Sunday, October 22, 2017

Comments by knowledgeispower

Showing 74 of 74 comments.

  • Beautiful tribute to a very intelligent, kind and thoughtful young man. Thank you, MIA editors. I enjoyed his posts very much on MIA which made me think and question how I was trained and increased my desire to fight for change. His death is not in vain. As Winston Churchill stated, “Never, never give up”. MIA readers and dissident professionals please keep pushing for change in the current mental health system, DSM-V, and how we view and treat our fellow human brothers and sisters. Things are changing, you are making a difference. We are all in this life together. Prayers of peace to Matt’s loved ones in this time of grief.

  • Thank you, for this article. My issue with MAT addiction and psychiatrists prescribing suboxone, methadone, vivitrol and campral is that very few individuals I see at the hospital and in the community ever get off these drugs. This is similar issue as with psychiatric drugs. As a social worker, it is very difficult to get patients into skilled nursing facilities on these drugs and many facilities just will not take individuals on these drugs. Discrimination but also facilities do not have doctors that know enough about them to continue to prescribe them. Some patients swear by the drugs usefulness. I have serious concerns that many individuals with addictions do not do the hard work of recovery and like those taking psychiatric drugs, just listen to the MD who has no financial interest in taking an individual off. Good old fashion 12 step meetings, sponsor and living a life away from people, places and situations that trigger use. Not easy but many people have done it. People in recovery are powerful individuals. I learned a lot from many early in my career. There is a lot of wisdom in those 12 steps.

  • Thank you, Dr. Kelmenson, for a great article. I appreciate your integrity in a world lately that seems to be increasingly lacking of this virtue. This is big business and big money for MDs. In the city near me a psychiatrist well-known for his overprescribing, get ’em and out 15 min. session for $300 just bought a building for over 4 million dollars. I saw one of his patients in the hospital, she was on a truckload of psychiatric drugs, no therapy, just drugged. Her partner is dying of cancer. I talked to her for awhile and gave her a hug, not something I usually do but she was hurting so badly. She said my psychiatrist does not even ask me what is going on in my life and has no idea. She feels rushed by him in session with his quick “How are you doing?”. I gave her other resources, Board of Medicine complaint and wrote a scathing review online about the MD. I feel so helpless watching so vulnerable people being abused by “medical professionals” who care more about their own wallets than the health and well-being of others.

  • I understand your point, Jolly Roger. There is a lot of childhood abuse out there. It is a fallacy about the greatest danger for children is abuse by strangers “stranger danger”. It is actually those closest, in one’s own family, that I have seen the greatest damage to safety, trust and security. This type of collaborative approach is definitely not for all families. Safety is always first. I worked with some really abusive parents. But most of the time parents do really want to do right by their children and in a nonjudgmental environment they can learn how to be better parents. It takes real courage to look at oneself and change negative patterns. Some cannot do it and continue to abuse. Therapists also have to have the courage to tell parents who are abusive that what they are doing is causing harm. Mandated reporting is our professional ethical obligation, though not saying that solves the problem. DCF has its issues as well.

  • I understand your point, Jolly Roger. There is a lot of childhood abuse out there. It is a fallacy about the greatest danger for children is abuse by strangers “stranger danger”. It is actually those closest, in one’s own family, that I have seen the greatest damage to safety, trust and security. This type of collaborative approach is definitely not for all families. Safety is always first. I worked with some really abusive parents. But most of the time parents do really want to do right by their children and in a nonjudgmental environment they can learn how to be better parents. It takes real courage to look at oneself and change negative patterns. Some cannot do it and continue to abuse. Therapists also have to have the courage to tell parents who are abusive that what they are doing is causing harm. Mandated reporting is our professional ethical obligation, though not saying that solves the problem. DCF has its issues as well.

  • Great article, thank you, Zenobia. For the family members and the therapist to view the transcripts of sessions would help each to be more mindful and accountable to the healing process and to each other. When I was trained in family therapy we had one way mirrors and had supervisors call us on phones during sessions and tell us what we were doing right and wrong. We wrote process recordings that we handed in to supervisors with our thoughts and reactions to sessions. By having all those in the family session review what was said, have time to think about it and come back together to critique oneself, each other and the process takes time and effort, but I can certainly see the benefit.

  • Nicely said, Frank, I completely agree as well. I see every day in a city hospital the depressed, demoralized, unemployed population on government welfare who got on disability for reasons I do not understand “depression”, “anxiety”,and “bipolar” who are now getting more unhealthy from lack of mental and physical activity. Our disability policies are not helping to empower in any way. Psychiatry gets them sicker with their drugs that cause all sorts of medical complications. Human service agencies need dependent people to survive so not all that motivated to empower people to leave them. It is also really difficult to get off SSI and SSDI if you are now out of the workforce for years, not developing new work skills and social skills that come with being with others and challenging oneself. There needs to be better financial incentives to get off disability. The medical costs are astronomical for taking care of a population that is used to being taken care of by the government (taxes from those of us who work and pay taxes), has fractured families and social networks, and has unhealthy lifestyles. Employment is therapeutic and good for one’s self-esteem. The disability policies need to change to help people become productive members of society.

  • Thank,Dr. Breggin, for a deeper understanding of this tragic story of confused and suffering adolescents. I know that the psychiatric medication piece was not taken very seriously in the trial with more of a need to seek justice through repudiation of Michelle’s character. Good family therapy for both Michelle and Conrad’s families would have been so valuable here not psychopharmcology psychiatry. They were just teenagers, they needed guidance from the adults in their lives. Where is the repudiation of the adults who did not seem to be a positive presence in their lives?

  • Purdue did have to pay a small fraction of their profits in lawsuit over misleading marketing for OxyContin. I am currently concerned about psychiatry prescribing suboxone, methadone, vivitrol, antabuse and campral for alcohol and drug dependence, “medication assisted treatment”. Forget about 12 step meetings and recovery work. Psychiatry has the answer in a pill.

  • Thank you, dfk, for your comments. If I were a psychiatrist who had been prescribing drugs that had caused harm to patients, because that was how I was taught by the medical school and other professionals who were my mentors and colleagues, and now from experience and lots of research and just common sense saw that what I was doing was not right I would be in a state of distress. My conscience would hound me until either I admitted that I was on the wrong course and then take action. Some psychiatrists have done this. It takes courage. Most continue to go on with blinders. They are choosing to ignore the evidence, covering up the truth with more lies, and attacking those who are speaking the truth. Is this any different reaction to other corruption we have seen in past history? You are right psychiatrists are just humans. But the profession of medicine has a higher calling. We should expect that the medical field acts out of well being for the patients they serve with treatment that is evidenced-based. It would be their own suicide if they admitted their wrongdoings, so they keep on with defending their disease model. I would respect an apology but taking full responsibility would mean the profession admitting they cannot to act in a harmful way toward patients despite mounting evidence that they are doing more harm then good, that there are safer, alternative ways of healing emotional distress and psychosis. I would personally need to leave such a profession and have to speak out against it.

  • Thank you, Michael, for a terrific article. My experience with working in a state hospital, community mental health and outpatient, and on a medical unit is that psychiatrists are for the most part rigid in their thinking, distant from their patients. arrogant and self-righteous. Their self-interest is to me at the heart of this. They want to continue to earn a 6 figure salary and keeping themselves in power at the top of the food chain giving orders to those who actually talk and listen to those we serve and their families. Prescribing these dangerous and unnecessary drugs is easy money. They complain in meetings about being paid so little compared to other MDs in other specialities. I have given some of them books including Mr. Whitaker’s Anatomy of an Epidemic and DVDs, and even had trainings on person centeredness and recovery-oriented therapy but most sadly ignore the information. I have been friendly with many and most are very complimentary of the work I do with patients and their families.
    But I have lost so much respect for them due to them not wanting to change their ways and hurting patients that I now warn my clients about seeing a psychiatrist and the drugs they prescribe. I do believe that in some cases psychiatric drugs are helpful but short term use. The field is corrupt, no doubt in my mind. I do see changes. Keep up the pressure MIA.

  • Wonderful article, thank you again, Mr. Whitaker. Person-centeredness, self-determination and strength-based treatment that allows the person seeking help to be an active partner and participant in their health. Looking at “symptoms” in a deeper and wider manner that shows deep respect and trust between “clients” and those providing support. The unit will be a challenge but most likely a worthwhile one. Best to Norway!

  • So do more testing and find out that a lot of children, adolescents and adults are depressed, then what? Force them to see therapists and psychiatrists? How about create better communities with more opportunities for children and adolescents to play and be kids, how about better jobs and a better economy so parents do not have to worry about providing for their families, better workplace polices to allow for taking time off to care for aging parents, parenting education, and promoting nurturing environments for all.

    These screenings only cause extreme anxiety and “medical student syndrome”, where you become overly concerned about having illnesses. Let’s solve the underlying problems.

  • Good for you, FeelinDiscouraged! I hope you feel empowered. I get so incensed when I read about codependent and unethical providers. The goal of therapy should be assisting a client in meeting their stated goals in a timely and effective manner. Empowering the client to think for himself or herself, understanding a person’s spiritual and cultural background and respecting this. We at just a guide, a facilitator, not the director. The client is the director of their own life and the expert in their own healing. Best to you in pursuing your dreams.

  • Dear Suzanne, My deepest sympathy and prayers during your grief for you and your family as you grieve the loss of your father. He sounded like a wonderful person with a loving family.

    Was the healthcare proxy invoked? Was the hospital contacting family about his care? Haldol and Ativan? That is terrible first line “treatment”, really Behavior control. Seroquel and risperdal as PRNs maybe if sundowning in dementia patients with violent outbursts. But hospital should be talking to HCP and family about any such treatment. Elders certainly are very vulnerable in this healthcare system. Families are often not close by and sometimes estranged. I see a lot of elders being neglected and alone. Other families I have are needing to take FMLA and quit their jobs trying to care for their parents.

    Good hospital staff should be trained to serve patients who are “acting out”. It takes patience. You never take it personally even when sworn at and hit which has happened many times to me. Patients are often just scared, helpless and confused. How horrible to be in a place you did not choose and with people you do not know and facing death.

    My advice is to have healthcare proxy completed and discuss end of life decisions when one is healthy. Appoint a healthcare proxy and alternate whom you know will carry out your wishes. Family meetings by phone and in person should be happening at the hospital. If not ask for them. ” Honoring Choices” is a great resource for this. If have more than $2,000 in the bank consult an elder attorney or at least understand elder law.

  • I agree, Aria. I would love students of psychology, social work and psychiatry to have a book in their studies about experiences such as Monica’s and many, many others harmed as a guide to good care and what to do and what not to do. Mad in America and Anatomy of an Illness sitsin my book case for clients, families and other providers to read. I still have my Psychodynamic Psychiatry by Glenn Gabbard, MD and Inside Out Inside In by Joan Berkoff in a prominent place but lacking books about being a patient in a system that has become very harmful and dysfunctional. I would love a new generation to learn from the past and move on to a more enlightened, egalitarian model of care.

  • “Mental illness” is used as a smoke and mirror technique to avoid looking at macro issues of institutional corruption on all levels of society which need restructuring and dismantling. It may feel that if we just “treat” at the micro level, the “mentally ill” individuals, then all will be well. Bandaids are not enough for a severed arm. Psychiatry thought they had the answers to societal problems with drugs and forced treatment. Our society is more mentally, physically and spiritually sick then I have ever seen it. Psychiatry failed. They will never fully admit it, but we know the truth. The drugs with their side effects, the diagnosing, and labeling that destroys individuals and families at their core sense of self-efficacy and self-worth is truly the evil and sin that psychiatry and therapy as well has perpetuated and profited. Stay politically active MIA and continue to use vehicles such as media, writing to politicians and protests to educate others and to curb the growth of psychiatry as an institution that is rooted in bad science.

  • Interesting article and comments. Labeling Trump “mentally ill” is a way of discrediting him and taking away his power. Same thing we do to all those labeled with DSM diagnoses. Trump obviously has a large ego and when you have lots of money and influence which billionaire businessmen do, people around you who benefit from that bow down to you certainly easy to create a false grandiose sense of self.

    Trump is a strange byproduct of our current society, a “symptom” like you mentioned Sera. American society is certainly very ill right now. The poor and disabled are being pushed further off the economic cliff with fewer hopes of getting out. Lack of good jobs and financial security has sparked this. It has caused fear, anger and mistrust. People get angrier when feel sense of scarcity and look to scapegoat and bully those whom they identify as weaker instead of looking at the institutions that we created that hold the real power and influence. Americans have seen tough times before and have been able to make positive changes.

    I have hope that American ingenuity and our innate sense of justice, fairness and compassion will prevail. We are much better off caring about one another then dismissing and disconnecting from one another.

  • I can see your point, Sally, in naming and explaining overintellectualized therapies it appears and certainly has the potential to dehumanize. I do not espouse psychopharmacology or psychotherapy wholeheartedly. I hope for a time when people are just able to be present and care for another without ever the need for a paid professional. I pray that no one ever needs to be hospitalized or medicated. I can honestly say I did not become a clinical social worker and psychotherapist for the money. I wanted to understand and help alleviate human suffering. I did study many types of therapies with distinguished clinicians and psychoanalysts but just tools. When you sit face to face with a child who has been abused or an adult with delusions and hallucinations those theories and techniques are just that. The human connection is what heals.

  • Drug “treatment” is quick and requires little effort for the prescriber and teaches the person taking the drugs nothing and certainly does not empower self-healing and self-efficacy. Healing is work and requires effort on both sides.

    Dialectical Behavior Therapy is a great package of skill teachings using Eastern philosophy and cognitive behavior techniques for solving interpersonal conflict and emotional regulation difficulties.
    It is a lot of work, too many acronyms and can burn people out. I like adapting it and incorporating parts of it in my practice. I agree with Matt about diagnosis of Borderline Personality Disorder and how the label has been used rather punitively by providers. We did a lot on training on adolescent psychiatric state hospital around empathy and strength based language for the staff. Just not useful nor kind. Certainly countertransference issues working with those who are in emotional distress but answer is good supervision, self-care and better training.

    Eye Movement Desensitization and Reprocessing (EMDR) not mentioned in article is a good trauma therapy using cognitive reprocessing and neuroscience. Mediation and visualization uses hypnotic induction to create more relaxed states and used for increased productivity and goal setting. Expressive therapies including music, drumming circles, art therapy and writing are also beneficial. And of course having positive, nonjudgmental supports of family, friends and co-workers is needed. Meaning roles like being a good parent, caregiver, volunteer and paid employment are also therapeutic and make one feel a sense of purpose to their lives. We all need to feel loved and important.

  • I agree with you, Kate, and others who responded to your powerfully truthful article. I have given up on trying to change the system from inside. I too found many of those who work in the system to be arrogant, judgmental and quite cruel to those they were supposed to serve and show respect and kindness. What I noticed with supervising a team of clinicians and peer specialists was often fear and envy by the clinicians who thought they would be replaced. Many of the staff completely dismissed the peer specialists or worse were patronizing. I loved the peer specialists I worked with but saw them getting beat up often by the professionals. Questioning the established system was not welcome and was quite dangerous in terms of shaming and discrediting. Keep forging ahead, Kate, you have a lot to offer. Peace and wellness to you.

  • Thank you, Eve, for your comments and courage to speak out about the dangerous current mental health environment. Many psychiatrists I have worked with have expressed the same disappointment in their careers. I believe that the medical model mixed with the business model has left patient care and safety secondary to profit and keeping hospitals and clinics in business. This is a very unethical and dangerous place patients are in now. In the past year working on medical floors as a SW I have seen suicide attempts from prescribed psychiatric drugs as well as a serious medication side effects in a 5-year-old in ICU. Psychiatrists do not know what is going on with their patients’ lives so are just keeping them on dosages that should be tapered off and stopped. This is medical malpractice in my humble opinion. I am advocating that patients and their families file complaints with the Board of Medicine if feel that they are being neglected by their prescriber. Meeting with a patient for 5-15 minutes every 3 months without colllaborating with other providers to know what is happening with their patient is not treatment, it is fraud.

  • Nice work. Psychiatry needs to take a big step back to me in this new narrative. Too much damage that the MDs have caused with their narrative. Insurance companies back off. Professionals in general need to be less aggressive in forming a vision. Let survivors, those who are paying for their own healthcare and children and adolescents and families lead the discussion for once. My opinion is to get rid of DSM V. Insurance should allow for consumers to pay for whatever they need which now needs to include detox from psychiatric medications. Let’s get back to healing people!

  • Thank you, Matt, for an interesting and well written article. Certainly those who experience psychosis need to be listened to and respected. Oftentimes they are dismissed because in their distress some can be very angry, not make logical sense and be socially withdrawn. This certainly elicits our own worst fears not just for “psychiatrist and allied mental health workers” but society in general. One sees someone on a street talking to oneself, wandering the streets, in dirty clothes and it can evoke all sorts of feelings. Compassion, fear, confusion and anger/rage. I think of parents and family members as doing the best they can to understand their family member so I caution against going back to any “blame” model, i.e. “schizophrenic mother” of the past. Having anyone who is ill affects the whole family system. “The identified patient” as we call the person experiencing the symptoms often feels scapegoated, but truly I see as a therapist and social worker the effects it has on the whole family. In addition society does look at those with psychosis in a fearful, misunderstood manner which then reinforces the feelings of shame that the person experiencing the symptoms and their families already may have. I agree with that medications are not the sole answer. The anti psychotics certainly work short term during crisis periods, but I see the long lasting effects of health problems as a serious issue as well as ignoring the root causes which can be childhood trauma and abuse but not always. Substance use can also bring on psychotic episodes and certainly continued use creates greater problems.

  • I wholeheartedly agree. Intelligently and beautiful written letter that hits right at the heart of the issue and provides solutions as well. Very impressed with your thoughtfulness and clarity. We can do much better to help our veterans. Less bureaucracy, more direct help that benefits the veterans directly, within their own communities, not in these large, outdated VAs.

    Much health, wellness and success to you! Maybe a political career for you, we need honest men and women of integrity and character.

  • Thank you, Naas, for your post as brings up a topic and population close to my heart, young adults, my favorite age group. Adolescence and young adulthood is an important developmental stage where often mental health diagnoses start. Hormones, body changes, psychologically and physical separation from parents and family, finding one’s identity, relationships and going to college and working. Wanting to be an adult but still needing guidance and direction. Full of dreams and idealism. It is a tough time for many young adults to go off to college from home. That separation is scary for many and forced into a new way of life. There needs to be resources within colleges to help with this issue. Unfortunately what happens is if get on the radar of the college, one often will be “forced” to get psychotherapy and medication, the standard treatment protocol. They want some assurance that students are not a harm to themselves or others. Unfortunately, psychotherapy and medication can be a further source of isolation and disconnection for students leading to further deterioration and possibly lifetime of disability. Colleges need to take more responsibility as institution of taking care of young adults to keep sources of connection and care for their students, i.e. support groups, education about taking care of oneself mentally and physically and mentoring. Discarding the students who do not fit the standard 4 year plan is not okay. As long as paying the tuition which is astronomical these days, colleges should not be renouncing their responsibility.

  • Thanks, Dr. Berezin, and MIA readers for great article and posts. We just did a forgiveness exercise at my Congregational Church this Sunday. You could put a name of a person who has harmed you and put it in a bowl and light a candle. I found it freeing. Forgiveness for me personally is about letting go of the anger and resentment that I hold towards the other person which only harms me and being able to move on. The opposite of love is not hate, it is indifference. Why give energy to an abusive person when I would much rather give that energy to causes and loved ones I care about? As a therapist, I never tell anyone who has been seriously abused that he/she “should” forgive in order to heal. I unfortunately have heard the most horrible stories of childhood sexual, physical and spiritual abuse usually by someone very close and trusted, i.e. parent, close relative, priest, minister, teacher, that have left me sickened by the cruelty that one human can impose on another. Feeling anger and rage is important stage in healing as it is a signal that boundaries have been violated. I have seen the worst and the best in humans. I became a therapist though for this very reason. I wanted to understand how such tragedies and abuse could occur, and what is it to be human. I wanted answers and how to prevent and stop such abuses, and help heal those who have been victims. I studied about psychology and world leaders looking at abuses of power in college and was startled more how fear and intimidation could make people follow a Hitler and do unspeakable acts toward others on a macro societal level. Understanding the dynamics of systems and power were helpful then in studying the most important institution and system, the family, the first one and most intimate we are born into, the micro system. So important that values of honesty, respect and dignity be upheld in all our institutions.

  • Thank you, Naas, for your example of courage and determination in face of opposition to you coming off psychiatric medications by psychiatrists. I too believe that some psychiatrists are capable of being retrained and reprogrammed. Most are going to need to be pushed to change or lose their jobs if the culture of recovery and healing truly takes hold, which because of individuals like you and other advocates including myself who works within this terrible system keep pushing. Psychiatrists are so use to doing it one way despite mounting evidence that what they are prescribing is harmful and that the medications themselves can create the problem that it was supposed to treat. Denial, denial, denial… They have had the power so long and are stuck with really what amounts to medical malpractice. It is sad, because I do remember a time when I worked with psychiatrists who were excellent psychotherapists and did great healing work. You are an inspiration and sign of hope that people can and do come off medications and do wonderful things with their lives. Much health and personal and professional success to you in helping others to heal.

  • Wow, powerful article and comments. There is certainly racism in the mental health field. My upper middle class clients in my outpatient practice in an upper middle class white suburbia area of Massachusetts vs my community, inner-city clients, mostly poor African-Americans. Who do you think gets the “schizophrenia” diagnosis more? Whose mental health and physical healthcare is better? Why so much poverty among people of color? Decades of oppression and discrimination. Still much to fight against. Thank you, Iden, for your article.

  • Thanks, Sera. This is a tough article for me professionally as 2 of the people pictured in the Globe were adolescents on the unit I worked. One there on forensic status after killing another adolescent and another who later killed whom we did everything to help clinically but there is a limit to what can do when someone so damaged by childhood abuse that he became an abuser himself. Even with working with an excellent team of well-trained, experienced and caring staff, there are limits to successful treatment and recovery. No consolation for the two innocent people and the families of those that these two young men killed. Horrible tragedies happen all the time despite best of efforts. There certainly were signs and precursors that the school and parents saw that one can find and assign blame. I can only speak to what I could control, treating parents and patients with respect and dignity, doing my best clinical work with the years of experience and training I had, seeking numerous consults and supervisions, and following due process of the laws and procedures of the hospital and the legal system. My heart and prayers go to continued victims of abuse of all forms.

  • I see the Globe just not reporting the whole picture, over focus on violence of the mentally ill and really trying to create policy changes such as creation of more mental institutions and forced outpatient treatment. I just do not see it as balanced reporting. I agree with many points. Certainly there are individuals with greater risk of violence due to past histories of violence, access to weapons, interpersonal, especially family conflict and abuse, and substance use. Instead of caring for these individuals through access to good programs that offer skill building such as interpersonal conflict resolution, job placement, and ability to move out of poverty. There are good programs out there, just need to know how to access it and need families to help their loved ones instead of discard and abandon them. I did not agree with the rapid closing of state hospitals without having infrastructure in the community to absorb the numerous issues such as housing, supervision, day structure and job placement. Community mental health workers are extremely underpaid, overworked, under trained and asked to work in very dangerous areas that put their own safety in jeopardy. We had individuals on the medical unit I worked who did not want to leave because they had no where to go. People dying of alcohol and drug use with liver disease and pancreatitis. Now you can say, Circa, well why do they drink and do drugs, just stop, well simpler said then done. Substance abuse programs are even more difficult to access. There is a lot of suffering going around and people dying. Unfortunate casualties of a world of excessive opportunities for some and few for others. Volunteer and do your part helping your own community. Less talk, more action. We have enough philosophers and talking heads, need people to take political and community action. Thanks, all, for caring enough about someone other than yourself and your own self interest and to engage in tough discussions and put it into action.

  • Nice work, Sera and those who protested! This misinformation and ignorance that the Boston Globe is perpetuating in Spotlight about mental illness and the real underlying issues that drive individuals to do violent and bizarre acts is so off target and certainly driven by a push to have policies of more forced treatment. What I see and work in is a very disconnected and fragmented system within a wider system of poverty, inequality and oppression. I have been working in Boston area doing home visits lately and have been astounded by the mass poverty I see for those labeled with “mental illness”. Medicating realities of a society that is consumed now with the almighty dollar caused by a stock market crash perpetuated by the greed of Wall Street and bankers and people who thought more about their own self-interest than society as a whole. Societal ills are not caused by the mentally ill who are just canaries in the mine. I am more afraid of the greed of banks and hedge fund managers than I am of the “mentally ill” whom I have worked for years in very impoverished urban areas. The mental health system of medication and forced treatment is to soothe our own conscience that our problems are caused by these “other” human beings, so different from the rest of “normal” society when in reality western “civilized” corporate culture and greed and plain sinfulness have caused these victims to be ill.

  • Very interesting and poignant article and discussion. Thank you, Michael, for your candor and your courageous. I am sorry about your negative experience working in an environment that needed to make you “sick” in order to justify its own sickness and dishonesty. What resonants for me is the defensive posture the “professionals” have for just questioning the validity of treatment and outcome for the very people they are here to help. Certainly much easier to just go along with your peers but that is plain cowardice. You were not mentally ill, just not fitting into a system that wants to keep status quo. Your peers dos to you what they apparently do regularly to their clients: disempower them. I feel for those trying to find help and are correctly confused by the differing messages and for not getting all the information they need to make a clear, informed choice. Your hurt and anger about what you experienced is justified. May it continue to make you a better person and therapist.

  • We have enough in our communities to care for each other. Let’s start with what we already have and not create more “institutions”. My advice: Help yourself and your own loved ones first especially if you have children, then your neighbors, be a person who has integrity and cares about others, get involved in an organization, and know what is going on in your own backyard, volunteer, give money if do not have time. We are such a society of disconnection. We all can make a difference, small or large.

  • Thank you, Chaya, for your thoughtful article. So happy that you had a good experience with therapy. Therapy is supposed to be a place for personal growth and development. It takes courage and maturity to admit one needs some extra support. We all need extra supports at times especially at times of a life change. Great that your therapist was transparent with you about the unfortunate realities of managed care insurance needs and told you the “diagnosis” that she needed to use to get reimbursed. The dilemma for therapists is that we either use insurance and play the game and it in a DSM V diagnosis or charge out of pocket which gets expensive. Necessary evil we call it. Much health and wellness to you!

  • You bet, Fiachra! The experience of a safe, supportive group of individuals who can be vulnerable with each other with rules of confidelity (and no cross talking, not monopolizing, etc are also useful) and care are the most powerful healing environments. I will be starting a caregivers group soon and looking forward to it. As a group facilitator I am not the healing force, I just keep the rules and move the process along, it is the power of those willing to share their experience and be willing to listen to others and be a support to others that is the key.

  • What a strange reason for not accepting Dr. Moncrieff’s proposal, “did not compete successfully for the limited spaces available”. This is the most relevant and hot topic in psychiatry right now. They are definitely avoiding as it appears they are not prepared and frightened what the outcome of all this will mean to them. They cannot hide forever. Much appreciation to Dr. Moncrieff for her efforts.

  • Class action lawsuits need to happen to get some justice here for those that psychiatry has harmed, certainly does not make up for loss of human life and health of so many, but at least will make a point about harm done in face of evidenced that what they are doing is harmful. I have some clients that have sued pharmacy companies, i.e. zyprexa, for side effects that caused diabetes and were given large sums.

  • I have alternatives: psychosocial rehabilitation, psychodynamic psychiatry, individual and group therapy, expressive, occupational therapy, vocational rehabilitation… That’s right, most psychiatrists you are not really interested in talking to your patients anymore, too much work when you can get paid for 15 min. of work writing scripts, so easy. Maybe a reduction in salary. Goodness no, not that, then let the rest of do the work and distribute your large salaries to programs and staff that do the work of recovery which works and actually helps our clients. I cannot defend psychiatry anymore as it is in the U.S. They have really lost credibility.

  • I see ADHD as one of the most bogus diagnoses of them all and certainly does such harm to the self-esteem of children. Attention is a skill set that can be strengthened through practice. I help children to learn better self-control, how to tolerate boredom and how to play the rules of school which include politeness and respect to teachers and peers but not interrupting others, waiting one’s turn, etc. Play therapy with dolls or puppets, chairs and chalkboard can be useful in recreating the classroom and solving “acting out issues”. Helping children engage in learning often means parents spending a lot of time with their children reading and doing homework so that they can learn how to manage their time, take good breaks, etc. It is important to praise children for being patient and taking their time doing homework and managing their time. There is no skill in a pill, parents need to take the time to teach their children skills not medicate for quick solution. Eating healthy, exercise, managing t.v., video game and phone time are all part of raising healthy children. I tell parents they are the CEOs of their family. Parenting is the most important role in society in my opinion. Psychiatrists and NPs stay out of medicating children who need adults around them to guide them in their development.

  • I apologize by suggesting that seeking out professional help is the only answer to recovery, it certainly is not. There are many ways to health and healing. Finding others with shared experience is wonderful. Internet has been helpful with this. High costs of specialized care is an issue. As a social worker I believe that all should get the best evidenced-based care regardless of ability to pay. I feel ashamed for those in the helping field who are doing harm, it truly breaks my heart and angers me too. You prove that the expert lies within not without.

  • I am sorry, Julie, for your bad experience at CBFS. There are not very clinically oriented and experienced CBFS workers. CBFS is good for some things like case management, housing and skill based activities such as managing finances, getting to medical appts, getting employment, etc. but not good for clinical work. For that get a private practice PHD or masters levels clinician with experience in certain area you need. Eating disorders is a specialty and one needs therapist with training and experience in this area. The CBFS you were in should have known their limits of what they can do and cannot. Good intentioned people certainly can do harm. I like CBFS for their mission of helping people to be more independent and learn skills to live successfully in the community. I became very involved in Psychiatric Rehabilitation Association because of my experience with CBFS as CBFS agencies certainly saw the need to train CBFS workers who generally do not have much training in mental health to at least get some basic clinical training and a set of ethics to guide them. Take care, I wish you well.

  • Thanks, Sera, for comments. I am actually just regurgitating CBFS/DMH risk management forms and what they state. I am still deprogramming from my 5 years of CBFS in Boston and Worcester area, taking some time. More documentation than actually meeting with individuals which was a shame. My Menninger training actually was around finding meaning out of psychotic experience. There is always some truth to psychotic thinking. People do get better and fully recover from psychosis, saw it time and time, and have gotten stronger for the experience. Few are dangerous to others. My mother had a terrible postpartum depression with psychosis with her first child, my older brother. She told me she had thoughts and voices telling her to harm her son which frightened her. Thanks to my father’s love she got through it though went through old ECT and some good therapy and hospitalized for 3 months. She made sense of it all given the stressors of being a young mother and some family of origin issues. She never had a problem after that and has been a rock of the family for many years even after losing a daughter a few years after. At Westborough State Hospital in the Child/Adolescent unit I worked with many teenagers who were severely traumatized, horrible sexual and physical abuse who had command hallucinations to harm others. We provided a safe, nurturing environment and let them process what they needed to along with structure and very good trauma work. Some live with voices all their lives and manage fine. Good treatment and good nurturing environment can help heal. Unfortunately, bad treatment and bad environments with untrained staff can do the opposite and re-traumatize.

  • Thank you, Sera, for posting this article and your comments. This Boston Globe is sensationalizing and adding to the stigma and misrepresentation of “mental illness” and violence in what I see as an attempt to certainly highlight the problems in the mental health “system” which does look like more like a random billiard balls on a table then a structured, coordinated system. There certainly has been a gap in services since the closing of state hospitals. CBFS (Community Based Flexible Supports Program) for adults and CBHI for children/adolescents were supposed to fill this gap in but not hitting obviously all the needs. Substance use, past history of violence and criminal behaviors, and psychosis with command hallucinations were the greatest “predicators” of risk for violence.

  • In your own state, mercy! That Tim Murphy uses his psychology credentials to gain credibility is really unethical. Has he ever worked in community mental health, because he is really out of touch with what is needed. We need collaboration and engagement of all stakeholders in community mental health. This bill is going to set us back. I have never seen such problems. People are really hurting with this economic and political climate. Take care

  • Thank you, Val, great article. If you really want good change in the mental health system that actually helps people struggling with life’s challenges get political. Whether you do not like politics or your local representative or state senator it does not matter, but getting involved and active in having your voice heard by him/her does. Otherwise as we have seen other people with different interests will get their voice heard and laws concerning coercive treatment toward those who are vulnerable and need good care and treatment will prevail. Email, call or write your legislators on this issue. It is easy to do. Democracy in action, do your part please to stop this hurtful legislator. We can do better than this.

  • This is a sad and frightening situation for Deryra and her family. Autoimmune encephalitis is serious. It is an inflammation of the brain and its presentation can include hallucinations and psychotic thinking that looks like a psychotic disorder such as schizophrenia. IV antiobiotics and steroids are usually the treatment. It takes a long time to recover and may never fully. If the hospital was treating her with antipsychotics they may have misdiagnosed her. Prayers to the family and may she get the correct treatment so this young, intelligent, talented and beautiful young lady may live a full, healthy life.

  • Oldhead, who are you referring to? I have worked and known some really good line staff who are front-line mental health counselors who are great with clients, kind and generous. They often get to know patients in hospital more than the more experienced, “professional” staff as they spend more time with patients.

  • Thanks, deeeo42, for good comments. Regarding #1: Danger to self, others or so mentally impaired cannot care for self are the criteria for Section 12. There are some individuals that I served as a director in the community that just could not stop getting into trouble with the community everything from minor disturbing the peace, being a public nuisance, panhandling to drug dealing to threatening people. Police certainly need to be called if serious issues and were but really public did not like having people sleeping on the sidewalks, asking for money, littering, being unkempt, as well as occasional sexual offenses from minor to severe. Most of this was due to use of substances in addition to mental health challenges which always increases risk level. In order to avoid overpopulating the jails and prisons, forced treatment is thought by many to be an alternative but what we need is incentives to get help not punishment. Having community centers to go to and have a meal and provide resources and help if want it is much better than forcing someone to get help. I am all about setting limits and reminding people about community level of behavior and giving warnings. 2) I agree with your point in theory. There are lots of people who are in our medical units who are here because of unhealthy behaviors, from not managing their medical illnesses by eating unhealthy, drinking excessively, not getting exercise, not attending regular medical appts. , etc. We certainly send people to nursing homes if no safe discharge and need 24 hour care. We do Section 35s on people with uncontrollable drinking and drug use. We do Section 12 those who are here for trying to commit suicide into inpt psychiatric units because of risk of harm to self. Insurance companies put caremanagers on frequent ER users. These individuals are seen to be exhausting resources. The question is how do we motivate people to stay healthy and behave in societally acceptable safe ways? In U.S. it is the right to pursue happiness as long as it does not infringe about the rights of others to do the same. Once get into a hospital, police take notice or family starts asking for their family member to get help do they get on the radar. We are talking about here is community mental health for basically those in the lower economic class, those on SSI and perhaps SSDI as well. The proponents of forced treatment are not evil people to me, just trying to find a solution to the above issues. It just does not work.

  • Beautiful blog, Andrew. I am so happy to hear that you had a good therapy experience with a skilled therapist. The therapeutic alliance, the relationship that is the sacred ground to which the healing work of recovery can take place between therapist and his/her client is pivotal. Trust and mutual respect and caring for the client and the therapeutic process in what Winnicott called a “holding environment” is what psychotherapy is. Therapists need continual training on boundaries, transference and countertransference and to have regular consultation and supervision. Whether seasoned or not therapists need to do their own work in order to serve their clients the best. Being a therapist is very tough work and requires a skill set that continually needs honing. We often become too complacent, set in ways of the past, so continual training is needed and self-care. Best to you, Andrew and rest of those out there in MIA.

  • Thank you both, Dr. Gøtzsche and Dr. Breggin. You both help me to keep motivated in the field, because I certainly have had regrets with what has been going on. Dr. Gotzsche’s video presentation and article show great integrity. Dr. Breggin is a also such an example, truly courageous to be so honest amongst his own colleagues. I used Dr. Breggin’s “Empathic Therapy” video in a class I recently talk at graduate school. The students loved it. I hope we can get back to teaching therapy instead of understanding DSM V. Forced treatment just does not work, period. We want people to find treatment that is helpful and nurturing. Empathic, nonjudgmental listening works, EMDR, hypnosis, CBT, DBT, sandtray therapy, psychoanalysis, expressive therapy, music therapy, peer to peer counseling, family and individual therapy, pet therapy, WRAP plans, volunteering, working, eating right, meditation, sleep and getting regular medical workups all work. We want people to heal and not be re-traumatized by abusive, violent and coercive treatment. If mental health professionals do not stand up against forced treatment, then we are part of the problem, not the solution to healing. Let’s not go along to get along.

  • This is a tough area ethically, professionally and personally to discuss especially in brevity. Considering adolescents and young adults do not quite have the maturity and developed brain of adults yet and tend to more impulsive, think less long term and more in moment, with death rates due to car accidents and suicide high, I would say that I hope we have a society that tries to prevent premature death by one’s own hand for at least this age group. I would say that suicide attempts by this age group as I have seen are a permanent solution to temporary, transient problems that could be solved by better coping skills and age/maturity, i.e. break up, family conflict. We had a elderly woman come in to the hospital after attempting to commit suicide. She did not complete the act as she was found by her husband after ingestion of pills. When I first met her the first day she was angry. “I want to die, is not that my right?”. She talked about being a “burden” to her family with medical issues and felt her quality of life was not good. She had a loving family, successful son and she was a practicing Jewish woman. After a week in a geriatric medical psych. unit she came to see that by being with others with much more serious illnesses, i.e. Lewy Body dementia, Alzheimer’s and others with no family or friends most of their lives, that she came to see that her suicide attempt was rather “selfish” act, that it caused great suffering for her family. She left with renewed gratitude that she was loved and appreciated more than she realized by her family and that we all appreciated her gifts of humor and intelligence and sensitivity. She is now volunteering at a nursing home helping other elders. I was brought up myself in the Catholic faith though I have always liked being with other people of different faiths and religions, just an interest and curiosity of mine, Jesuit education encourages that. I do have my own Christian value system that is dominant but as a psychotherapist and social worker I have to put that aside, be objective, nonjudgmental when I am with clients and listen to them and understand their pain. I believe in a person’s ability to find their own answers to their problems but also that goodness lies within each of us and that a sense of belonging and community and understanding helps to alleviate the loneliness and pain of human suffering.

  • Hi Richard, you are right, the word “medications” imply some type of medical intervention that is has scientific validity and demonstrated positive effect like antibiotics. The 20 years now that I have worked as a clinical social worker in various environments, inpt. state child/adolescent hospital, outpatient, schools, community mental health and now medical hospital, these “medications” have proved to be effective at the beginning of treatment at best for the most psychotic and depressed patients, but invariably their side effects in the long term far outweigh their benefits. Due to brillant advertising and promotion by the pharmaceutical industry, and psychiatrists as well as NPs and PCPs buying into this and overprescribing, lack of oversight and seeing “depression” and other “DSM” diagnoses that were once rare now prescribing in what is really just the normal, “worried well” population who have stressors related to the living in a changing world. I am sorry that your friend had to go through what she did, completely unnecessary trauma for her. Few psychotherapy sessions, a support group, linking her to kind, loving, supportive community supports. rest, relaxation, exercise, etc. should have been advised instead of rushing to prescribed drugs. Robert Whitaker’s presentations and research findings are absolutely right. I know I am angry at how the established professionals, many of my colleagues whom I have worked with are ignoring and discrediting this information and those like Mr. Whitaker who are just the messengers. How many victims do we need to stop this? Thank you, Richard, for your care and concern and activism. Keep it up. I will keep fighting this from inside out. Blessings of peace and health to you and your loved ones. Susan

  • Thank you, Dr. Brogan, for your article and thoughts about suicide, antidepressants and your honesty about the psychiatric profession and commentary about society. I think all of us who go into the mental health field as a profession wanted to alleviate suffering and certainly felt that psychiatric medications were going to help in this effort. The reality is that life can be very painful at times. There is sickness, death and unfortunate violence, poverty, injustice and inequality all around us. Suicide is certainly a way out but a certainly permanent solution to life’s problems that are usually temporary and transient. Medications have proven to be more of a curse than a blessing as they have been used far too often, a panacea to life’s problems.

    I currently work in a medical pediatric unit and I see children and adolescents with cancer and genetic disorders that have no cures. I see the limits to medicine even though I work with experienced, talented doctors and nurses with the latest technology and medical care available. I am in awe of the courage though I see often of those who face life on life’s terms. Courage to live a meaningful life that faces challenges, promotes healthy, peaceful and loving relationships and to create a society that promotes the health and well-being of all its people has been the struggle of all civilizations. “Mental illness” is a societal disease caused by many factors. Cure to me lies in the way we treat one another individually and as a bigger society through policies that promote self-responsibility, accountability, economic and social equality and justice.

  • I am astounded by the reactivity and anger toward you, Mr. Whitaker, for asking really good questions, questioning the “experts” and the way the mental system and professionals work. Why so reactive, psychiatrists, especially you Harvard Medical School doctors? I guess some are invested in their own view of the world of psychiatry, it works for them and challenging that well would mean causing some distress, an ego-dystonic reaction. Now with that said I also know of some really down to earth, approachable psychiatrists with degrees from prestigious schools who are willing to be vulnerable and state that there are a lot of mistakes psychiatry has made, that there is much we do not know about the brain and that medications are not the sole answer. The problem is psychiatrists are no longer trained like they use to be in psychotherapy, instead psychopharmacology pays higher salaries,so 15 min. session. Many have lost their skill set as psychotherapists, because they do not practice the art and science of psychotherapy. I am a psychoanalytically trained psychotherapist and I know that we have failed our clients at times too when pushing own theories of recovery and infantilizing our clients out of our own need to be needed. At this point in time it is about integrated care, having teams with specialities from a variety of fields, OT, SW, psychology, nursing, psychiatric rehabilitation and psychiatry. Peer specialists getting in their too. I like seeing priests, ministers and rabbis being part of teams too. But most importantly, it is about making our clients and their families the center, empowering them with decision-making about their own health. This is where healthcare in general is going. Funding is the tricky part. Keep up the good work, Mr. Whitaker, you are on the right path. We love you in the psychotherapy and psychiatric rehabilitation world.

  • Thank you, Mr. Whitaker, for repeating and synthesizing studies on antipsychotic medications. I heard you did a great presentation yesterday at PRA conference in Boston. Today, Kim Mueser, PhD at Boston University’s Center for Psychiatric Rehabilitation made a presentation today at PRA conference in Boston discussing some of what you presented (Harrow’s study) and focusing on NAVIGATE Program for first episode psychotic episodes. A point made was that those who went off antipsychotic medications altogether and did well not needing medications again, tended to be “higher functioning” to begin with, i.e. working, supports of family, friends, etc., then others that either sometimes took antipsychotics and sometimes stopped and then those who stayed on antipsychotics long-term. Due to sensitivity of medication side effects which we know can have serious health consequences, use of short low dosages of atypical antipsychotics for first episodes for extended period (no more than a year) is recommended, and if no symptoms then reduce maintenance dose and eventually stop. 20 percent of those diagnosed with schizophrenia have psychotic symptoms due to PTSD which complicates the process of healing. Conclusion was that not everyone should be prescribed antipsychotic medications, some do well without medications using variety of recovery-oriented interventions including psychotherapy, CBT, family support, psychoeducation and encouragement to go to work and school. Working collaboratively with our clients and their families in the Open Dialogue model of providing immediate help, shared decision-making and collaborative psychopharmacology with informed consent in a context of a caring, nurturing relationship between providers (“teams”) and those we serve is what is going to heal. Antipsychotics are still part of treatment if needed but only for short term use if that, to just alleviate symptoms enough to do the work of psychotherapy and rehabilitation. I hope that Dr. Pie and Dr. Frances get to work more in this vein of treatment and rehabilitation and collaboration with those they serve.

  • Meditation and exercise are certainly great recommendations for overall good physical and mental health for all of us. Part of the toolbox. I recommend meditation to almost all my clients for variety of issues from depression and anxiety, to dealing with medical issues, grief to improving performance at work and school. I have been unsuccessful at times with those who are experiencing psychotic symptoms or sever depression and needed to change the meditation style to suit a client’s needs. Clients tell me what helps and what does not and are usually quite forgiving when I get too ambitious with them and not meeting them where they are at, my “aggressively helpful” self, something I continue to examine and change in myself. There are a myriad of meditation styles. I myself have tried most from transcendental meditation, vipassana, and Zen. Eastern psychology and philosophy particularly from Buddhist tradition has been very helpful to me and some of my clients who are interested. You can do retreats for a day, a week or more and learn from expert meditators. Right now I like my sangha at Center for Mindfulness at UMASS, Jon Kabat Zinn, PHD, one day a week on a Monday evening and just right down the street from my home so no more going to Cambridge though I do like the Cambridge Insight Meditation Center and the Shambala Center in Brookline, MA. I need the encouragement and support that comes from doing meditation in a group plus get instruction from an experienced meditator. At home I have a cushion and try to meditate alone for at least 10 min. morning and night. Meditation is not as easy as it seems, the “monkey mind” wants to go to the past or the future so always learning new ways to train the mind.

  • I strongly believe in the valuable contribution that Robert Whitaker and Mad in America has made to the conversation about the mental health system. I thus have donated and wish I could give more. The only objection I do have with the site and discussion at times is the global character attacks on psychiatrists. To say that they are all in it for the money and essentially do not care about their patients is a terrible generalization. I certainly know of many psychiatrists that are not good at what they do, do not keep up with lastest best practice and never question their profession. That is a shame. I just know personally and professionally many who are really good and do listen to their patients and families as well as other professionals they work with in teams. Respectful, intelligent arguing is great, just not personal global character attacks. Profession needs leadership and new direction. Thank you Mr. Whitaker for your perseverance and dedication to this worthy cause and contributors who have made me more knowlegeable and a better professional serving others who put so much trust in professionals. I carry this responsibility very seriously and want my clients to have choices about treatment.

  • Great article! Thank you for publishing. I feel sane and validated but also again saddened and ashamed to be working in a field that I see so many clients dying now because of being prescribed medication that not only does not work effectively but is doing terrible harmful to their minds and bodies. What is making me furious is when psychiatrists, MDs, are obviously not reading their patient’s histories, not communicating with other providers and prescribing carelessly. I am only a LICSW and know that you do not prescribe antidepressants to someone with history of bipolar, depressive type. A psychiatrist and I just told a very sweet elderly woman that paxil should not have been diagnosed by her outpatient psychiatrist and was likely the precipitating factor in most recent manic episode and by the way the lithium you were prescribed for years caused you to have chronic kidney disease. Patients are being helplessly drawn into an abyss here toward their death. This is not treatment. CBT, psychotherapy, support group, a new outpatient psychiatrist and a lawyer is what I recommend. Where are the lawsuits?

  • Bingo, vested self-interest is a real issue. Basic economic theory of supply and demand and the psychology of fear and greed. See it in business and political world, unfortunate when it occurs in healthcare and healing professions. Ethics and morality still never old topics to discuss in every discipline. Thanks for interesting topic. May we all be healthy and at peace in our own truth.

  • Thank you, Stephen, for your comments. You hit on the topic that I kept being surprised by when working in adult mental health system and quite frankly burned me out. Learned helplessness was rampant. Culture and belief system of disability not ability. Some more motivated than others. I had been working in the child and adolescent state system prior to moving to DMH adult system and our motto was get them out of the hospital and mental health system quickly, get them into society with peers that were healthy, and do not get them associated with adult system for fear they would never get out and become institutional minded. Our program offered thousands of dollars of great vocational programs free that would offer great career opportunities that myself and others I know would have jumped at due to the economy, but only a couple of the two hundred clients took advantage of it. I was shocked, but if part of a culture that expects nothing of you, that all your needs will be met, financial, housing, medical, etc., why put in the effort? For some, being a “victim”, a “mentally ill patient”, “disabled” was an identity that was comfortable. I felt often that I was working with adolescents if not younger. There were definitely developmental milestones that somehow got missed. I kept thinking how can this be a life worth living? We used motivational interviewing techniques and all sorts of ways to get clients to do more for themselves. I was impressed with the small steps that some did, getting job or volunteering after multiple years of not working, even if just a few hours a week. Institutionalization was/still is a very expensive thing, over $1200 a day. Living in the community is also an expensive thing, housing expenses, new mental health model of community case management, health care, etc. There will always be a subset that want to be taken care of and lack motivation and hope to do better for themselves. Many of their families have given up on them from burn out too and have felt guilty but had to put them in group homes. Those who have risen out of the system are unique but their standards are not what others may want or seek.

  • Thank you, Tabita, for great article. This new generation has a lot of challenges as each generation does. Let’s help them by listening and teaching them what we can but giving them wings to learn for themselves as well. As a child and family therapist I see an array of issues from the overindulged child to the neglected, abuse child. I am tough on parents being the “CEOs” of their families, being strong moral examples. I hold them accountable just as I would the head of a company. I sometimes see parents shirking their responsibilities and wanting schools, therapists, and society to do their job for them. This is not acceptable. I take a lot of heat from parents who do not like what I have to say, often it is get yourself help, stop blaming your children and take responsibility for creating a family that is healthy. Divorce, marital discord, financial pressures, addiction, declining adherence to traditional values and religion, and having had unhealthy childhoods I see as the main culprits. Being a parent is a privilege, a gift, a vocation and requires training and education and investment of time and resources. It should not be entered into lightly.

  • Thanks for comments, Steve. I cannot agree more that it has been mental health professionals that have incurred a lot of harm and we need to collectively own it and change it. As LICSW I can diagnosis and legally do Section 12s. Not something I like doing but have had to if working within established mental health system. I have seen some good changes to the system though with reduction in restraints and introduction of peer specialists and increased person-centered approach. Part of the difficulty had been in retraining staff’s mentality but also changing clients’ mentality. Empowering clients now meant asking more of them, not treating them like children, but giving them opportunities and encouragement to grow which meant discussions about working, doing more for oneself, not expecting others to do for you but to be taught how to do it on one’s own. I will be honest, not everyone is buying that “recovery cool aid” as one of my colleagues at a large human service agency in Boston stated aptly said about clients leaving state institutions. Everyone is at different stages in the process. Change is slow. Growing up and maturation process for all.

  • Interesting research and discussion. Good intentioned people from politicians, policymakers and mental health professionals and others made “mental illness” more of a “physical illness” in order to reduce stigma as well as get insurance coverage. Mental health is a continuum. People do get better with good treatment and supportive environment. I have been privileged to be a part of many clients’ recovery, individuals whom really recovered especially when I did inpatient state hospital work sometimes just because someone believed in them and held hope. Certainly attitudes make a difference. If one (consumer, professional, family member, society) thinks that if you have been diagnosed within the medical model of diagnosis of DSM 5 your fate is that you will “never” be okay, “never” hold a job and be a functioning member of society, “never” get off state benefits, etc. then certainly that may become a self-fulfilling prophesy.

    It takes tremendous amount of persistence and tenacity to get oneself out of the system and find healing. Though I have been part of the problem as a professional working in a broken system and disheartened many times witnessing bad care and bad treatment though I do fight back as much as I can and advocate for my clients, I have also witnessed the courage of many individuals break out of the patient role and live fulfilling lives of their choosing. I have seen good work by dedicated professionals and still hold onto that as well. It is not “us” vs. “them” as we are all humans looking for a life free from suffering. The problem arises with funding sources, how to pay for good care and environments. I have been through closing of many good places due to lack of adequate funding. Healing is often not a short process, takes time and hard work on the part of the client. You get out what you put in and healing occurs through different modalities depending on the individual, their background, resources, etc. Creating bigger support system for individuals to succeed in the communities is the key plus resources for housing and employment opportunities as need financial resources as well.

    I wish my profession could go out of business and everyone would be healthy and free from need for professional intervention. Every citizen has a responsible to each other in this society. We are all called to be advocates for social justice and equality, we can all do our part by taking responsibility for our words and actions.