2 lyrics! Thanks for your comment.

  • Thanks Jack. I will take you up on your offer to excerpt some sections of your fine piece.
    Also, related to an earlier post, New York is one of the earlier adopter of “Health Homes”
    Ohio just started this in October. I always like reading what you’ve heard/seen about this latest effort at “best practices”

    D

  • Thanks for your thoughts Batesy. You’re spot on as usual.
    Many of the parents with children “in the system” are particularly vulnerable to inaccurate and misleading information. I think many desparately want their child/ren to not suffer and organizations like TAC and NAMI pretend to offer that comfort, but in actuality perpetuate and compound the individuals suffering. Best, David

  • This is a must read MIA’ers!
    The story is so rich with what we’ve been talking about on this site since its inception.

    The last quote, “I am the doctor for the patient, not for society” is the EXACT sentiment expressed by physicians interviewed in an Ohio county struggling with…wait for it, opiate abuse. That’s right, the physicians felt exaclty the same way. The person needs it, they’re struggling with pain and discomfort, we’re going to prescribe it to them. We’re not the police, we’re doctors!

    You have to respond to the father who admits he knows that giving his daughter Adderall is for “cosmetic” reasons.

    Please note, that one physician felt like he couldn’t say no to the parents seeking these drugs. Unfortunately, this is what I hear far too often. Physicians report being “helpless” in the face of parental demands for pills.

    There’s so much more to mine, but I trust others will weigh in.

  • You’re post certainly explains NAMI Ohio’s push recently to expand existing involuntary outpatient commitment laws. Many individuals and groups are trying to stop this expansion. I’ll post on the outcome sometime in January I expect. I liked the length of this post actually, good information, nothing seemed to be “filler” Of course I was an interested reader!

    Thanks for all you do Jack,
    D

  • “Bernet’s proposal to the DSM-5 task force defines parental alienation disorder as ‘‘a mental condition in which a child, usually one whose parents are engaged in a high conflict divorce, allies himself or herself strongly with one parent, and rejects a relationship with the other parent, without legitimate justification.’’”

    Just in case anyone was wondering how nonsense get’s spun as “science”

  • Thanks Chrys. I think you’ve hit on one of those relationships I was asking about. Meaningful activity is a critical component of living for most people. The disability system CAN rob people of that initiative. Especially when coupled with “professionals” or others who tell them they can’t work, shouldn’t work, too risky to work and then offer nothing of meaning to replace those 40 hours a week. Nobody, in my opinion, can maintain much sanity sitting around an apartment/house all day everyday with a lack of meaningful activity (paid or unpaid).
    Thanks,
    D

  • I’m taking a huge risk in this comment, but I hope folks understand the intent and its relationship with this blog and several others by Corinna.

    What is the relationship between “recovery” or “recovered” and receiving a disability check for a “diagnosed mental illness”? Is there any?

    Corrina, in my opinion, is trying to encourage all of us to recognize a simple, yet important point, if you want something to happen, go make it happen. One way to make it happen is through work; whether thru entrepreneurial endeavors or just plain working for someone.

    Dr. Bob Drake has consistently shown that the best intervention for persons struggling with so-called mental illnesses is competitive employment. Models like Supported Employment and IPS have been around a long time but don’t get the attention they deserve.

    I personally believe that social security disability helps many people exist but prevents them from living. In so many ways, it’s a diabolical arrangement.

  • I appreciate this being posted as it’s a reminder, in case we needed it, that there’s big money on the line. Many many people are invested in the status quo and resist strongly the reform efforts espoused on MIA.

    We’re past due for more studies focusing on the lifespans of persons taking psychotropic drugs versus those who do not. The last major reported, often cited, is that there is about a 25 year difference. Are there more studies like this? Are we including persons who begin these drug regimes as children?

    D

  • Thanks for sharing your story Vanessa!

    “…perturbed by 17 years of 12 psychiatric drugs, up to five at a time…”

    Wow! I like your insight that given this lengthy period of drug use, it may well take your body some time to re-adjust. My hope for you is that you have a support network in place that can help you through the difficult times and celebrate along the way. I hope this website and the connections you make can be useful as well.

    Best,
    David

  • “…a curious tendency to shy away from such internal awareness.”

    Batesy, I think you’re right. Many people on this site, including myself, tend to shy away from what you call internal awareness discussion. I’m not sure it’s because people don’t agree with you, my theory is that there is no language known by the vast majority of MIA participants on this subject.

    Let’s call it “Language of Within”

    I’ve noticed people have both a difficult time understanding you and your points as well as responding to you because they “don’t think they’re speaking your language.” I’ve joked with you before that some of the words you use are just word salad to me. That’s true, sometimes I just see a bunch of words with about an alien/foreign concept. The Within.

    I’m not sure folks like Bowen, Porges, and Joseph Campbell help clear things up much. So, as we seek to understand each other I hope a common language of the within can develop.

    Best,
    David

  • I can’t answer as part of the “super intellects”

    I can say that I like what David Cohen and Joanna Moncrieff have said about this topic. It seems very honest, accurate and straightforward to explain.

    There is no illness to treat. So let’s get that out of the way. What’s treated is problems of living. How are they treated? Sometimes with drugs. Is this unusual in our culture? Nope. Lot’s of people use drugs to “deal” with problems of life/living. Most of those drugs have far fewer brain damaging effects than so-called “psychotropic medications.” I think we do need to make room for the possibility that a percentage of people taking drugs of any kind will come to believe, truly believe, that they “do better” on the drugs than off. Sometimes this belief is false, temporary or ill-informed, but it’s not uncommon. I’m not sure who among the super intellectuals you mean, but these are my thoughts.

  • Great question Batesy. I admit my view may seem a bit strange, even to myself! There’s nothing in my life more important than my faith. I have a feeling that there are many here on MIA that feel the same way. Within different faith traditions are tenants and principles that those in that faith believe. Very strongly in most cases. To think we could have a debate between those traditions here, via this medium, when so much emotion and cognition is involved, seems impossible and therefore counter-productive. For example, some faith traditions teach that there is only one true and legitimate faith tradition and all others are untruth and idolatry. Now how exactly are those people going to truly have a constructive debate here? I’m not saying it’s impossible, but I think it’s far more likely that people become upset and the exchanges aren’t helpful.

    Personally I will tell you, that as you mention above, an individual’s faith is at the heart of living in this world. I can’t think of a more important conversation that needs to be had. These conversations do happen in different forums (face-to-face typically) regularly. I’m just hesitant that MIA is the right forum, but I should have clarified that religion IS the right topic!!! So, I can understand why I came off as confusing. Sorry about that.

  • Sinead, I do believe you’ve used the first Zsa Zsa reference on MIA! Congrats.

    I think I understand what you’re saying about the debate now. I’m not sure we have any typical MIA bloggers that would fit the bill but perhaps a debate like this could be arranged.

    You know, just brainstorming here, Bob has traveled all over the world talking abot Anatomy of an Epidemic and he’s had many many conversations with those who disagree with parts/all of his book. Some of those folks would definitely meet the criteria you describe above. I wonder if Bob could find the time to turn the many conversations he’s had into a book. A kind of “On the Road with Anatomy: Conversations & Musings”

    Hmm.

  • Batesy and Sinead, haven’t we had this disucssion on the causes of so-called mental illness already? A couple times no?

    Many on MIA take (more or less) the view that there’s no such thing as “mental” illness as “mental” is a construct or metaphor, not an actual organ. No one on this site, that I’m aware of is promoting, Brain Illnesses. You have to go to NAMI, TAC and the APA for that non-sense. Again, more or less the Szaszian view. Spring Fever = Mental Illness. The Spring can not rightly be said to have a fever anymore than Mental can be ill.

    Different words have been thrown out that more accurately reflect what has been mis-labeled mental illness. Problems of living, problems/challenges of life, distress, extreme states of distress, etc.

    Yours and Davids call is for us to consider the underlying connections between the unconscious, reptillian vagal systems and emotions and it’s interesting stuff.

    We need to consider it, along with our cognitions, as well as environnment including trauma, toxins, substance abuse, family dynamics, traditions, mores, cultural norms, religious traditions, etc. etc. etc.

    We’re very complex and I think the consensus on MIA is that we won’t be reduced to low Serotonin or out of control Dopamine.

    -D

  • It IS a compliment David. More often than not when you offer your thoughts, ideas, insights, feelings, the responses are numerous. Some agree, some disagree but I think it helps the discussion. I’m afraid of being exposed for my lack of self-awareness all the time, especially with women. Let’s say you’re chatting up a nice young lady and at some point in the conversation (at least my conversations) she says, “You don’t know how you’re coming off do you?” To which I say, “No, no I don’t. Please, enlighten, hold on, let me order another round.” It’s a typical Friday night for me Batsey, so I’m not afraid to admit it.

  • “You say that, as a budding coercer, you were determined…”

    Now I know that this is a serious discussion, but I just had to point out this particularly clever phrase. A budding coercer. That’s good stuff Cledwyn. You’re an excellent writer and know how to turn a phrase.

    We’re over a 100 comments on this one! This always happens when my friend Batesy is involved.

  • Can’t read the article, but this abstract seems to confirm the Adverse Childhood Events (ACE) data. The ACE Study is being used more and more in discussions ranging from alcoholism to obeseity to heart disease to problems of living (so-called mental illnesses). The ACE Studies conclusions aren’t rocket science. People who have multiple “traumatic” or “adverse childhood events” without mitigating “protective factors” are more likely to develop life challenges. Not because of chemical imbalances, not because of broken brains, but because, environmental factors play a huge role in our development as humans being.

  • This is in response to Sinead latest to Sandy, which is hard to link to since we ran out of “reply to”, but it had to do with the unique position of psychiatrists in that they can prescribe drugs and make commitment (sanctioning) decisions.

    We need to start a thread or forum on the following:
    -Where should people go when they are interested in receiving help for problems of living?
    -What training, if any, is necessary for those in a “helping” role?
    -What reimbursement structure, if any, makes sense in these instances?
    -How will everyone know that the process/relationship was beneficial to the person seeking help?

    Maybe this is being discussed in Laura Delano’s forum, but I think we need to start discussions on these very basic concepts.

  • This is an interesting point Jeff.

    What is the relationship between “brain shrinkage” and behavior? It seems to me a complicated question. Depends on where in the brain, the extent of the damage, any compensatory adaptations made by the body, etc.

    One theory might look like this: So-called anti-psychotic drugs cause brain shrinkage which in turn influence cognitive functioning (memory, recall/recognition) and behavior (speech, gait, appetite).

    I think we need more research on how damage to these areas of the brain “play themselves out” in a persons life.

    And researcher, psychologists aren’t the only profession that has become willing handmaids of psychiatry, social workers and counselors have a lot to answer for as well.

  • “What was wonderful about this meeting is that these individuals seem to practice their ideas in the way they live”

    This seems a pretty important observation Sandy and is related to several of the comments. People want to be treated with dignity, respect, basic human compassion. Hopefully this is the way people live their lives as well. When we put on a different persona to “help others” we have to stop and question. There should be no need of such a persona. We just need to be one person offering help, support, etc. to another. Period. No lables, no psycho-babble, no power differentials, or need for ego-stroking, etc.

    Thanks for this update.

  • Laura,
    You may want to talk with Kermit about an idea.

    If MIA archives it’s blogs/comments there is already a TON of good information that’s been said on this site specific to each of your bullited points. So having access to that information would really kick start the forums. For example, Duane (thanks for the kind remarks above Duane) has laid out several action steps over the last 4-5 months and rather than having to retype, if there’s a way to retrieve from an archive, that may be the most efficient method.

    D

  • Good stuff Laura. My blogs are pretty much all about bringing about these reform efforts from a county-wide policy and funding level. We can’t do it all, but we can certainly have an effect and make a difference. We’re in this for the long-term. We have a very supportive Board and a dedicated Exec.

    As several folks have already mentioned, changes need to happen at different “levels” at the same time. Your forum should be a nice place for all those efforts to be discussed.

  • Thanks for your thoughts Batesy. Postmodern beliefs are very common here in the states. It maintains that creation itself was a “cosmic accident” and when we die, existence ceases. They believe that we are born from meaninglessness and return to meaninglessness and in between each person contructs for themselves “meaning” It seems a bit odd to believe that one can come from nothing, end in nothing but in between have so much something! This is where postmodern thought runs headlong into illogic. Everything is true if it’s true for you. That’s just nonsense, but it appeals to the narcissism within each of us.

    About that mind-body split you keep mentioning. Of course I agree that western thought has gone too far emphasizing left brainedness but the answer isn’t to abandon the left but to embrace the right and have a more balanced approach. Not sure if that’s what you’re saying, but extremes in either direction are problematic no?

    Hope Thailand is treating you well,
    D

  • I find it interesting that someone who wrote a book entitled: “Mental Health in a Postmodern World (Oxford University Press, 2005).” Also says, “To recover from illness, people need to have a sense of hope, purpose and meaning in their lives and ultimately, this comes more from the culture, economy and relationships they have.”

    There’s nothing “hopeful” in postmodern philosophy. There isn’t any ultimate purpose or meaning to life either in that philosophy. Hmm.

  • As I’ve blogged before, NAMI Ohio uses this term to support their efforts to expand involuntary outpatient commitment (IOC). They believe, and some family members as well, that they’re “helping” the person who “can’t help themselves right now.” Establishing and/or expanding Involuntary Outpatient Commitments is part of a national strategy involving NAMI National, some State/Local NAMI, TAC and others.

    Thanks Dr. Steingard for your blog. It will help in our efforts to defeat IOC in Ohio.

  • I like a lot of what you’re saying Sinead, I just worry a bit that we’re not focusing on the power of the person seeking services. Of any kind. That person has power too. That’s why coercize laws, shock, drugs, hospitalization generate so much discussion on MIA, rightly so, but I don’t want us to lose sight that a person choosing to see a physician has power too.

  • Thanks for your thoughts David.

    “Free agents, yet to what degree, David?
    How do we decipher the extent to which we are autonomously self directed and the the same time bound by our innate dependence?”

    We disagree on many things Batesy but one area where we have some small continuity is this notion of human “freedom” I think we need a blog just on this subject. Fancher might be the guy to right it. My references to Luther and Edwards explore this issue from an Orthodox Christian perspective, I know you approach the issues from other perspectives. People are who they are. People do who they are. We have limits both imposed from without and limits from within. None of this is “illness” diagnosable or the absence of “mental health” Here’s my stuggle with Porges stuff:
    “The polyvagal perspective emphasizes how an understanding of neurophysiological mechanisms and phylogenetic shifts in neural regulation, leads to different questions, paradigms, explanations, and conclusions regarding autonomic function in biobehavioral processes than peripheral models. Foremost, the polyvagal perspective emphasizes the importance of phylogenetic changes in the neural structures regulating the autonomic nervous system and how these phylogenetic shifts provide insights into the adaptive function and the neural regulation of the two vagal systems”

    These words/concepts are non-sensical to me. I need someone to translate this theory to me before I can form an opinion.

  • And let me add Sinead ( I don’t consider this whining, just talking about current dynamics); Payors hold doctors accountable for what they claimed they were doing, only in part. The payors looked at those claims through the lens of profit and further set reimbursement criteria based on a hybrid model of error combined with profit…so you’re tangled web metaphor is apt. I’m not trying to engage in “victim” labeling but we all need to agree this mess is a MESS and will take some time to reform/correct. I’m glad to read of your own personal efforts as a reformer!

  • In Stevie’s response to Steve above an interesting, sad , but very real dynamic is revealed. Our current system of “care” be it for mental health, addictions, or primary health is designed (gulp) first and foremost with the payor source in view. I know it’s ugly and terrible and criminal, but that’s the reality in everyday healthcare. Many people have used the expression, “He who pays the piper calls the toon” and that’s what we have. Payors call the toon and the toon is a dirge (for those in Rio Linda, that’s not a happy song). “Professionals” everywhere like the good Dr. are just going thru the motions to get reimbursed. As we all know on this site, those “motions” are often deadly.

  • Human beings as free agents? Yes, but free to do what exactly?

    This is where I find the works of Jonathan Edwards (“Freedom of the Will”) and Luther’s “On the Bondage of the Will” to be so interesting.

    I think Bob is making a very sound argument in both his blogs on this subject for why this particular myth won’t go away quickly. I do think it can go away, but as many have said, it’s hard to see that happening quickly.

  • I hope you’re right Batesy. I certainly see a lot of potential with the site too. As you’ve said before it is Ok to disagree and even disagree passionately. I guess I’ve seen many back and forth posts/comments on this site and I hardly see, in my opinion, positive outcomes. Look what happened with Fancher’s piece recently. And what happened to Dr. Keys?

    I guess, for me, it seems dialogue over particularly controversial issues loses something when it’s not done face-to-face. I do enjoy the internet, but communicating via email is limiting and effects a good discussion. Regardless, I accept the decision of the MIA site administrators.

    Thanks for you comments.
    D

  • Kermit/Matt,
    You may want to consider the appropriateness of blogs/comments regarding religions on this site. People are very passionate about these issues and rarely agree leading to non-productive communications. I completely disagree with the statements made in this piece and some of the comments, but it won’t be productive to do the back-and-forth.

    Just a suggestion.

  • Excellent point. Even when people are assured their responses will be “confidential” there’s going to be very real anxiety of answering honestly.

    These types of surveys should be given post-discharge in an effort to help alleviate the pressure to answer in a certain way.

  • Jeff,
    This is in fact what I’m hearing/reading from a policy and funding perspective. “Funders” are coming to the conclusion that medical school isn’t necessary to follow a flowchart of medication dispensing. Diagnosis A? Then give Xmg of WunderMood. WunderMood no good? Give Xmg of Pleasantus. Pleasantus not doing the trick? You get the idea.
    Scary stuff.

  • Ha! Readers, who doubt the humor of those posting on this site, take notice!

    This may rank as one of the best “pot calling the kettle black” instances in recent memory. Amen is frowned upon by his colleagues, because he more deftly and successfully capitalized on the myths surrounding “mental illnesses” than they did.

    His detractors are just jealous they didn’t think of it first!

    Are we fighting an uphill battle here at MIA? Perhaps, I mean, Amen.

  • Bob,
    Isn’t Adam’s point above that “the term dysfunction be applied to its proper subject: the mechanism which fails to work as it is designed” consistent with what you’re saying? That human beings weren’t designed to be free of distress, worry or struggle? So when we experience these, they can’t rightly be called “dysfunction” but functional?

  • Adam,
    Is your point about the concussion that the hemorrhage is a functional response to a dysfunctional event? If so, would a person experiencing a hemorrhage be functioning optimally or less than optimally, but not necessarily dysfunctionally? Is that kinda what you’re getting at?

  • Cledwyn,
    I hope you and Bob keep this discussion going. I think it’s important. If mind is metaphor, can metaphors be observed in terms of form and function? Is that ascription? Description? I’m curious to read how this develops.

  • “We really, really want to believe that suffering isn’t our natural lot…”

    This is the key piece for me Bob. I don’t bring up religion in my blogs or comments because it’s just too divisive and I don’t think it will move the conversations forward, but I’m tempted!

    I think suffering is a natural part of life. Of course we try to minimize suffering and maximize pleasure, we are all a little Epicurean at heart no? But to imagine we’re entitled to a life “free from suffering” Not in this life. So I guess I’m one of those who doesn’t want to conceptualize normal human suffering as illness but as part of man’s condition.

  • “The second statement that antidepressants save lives has simply got no evidence base.”

    Healy really wrote this? I’m no wordsmith (just read my blogs) but this seems out of step with his usual grammatical flair.

  • Sinead, I agree with much of what you said, particularly the role of the courts in holding people responsible. I think a major challenge to this is money. Resources. You’ve probably read on this website how hard it’s been for folks like Jim Gottstein to wage legal battle against the deep pockets of Pharma and their minions. I don’t know the history but how did people start challenging “big tobacco” back in the day? That must have seen like an impossibility as well.

  • Duane,
    Thanks for your thoughts. You’re right about Medicaid. It’s such a large bureaucratic process. I’ve not seen much “transformative” that’s endorsed and funded by Medicaid. Ask Jack Carney about “Health Homes” He’s written several excellent pieces about that here at MIA. What about “Peer Support Specialists”? Sounds great right? Several bloggers and commenters have rightly pointed out that typically these oft-times well-meaning peers get co-opted into the medical model fraternity and actually encourage other peers in a way they wouldn’t have imagined before becoming “trained” as a specialist. Medicaid likes “Evidence Based Practices” but as Darby Penney commented recently, this is often code for a “one size fits all” approach. No, I do not miss Medicaid. In the words of Billy Joel (pre-Brinkley of course), “Say good-bye to Medicaid, say good-bye my baby”

  • “Apply the following method: psychiatry can’t prove your brain is diseased, so why drug it at all?”

    Some people find that an intoxicated state brought on by drugs to be preferable? I agree that the brain isn’t “diseased” and there is no “imbalance” If someone is truly given “informed consent” the pro’s and con’s of any drug (let’s assume legal drug at this point), do they not have a right to choose it? And isn’t it likely that a percentage will find their drug-induced state preferable to non-drug?

  • “In a crisis I wouldn’t want to be anywhere near anyone who thinks nothing of the medicalized phrase “first episode psychosis” coming out of their mouths.”

    This wonderful statement should guide the development of a crisis response alternative for people like A. Put this on the brochure, above the front door, on the letterhead, etc. Let it guide hiring decisions and operational decisions.

    I know programs like this do exist, but we need many many more. MIA has featured Cornwall and others.

    Non-medicalized options for persons in severe distress/crisis should be the norm not the exception.

  • “It is relevant to this assumption that 20-year outcome data from the Chicago Follow-Up Study suggest that service users who decide not to take antipsychotics (often against medical advice) do relatively well, if not better, in comparison with service users who take such medication continuously”

    Relatively well, if not better? I’ve seen the data and listened to Bob and others speak/write about Harrow’s outcomes and I have to say, the authors appear to be minimizing the dramatic differences between those off-meds vs. on-meds.

  • Jeff, your argument breaks down for me in the middle. As the author points out, the word “mind” is a metaphor, like intelligence. It’s not tangible, since metaphor’s can’t be tangible. Although metaphors are perfectly legitimate words and can be used in discussion, we just can’t make the leap that mind = brain. Mind relies on brain, but that’s different than saying it must be tangible since brain is tangible.

    Good article, this seems to me the classical Szaszian position. Szasz has been ignored and marginalized for years but I still think his positions have merit. At its core Szasz didn’t want us to reduce the complexity of human emotions, feelings, behavior to mechanistic and reductionistic concepts. Language does in fact matter. The proliferation of Psychiatry and their plethora of pills for people’s suffering is the outcome Szasz feared.

  • Wow! Just watched the piece. That’s tough to take in places. Ms. Satel is particularly distressing to listen to. The “bogey man” she uses is this very small percentage of seriously mentall ill people that she actually characterized as walking down the street slinging their own feces! Wow Dr. Satel. That’s quite a poster child you’ve created to support your point of view. Dr. Satel wants license to control others due to the seriousness or their “illness” She will use her bogey man creation to support all of her extreme and dehumanizing positions (of course she won’t recognize them as such).

    Also, Kermit, Torrey says he replied to Bob’s book Bob replied to him (which was posted) and that there was further back and forth. Could that also be posted?

  • I think you’ve articulated the current situation perfectly. It is going to be difficult, take lots of effort but I’m still hopeful a humane care model is possible. One huge advantage for reform comes by way of the shortened life spans you mention. It is sad and a bit macabre, but as more and more people die prematurely from these drugs, society may (may mind you) be so outraged a wholesale change will occurr. I just don’t want us to have to wait and see thousands of 36 years olds who started these drugs when they were 5 or 6 dying before people get the message.

    Thanks for this piece Leah.

  • Faith,
    Let me add a comment about your final thoughts (states shifting funding to models… and mess).

    Yes and Yes!

    I work at the local level but also interact with our state partners. At least in Ohio, the biological narrative has been predominant for the last 25 years or so, but it was not always so.

    Bob’s book has helped us focus that, from a state perspective, the biological narrative isn’t working. State folks are also starting to recognize that we’re creating dependency in the people seeking services as a way to fuel the “fee-for-service monster”

    I think from a purely economical point of view, states will start to question the notion of biological narrative, pills for all and fee-for-service. But as you say, it will be messy!

    One opportunity for you and others is to work with your local “behavioral health authority” It’s called different things in different areas. Typically there is a local entity, given the authority to raise local funding (levy) for mental health and substance abuse services. Work with them on developing approaches that are consistent with what we talk about here on MIA. These funds, since they’re local, are extremely flexible and not constrained by what the Feds or Medicaid deem “treatment”

    Hope that helps.

  • We’ve suffered through the “Decade of the Brain” and come out the worse for it. We need a “Quarter Century @Trauma” Timing seems to be getting for the role trauma plays in human development, relationships, health, wellness. No thanks Nancy A. we’ve got Darby Penney, Ann Jennings and Vince Felitti to help us.

  • Ah Life. It all gets back to philosophy no?

    Philosophy drives Theology which drives Society which in turn drives Technology, Industry, Products and Services.

    That’s why we’ve got Fancher, to remind us of
    “Primum prima” first things first.

  • That’s a blog I would be interested in reading Richard!

    It is difficult to reform from within. You have to say things to clients like, “I have to give you this label, so that the care you receive will be paid for by your insurance, but I want you to know that I don’t believe in labels and don’t think any human person could be reduced to a label. Is this ok with you?”

    But the label is there, its in the record and other professionals that aren’t reformers see that as validation of the diagnostic procsess. You have to be careful which supervisor you tell about just giving a label for insurance covereage…you may not want to mentio to the insurance carrier either..in fact you may not want to mention to your good friends…you see how tough this is? Just one example of the contortions reformers in a broken system deal with. But what about the so-called clients? If we’ve got it rough, what about them!

  • This is a tricky topic. It brings into view concepts of the free market, subsidies for the “poor” and “disabled” and good ‘ole fashioned horsetrading.

    I’m a free market guy, so I believe if you provide a service/product that people want good for you. Go forth and prosper. But as you say Bob, what happens when you want more than what the market will pay? You should go out of business or adjust your busindess plan but here’s where subsidies via insurance step in and muddy things. Once we start down the subsidy road, all kinds of perversions await.

    I’ve no solutions here. In a perfect world, I’d like to think the work I did was valued enough by enough that I could support myself and family. Thanks for raising these issues.

  • Your point about chronicity is a critical one. I hope the doctor is reading these comments. Its only been in the last 25 years or so that the narrative of chronicity and irreversability has emerged. Robert outlines this well. That’s a HUGE change from the way these “illnesses” were viewed for many many years.

    Once you realize that it’s a marketing message made real by the toxic drugs you will be motivated to look at how we did things prior to reductionistic conceptualizations.

    Also, a question Dr. your comment, “In general most psychiatrists I have met would rather have more time to spend with their patients and do the psychotherapy…”

    Has not been my experience in talking with psychiatrists. I’m told they receive virtually zero training in talk therapy during their training. Can you confirm?

    Thanks for your contribution here.

  • Encouraging! The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for all professionals (myself included).

    It’s become a bit of a shibboleth for my collegues and I when someone has claimed to read Bob’s book. If they don’t say something like, “after reading Anatomy, I can’t just go back to doing things like I always have” we know they haven’t read it!

    It’s a little like Luther’s “Tower Experience” a conversion experience if you will. That’s why we buy Bob’s books in bulk and hand em out to profesionals in need of saving! Glad these nurses have gotten the “spirit”

  • What can we do indeed! I was having a good day until reading this, thanks Bob! 😉

    I think lots of people are doing lots of different things to bring about change. This website is an obvious example. A change of the size and scope needed will take time I imagine. All the while we’re fighting folks like Gibbons who are desparate to keep the status quo going. The slogan, “I can’t but we can” comes to mind.

    Thanks for another great piece Bob.
    D

  • Yep. I know your position on drugs causing behavior has met with quite a bit of resistence on this site and like I said, I’m still trying to educate myself on the different views. I agree with you that problems of life/living are not best thought of as medical problems requiring medical interventions. I agree as well that personal responsibility exists and must be considered in any discussion around the impact/influence of drugs on our thoughts, behaviors, etc.

  • Now A, in deference to you I purposely did not say the drug would cause strangulation just a desire to. Big difference. I think you’ve agreed in other posts that drugs at least can influence the behaviors we make. Your objection was with causation. The notion that once we take a pill all free will departs and we are like robots, slaves to the drugs coursing through our bodies. I’m still seriously considering your position on that.

  • “Our approach positions the people who are prescribed antidepressants as the experts,” says Ms Gibson

    Really Ms Gibson?

    I have to wonder if these people were considered experts when they first call the agency? When they completed their assessment? When the pros and cons of psychiatric medications over alternatives was explained..were they experts then too Ms Gibson? Certainly they were the experts when they decided they didn’t want to take the medications too right? Oh, they probably didn’t get counted in this study. Where was their expertise when it was explained thay by taking these drugs they would lose their sex drive, gain 60 lbs and have a strong desire to strangle their neighbor? Maybe if I re-read the piece…

  • This is a good reminder of why fundamental reform is needed first. We can’t continue to encourage people to “get help” from a system shown to actually cause harm. Depending on each community, it’s not extreme to encourage people to stay away from the system until their are enough reforms put in place to actually assist them in a humane way. For most communities this change will happen somewhat gradually rather than all at once (preferable but I’m not sure always practical). Any vehicle (like TeenScreen) that increases people to a harmful system must be questioned. Of course there’s all the issues of the instrument/process itselt which the article discusses.

  • Statistical Significance versus Clinical Significance versus real world significance.

    I want to believe that we are becoming more critical thinkers about all things psychiatric and drugs. This site is helping us do that. To the extent mainstream media is picking up this thinking great.

  • Bob, in light of Marian’s comment I go back to another I made about one of your previous blogs. Help me understand this. I was always taught that Freud was critical in ushering in biological psychiatry because his contemporaries refused to see “mental illness” as organic illness and so in their minds it was not-illness, often called malingering. Didn’t Freud create functional illness as a way to say things like hysteria are in fact illnesses too?
    Thanks,
    D

  • Yes, this is what I’m wondering John. So many of the diagnostic terms have become “loaded” besides the fact IMO they’re not useful, in fact, often harmful.

    This idea of a “formulation” or an agreed upon summary of what the difficulty is and an agreed upon strategy to try and lessen and/or overcome the difficulty between both parties seems reasonable to me. You’re comment about friends resonates with me, because I feel friends have probably done far more good than “professionals” in aleviating distress. Thanks again. PS Do folks in Great Britain like the show Wheeler Dealers or is it just me?

  • A raises (and has for some time) an interesting point. What does psychiatry, social work, psychology, counseling look like without the diagnoses we currently have? Could any of these disciplines survive and if so, how? I believe three of the disciplines could roll with “problems of life” or “life challenges” as “presenting problems” There’s one discipline that I don’t think could ever make that transition.

  • “Physical punishment was defined as pushing, grabbing, shoving, slapping and hitting…”

    Yet the title is Spanking? Pushing, grabbing, shoving and slapping are not spanking. I’m not sure “hitting” is spanking. I’d need to see a more specific definition.

    I guess they wanted a headline to generate interest. We’re about two years away from ‘World Spank Out Day’

  • I remember when I was a young counselor (younger than I am now Batesy!) the agency I was with was just making the switch to embracing Medicaid as its primary revenue source rather than self-pay and insurance. Our staff of 12 clinicians included six Ph.D.’s Within a year and a half they had all left the agency. Some had left the field entirely. Their reasoning was similar to Fancher’s points. They didn’t want to “sell out” to this new DSM, illness like any other, cook-book approach to helping people. They didn’t believe the medical model and didn’t want to be at an agency that promoted it.

    Which begs the question, for all those social workers and counselors who didn’t leave, are you(we) part of the problem too? Until I got my head straight, I believe I was. My experiences convinced me that system change was necessary. I had to be in a position where I could do something about the medical model, DSM, Insulin-for-Diabetes juggernaut. Fancher’s history lesson is a good one, unwinding this mess is going to be tough. I’m grateful for Bob, this website and everyone’s efforts to bring reform.

  • Not trying to be controversial here, but what kind of country has a law allowing the wholesale murder of millions of the unborn each year? We’ve lost the value of life. The respect of and for life. And the image our lives reflect. Once we’ve done that, medicating children into oblivion is par for the course no? Ancient Rome indeed.

  • I agree A. The term is so stretched it has become a catch-all when you want to support coercive interventions. It is used repeatedly by NAMI National, TAC, and our local Ohio NAMI features this pseudo-scientific word prominently in their rationale for expanding involuntary outpatient committment.

    Curiously, Peter Breggin has used the term in the past (I believe he uses the term ‘spellbinding’ now) to describe a persons inability to understand that they’re not “getting better” due to being on psychiatric drugs. The drugs have “blinded” them to themselves. This ties back to the news story on children and emotional development.

  • This is an excellent point often overlooked by “professionals” and some family members. Often, there’s such a desparation for the individual to be “better” even a “little bit better” that the sedating effects of many psychiatric meds, which seem to tamp down “symptoms”, are heralded. Finally, my loved one (or patient) is on the right track. Unfortunately, so-called symptom remission is as far as the drugs typically take folks. In fact many studies reported here on MIA have shown that long term use of psychiatric drugs actually worsen recovery (Harrow).

    How can we bring about that “relief” without the use of drugs?

  • Wow! That’s too bad these folks didn’t feel they could post here. I really didn’t think it was that bad, but I understand this is subjective.

    Maybe these folks could contribute in another way? Do we want to have posts where comments are turned “off” for that particular post? I know it runs a little contrary to what we’re trying to accomplish but just brainstorming some solutions.

  • Amphetamine’s Ok for our children, but not Ok for us adults? Hmm.
    I don’t know what “drugs of sin” are either but I’d love to find out! I’m not sure what Alto’s getting at here.
    The use of drugs to make life more enjoyable, easier, more “productive” has been going on since, well forever. There’s always been a percentage of people who use too much of the drug(s) with often devastating consequences.
    I think what’s been new/different in the last 60 years or so is the belief by some that drugs can “correct” so-called mental illnesses. Of course this is nonsense, but let’s not forget that drugs do have effects. Someone taking a drug, any drug, will experience some kind of effect. Please let’s not call those effects “treatment” or “corrective” People on drugs act differently…sometimes that difference is desirable by the person or others.

  • “…getting to where one neither has the mental health problem nor is taking the drugs.”

    This is the end game Ron. I agree this needs to be more of a focus. I understand the need for so many posts, articles, etc. exposing the chemical imbalance myth, ghostwriting, unsavory relationships, etc. But I’m hoping, in time, more and more posts will have to do with remaking our system so that what are called “mental illnesses” today do not exist. Distress, even extreme states of distress must be seen differently, not as illness. If we remove the diagnostic dogma we are still left with our cultures desire for quick fixes thru drugs. This is an issue that transcends psychiatry.

  • Good stuff as always. Do you sense the desparation in the folks that use the “ICMJE Defense”? As a friend of mine always says, “It’s like the last days of disco Dave.”

    I think it only a matter of time until we’re burning these “albums” at Comiskey park! Psychiatry Demolition Night indeed! Put something together MindFreedom, it’s a better idea than that damn chicken test for mental illness.

  • I think this is a good re-statement of what we’ve known about the chemical imbalance myth for some time. We can’t say or hear this message too much so I always applaud and encourage it.

    Your statement:

    “When a physician prescribes an antidepressant, he cannot but help but also prescribe an idea.”

    Is one I believe I can use in our local efforts to bring about reform. I agree with you, but I think physicians don’t always realize they are prescribing an idea. A good point to bring up in our conversations with them.

    You can replace “antidepressant” with any type or method of intervention though and make the same point that whatever we do promotes an idea or view of people (usually based on our own experiences — David’s piece above shows this perfectly.

    This is why, in my opinion, people may want to seek help from those most similar to them. It’s more likely that what is offered is consistent with how you see yourself and the world.

    Thanks for this piece.

  • Thanks for this Stephany. As you may know we’re right in the middle of fighting a bill that would allow an expansion of involuntary outpatient commitment (IOC) in Ohio. NAMI Ohio is pushing hard for this and peers and professionals are pushing back. We suspected that the push was part of a larger national strategy designed by NAMI National and TAC. Your comments lend support to that idea. The phrase “anosognosia” is being promoted in Ohio but comes from TAC and NAMI National. They are trying to use this misplaced term to give “medical cover” to forcible treatment. “If people could only understand how sick they are, they would agree with us.” Scary stuff. When I asked the NAMI Ohio exec recently about how IOC squares with Recovery Principles he said, “recovery principles don’t apply when someone is this sick.” Dr.Frese is an Ohioan who seems hopelessly tied to NAMI’s devices. There’s nothing “civil” about stripping persons of their civil liberties.

  • Don’t forget to go back to Freud’s day with this history lesson. “mental illnesses” didn’t exist at that time. Persons were seen as either having an actual medical problem or they were catagorized as “malingerers” Freud is a key player in turning malingering (in essense, a false medical disease) into a “mental disease”

  • This may well be my favorite Fancher post! Good stuff. The emphasis on “finer” distinctions implies a need for more individualized care and I think we are all for that. “We’re not making widgets!” my old counseling professor would say. The complexity of human beings should make us awestruck not arrogant. Approaching people with this sense of awe and consideration can go a long way in forming a relationship.

    PS Check out Melancholia the movie! Beautiful in it’s production value…perhaps a bit lacking in writing.

  • I like both these movies! They both have these elements of “madness” or sanity which you describe.

    These things are often a matter of perspective. Are the actions consistent with the individuals values, beliefs, and understanding? Likely. Regardless of how discordant those beliefs, understandings, values and behaviors are for the broader society, from the perspective of the individual…perfectly sane.

    Society has a continuum on which behaviors, beliefs, etc. can be plotted. Of course this continuum is in constant flux, but the point is once a “threshold” has been crossed the person can be said (by the broader majority/ruling culture) to be insane.

  • Ha!

    “Knowing is nothing but working with one’s favorite metaphors.’ –F. Nietzsche

    I’ve seen a similar vigorous debate on whether the Euro is “soft”

    When what’s being discussed is figurative rather than literal, whose to say which view carrries the day!

  • Now, don’t get me wrong. I’m all for closing down these State Psychiatric Hospitals. But what we’ve seen too often and it’s not mentioned in the article is the following dynamic.

    Reduction in State Psychiatric Hospitals = Increases in private psychiatric beds, increases in persons designated as “mentally ill” in the jails, increases in persons designated “mentally ill” as homeless and increases in persons designated “mentall ill receiving powerful psychotropics sometimes against their will (involuntary outpatient commitment).

    So please don’t be fooled by the rosey sounding headline. We need to ask more questions. And then more.

  • Good stuff here Marian. This overlooking of the physical and rush to the mental is my experience as well. Ironically, my college training was just the opposite. We were trained to see physical conditions as “rule outs” that must be considered first, than we needed to consider any kind of substance intoxication before even considering a so-called mental illness. Getting rid of DSM though is the right approach, it’s fatally flawed and perpetuates this mythmaking around calling life challenges mental illnesses.
    Best,
    D

  • Interesting piece.

    This quote:
    “Was it something about the structure of American Society itself that was causing so much unhappiness?”

    Can lead to some interesting discussion I think. Yes, would be my short answer. Let me broaden your question this way and ask, “Is there something about the nature of human beings that was/is causing so much unhappiness?” Again, my short answer is “yes.”

  • Just wanted to update folks on our meeting Friday with NAMI Ohio leadership. What became clear from the very beginning was that no positions were going to be changed based on the information exchanged. NAMI Ohio seems to believe it’s in a person’s “best interest” to be subject to involuntary outpatient commitment. They need to be protected from themselves. Recovery principles don’t apply because the person can’t make “good” decisions when “in this state.” References were made to T.A.C and NAMI National (no surprises).

    In short, we have to fight for a view 180 degrees different from the NAMI view. We will be trying to influence professionals, politicians, state and local policy makers, families and peers of our position and encourage them to speak out.

    In short:
    1. Involuntary Outpatient Commitment (IOC) Remains Unproven
    2. IOC violates fundamental rights of autonomy, liberty,
    choice, freedom and confidentiality
    3. IOC is inconsistent with Recovery and Trauma Informed
    Care principles

    The only glimmer of hope (and it was faint) was an acknowledgement by NAMI that if different services existed, perhaps IOC wouldn’t be needed. I agreed that different services are in fact needed but IOC is never needed.

    The next few months will hopefully see us successful, like Connecticut, in defeating this inhumane Bill.
    Thanks for everyone’s interest and support!

  • “Mental illness” is not physiological. If it is, it is not “mental illness”.

    -This is, for me, a critical fundamental. As Szasz and others have said (Robert Spillane for my Australian friends)Mental processes cannot rightly be said to be “ill” anymore than any metaphor can be “ill”

    Neurology deals with real diseases/abnormalities of the brain.

    Part of the reform efforts will need to be focused on the language we use in referring to people who report “distress” Some like the term “challenges of life” or “challenges of living” It’s hard to get much worse than acting like a created metaphaor (Mental Illness) actually exists! I’ve got Spring Fever!

    R Spillane information:
    Read more here…if you dare!
    http://robertspillane.info/2010/05/16/the-mind-and-mental-illness/

  • Thanks for this Kermit. I’m waiting for Bob’s blog on the research into how much earlier people die when they’ve been on psychiatric medications beginning at a young age.

    Everyone talks about the “25 years earlier” study but that was based on adults talking the meds. What’s the life expectectancy for someone who is started on antipsychotics at age 5, 6, 7?

    I don’t relish the results but they just might be so shocking to the general populace that we can finally ban these drugs for youth. Period.

  • Thanks for this Tina. I’ve blogged previoulsy about our fight in Ohio to stop legislation that would expand involuntary outpatient commitment. Person’s not “adhering” to a treatment plan would be subject to psychiatric hospitalization which includes forced drugging. Ultimately Federal Legislation is needed to stop this but in the mean time we’re trying to defeat it State by State.

  • I think David you need to be open to the possibility that what you believe and say is not viewed as meaningful or correct by others and that is just as “true” for them as what you espouse. Why should someone read Tomkins if they don’t agree that it has any meaning for them? If it doesn’t that’s ok right? If “unconscious scanning” is rejected as an inaccurate conclusion on your part, then it is. I have no doubt that you believe what you believe, please allow others to disagree and believe differently. That’s my point.

  • “I understand how much you have invested Duane.”

    “I understand how hard it is to let go of such an emotional investment.”

    Goodness David. How can you possibly “understand” these things for another person? Please stop being so arrogant and condescending in your posts. I challenge you to stop using cut and past quotes in your responses. This is not about talking to yourself. Try to move the discussion forward with concise yet meaningful dialogue. Park that enormous ego at the door. Thanks!

  • Michael,
    Descartes radical doubting was his attempt to not accecpt anything as true unless it struck him as clearly and distinctly true, in itself. I’m not sure this has to “pathologize emotion” necessarily. Certainly it can but it’s not necessary. I’m not sure we need to focus on how thought and emotion are separate so much as how them compliment each other and work together.

  • Our back and forth reminds me of the work of Steve de Shazer, Dick Fisch, Weakland, et al. There really is no such thing as communication; just varying degrees of mis-communication. We always say more or less than we intend to say.

    I enjoyed Avatar! What is meaning? What is sight? is it a purely physical process? An invisible connection between souls? A kind of union that can’t be expressed with verbal language? I imagine you would get lots of responses to that question! The answer to all might just be, “yes.”

  • Ken,
    Let me give you a current story that I think reflects a bit of what you’re saying.
    NAMI Ohio is pursuing an expansion of Involuntary Outpatient Commitment in Ohio. In researching the best responses to an upcoming meeting with their leadership I discoverd that NAMI CT just went through this same fight, but guess what, it was NAMI CT that was trying to prevent Involuntary Outpatient Commitment! So yes, not all NAMI’s are alike. I agree with Duane though that once this new information has been learned it seems NAMI has a role or responsibility to “undue” the consequences of years of advocating for things that actually hurt people (unintentionally I know). Thanks for your courage in writing the piece.

  • “Righteous anger against killers and human rights abusers isn’t self righteous projection”

    Thanks for this Dr. I think circumstances can exist where action is not only necessary but required. What those circumstances are certainly can be debated but I don’t think we can “sit on our hands” and allow for injustice to continue. Mr. Bates does make intriguing comments, I tease him a bit only because he and I have little common language but you Dr. C, you can talk to this man, you’ve read the pink book, blue book? THAT book. All the best.

  • Yes! Diana, would you say more about this? Are hospitals “obligated” to ensure patients are not in any pain? Is this why they are so liberal with handing out the oxys? I’ve heard that their internal quality scores go down if people report they are in pain and the hospital isn’t addressing it adequately.

    Hisorically, it seems to me, hospitals tolerated the fact that patients would be at a higher level of pain after certain procedures and so did the patient. This led to a shorter “disability” course. As you suggest, by minimizing pain in the short term we’ve increased pain over the long term. Surely this is yet another result of American’s penchant towards Pragmatism.

  • “Don’t maim the foot to fit a broken shoe”
    I like that! I’d like to use that with your permission Jeanne.
    This applys globally to our broken mental health system. How many people have we “maimed” over the years? How many more will be “maimed” for the sake of refusal to ackowledge the shoe is good and well broke!

  • That tagline, “The voice on mental illness” Rubs me the wrong way. It’s arrogant for anyone or any group to think they speak monolithically for another.

    NAMI National did comply to Grassley to some extent. It’s unclear to me if State chapters can do the same. Examining their IRS 990 form it’s not clear what income is pharma or not.

  • This is a great example of where your leadership and experience can help others Duane.
    I can’t say enough how grateful I am that you’re taking the time to advocate for humane care and respectful treatment.
    Friday is shaping up to be an important meeting. While I don’t expect to change any NAMI minds, they will know that we don’t approve of their position and we’re going to enlist as many people as possible who feel the same to way to speak out.

    David

  • Ha! So you decline to answer my original question to you. That’s fine. You’ve provided enough for me to believe we can be cordial but I belive your reluctance to answer my question to you reflects that you know exactly why I asked it and what I’m trying to determine and your choice is not to answer. We’ve gone as far as we can I think.

    I didn’t realize the word “diagnosis” was loaded for you. Or that you are emeshed in the medical model or a psychiatric survivor. I will bear that in mind in my future comments. For what it’s worth the survivors I know choose to not let words like this impact/control/define them.

  • All conversations start with presumptions no? I certainly meant no offense David. My “diagnostic” question wasn’t mental health oriented it was diagnostic more in the sense of trying to understand your comments. Sorry if that wasn’t clear. You tend to quote a lot from others so I wanted to read “you” more. I appreciate your response. I must say you seem a bit upset in your response though. I hope we can still be cordial Mr. Bates!

  • No, I don’t take it that way. Your response is one possibility. Another, the one I believe is true, is that I asked you a question based on your comments that I believe will tell me more about why you comment the way you do. It’s a diagnostic question if you will. I try to understand where people are coming from and to do that, you have to have a conversation and ask questions. That’s all I’m trying to do. So about that question…

  • Duane your point about NAMI Ohio receiving “State” funds raises an important question and potential opportunity.

    NAMI Ohio does receive a large amount of funding from the Ohio Department of Mental Health (for “advocacy”) but the funds are Federal Block Grant Funds funneled through ODMH to NAMI.

    The opportunity is to continue to engage the Department in a conversation about NAMI’s efforts. Does the Department agree with their advocacy? How does that position harmonize with statutorily defined client rights? How has the Department determined that advocating for forced care is preferred over focusing on advocating for alternative services for people in crisis or “headed towards a crisis”?

    As always, your interest and commitment are appreciated.

  • Yes, the IRS 990 form is of little help. State and local NAMI’s should follow the same guidelines as NAMI National in disclosing their funding sources and levels. Although that’s not a guarantee of a complete picture. It’s relatively easy to “shield” funding types legally.

    No evidence supporting his outrageous statement was given. Link to the full Vindy.com story is posted above in an earlier response.

    The “dangerousness” of the mentally ill is used by NAMI as a way to convince lawmakers of the need for coercive care. Of course, this is done to “help” them. They don’t know how sick they are, but if they did, they would gladly take the medications in spite of the devastating side effects.

    Anosognosia they say. A term being misused but that could be applied, at least in the way they are using it, to anyone who disagrees with you. “I know you don’t agree with what I’m saying but that’s only because you’re suffering from anosognosia which prevents you from seeing how right I am. Trust me; I’m acting in your best interest…”

    Thanks for your thoughts and comments acid.

  • Terry Russell the Director of NAMI Ohio was quoted online as saying: [In contrast, Russell said the mentally ill commit 50 percent of the “horrendous crimes” in Ohio]

    What do you think of that acid pop? Either Mr. Russell was misquoted or the head of NAMI Ohio thinks the mentally ill are monsters.

  • Chief Sponsor is State Sentor Dave Burke contact below:
    http://www.ohiosenate.gov/dave-burke.html

    This is going through the Judiciary Committee contacts below:
    http://www.ohiosenate.gov/committees/standing/detail/Judiciary.html

    Great letter to Betsy by the way.
    Appreciate all the support. This is the wrong approach to helping those struggling with mental health issues. Focusing on the way we provide services and the types of services is what other states have found make the difference. Not criminalizing people who don’t “do as their told”

  • That was not the conclusion of Senator Grassley’s investigation Betsy. You may want to read the facts of that investigation below:
    http://blogs.wsj.com/health/2010/04/28/mental-health-groups-state-chapters-get-millions-from-pharma/?blog_id=10&post_id=33035

    NAMI National was pressured to start posting their finanical information on their website and they have started to do that. Senator Grassley urged State NAMI’s to do the same. Will NAMI Ohio list their funding sources and level of support similar to NAMI National?

    That level of transparency would go a long way in clearing up whose message it is when NAMI Ohio speaks.

  • What? How can this be? We’ve been told for years that we’re on the cusp of great discoveries! Thomas Insel himself touts genetics as the future for understanding mental illness ( he also admitted that theories based on chemical imbalances were far to simplistic and reductionistic…about 50 years too late).

    I know this is a small thing, but I’m just not convinced that studying the brains of rats or mice will shed any light on the human suffering, trauma, love, disappointment, etc.

    I know mice get stressed when someone moves their cheese but come one!

  • Damn this is powerful stuff!
    Thank you Olga.
    I’ve been readying for a “fight” around forced treatment here in the States and I read your piece and get a much wider perspective.

    Please keep blogging here. Your voice is important, you’re important to the change underway.

  • I tend to put the reason first, but admit that, as an emotional creature, it doesn’t always work out that way. I don’t find it reasonable or necessary for one group of people with power to exercise it in such a way to deprive another group of people (with less power) of their basic rights (in US) of life, liberty and pursuit of happiness.

    Then the posture is assumed!

  • Mr. Bates,
    Your points are well taken. My training in motivational interviewing techniques is very consistent with this approach. When someone is the earliest stages (pre-contemplation/contemplation) on an issue/idea/behavior, it’s not very productive to engage in a tug and war.

    Sometimes you have to say/act in a way you believe is “right” regardless of whether anyone is persuaded or the outcome you desire comes to pass. I don’t want to get into too much of a philosophical bent, but I find postmodern philosophy irrational. For instance, I’m not going to concede that NAMI Ohio is equally right in their push to force meds as I’m right to reject such efforts.

    I’m definitely thinking through my strategy though!

  • When Senator Grassley investigated the ties between the pharmaceutical industry and NAMI National and State NAMIs, they discovered NAMI Ohio was the second largest recipient of Pharma dollars in the country. Hearing the executive director of NAMI Ohio speak is like listening to a drug rep. He is paid to advance their goals.
    I am glad you wrote and they responded. They know that people are not just going to yawn and look the other way.
    I will definitely let you know how the meeting goes Duane.
    I fully support National reforms as well.
    Best,
    David

  • “To debate such a specific issue in society, with the amount of intense emotion in the issue, would result in non-productive polarization and further fixation of current policy and procedures.”

    I take this idea seriously. I believe this is a real possibility when passionate people with definite but different views debate and discuss anything.

    I do believe vigorous oppostion can turn back the tide and is worth the risk of further polarization. Duane has commented before about the need for broader reform efforts, I believe, for this very reason. He’s tired of nibbling around the edges. I support opposition efforts at multiple levels I guess. I don’t want to concede this fight in the hope that a second order change (federal legislation) will occur (but of course I hope it does).

  • Corinna, this is an important point. There haven’t been too many blogs or news stories on MIA yet specific to those classifed as “mentally ill” in the criminal justice system. Whether we’re talking jail, prison, or persons determined to be NGRI (Not guilty by reason of Insanity” or IST-U-CJ (Incompetent to Stand Trial, Unrestorable, Criminal Court Jurisdiction) and being considered for Conditional Release or otherwise on parole/probation.

    You can see the extreme power differentials at play. In fact, I’m embarrased to do this, let me provide you with a link to a recent story here in Ohio which involves the head of NAMI Ohio and relates to mental illness and the criminal justice system. If this doesn’t keep you up at night…well here’s the link:

    http://www.vindy.com/news/2012/apr/22/facing-mental-illness/

  • I agree with you John and appreciate you responding. “Degrading” and “Dangerous” are exactly the right words. Less than human also comes to mind for me.

    ***Some breaking news***
    I will have an opportunity for a face-to-face conversation with the NAMI Ohio Director June 15th.

    I doubt I’ll change his mind, but I’m going to try.

  • Yes, this is the dangerous point. Outpatient Treatment includes any of the following:community psychiatric supportive treatment (case management), assertive community treatment, medications, individual/group therapy, peer support services, financial services, housing or supervised living services, alcohol or substance abuse treatment and “any other services prescribed to treat the person’s mental illness and to either assist the person in living and functioning in the community or to help prevent a relapse or deterioration.”

    So, pretty much whatever a professional determines a person needs can be ordered. When the individual refuses any/all services or isn’t “compliant” they can be found in contempt and hospitalized where “treatments” like medications can be forced.

  • That reminds me. Maybe Corrina or someone she knows can do up some MIA shirts for sale.

    My concept is a MIA logo on the front and on the back, “I got censored by Kermit — 2012”

    It will get a discussion started when you wear to your favorite eatery!

  • I love your feedback A. but I find myself still hopeful that change can/will happen (naive? perhaps.)

    I know these types of bills have been beaten back in other States, so it’s possible. Slowing the inexorable tide of chemical imbalance myths, calling life struggles “illnesses, Pharma, Psychiatry, Government and Education in the same hammock…these issues do get me down.

    I appreciate your thoughts and I’m pretty sure Kermit will let them stand!

  • You’re spot on Stephen. Not going to the sources reflects an unhelpful arrogance. What’s worse is asking people for their input, pretend to listen but disregard their feedback. I’ve seem many professionals “go through the motions” of soliciting consumer/peer feedback. Fewer actually put what they were told into action or used the feedback to change/reshape a system or service.

    Appreciate your thoughts.

  • The statewide group representing peers (Ohio Empowerment Coalition – OEC) is NOT in agreement. Neither are the statewide organizations representing provider agencies and mental health & recovery boards (local planning authority).

    Given that most legislators are wise enough to pause when these three groups don’t support an issue, my hope is that the bill fails miserably.

    Any letters or thoughts are welcome. We appreciate that other States have gone through something similar (Connecticut) or could in the near future.

    One last bit of irony. The fact they are using the term “anososgnosia” is ironic. Google Dr. Breggin’s piece on ‘Intoxication Anososgnosia’ when you get a chance.

    Thanks Stephen.

  • Appreciate your thoughts and feedback Jack. Our county has decided to take a “wait and see” approach to Health Homes here in Ohio. For all the reasons you cite, we just don’t think this approach is the right direction. We feel blessed that we’re not forced to adopt this paradigm and still have the flexibility to adopt recovery oriented services that embrace Medication Optimazation principles (low/no meds); focus on employment/education, alternatives to traditional service array, etc. Have a great weekend, it’s getting darn hot here in Ohio!

  • Jack, Ohio doesn’t begin this “strategy” until October. Could you say a little about the concept of case-rate versus fee-for-service? My understanding is that Health Homes will be paid via a case rate. Now on paper that may make some sense. Agencies are “encouraged” to provide the best possible care thereby reducing/eliminating high-cost services (hospitalizations) and reducing service volume such that the case rate is attractive to the provider. Do you think the shared risk arrangement between the State and Providers is sufficient to encourage quality treatment? Thanks

  • You have to wonder if he really believes what he just wrote or feels obliged because his “bank” asked him to. Such an anemic response makes me think his heart really isn’t in it.

    Remember Baghdad Bob during the first Gulf War? Even when US troops were banging at the doors Bob assured the world that Iraqi troops had roundly beaten the infidels! Pay no attention to the man behind that curtain…

  • Thanks again for posting Dr. Foster! Several bloggers and responders have raised this issue, globally called “Informed Consent” Truly informed consent is rarely offered or given for all the reasons and more you’ve outlined in your piece. This should be an ethical obligation all physicians take very seriously in my opinion. It’s a two way street. Physicians needs to be informed and those seeking services need to be informed. Anytime a physician and someone seeking services sits down for a discussion, two experts are in the room. Presumbably one is an expert in “medicine” while the other is an expert on themselves. Power has to be equal for consent to take place.

  • I first heard of the word anosognosia reading Peter Breggin’s works. I think he refers to it as “Spellbinding” now. It’s when the effects of a drug on a person are not fully realized by the person. This word seems to have been hijacked by those who want to force treatment (usually meds)on individuals because they just don’t know how sick they are…strange twist.

  • I appreciate your honesty Dr. Keys. I’m waiting for the next blog or maybe the one after that, because I think you’re at that fork in the road regarding future career path. Don’t we all want to be involved with vocational efforts that are meaningful and fulfilling? I can see how the profession has changed so dramatically that some just wouldn’t want to keep doing it anymore.

  • Check out the Frances video on MIA but listen near the end and hear Dr. Frances’ views on the future of psychiatry. I’m hoping some of our psychiatrists bloggers will weigh in. Summary version: He absolutely believes there’s a need for psychiatrists going forward. He thinks all of us need to start paying more attention to “severe mental illnesses” not mild to moderate ones where there’s no evidence that meds help. So, for all the things Frances says that I agree with, I’m still wondering about the distinctions he’s making, it’s one I hear NAMI make a lot. “You’re not saying Schizophrenia isn’t a real illness are you?” “What about Severe Depression (Melancholia – great visual movie by the way), that’s real right?” Anyway, hope folks get a chance to watch and respond.

  • Thank you Duane! We’ve pointed to your website(Discover & Recover)in Ashland as a good source of information for “whole person recovery.” I’ve found that your responses on this site seem to move the conversations forward, so I hope this hand sitting doesn’t last too long!

  • Great stuff in this link Duane. We’re implementing now and planning to implement many of the programs, approaches, concepts, etc. articulated. I’m hopeful other folks around the country/globe who are engaged in similar transformative change efforts will weigh in.

  • “It’s not involuntary intoxication. You choose to take these drugs. Of course there is fraud, the whole of psychiatry is fraud.”

    It may be voluntary but for many wouldn’t you agree it is uninformed? Voluntarily taking a pill that produces unexpected or unknown consequences is a factor no? You’re familiar with akathisia which we know a bit about:

    Suicide attempts associated with akathisia.
    Drake, Robert E.; Ehrlich, Joshua
    The American Journal of Psychiatry, Vol 142(4), Apr 1985, 499-501.

    I understand your point regarding pills and robots, I’m just not sure its as clear cut and simple as you’re arguing.

  • This is helpful Stanley. We’ve come to the same conclusion regarding communication. It’s a bit like Motivational Interviewing with these folks. We try to understand the language they use and work within it to make our points. We’ve gotten too many blank and glazed eye stares when we use “recovery” language.

    I heard a quote the other day that seemed relevant to the challenges we’re facing. “It’s not that (insert person, institution, etc. here) is stupid, it’s just that they know so many things that aren’t so.” Cheers.