Wednesday, November 14, 2018

Comments by nickdrury

Showing 11 of 11 comments.

  • 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
    https://www.theguardian.com/commentisfree/2018/jun/10/inequality-stress-anxiety-britons?CMP=share_btn_link

  • 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….