Wednesday, May 23, 2018

Comments by knowledgeispower

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  • I agree, Stephen, that MDs hold too much power that is unchallenged which creates the seed for unethical behaviors. It reminds me of a time when one would never confront or question a Catholic priest and we know what happened with that institution. Schools and teachers want quiet, behavior free children. Parents do not want to keep being called about their children who are having behavioral issues at school. They may not want to look at their parenting and/or their marriage issues that may be the underlying cause of the behavioral disturbance. Then we have psychiatry and pharmaceutical with their solution of pills and the false narrative of brain diseases. Perfect storm here. I see it as child abuse. If parents were giving their children marijuana or alcohol I would be filing 51A but psychiatric drugs with MD signing off is legal.

  • Thank you, David, for your article with great questions and comments. I have a wonderful 3rd grade teacher friend who is struggling with children telling her that they cannot and will not do work because they are on “Individual Education Plans” (IEPs) due to ADHD. I see 8-year-old boy whose divorced parents are still angry at each other in my therapy practice telling me how broken his brain and how he is not smart in school, because he has ADHD. I had a 17-year-old junior girl’s parents wanting me to diagnose their daughter with ADHD so that she would not get below a B in classes and hopefully get into a college that is beyond her current abilities. I see a lot of this as problems with the schools not engaging and motivating students as some MIA readers have stated. I often help kids with their homework and much of it is online and quite boring. I see parents who are so busy having full-time careers that they just do not have the time and energy to spend with their children doing homework, playing and reading together. I see adults who are angry that they were essentially forced by their parents and the schools to take medications as children and adolescence years that they did not want and be given a diagnosis that followed them.

    I see psychiatry and certainly pharmaceutical industry both looking for short-term fix with pills that do nothing for a child’s self-esteem and negative long-term health consequences. I remember going to Cape Cod conference for a week years ago with Edward Hallowell, MD, the ADHD/ADD guru, to see what this new fad diagnosis was and thinking what a hoax diagnosis this was and how terrible to use one’s MD status to promote it. Psychiatrists need DSM diagnose in order to get paid rather well by health insurance companies. A MD/PHD said in another conference I went last fall that he is often asked to consult in schools. A boy he said was poor and had a challenging family situation. He did not think medications were the answer but admitted that he still gave ADHD medications to him, because “if I didn’t some other MD would” and the school which pays him wanted him to “fix” the boy. What kind of society are we if we do not put children’s well-being ahead of professional self-interest and greed?

  • The problem is not who diagnoses bipolar disorder in children and adolescents. It is the diagnosis itself that is wrong. Bipolar disorder in children was a big cash cow for psychiatry. Lifetime diagnosis and years of medications that we know have negative effects on the growing brain as well as further victimizing children for reactions to their environments, i.e. home, school, peer group. These environments are the problem, not the children. Loving, nurturing environments are the key not years of medications and deferring to psychiatrists and family medicine physicians. Do not put absolute trust in MDs. I work with family medicine MDs and with psychiatrists in the past, they think within a box. We need to love our children, empower parents to be more effective, nurturing caregivers, not medicalize normal childhood behaviors or reactions to negative, traumatic environments.

  • I agree, Steve. Billionaires gave millions to political campaigns and politicians that had incentives to act in their interest. Our current administration is full of former Goldman Sach executives. Ayn Rand, Russian-American author of Atlas Shrugged and The Fountainhead is the political philosophy that Trump and Paul Ryan espouse. We are no longer a republic but a plutocracy.

    I do have optimism stemming from my conversations from many adolescents and young adults who want change. More people are getting politically active and running for office. Perhaps some MIA readers will see office. In Massachusetts we have organizations like Emerge which help to train people to run for office.

  • Dear Richard, thank you for sharing your talent and your thought-provoking article. Economic justice is very tied to social justice. I agree that psychiatry with the government’s backing has been successful at dis-powering marginalized groups in order to quell rebellion. It is a different beast then something like we saw in other countries like communist China or Russia with ethnic cleansing but still oppression. Capitalism as it is today is deadly and the continued treating of humans as commodities will eventually end our world. Humans are capable of destruction but also of great compassion and love for one another.

    As Robert Reich’s book, The Common Good, states, we need to get back to thinking not in the selfish manner that capitalism and economic inequality promotes but thinking of the good of all. There is a lack of trust in society of all our institutions due to the dominance of the one percent who are controlling our society. Trickle down economics does not work. We need power from the bottom up and a more fair and just economy.

  • 1% of the United States population owns 40% of the wealth in this country. That is outrageous. Let’s reign in capitalism with legislation that protects the worker.

    I was proudly with 700 social workers today at Boston statehouse and advocating for raising minimum wage to $15/hour as well as paid Family Medical Leave. Raise Up, a nonprofit organization also advocating for those making over $1 million a year to pay to help pay for transportation and higher education costs. Single payer legislation is on its way. Please get to know your state senators and representatives through emails, calls and in person discussions. They are there to serve us. Democracy works if citizens educate themselves and get involved.

  • Great suggestion! I found Freud to be egoistical and consumed with creating a. false medical science. Freud was a Jewish man who was discriminated in his time. He found a way to make himself important. I spent a year reading his work and just found a lack of care and appreciation for the patients he treated. I found him to be condescending toward his patients. Smart man undoubtedly but troubled himself. Perhaps too much cocaine use.

  • Well said, Rachel777! I am impressed with your humor and intelligence. How crazy making, disempowering and demeaning to label someone with a diagnosis that is not evidenced-based, is really a short-term problem in most cases, a temporary reaction to an environmental stressor, and then the treatment is a medication that causes side effects that are disabling and makes you even sicker, feel worse about yourself causing more isolation. I am so sorry for the hurt and pain you endured. I see it all too often. Peace and loving kindness to you.

  • Thanks, Rachel, for your comment. I do agree that poor relationships especially abusive and toxic relationships can cause and contribute to severe mental symptoms of depression and anxiety and even psychosis. Alcoholism and addiction to drugs are often from attachment issues.

    How does one learn how to have healthy relationships? Therapy certainly can be helpful in understanding relationship patterns, childhood family dynamics and with healing trauma, as well as learning what healthy relationships are. I think everyone can relate to relationship issues at certain times, whether with spouse, parent, one’s child, supervisor, etc. Life can be very difficult at times. Understanding, acceptance, love is needed but all of us.

    How one relates to relationships with institutions of society such as school, work, church and one’s community are vital as well. Those can become unhealthy as well. Bibliotherapy and support groups can be very helpful. Having a meaningful role on society, i.e. caregiver, worker, student, volunteer, parent, can bring purpose.

    Oftentimes I know in my own life I have had to take a hard look at myself and reassess my values, my career goals, my health and nutrition, finances, and my relationships and find ways to continue to grow and change. I continually want to be a better partner, friend, sister, daughter, worker, community member, etc. Healing and growth takes courage and self reflection but also resources. I wish more funds for “mental health” went to supporting and building more caring and supportive communities. Disconnection is harmful.

  • I think there certainly is a sensitivity that is very understandable about being “blamed” for getting “institutionalized” by psychiatry when I see the responsibility in the hands of the medical professionals for propagating dependence and profiting off it. I think Lawrence is an ethical person and I think it is unfair for him to hold the whole bag for psychiatry’s sins. He has written extensively about how wrong psychiatry has gone. People certainly can and do overcome their circumstances which should give hope that one has inner strength and their own innate ability instead of reliance on psychiatry and drugs that we know now are harmful. Reduce demand and psychiatry will go away.

  • Hi Lawrence,
    Your comment, “my focus here was on alternative explanations of why people who take any psych drug long-term, not just the zombifying ones, invariably deteriorate and have such trouble coming off them.” The reason why people stay on long-term is because they have been told by MDs that they need it. Also when people try getting off they have reactions to coming off that terrify them to get back on. MDs tell individuals you have a brain illness, a disease, and you need to take these “medications”. I have heard MDs tell their patients that “See you tried getting off and look what happened?” The message is “trust me, I know better than you”.

    MDs and NPs are the one writing the scripts. Where is the medical professional responsibility knowing the dangerous effects of these drugs to just not prescribe? Why is there not more outrage now among medical professionals now that there is clear evidence that these drugs do nothing at best and certainly do more harm than good. Where are the health care ethics MDs are supposed to follow: beneficence, non maleficence, autonomy and justice?

    I still keep a small private practice, because I love my clients and seeing them do well. I have a full-time job so I do not need my private practice to financially support myself so I charge what is affordable to my clients. I do not take away their power by telling them I know better. I work collaboratively. I speak openly to clients on psychiatric drugs and read off the side effects as the MD or NP that prescribe it did not thoroughly do so. I challenge their diagnoses when they come in saying “I am damaged, I have bipolar, I have ADHD, I am depressed, anxious, etc”. I speak openly about getting off these drugs as I have never seen any of my clients benefit from long-term use. Certainly in a crisis situation, a small dose has been helpful to them. I will not argue with them for this. But there is NO SKILL in a pill. I am honest about them and require that they do the work, i.e. look within, examine one’s history with family, friends, work, take a fearless look at their lives, read books, work on their careers, spirituality, stress management, exercise, family relationships, hobbies, express themselves through journaling, blogging, etc. and discuss what they want from their lives and what is meaning to them. My clients are healthy people and I see them as that. Individuals like me struggling in a world that has ups and downs. I am in it with them but my job is to get them to not need me but to find other ways to view the world and their relationships. I want my clients to be happy and fulfilled. Why else would I do this work? Healing and health is the motive. But why do psychiatrists do their work? I am still wondering despite fearfully knowing the answer. How do psychiatrists justify their high fees and the disastrous results?

  • Thanks, Lawrence, for article and those who responded. “Learned helplessness” is certainly a valid phenomenon. I saw it in the adult units in the state hospital as well as in group homes for those with “severe and persistent mental illness”. This occurs because of the philosophy of these places. I saw the cause as paternalism and a sense that these individuals had permanent disabilities and no chance of being functional human beings. When you have low expectations and that is what you get. Being a “good patient” also meant doing what the staff wanted, i.e. go to groups, take medication and do not cause any disruption to make the staffs’ jobs more difficult.

    I would say that this article puts too much blame on the victims. MDs are in a position of power and trust in this society. Many seem to enjoy their status and power position and love the dependency that others transfer on them. Psychiatry truly has taken advantage of those most vulnerable in society: the poor and traumatized. They have lost any trust society placed on them.

    Freud certainly was a great intellectual of his day, and I enjoyed reading some of his work, “Civilization and Its Discontent” was my favorite which I remember reading first in theology class in college. Psychoanalysts are always interesting but psychoanalysis is more for the white upper classes and misses race and socioeconomic issues. Freud was obviously wrong about sexual abuse and women. It is 2018 and women fortunately have gotten more social, economic and political power than in Freud’s day. We no longer have to have “penis envy”.

  • Hi madmom, managed care is here to stay. ACOs for Medicare and Medicaid are in full force to save costs. $14-$16 billion is the Masachusetts Medicaid budget alone. Unsustainable health care costs which are continuing to rise with aging population. Parity law is not often enforced. I met one attorney, Meiram Bendat, JD, PHD in California whose practice is enforcing the mental health parity laws.

    The problem as you stated is “ineffective and inhumane involunatary incarcerations”. I cannot even recommend in good conscience any inpatient psychiatric units any more. I know some great people who work in some better than other places but the cost of some of these facilities is astronomical and the care is still medications as standard of care.

    Psychiatric drugs pay the bills for these facilities. Psychiatrists become cash cows. Good treatment and care is no longer the center and mission. It is staying alive. Menninger Clinic used to be a beacon of good care, but when I was studying there as a fellow it was their last year in Topeka they were unable to be financially viable and had to merge with Baylor Methodist in Houston. It is our U.S. healthcare system and reimbursement rates for behavioral health that is much less than medical care. The standard of care for mental health treatment also that is upheld by the self-interested American Psychiatric Association as well as in part the American Psychological Association is the problem as well. Psychiatric drugs do not heal, they treat symptoms but do not address underlying root causes. Forced treatment just breeds distrust. No thanks, I am out.

    You sound like a very loving and protective mother. Your daughter sounds like a lovely young lady. I trust in your love and your daughter’s resilience.

  • You are very bright, gifted and a fabulous writer, Julie. I learn a lot from you. I could see you doing many things. Massachusetts Rehabilitation Commission and UMass Medical School Work without Limits has been a very useful resource for getting individuals with disabilities jobs in my area. I like navigating complex, archaic systems and enjoy helping others apply and get resources in their communities they may not know about.

  • Recovery Learning Communities in Massachusetts are state funded, Dept. of Mental Health. They are certainly not political activism centers. DMH is old school “take your medications”, psychiatrists rule, medical model… Western MA RLC’s are at least the most radical in Massachusetts. I am sure Sera Davidow does a great job in her role and certainly is a great advocate there, but she certainly cannot say as a paid government funded program employee the most radical thoughts and ideas at MIA without some repercussions. I would give money to an independently funded agency that is peer run and politically active. Other organizations including my own, NASW, is reluctant to go against the MDs.

  • Stephen, I applaud you for trying to make a difference from within and I am sure you do make a positive difference even amidst those who may not agree with you.

    We use to do debriefings after every restraint, a horrible thing to experience for patient and staff. For a while they were helpful and often painful. What could we have done better? Self-reflection and criticism of ourselves was encouraged for awhile. Restraints did go down. However, criticize the psychiatrist who ordered the restraint which I had seen incorrectly done several times and experience ostracizing and career suicide. I and others fought some good battles and won sometimes with HR, but MDs ruled and were considered more important to the hospital.

  • I agree, Darby, should be independent organization, run by peers, have own way of running it. I am just telling you my experience with peers within traditional settings which does not work, they become just as “professionalized” and indoctrinated as the rest of us. They have to do similar roles and documentation and follow agency rules. These agencies whom I have worked are funded by Department of Mental Health. Their mission sounds like it is peer recovery focused but really mission in my experience is to keep the agency alive, co-dependency model. DMH was tough at times, too tough, and in meetings would make statements with peers and staff present, “That working is what adults do and not working should not be an option”. Recovery Learning Communities have been helpful but funded by DMH here in Massachusetts so not completely independent. Funding for independently run agencies is a battle that is worth fighting. Training is part of any agency even peer run groups. You have to decide on policies, etc. when become an organized entity.

  • I agree, Dan, with allying with others. Human rights violations, abuse of power and discrimination should be fought with a united front by everyone. Injustice is injustice. Reaching out to law schools has been useful as well as already existing legal/advocacy organizations such as Center for Representation. I would really like to see a class action suit where the funds go into funding organizations that support alternatives to mainstream mental health. I have spoken to attorney friends and say that it would be a long and expensive process. I still think it can be done. There have to be some idealistic young attorneys out there.

    There are many stakeholders in changing the current mental health system which is embedded in our healthcare system which needs reforming. This includes insurance companies, government, health care providers, the powerful AMA, as well as patients and their families. Healthcare is not a right in the United States. I think it should be. Healthcare costs are continuing to soar and not sustainable Our population is aging. We have a lot of battles ahead. Let us continue to have productive discourses. We do not have to all agree, but agree to be respectful and seek to listen and understand one another. None of us is perfect human beings with all the answers.

  • Dear madmom, I am definitely not saying that peers are less able to be discrete with self-disclosure. My point is actually that peers are actually in a much more vulnerable and authentic place then clinicians. I think that this can have far more healing power. Hearing trauma stories can have effects on anyone and thus my point is that processing it with others can be very helpful as MIA reader here do.
    My experience is with the start of peer specialists in traditional psychiatric inpatient and community mental health settings. I left working in these places due to lack of progressive change and abuse and power struggles by professionals that was very harmful. I refuse to work in setting with psychiatrists and forced treatment of any kind. I have challenged and been beaten down quite a bit by colleagues and psychiatrists. I advocate for those harmed by society in all forms. I see most professionalization in the “mental health field” as causing harm, an unequal power over others versus collaboration. I do not want any part of harmful power system. I want to be an honest and sincere human being in the struggle and pain I see around me and be able to be of some benefit to others. I work with those with physical illnesses now but certainly the pain and suffering of homeless, addiction and poverty is there as well. I asked God for help every day. I have met such incredible children, adults and families along the way. They changed me more in ways I can never give back. I wish you and your daughter much wellness.

  • I think peers are being more and more professionalized whether that is good or not it is going the way of other professions with certifications, etc. If getting paid, you are a professional. Friends, family or volunteers do not get paid. If get paid should be some standards, shouldn’t there? I wish that people would just volunteer and that natural supports like friends, family, ministers/priests would be more active and helpful. But we live in a culture of disconnection. Sadly, the disconnection is what is causing the problems.

  • Good points, bron76! Peer specialists definitely need lots of training and supervision. Working with individuals in crisis situations is emotionally draining and triggering as well. Peers are in a more vulnerable position in my opinion then clinicians like myself who are trained not ever to self-disclose unless in the benefit of the client’s progress in their goals. I have hired and supervised adult peers and had the first adolescent peers who were former patients who I knew as their individual and family therapist. There are similar issues of “transference” and “countertransference”, “overidentifying”, “vicarious traumatization” etc. that new clinicians have. Sorry for the clinical language, hard to de-program. Just because you have been through a similar experience of being labeled and in the mental health system does not mean you can fully be in the shoes of another. That needs to be acknowledged in the peer to peer relationship. I fully support having all peers run respite programs. I see the benefit just like I see the current benefit of “Recovery Coaches” for those with addictions.

  • Thank you, Bob, for this a lovely and hopeful story. Amazing what a safe, nurturing and nonjudgmental environment can do. Free from fear of being harmed and accepting others as they are. Common sense so why so hard to achieve in the United States? $5,500/month is cheap compared to the $1,000-$1,200/day price tag of private and state hospitals in U.S. which is the cost to have nurses and psychiatrists present. Take out the medical model and create more of a sanctuary with rules for safety and reasonable expectations. Healing is really pretty simple.

  • Thanks, Darby, for your article and your work. The dominant medical model and ego degreeism entrenched model always seemed to aggressively overshadow the “peer recovery speciailists” in places I worked, psychiatric adolescent state hospital and city community mental health centers. An entire culture change at the very top down was needed with all getting trained in peer support model and principles as well as the agency fully embracing and holding everyone accountable to those principles. There was a lot of lip service and praise for peer support on the surface but have yet to see an agency fully internalize the peer support model.

    Many of the professionals I worked did not want the peer support model, because they benefitted from the old model in their status, power, autonomy and income. Some were just so used to one way of doing things, not wanting to change that inertia set in which becomes frustrating to those who wanted change. Some like myself just left these entrenched systems in disgust and exhaustion.

    Thank you for your efforts. I do believe that change is possible.

  • Hi TirelessFighter3,
    I agree that some psychiatric drugs can contribute and even be the precipitating cause of someone committing suicide. “Talk psychotherapy” especially psychoanalytic therapy is not always advised for certain individuals at certain times, i.e. in crisis, psychotic. Some individuals just are not good candidates for pure “talk therapy” and may benefit from more “supportive counseling” with less emphasis on the past, and may benefit better from family therapy, group therapy, expressive therapy or no therapy at all, i.e. community supports, journaling, bibliotherapy, etc..

    But I disagree that professionals or least all, “make people believe their anger and distress are not warranted, and that it is they themselves that are the problem”. That certainly is not how I nor many of many fellow therapists, especially if clinical social workers as social work is based on theory of interaction between “person in environment”. One needs to look at the individuals family, culture, religion, work environment, socioeconomic class, and wider political and social environment. Trauma-informed therapy looks at all sources of distress. Individuals have a right to be angry at the political and social environment they are in and therapy itself cannot change those bigger issues but therapists certainly have an obligation to point out these factors and injustices.

  • I agree, littleturtle, humans are much more complex and deserve individualized care and treatment more than a single, one fit model. This takes time and effort to achieve for whose of no fault of their own life has hit them unfairly hard. Those who take the time and effort to do the work do not need medication, endless therapy, being hooked to state and human services their entire life and being on social security disability. Developing good coping strategies for life, having supported, positive supports is what heals in my opinion.

  • Thanks, PatH80 for the link to approach to depression that has broader view of looking at depression, causes and treatment options. Psychopharmacology psychiatry which I call modern day psychiatry is far too narrow and self-serving. I like the “service to others” and “bibliotherapy” recommendations. There is something about doing for others when depressed even though certainly do not feel up to it. Good books with positive messages about being human are always helpful. I am sure all of us have some good books to recommend for this. Being good to our bodies with massages and relaxing baths help with self-care. Speaking kindly to oneself also has been helpful with depressed clients and myself when life is a stressful. Depressed individuals often think negatively about themselves and are very harsh toward themselves. Cognitive-behavioral therapists work on changing the thinking patterns and refuting automatic thoughts and replacing with more realistic and less punitive ones. Also being in touch with anger is important. Psychoanalysts would say depression is “anger inward” which has some merit.

  • Thank you, Dr. Brogan, for presenting this study. The healthcare ethic is first do no harm and secondly provide a benefit for the patient. I see no benefit in antidepressants and certainly have seen harm. At best they provide a placebo effect or initial boost but inevitably my clients in my private practice tell me that the antidepressant is dong nothing or causing side effects. I have actually seen patients on the pediatric ICU unit and adult medical/surgical unit in the hospital I work attempt suicide using their prescribed antidepressant medications. What a strange and horrible irony.

    Exercise, good nutrition, balanced life, spirituality, meaningful role in life and supportive, nonjudgmental listening from caring individual does wonders. Time and love heals. Antidepressants disempower individuals and give a sense that inner psychic and natural pain caused by being human can be solved by a toxic pill. Humans are made to feel pain and experience suffering. Humans also have the capacity to heal, to love and be loved.

  • Dear Robert,
    I love the story of Scrooge and his transformation. Thank you for looking at the story as one of trauma and need for processing and grieving, forgiveness, humility and kindness. Human resilience and the power of transformation are what gives me hope in a world certainly full of suffering but also one of compassion and kindness. I wish you and all MIA a wonderful holiday season.

  • Thank you, Dr. Kelmenson, for another great article. In community mental health psychiatrists are taking hundreds of clients on their caseloads. There just was no way that they could know these seriously and chronically mentally and physically disabled patients well.

    I do feel for some of them who are truly in it to help and heal but find out quickly when they start working the reality of how psychiatry is actually practiced. In meetings I remember in a busy community mental health agency where I was a director one second career psychiatrist who was just starting working was trying to get to know her clients in more depth. She wanted to get to know her patients better and had long meetings with her patients and direct care staff. She was quickly burning out though as she was falling behind on seeing the required number of patients a day, the 15-minute standard. Though I complimented her to her supervisor, the medical director, about her dedication to her patients; I was met with anger by the medical director who said she needed to focus on completing her billing and notes. The agency could not financially survive without this. Reimbursement rates from the state health insurance continue to be very low.

    Ironically it was the lowest paid employees, the residential staff and case managers who actually knew the patients the best in group homes. The master level clinicians who were very underpaid did not stay long, just long enough to get their license and find better paying positions. Peer specialists also were terribly paid and what I saw not well treated and respected. The ones that stayed were nurses and psychiatrists who were the better paid. The individuals in these programs needed the most care and time but got improperly trained staff with huge turnover, and psychiatrists who did not have the time to do anything but bill and were not aware of their patients deeper lives and activities. Patients stayed on the same psychiatric drugs because it was easier to do and paid the bills. Shameful system that does not serve the interest of the individual needing help.

  • I appreciate the interesting article from Emily and the comments from others about this controversial diagnosis. When I studied with psychoanalysts it was the diagnosis to fear when treating if you did not have extensive training and experience. “Management of countertransference” trainings were a common training for new therapists as this personality disorder could throw a therapist into an abyss of either hatred and anger and thus retaliation against the patient/client or boundary violations as the therapist wrongly tried to meet the bottomless needs of the client. The diagnosis reportedly was caused by “an invalidating” childhood, usually meaning a mother who was consumed in her own narcissism and unable to meet the emotional needs of the child. The patient’s/client’s behaviors including suicidal threats and attempts and self-injurious behaviors. I did find these behaviors rampant on an adolescent inpatient psychiatric unit. Most labeled were females and some gay males. We used Dialectical Behavior Therapy which Marsha Linehan, PhD created, a psychologist who has come out as a former psychiatric patient labelled with this diagnosis herself. It is a skilled based curriculum of lessons taken from variety of sources including Buddhism. It is a good compilation of lessons with the hope of being more centered in the “wise mind” vs. the overly emotional or intellectualized mind. Most of the adolescents had taken years of DBT and were better experts at it than I was who needed to quickly learn it. The information in it is good for anyone but to do DBT according to the rules one needed to be in a DBT group and have a DBT outpatient therapist. I did see improvement in certain types of behaviors that we were trying to target, i.e. self-injurious behaviors and suicide attempts. My problem was that they had to go back to their families with same environments. Relapse was common and often they would come back to the hospital. Best treatment I found was working with the parents and siblings and creating a healthier environment for the system itself. Changing a toxic environment with consistent rules and boundaries and mutual respect does wonders.

    The diagnosis itself is very stigmatizing even on a psychiatric unit where you would think trained staff would be more caring but not always. We had to fight the language of staff, i.e. “manipulative” behaviors and “splitting”. Everyone is an individual with his/her own personal experiences, social economic background, gender, culture, religious or not religious background, and education that putting individuals into this limiting diagnostic category is absurd and truly not respectful nor humane. Adolescence and young adulthood is tough enough without adding a misunderstood and misleading diagnosis. Self-consciousness and fitting in with peer group, moving from the family of origin to more independence as an adult is tough. Having maladaptive and unhealthy coping strategies such as cutting and threatening suicide serve a purpose which can be retrained. This diagnosis was created by mainly psychiatrists, “the thought leaders” from APA which wants to be seen as a credible, scientific entity on par with the AMA and other medical professionals.

  • 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