Saturday, July 2, 2022

Comments by nickdrury

Showing 43 of 43 comments.

  • Niall & James – you’ve done a good job judging by the comments section – many intelligent and responsive remarks. Since psychiatry started in the 19th century we have found a great deal of biological disorders mixed in with psychiatry – such as dementia, what we once called “imbecility”, autism, etc etc. These have gradually been weeded out of psychiatry and handed over to the department of neurology etc. This process Foucault refers to as “depsychiatricization”. Once we have completed this weeding out process we are left with folk who have some disruptions in their primary intersubjectivity; their innate ability to read and respond to others in their local culture spontaneously. The enactivists, especially the radical enactivists (Hutto et al), propose that mental health professionals do away with any efforts to “know about” their “clients” (or whatever word suits), and instead focus on developing their own “know how” skills so they can re-engage these people in their primary intersubjectivity. Seikkula’s open dialogue is a method – which he refers to as “a way of life” (2011, p. 185) – that has helped people recover from psychosis by facilitating the recovery of primary intersubjectivity with their social network (and vice versa). Subsequently, the University of Jyväskylä in Finland is conducting research on treating trauma, marital difficulties, and other problems using the same approach.

  • Allan – what do you make of the dodo bird finding with regards to outcome research?

    And Allen do you acknowledge that 4e or enactive approaches to cognitive science are (in the words of one of the leading exponents) ‘no longer the barbarians at the gates of cognitive science but now occupy the cafes and wine bars’. If so what forms of psychotherapy do they support – do you know?
    (Science at the cutting edge)

  • Twenge (‘iGen’ 2017) and Greg Lukianoff & Jonathan Haidt (‘The coddling of the american mind’ 2018) say in their books that the increased concern with safetyism and the iPhone social media phenomena is “coddling” the American mind (& all developed countries likewise) – and it is responsible for much of the mental health epidemic in the young. As children have far less unsupervised time when they are growing up they are reaching the “leaving home” stage in a state of immaturity. Social media is intensifying panopticism – everybody looking in the mirror of social judgement – leading to the development of completely fabricated selves – and little of our natural human relational selves are left. Mental health industry adds to this due to the ‘looping effects’ (Hacking) of the Dark Side Manual (DSM)(or the Book of Woe) – which is where the self-fulfilling prophesy of these diagnoses kick in, as well as the formation of like minded groups which interact with these labels – consider the number who identify as “neuro-diverse” or the exponential rise of transgender youngsters (and their parents demanding puberty blockers). This survey is yet another pointer to this social phenomena – which is not going to get better by pumping more money into mental health as it currently stands.

  • Hi Anders

    You have left the problem of deciding which of the estimated 500 schools of psychotherapy one should prevail. You appear to have presented from a CBT perspective – but what if you had presented from a psychoanalytic perspective, or a solution focused brief therapy perspective, etc etc. Its a veritable Tower of Babble situation as these various schools compete in the market place. Most are like religions in that they require both practitioner and “client” to accept certain assumptions – in your case that it is possible to have meta-cognitions – cognitions about cognitions – which has been questioned by some philosophers. Just as psychiatry has got a significant number of people f..ed up on drugs, so too do a number of psychotherapies get people hooked on a set of metaphysics – which may turn out to be equally harmful. First do no harm.

  • Hi Justin – thanks for this. I am inclined to agree with l. e. cox, there have been many ancient paradigms – “demon possession” is played out today by White & Epston’s narrative therapy – they “externalise” the problem and then look for “unique outcomes”, ie. times when you didn’t succumb to the “devil” – and then build those (often unnoticed) responses until you are free. Madness-as-strategy can often be played out by viewing so-called depression as the time your ‘soul’ goes on the journey emulating the seasons – summer, things are fine; then autumn, when things die and it goes from wet to sunny many times a day; then winter, when I retreat into my heart’s cave to hibernate, & in the stillness of winter somethings crystallise; which is followed by spring, when there are lots of new flowers, many of which don’t make thru to summer. Even the ice age had its thaw. As a philosophy professor you’ll surely like Wittgenstein’s take on psychosis, which was partially inspired by Arthur Schopenhauer whom Witt. read as a young man – bringing back into balance the “soul” (the subjective self that “is the world”) and the objective self (see Sluga)….

  • Nice article Andrew – a keeper. I was put in touch with Ivan Illich’s paradoxical counter-productivity reading this – Illich of course was writing about several institutions in modern society where as they poured more money into them there was greater negative effect at the other end – which of course then demands more resources to tackle the problem – and the result is even greater harm – which of course then demands… You get the picture! One of the things I’m increasingly attracted to is depsychiatrization – which is not and can be distinguished from anti psychiatry. Foucault traces the commencement of depsychiatrization to the 19th century when they started filtering out dementia etc as belonging more in the department of neurology. I think most doctors outside of psychiatry are recognising that what’s left does not belong in medicine. Now psychiatry came about when the doctors put up their hands in the 19th century to answer the magistrates question of who can predict dangerousness. We now know that claim was false – and still is – no profession has more claim on the prediction of dangerousness than any other. Now I am proposing that this task should fall back on the police, the traditional dealers of dangerousness in society. Currently police forces around the world are attempting to adopt a “policing by consent” policy where they can, which would humanise policing (US policing is seen as the anti-thesis to this). Police are employing social workers with greater frequency. Other social agencies, especially public welfare, are picking up on many people who had previously been dealt with by “mental health” services – most not requiring the debilitating requirement of a diagnoses.

  • In countries that have public health the tax payer has a claim in what is measured as outcome. For me, I would want to see 3 simple and overlapping measures – Are they in full time work or study? Do they still have symptoms which attract the attention of a psychiatrist? Are they medication free? These 3 measures are used by Seikkula to argue for good and bad outcomes.

    I think for individual therapists working in MH settings – you mention Duncan’s “Partners for Change Outcome Management System” (PCOMS) (which is also known as Scott Miller “FIT”) – is recommended as it facilitates the therapist being accountable to the client (or whatever term you prefer to use here).

    I would suggest keeping it simple (the PCOMS takes 1 minute at the beginning and another minute at the end to administer and score). And the 3 outcome measures of questions could provide us with a simple way to compare effectiveness around the world. (Instead, I fear we will get numerous suggestions and questioning of this – which will muddy the waters – and we will have no idea of our successes and failures – which is close to the current state).

  • Peter – thanks for this, I downloaded the original article. Wittgenstein ends ‘Philosophical Investigations’ with this remark: “The confusion and barrenness of psychology is not to be explained by calling it a “young science”; its state is not comparable with that of physics, for instance, in its beginnings… For in psychology there are experimental methods and conceptual confusion… The existence of the experimental method makes us think we have the means of solving the problems which trouble us; though problem and method pass one another by”.
    His ‘Remarks on Psychology’ and ‘Philosophy of psychology’ contain some very astute observations of human psychology – more than many textbooks on psychology – and those remarks have led to radical enactivism which has become the dominant voice in cognitive science today. (Kahneman, who is referenced in the Debrouwere & Rosseel paper, was a student of Wittgenstein; and went on to develop his ‘fast and slow thinking’).

  • Liam, I would suggest that amongst your reading some of it is dedicated to radical enactivism, which is a Wittgensteinian approach to “mind”. The enactivists are more likely to say thinking goes on in the body, or that it is subtle shifts in body positions or postures as we consider something from this point of view or that. The mistaken neuroreductionism that assumes thinking is a process that goes on the head characterises the authors of the paper you refer to. Radical enactivism is, to quote Dan Hutto, no longer the barbarian at the gates of cognitive science, but occupies the cafes and wine bars. (Great quote don’t you think.) The conclusion of this research (Valtonen et al) is partially correct, the psychotherapists cancel out the medicating doctors, and vice versa; because neither of them have reached deep enough down to root out the misunderstanding that was fostered largely by Descartes. Both Freud and Wittgenstein said you have to reach deep down to root out the problem, and although Freud was largely mistaken as to what the problem is, this error (about the nature of mind) is partially fuelling the epidemic that we are all drawn to on this site.

  • Hi Joanna, nice article, however your brief history doesn’t account for how come these ‘social problems’ came under the jurisdiction of welfare, and then health. Foucault provides me with a stronger clue by saying that in the early 19th century medicine put up its hand when the magistrates were asking who could predict dangerousness. It was that claim that got medicine (later operating as psychiatry) the key to the asylum. If we acknowledge that was a false claim, and no one can predict dangerousness better than anyone else; then presumably that function would fall back into the hands of the police. Currently there is a ‘movement’ to transform policing to ‘policing by consent’ – which is a move to humanise policing. If these ‘social problems’ were tackled in a solution-focused manner, (which ultimately stems from Wittgenstein), then police could be educated in a SF philosophy, and people wouldn’t get bogged down in endless analysis of the problem(s). This newly emerging shoot needs nourishment.

  • Thanks Philip, great article. Many years ago I saw an old NZ Måori women who said she had never been ‘depressed’. I asked her what her secret was and she told me that she had been taught by her people that our moods come with the seasons. In summer everything is going along fine, then comes fall and the weather can change many times in a day, and that is followed by winter when I retreat into my heart’s cave, and every thing becomes so still and things crystallise. That’s followed by spring when life emerges again; nature is so prolific in spring and not everything makes it thru to summer. She said she known her share of winters in her life, but she had faith that even the ice age had its thaw. She said the problem with your culture is you are a bunch of surfies wanting an endless summer.

  • Jenny, I think everyone here on the MIA website is keen to see de-psychiatrization, and OD provides some light on how this might be achieved. One of the facets that von Peter et al credit OD for identifying is its use of language and meaning-making. Using non-psychiatric language the facilitators pay attention to words, stories, and themes the network participants perceive as important, and facilitate a ponderance upon these, tolerating silences. One could be excused for seeing this as a form of psychoanalysis, albeit without the authority of the analyst offering interpretations. (Which von Peter describes in the section on professionalism.) When Trigant Burrow, a founder of the American Psychoanalytic Association and contemporary of Freud, broke with the APA (they in fact kicked him out), he formed a community, that lasted well beyond his death, that was without the authority of an analyst offering interpretations, and that appears very much like OD.

    So perhaps one of the paths to de-psychiatrization is thru a renewal of interest in psychoanalysis, albeit without the authority of analyst. Indeed we can see this with the relational mind research that Seikkula is heading at the University of Jyväskylä, where he is taking an OD approach to a variety of other problems. Recently radical enactivism has offered a new slant on what used to be called “the unconscious” that was the target of analysis. This is easiest to understand by using Daniel Kahnman’s ‘fast’ and ‘slow thinking, to suggest that mostly we use ‘fast’ (intuitive) thinking, especially when we are in conversation with each other; and when we both do the conversation ‘takes on a life of its own’ (think of conversations with friends). Blocks in this are often mental health problems – and the task of OD facilitators or therapists is to get the conversation flowing again. The task of the therapist is to dissolve the ‘block’, and not to name it. (To name is part of slow thinking.) A similar ethos existed in the zen monasteries.

    Psychiatry first adopted versions of Freudian (and his disciples) psychoanalysis, but as it was wrongheaded (due largely to the receptive culture it appeared in – see ‘The Southern Theory’), and so they moved to the medical model, which was equally wrong-headed, for the same reasons. As Wittgenstein commented on psychoanalysis from his day, we can say the same for psychiatry today, “its done little good, and a great deal of harm”. But we shouldn’t let this distract us from the potential to do good; that change for the better can come thru talk.

  • I suggest you look at Trigant Burrow who got kicked out of the psychoanalytic community in the 1920s for saying that it makes more sense to regard mother as the love subject and not the love object as Freud had proposed. This inverts western psychology. He was so marginalised for this claim, even though he was one of the original founders of the American Psychoanalytic Association, that he often doesn’t even appear in those histographies of break-away analysts forming their own school. In July 2022 the International J of Psychoanalysis will be honouring him with a special edition.
    You are reading Daniel Kahneman, I suggest you study Radical Enactivism, as it incorporates all your interests. R.E. claims that mostly we engage in fast thinking, which is without content, as we (usually subtly) adjust our sensori-motor orientations to things. Like a blind-man with a cane, we are constantly re-attuning to the world. Conversations take on a life of their own, especially good conversations, as we give ourselves to them. Mental health problems are seen blocks in this flow. Seikkula’s Open Dialogue approach with psychosis is seen as one way of re-obtaining flow.

  • Thank you for writing this Sheelah. You could make the case that the rest of psychiatry consists of mainly cargo cult science also. I will look for references to John Frum (see the wikipedia on cargo cults) in psychiatric journals in the future (lol). Have you looked at enactivism with regard to cognitive science and so-called ADHD – e.g. Michelle Maiese’s work? Enactivism, with its acknowledgement of fast & slow thinking, fits better with Bronowski’s musings over language evolution. Maiese suggests many of the kids attracting this diagnosis can best be helped by intensive activities that engages the whole body rather than focus on so-called executive brain functions; although many will grow out of any differences with their peers naturally – and the problem all along was the industrialisation of education assumed children develop at the same rate.

  • If you are interested in this look at Connell’s ‘Southern Theory’ – which is about the social sciences being dominated by the Northern theories, which frankly don’t work when applied to many indigenous cultures. Another very good broad overview, but a bit lengthy to read, is Joseph Henrich’s ‘The Weirdest People in the World’ – where ‘WEIRD’ is an acronym for Western, educated, industrialised, rich, and democratic) besides the usual implication of being peculiar. He plays out the origins of this in the Roman Catholic church, and later the protestants, forbidding cousin marriages, with increased rigidity (4th 5th and even 6th cousins not being able to marry each other), which had the effect of mobilising this european populace, and making them more individualistic. He tends to kill the book with too much detail. Then you can also blame Cartesianism for individuating the European mind – most westerners believe they have a mind (as a thing) inside their heads, which allows them to stand apart from the world and manipulate it (and their fellow travellers); but a new philosophy of mind has arisen this century that puts Descartes in his place. Its called enactivism – and it doesn’t think of ‘mind’ as a thing (noun) but more as a process (a verb); and as you have more (motor) nerves going to the senses than coming in, you can think of yourself as like a blind man with a cane – using your senses to stay in tune with the world. This is far closer to the way (many) indigenous people see the world.
    When it comes to psychotherapy, I think solution focused brief therapy comes closer to this new philosophy of mind – as it doesn’t even bother with the problem

    Hope this makes sense and I hope its not too late..

  • Again Rebel I think you are mistaken when you say there is no such thing as a “good trip” – I have had nothing but good trips since I first ingested a psychedelic in the 1960s. As I said previously, I think the crux of the matter is Dr Moncrieff’s remark “When, and if, psychedelics get a medical license, the psychotherapy is likely to be dropped or minimised.” I’ve guided many people on “good trips” – and they have thanked me for years after. A good guide is essential and the release of these drugs without the safeguard of good guides is a recipe for disaster.

  • Rebel – I think you are wrong when you assert that psychedelics cause brain damage just as psychiatric drugs do. I have not found any evidence of this in over 50 years following the research. If you have some evidence please point me to it.

    Joanna makes the remark “When, and if, psychedelics get a medical license, the psychotherapy is likely to be dropped or minimised.” And I think that is the crux of the matter. The CBS documentary that cwyandot posted above, that was done on the Spring Grove treatments that were offered in the 1960s, makes much the same conclusion. Those folk with the key to the medicine cabinet must assume a far more humble position, much as anaesthetists do in surgery, and give leadership to the therapists (the surgeons of the mind).

    Microdosing is being popularised in Nicole Kidman’s new TV series ‘Nine perfect strangers’ (based on Lianne Moriaty’s book).

    good wishes

    Nick Drury

  • Thank you Brett – as a Wittgenstein inspired psychologist I am very aware of the mereological fallacy. Neural patterns are called ‘neural signatures’ by the enactivists (a movement which is sweeping the planet in cognitive science, as we get to understand what Wittgenstein was on about), as neural signatures are but a small part of the “mind” (or mental circuit) which includes the larger brain-body-world dynamic (which is the whole). (See Gallagher – 2017 ‘Enactivist interventions). Enactivists Hutto & Kirchhoff (2015) have been quick to point out that there are few neural networks (signatures) in play throughout development – at different ages different signatures – especially for social functioning. Wittgenstein once said with regards this debate: “The best prophylactic against this is the thought that I don’t know at all whether the humans I am acquainted with actually have a nervous system”.

  • I would suggest that some may find the work of Trigant Burrow useful in thinking of a new (old) paradigm – he said that “it is futile to attempt to remedy mental disease occurring within the individual mind so long as psychiatry remains blind to the existence of mental disease within the social mind” (1926, Our mass neurosis, Psychol. Bull, 23, 305-312) (You will have to excuse his language – its a bit dated). Burrow was a founding father of American Psychoanalytic Assoc, but he was kicked out of there for his unorthodoxy. His thesis was that the “social mind” was “suffering” (our mass neurosis if you will) from what we would describe today as “Cartesianism” – the idea your mind is in your head, that you have an individual ‘mind’. He said that Freud got it wrong by saying that mother is the love object; when she is in fact the love subject. Freud thought that you became frustrated in not being able to access the breast when you wanted it, and in your rage you objectified mother; but Burrow reasoned that you retain the primary harmony and identity you have with mother in the womb, despite frustrations – and we have a primary harmony with each other as we develop (see Levy-Bruh – the ‘Primitive Mind’ – many indigenous cultures have a sense of “we” or “us” that is primary – eg the Zulu “ubuntu”). What we objectify is ourselves – we start thinking of ourselves as separate isolated minds – Cartesianism. We become divided within ourselves – constantly checking ourselves out in various mirrors (panopticism for Foucault). Burrow was doing research on divided attention versus the undivided and publishing is in Nature (a v. prestigious journal) in the 1930s – needless to say when a similar line of research occurred in the 1960s, nobody mentioned Burrow. He was terrible writer, as DH Lawrence told him, but he was praised by Lawrence and other noteworthy thinkers of his age; but not by the “psy” field (although some were plagiarising bits of his work). Wittgenstein has criticised Cartesianism (an enduring hostility to the idea of “individuated substantive self”) and he exposed Descartes philosophy of mind as containing self-referential paradoxes (similar to Epimenides ‘Liar Paradox’ – e.g ‘this is a lie’). From Witt. has come a new science of mind (this century) called enactivism (or 4E cognition) that recently explored the idea that our first consciousness is in the womb (cf Ciaunica) and instead of explaining that we are social beings because we are innately empathic, (and then its mystery as to how we are empathic), we are empathic because of this early experience. In other words Burrow is right. Burrow did not advocate a return to this primordial state of unity but reinstate a specie-wide integration of a mature and culturally advanced level. As Sami says “There is no doubt in my mind that such societies cannot happen under the umbrella of capitalism”.

  • Great commentary Cabrogal (a girl from Cabramatta??) – where can I get some! Great conversation old head.

    If ego death is a “curative” factor for some using psilocybin (and other entheogens) might there be a non-drug way of achieving this? The philosopher Wittgenstein, was deeply anti-Cartesian; and it was Descartes “I think therefore I am” (‘Cogito, ergo sum’) that has led to the ego being a central assumption in Western culture, especially under neoliberalism which assumes people are isolated monads (& judges you on what you do, and not on your being). Wittgenstein said the task of philosophy was to sort out conceptual confusions that prevent us from thinking clearly, and Descartes error is central to this. Wittgenstein drew our attention to the 2 ways that we use the word “I”. We use “I” to describe ourselves as an object, as in ‘I have grown a centimetre since I last measured myself’, ‘I have broken my arm’, ‘I have a bump on my forehead’. But we also use “I” as a subject. This is done to refer to our mental states and sensations, such as seeing & hearing etc, and feeling pain. This is where Descartes went wrong, he tried to objectify the use of “I” as a subject. Nietzsche drew our attention to the noun-verb structure of our language, and how it creates ghosts in our thinking, like the “it” in ‘It is raining’; or how we break up one thing into two as in “the lightening flashed”. There is of course no lightening apart from the flashing. So there is no “I” who is thinking, seeing, hearing, etc. It is just a convention of language. In his Tractatus, Wittgenstein says that the ‘I’ who is thinking or seeing (etc) is the world (just as the ‘it’ in “It is raining” is the world). He confirms that this egoless subjectivity is the mystical (of the Lao-tsu or Meister Eckhart variety).

    Now a number of subsequent Wittgenstein scholars have suggested that we cultivate an imaginary self (or socially construct an imaginary self), but that it has no substance. There is just the narrative of a self. Foucault has one of these in mind when he speaks of the care of the self. However Lao-tsu warns we should drop that readily, with his comment “accept disgrace willingly”. Schopenhauer, who had a strong influence on Wittgenstein, taught that without a self, we were naturally very caring towards each other (cf. Matthew 18:3). Foucault, I think, wants us to cultivate a self based on this more natural way of being.

    Now I think, for some cases of so-called “depression”, but not all, ego-death is “naturally” occurring. If you look upon so-called “depression” as the ‘winter of the soul’, it makes some sense to imagine that some of our moods arose with the seasons. In ‘summer’ things are rosy as life blooms and buzzes, but it is followed by ‘autumn’ when it goes from being ‘wet and windy’ to ‘fine’ again, sometimes many times in a day. Then in ‘winter’ I retreat into my ‘heart’s cave’ where things ‘crystallise’ as things become very still. Of course ‘winter’ is followed by ‘spring’, and remember the ice-age even had its ‘thaw’. Nature is prolific in ‘spring’, and not everything arising makes it thru to summer. Although I have consumed my share of entheogens in my younger years, I have also experienced my share of ‘winters’, and now see more clearly.

  • Sorting out confusions is the domain of philosophy not science – philosophy is about elucidations, science about explanations. Science deals with causes, philosophy with reasons. This was the essence of Wittgenstein’s philosophy, but the world has been taken over by a scientism – the great hope that a scientific answer can be found to our confusions. Some psychotherapies come closer to philosophy than science – such as Open Dialogue and Solution Focused Practices – they allow confusions to dissolve (“like sugar in water” – Wittgenstein). “We are aiming at complete clarity – so all philosophical problems should completely disappear” (Wittgenstein). Scientism is rooted in Francis Bacon, when he separated “scientia” (knowledge) from “sapientia” (wisdom) and instead united it with “prudentia” (‘Knowledge is power’). Scientism looks for leverage – in mental health this generates much suffering as we all know. Both APAs approach individual confusions with institutional confusions; but they are not alone. Most social services are making a similar error.

  • Hi José
    The correct Illich term is ‘conviviality’ not ‘coviviality’. I read the original, and I take my hat off to you for attempting to summarise it. Dr di Nicola has written, what amounts to a political essay, suggesting a paradigm change can occur in the “west” (or the Northern countries) if they could learn some lessons from the south. Judging by their comments, many consumers didn’t realise this is what his article is about. Most consumers want a paradigm change to occur in mental health. I think di Nicola has attempted to summarise many complicated ideas, and as Wittgenstein would say, a place is not prepared in the average reader’s minds for many of these. For example, Foucault’s term “dispositif” he summarises using Agamben reworking of it, but I think it simpler to say that it is the ideas that lead to institutions and practices that ‘disposes’ us to act in certain ways. Di Nicola is saying that the northern countries could well develop some new ‘dispositifs’ from lessons it learns from the south. For example using Illich’s conviviality, the north could learn some lessons about co-operating better. Thank you for bringing this article to my attention.

  • Hi Laurell, NZ Maori have the 4 minds as the physical (tinana), spiritual (wairua), emotional-thinking (hinengaro), and the social (whanau). It would seem that you intuitively combined thinking and emotional, but you omitted the social ‘mind’. I think this is closer to the division of the 4 “minds” to many indigenous peoples, and I think it is typical of western culture to omit the social mind. I think the reason was identified by Foucault in his comments on “the cartesian moment”, and it has been commented on by the anthropologist Clifford Geertz (p.59, 1983, Local Knowledge). Thank you for your article.

  • Nobody has commented much on the risk factor that the article mentions. The governments are keeping psychiatry alive and in power due to their claim that they can assess risk to society. Indeed in the middle of the nineteenth century, when arguments were being held whether you needed medical specialists in the new built asylums, let alone running them, the medics argued strongly that only they could detect dangerousness, at 50 paces if you like, even when it wasn’t apparent to others. This gave them key to the asylum, and they have held them ever since. No other profession or body, other than the courts, have made this claim. Until this is addressed psychiatry will rule the casino.

  • Yes Bradford is on to it.I agree with David Clark that service users should be able to access outcome data of clinicians – but David Clark is producing dodgy outcome statistics. In a parallel with the drug companies, Clark is not independent from the outcomes he’s reporting – and indeed it is very difficult to get someone who is. MJ Scott – ‘IAPT the need for radical reform’ – JHealthPsychology, 2018, 23(9) 1136-1147 is one of the rare individuals standing apart from the IAPT making comment. Scott Miller and Barry Duncan have been producing outcome informed therapy articles for nearly 20 years – their measures are simple, fit for purpose (unlike the IAPT tools), etc. Bruce Wampold even delivered a key note at the IAPT conference pointing out that the NICE guidelines are tram tracks hampering effective therapy. There is bad politics in IAPT, showing that psychologists are just as prone to institutional corruption as the psychiatrists are.

  • It is difficult to find any reviews of the IAPT that are not written by someone who has a vested interest in this – ie in the case guild interest. Here is one I found MJ Scott 2018 Improving Access to Psychological Therapies (IAPT) – The need for radical reform. (Journal of Health Psychology 23, 9: 1136-1147 doi: 10.1177/1359105318755264) Basically the author is saying that there are too many restrictions around the protocols of how it is administered – the results are not what they are cracked up to be – There seems to be a case here for “institutional corruption” in a similar way to Robert Witaker book ‘Psychiatry under the Influence’ – but here it is psychology – showing they can be corrupted similarly – Lets not have the Greens in NZ rush in with this waste of tax payer dollars – lets develop some thing different.

  • A timely report Robert. I think one of the most compelling accounts of the mental health epidemic in general is Wilkinson & Pickett’s latest book on wealth disparity (The Inner Level). They cite research that found threats to social status pushed up the stress hormones the most of all anxiety inducing situations. They then reviewed status anxiety research in relatively equal and unequal societies; and not surprisingly found that mental disorder increased a society’s wealth disparity increased. But not only does status anxiety increase as equality goes out the window, but so too does community life. As sense of community goes, interpersonal trust lowers, and the level of violence (as measured by homicide rates (and I dare say suicide rates)) increase.

  • Look at Wilkinson & Pickett – ‘The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyones Wellbeing’ – they argue that it is not poverty per se that is causing the stress, so much as the disparity between the wealth disparities – the same applies in very poor countries – if there is wealth disparity there is increased mental disorder etc – if there is greater equality there is greater community life, trust, willingness to help each other, and low levels of violence,
    Here is a 5 minute read

  • It appears to me that a great many people who have commented haven’t understood the article or are just giving their usual response we read frequently on MiA- its a justifiable argument to present the Szasz anti-psychiatry argument – and I can understand how many of you are angry at what psychiatry has done – but it seems that it is arguments like Joanna is writing that is going to dismantle psychiatry – not just your expressions of anger. I would like to hear from some more philosophers, especially those with a Wittgenstein bent. I think he holds a key because unlike Descartes he starts out from a position of social unity, whereas Descartes starts with individualism.

  • At the risk of adding yet another view to this long train – it took a couple of hours to read it thru – and adding to the confusion – let me offer this. When I began training as a psychotherapist I was attracted to the Mental Research Institute’s (MRI – Haley, Watzlawick, etc) take on problems; that most problems are attempted “solutions” to some other life difficulty that hasn’t been successful; and some of us began writing the word “problem”, or “depression”, or “panic”,etc in strikethrough (which I don’t seem to be able to do on this site). I later discovered it was the “sous-rature” style of Heidegger and Derrida, the view that the word was “under erasure”. This is the Easter Bunny dilemma that others raise, if there are no mental health disorders then what are these woes? It seemed to me that this view enabled me (and others) to stop pulling the noose of diagnosis tighter, and review such situations as wrongly formulated. My friends in psychiatry insisted I pull the noose of diagnosis tighter. Later I was encouraged by Solution Focused Brief Therapy, and by simply exploring the preferred future there was no need to know of the problem, and I found problems (under erasure) dissolved literally like sugar in water as people began realising their preferred future.
    Lawrence, you offer an analysis of the reason d’être for psychiatry pulling the noose tighter as changing historical conditions. If I get it – once it was to warn others that there is no escape from the factories of industrialisation (you can’t get out of the social contract that way!); but this has mutated into a disabling profession thats become parasitic on producing increasing numbers of disabled. You cite Foucault, and no doubt you are aware of his analysis (eg Society must be Defended) that since Machiavelli governments have moved resources here and there that have contributed to the thriving of some sectors of the population and the decline of other sectors of the population. As I understand it he gives the psychiatric rationale as “we can detect dangerousness at 50 paces, so allow us to lock these people up” (Society must be Defended). Todays world is, presumably, perceived by psychiatry as more dangerous, and hence more people are disabled – you got to admit their strategy is simple – get the people pulling their own nooses tighter.
    You cite the social contract theories of Rosseau, Locke, Hobbes, as a rational behind the politics of this. But have you looked at Wittgenstein? The social contract theories stem from Descartes individualism – I can know my own mind, but not others, with certainty. From this individuals got together like some sort of Rotary club. But Wittgenstein reverses all this – you don’t join society you are already part of it! And I know your mind better than my own. Consider pain. In fact I know you are in pain immediately (most of the time); I don’t make an inference you are from your grimacing or because I have an internal Theory of Mind that I consult to understand you. I react as if I myself was in pain (especially my kids), no pause here for interpretation. I comes out of we. Dan Siegel has this neurological terms. Indigenous cultures have this as central – ubuntu in Zulu, whanuangatanga in NZ Maori, Shimcheong in Korean. If we are to recover as a culture – from greedy individualism in all its forms, we must humble ourselves to our indigenous people. Social contract theories are surrendered, ethics first (Levinas).
    So we see in Seikkula’s Open Dialogue a “treatment” that utilises this sense of “we-ness” or dialogicity. If there’s one thing we know, anyone coming near a psychotic (in strikethrough) person with an agenda, is treated with suspicion – and the most successful treatment is those where the “alliance” is good. If we look back at Pinel in Paris he tried to manipulate people into change by having Pussin rattle chains etc. He gave birth to psychiatry. But when we look back at Tuke in York, he built relationships of respect. Like Soteria he advocated lay treatment. No giving them a noose.
    Its now a hundred years since Wittgenstein, but he said it would take that long before he was understood. We are seeing glimpses of the Wittgenstein philosophy of mind permeating our intellectuals wine bars and cafes today, and the disappearance of Descartes…

  • Joannna, what do you make of Stephen Porges ‘Polyvagal Theory’ as a biological marker of mental distress; the idea that one’s vagal tone is a measure of how “uptight” or “depressed” one is? Its early days yet, but this idea looks promising.
    The idea that mental disorders are the domain of medicine is I think, an accident of history. If we had followed Tuke and not Pinel, we may well have placed mental disorder under the welfare, as Tuke was closer to Seikkula. Its a breakdown of human caring – and as Tuke and Seikkula have adequately demonstrated ‘being there’ is what makes a difference. Psychiatry offered the government with a mechanism to predict dangerousness, and this is what gained to the key to the asylums (even though they couldn’t).

  • Nice deconstruction Bob – so scary to see this. You attribute the motivation more strongly to guild interests than Big Pharma interests – but have you considered both of these as expressions of political interests? Foucault’s “Society must be defended” lecture series and other works of that time argues that ever since Machiavelli societies have allowed or facilitated the slaughter (Foucault’s word) of some of its population in order to govern – usually by the withdrawal or supply of resources – allowing some to flourish and others to be left to wither. Following the apparent success of Pinel & Tuke (1800) asylum building took off with a flourish – and the medics got to be in charge, not because Pinel (a medic) was more successful than Tuke (a non-medic) but because the doctors convinced legislators they could detect dangerousness even when it was not obvious to the naked eye. Not only that, as Foucault also showed, Western societies have increasingly (since the 12th century) been governed (ordered) by keeping people in a constant state of self-observation and self-discipline, fabricating (Foucault’s term) the excessive individualism their economic systems were built upon. So DSM psychiatry facilitates this self-diagnosis/discipline (as the confession once did).
    Seikkula is not only showing us how to respond to psychosis, but also to our collective madness. His thinking is closer to Tuke’s moral philosophy than Pinel’s medical engineering approach, as it stresses “being with” than “doing to”. This way of thinking is now finding expression in 4E cognition – the idea that “mind” is not in the head (noun-like), but embodied (verb-like) – and socially, group cognition precedes individual cognition (as Merleau-ponty saw – and Descartes didn’t). ‘We’ comes before ‘I’ – as most indigenous cultures recognise (e.g. ubuntu). Recognition of our humanity – our “we-ness” (as the Delphic Oracle suggested) leads to the kind of self-discipline we see in most pregnant women, who give up smoking and drinking with ease -(where care of self and care of other take in each other’s washing). In turn this leads to social ordering processes that are heart-felt and closer to James Cameron’s Na’vi, than the current panopticism does. Tuke comes closer to this ‘way of the heart’ due to the influence on him of Francis Hutcheson’s moral philosophy.
    So from this perspective neo-kraepelinian psychiatry is a keystone to maintaining a particular political agenda that is now well-entrenched in Western cultures – one which will no doubt see such continuing rationalisations as Lieberman (its difficult not to make fun of that name) has provided here, reminding us of the rationalisations of the tobacco industry as the evidence mounted. I suspect that as the social implications of 4E cognition mount neo-kraepinianism may find itself in a similar position.

  • Nice article Jock – any chance of getting it published in a peer review journal – perhaps one of the English critical psychiatry ones?? I came upon this article of yours whilst out hunting for those elusive outcome statistics for mainstream MH – we have great stats from Seikkula – but I would be nice to be able to compare them with other clinics – it would make his findings more newsworthy. You’ve got some here – but also you need to tie down the figures to location – like when you say $2.5 billion in psychiatric research – where? – this is an international forum – is that 2.5 Oz or international or what?

  • Yes – If medicine is to have a role in madness, it shouldn’t be lead – the anaesthetist shouldn’t be in charge in the theatre of mind – other disciplines are better suited.
    What I think Bob and Allen both need to do is look through some other lens on this – Foucault for example portrays this as a symptom of an industrialised society where the ‘self’ is fabricated by social forces (“normal self” is the water fish swim in and are unconscious of) – we are all a little out of touch with reality – the ecological disaster should provide ample evidence that mechanised society – the Empire – is a menace. Then look at Wittgenstein’s attraction to Spengler’s Decline of the West – “Even in Brahms I can hear the machine” – and his claim that he (Witt.) was writing for 100 years hence (in 1930) when “culture” might be returning. In Indigenous cultures ‘self’ is centred in Other (heteronomy not autonomy)- and the dialogicity of Seikkula etc – shows this return of responsivity as the path out of madness – The Jedi showing this path are appearing – the Empire continues to convince you that its risk management processes are not a protection racket……But the move from the cartesian-kantian empire to the Wittgensteinian-Levinasian culture is gathering momentum, and we look for outcome monitoring as accountability rather than process adherence. enough – this key is getting to large for you to weild….