It really doesn’t matter. Canada did ratify the CRPD and the result was … absolutely nothing has changed.
Thank you for this, Peter. You are wonderful at dissecting psychiatric research to make it accessible to the rest of us. Your work is really appreciated.
Thank you, Megan, for this wonderful article. I completely agree that a mental health worker’s language is very powerful and hugely important to any therapeutic relationship.
One example from my own experience: I was told the ACT team wanted to “check up” on me. A more thoughtful way to phrase that would have been to say that the ACT team wanted to “check in” with me.
Thanks for reading and weighing in, bcharris.
Thank you for commenting, Someone Else.
Thank you for your kind words, Sam.
I would support the concept of asylums but in the early sense of the word: places of refuge. However, I fail to see why care would need to be involuntary.
Thank you, Rachel.
Thank you, Amy. I am blessed with several supportive voices. I don’t think I could have survived this long without them.
Thank you, Sam. You make a great point about language. Just as “community” sounds warm and fuzzy, the benign-sounding “right to treatment” sounds like a good thing.
How so?
You’re kidding, right?
‘…Quetiapine, which we now know is not, and could never be an “anti psychotic”….’
This piqued my interest. Why can’t Seroquel be considered an antipsychotic?
” … found out there was a significant reduction in symptoms in the intervention arm (who had some antipsychotics) compared to the control arm (who had no medication) ….”
Wondering about the medication status of the control arm, i.e. were they pulled off medication suddenly or were they medication-naive?
Thanks for your article.
25 mg Seroquel is nothing. I’m prescribed 200 mg plus 600 mg extended release daily. And let’s not even talk about the Maintena, Abilify and Epi-Val on top of all that.
Examining each patient’s particular circumstances takes way, way too much time out of a psychiatrist’s day.
The problem for me with the bio-psycho-social model is that your typical psychiatrist is only interested in the first two syllables.
The mental health police already lock people up for talking about suicide. I wonder how many people could be saved by having somebody they could talk to without fear. My best friend in the whole world has promised never to turn me in and we have had lengthy discussions about various suicide methods and what’s wrong with each. Basically, he tells me that it likely won’t work and that I’ll be in a worse off position than I was before I tried it. This is good advice.
Suicide already is a right. It’s attempted suicide that’s treated as a crime.
Thank you, truth.
Julie, I would be very interested in discussing this further with you. I can be reached at http://www.goodbyepie.com if you ever have a free moment. Thanks.
Thank you. Could you provide a link to the article? I’d be fascinated to read it. I’ve written a book called A Terror Way Beyond Falling in honour of him.
I don’t know that we can blame DFW’s depression on psychiatric medication. Why, then, was he on antidepressants in the first place?
DFW had ECT twice in total or two series of ECT?
“Safe and effective” was the verdict in Psychology 100B at the University of Victoria. I wrote to the prof but never heard back from her.
Could you share with me what the “recovery movement” is? And what’s your beef with psychotherapy?
I’m in Victoria, British Columbia and consulted Dr. Abram Hoffer in the early 1980s. He diagnosed me with “anxiety probably bordering on schizophrenia” and prescribed me liberal doses of niacin. I always thought he was kind of a quack but that’s a good quote of his – thanks for sharing that.
Wouldn’t a psychiatrist just claim that the reason that ECT is inflicted on women more than men is because women more commonly suffer from depression than men do?
I’m an ECT survivor myself. I developed frontal lobe epilepsy which cleared when the ECT stopped. There were hundreds of treatments. That David Foster Wallace went through this makes me feel a little less ashamed.
Great article, Phil.
From the editorial you cite: “As psychiatrists we are skilled in using science to change the thoughts and behaviours of individuals ….”
Thanks for the much-needed laugh.
Interesting study but the results seem intuitive.
I disagree. Mental disorders exist. I know because I have a serious one. I take plenty of actions to defend myself and I haven’t been conned.
That’s fine, so long as you’re a voluntary patient.
If and when mental disorders are ever found to be neurological disorders, psychiatry will collapse and we will all consult neurologists for our biological diseases. Fuller Torrey’s assertions notwithstanding, I’m not anticipating such a development any time soon.
This isn’t terribly surprising. My social network is what keeps me (relatively) sane.
I was sexually assaulted by a male co-patient in the Psychiatric Intensive Care unit at the Royal Jubilee Hospital. In my view, locked wards should be segregated.
At Colony Farm, the forensic psychiatric hospital in Coquitlam, I was stripped and thrown under a shower in full view of a male nurse.
Actually, I found the psych ward to be an incredibly social place and met a few good friends there. Outpatient commitment, on the other hand, is one of the loneliest things I’ve ever experienced.
“psych drugs are a legitimate “medical intervention,” which they are not, at least beyond acute/emergency care”
Pleased to see you write this, Steve. Not everybody is on board with psych meds in a crisis but I sure am.
In British Columbia, the standard for involuntary treatment can be as low as “has a mental disorder” and “is capable of deterioration.” If a more rubbery standard exists, I have not heard of it. We’re not entitled to a Court application, just the pathetic Review Panels which are infuriatingly biased and unfair. I’d feel much safer as an American citizen and sometimes consider getting dual citizenship (my mother is American) for this reason.
You’re preaching to the choir. I’m giving you honest feedback. Comparisons to Nazism just turns people off your argument.
No, I’m not saying it’s exaggerated. I’m saying it’s a bad advocacy strategy.
I don’t understand why this is being pursued when there is already a depot injection called Maintena which is the injectible version of Abilify. I should know: I’m being forcibly injected with 400 mg every three weeks.
Edited to add: And I’m wondering what effect this digital Abilify might have upon a paranoid schizophrenic. In this instance, could we really attribute her paranoia to mental illness?
With respect, references to Nazis (no matter how apt those references) actually detract from your very worthwhile message.
Pull yourself up by your bootstraps and cheer up? Brilliant advice. Why didn’t I think of that? 🙂
I think most (but certainly not all) anti-psychiatrists acknowledge a need for the “not criminally responsible by reason of mental disorder” plea, as it’s termed in Canada.
Great article. I agree these policies are deeply, deeply disturbing. We’re supposed to be eradicating stigma and “coming out of the shadows.” And look what happens when we do. If the University of Victoria did this to me, I’d sue for damages before BC’s Human Rights Tribunal.
I only use the term “mental illness” in the interest of shared terminology. Whatever we choose to call it, certainly such a phenomenon exists. The question, as always, is what it actually is. The distinction between “illness” and “disorder” is a critical one.
I’m glad for the research but isn’t exercise and good nutrition critical to the treatment of any health condition?
My impression has been that BPD is another way of saying they don’t like you and they don’t want to help you.
Great. Something else for me to worry about.
Antidepressant-induced mania destroyed my marriage, my career and many friendships. It provided me with a criminal record and a divorce. Your story speaks to me.
This is intensely depressing (but not surprising). Money really is the root of all evil. Big Pharma doesn’t give a shit about any of us.
I remember being a very unhappy voluntary patient and starting to make noises about going home. I was advised “not to try to do that” in a rather sinister fashion. As long as there is involuntary psychiatry, there can be no truly voluntary psychiatry (I think I stole that line from Thomas Szasz).
I imagine one result would be an increase in therapeutic abortions.
I wish you were my psychiatrist, Sandra. Mine’s mantra is drugs, drugs, drugs. In the past, I’ve gone for a decade with no treatment and no symptoms (1990 – 2000) so clearly I’m a good candidate for an alternative approach like you describe.
At the moment, I’m an involuntary out-patient, being coercively drugged with a 400 mg Maintena injection every three weeks, rather than the recommended four. I’m also on 800 mg Seroquel, 30 mg Abilify and 2 mg clonazepam. It’s an insane maintenance drug regime and will continue indefinitely thanks to British Columbia’s draconian Mental Health Act.
Thanks for this article, confirming many of my suspicions. I just recently inherited a flip phone and I don’t answer incoming calls unless I’m specifically wanting to talk to somebody. I only carry it for emergencies and to have an easy way to dial home and check for voice mails to my landline. Maybe they should call them dumb phones.
I don’t think anybody thinks mental illnesses are made up. The question is: are they illnesses?
Careful, Steve. The NRA doesn’t like that kind of talk.
I remember telling a psychiatrist long ago that bipolar disorder did tend to run in my family. I have two cousins with Bipolar 1. He nodded knowingly before I pointed out that both of those cousins are adopted. It was a sweet moment.
I think all mental disorders probably involve biological, psychological and social factors. It’s very rare to have the latter two addressed. Consider yourself lucky.
“Another no brainer study.”
Indeed. What next? Good nutrition helps to alleviate symptoms?
I’ve never heard that 40% statistic before. Could you provide a link to the study?
Yes, I should have made better choices but I could not because I was floridly psychotic at the time.
As to what causes my mania, I have three answers:
1. sleep deprivation
2. alcohol abuse
3. antidepressants and/or ECT
The Judge was an incompetent buffoon. Middle-aged woman without a criminal record convicted of mischief for emptying the salt and pepper shakers at a pub. The Judge made psychiatric care a term of my probation so CLEARLY he understood mental illness was at play. I wasn’t competent to instruct counsel, counsel shouldn’t have taken my instructions and the Court shouldn’t have accepted my plea. I needed hospital care not jail time. Now I’m applying for a “pardon” for crimes for which I feel absolutely no remorse.
Clearly, the Judge agreed with you. I was convicted of assault, harassment, mischief ….
Great article, Phil. When manic, my own bad behaviour has sometimes been written off as mental illness. Clearly, it’s not illness because, if it was, I wouldn’t be divorced and have a criminal record. It was bad behaviour with painful consequences. The answer is to make better choices in the future.
My understanding was that antidepressants haven’t been shown to beat placebo response for mild to moderate depression.
Are there studies showing that benzos are superior?
“If the drug is degrading the situation in the long run, it’s a bad idea from the start.”
That’s not at all clear. In a crisis, antipsychotic medication can be invaluable. That doesn’t make drug therapy a good long-term solution.
” … good advocacy, drug withdrawal help and social support … ”
These are absolutely crucial and I’m glad you identified them so clearly. I never used to take drug withdrawal seriously – I would just stop cold turkey and then launch into rebound psychosis within weeks.
This time, I’m tapering responsibly, with the help of my treatment team. I’m still on a shitload of meds but I can see light at the end of the tunnel.
We’re all guilty of confirmation bias. We tend to find what we’re looking for.
In my view, antidepressants appear to have caused my bipolar disorder. Of course, my treating psychiatrists have all claimed they just “uncovered” my true psychiatric disease. Obviously, correlation doesn’t prove causation but I have reviewed my medical records extensively and truly believe that psychiatric treatment made me bipolar.
I have an Advance Directive which unequivocally states that under no circumstances am I to receive ECT.
I’m just grateful that I grew up before ADHD was invented.
I don’t recall Hoffer sending me for any testing.
Thanks, markps2. I agree economics is the driving force. Extended Leave is just a sleazy way of cheaply incarcerating you in your own home.
Thank you, Lidi. We can talk more at Matt’s blog.
Thank you, Irit. Maybe you can try to change my mind over lunch on Friday. Nothing better than two old friends engaged in a friendly debate.
Thanks, Julie.
I actually consulted Dr. Abram Hoffer in the 1980s. He diagnosed “anxiety bordering on schizophrenia” and prescribed liberal doses of niacin. Hoffer’s rejection of mainstream psychiatry didn’t make him any less of a quack.
I’m largely immune to chemical substances so I wasn’t actually terribly affected by the drug cocktail. In the throes of manic psychosis, however, the sedative effects of antipsychotics are a lifesaver for me.
As for the reasoning behind polypharmacy in the long term, the psychiatrist’s thinking seems to be simply “Why not? Everybody else does it.” I am strongly opposed to maintenance treatment.
Hi, Frank. Thanks for reading. I’m not surprised you couldn’t hack the peer support training. I couldn’t have, either. My ACT team’s idea of the role of a peer support worker varies considerably from mine.
Thank you, Matt, for your thoughtful comments. I am aware that my terminology is a problem for some.
With respect to less restrictive jurisdictions, yes, moving to a different province would definitely help as I believe British Columbia has the most regressive mental health legislation in North America. Nevertheless, this is where my work, friends and family are and I prefer to stay and fight the system here rather than be forced to become a psychiatric refugee.
It really doesn’t matter. Canada did ratify the CRPD and the result was … absolutely nothing has changed.
Thank you for this, Peter. You are wonderful at dissecting psychiatric research to make it accessible to the rest of us. Your work is really appreciated.
Thank you, Megan, for this wonderful article. I completely agree that a mental health worker’s language is very powerful and hugely important to any therapeutic relationship.
One example from my own experience: I was told the ACT team wanted to “check up” on me. A more thoughtful way to phrase that would have been to say that the ACT team wanted to “check in” with me.
Thanks for reading and weighing in, bcharris.
Thank you for commenting, Someone Else.
Thank you for your kind words, Sam.
I would support the concept of asylums but in the early sense of the word: places of refuge. However, I fail to see why care would need to be involuntary.
Thank you, Rachel.
Thank you, Amy. I am blessed with several supportive voices. I don’t think I could have survived this long without them.
Thank you, Sam. You make a great point about language. Just as “community” sounds warm and fuzzy, the benign-sounding “right to treatment” sounds like a good thing.
How so?
You’re kidding, right?
‘…Quetiapine, which we now know is not, and could never be an “anti psychotic”….’
This piqued my interest. Why can’t Seroquel be considered an antipsychotic?
” … found out there was a significant reduction in symptoms in the intervention arm (who had some antipsychotics) compared to the control arm (who had no medication) ….”
Wondering about the medication status of the control arm, i.e. were they pulled off medication suddenly or were they medication-naive?
Thanks for your article.
25 mg Seroquel is nothing. I’m prescribed 200 mg plus 600 mg extended release daily. And let’s not even talk about the Maintena, Abilify and Epi-Val on top of all that.
Examining each patient’s particular circumstances takes way, way too much time out of a psychiatrist’s day.
The problem for me with the bio-psycho-social model is that your typical psychiatrist is only interested in the first two syllables.
The mental health police already lock people up for talking about suicide. I wonder how many people could be saved by having somebody they could talk to without fear. My best friend in the whole world has promised never to turn me in and we have had lengthy discussions about various suicide methods and what’s wrong with each. Basically, he tells me that it likely won’t work and that I’ll be in a worse off position than I was before I tried it. This is good advice.
Suicide already is a right. It’s attempted suicide that’s treated as a crime.
Thank you, truth.
Julie, I would be very interested in discussing this further with you. I can be reached at http://www.goodbyepie.com if you ever have a free moment. Thanks.
Thank you. Could you provide a link to the article? I’d be fascinated to read it. I’ve written a book called A Terror Way Beyond Falling in honour of him.
I don’t know that we can blame DFW’s depression on psychiatric medication. Why, then, was he on antidepressants in the first place?
DFW had ECT twice in total or two series of ECT?
“Safe and effective” was the verdict in Psychology 100B at the University of Victoria. I wrote to the prof but never heard back from her.
Could you share with me what the “recovery movement” is? And what’s your beef with psychotherapy?
I’m in Victoria, British Columbia and consulted Dr. Abram Hoffer in the early 1980s. He diagnosed me with “anxiety probably bordering on schizophrenia” and prescribed me liberal doses of niacin. I always thought he was kind of a quack but that’s a good quote of his – thanks for sharing that.
Wouldn’t a psychiatrist just claim that the reason that ECT is inflicted on women more than men is because women more commonly suffer from depression than men do?
I’m an ECT survivor myself. I developed frontal lobe epilepsy which cleared when the ECT stopped. There were hundreds of treatments. That David Foster Wallace went through this makes me feel a little less ashamed.
Great article, Phil.
From the editorial you cite: “As psychiatrists we are skilled in using science to change the thoughts and behaviours of individuals ….”
Thanks for the much-needed laugh.
Interesting study but the results seem intuitive.
I disagree. Mental disorders exist. I know because I have a serious one. I take plenty of actions to defend myself and I haven’t been conned.
That’s fine, so long as you’re a voluntary patient.
If and when mental disorders are ever found to be neurological disorders, psychiatry will collapse and we will all consult neurologists for our biological diseases. Fuller Torrey’s assertions notwithstanding, I’m not anticipating such a development any time soon.
This isn’t terribly surprising. My social network is what keeps me (relatively) sane.
I was sexually assaulted by a male co-patient in the Psychiatric Intensive Care unit at the Royal Jubilee Hospital. In my view, locked wards should be segregated.
At Colony Farm, the forensic psychiatric hospital in Coquitlam, I was stripped and thrown under a shower in full view of a male nurse.
Actually, I found the psych ward to be an incredibly social place and met a few good friends there. Outpatient commitment, on the other hand, is one of the loneliest things I’ve ever experienced.
“psych drugs are a legitimate “medical intervention,” which they are not, at least beyond acute/emergency care”
Pleased to see you write this, Steve. Not everybody is on board with psych meds in a crisis but I sure am.
In British Columbia, the standard for involuntary treatment can be as low as “has a mental disorder” and “is capable of deterioration.” If a more rubbery standard exists, I have not heard of it. We’re not entitled to a Court application, just the pathetic Review Panels which are infuriatingly biased and unfair. I’d feel much safer as an American citizen and sometimes consider getting dual citizenship (my mother is American) for this reason.
You’re preaching to the choir. I’m giving you honest feedback. Comparisons to Nazism just turns people off your argument.
No, I’m not saying it’s exaggerated. I’m saying it’s a bad advocacy strategy.
I don’t understand why this is being pursued when there is already a depot injection called Maintena which is the injectible version of Abilify. I should know: I’m being forcibly injected with 400 mg every three weeks.
Edited to add: And I’m wondering what effect this digital Abilify might have upon a paranoid schizophrenic. In this instance, could we really attribute her paranoia to mental illness?
With respect, references to Nazis (no matter how apt those references) actually detract from your very worthwhile message.
Pull yourself up by your bootstraps and cheer up? Brilliant advice. Why didn’t I think of that? 🙂
I think most (but certainly not all) anti-psychiatrists acknowledge a need for the “not criminally responsible by reason of mental disorder” plea, as it’s termed in Canada.
Great article. I agree these policies are deeply, deeply disturbing. We’re supposed to be eradicating stigma and “coming out of the shadows.” And look what happens when we do. If the University of Victoria did this to me, I’d sue for damages before BC’s Human Rights Tribunal.
I only use the term “mental illness” in the interest of shared terminology. Whatever we choose to call it, certainly such a phenomenon exists. The question, as always, is what it actually is. The distinction between “illness” and “disorder” is a critical one.
I’m glad for the research but isn’t exercise and good nutrition critical to the treatment of any health condition?
My impression has been that BPD is another way of saying they don’t like you and they don’t want to help you.
Great. Something else for me to worry about.
Antidepressant-induced mania destroyed my marriage, my career and many friendships. It provided me with a criminal record and a divorce. Your story speaks to me.
This is intensely depressing (but not surprising). Money really is the root of all evil. Big Pharma doesn’t give a shit about any of us.
I remember being a very unhappy voluntary patient and starting to make noises about going home. I was advised “not to try to do that” in a rather sinister fashion. As long as there is involuntary psychiatry, there can be no truly voluntary psychiatry (I think I stole that line from Thomas Szasz).
I imagine one result would be an increase in therapeutic abortions.
I wish you were my psychiatrist, Sandra. Mine’s mantra is drugs, drugs, drugs. In the past, I’ve gone for a decade with no treatment and no symptoms (1990 – 2000) so clearly I’m a good candidate for an alternative approach like you describe.
At the moment, I’m an involuntary out-patient, being coercively drugged with a 400 mg Maintena injection every three weeks, rather than the recommended four. I’m also on 800 mg Seroquel, 30 mg Abilify and 2 mg clonazepam. It’s an insane maintenance drug regime and will continue indefinitely thanks to British Columbia’s draconian Mental Health Act.
Thanks for this article, confirming many of my suspicions. I just recently inherited a flip phone and I don’t answer incoming calls unless I’m specifically wanting to talk to somebody. I only carry it for emergencies and to have an easy way to dial home and check for voice mails to my landline. Maybe they should call them dumb phones.
I don’t think anybody thinks mental illnesses are made up. The question is: are they illnesses?
Careful, Steve. The NRA doesn’t like that kind of talk.
I remember telling a psychiatrist long ago that bipolar disorder did tend to run in my family. I have two cousins with Bipolar 1. He nodded knowingly before I pointed out that both of those cousins are adopted. It was a sweet moment.
I think all mental disorders probably involve biological, psychological and social factors. It’s very rare to have the latter two addressed. Consider yourself lucky.
“Another no brainer study.”
Indeed. What next? Good nutrition helps to alleviate symptoms?
I’ve never heard that 40% statistic before. Could you provide a link to the study?
Yes, I should have made better choices but I could not because I was floridly psychotic at the time.
As to what causes my mania, I have three answers:
1. sleep deprivation
2. alcohol abuse
3. antidepressants and/or ECT
The Judge was an incompetent buffoon. Middle-aged woman without a criminal record convicted of mischief for emptying the salt and pepper shakers at a pub. The Judge made psychiatric care a term of my probation so CLEARLY he understood mental illness was at play. I wasn’t competent to instruct counsel, counsel shouldn’t have taken my instructions and the Court shouldn’t have accepted my plea. I needed hospital care not jail time. Now I’m applying for a “pardon” for crimes for which I feel absolutely no remorse.
Clearly, the Judge agreed with you. I was convicted of assault, harassment, mischief ….
Great article, Phil. When manic, my own bad behaviour has sometimes been written off as mental illness. Clearly, it’s not illness because, if it was, I wouldn’t be divorced and have a criminal record. It was bad behaviour with painful consequences. The answer is to make better choices in the future.
My understanding was that antidepressants haven’t been shown to beat placebo response for mild to moderate depression.
Are there studies showing that benzos are superior?
“If the drug is degrading the situation in the long run, it’s a bad idea from the start.”
That’s not at all clear. In a crisis, antipsychotic medication can be invaluable. That doesn’t make drug therapy a good long-term solution.
” … good advocacy, drug withdrawal help and social support … ”
These are absolutely crucial and I’m glad you identified them so clearly. I never used to take drug withdrawal seriously – I would just stop cold turkey and then launch into rebound psychosis within weeks.
This time, I’m tapering responsibly, with the help of my treatment team. I’m still on a shitload of meds but I can see light at the end of the tunnel.
We’re all guilty of confirmation bias. We tend to find what we’re looking for.
In my view, antidepressants appear to have caused my bipolar disorder. Of course, my treating psychiatrists have all claimed they just “uncovered” my true psychiatric disease. Obviously, correlation doesn’t prove causation but I have reviewed my medical records extensively and truly believe that psychiatric treatment made me bipolar.
I have an Advance Directive which unequivocally states that under no circumstances am I to receive ECT.
I’m just grateful that I grew up before ADHD was invented.
I don’t recall Hoffer sending me for any testing.
Thanks, markps2. I agree economics is the driving force. Extended Leave is just a sleazy way of cheaply incarcerating you in your own home.
Thank you, Lidi. We can talk more at Matt’s blog.
Thank you, Irit. Maybe you can try to change my mind over lunch on Friday. Nothing better than two old friends engaged in a friendly debate.
Thanks, Julie.
I actually consulted Dr. Abram Hoffer in the 1980s. He diagnosed “anxiety bordering on schizophrenia” and prescribed liberal doses of niacin. Hoffer’s rejection of mainstream psychiatry didn’t make him any less of a quack.
I’m largely immune to chemical substances so I wasn’t actually terribly affected by the drug cocktail. In the throes of manic psychosis, however, the sedative effects of antipsychotics are a lifesaver for me.
As for the reasoning behind polypharmacy in the long term, the psychiatrist’s thinking seems to be simply “Why not? Everybody else does it.” I am strongly opposed to maintenance treatment.
Hi, Frank. Thanks for reading. I’m not surprised you couldn’t hack the peer support training. I couldn’t have, either. My ACT team’s idea of the role of a peer support worker varies considerably from mine.
Thank you, Matt, for your thoughtful comments. I am aware that my terminology is a problem for some.
With respect to less restrictive jurisdictions, yes, moving to a different province would definitely help as I believe British Columbia has the most regressive mental health legislation in North America. Nevertheless, this is where my work, friends and family are and I prefer to stay and fight the system here rather than be forced to become a psychiatric refugee.