Thanks so much for this post, Sarah – really enjoy your passion & insights. Like you, I’ve been very impressed w/ PTM & have followed the blow-back it has received in the UK. Trying to discern patterns & create models of human responses to overwhelming stress helps us understand ourselves and others, I think. For me, PTM effectively counters the dominant medical/disease model – & offers a meaningful pathway out.
Thanks for this post, Sandy. So glad you are addressing this important topic. The “Holy Grail” of the DUP drives such anxiety, such demands for compliance, such unquestioned certainty. It’s hard for anyone to withstand – let alone a vulnerable, overwhelmed youth & family. Keep up good work.
Daniel – interesting points. I’m leery of “trauma inflation” – more & more painful experiences being categorized as trauma. Ultimately, I think we have to go w/ what people’s subjective experiences are.
That being said, I do believe it’s important to understand traumatic experiences as a threat to ppl’s survival, overwhelming their ability to cope etc…, basic safety sense of safety being compromised etc…
In that light, many of the examples you cite may be very distressing, painful – but not traumatic?
Hi Daniel, I too believe that trauma is under-reported & under-recognized (by traumatized ppl themselves, as well as by others.) There’s many factors at play; in addition to the secrecy, shame & taboo – there’s the concept of “attachment trauma” – when the essential bonding gets compromised (self-regulation, distress tolerance is learned through this attachment process.) Needless to say, when it occurs at developmentally vulnerable ages , esp 0-3, it’s unlikely to be verbalized or “conscious”. Severe emotional neglect & abuse is cited as the most common form of trauma, & often not reported or understood as a traumatizing “event”, but very insidious. Thanks for your comments & questions.
Hi John – maybe you’re thinking of Portugal? “Illicit” drugs are for most part legal & they redirect a great deal of resources away from law enforcement to subsidizing job apprenticeships & support networks?
I think Johann Hari & Gabor Mate discuss this approach. Sounds promising.
Lawrence (can’t seem to put reply in right place)
You raise some good points & data I have not seen. I disagree w/ your (over) statement that there is “nothing well intentioned” about MAT. Many good people on the front lines trying to get a handle on a huge problem.
Your statement re: Suboxone as likely contributor to opioid crisis is provocative – would like to learn more. Thanks for commenting
Thanks for this post.
Jill, I see you as substituting 1 reductionistic, decontextualized theory for another. It still begs the central question; what causes the inflammation/chemical imbalance?
Kenneth- thanks so much for this insightful post. From the perspective of working w/ traumatized young adults for the past 20 years – I couldn’t agree more.
I particularly applaud your point; “the institutional rigidities, constraints, fears of liability, and risk are major impediments. Additionally, the “love affair” for “evidence-based” approaches to treatment of so-called mental disturbances, the monolithic nature of the medical model, and the primacy of the pharmacological approach only add to the roadblocks. Cushman and Gilford define evidence-based as “an abhorrence of ambiguity, complexity, uncertainty, perplexity, mystery, imperfection and individual variation in treatment” To that I add an abhorrence of improvisation. No wonder “evidence-based” is the way.”
That nutshells it pretty well! Despite all of these roadblocks – I share your sense of hope. thanks again
thanks for your comments, The_cat. I’m interested in your point; “Problem is they can’t learn to regulate emotions if they spend their childhoods in drug induced emotional flatness”.
I’ve been thinking about how meds undermine trauma-informed therapy. Any articles to recommend? Thanks again
Nomadic – that hasn’t been my experience that therapists attempt to talk people out of their awareness & into denial. Pretty clear guidelines to not do so and make a report. But can’t say it doesn’t happen.
Belinda – thanks for the report from Australia You make a few points I’d like to comment on. You mention that all should at least be acknowledged as PTSD and I agree – yet none are. This has been my experience as well. The one Dx in DSM that points to a clear, environmental cause – and not used? WTF?
You also comment on the unfortunate, offsetting “mix ” of psychosocial therapy + meds. Makes me question how this will ever work for youth – when “paradigms collide”. About the push on cognitive – I don’t get it. Teaching emotional regulation always seems front & center to me.
Your ill-informed question makes the point – “Or are you going to criticize the drugs used to treat them for their unhappiness and lack of love?” What exactly is the drug that treats a lack of love? What medication for a shattered heart? Foster youth can recover from these wounds, but psychotropics cannot heal.
Wow, Peter – I really appreciate you sharing all the years of first hand experiences that align with my understanding. Thanks.
Your ending comments; “Foster care is a high stress environment in which the temptation to drug our way out of frightening jams is seldom resisted.” is so spot on. Acknowledging the “frightening jams” is important – standing by staff’s side as they struggle to deal w/ intense, scary reactions of traumatized foster youth, while trying to keep people safe is incredibly challenging.
Thanks for your comments, Richard. I don’t disagree with your overall points, some of the differences have to do w/ rhetoric vs. more science based dialogues.
I’m leery of absolutist positions of “it’s all this, or all that”. I do believe that if the many causes of mental disturbances and distress were ever actually ever honestly investigated, it would probably reveal incredible heterogeneity – and some of those causes might prove to be physiological.
But I agree with you that in the current climate, leaving that door cracked open even a little can be exploited to maintain the status quo. With the profit driven corruption of science, we may never know.
Thanks so much for this post, Corinna. It articulates so well what rarely gets stated amidst all the EBP-mania. I like how you’ve used the term disease label education vs. people in distress. The current anti-stigma approach seems like saying people have “cooties” (diagnostic label), and then try to educate to not feel so fearful, avoidant, judgmental about cooties.
The infographic is excellent.
Wow – the bully boys have gathered ’round to stomp a writer. Rather than address any of her presented ideas, you attack her – comparing her to a crack dealer and accusing her of being an enabler.
You don’t know what her attitudes are about biological psychiatry & the MH system. You don’t know what she does to support & empower people who’ve been harmed by meds & psychiatry. You don’t know what adversities she has had to overcome. In your self-righteous condescensions, you just assume.
Low. Troll-ishly low.
Hi Corinna – thanks for post, I admire your honesty & tenacity.
I’ve been supportive of the “ACE’s movement”, so your experiences & analysis are important to hear. I’d like to respond to 1 thing, (the rest I’m still mulling over). The focus on trauma biology hasn’t created the disconnect for me, as it has for you. I thought, unlike biopsychiatry message of it’s a disease, chem imbalance, etc… ACE’s emphasizes the contexts, the impacts on neurodevelopment of adversities such as poverty, discrimination, neglect – but clearly call out the toxic stressors in the environment. The good news, unlike genetically based brain diseases that do create stigma, is neuroplasticity – improving the environment, income inequality etc… improves all of our brains/spirits. Locating the defect/disease in individuals is much different than ACE’s recognition of social conditons & maltreatment. For me, ACE’s approach of understanding “what’s happened to you” can create compassion, rather than more stigma & othering.
This is a very helpful analysis, thanks Bob.
In the movie/book, the Big Short – Mark Twain is quoted; “It ain’t what you don’t know that gets you in trouble. It’s what you know for sure that just ain’t so”. The movie resonated w/ me in regards to this debate – the Big Short of Psychiatry. I hope to see the day when the willful blindness to evidence, the self-interested disinterest in facts will come crashing down. It’s interesting to me that Whitaker the journalist seems so much more engaged in true science than so many Psychiatrist/experts.
One other bogus pillar that is used to prop up the biopsych approach of carpet bombing/medicating anything labeled psychotic is the Duration of Untreated Psychosis (DUP). It creates this urgent rush to “treat” i.e medicate, as if delay is allowing a virulent wildfire to spread unimpeded. (B4Stage4). The sacred DUP is a key impetus & rationale to medicate early & not ask questions later. This must be challenged as well.
Paris – I really think you’re on to something with your unified theory – write on!
In terms of sub-optimal attachment, the impact on neurodevelopment is profound. (Dan Siegel comes to mind) especially the ability to tolerate distress and self-soothe can be compromised.
Looking forward to Part 3.
Thanks both for this, Paris – as well as your book – very helpful. Glad someone is calling out the taboo topic.
Wish to emphasize the impact of ACE’s/trauma contribution to psychosis – particularly the developmental traumas that occurs at very young ages (0-3), pre-verbal, that undermine attachment and ability to self-soothe. I believe this really lays an often unrecognized foundation for later “psychotic” experiences .Also noting, that the since the diagnosis of psychosis has such little validity – that there are probably several different etiologies, manifestations – that currently all lumped together. It makes these conversations difficult, as we attempt to compare apples with watermelons.
Thanks for this post Malia and welcome to MIA. My difficulty with your overall point has to do with Prof’s “not traditionally including the disclosure of personal lived experience as a tool”. This is a tradition that ought to be changed (and many professionals that I know do self-disclose about various kinds of struggles and distress). So I’m not sure about the whole “unique scopes of practice” thing – Peers can provide what prof’s offer (often more effectively) – and prof’s should be encouraged to selectively self-disclose. Thanks again for adding your voice.
Thanks Randy for this insightful post. Squishing people into these invalid boxes is such a disservice. The toxic impact on how they see themselves, on how others see them is substantial. We spend so much time talking about reducing stigma – when it is being inflicted by the very people trying to help.
One quibble – ” As ubiqitous as Jelly Tots”?? (wish I had a clue what they were)
Great question Steve – I too have been trying to sort out useful, empowering words. Mental injury, while an improvement over mental illness, focuses on the harm, the event(s), toxic stressor etc…? “Trauma adaptations” call attention to the many normal reactions and ways that people often cope with and survive abnormal experiences. Thoughts?
Thanks for your comments Fiachra – I do think there’s a growing recognition of the importance of employment & education support which I think is key to recovery. Working on some way for the young person to access the life they wanted, and escape the MH system and disabled identity.
As you say, help in finding a way through problems (and believing that’s possible) is crucial as well.
Right Oldhead, not sure what personalized meds means either (there has been lots of talk of low-dosage, but not reported) They’re also apparently really pushing long acting injectables and that seems pretty impersonal. What’s a young person supposed to do once it’s in ’em?
Someone Else – it is disempowering to call it a disease. It induces so much passivity, helplessness & despondency. Your point;” it’s possible their use at all is unwise.” is spot on. Thanks for commenting.
Thanks for weighing in bpd – your comment; “(so-called “schizophrenia”) is not one unitary illness and may not be lifelong,” is an important one. I think there is substantial indications that what gets lumped together under the invalid label of psychosis – is actually several different etiologies and issues. Why psychiatry persists in acting as if they are unitary is beyond me. So much for personalized medications.
Sandy – thanks for this post. I feel more hopeful after reading it. It seems straightforward, transparent & cuts through the dense fog created by medicalizing misery. The drug centered + need adapted is more empowering & informative IMO. Humble, humane, honest – 3 H’s I could get behind.
Hi Jen – just noticed your post and wanted to respond. When people address themselves to specific others, as you (& others sometimes do) I’ve generally refrain from commenting, as I think I’m intruding.
I believe that for trauma informed care to be effective, it can’t come from a “one up” experts w/ alphabet soups after their names. We’re all bozos on this bus – and as someone who struggles w/ my own ACE’s, prefer a side-by-side, transparent approach.
For what it’s worth – my own experience w/ this site is that it is remarkably not dominated, or segregated by professional/survivor status. MiA has been a an incredibly educational forum for me because of that.
“Complex-PTSD,” which all to often goes totally untreated” – sad, but true hpostpsychiatry, I believe trauma is under-reported, under-recognized and vastly under-treated.
Loving it, Catnight! The ACE Avengers are born!
In my trainings, I often make note of the ubiquity of childhood trauma narratives in the Super-Hero pantheon (Batman, Spiderman, X-Men etc…) – they derive their super strengths (post-traumatic growth) from their grievous wounds.
Thanks for your comments, firewoman. Your points about the chilling effect of continued reliance on Psychiatry for research funding make sense. When van der Kolk’s proposed diagnosis of Developmental Trauma Disorder was slapped down by the DSM committee for lack of evidence (despite substantial research backing, that exceeded most other diagnoses) you wonder what it will take to break through the wall of denial and self interest.
You couldn’t be anymore spot on when you say – “we need to reach a point where childhood maltreatment becomes a more open conversation, though this is going to take a lot of work.” True that.
Great questions, Joe. IMO Yes- training, coupled w/ bold, impassioned leadership that has drank the TIC kool-aid can bring significant change (not that common)
But no, a webinar alone ain’t enough. For me, the key is the commitment of supervisors (mid-levels) to implement TIC, long after the trainings are over. Without them, very little progress.
I have seen it happen, organizational alignment a must.
Thanks for your thoughts bpdtransformation. I am working at spreading this viewpoint. You take the long-view which I think is helpful and hopeful. Meanwhile, I’m just another termite gnawing on the front porch of bio-Psych.
You’re very welcome, Anonime. You’ve nutshelled the disconnect very well. On the one hand, non-evidence based/dominant approach in mental health; OTOH evidence based alternatives that are barely mentioned in the national debate.
The big difference = $
Thanks for weighing in, Steve. Much appreciated. I did say “what if”?, not what will be. (or what I hope) but I do believe that the pendulum is beginning to swing back towards understanding human beings in their environments? But agree with you that the huge profits to be made in current paradigm will slow the pendulum down.
Thanks ! Yes, traumas exacts huge toll across the lifespan, just more acutely at more developmentally vulnerable ages. Especially ages 0-3 when attachment problems affect capacity to self-soothe and trust that the world is a safe place.
Thanks Timothy for this post. I too thought that Whitaker may overemphasize and oversimplify in his assertions that medications are the major driver fueling the rise in SSI/SSDI rates. Another Boston Globe journalist, Patricia Wen, wrote a piece a few years back about “SSI – the New Welfare”. In it, she described impoverished families seeking a stable income by taking their children to Psychiatrists to qualify for SSI. (ADHD was the most common diagnosis, if I recall correctly.) Some parents she interviewed commented that to qualify for SSI, the child must be on meds.
The political push behind the Welfare to Work legislation aimed to reduce the Welfare rolls. This resulted in a cynical relabeling from being low income to being disabled. Entitlements based on low income seem far less damaging to these poor children than being psychiatrized.
Thank you, Scott for describing a comprehensive alternative approach. Much needed.
My misgivings are based on the whiz-bang hi technology of it all – i.e. Q EEG/Brain Map; lab assessments; assessment of genetic profile as it relates to MH?? Americans deeply love hi tech solutions and the magic bullets – so dazzling seductive vs. low tech accepting suffering, empathy and listening. “You’ll have to work hard to grow and overcome this” – has never been a popular message.
The kitchen sink approach of it all would seem to be so costly.
I’m in the public sector – so perhaps I’m too accustomed to low budgets and scarce resources, but this seems gold-plated.
Well done, Peter. I think of this movement as a bunch of termites gnawing away at the front-porch edifice of Psychiatry. One day the porch will collapse. You are a BIG termite that got noticed by a much wider audience – good job!
Thanks Noel for this post – it raises a confusing range of questions.
On the science of it, I look no further than the Related Post link – “Questions about Childhood Trauma & Schizophrenia Settled”. I also offer this link – https://childtrauma.org/wp-content/uploads/2014/04/Read_Fosse_-Moskowitz_-Perry_2014.pdf The evidence is compelling that a clear link is present.
But you aptly point to a Political Battle – I assume that BioPsychiatrists see this research as encroaching on their turf and undermining the dominant chemcial imbalance narrative. And I agree w/ Ron, that Trauma providers and survivors don’t wan’t to be associated w/ this intensely stigmatized group of people .
For me, a great deal of this battle is about definitons and labels. The label of psychosis is worse than meaningless – it is not descriptive, prescriptive or predictive. It only manages to stigmatize and make people feel hopeless/helpless. A “symptom-based” approach offers some clarity where we seek only to address what barriers, distress, concerns a person presents – i.e. I feel scared that people are trying to hurt me, I’m confused about who I am” seems a much more straightforward, collaborative starting point. Our insistence on diagnoses and defining dissociative can obscure this. Lucy Johnstone & others recommend “psychological formulations” – simple problems-in- living statements in help-seekers own words without the need for the psychojargon.
Will get to hear from John Read, a leading reseracher on this topic, tomorrow at ISEPP conference in CA. Keep the dialogue going.
Thanks so much for this thoughtful post, Sandy. I greatly appreciate your candor as just one person struggling humbly w/ complex issues. It makes me feel more hopeful.
One statement you made – ” psychosis for some can lead to a rupture on many levels that is frightening.” that I’d like to comment on. I was talking to a friend who was removed from her home as a child when her father became psychotic and violent. She related how terrified she was and how she dreaded going home.
We can become so focused on how extreme distress affects a person and how to try and help them – and occasionally overlook the many other people who are deeply impacted. No easy answers – that’s for sure. As you say – the problem of uncertainty is so great.
Thanks for this post, Noel. You pose a great question; how does diagnosis/labeling help treatment? While I agree w/ your assertion that “it just doesn’t” – you still note that many people in distress find value and comfort in being diagnosed. You touch on some of the reasons; >not feeling alone and unique in their suffering >someone (with power and authority) understands >I can be helped, there is hope >now that “the problem” has been named, it can be fixed (and as easy as taking pills) All very comforting and seductive messages.
How can we change the narrative to helping people experience their pain while feeling safe, embracing suffering, finding meaning in anguish, working hard to build distress tolerance? A much more challenging message.
Thanks for clarification, John. I do know of outreach workers who provide this outreach (but drop the patronising tone.)
I do think this is what The Village offers in large part.
Boans – good pts. Some have asked whether the “commitment” is a 2 way street? Is the MH system/community commited to offering empowering, client driven care that asks “what happened to you?” (rather whan what’s wrong?) This infrastructure needs to be in place before people get commited to care they don’t want.
Could you say more about the “failure” in Australia? Any articles?
Thanks for post, Jonathan. I think the emphasis on “beds” may be misplaced – whether in hospitals or in your preferred crisis residential settings. Mobile, supportive staff/peers going to people’s homes, similar to Open Dialogue, avoids much of the high costs of running facilities, keeps people in familiar places & routines (family, pets) and the intensity of support can be titrated. This seems far less disruptive & can potentially strengthen natural supports.
Of course, it does depend on a person having adequate housing. As you know, hospitals get used for housing/food quite a bit.
Thanks for this post, Ron. One of the steps I’m taking is educating MH professionals about traumagenic psychosis. One study (J.Read) I’ve read indicates that up to 85% of psychotic episodes are attributable to past traumatic exposures.
That we’ve been blinded to such an obvious link for so long, is an indication of how the medical model/brain disease dominates. Once people begin to consider the role of trauma in precipitating severe emotional distress – the more they may have to reconsider the chemical imbalance/illness explanation.
How is Zyprexa supposed to heal the impacts of trauma? Trauma informed care may prove to be an important lever in dislodging reductionistic psychiatry.
I agree Larmac with your Pulitzer nomination – this journalist really dug in, persisted and got multiple perspectives (esp from foster youth)
One other aspect – I believe foster parents have a financial incentive to get their youths on psychotropics – higher reimbursements if medicated.
Good idea about comparing predictive values of nature vs. nurture (but that makes way too much sense) Research by Shevlin reports that a child who has experienced
3 ACES is 18 times more likely to develop psychotic like symptoms; 5 ACES? = 193 times more likely for psychosis.
Thanks for this post, Noel and welcome. Like you, I have found the profound disconnect bewteen trauma adaptations and DSM symptom categories to be bewildering.
I suspect that your statement about the “understandable (but not necessarily defensible) tendency to deny the existence of trauma” is likely true. (I’ve heared Bessel van der Kolk say much the same thing.)
I heartily agree with the call for “trauma & psychosis fields to join forces”. When that happens, we could shift away from the meds first & last approach and move towards true healing.
I hear you humanbeing.
The Recovery model programs I have in mind are typically reserved for people who are costing the system alot of $ (hospitals/jail/ER’s). The irony is how much this approach of creating community and meaningful roles is good medicine for us all (the diagnosed and yet to be diagnosed).
Boans & Johnathan – yes, perfect. (I’ve trying to think of some other clever French quip, but gave up)
A lot of psych meds are directed to homeless people – much easier than finding affordable housing.
Thanks for your comments, Andrew. I agree that it’s one of the most culturaly taboo topics (we’re even more open to talking about racism, than classism).
Good point about the overriding focus on stabilization – that is a pervasive attitude of MH systems unfortunately.
Thanks for this excellent resource, Ron. Great way to get the word out. One way to “normalize” that I find useful is asking professionals to self-disclose an experience when they were severely distressed and thinking & feeling was impacted. A recent post on MIA noted how just sleep deprivation alone can readily produce psychotic-like experiences.
Some prof’s are hesitant, but acknowledging we are all vulnerable under stress moves the conversation away from illness and pathology towards improving coping.
Thanks for this post, Peter. Welcome. I’d like to respond to your suggestion; “One possible factor to consider could be standardizing education and training requirements for case managers.” The key question for me is what would they be taught? Education or indoctrination? I’m glad to hear of RW’s visit to your campus, but not aware of his info getting into graduate curriculums much.
I generally haven’t found a strong relationship between the level of education and the quality of “case-m’gmt” (BTW – people aren’t cases and don’t want to be managed). I’ve seen many people w/ life experience & HS diplomas excel at providing recovery support, often being preferred to their better educated colleagues.
Yes, you do look pretty intense in that pic – (even your hair looks like it wants to attack me 😉
I appreciate this truly enlightening post – I also missed some of the key intentions you’ve pointed out. The funding being diverted from SAMSHA seems to send a clear, chilling message. “Ok, enough of this consumer driven crap – it’s time for the adults in the room to reassert control”
Thanks for this post, Mark. In my training, I too was taught (more acculturated) to the idea of not engaging w/ people having anomalous experiences, hearing voices etc… Too often, MH professionals respond w/ fear, hopelessness and avoidance – and a peremptory referral to a Psychiatrist such as yourself (what could we do about chemical imbalances?)
CBT tries to “decatastrophize’ the experiences – as important for providers as it is for distressed help seekers. Be respectfully curious about meanings, enhance coping, reduce stress if possible.
I think it’s notable that in the Eleanor Longden TED talk, she points out that it was the frightened over-reactions to her voice hearing that precipitated her struggles. It was as if she was taught to fear and distrust her voices that intensified her suffering.
Johnathon – you raise some excellent points. One that resonates with me is;
“f a place that is as open minded as the Unitarian Church will no longer host a psychiatric reform group, what does that say about our message to the broader public?”
The phrase; for me to be right does not require for you to be wrong – comes to mind. The importance of this blog and the Rethinking Psych forums for me is bearing witness to the many anguished stories from people who have been harmed by Psychiatry. Survivors whose stories are met w/ dismissal, invalidation and attack. These experiences are not heard by the public nearly enough (if at all) and are largely ignored by the media.
But the many people who report being helped by meds or Psychiatry do not have to be wrong. They are entitled to their story and hopes and may feel threatened and dismissed by many writers in this movement. I once heard BWhitaker respond to a visibly nervous “consumer” at a conference who said he felt his meds were helping him and did Bob think that was wrong. Whitaker responded exactly how I felt – glad to hear it, I accept your story.
Thanks for the post, James. In CBT for psychosis, there is a pursposeful focus on normalizing experiences like hearing voices, having unusual beliefs etc… The key questions (as you suggest) are these experiences causing significant distress and functional impairment to the person? Mental health/mental illness not being an either/or dichotomy – but how well is person getting their needs met is the way I believe PWilliams put it.
So much of the debate revolves around who does the defining it seems.
Sera – Thanks for insightful, honest post. I have witnessed several clinics/facilities react to violent/disturbing events – and most of the time they lock into a hyper-vigilant over-reaction such as installing metal detectors, security guards, barriers between consumers and staff. I think you are bravely doing something that they often do not – transparently discussing the fear, vulnerability and urge to act (Don’t just do something -sit there!) It’s hard for leaders to not try to give people the illusion of safety.
Interesting that in our country, much the same phenomena has played out post 9/11 and in our search for simple (but invariably wrong) answers to complex problems. (such as mass shootings)
Keep up the good work.
Thanks Ron for this informative post.
I also appreciate this approach’s emphasis on collaboratively creating and hearing of people’s stories of what’s happened to them. So much more meaningful and empowering than a diagnostic label.
I find myself feeling very ambivalent about the over-riding focus on evidence based practices. On the one hand, they can help explain and teach a method or technique. On the other, they can tend to squelch the flexibility, creativity and humanity out of trying to be helpful.
Then. someone comes along to “professionalize” what may have been an organic, healing practice – (and then sell it).
Excellent post, Ron. Being the change you want to see. Providing this education on alternatives makes a lot of sense as a a change strategy- empowering and hopeful. I’ll take a look at the on-line conferences.
Johnathon – I appreciate your honest post. As a fellow traveller in the gray lands, I cling to the hope of working for change from the inside. I understand the criticisms, but I can’t take responsibility for the whole industry – just 1 conversation, 1 training, 1 challenge to the dominant paradigm at a time.
One day, with enough termites munching away – maybe the porch will collapse.
Jack – thank you so much for celebrating this wonderful man and spirit. ONe thing I know for sure, Pete Seeger would embrace anyone as an equal human being, struggling and singing together.
He also showed great courage, love and humor in fighting the good fight.
Sandra – thanks so much for this post. One more candle in the dark. I appreciate your transparency and integrity in writing it. I understand your doubts about what impact it may have, but few people who speak truth to power can have any assurances – please keep it up.
Greg- great post! Really insightful and honest. Thank you.
Your points about stigmatizing suffering and shielding people from self-responsibility are profoundly important.
I would suggest that your statements re: the death of bio-psych are greatly exaggerated (perhaps hopeful?). The bio-psych narrative, suffering & responsibility avoidant, “take this pill to be happy and lose weight now” is deeply ingrained in our culture.
Hi Chaya – wanted to take this opportunity to thank you for this and last years posts. I find your combination of passion, courage, focus and vulnerability to be very inspiring. Thanks again and please keep it up!
thanks for this post, Maria. I can’t speak to how others maybe trying to co-opt Motiv Interviewing for under-handed purposes, but they way you are describing it is not entirely accurate. Bottom-line; Mot Interv is about informed choice and empowerment. It encourages people to seriously consider reasons why and why not they may decide on a course of action.
The rub may come in when a practitioner has an agenda, and wants someone to do what they think is best (which is so often the case when it comes to med compliance or mothers trying to bathe their children).
I’ve heard that used car salesman also try this technique, but like trying to get someone to take meds – it is a corrupt application. Just saying, because I do like this approach when honestly trying to help someone follow their own mind & values.
I must say it takes some guts to post on this web-site with an almost inflammatory title; “Do I Enjoy…” I do respect the writers’ willingness to engage, and his openness and honesty. He cannot speak for all psychiatrists/Psychiatry, anymore than other writer’s can speak for all survivors of psychiatric maltreatment. Similar to Steingard’s recent article in WaPo, I think having M.D.’s join in this intense dialogue can help change the system for the better.
There’s another factor to consider when thinking about what is driving children towards bio psychiatry. Patricia Wen wrote a series of articles in the Boston Globe in 2010 http://www.boston.com/news/health/articles/2010/12/13/follow_up_process_lacking_in_ssi_disability_program/
about the “New Welfare”, detailing that many poor families seek out the the stable income provided by SSI disability for children. Parents were quoted as saying, you got to have a diagnosis and get the drugs to qualify.(ADHD and bipolar were the top 2 diagnoses.) This does not excuse Psychiatrists from unethically diagnosing & prescribing. But it does introduce another important variable in Whitaker’s thesis that neuroleptics are fueling disability rates. Welfare reform has possibly driven many impoverished families to seek stable financial support by getting their child diagnosed and “treated”.
Thanks for this post, Johnathan. It reminds me that while I observed a great deal of psychiatric abuses when I worked inpatient in the 80’s – I also saw great compassion exhibited on occasion towards people acting out violently when in the midst of a severe crisis. A slippery slope, I know – but I can’t rule out restraint absolutely when witnessing people trying to hurt others and themselves.
I appreciate Yana’s comment about the “gap”, acknowledging the struggle between our values and practices.
To widen the context a bit – many people get incarcerated for acting dangerously while in an emotional crisis. How can we act most compassionately when people are in these extreme states? Certainly we can do better than jail?
Thanks for post Sandy. You again affirm that you are my kind of practitioner and thinker. Acknowledging uncertainty, exploring views counter to our own – keeps us humble and open to the experiences of others. God help those who encounter “experts” (like Torrey) armed with their certainty and righteousness.
Nicely done, Andrew! I want to reinforce your message of hope for change. You (and many others) are succeeding in “keeping people talking”. I encounter many MH professionals who are in full accord w/ your views.
It wasn’t that long ago that gay marriage was feared and opposed by most of the public – and now it seems supported by most.
This may surprising – but in my experience, those outcomes would qualify that program as top notch. Most supported employment programs I’m familiar with report much lower percentages.
Ragins will also be having a dialogue with Whitaker at a confernce in Burbank, CA in a couple of weeks. The hope is that by getting all the parties talking, we can better advance changes. While SAMSHA may have wanted a rebuttal to Whitaker at Alternatives, that’s not what they got in Ragins.
I’m also glad for this post. I hope this blog can continue to offer a safe space for honest dialogue and disagreement – it increases the chances for change and progress.
But the question is 17 years from when? Can we backdate it to Harrow’s study, or earlier? On the other hand, this change process is up against such entrenched beliefs and interests.
As far as getting to a wider audience – 1 step is getting on MH conference programs. Whitaker will be presenting soon in Burbank and having a dialogue with a well known psychiatrist.
Appreciate your comments, Rossa. I’m glad you mentioned the good intentions of the program. These programs do have caring, talented staff who do want the best for their clients. It just seems that the mental health system has been operating from this faulty premise.
I appreciate your comments and am very sorry to hear about your loss. It often seems in the rush to medicate, we pay such short shrift to compassionate understanding of the “sea of stressors” that people are swept up in.
BTW: The TraumaCon training in Compton you mention on 9/27 features myself – hope to meet you there.
Thanks for the input, Bob – I do understand the requirements of obtaining informed consent. My experience is that this usually entails more of a form to be signed than a learning process. It just doesn’t seem so cut & dried for me on how one covers the nuances of risk/benefits – as this blog would attest.
Thanks so much for this post, Sarah – really enjoy your passion & insights. Like you, I’ve been very impressed w/ PTM & have followed the blow-back it has received in the UK. Trying to discern patterns & create models of human responses to overwhelming stress helps us understand ourselves and others, I think. For me, PTM effectively counters the dominant medical/disease model – & offers a meaningful pathway out.
Report comment
Thank you for sharing this, Rossa. This is indeed a hero’s journey (but I hesitate to call you a side-kick, you seem to be on your own journey.)
Report comment
Thanks for this post, Sandy. So glad you are addressing this important topic. The “Holy Grail” of the DUP drives such anxiety, such demands for compliance, such unquestioned certainty. It’s hard for anyone to withstand – let alone a vulnerable, overwhelmed youth & family. Keep up good work.
Report comment
Daniel – interesting points. I’m leery of “trauma inflation” – more & more painful experiences being categorized as trauma. Ultimately, I think we have to go w/ what people’s subjective experiences are.
That being said, I do believe it’s important to understand traumatic experiences as a threat to ppl’s survival, overwhelming their ability to cope etc…, basic safety sense of safety being compromised etc…
In that light, many of the examples you cite may be very distressing, painful – but not traumatic?
Report comment
Hi Daniel, I too believe that trauma is under-reported & under-recognized (by traumatized ppl themselves, as well as by others.) There’s many factors at play; in addition to the secrecy, shame & taboo – there’s the concept of “attachment trauma” – when the essential bonding gets compromised (self-regulation, distress tolerance is learned through this attachment process.) Needless to say, when it occurs at developmentally vulnerable ages , esp 0-3, it’s unlikely to be verbalized or “conscious”. Severe emotional neglect & abuse is cited as the most common form of trauma, & often not reported or understood as a traumatizing “event”, but very insidious. Thanks for your comments & questions.
Report comment
Great points, Richard. The rewording & rebranding is so skilled & pervasive – I must admit to having missed it.
Report comment
Hi John – maybe you’re thinking of Portugal? “Illicit” drugs are for most part legal & they redirect a great deal of resources away from law enforcement to subsidizing job apprenticeships & support networks?
I think Johann Hari & Gabor Mate discuss this approach. Sounds promising.
Report comment
Hi Frank – any thoughts on imagining a “third way”? I don’t really understand your point about trauma theory being a disincentive to recovery.
Report comment
Lawrence (can’t seem to put reply in right place)
You raise some good points & data I have not seen. I disagree w/ your (over) statement that there is “nothing well intentioned” about MAT. Many good people on the front lines trying to get a handle on a huge problem.
Your statement re: Suboxone as likely contributor to opioid crisis is provocative – would like to learn more. Thanks for commenting
Report comment
Thanks for this post.
Jill, I see you as substituting 1 reductionistic, decontextualized theory for another. It still begs the central question; what causes the inflammation/chemical imbalance?
Report comment
Kenneth- thanks so much for this insightful post. From the perspective of working w/ traumatized young adults for the past 20 years – I couldn’t agree more.
I particularly applaud your point; “the institutional rigidities, constraints, fears of liability, and risk are major impediments. Additionally, the “love affair” for “evidence-based” approaches to treatment of so-called mental disturbances, the monolithic nature of the medical model, and the primacy of the pharmacological approach only add to the roadblocks. Cushman and Gilford define evidence-based as “an abhorrence of ambiguity, complexity, uncertainty, perplexity, mystery, imperfection and individual variation in treatment” To that I add an abhorrence of improvisation. No wonder “evidence-based” is the way.”
That nutshells it pretty well! Despite all of these roadblocks – I share your sense of hope. thanks again
Report comment
thanks for your comments, The_cat. I’m interested in your point; “Problem is they can’t learn to regulate emotions if they spend their childhoods in drug induced emotional flatness”.
I’ve been thinking about how meds undermine trauma-informed therapy. Any articles to recommend? Thanks again
Report comment
Nomadic – that hasn’t been my experience that therapists attempt to talk people out of their awareness & into denial. Pretty clear guidelines to not do so and make a report. But can’t say it doesn’t happen.
Report comment
Belinda – thanks for the report from Australia You make a few points I’d like to comment on. You mention that all should at least be acknowledged as PTSD and I agree – yet none are. This has been my experience as well. The one Dx in DSM that points to a clear, environmental cause – and not used? WTF?
You also comment on the unfortunate, offsetting “mix ” of psychosocial therapy + meds. Makes me question how this will ever work for youth – when “paradigms collide”. About the push on cognitive – I don’t get it. Teaching emotional regulation always seems front & center to me.
Report comment
Your ill-informed question makes the point – “Or are you going to criticize the drugs used to treat them for their unhappiness and lack of love?” What exactly is the drug that treats a lack of love? What medication for a shattered heart? Foster youth can recover from these wounds, but psychotropics cannot heal.
Report comment
Thanks for commenting. I can’t argue with your dire outlook. However, I do believe we are making some incremental progress.
Report comment
Wow, Peter – I really appreciate you sharing all the years of first hand experiences that align with my understanding. Thanks.
Your ending comments; “Foster care is a high stress environment in which the temptation to drug our way out of frightening jams is seldom resisted.” is so spot on. Acknowledging the “frightening jams” is important – standing by staff’s side as they struggle to deal w/ intense, scary reactions of traumatized foster youth, while trying to keep people safe is incredibly challenging.
Report comment
Thanks for your comments, Richard. I don’t disagree with your overall points, some of the differences have to do w/ rhetoric vs. more science based dialogues.
I’m leery of absolutist positions of “it’s all this, or all that”. I do believe that if the many causes of mental disturbances and distress were ever actually ever honestly investigated, it would probably reveal incredible heterogeneity – and some of those causes might prove to be physiological.
But I agree with you that in the current climate, leaving that door cracked open even a little can be exploited to maintain the status quo. With the profit driven corruption of science, we may never know.
Report comment
Thanks so much for this post, Corinna. It articulates so well what rarely gets stated amidst all the EBP-mania. I like how you’ve used the term disease label education vs. people in distress. The current anti-stigma approach seems like saying people have “cooties” (diagnostic label), and then try to educate to not feel so fearful, avoidant, judgmental about cooties.
The infographic is excellent.
Report comment
Wow – the bully boys have gathered ’round to stomp a writer. Rather than address any of her presented ideas, you attack her – comparing her to a crack dealer and accusing her of being an enabler.
You don’t know what her attitudes are about biological psychiatry & the MH system. You don’t know what she does to support & empower people who’ve been harmed by meds & psychiatry. You don’t know what adversities she has had to overcome. In your self-righteous condescensions, you just assume.
Low. Troll-ishly low.
Report comment
Hi Corinna – thanks for post, I admire your honesty & tenacity.
I’ve been supportive of the “ACE’s movement”, so your experiences & analysis are important to hear. I’d like to respond to 1 thing, (the rest I’m still mulling over). The focus on trauma biology hasn’t created the disconnect for me, as it has for you. I thought, unlike biopsychiatry message of it’s a disease, chem imbalance, etc… ACE’s emphasizes the contexts, the impacts on neurodevelopment of adversities such as poverty, discrimination, neglect – but clearly call out the toxic stressors in the environment. The good news, unlike genetically based brain diseases that do create stigma, is neuroplasticity – improving the environment, income inequality etc… improves all of our brains/spirits. Locating the defect/disease in individuals is much different than ACE’s recognition of social conditons & maltreatment. For me, ACE’s approach of understanding “what’s happened to you” can create compassion, rather than more stigma & othering.
Report comment
This is a very helpful analysis, thanks Bob.
In the movie/book, the Big Short – Mark Twain is quoted; “It ain’t what you don’t know that gets you in trouble. It’s what you know for sure that just ain’t so”. The movie resonated w/ me in regards to this debate – the Big Short of Psychiatry. I hope to see the day when the willful blindness to evidence, the self-interested disinterest in facts will come crashing down. It’s interesting to me that Whitaker the journalist seems so much more engaged in true science than so many Psychiatrist/experts.
One other bogus pillar that is used to prop up the biopsych approach of carpet bombing/medicating anything labeled psychotic is the Duration of Untreated Psychosis (DUP). It creates this urgent rush to “treat” i.e medicate, as if delay is allowing a virulent wildfire to spread unimpeded. (B4Stage4). The sacred DUP is a key impetus & rationale to medicate early & not ask questions later. This must be challenged as well.
Report comment
Paris – I really think you’re on to something with your unified theory – write on!
In terms of sub-optimal attachment, the impact on neurodevelopment is profound. (Dan Siegel comes to mind) especially the ability to tolerate distress and self-soothe can be compromised.
Looking forward to Part 3.
Report comment
Thanks both for this, Paris – as well as your book – very helpful. Glad someone is calling out the taboo topic.
Wish to emphasize the impact of ACE’s/trauma contribution to psychosis – particularly the developmental traumas that occurs at very young ages (0-3), pre-verbal, that undermine attachment and ability to self-soothe. I believe this really lays an often unrecognized foundation for later “psychotic” experiences .Also noting, that the since the diagnosis of psychosis has such little validity – that there are probably several different etiologies, manifestations – that currently all lumped together. It makes these conversations difficult, as we attempt to compare apples with watermelons.
Report comment
Thanks for this post Malia and welcome to MIA. My difficulty with your overall point has to do with Prof’s “not traditionally including the disclosure of personal lived experience as a tool”. This is a tradition that ought to be changed (and many professionals that I know do self-disclose about various kinds of struggles and distress). So I’m not sure about the whole “unique scopes of practice” thing – Peers can provide what prof’s offer (often more effectively) – and prof’s should be encouraged to selectively self-disclose. Thanks again for adding your voice.
Report comment
Thanks Randy for this insightful post. Squishing people into these invalid boxes is such a disservice. The toxic impact on how they see themselves, on how others see them is substantial. We spend so much time talking about reducing stigma – when it is being inflicted by the very people trying to help.
One quibble – ” As ubiqitous as Jelly Tots”?? (wish I had a clue what they were)
Report comment
Great question Steve – I too have been trying to sort out useful, empowering words. Mental injury, while an improvement over mental illness, focuses on the harm, the event(s), toxic stressor etc…? “Trauma adaptations” call attention to the many normal reactions and ways that people often cope with and survive abnormal experiences. Thoughts?
Report comment
Thanks for your comments Fiachra – I do think there’s a growing recognition of the importance of employment & education support which I think is key to recovery. Working on some way for the young person to access the life they wanted, and escape the MH system and disabled identity.
As you say, help in finding a way through problems (and believing that’s possible) is crucial as well.
Report comment
Right Oldhead, not sure what personalized meds means either (there has been lots of talk of low-dosage, but not reported) They’re also apparently really pushing long acting injectables and that seems pretty impersonal. What’s a young person supposed to do once it’s in ’em?
Report comment
Someone Else – it is disempowering to call it a disease. It induces so much passivity, helplessness & despondency. Your point;” it’s possible their use at all is unwise.” is spot on. Thanks for commenting.
Report comment
Thanks for weighing in bpd – your comment; “(so-called “schizophrenia”) is not one unitary illness and may not be lifelong,” is an important one. I think there is substantial indications that what gets lumped together under the invalid label of psychosis – is actually several different etiologies and issues. Why psychiatry persists in acting as if they are unitary is beyond me. So much for personalized medications.
Report comment
Agreed Rossa – and although intended to reduce stigma, actually increases it.
Report comment
Thanks for story of hope, glad your son is doing so well. Afraid you’re right about following the money.
Report comment
Very much appreciate this post, Kelly. Eloquent and insightful. Thank you!
Report comment
Sandy – thanks for this post. I feel more hopeful after reading it. It seems straightforward, transparent & cuts through the dense fog created by medicalizing misery. The drug centered + need adapted is more empowering & informative IMO. Humble, humane, honest – 3 H’s I could get behind.
Report comment
Hi Jen – just noticed your post and wanted to respond. When people address themselves to specific others, as you (& others sometimes do) I’ve generally refrain from commenting, as I think I’m intruding.
I believe that for trauma informed care to be effective, it can’t come from a “one up” experts w/ alphabet soups after their names. We’re all bozos on this bus – and as someone who struggles w/ my own ACE’s, prefer a side-by-side, transparent approach.
For what it’s worth – my own experience w/ this site is that it is remarkably not dominated, or segregated by professional/survivor status. MiA has been a an incredibly educational forum for me because of that.
Report comment
“Complex-PTSD,” which all to often goes totally untreated” – sad, but true hpostpsychiatry, I believe trauma is under-reported, under-recognized and vastly under-treated.
Report comment
Loving it, Catnight! The ACE Avengers are born!
In my trainings, I often make note of the ubiquity of childhood trauma narratives in the Super-Hero pantheon (Batman, Spiderman, X-Men etc…) – they derive their super strengths (post-traumatic growth) from their grievous wounds.
Awesome idea.
Report comment
Thanks for your comments, firewoman. Your points about the chilling effect of continued reliance on Psychiatry for research funding make sense. When van der Kolk’s proposed diagnosis of Developmental Trauma Disorder was slapped down by the DSM committee for lack of evidence (despite substantial research backing, that exceeded most other diagnoses) you wonder what it will take to break through the wall of denial and self interest.
You couldn’t be anymore spot on when you say – “we need to reach a point where childhood maltreatment becomes a more open conversation, though this is going to take a lot of work.” True that.
Report comment
Great questions, Joe. IMO Yes- training, coupled w/ bold, impassioned leadership that has drank the TIC kool-aid can bring significant change (not that common)
But no, a webinar alone ain’t enough. For me, the key is the commitment of supervisors (mid-levels) to implement TIC, long after the trainings are over. Without them, very little progress.
I have seen it happen, organizational alignment a must.
Report comment
Great point, Hugh. I was considering a Part 2 to this blog and looking at our massive prison populations & ACE’s makes a lot of sense.
Report comment
Agreed Alex – I do believe that a lack of self-compassion is common. This “applies to everyone” – yes,we are all Bozos on this bus.
Report comment
No problem, SOmeone Else. (and thanks for noting Steve’s impressive longevity)
Report comment
Thanks for your thoughts bpdtransformation. I am working at spreading this viewpoint. You take the long-view which I think is helpful and hopeful. Meanwhile, I’m just another termite gnawing on the front porch of bio-Psych.
Report comment
You’re very welcome, Anonime. You’ve nutshelled the disconnect very well. On the one hand, non-evidence based/dominant approach in mental health; OTOH evidence based alternatives that are barely mentioned in the national debate.
The big difference = $
Report comment
Thanks Fiachra. In addition to Steve’s previous points about money, American culture has an ongoing love affair with quick fixes in the form of pills.
Report comment
Thanks for weighing in, Steve. Much appreciated. I did say “what if”?, not what will be. (or what I hope) but I do believe that the pendulum is beginning to swing back towards understanding human beings in their environments? But agree with you that the huge profits to be made in current paradigm will slow the pendulum down.
Report comment
Thanks ! Yes, traumas exacts huge toll across the lifespan, just more acutely at more developmentally vulnerable ages. Especially ages 0-3 when attachment problems affect capacity to self-soothe and trust that the world is a safe place.
Report comment
Thanks Timothy for this post. I too thought that Whitaker may overemphasize and oversimplify in his assertions that medications are the major driver fueling the rise in SSI/SSDI rates. Another Boston Globe journalist, Patricia Wen, wrote a piece a few years back about “SSI – the New Welfare”. In it, she described impoverished families seeking a stable income by taking their children to Psychiatrists to qualify for SSI. (ADHD was the most common diagnosis, if I recall correctly.) Some parents she interviewed commented that to qualify for SSI, the child must be on meds.
The political push behind the Welfare to Work legislation aimed to reduce the Welfare rolls. This resulted in a cynical relabeling from being low income to being disabled. Entitlements based on low income seem far less damaging to these poor children than being psychiatrized.
Report comment
Thank you, Scott for describing a comprehensive alternative approach. Much needed.
My misgivings are based on the whiz-bang hi technology of it all – i.e. Q EEG/Brain Map; lab assessments; assessment of genetic profile as it relates to MH?? Americans deeply love hi tech solutions and the magic bullets – so dazzling seductive vs. low tech accepting suffering, empathy and listening. “You’ll have to work hard to grow and overcome this” – has never been a popular message.
The kitchen sink approach of it all would seem to be so costly.
I’m in the public sector – so perhaps I’m too accustomed to low budgets and scarce resources, but this seems gold-plated.
Report comment
Well done, Peter. I think of this movement as a bunch of termites gnawing away at the front-porch edifice of Psychiatry. One day the porch will collapse. You are a BIG termite that got noticed by a much wider audience – good job!
Report comment
Thanks Noel for this post – it raises a confusing range of questions.
On the science of it, I look no further than the Related Post link – “Questions about Childhood Trauma & Schizophrenia Settled”. I also offer this link – https://childtrauma.org/wp-content/uploads/2014/04/Read_Fosse_-Moskowitz_-Perry_2014.pdf The evidence is compelling that a clear link is present.
But you aptly point to a Political Battle – I assume that BioPsychiatrists see this research as encroaching on their turf and undermining the dominant chemcial imbalance narrative. And I agree w/ Ron, that Trauma providers and survivors don’t wan’t to be associated w/ this intensely stigmatized group of people .
For me, a great deal of this battle is about definitons and labels. The label of psychosis is worse than meaningless – it is not descriptive, prescriptive or predictive. It only manages to stigmatize and make people feel hopeless/helpless. A “symptom-based” approach offers some clarity where we seek only to address what barriers, distress, concerns a person presents – i.e. I feel scared that people are trying to hurt me, I’m confused about who I am” seems a much more straightforward, collaborative starting point. Our insistence on diagnoses and defining dissociative can obscure this. Lucy Johnstone & others recommend “psychological formulations” – simple problems-in- living statements in help-seekers own words without the need for the psychojargon.
Will get to hear from John Read, a leading reseracher on this topic, tomorrow at ISEPP conference in CA. Keep the dialogue going.
Report comment
Thanks so much for this thoughtful post, Sandy. I greatly appreciate your candor as just one person struggling humbly w/ complex issues. It makes me feel more hopeful.
One statement you made – ” psychosis for some can lead to a rupture on many levels that is frightening.” that I’d like to comment on. I was talking to a friend who was removed from her home as a child when her father became psychotic and violent. She related how terrified she was and how she dreaded going home.
We can become so focused on how extreme distress affects a person and how to try and help them – and occasionally overlook the many other people who are deeply impacted. No easy answers – that’s for sure. As you say – the problem of uncertainty is so great.
Report comment
Thanks for this post, Noel. You pose a great question; how does diagnosis/labeling help treatment? While I agree w/ your assertion that “it just doesn’t” – you still note that many people in distress find value and comfort in being diagnosed. You touch on some of the reasons; >not feeling alone and unique in their suffering >someone (with power and authority) understands >I can be helped, there is hope >now that “the problem” has been named, it can be fixed (and as easy as taking pills) All very comforting and seductive messages.
How can we change the narrative to helping people experience their pain while feeling safe, embracing suffering, finding meaning in anguish, working hard to build distress tolerance? A much more challenging message.
Report comment
Thanks for clarification, John. I do know of outreach workers who provide this outreach (but drop the patronising tone.)
I do think this is what The Village offers in large part.
Report comment
Boans – good pts. Some have asked whether the “commitment” is a 2 way street? Is the MH system/community commited to offering empowering, client driven care that asks “what happened to you?” (rather whan what’s wrong?) This infrastructure needs to be in place before people get commited to care they don’t want.
Could you say more about the “failure” in Australia? Any articles?
Report comment
Thanks for post, Jonathan. I think the emphasis on “beds” may be misplaced – whether in hospitals or in your preferred crisis residential settings. Mobile, supportive staff/peers going to people’s homes, similar to Open Dialogue, avoids much of the high costs of running facilities, keeps people in familiar places & routines (family, pets) and the intensity of support can be titrated. This seems far less disruptive & can potentially strengthen natural supports.
Of course, it does depend on a person having adequate housing. As you know, hospitals get used for housing/food quite a bit.
Report comment
Thanks for this post, Ron. One of the steps I’m taking is educating MH professionals about traumagenic psychosis. One study (J.Read) I’ve read indicates that up to 85% of psychotic episodes are attributable to past traumatic exposures.
That we’ve been blinded to such an obvious link for so long, is an indication of how the medical model/brain disease dominates. Once people begin to consider the role of trauma in precipitating severe emotional distress – the more they may have to reconsider the chemical imbalance/illness explanation.
How is Zyprexa supposed to heal the impacts of trauma? Trauma informed care may prove to be an important lever in dislodging reductionistic psychiatry.
Report comment
I agree Larmac with your Pulitzer nomination – this journalist really dug in, persisted and got multiple perspectives (esp from foster youth)
One other aspect – I believe foster parents have a financial incentive to get their youths on psychotropics – higher reimbursements if medicated.
Report comment
Good idea about comparing predictive values of nature vs. nurture (but that makes way too much sense) Research by Shevlin reports that a child who has experienced
3 ACES is 18 times more likely to develop psychotic like symptoms; 5 ACES? = 193 times more likely for psychosis.
Report comment
Did you read the article?
Report comment
Thanks for this post, Noel and welcome. Like you, I have found the profound disconnect bewteen trauma adaptations and DSM symptom categories to be bewildering.
I suspect that your statement about the “understandable (but not necessarily defensible) tendency to deny the existence of trauma” is likely true. (I’ve heared Bessel van der Kolk say much the same thing.)
I heartily agree with the call for “trauma & psychosis fields to join forces”. When that happens, we could shift away from the meds first & last approach and move towards true healing.
Report comment
I hear you humanbeing.
The Recovery model programs I have in mind are typically reserved for people who are costing the system alot of $ (hospitals/jail/ER’s). The irony is how much this approach of creating community and meaningful roles is good medicine for us all (the diagnosed and yet to be diagnosed).
Report comment
Boans & Johnathan – yes, perfect. (I’ve trying to think of some other clever French quip, but gave up)
A lot of psych meds are directed to homeless people – much easier than finding affordable housing.
Report comment
Thanks for your comments, Andrew. I agree that it’s one of the most culturaly taboo topics (we’re even more open to talking about racism, than classism).
Good point about the overriding focus on stabilization – that is a pervasive attitude of MH systems unfortunately.
Report comment
Thanks for this excellent resource, Ron. Great way to get the word out. One way to “normalize” that I find useful is asking professionals to self-disclose an experience when they were severely distressed and thinking & feeling was impacted. A recent post on MIA noted how just sleep deprivation alone can readily produce psychotic-like experiences.
Some prof’s are hesitant, but acknowledging we are all vulnerable under stress moves the conversation away from illness and pathology towards improving coping.
Report comment
Thanks for this post, Peter. Welcome. I’d like to respond to your suggestion; “One possible factor to consider could be standardizing education and training requirements for case managers.” The key question for me is what would they be taught? Education or indoctrination? I’m glad to hear of RW’s visit to your campus, but not aware of his info getting into graduate curriculums much.
I generally haven’t found a strong relationship between the level of education and the quality of “case-m’gmt” (BTW – people aren’t cases and don’t want to be managed). I’ve seen many people w/ life experience & HS diplomas excel at providing recovery support, often being preferred to their better educated colleagues.
Report comment
I agree with JD. The thrust of the article is spot on and what AbbVie is doing is despicable, but MI does not attempt to push an agenda or manipulate.
Report comment
Yes, you do look pretty intense in that pic – (even your hair looks like it wants to attack me 😉
I appreciate this truly enlightening post – I also missed some of the key intentions you’ve pointed out. The funding being diverted from SAMSHA seems to send a clear, chilling message. “Ok, enough of this consumer driven crap – it’s time for the adults in the room to reassert control”
Report comment
Thanks for this post, Mark. In my training, I too was taught (more acculturated) to the idea of not engaging w/ people having anomalous experiences, hearing voices etc… Too often, MH professionals respond w/ fear, hopelessness and avoidance – and a peremptory referral to a Psychiatrist such as yourself (what could we do about chemical imbalances?)
CBT tries to “decatastrophize’ the experiences – as important for providers as it is for distressed help seekers. Be respectfully curious about meanings, enhance coping, reduce stress if possible.
I think it’s notable that in the Eleanor Longden TED talk, she points out that it was the frightened over-reactions to her voice hearing that precipitated her struggles. It was as if she was taught to fear and distrust her voices that intensified her suffering.
Report comment
Johnathon – you raise some excellent points. One that resonates with me is;
“f a place that is as open minded as the Unitarian Church will no longer host a psychiatric reform group, what does that say about our message to the broader public?”
The phrase; for me to be right does not require for you to be wrong – comes to mind. The importance of this blog and the Rethinking Psych forums for me is bearing witness to the many anguished stories from people who have been harmed by Psychiatry. Survivors whose stories are met w/ dismissal, invalidation and attack. These experiences are not heard by the public nearly enough (if at all) and are largely ignored by the media.
But the many people who report being helped by meds or Psychiatry do not have to be wrong. They are entitled to their story and hopes and may feel threatened and dismissed by many writers in this movement. I once heard BWhitaker respond to a visibly nervous “consumer” at a conference who said he felt his meds were helping him and did Bob think that was wrong. Whitaker responded exactly how I felt – glad to hear it, I accept your story.
Report comment
Thanks for the post, James. In CBT for psychosis, there is a pursposeful focus on normalizing experiences like hearing voices, having unusual beliefs etc… The key questions (as you suggest) are these experiences causing significant distress and functional impairment to the person? Mental health/mental illness not being an either/or dichotomy – but how well is person getting their needs met is the way I believe PWilliams put it.
So much of the debate revolves around who does the defining it seems.
Report comment
Sera – Thanks for insightful, honest post. I have witnessed several clinics/facilities react to violent/disturbing events – and most of the time they lock into a hyper-vigilant over-reaction such as installing metal detectors, security guards, barriers between consumers and staff. I think you are bravely doing something that they often do not – transparently discussing the fear, vulnerability and urge to act (Don’t just do something -sit there!) It’s hard for leaders to not try to give people the illusion of safety.
Interesting that in our country, much the same phenomena has played out post 9/11 and in our search for simple (but invariably wrong) answers to complex problems. (such as mass shootings)
Keep up the good work.
Report comment
Thanks Ron for this informative post.
I also appreciate this approach’s emphasis on collaboratively creating and hearing of people’s stories of what’s happened to them. So much more meaningful and empowering than a diagnostic label.
I find myself feeling very ambivalent about the over-riding focus on evidence based practices. On the one hand, they can help explain and teach a method or technique. On the other, they can tend to squelch the flexibility, creativity and humanity out of trying to be helpful.
Then. someone comes along to “professionalize” what may have been an organic, healing practice – (and then sell it).
Report comment
Excellent post, Ron. Being the change you want to see. Providing this education on alternatives makes a lot of sense as a a change strategy- empowering and hopeful. I’ll take a look at the on-line conferences.
Report comment
Johnathon – I appreciate your honest post. As a fellow traveller in the gray lands, I cling to the hope of working for change from the inside. I understand the criticisms, but I can’t take responsibility for the whole industry – just 1 conversation, 1 training, 1 challenge to the dominant paradigm at a time.
One day, with enough termites munching away – maybe the porch will collapse.
Report comment
Jack – thank you so much for celebrating this wonderful man and spirit. ONe thing I know for sure, Pete Seeger would embrace anyone as an equal human being, struggling and singing together.
He also showed great courage, love and humor in fighting the good fight.
Report comment
Sandra – thanks so much for this post. One more candle in the dark. I appreciate your transparency and integrity in writing it. I understand your doubts about what impact it may have, but few people who speak truth to power can have any assurances – please keep it up.
Report comment
Greg- great post! Really insightful and honest. Thank you.
Your points about stigmatizing suffering and shielding people from self-responsibility are profoundly important.
I would suggest that your statements re: the death of bio-psych are greatly exaggerated (perhaps hopeful?). The bio-psych narrative, suffering & responsibility avoidant, “take this pill to be happy and lose weight now” is deeply ingrained in our culture.
Report comment
Hi Chaya – wanted to take this opportunity to thank you for this and last years posts. I find your combination of passion, courage, focus and vulnerability to be very inspiring. Thanks again and please keep it up!
Report comment
thanks for this post, Maria. I can’t speak to how others maybe trying to co-opt Motiv Interviewing for under-handed purposes, but they way you are describing it is not entirely accurate. Bottom-line; Mot Interv is about informed choice and empowerment. It encourages people to seriously consider reasons why and why not they may decide on a course of action.
The rub may come in when a practitioner has an agenda, and wants someone to do what they think is best (which is so often the case when it comes to med compliance or mothers trying to bathe their children).
I’ve heard that used car salesman also try this technique, but like trying to get someone to take meds – it is a corrupt application. Just saying, because I do like this approach when honestly trying to help someone follow their own mind & values.
Report comment
I must say it takes some guts to post on this web-site with an almost inflammatory title; “Do I Enjoy…” I do respect the writers’ willingness to engage, and his openness and honesty. He cannot speak for all psychiatrists/Psychiatry, anymore than other writer’s can speak for all survivors of psychiatric maltreatment. Similar to Steingard’s recent article in WaPo, I think having M.D.’s join in this intense dialogue can help change the system for the better.
Report comment
There’s another factor to consider when thinking about what is driving children towards bio psychiatry. Patricia Wen wrote a series of articles in the Boston Globe in 2010 http://www.boston.com/news/health/articles/2010/12/13/follow_up_process_lacking_in_ssi_disability_program/
about the “New Welfare”, detailing that many poor families seek out the the stable income provided by SSI disability for children. Parents were quoted as saying, you got to have a diagnosis and get the drugs to qualify.(ADHD and bipolar were the top 2 diagnoses.) This does not excuse Psychiatrists from unethically diagnosing & prescribing. But it does introduce another important variable in Whitaker’s thesis that neuroleptics are fueling disability rates. Welfare reform has possibly driven many impoverished families to seek stable financial support by getting their child diagnosed and “treated”.
Report comment
Thanks for this post, Johnathan. It reminds me that while I observed a great deal of psychiatric abuses when I worked inpatient in the 80’s – I also saw great compassion exhibited on occasion towards people acting out violently when in the midst of a severe crisis. A slippery slope, I know – but I can’t rule out restraint absolutely when witnessing people trying to hurt others and themselves.
I appreciate Yana’s comment about the “gap”, acknowledging the struggle between our values and practices.
To widen the context a bit – many people get incarcerated for acting dangerously while in an emotional crisis. How can we act most compassionately when people are in these extreme states? Certainly we can do better than jail?
Report comment
Thanks for post Sandy. You again affirm that you are my kind of practitioner and thinker. Acknowledging uncertainty, exploring views counter to our own – keeps us humble and open to the experiences of others. God help those who encounter “experts” (like Torrey) armed with their certainty and righteousness.
Report comment
Nicely done, Andrew! I want to reinforce your message of hope for change. You (and many others) are succeeding in “keeping people talking”. I encounter many MH professionals who are in full accord w/ your views.
It wasn’t that long ago that gay marriage was feared and opposed by most of the public – and now it seems supported by most.
Report comment
This may surprising – but in my experience, those outcomes would qualify that program as top notch. Most supported employment programs I’m familiar with report much lower percentages.
Report comment
Great points. Stigma is a powerful blinder.
Report comment
Ragins will also be having a dialogue with Whitaker at a confernce in Burbank, CA in a couple of weeks. The hope is that by getting all the parties talking, we can better advance changes. While SAMSHA may have wanted a rebuttal to Whitaker at Alternatives, that’s not what they got in Ragins.
Report comment
I’m also glad for this post. I hope this blog can continue to offer a safe space for honest dialogue and disagreement – it increases the chances for change and progress.
Report comment
Wow! Your experience gives me a real sense of progress and hope.
Report comment
But the question is 17 years from when? Can we backdate it to Harrow’s study, or earlier? On the other hand, this change process is up against such entrenched beliefs and interests.
As far as getting to a wider audience – 1 step is getting on MH conference programs. Whitaker will be presenting soon in Burbank and having a dialogue with a well known psychiatrist.
Report comment
Appreciate your comments, Rossa. I’m glad you mentioned the good intentions of the program. These programs do have caring, talented staff who do want the best for their clients. It just seems that the mental health system has been operating from this faulty premise.
Report comment
I appreciate your comments and am very sorry to hear about your loss. It often seems in the rush to medicate, we pay such short shrift to compassionate understanding of the “sea of stressors” that people are swept up in.
BTW: The TraumaCon training in Compton you mention on 9/27 features myself – hope to meet you there.
Report comment
I’d better take your word on that one, Darby. Thanks for the correction.
Report comment
Thanks for the input, Bob – I do understand the requirements of obtaining informed consent. My experience is that this usually entails more of a form to be signed than a learning process. It just doesn’t seem so cut & dried for me on how one covers the nuances of risk/benefits – as this blog would attest.
Report comment