This is a human rights movement. Period. 10/08/2012Posted by ALT in Patient Rights and Advocacy.
Tags: APA, human rights, Laura Delano, mental health activism
This movement is not a “recovery” movement, a “peer” movement, or a “mental health” movement. It is a human rights movement, and must be understood no other way. Until our emotions, thoughts, and unique realities are defined solely as a part of the broad spectrum of human experience, never as “symptoms” or “mental health issues”, we will remain mired in oppression. When I identify as having “lived experience”, it isn’t of “mental health challenges”, or of “disorder” or “illness”; it means that I’ve lived the experience of being oppressed and dehumanized, and that the only thing I’ve “recovered” from is psychiatry, itself.
- Laura Delano, HUMAN RIGHTS activist
from a speech given 10/6/12 in NYC as part of the protest of the APA’s “Institute on Psychiatric Services” conference
She gives fantastic speeches. Hope I can see her give one in person someday.
Tags: APA, conversion therapy, Dr. Robert Spitzer, DSM-5, mental health, psychiatry, stigma
Meet Dr. Robert Spitzer.
This man has recently done something no other psychiatrist [to the best of my knowledge] has done: when confronted with an insurmountable critique of a view he had previously defended vehemently as “scientific,” he admitted he was wrong. Publicly.
And then he said he was sorry.
Well done, sir.
On Monday, the New York Times ran a story about Spitzer’s public apology for the publication of a 2001 study claiming to prove that so-called “reparative” or “conversion therapy” is effective – some of the time, with highly motivated individuals — in enabling homosexual individuals to “change” their sexual orientation to heterosexual.
I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works.
- Dr. Robert Spitzer; Professor Emeritus of Psychiatry, Columbia University [emphasis added]
This was big news nationally – for homosexuals, gay advocates, and also various religious and “family”-oriented groups who have been using that “Spitzer 2001” citation for years to promote conversion therapy.
But I think this news is bigger than big (huge, even!) for the mental health advocacy community. If we can understand Spitzer’s reasons for apologizing, and his path to doing it so publicly and with such grace, we will be one giant step closer to eliciting other much needed apologies in psychiatry, to bridging the gap between psychiatric professionals and patients. A “truth and reconciliation” between psychiatry and its survivors is a real possibility, if more apologies are forthcoming.
Why did he change his mind?
On Monday, Spitzer gave a brief interview on NPR’s Talk of the Nation. When bluntly asked, “Why did you change your mind?” he replied:
I changed my mind because I had been bothered for several years about it, and then when I was visited by Gabriel [gay journalist who had undergone conversion therapy]… and he described what it was like to be in therapy when he really didn’t get any benefit from it at all… and I just realized that I had to make – explain to people why I think I made a big mistake.
- Dr. Spitzer on NPR’s Talk of the Nation
Later guests on the show discussed some of the more “bothersome” aspects of the study. It was rushed to publication and wasn’t “peer reviewed,” its data was not – really could not be – validated, as it was based entirely on self-reporting over the short term.
But more important were the philosophical and societal consequences of the study’s publication. The legitimization of “conversion therapy” (which indirectly treated homosexuality as pathology)…
1. Was used by certain groups to perpetuate the stigmatization of homosexuals under the guise of “helping” them:
And what it [Spitzer’s study] allowed the Christian right to do is put a more benevolent face on anti-gay prejudice… Instead of angry denunciations from the pulpit, the Christian right could then say that they were actually caring for homosexuals, that they wanted to help gay people and that they wanted to help cure them.
- Gabriel Arana, gay journalist and activist
2. Caused various homosexuals to internalize fundamentally negative, pathologized views of themselves
It [conversion therapy] stopped me from accepting myself, it lowered my self-esteem. As I said earlier, it made me see myself as… as a leper without a cure. And encouraging – I mean, and the premise of therapy is that there is something wrong with – fundamentally and innately wrong with the person, and if you can’t change it, then you’re sort of left with this disease that has no cure. And I think that… affected [me] very much as a young adult.
- Gabriel Arana [emphasis added]
Regardless of your stance on homosexuality, I think the parallels to the broader debate about psychiatry are clear.
Psychiatrists publish studies and papers in academic journals (about mental illness as brain disease, for example, or childhood bipolar disorder as a widespread and “undertreated” phenomenon, or the existence of such things as “dysphoric mood disorder,” “psychosis risk syndrome”, et al.) that are highly flawed, but touted as science. This pseudoscience is used to legitimize various practices — like pharmacological intervention as first line treatment for mental distress, forced outpatient therapy, the DSM itself — that pathologize a variety of human experiences that simply ARE NOT pathologies in the strict sense of the word. They’re not physical maladies of the body diagnosed by blood tests or other physical symptoms, their causes are not empirically known, they’re not like diabetes. Countless people are taught to internalize the belief that a “biochemical imbalance” in the brain causes them to be fundamentally different from humanity – truly lepers without a cure – and only a semblance of normality is possible through pharmacology, symptom suppression, and denial of self.
To stand here before you as a person who ingested the intoxicating language of psychiatry and began to speak it as her own, who incorporated the clinical gaze and began to see herself entirely through its lens, brings a flood of emotions … These emotions bring with them the pain that came with being labeled ‘abnormal’ and unacceptable by society for my most formative years; with carrying a diagnosis after my name that meant I would always be different, always fighting to appear like everyone else, struggling to manage life instead of living it. I was bipolar, from my teenage years until age twenty-seven, and I was convinced it was all I ever would be.
– psychiatric survivor and activist Laura Delano, in a speech at “Occupy the APA”
Psychiatric survivors are in a position very similar to that of the gay community after the publication of Spitzer’s 2001 study, except for the fact that many scholarly publications (including the DSM), faulty clinical trials, “treatment advocacy” organizations, and public institutions are replicating the same kind of errors and prejudices, day after day. An unrelenting campaign of stigmatization and “for your own good” interventionism.
An apology is long overdue.
If he’s in the mood for apologizing…
Maybe Dr. Robert Spitzer might like to reconsider some of his other scholarly publications. The most of famous of which is… the DSM-III.
Technically Spitzer is not the author of the first edition of the Diagnostic and Statistical Manual to include the “modern” mode of classifying mental illnesses by their symptoms – and leaving causation completely out of the question. But he is almost universally acknowledged as the main architect of that third and pivotal edition (I guess appointing yourself head of all 25 development committees will do that for you) and certainly was its defender for years.
When I say what I’m about to say, I’m not being sarcastic or vindictive – I’m being sincere.
Maybe Spitzer (and his colleagues) are nearly ready to apologize to psychiatric survivors at large. Maybe the time for truth and reconciliation has come.
Spitzer is reaching the end of his career and perhaps even his life (he suffers from late stage Parkinson’s Disease). Priorities are changing. Misgivings long buried are being brought to the surface and addressed. An interaction with a “survivor” of the policies born of his conversion therapy research was the catalyst for a change of heart, publicly declared.
Has the time for truth and reconciliation come? As psychiatric survivors continue to lift their voices and share their stories, to graciously and meticulously expose the flaws in the pseudoscience, psychiatry as a profession has a chance (just as Spitzer did) to explore buried conflicts, half-acknowledged truths that have been hidden from the light of day for years. Will they acknowledge the damage that has been done, will they apologize, will they move forward in partnership with psychiatric survivors?
Some may say it’s unlikely, but because of Spitzer’s actions, we know at least that it is possible.
Dystopian Dreams of a World Without the DSM 05/15/2012Posted by ALT in DSM-5, Patient Rights and Advocacy, Philosophy/Spirituality.
Tags: APA, biopolar disorder, diagnosis, DSM-5, eugenics, mental illness, psychiatry, schizophrenia
A world without psychiatry’s “Bible,” the DSM [Diagnostic and Statistical Manual]. I can see it now…
In this world, much like our own, there is still suffering. There is still poverty, crime, crushing sadness, despair. There is still violence. Regrettably, there may even still be some people who choose to take their own lives, preferring death over the pain of the moment.
But things are a helluva lot better in this world. Not perfect, mind you. Nevertheless a far more hospitable place for humans to be (in distress or not).
Not a utopia
I don’t promise you a utopia, because I have learned that utopian thought is always a trap. It inevitably leads to State supervision of, well, everything. We’ve got to maintain that perfect agreement about what constitutes the perfect order, right? At any cost. Moreover, utopian thought requires the mechanization (and consequently dehumanization) of the culture, the community, the human beings involved therein.
A feature of nearly all utopias has been addiction to elaborate social machinery like schooling and to what we can call marvelous machinery. Excessive human affection between parents, children, husbands, wives, et al., is suppressed to allow enthusiasm for machine magic to stand out in bold relief…
All machines are merely extensions of the human nervous system, artifices which improve on natural apparatus, each a utopianization of some physical function. Equally important, the use of machinery causes its natural flesh and blood counterpart to atrophy, hence the lifeless quality of the utopias. Machines dehumanize, wherever they are used and however sensible their use appears. Yet the powerful, pervasive influence of utopian reform thinking on the design of modern states has brought utopian mechanization of all human functions into the councils of statecraft.”
- John Taylor Gatto in “The Lure of Utopia”
So I give you, instead, some dystopian dreams of a world without the DSM.
In this world…
Psychiatrists, as a profession, en masse, have admitted: WE WERE WRONG.
“We shouldn’t have done it,” they will humbly concede. “We shouldn’t have insisted it was a fact that the ‘disorders’ we outlined in the DSM were objective, scientific, distinct pathologies (just like diabetes!) when we had virtually no proof of that. We shouldn’t have told our patients that they had ‘faulty genes’ or ‘faulty brains,’ that they were doomed to suffer chronically, for the rest of their lives, from the effects of chemical imbalances of neurotransmitters in their heads when we literally had no way of measuring balances of neurotransmitters [in the brain] in the first place, no way to establish a baseline for what is ‘normal’ and what is not.
And we certainly shouldn’t have partnered with drug companies, we shouldn’t have accepted their bribes, their promises of prestige and honor, allowing them such tremendous influence over the development of the diagnostic criteria. We shouldn’t have turned a blind eye to the terrible, terrible harm the pharmaceuticals they were so enthusiastically peddling were doing to our patients, to our communities. We should’ve looked further than the drug company-sponsored ‘research,’ we should’ve listened to what our patients were telling us, the facts that were staring us in the face, if only we were willing to take off the blinders so kindly provided us in our years of PhD training in pharma-sponsored schools and research hospitals.
Folks, we were wrong, and we’re deeply sorry for the harm we’ve caused. We’d like you to send back your DSMs (don’t worry, we’ll cover the postage), so that we can dispose of them in a safe and secure manner.”
(Dumping them down the drain, so to speak, simply won’t do.)
Now, as my significant other likes to say, there are three kinds of apology:
Type One: “I’m sorry you didn’t like it, but I fully intend to do it again.”
Type Two: “I’m sorry it happened, but it wasn’t really my fault.”
Type Three: “I’m sorry I did it, I take full responsibility for my actions, and I will make sure not to do that again.”
This will be a full-on, Type 3 apology, and it’s going to force all psychiatrists to ask of themselves some very serious questions about their profession, their practice, their beliefs about humankind. The self-proclaimed “soul healers” are going to do some critical thinking and some soul searching (like this). With humility and a greater sense of empathy, many (but probably not all) will emerge on the other side, repentant, contrite.
We move forward, having abandoned the purely “biopsychiatric” approach to mental illness, with a renewed commitment to seeing mental distress and madness for what they are (instead of trying to fit them to a biopsychiatric model that was flawed from the start, given its roots in pharmaceutical marketing campaigns, NOT actual observation of the process).
We move forward.
Our cultural narrative about mental distress has fundamentally changed.
Once this monumental apology has been issued, the books sent back, the labels redacted, “bipolar disorder,” “schizophrenia,” and “dysphoric mood disorder” won’t exist anymore as such. [oh wait, I guess Dysphoric Mood Disorder doesn’t quite exist yet… well, give it time, give it time.]
But there will still be people convinced of the coming apocalypse, walking circles around the city at night with visions of destruction surrounding them. There will still be children throwing terrible tantrums day in and day out. There will be racing thoughts, deep depressions, panic attacks; there will also be euphoria, epiphanic realizations of the oneness of humanity, creation, deep outpourings of love and spiritual healing.
Yes, there will still be “extreme states of consciousness” – some of which will be quite distressing to the people who experience them.
But our cultural narrative explaining the presence of such extreme states will have changed dramatically. When they are no longer catalogued “symptoms” of a fearsome “disease” that some people get and some people don’t, but just one part of a vast spectrum of human experiences possible to all humankind, it will no longer be feasible to adopt an us and them mentality.
“Mental illness” as the “bad genes” of “unfit stock” manifested? Not anymore. We weed out our old eugenical ideas about “the mentally ill,” roots and all (and that includes the idea that there exists a class of people called “the mentally ill” and another class called “the normal” and that the one is fundamentally different from and dangerous to the other).
We understand that “it” (extreme states of consciousness and diasgreements with consensual reality) could happen to any one of us – and that if it does happen, each and every human deserves to be treated with compassion, respect, lovingkindness… like this.
In practical terms, we don’t give folks forced “intramuscular medication” (time-released injections), we don’t electroshock people against their will, we don’t chain them, humiliate them, perform experiments on them, stigmatize them, silence them, lie to them “for their own good,” condemn them to a slow, drug-induced death, brand them again and again as a “danger to society,” something fundamentally different, other. We don’t do any of these things because we refuse to violate anyone’s humanity — and we recognize that when we do this to someone else, we open the door to having it done unto us.
People are able to define, for themselves, their subjective experiences of reality.
Without a so-called “scientific” definition of mental illness spelled out in the DSM, readymade for the force-feeding, people will be left with a blank page on which to write out their own truths. Truths about our society, our world, and what is “acceptable” in these contexts. Truths about what it means to be well, right-minded, living right.
Those who reject the DSM are already doing this:
In the culture of the Icarus Project some years ago we developed a rough prototype of a document we call a Wellness Map (or affectionately a “Mad Map”.) It’s a very practical document to be written in good health and shared with friends and loved ones and it starts with the simple (yet not always easy to answer) question:
How are you when you’re well? What does wellness look like to you?
This question is followed by: What are the signs that you’re not so well?
and eventually: What are the steps that you and your community need to take to get you back to wellness?
-Sascha Altman DuBrul, in his essay “Mad Pride and Spiritual Community: Thoughts on The Spiritual Gift of Madness”
Maps of wildly diverse terrains, pages and pages of difference! What’s right for me may not be right for you – and that’s a beautiful thing. As you can see, this is no utopia. We don’t have to agree about what “perfect order” is [and then single-mindedly enforce that order everywhere]; we don’t even have to strive for perfection at all! We just have to be honest, creatively living our lives each day, mapping out our mental, emotional, and spiritual geographies, all the while respecting our fellow humans as they do the same. And most importantly…
We offer our compassionate, “un-professional” support to our fellow human beings in distress (and out of it!).
This is crucial. We humans weren’t made to be lonely – not in joy or grief, and certainly not in madness. We long to share our experiences, to bond, to connect, to feel the lovingkindness of someone else’s attention, care.
So in distress and out of it, we can follow as an example the standard of care provided by luminaries like Loren Mosher and John Perry . In distress and out of it, let’s be with each other, without judgment (diagnosis) or manipulation (“for your own good interventionism”), without “professional opinions” (self-fulfilling prophecies of chronicity and doom) or prescriptions (forced care).
Let’s make maps together; let’s be fellow geographers of the human condition. Allow for grief in response to the deep sadness that is inevitably a part of life. Allow for terrible fear, at times, and unbelievable joy. Allow for madness as a transformative process, when it occurs; the birthing of a new consciousness. Allow a safe passage, in loving company, through difficult times. Allow our fellow human beings to emerge, on the far side of their extreme states of consciousness, “weller than well.”
We move forward. We don’t look back.
DSM-5 round three: can other cries of protest be heard over the clamor of “middle way” voices? 05/09/2012Posted by ALT in DSM-5.
Tags: APA, conflict of interest, DSM-5, therapeutic state, thomsa szasz
The third and final “draft” of the DSM-5 has been posted, and the various work group members (you remember them, don’t you?) have asked for feedback from the general public. It’s open for comment until June 15th.
I was going through the new draft, checking up on some of my favorite controversies over diagnostic criteria, their intersection with work group member conflicts of interest and pharmaceutical dollars (there being no shortage of any of these things), and thought I might share a few developments.
First, some good news
[Though let me first state that the ultimate good news would be if this thing never went to press at all, if the whole paradigm of labeling, pathologizing, and dehumanizing embodied by this “bible” (aptly named, as it is certainly more of a quasi-religious text with a life of its own that one must both believe in and claim as his own (my schizophrenia, my bipolar, my depression) than a scientific manual containing objective facts) were abandoned. If we let people describe, by themselves and for themselves, their experiences, their realities; if we abided by the Universal Declaration of Mental Human Rights and Freedoms…
But if it’s going to go to print, it would be great if the damage were minimized… so I refer to the following as “good news items” despite my caveat.]
- “Psychosis Risk*” (or “Attenuated Psychosis Syndrome”) – a proposed disorder characterized by “strange thoughts” or hallucinations at least once a week with the potential to become psychotic — will not be included as an official disorder in the DSM-5. This will likely prevent untold thousands of “preventative” prescriptions of anti-psychotics, self-fulfilling prophetic progressions into “chronic schizophrenia” (a phenomenon that really only exists in large numbers where folks are psychiatrized the American way), etc. A very good thing.
- “Mixed Anxiety Depression” isn’t going to be in there either. This was another label that would have vastly expanded the boundaries of what is considered pathological, what might be remedied pharmacologically.
- Rather, they (and quite a few others), will be included in the newly invented “Section III” a sort of purgatory where diagnoses that “need more study” will be named, and tentatively described, but [I gather] will not be official. Whatever that means.
- And a small victory for lovers of acronyms everywhere: our beloved “NOS” [Not Otherwise Specified]remains in this draft of the DSM. For awhile there all the “NOSes” had been transfigured into “NECs” [Not Elsewhere Classified], which simply doesn’t have the same ring to it, and isn’t nearly as punny…er, funny.
And now the bad news
This baby IS still going to press, whether we like it or not. Moreover, it’s the middle way detractors’ critique that is being heard and addressed by the media and the APA itself, as is all too clear in this third and final draft.
Middle way protestors (like Allen Frances, for example) are against the DSM-5 in particular, criticizing the development process, the addition of so-called “unscientific diagnoses,” financial conflicts of interest of the developers, etc.
The idea being that we simply need a better process for creating this thing. And that the botched development of the DSM-5, which will result in flaws that could’ve been avoided with more rigorous procedures, is a risky business because it might turn the tide of public opinion against the very institution of the DSM; which would be terrible because we need some kind of DSM in order to treat mental illness at all.
But there’s another camp, led by people like Paula Caplan – I like to think of it as the true DSM detractors. Instead of being against the DSM-5 in particular, this camp (including myself) is against the institution of the DSM, period. Instead of arguing that the DSM-5 is marginalizing, stigmatizing, unscientific, it argues that the practice of diagnosing people itself is all of these things and worst of all… dehumanizing!
In the final draft of the DSM-5 , the Middle Way Critique is addressed, or at least acknowledged, but the Work Group Members stubbornly persist in expanding diagnostic criteria and opening the door for more and more pharmacological interventions (“first line treatments,” they say, mostly in their private publications), their conflicts of interest and grant monies often all too obviously influencing this process.
What can we do about it? Who knows what can be done to stem the rising tide of the “Therapeutic State,” armed with an ever more expansive and “inclusive” definition of mental illness!
But we can start by leaving a strongly worded comment or two on the DSM-5 website about what this “bible,” and the pseudo-scientific/religious beliefs it outlines, has done to our society, our humanity.
*Yes, I linked to an Allen Frances article. Please don’t take that as an endorsement, however!!
Tags: APA, DSM-5, Occupy the APA, Paula Caplan, psychiatry
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I received a request from Paula Caplan today calling for psychiatric survivor stories. I promised to post it here [see below]. Paula is one of the most vocal critics of the forthcoming DSM-5, and she will be speaking in Philadelphia on May 5th as part of the “Occupy the APA” festivities. Your survivor stories will be an extremely important contribution to the cause of telling the American Psychiatric Association to stop labeling, dehumanizing, and condemning human beings who happen to experience things differently. If you have a story to share, please consider doing so!
(from Paula Caplan)
Paula J. Caplan, author of They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, would like to receive one-page (yes, just one page, please) brief summaries — even bullet points will be fine — from people who have been harmed in any way by psychiatric diagnosis. These are to post on her psychdiagnosis.net website, where she has had 53 stories of harm but wants more recent ones. The writer will have the choice of having their real name, a pseudonym, initials only, or “anonymous” used when their story is posted. The one page should consist of the following information:
(1)Psychiatric label(s) I was given
(2)What was happening that seems to be why they gave me the label(s)
(3)The kinds of harm I suffered because of getting the label(s)
Please send by March 23 to email@example.com
DSM-5 conflicts of interest hit mainstream media; protestors rally, but is it for the right reasons? 03/14/2012Posted by ALT in DSM-5, Mental Health Policy and Inititatives, Patient Rights and Advocacy.
Tags: APA, conflict of interest, DSM-5, John Perry, mental health, Occupy the APA, psychiatry, psychosis, schizophrenia
I’m no journalist.
I did write for my high school newspaper (I can recall a particularly riveting article about different styles of shoes!), but these days I’m strictly a blogger, cavalierly inserting humor, my own biased opinion, and all manner of distractions and sidetracks into my “articles.”
Nevertheless, this ABC news article from yesterday (“DSM-5 Under Fire for Financial Conflicts of Interest”) follows the exact argument I put forward in my little piece entitled “For the DSM-5 Task Force, Being Greasy Never Been So Easy!” Whoa, did I inadvertently produce some journalism here?
I have to admit, I liked my title better.
Ok, ALT; stop patting yourself on the back!
Done. Now let’s dig in.
The ABC story was fueled by the publication of an academic analysis of the conflicts of interest of the various DSM-5 committees, conducted by the same researcher (Lisa Cosgrove) who published a similar analysis in the days of DSM-IV development.
As I wrote awhile ago, it’s practically a conflict-of-interest OLYMPICS! Cosgrove found that about ¾ of the work groups have a majority of members with major ties to the pharmaceutical industry. Some standout groups include:
- Mood Disorders Group: 67% of members report ties to industry
- Psychotic Disorders: 83%
- Sleep/Wake Disorders: 100%
Moreover, when comparing the figures from the DSM-5 to her previous analysis of the DSM-IV workgroups, Cosgrove has found that in about half the work groups, conflicts of interests have only gotten worse.
[click to enlarge]
It appears that the APA thought transparency alone would be a solution to their metastisizing “conflict of interest” problem.
Well, they’re wrong. We can clearly see the giant, throbbing tumor now, but the fact is it’s still there.
The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process. For this to be in any way legitimate, there must be some threshold where the person’s conflicts of interest are too great, where they are removed from the process. But the APA apparently has no limit.
Oh, sure, they say something about “no more than $10,000/year directly from the pharmaceutical industry and no more than $50,000 in pharma stock options” … but with major gaps in their disclosure policy and no dollar amounts made public, how can we be sure this is any less of an empty gesture than the rest of their carefully choreographed “transparency” dance?
DSM detractors say the darndest things…
A wave of protest against the DSM has been building over the past few months, but I’m not sure that I’ll be able to unite with the mainstream (or “middle way”) DSM protesters. Here’s why:
Middle way protestors are against the DSM-5 in particular, criticizing the development process, the addition of so-called “unscientific diagnoses,” financial conflicts of interest of the developers, etc.
The idea being that we simply need a better process for creating this thing. And that the botched development of the DSM-5, which will result in flaws that could’ve been avoided with more rigorous procedures, is a risky business because it might turn the tide of public opinion against the very institution of the DSM; which would be terrible because we need some kind of DSM in order to treat mental illness at all. The DSM detractors quoted in this article all seem to fall into that camp; Allen Frances, David Elkins, and Cosgrove herself.
But there’s another camp, which I and many others belong to. Instead of being against the DSM-5 in particular, we’re against the institution of the DSM, period. Instead of arguing that the DSM-5 is marginalizing, stigmatizing, unscientific, we argue that the practice of diagnosing people itself is all of these things and worst of all… dehumanizing!
In ABC’s coverage, only the “middle way” DSM detractors are represented. And I find myself feeling a little piqued by what they have to say. For example:
Dr. Allen Frances, who chaired the revisions committee for DSM-4, said the new additions would “radically and recklessly” expand the boundaries of psychiatry.
“They’re at the boundary of normality,” said Frances, who is professor emeritus of psychiatry at Duke University. “And these days, most diagnostic decisions are not made by psychiatrists trained to distinguish between the two [normality and mental illness, presumably]…”
- From ABC News article “DSM-5 Under Fire for Financial Conflicts of Interest”
The boundary of normality? He speaks as if he knows exactly where that is! And that the DSM-IV catalogs “diseases” that fall well beyond it.
I beg to differ.
Take so-called “schizophrenia,” or psychosis, for example. As John Perry so nicely puts it:
In my opinion, the real pathology in psychosis does not reside in the “mental content,” the images and the symbolic sequences. All of that appears to be a natural psychic process, present and working in all of us. This is normal madness, so to speak. The schizophrenic “disorder” lies rather in the ego, which suffers from a constricted consciousness… The problem of the prepsychotic state is how to discover the impassioned life, and nature has its own answer in the form of a turbulent ordeal, a trial by immersion in the source of the passions – that is, a psychosis.
- John Perry, in The Far Side of Madness
[If you liked that quote and have some time on your hands, read this!]
From Perry’s point of view, psychosis is often a naturally transformative and healing process, somewhat like childbirth. If there is such a thing as a “boundary of normality” (which I doubt), it falls well within it. Psychosis is the “normal” response of a psyche needing to heal.
Here’s another rather disturbing quote from the middle camp:
“My best hope would be for the APA to respond in a substantive way to the concerns we’ve raised. They have an opportunity here to make a correction that would give the appearance, if not the reality of developing a diagnostic instrument that’s objective and has integrity.”
- Lisa Cosgrove, in the ABC News article DSM-5 Under Fire for Financial Conflicts of Interest; emphasis added
A semblance of objectivity and integrity – not necessarily the real thing – is her best hope for the DSM committee??
Way to aim high!
Should all the DSM-V detractors put aside their differences and join together to protest the DSM-V, or are the two camps far enough apart that their protests really can’t align?
As you ponder, consider this: a large DSM-5 protest (Occupy the APA) is planned for May 5th in Philadelphia at the site of the APA convention. The middle way camp will necessarily be inside the convention (most of them belong to the APA, after all), while the rest of us will be standing outside, barred from entry.
It appears that more than mere distance separates our two camps.
Tags: APA, APA conference, DSM-V, MindFreedom, Occupy, Occupy Normal, Occupy Psychiatry, Philadelphia, robert whitaker
The APA must have an almost supernaturally subtle sense of humor and irony – the finest and most unflinching I have ever encountered.
Or else they are so steeped in hypocrisy that even the most blatant contradictions, the most horrendous lies (cross-referenced, of course), are fervently preached as gospel truth. A pack of true believers, indeed.
There’s a spirit of unrest sweeping this country – the recent and successful PIPA/SOPA internet blackout protest, the various “Occupy” movements, the multiple student protests on college and occasionally high school campuses being a few examples. People are getting stirred up.
Well, the APA doesn’t want to be left out. Let it be known that they, too, can occupy something!
“Occupy Medicine: Reclaiming our lost leadership”
A call to arms was issued in the January edition of the APA’s journal, the Psychiatric Times. It’s hard to know whether to laugh or cry bloody tears of frustration. Let’s try to laugh, shall we?
It begins like this:
Maybe the “Occupy Wall Street” movement suggests a different kind of protest …What about “Occupy Medicine” for us psychiatrists? This may sound somewhat ridiculous, given that psychiatrists still make a good living, but we are surely in the 99% of medicine. In fact, we may be in the lower 1% for reimbursement… I’m often struck that plumbers make more per hour.
- H. Steven Moffic in “Occupy Medicine” Psychiatric Times article
Now this article is posted right next to the “Psychiatry Compensation Survey 2011,” an annual survey regarding income and income satisfaction of APA members, on the Psychiatric Times website. The average income of these 99%-ers was neatly displayed in colorful pie graphs just inches away from Moffic’s petulant cries for protest.
The majority of psychiatrists make over $175,000/yr, yet Moffic proudly proclaims them an oppressed part of the “99%”! Is this that subtle sense of irony again?
Oh, and plumbers do NOT make more money.
As near as I can tell (and they didn’t include much information about their survey methods, so it’s hard to say for sure) – but it appears that this survey only counts money directly obtained through practicing psychiatry. So it does NOT include any “extra” income, like money from pharmaceutical companies. You know, honoraria, “lectures,” “consulting,” “research,” etc. Considering that 1 in 4 doctors offer these kinds of “services” to pharma, adding that income would further enhance their salaries.
Nevertheless, over 40% of the psychiatrists surveyed were “disappointed” with their level of income.
Yes, psychiatrists are a downtrodden lot. Much has been taken from them. For example:
Other medical and mental health professionals have taken over our business to a great extent. Take primary care physicians, who now prescribe well over half of psychiatric medication prescriptions, despite evidence of limited expertise and success.
“Limited expertise and success,” eh? One could surely say the same about psychiatrists! But I digress…
Where psychiatrists are really bleeding money is in the land of diagnosis, which should, according to Moffic, be their own exclusive province.
Where we’ve really given up our product is in diagnosis. Though the APA has put out the official diagnostic manuals in the United States for decades, it opened up its use to any clinician who claimed enough expertise and knowledge. The APA makes a lot of money selling these manuals to other clinicians, who far outnumber psychiatrists, but what does this do to our role and status? …
Psychiatry is a strange kind of business. We’ve given out our products for free, then watched as other businesses—whether they be other types of clinicians or insurance companies—take over what we do… as important as what the diagnostic criteria should be, so is who is qualified to use them.
- Dr. Moffic [emphasis added]
Their “products?” But I thought the DSM was an objective, scientifically-derived set of criteria defining real, biologically-based diseases? And psychiatry a scientific discipline, not a business?
Clearly, an occupation is needed, so that psychiatrists can reclaim the [additional] wealth that is rightfully theirs. There are some barriers, however. You see, according to Moffic “psychiatrists tend to caring and compassion,” and so they have passively allowed the oppression thus far. But Moffic remains hopeful:
Thankfully, the anti-psychiatry movement has died down. In an unexpected way, there’s more of a pro-psychiatry movement becoming embedded in our systems. These are our patient consumers and peer specialists. Could they be recruited as our advance force for Occupy Medicine? Who knows better? Most naturally our patients and their families know what the illnesses have caused them to lose and what they need to recover.
Oh, that’s rich.
What say ye, psychiatric survivors? Would you like to join forces with the APA in demanding that psychiatrists make more money? Let’s catapult them into the top 1%, where they belong!
Let me present an alternative
One that may be more to your liking.
In the run-up to the release of the DSM-V on May 5th, Mind Freedom International [MFI] is urging its members to “Occupy Normal.” It is a “fight to stop corporate and government sponsored brain damage, trauma and an epidemic of human suffering” by “occupying the mental health system.”
They have a number of ways you can participate listed on their website. Additionally, a large protest is planned for that fateful day – May 5th – in Philadelphia, the site of the APA conference where the DSM-V will officially be released. Lots of influential folks in the anti-psychiatry movement (which is alive and well, thank you very much Dr. Moffic!) will be there, including Robert Whitaker, author of Mad in America and Anatomy of an Epidemic.
Now what say ye, psychiatric survivors, peer supporters, and people who think critically about mental health in our society? Is this an occupation more to your liking?
Tags: ADHD, anti-psychotics, anxiety, APA, big pharma, DSM-V, mood disorders, psychotic disorders
It’s not easy to balance a private medical practice, pharmaceutical company-sponsored lecture tours or research projects, and the invention of new psychiatric diagnoses… but at least 68% of the DSM-V Task Force is doing it! Yup; 68% of them openly report financial ties to the pharmaceutical industry (that’s up from the last time around, when 56% of the DSM-IV Task Force reported financial ties to pharma).*
It’s the Conflict of Interest Championships!
The DSM-V task force is divided into 13 work groups: ADHD, Anxiety, Child-Adolescence, Eating, Mood, Neurocognitive, Neurodevelopmental, Personality, Psychosis, Sexual-GID, Sleep-Wake, Somatic Distress, and Substance-Related. [They're wild about hyphens over at the APA...] Each task force has 8-12 members, and each one of those members is required to disclose all ties to industry, professional organizations, and any other conflicts of interest [COI].
So here’s a fun game: go to the APA’s “Meet the Work Groups” web page, pick your favorite task force, and do a little investigating. How many members have financial ties to the pharmaceutical industry? And what kind of ties… is their research funded by pharma? Are they being paid for the use of their “expert opinion” in drug advertisements? Or is it an out-and-out bribe?
I’ve been playing the game all morning. Here’s the score:
Psychotic Disorders Work Group
80% (8 of 10 reporting members) have direct financial ties to the pharmaceutical industry.
4 of those 8 receive it in the form of what I like to call “free money” – they simply stand in front of a pharmaceutical company-designed powerpoint or give their name to a ghostwritten scholarly article, lending it an air of credibility, and win a cash prize! It’s called “honoraria,” “consultation,” or sometimes just “other” in the COI disclosures published on the APA’s website.
All Star Member: Wolfgang Gaebel, Professor Dr. med., M.D.
9 reported ties to pharmaceutical companies, including: Astra-Zeneca, Bristol-Myers Squibb, Lilly, Janssen-Cilag, Novartis, and Wyeth.
Coincidentally [or not], the makers of the 5 most commonly prescribed atypical antipsychotic medications** — in order… Astra-Zeneca (Seroquel), Janssen-Cilag (Risperdal),Bristol-Myers Squibb (Abilify), Lilly (Zyprexa), Pfizer (Geodon) — have ALL sponsored one or more members of the Psychotic Disorders Work Group.
ADHD Work Group
57% (4 of 7 reporting members) have direct financial ties to the pharmaceutical industry.
All 4 are receiving “free money.”
All Star Member: Rosemary Tannock, Ph.D.
8 reported ties to pharmaceutical companies, including: Pfizer, Lilly, and McNeil. She also helped make an “informational” video about ADHD for teachers. Great.
Mood Disorders Work Group
56% (5 of 9 reporting members) have direct financial ties to the pharmaceutical industry.
All 5 receiving “free money.”
All Star Member: Trisha Suppes, M.D.
46 reported ties to pharmaceutical companies including: Abbot Laboratories, Astra-Zeneca, GlaxoSmithKline, JDS Pharmaceuticals, Janssen, Lilly, Novartis, Pfizer, and Wyeth. And she’s a professor at Stanford to boot! She might just be our league MVP.
Again, this strange coincidence: The makers of the 5 most commonly prescribed antidepressants – in order… Zoloft (Pfizer), Prozac (Lilly), Cymbalta (Lilly), Effexor (Pfizer), and Wellbutrin (GlaxoSmithKline) – are all contributing to the various bank accounts of our Mood Disorders Work Group workers.
The makers of 3 common “mood stabilizer” medications — Abbot Laboratories (Depakote), GlaxoSmithKline (Lamictal), Pfizer (Gabapentin) — are doing the same.
And our All Star, Trisha Suppes, represents the makers of ALL of these drugs, by herself!
Looks like greasy goes down real easy with her.
Anxiety Disorders Work Group
56% (5 of 9 reporting members) have direct financial ties to the pharmaceutical industry.
All 5 receiving “free money.”
All Star Member: Murray B. Stein, M.D., M.P.H., FRCPCC [they should have him guest star on Sesame Street!]
12 reported ties to pharmaceutical companies including:Forest, GSK, Astra-Zeneca, Lilly, Bristol-Myers Squibb, Johnson & Johnson, and Avera. Plenty of free money to be had from these folks!
Now you know what I’m going to say; the makers of drugs commonly prescribed to patients labeled in this category are well represented in those COI statements released by the Anxiety Disorders Work Group.
“But we thought the more hyphens and COI disclosures, the better!”
Sorry, APA. I don’t think you guys get it.
Let me make it real simple:
Hyphens for the sake of hyphens don’t make you look smart, and COI disclosures made with no fear of penalty or reprimand don’t make you look ethical.
The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process. So when Trisha Suppes says, “I have 46 financial ties to pharmaceutical companies, many of whom are trying to sell drugs to the people I’m trying to label,” … that should raise some red flags. She should not be included in the Mood Disorders Work Group, because she is clearly NOT capable of making unbiased contributions.
With this level of greasiness going down, you guys are in for some serious indigestion. But, hey, don’t worry — there’s a pill for that!
Tags: APA, bipolar, Carl Elliott, dehumanization, DSM, encephalitis lethargica, love, Mental Health Awareness Month, psychiatry, schizophrenia, VNR
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So, it’s “Mental Health Awareness Month.”
But that’s not all!
Better get to work on “neurofibromatosis” right way… and I must admit I’m very much looking forward to celebrating “Better Sleep Month” in style (once I’ve become sufficiently aware of everything else, of course).
Ever wonder where all these medical awareness months come from?
News is something somebody doesn’t want printed; all else is advertising.
(William Randolph Hearst)
It should come as no surprise that they are often just one component of a complete public relations package pharmaceutical and medical device companies purchase from firms like DWJ Television, Schwartz PR, and others specializing in health industry promotions. The awareness month’s main function is not really to promote awareness of a condition or issue – but to promote certain (expensive and patented) treatments for that condition.
They are also used to propel what are called “Video News Reports [VNR]” into the forefront of the media. A VNR is essentially the multimedia evolution of a press release – a ready-made story that broadcasters can air as their own “reporting” with only minimal doctoring.
Here’s an example of one from the dental industry:
As you can see, a VNR looks exactly like a news short, and may even come with a script that the station’s reporter can read over the pre-manufactured footage [that's the voiceover you heard in the above video; it's a separate audio track that can be removed and replaced with the station's customized one]. Stations have something to fill dead airtime that costs them almost nothing to produce, and PR firms get to hawk their wares in a subtle and really quite insidious way; most viewers have no idea that they’re essentially watching a commercial – they think it’s objective, fact-based reporting (news).
The pharmaceutical industry was one of the first to use VNRs to promote drugs. And as early as 1990, critics were calling attention to the practice, decrying the “covert” nature of VNRs and their ability to “reach the unguarded mind.”
Now, in order for the VNR to air, it has to be newsworthy, connected in some way to current events. But what if there is no related current event? Why, then you must invent one, of course!
Production companies often build VNRs around events that are manufactured or exaggerated for dramatic purposes… But sometimes, a production company has to get creative. “If there is no hard news, we will generally do it in terms of a disease, and get a real person suffering from the condition who has had it improved by taking this medication,” Friedman [PR executive at the aforementioned firm DWJ Television] says. “So we may see him or her with a physician; we may see him or her doing things in everyday life; and we’ll also interview on-screen, and interview the physician on-screen.” Many production companies build VNRs around disease-awareness events. The national Sleep Foundation, an organization funded by manufacturers of sleep drugs and other sleep aids, often uses National Sleep Awareness Week as a hook, usually coupled with a survey about how much trouble Americans have sleeping. “To me, that’s the last possibility,” says Friedman. “There’s always a day, there’s always a week, there’s always a month.”
(from Carl Elliott’s White Coat, Black Hat: Adventures on the dark side of medicine; emphasis added)
Why do I bring this up? Believe it or not, it’s not so that we can all joyously engage in another round of pharma-bashing [I’ve had enough of that].
I believe that there is a desperate need for a Mental Health Awareness Month. Speaking as someone who – just 2 short years ago – knew NOTHING about the mental health world except the so-called “common knowledge” the general population shares, I am well aware how much was missing. But, given the origins of these “awareness months,” is this May going to fill the gap?
The Mental Health Awareness Month we’re likely going to have is one envisioned, carefully outlined, and “generously” funded by pharmaceutical companies and their friends, one that efficiently conveys only the dominant, pharmaceutical companies’ profit-enhancing message.
In this pharmaceutical-funded framework, there’ll be no room for alternatives.
No unauthorized survivor voices. No stories of [un-medicated] recovery, resilience, survivance. Of alternative healing, balance, and perhaps even acceptance of some of these pathologized “extreme states of consciousness.”
Unless… we step outside the framework.
UNLESS WE SUPPLY THE MISSING PERSPECTIVES!
We humans, we who aspire to join the ranks of soul healers, we who have either experienced “extreme states of consciousness” or support those who do – we have to claim Mental Health Awareness Month as our own! As our rightful platform to speak, in the first person voice, about what these experiences might mean, to individuals, and to society!
If we raise our voices, we could be the start of a true awakening, a renaissance, a new and much truer awareness of so-called “mental health,” and the integral role that it plays in individual and collective health (wellness/balance).
That being said, here are a few things about the mental health world I wish I’d known, I wish everyone knew as part of that cultural package of “common knowledge” every member of the general population has.
If it were up to me to envision the central message of a “Mental Health Awareness” Campaign, it would include these key points:
Those mental health labels that people have attached to them – labels like “schizophrenic” or “bipolar” – somebody, somewhere, at some time, subjectively made that shit up.
Despite the mantra (“Mental illness is just like diabetes; mental illness is just like diabetes…”), mental illness is fundamentally NOT like diabetes. Diabetes is a physical illness, a grouping of bodily pathologies (the body fails to produce sufficient insulin) that produce certain recognizable symptoms (low blood sugar, susceptibility to infections, constant urination). There is a physical test for diabetes (blood test), known treatments that are proven to directly address the underlying disease mechanism/pathology.
These “mental illnesses” are something else entirely. Take schizophrenia, for example. The inventor of the term, an Austrian doctor by the name of Emil Kraeplin, was trying to describe a common set of symptoms he saw in many asylum patients. But it later turned out that these patients were suffering from a [rare, now, but somewhat common, at the time] disease called encephalitis lethargica, which produced Parkinsonian-type problems in its victims (shuffling gait, drooling, vacant expression, uncontrollable, jerky motions, psychosis). When psychiatrists subtracted all the patients who had the physical, virus-caused encephalitis lethargica from the schizophrenia roll call, there were almost no patients remaining! So the term “schizophrenia” began a long process of evolution and shape-shifting, its parameters changing with every new edition of the DSM [Diagnostic and Statistical Manual] to match the cultural prejudices of the time. The term was so amorphous for so long, in fact, that the writers of the 2nd edition of the DSM-II freely admitted:
Even if it had tried, the [APA] Committee could not establish agreement about what this disorder is; it could only agree on what to call it.
(from the 2nd edition of the DSM)
They [the committee of psychiatric experts, literally “sworn to secrecy,” that develops the diagnostic criteria] are at it again, set to release a new edition of the DSM in 2013. You can rest assured that it will contain quite a few more “diseases” with neat little acronyms and pre-approved drug therapies included.
Back to diabetes: there’s a huge difference between Doctor A who tells his patient “You have diabetes,” and Doctor B who tells his patient “You’re schizophrenic.” Doctor A knows his patient has diabetes – he did a blood test. Meanwhile, Doctor B only thinks he knows his patient is schizophrenic, and that is based mainly on the patient’s willingness to self-report symptoms and the doctor’s interpretation of those symptoms. Keep in mind that Doctor B might have made this decision in 15 minutes or less, and that his subjective decision is likely going to stick with the patient for life (regardless of the patient’s later “return to sanity” it’s “once diagnosed, never undiagnosed”).
You’re getting the picture: these labels don’t [objectively] mean much.
The so-called “mentally ill” person’s experiences and interpretations of those experiences are where true meaning lies – but it is up to that person (with the help of his supporters) to assign meaning to the experiences, in his own way, his own time.
I like to refer to this person as “our hero” — because that’s really who he/she is. Here’s a quote from one such hero:
Just as there are many forms of “cancer” so too there are many forms of “psychotic experience.” Just as with any other illness, we don’t get to choose what kind we get. It is however, up to us to determine how we are going to interpret our experience and find purpose and meaning in it. I would not have made it through that experience of mine were it not for a few critical factors[:]… my ability to accept that my experience was uniquely individual and mine alone… my willingness to accept whatever came up and deal with it, not necessarily in graceful fashion… [and] the very vital support of people who cared about me: my husband, some exceptionally good friends, and some very kind strangers. Love alone was my saving grace.
(from an inspirational psychiatric survival story which you can read in full here)
I also talked a little more about the right to experience reality for oneself once here.
So-called “mental illness” does not have to be a chronic, lifelong experience.
Objective, scientific data describing the psychotic experiences of people in underdeveloped countries (where mental illness is treated, not with drugs, but with increased social support and engagement in community) show that for many, a psychotic episode is a once-in-a-lifetime experience. Outcomes there are much better than in the US, where it can indeed turn into a chronic problem – because of the “treatment” applied to it. Please see this entry for more info. And, if you like, read the study (a controversial duplication of a previous study; both produced the same results: outcomes for “schizophrenics” in countries where drug therapy is uncommon are consistently better than in so-called developed countries where drug therapy is the first line treatment).
The very best medicine or “treatment” for a psychotic episode/spiritual crisis/extreme state of consciousness (or whatever you want to call it!) is LOVE.
Love, compassion, empathy, support. The willingness to listen calmly, to avoid at all costs doing anything which might threaten, dehumanize, or traumatize an individual that is already going through so much. These are all things which you definitely don’t have to be a professional to provide (or, rather – give). In fact, it’s been shown that it usually works better if you’re not (in America, once, here; and in the present day, here!).
JUST IMAGINE: what if, this month, May of 2011, the general public learned these four basic ideas, became aware and self-aware on a societal level, of them. What would the future hold?
Would we see changes in the way the so-called mentally ill (the outliers, the exceptions) are treated? Would life in this modern, corporate, industrialized society be a little bit less traumatic for both those who experiences things differently, and those who have learned to empathize with them? Would there be more love, more compassion, more sense (as opposed to senseless waste and hurt)?
The APA on happiness and motherly love 02/14/2011Posted by ALT in Mental Health News, Philosophy/Spirituality.
Tags: APA, happiness, Valentine's Day
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I’d like to wish you all a “Happy Valentine’s Day” APA Monitor-style… by digging up the cover story from their October 2010 issue: “Does Marriage Make Us Happy?”
The APA’s Monitor, a monthly publication specifically for mental health professionals, is more popular magazine than scholarly journal. It presents the latest APA-endorsed psychological “research” to practitioners, aiming to improve their service delivery, making it more “evidenced-based.” (more on the phenomenon of “evidence-based practice” someday soon…)
The author focuses on the work of Daniel Gilbert (PhD), an expert on happiness, mind you… he’s a pioneer in the field and the author of a New York Times Best Selling Book! These are all the references he appears to need – despite repeated mentions of “over 20 years of research,” the author fails to list a single study to support Gilbert’s claims.
And let me tell you, he makes some pretty incredible claims…
So, tell me… Will Marriage Make Me Happy?
Well according to Gilbert, only a happy marriage will make you happy. And dissolving an unhappy marriage will make you even happier. Also, enough money to meet the basic needs of yourself and your family will make you happy.
Ok; not so surprising.
But check this out:
Resting and relaxing don’t bring happiness because when you’re not engaged in a task – even a generally unpleasant one – your mind wanders, and you may ruminate on unhappy experiences.
(Dr. Daniel T. Gilbert, professor of psychology at Harvard University)
WHOA, Dr. Gilbert. If only there were a citation for this statement; I could check the science out for myself.
Left to my own devices, I stumbled upon a host of studies that directly contradict the idea that resting, relaxation, and mental processing of unhappy experiences [ie, meditation] are anything but therapeutic… (like this one, this one, and this one).
Keep in mind; not only does this guy teach at Harvard; he was the keynote speaker at the 2010 APA convention (presenting this and other ground-breaking research).
What else makes us unhappy, besides relaxation and resting?
Happiness falls for both men and women after the first child is born. Some 20 years of research shows that people without children are happier than people with children and that people with young children living with them are the least happy of all, Gilbert says. For women, spending time with their children ranks about the same as vacuuming on happiness scale [sic]. [emphasis added]
(again, Dr. Gilbert, Harvard University professor of psychology)
The eugenic undertones in this quote are pretty astounding. Eugenic attitudes have been a regular feature of the professional treatment of the mentally ill for centuries, though you don’t usually see it so explicitly stated these days.
Another thing: we’re not sure how Dr. Gilbert defines “happiness” – it’s not described in the article. What is this “happiness scale” which yields such surprising results? If his website is any indication, it might in some way correlate to the main research activity of the Gilbert Lab: “Track Your Happiness with your iPhone.”
(Presumably, without an iPhone, your happiness is so minimal it’s not even worth tracking.)
So, Happy Valentine’s Day! Instead of expressing love for family and friends, perhaps you might enjoy vacuuming the living room?
And if you were saving up money to send your kids (bane of your existence, I’m sure…) to prestigious Harvard University to study psychology… I think your money would be better spent elsewhere.
On a more serious note, if this is the kind of “evidence” the APA is providing its professionals with (upon which their “evidence-based practice” is presumably based)…
How will this affect the care they provide to their patients, many of who mare seeking serious emotional/mental/spiritual guidance (and have a right to expect it from those who claim to be “soul healers”)? How would you react if your therapist calmly told you that science has proven that vacuuming is going to make you just as happy as interacting with your children?