The truth is the dynamics discussed in the article are universal: social defeat, marginalization, manipulation and coercion all increase the likelihood of psychosis for targets of these types of behavior. The police certainly are guilty of this, under substantial, imminent and constant stress, while the liberal arts professors are guilty of the same dynamics from a place of social privilege. Start writing articles about misuse of authority and power across systems, including your own academic sphere that targets and marginalizes Republicans, Christians, libertarians and MANY other groups, rather than simply targeting the police because it’s “hip” and “progressive”.
The truth is the dynamics discussed in the article are universal: social defeat, marginalization, manipulation and coercion all increase the likelihood of psychosis for targets of these types of behavior. The police certainly are guilty of this, under substantial, imminent and constant stress, while the liberal arts professors are guilty of the same dynamics from a place of social privilege.
Start writing articles about misuse of authority and power across systems, including your own academic sphere that targets and marginalizes Republicans, Christians, libertarians and MANY other groups, rather than simply targeting the police because it’s “hip” and “progressive”.
Another home run by Dr. Hickey! Keep it up! Your work is so important.
You are the biggest reason that I return to read MIA!
Thanks Corinna, excellent article, offering critical thinking and a well thought out, logical argument that too often is not considered in “mainstream” conversations about mental health policy.
The comparison of Psychiatric theory to religion, based on Geertz’s definition, is the best explanation of the culture that promotes psychiatric dogma I have come across. Perhaps, “religion” and “worldview” could be exchanged, but use of “worldview” could underscore the tenacity of the deeply held theoretic underpinnings of the psychiatric tradition. Well done!
While I can’t speak for Kjetil, I interpreted the paragraph you cited as a belief that a natural creative process, without sufficient Omega 3 nutritional requirements, results in a more confused and painful process that manifests in forms referred to as ‘Schizophrenia’ by the medical community.
Am I following this correctly?
Thanks Kjetil! Excellent article!
Thanks Dr. Hickey! Another home run article!
Poison Ivy is a plant. The rash some people get from it is an allergic reaction.
This is a good idea oldhead. Some of the environmental groups I support will call (either in person or through a recording) supporters and than patch them directly through to their senators or congressmen to leave a message regarding an important bill. The whole process takes less than five minutes and results in much more support for the movement than would have occurred without the system. Mental Health advocacy could benefit from this type of system through MIA.
Thanks for the important article. I agree that opposing the Murphy Bill is very important from a mental health reform perspective.
I’ve been following the Libertarian party’s presidential campaign recently and have been thinking about how the advancement of the Libertarian philosophy into mainstream American politics could do a lot to reform the culture of psychiatry that readers and writers here at MIA are highly critical of.
I was wondering what people’s thoughts are concerning the relationship between Libertarianism and Critical Psychiatry.
Thanks for the informative article, Michael.
Since childhood, in the 90s, I’ve found the tradition of medicating children for under performance, bizarre and at times frightening. I felt like I was in “The Twilight Zone” seeing my friends and classmates being given meds during school hours to “help” them pay attention and get better grades. To this day I am still baffled.
Later, in life my brother was able to acquire Adderol from a general practicioner, even though he never had concentration or attention issues. He popped them like candy and within a month, stopped sleeping, taking the pills around the clock. He became paranoid and delusional and was eventually picked up by the police and hospitalized. In the hospital he was put on anti psychotics and benzos, and never taken off the amphetamine.
It wasn’t until I started to learn more about psychiatry years later, that I realized that there was a direct link between his amphetamine use and the psychosis. I spoke with him about it, and he endorsed that, initially, he probably experienced amphetamine psychosis and not bipolar disorder, but the psychiatric establishment never put two and two together. They continued giving him more and more drugs, by no means against his will.
A few years ago he passed away from a heroine overdose. During his last voluntary hospitalization, family therapists accused both my parents of being “enablers” (for not throwing him out of the house), rather than realizing that their very system and facility were playing the most direct enabling role in his drug use…as pushers.
“Robert Whitaker has documented how many of the children who are started on amphetamines like Adzenys or other stimulants as young children will go onto being diagnosed with a bipolar disorder as teenagers and young adults.”
This phenomenon is very likely iatrogenic. It is due to both blind and willful ignorance practiced traditionally in psychiatric culture…When will this despicable drama end?
I think that it is a “cognitive shortcut” to suggest that the current excesses of both criminal and psychiatric “incarcerations” are the same thing as America’s shameful history of slavery.
By cognitive shortcut, I mean that it takes significantly less mental effort (and fewer mental steps) to call these different historical scenarios (incarceration and slavery) the same thing than it is to develop a new paradigm that includes new contextual factors, while eliminating contextual factors that do not apply. It is easier because we can cognitively conjure up the context of the slavery situation and apply it to the new situation without eliminating or adding any old or new factors that do not fit the new scenario; however, use of the shortcut results in a less accurate explanation of what is going on than the paradigm changes (adding and eliminating contextual factors, or developing something newer, which could be considered a new paradigm) would entail.
Forced hospitalization and the excesses of incarceration have in common with slavery the fact that people’s freedoms are being stripped of them while an “authority” (plantation owners/overseers, stockholders/institution employees) are benefiting financially from the removal of that freedom.
What is different is that in slavery the economic gain is derived from the unpaid work of the slaves. The finances generated by the work of the slaves go directly to the slave owners, and the reason for the enslavement is for the slave owner to gain wealth from the work of the slave (who, in American slavery at least, was considered “property” and less than human).
In the incarceration situation, money is being made by the stockholders and institutions through government grants and insurance reimbursements to “care for” the incarcerated individuals, by offering them “treatment”, “rehabilitation”, and/or basic needs (food, shelter etc.) while incarcerated. In the incarceration contexts the inmates or patients are considered human, not property. The reasons (whether legitimate or not) for incarcerations are to protect the safety of either incarcerated people and/or society in general. These are some major differences.
For these reasons a more context-accurate cognitive shortcut could be to call both the over incarceration and inpatient situation a forced “adult daycare industrial complex”, that redistributes tax and corporate revenue, but never actually generates it. They both also purport to “treat” or “rehabilitate” inmates or inpatients, but these other reasons are largely secondary, just as a child may learn a thing or two in daycare, they are really there to be kept safe.
I was wondering what you think of psychotherapeutic interventions based on neurological theories like EMDR for trauma specifically. Do you support them or are you skeptical?
Anonymous’ idea might not be “the only way”, but it certainly would be extremely effective and can be accomplished in a fairly direct step by step manner…In my opinion, it might be the most likely way that a reduction in psych’s reliance on biological/medication management strategies would occur.
Some plaintiff’s attorney, perhaps a personal injury firm, really stands to make a TON of money if they use the scientific research constantly discussed on this sight in order to win civil suits. Once the excesses of med management are exposed and are no longer profitable, the culture of “mental health” care will have to change in response.
How about “Psychiatry: that’s quacktastic!” With a duck in a white lab coat wearing a head mirror. lol
Wonderful article Kelly! Your passion and your energy are so empowering. You speak with the spirit that so many of us need to hear, that inspires us to realize the sacredness of this life journey! Thank you.
I found your article deeply troubling, and very important. I recall while in graduate training for psych, I consistently experienced intense, confused/outraged reactions to much of the genetic and biological psychiatric discussion (that borders on eugenics) in mainstream mental health training. I remember thinking to myself “what is this, Nazi ideology?”, repeatedly, while listening to my professors. While I was deeply troubled by it than, and continue to be now, this is the first article that I’ve read that was able to elucidate the visceral intuitive feeling I have had for years: The German psychology that rests as the foundation for “Western” psychological theory and practice is the very same philosophy used by the Nazis…I am following your premise correctly?
The worldview you described does sound very sad and hopeless. I understand your position.
Much love, light and compassion to you, brother. I wish you the best. Looking forward to your ongoing contributions on MIA.
First, I appreciate you coming on this forum to play the role critiquing critical psychiatry. Your voice is an important and necessary one for our ongoing dialogue about issues that matter to us all.
To quote you:
“Sir the evidence is in plain view for all to see, western society is depreciated where many are becoming sad and need to be medicated…Now if you think there is a better way to treat sadness other than medications, that is a different discussion and one that probably not only the psychiatric industry can solve but greater society involvement.”
I agree that Western society’s ongoing development has resulted in a dramatic increase in sadness. I argue with the NEED to be medicated as the only logical response (I would always agree that medication use is best framed as a coping style choice, rather than a need).
Instead, as psychopharmacology has become a mainstay of the Western model of handling emotional difficulty, rates of sadness have only increased, as have diagnosis and treatment. A logical response to this phenomenon would be the implication that medication management on the wide scale is not effective as a full scale “cure” for sadness, as it is most often implied.
Instead, what is necessary the recognition that there a “better way”, or at this time at least, ANOTHER way. This other way, however, will require more initiative on the part of the patient, which is a change of life style: diet, social support, a search for meaning (political/spiritual/creative or otherwise) and exercise.
If these possibilities could be included in the conversation as viable paths toward fulfillment, the “depreciating” culture itself would be altered and the catalyst for the increase of sadness would be mitigated.
I’m wondering about your thoughts on this.
“welfare resources are less used because of these drugs”
How did you arrive at this conclusion? If it’s true, wonderful. I’m just not certain how this point could be proven or defended.
To be honest I prefer not to use clinical terms like “mania” because they’re too mechanistic and deterministic for my standards…There’s got to be a better word to explain “getting jacked up and not giving a damn.”
It sounds like these “sex and gambling” side effects are drug induced mania, as we often see with SSRIs.
Interestingly enough Abilify was originally designed to stop manic episodes in the short term. Sounds like these “compulsive symptoms” are “paradoxical effects” of the medication.
It is beyond me why physicians and consumers alike still have any desire to prescribe and use these psychotropic medications considering the MASSIVE risks inherent in their use: “You might be less irritable or you might end your marriage gamble away your mortgage.”
Near vegetarian diet, exercise, meditation, yoga, time in nature, hobbies and social support are the only safe way out of misery…Anyone still surprised why India’s outcomes for Bipolar and Schizophrenia are SO much higher than they are in the states?
“They claim the success of the course is that on average 60 -70% of people who participate in the course, take themselves to the doctor after realising they have anxiety or depression. Yet before the course they were working full time, raising a family, socialising with friends, etc., etc., without issues!!”
“The government here will even fund people doing the course and employers training all staff in in, which is not of any use really, because then they wonder why the whole population becomes mentally ill, when we are doing first aid, and then they all suddenly need disability pension and cannot work anymore!”
Belinda, this is so awful, it’s almost funny! People need to wake up and see what we are doing to ourselves. I wish it was unbelievable, but I believe it because I’ve seen this sort of thing over and over again.
“Mental Health” education or “treatment” is often “iatrogenic” meaning that it causes the very issues that it purports to cure. (This happens often in “training analysis, but can be present at any level of the Psych/MH tradition, clearly here in “MH First Aid”).
It’s like a snake oil salesman who poisons people and than cures them of a disease that he actually caused. The biggest problem is that the snake oil hawker is almost always better at infecting people than he is at curing them of that infection!
Thanks for your article David,
It’s interesting that even here in MIA when the election is discussed as it relates to the “Mental Health” industry, we immediately fall back into the rhetoric of mainstream American politics, pointing fingers at whomever we don’t support in the next election.
The fact of the matter is NONE of the mainstream candidates (and as far as I am aware none of the third party candidates ) have the type of understanding of the culture of mainstream mental health practice that is usually discussed here on MIA.
For that reason, we can’t expect any of the candidates to support a critical psychiatry philosophy and agenda. Our voices are still outside the bounds of the “business as usual” political conversation. Virtually everybody in American culture (minus some psychiatric survivors, Libertarians, and religious fundamentalists) believe in the psychiatric dogmas of genetic basis, “mental illness”, and medication management.
We have A LOT more speaking to do before an alternative position can be included in the conversation. Getting side tracked by political finger pointing is unlikely to expedite the inclusion of criticism of current practice into the widespread convo. Virtually every politician is looking to find the genetic basis for problems in living or the “right meds” to help people “get ahead”…all the while never hearing about outcome data coming from the “developing world”, “Open Dialogue”, and philosophical challenges to the tenets of mainstream diagnosis and practice. It’s probably in our best interests to keep our eye on the ball, because whoever wins this next election is unlikely to be critically minded when it comes to psych.
Another great article Sera…although this one is just so sad…
The saddest part of Mental Health first aid is the fact that “ordinary citizens” are being taught to identify people behaving strangely and than are encouraged to recruit them for medicalized treatment, with the assumption that this will be helpful. Feels fascist to me.
People should be taught to be polite, or otherwise just leave other people alone if the potential “helper” lacks the intelligence, courage, and/or resources to be of real assistance. Yes, we will see homeless and ranting people on our streets under such circumstances, but I’m uncertain that American society has developed a less harmful alternative. If you feel so guilty, have a conversation, give them some money or buy them some food (or bring them into your own home if you’re THAT guilty).
Personally, I wouldn’t want anyone’s “help” under these circumstances. I’d be perfectly happy handling my suffering on my own, considering the cultural climate available to me.
Spiritual teachers GI Gurdjieff and Chogyam Trungpa both spoke of “idiot compassion”, “compassion” without courage or intelligence. This is the ignorant mentality we are seeing promoted by these cultural overhauls led by the faceless MH establishment.
All of the quotations on your list, as you say, are extremely unhelpful and “hope quashing”. I think that in the USA use of this kind of language varies from institution to institution or practice to practice, depending on the leadership style and opinions voiced by members of the specific “mental health” organization. We see this type of language most commonly communicated (in epidemic proportions) in high volume inpatient institutions or organizations composed entirely by or under the direction of insecure psychiatrists. (Psychology practices that adhere dogmatically to psychoanalytic doctrine may be largely biopsych free, but can also enact a similar form of blind “hope quashing” nevertheless.)
The organizational culture of a mental health institution, and how that culture is defended impacts the choices made by clinicians which can limit the potential for “recovery” (or whatever word you want to use for what I’m talking about) for the patient. In its worst form, the culture maintains itself as a group- think mentality that uncritically protects the unsubstantiated and dogmatic claims of biopsych and represses critical discourse.
The critical analyses that you offered for each statement appear to be “common sense” and certainly can be understood by the vast majority of clinicians. I would suspect that clinicians who would not be open to such a discussion would be those caught in a repressive system where they experience their work situation as so fraught with physical, emotional, social, and financial danger that critical discussion is not a safe option. The danger I am talking about, as I’m sure we both know, is not only the danger of working with aggressive patients, but also the social, financial, and emotional danger threatened overtly or subtly by repressive “colleagues”.
I think that continuing the anthropological approach to the study of psychiatric and psychotherapeutic culture(s) is one very effective way to bring these unhelpful patterns of communication, values, and symbols to light and to understand the social dynamics through which these perpetuate themselves. Such analyses can be used to develop better explanations for what is going on in practice to offer better outcomes (or lives, really) for everyone involved in the “therapeutic situation”.
Thanks for your article!
Thanks for writing this article Dr. Hickey! I always appreciate your work!
“So, yeah, I’m not entirely sure that calling it something else and asking people to water down the truth is right, or even fair to ask?”
I don’t think we should expect people who experience oppression to not call their oppression what it is either. (Although as we both know this happens all the time, as an additional form of oppression.)
The question remains, (as per JackDaniels) if someone wants to gain “allies” within the field is the word choice of “oppression” going to result in gaining the most allies, and the answer is probably not.
However, people traumatized and concerned about their experience of oppression are rarely, if ever, looking for “allies” among their former or current oppressors. Very often they are looking for justice or retribution and, of course, they don’t actually need to be looking for “allies” at all. There are alternatives for them such as activism and social criticism.
Anyone critical of bio psych has two overarching directions they can take (there may be others but I chose two for simplicity’s sake), these are to work within the system or outside it. Working outside the system can be in a critical capacity or in the creation of an alternative system altogether. I tend to prefer the creation of an alternative system, and if that system has better outcomes than the mainstream system, the less effective, mainstream system, will either adopt the practices of the alternative system, or become obsolete itself.
Responding to JackDaniels,
“With all respect, I don’t think that view is realistic at all, there is no insurance reimbursement for emotional trauma. You have to be diagnosed with a chemical imbalance to get help for your sadness.”
There actually can be insurance reimbursement for emotional trauma, as long as the individual’s response to said trauma fits the criteria of a DSM diagnosis, meaning the traumatized individual presents with a series of behavioral “symptoms” that meet minimum criteria for diagnosis. No found chemical imbalance is necessary for diagnosis, because these chemical imbalances are not easy, or are potentially impossible, to detect in people. They are hypothesized due to the theorized effects of chemical substances (medications) on behaviors and subjective ratings of distress offered by patients who use them. If we were to use a more easily detectable mechanistic explanation for diagnostic distress, we could use the atypical results in magnetic and electrical brain patterns found in traumatized people based on brain scans. The logical mechanistic interventions based on these results however would be the use of magnetic and electrical means to treat the “abnormalities”. Interventions such as these are being used (ECT, electro cranial stimulation, and newer magnetic based interventions for example.) However, the results of these brain scans from a non mechanistic perspective could view the electrical or magnetic patterns as behavioral, ways of “acting in” while in distress, rather than “acting out”.
“What I’m saying is whatever you think is proper therapy for emotional trauma, and you admit medications are okay for some people, you need to provide them with an avenue to get that assistance.”
There certainly can be means by which patients can access psychotropic medications without telling them that they definitively have mental illnesses or chemical imbalances. One way could be to simply tell patients that we know medications make many people feel better when they are experiencing emotional distress, while also informing them of potential side effects that also occur in many people and also informing them that theories of how the medications work are largely based on hypotheses. Many people would certainly be able to understand this and make an informed decision. However, there certainly are people who are in so much distress that their capacity to make informed decisions is severely impaired. The vast majority of patients and inpatients do not fit this description, however. An ethical conversation should be had about whether or not administer medications to the severely impaired. I do not have an easy answer to this dilemma and have seen medications sincerely help people in this category. Many of these people who are assisted greatly while in acute distress remain on the medications too long which often leads to irreversible side effects.
“Their are failures in the system like I mentioned before, misuse of involuntarily commitments, and overuse of medications, but to slander the system as oppressive defeats your goal of having allies to your cause.”
There absolutely are failures in the psych system, as there are in all systems and all human attempts at success. Misuse of involuntary commitment and overuse of medications fit this description for sure. To “slander” the system as oppressive has definitively resulted in defensive responses by many psych professionals who could have been allies. The use of the word “oppression” is extremely loaded and insulting to many people with good intentions who work in the system. At the same time, many patients have experienced “oppression” within this system. It is possible that the system can be made less oppressive (and will have better results, see ‘Open Dialogue’) without calling it’s oppressive aspects oppressive outright. Conversations to develop effective language need to occur in forums such as this in order to recruit allies within the system. This dialogue is a start in my opinion.
I’d like to put my two cents in on this one:
All hierarchical systems are inherently oppressive, meaning that the voices of individuals at the lower rungs of the hierarchy are not granted the same level of respect as those coming from people at higher rungs of the hierarchy. In a rigid hierarchical system there is going to be increased stress placed on individuals on the lower rungs of the hierarchy, especially those who actually espouse better explanations of reality than those in higher positions, if those in higher positions are trying to maintain their status regardless of how well their explanations of reality actually fit that which they are trying to explain.
If those at the top consistently espouse explanations that are worse than those espoused by individuals on lower levels, and the better explanations are not able to be accepted into the social conversation, more people on the lower end are going to experience intense distress and emotional breakdowns (which the current psych system classifies as DSM diagnoses).
People on the higher end are also going to experience the breakdowns, however, but in fewer instances, (as we see in society today), depending on how those on their particular rung or those above them permit their voices to be heard.
The impacts of a hierarchical system that protects worse explanations can be amended through non hierarchical open dialogue. I believe this is why the Open Dialogue intervention has been so effective in helping people to come out of nervous breakdowns, while the hierarchical system of worse explanations (bio psychiatry) has worse outcomes than Open Dialogue and open dialogue styled techniques used in cultural and communal “healing” practices in “developing nations” like India and others.
I am not suggesting that the bio model is not a better explanation than certain explanations for problems in living (like “unresolved Oedipal Complex” perhaps). But it certainly is a worse explanation than: power differential (hierarchy)+ denial of person hood (physically, sexually, or emotionally)= trauma (which results in distress that is represented medically by decreases in efficiency of neurological and executive functioning capacities, often referred to as “mental illnesses” in all their varieties).
“Mental Illnesses”, the effects of psychological traumas and stressers, will decrease substantially in a less rigid social system where people who espouse and utilize the best explanations for reality (internal, external, and interpersonal realities) occupy the highest rungs in society, establishing and amending it’s social processes.
Does this make sense?
Great article sister! Mainstream liberality’s knee jerk reaction toward supporting the oppression inherent in the psych establishment needs to be recognized and amended.
There certainly does seem to be an inconsistency in the current “progressive” conversation which fails to recognize depth and breadth in morality and ethics which manifests in support of the psychiatric status quo.
Szasz was a libertarian after all, and while I’m not suggesting that anyone take on his political views, they did exist on a spectrum that does not so easily fit into the current climate of left versus right rhetoric.
A paradigm shift (or perhaps a logical analysis of the current paradigm) is much needed, and with this article has begun.
Thanks for your voice and your courage, Sera!
Very cool! Wishing you the best of luck with your creative endeavors…I certainly identify with your experience in graduate training. What a strange way to “help” people…
Stay true, brother!
Thanks Alex. What field did you switch to?
“The power, the sexualisation of the relationship (by them actually demanding I “fall in love”) while the whole time knowing they could lock me up and drug me if I didn’t comply or reacted negatively to their requests was just plain sick. It was rape, rape and more rape. A total abuse of power and their situation….and my humanity.”
I had this experience too and it was traumatic. With patience, the fear is subsiding, now that I am safely outside the psychotherapeutic system.
What’s interesting is that our experiences seem to be very similar, but I am a male married to a female, and the clinicians who hurt me did not share that identity.
Due to my circumstances I do not have the same personal narrative as the author through which to make sense of our similar situations, aside from an earnest need to seek freedom and truth for everybody. I hope we can all work together to change the status quo, as human beings with different personal identities.
Wow Kelly! What an awesome article…such passion for the truth!
Any suggestions on how early career psychologists could make an inroads into your holistic vision? I’m trying to start my career and looking for direction from holistic warriors like yourself!
“What struck me being on the client side was how dialogue was often seriously weird, in that it was slanted, controlled, tons of innuendo, not straightforward but more ambiguously suggestive, and if questioned or criticized–which I think is totally fair and natural–it could easily become quite demeaning and crazy-making. It’s enough to make anyone feel enraged from powerlessness, because the grievance process is futile, people tend to band together in the system, it’s not neutral. It’s about alliances, which I believe is more regressive than progressive.”
Amen, Alex! How weird is this aspect of psychotherapeutic culture!? I spent a long time trying to figure out how to “submit” effectively to the authority of clinicians when in the coercive ritual of “training analysis”, (really to avoid the gaslighting and crazy making you described so well) and afterword trying to “heal” from it with another therapist.
I think what I’ve learned is that you don’t have to play into this crazy making aspect of the game. You only feel crazy if you buy into their covert techniques by trying to confront them or figure them out. The power imbalance between patient and therapist is immense, so you can’t really challenge them without great risk to yourself. Don’t challenge, just ignore and don’t react directly…eventually they’ll give up.
If they don’t want to have a real dialogue with you, you should just leave or say whatever you want and don’t over value their feedback and assessment because it’s too indirect to be meaningful anyway.
Also there’s this awesome, but pretty analytically heady book called “Gaslighting, the double Whammy, Interrogation and other Methods of of Covert Control in Psychotherapy and Analysis” by this Analyst Theo Dorpat. It is brilliant and can basically help you make yourself immune to the crazy making techniques you’re talking about in therapy, as well as in non therapeutic interactions.
Thanks for the direction and encouragement Mariaelena! I’ll check out the authors.
Thanks for writing this article. It resonated with me deeply.
I recently received a doctorate in Clinical Psychology and work as an unlicensed practicioner, studying for licensure. Prior to beginning my graduate studies, my scholastic interests were in anthropology and religion.
I didn’t realize that mainstream psychiatric practice was as narrowly focused on specific doctrines and was as guild oriented as it is until I was financially tied to the field, having not been a consumer prior to graduate education.
While I have been consistently offered very positive feedback by my supervisors, teachers, and clients about my work, and have been awarded highly sought after positions through externship, internship and post doc, I have virtually no idea how to begin my career if I take my beliefs, values, and the way i think about my work into consideration (aside from a life of quiet subversion or something else as inauthentic.)
Both of the writers are accomplished in the field and I was wondering if they, or others, have any advice or direction to offer early professionals who need to make a living in psychotherapeutic practice whose positions would be labeled “anti-psychiatry” or social constructionist in regards to the field.