Thank you Alex. I think this is such an important point that we are not discussing much, which is what to do with all our emotions about these topics. Maybe we need to distinguish whose clarity we are talking about. I agree that our emotions are integral to being genuine. Also, for me to achieve clarity for myself, I must pay attention to and try to understand my own feelings. And it helps me to discuss these feelings with people in my life who understand and are supportive.
In contrast, when I think about having a conversation with a colleague who adheres to the dominant model (i.e., DSM diagnoses are valid, medications work and are safe), starting off by expressing my anger, sadness, or fears seems to turn people off and shut down the conversation. So, to encourage them consider different perspectives (and hopefully move toward greater clarity for themselves), I believe that I can be more effective if I begin by empathizing with their good intentions, current perspective, and how it can be hard to hear conflicting ideas. This seems to open someone’s mind a little. In time, perhaps they will be ready to listen to other people’s anger, grief, and other feelings. I’m not sure it will work, but it’s the approach I am trying for now.
Thank you oldhead! The discussion about the medical model was very illustrative of this problem of definitions. I read it and appreciated all the comments and efforts. We have a lot of work to do…
Thank you Richard. You have captured several important issues, all of which influence which ideas make it into the “marketplace.” And thank you for the encouragement.
Thank you Alex. I appreciate your comments about the goals of having open dialogue, trying to move toward greater clarity, even if we won’t all agree with each other.
I think you are also right that passion was overtly missing from our writing, although like Mariaelena, I have felt a lot of emotion about these issues. But I think that expressing my anger, frustration, or sadness is not effective in reaching my goal. So, I try to write in an empathic, even tone, in the hopes that people who disagree with me will feel less attacked and defensive, and will engage in discussion.
Thank you seltz6912. Very good points – there is no single solution like yoga or psychotherapy. There will be different solutions for different people, and at different times. My understanding of the research to date is that, if we can help people be safe during an acute episode with no to minimal medication, they can recover and do better in the long-term than if they receive more medication for longer durations.
Rooster, thank you for your comments, and more importantly, thank you for being so thoughtful and mindful about all these issues. It’s very hard, and even harder to take a different perspective at the early stage of one’s career. As Mariaelena said, you seem to be doing fine! I am finding it helpful to find colleagues who think similarly (although no one will agree with you 100%) to discuss and advise each other. I also like Peter Breggin’s book Psychiatric Drug Withdrawal, where he has some advice for mental health providers other than psychiatrists about how to help clients learn more about medications and perhaps reduce medication use.
I can see different sides to this issue, about unhappiness and the need to treat it. I think the key is the individual’s goal and freedom to choose. Absolutely, there is too much focus on happiness, and we get many messages to be happy and to stop feeling sad, afraid, or mad. So we need to stop sending the message that these emotions always need to be changed or treated in some way. On the other hand, many people go to their primary care providers with feelings they want to change, have tried to change, and don’t know how. So if a person has goal to change feelings they are tired of having, then it seems it is this person’s choice to look for resources to help, and the options that Jill mentioned can be effective for people who choose to engage in them.
Thank you Jill. I appreciate how you distinguish between the dominant medical model (psychiatric labels, medication) and studying the role of physical processes like inflammation. Plus, people seem to forget that it is not uni-directional – we can change our biological processes through behaviors. I am hopeful that NIMH’s rejection of DSM is on the right track, but I fear that RDC is also biological/reductionistic, just focusing on different biological processes. It is described as integrating various levels of functioning (biological, psychological, social/cultural), so maybe it will move us forward. I also am cautiously optimistic about integrated care, although so far it is still dominated by the mainstream medical model of medication management. I think this can change, with broader interventions available as you suggest.
This is my goal in all this, to encourage debate and discussion in colleges. I think it will first take place in departments other than psychiatry, like maybe in psychology, social work, communication, anthropology…
Thank you for this discussion, BPDTransformation, Frank, and Mariaelena. BPDTransformation commented about “approaches which respect the individual’s ability to choose,” and I think this is integral to this discussion. I believe people need the knowledge and freedom to choose from among many different options if they are suffering or want assistance with some kind of problem – including the ability to choose no interventions.
I could not agree more with your comment about the power of people who have personal experience with psychiatric treatment, especially with modern technology. I think we may be able to make more changes by our multiple approaches that challenge from the inside and outside, so I’ll keep trying from the inside too. Thank you for your work.
Thank you Alex. I think this is such an important point that we are not discussing much, which is what to do with all our emotions about these topics. Maybe we need to distinguish whose clarity we are talking about. I agree that our emotions are integral to being genuine. Also, for me to achieve clarity for myself, I must pay attention to and try to understand my own feelings. And it helps me to discuss these feelings with people in my life who understand and are supportive.
In contrast, when I think about having a conversation with a colleague who adheres to the dominant model (i.e., DSM diagnoses are valid, medications work and are safe), starting off by expressing my anger, sadness, or fears seems to turn people off and shut down the conversation. So, to encourage them consider different perspectives (and hopefully move toward greater clarity for themselves), I believe that I can be more effective if I begin by empathizing with their good intentions, current perspective, and how it can be hard to hear conflicting ideas. This seems to open someone’s mind a little. In time, perhaps they will be ready to listen to other people’s anger, grief, and other feelings. I’m not sure it will work, but it’s the approach I am trying for now.
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Thank you oldhead! The discussion about the medical model was very illustrative of this problem of definitions. I read it and appreciated all the comments and efforts. We have a lot of work to do…
Report comment
Thank you Richard. You have captured several important issues, all of which influence which ideas make it into the “marketplace.” And thank you for the encouragement.
Report comment
Thank you Alex. I appreciate your comments about the goals of having open dialogue, trying to move toward greater clarity, even if we won’t all agree with each other.
I think you are also right that passion was overtly missing from our writing, although like Mariaelena, I have felt a lot of emotion about these issues. But I think that expressing my anger, frustration, or sadness is not effective in reaching my goal. So, I try to write in an empathic, even tone, in the hopes that people who disagree with me will feel less attacked and defensive, and will engage in discussion.
Report comment
Thank you seltz6912. Very good points – there is no single solution like yoga or psychotherapy. There will be different solutions for different people, and at different times. My understanding of the research to date is that, if we can help people be safe during an acute episode with no to minimal medication, they can recover and do better in the long-term than if they receive more medication for longer durations.
Report comment
I like this, “a good word for the life of quiet subversion.”
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Rooster, thank you for your comments, and more importantly, thank you for being so thoughtful and mindful about all these issues. It’s very hard, and even harder to take a different perspective at the early stage of one’s career. As Mariaelena said, you seem to be doing fine! I am finding it helpful to find colleagues who think similarly (although no one will agree with you 100%) to discuss and advise each other. I also like Peter Breggin’s book Psychiatric Drug Withdrawal, where he has some advice for mental health providers other than psychiatrists about how to help clients learn more about medications and perhaps reduce medication use.
Report comment
I can see different sides to this issue, about unhappiness and the need to treat it. I think the key is the individual’s goal and freedom to choose. Absolutely, there is too much focus on happiness, and we get many messages to be happy and to stop feeling sad, afraid, or mad. So we need to stop sending the message that these emotions always need to be changed or treated in some way. On the other hand, many people go to their primary care providers with feelings they want to change, have tried to change, and don’t know how. So if a person has goal to change feelings they are tired of having, then it seems it is this person’s choice to look for resources to help, and the options that Jill mentioned can be effective for people who choose to engage in them.
Report comment
Thank you Jill. I appreciate how you distinguish between the dominant medical model (psychiatric labels, medication) and studying the role of physical processes like inflammation. Plus, people seem to forget that it is not uni-directional – we can change our biological processes through behaviors. I am hopeful that NIMH’s rejection of DSM is on the right track, but I fear that RDC is also biological/reductionistic, just focusing on different biological processes. It is described as integrating various levels of functioning (biological, psychological, social/cultural), so maybe it will move us forward. I also am cautiously optimistic about integrated care, although so far it is still dominated by the mainstream medical model of medication management. I think this can change, with broader interventions available as you suggest.
Report comment
This is my goal in all this, to encourage debate and discussion in colleges. I think it will first take place in departments other than psychiatry, like maybe in psychology, social work, communication, anthropology…
Report comment
Thank you for this discussion, BPDTransformation, Frank, and Mariaelena. BPDTransformation commented about “approaches which respect the individual’s ability to choose,” and I think this is integral to this discussion. I believe people need the knowledge and freedom to choose from among many different options if they are suffering or want assistance with some kind of problem – including the ability to choose no interventions.
Report comment
I could not agree more with your comment about the power of people who have personal experience with psychiatric treatment, especially with modern technology. I think we may be able to make more changes by our multiple approaches that challenge from the inside and outside, so I’ll keep trying from the inside too. Thank you for your work.
Report comment