In the mental health system, 1984 is the NOW 04/30/2013Posted by ALT in Activism, Patient Rights and Advocacy.
Tags: assisted outpatient commitment, forced drugging, George Orwell, human rights, mental illness, oppression, psychiatry
Too many Orwellian concepts have made the leap from fiction to disturbing reality in recent years.
The NEWSPEAK employed by pharmaceutical companies intent on selling ANY chemical they manage to patent to the largest population possible, in the process crafting a language where fundamental questions such as “Does this chemical have any therapeutic value whatsoever?” are impossible to ask. How does one question the effectiveness of a so-called “antipsychotic” medication’s ability to suppress psychotic symptoms?* The very word forbids such an impertinence. And when that same medication is later referred to as an “antidepressant,” doesn’t it seem as though it is an antidepressant, and it has ALWAYS been an antidepressant?
The DOUBLETHINK that proclaims we must fight stigma in mental health by promoting stigmatizing beliefs. Anti-stigma “activists” like Glen Close would have us preach the biological disease model (though it lacks credible scientific proof) far and wide, despite consistent research showing the disease model actually increases stigma, while a psychosocial model explanation slightly decreases it (and — incidentally — has quite a bit more scientific credibility).
The slogan emblazoned on the Ministry of Truth (IGNORANCE IS STRENGTH) in Orwell’s 1984 might as well be carved into the hearts of the many mental health professionals who maintain a death grip on their ignorance of the very unhelpful nature of their so-called “helping profession.” Unhelpful in the sense that:
1. The technical and impressive-sounding names of “diseases” passed down to them in the Diagnostic and Statistical Manual [DSM] — which are then applied cavalierly to any distressed individual that crosses their threshold — were literally voted into existence by committees of “experts,” a majority of whom receive large amounts of cash from pharmaceutical companies set to profit from the invention of new mental pathology. A far cry from the discrete, physical pathologies they’re proclaimed to be (“just like diabetes!” they say).
2. The pronouncements the helping profession often makes about the hopeless nature of so-called “mental illness” and the impossibility of recovery after assigning a diagnosis for life (once diagnosed, never undiagnosed) are USUALLY untrue.
More on that HERE.
3. The chemicals they peddle — often as the first and ONLY possible treatment — are significantly more dangerous and addictive than advertised and much less effective (that’s putting it mildly). Examine the long-term outcomes and you’ll be hard-pressed to find a single psychotropic drug that does not induce chronicity and worsen global functioning when compared to no medication.**
Yes, a willfully-maintained ignorance is key for many of the folks working in a mental health system who find strength in the sheer numbers of “professional” people who are willing to go on marching in lockstep to the beat of the drum of corporate, pharmaceutical profits — trampling many a distressed human being underfoot as they solider on. I saw it myself, in sickening detail, during my 2 years of employment with the Research Scientists who didn’t give a damn about data or truth, so bent were they on being mental health “experts,” winning more lucrative contracts to conduct research with predetermined outcomes, and (most important of all) curating the twin museum pieces of their innocence and self-respect.
Fragile artifacts from younger days, best kept under glass.
In the end…
In the grand, tragic finale of Orwell’s 1984, we witness the complete erasure of the final vestige of our protagonist’s personhood. Resistance was always futile, we learn; one way or another, the State would own him — body, mind, soul, and (above all) obedience.
This is the final domino, the last of the Orwellian metaphors in the process of being realized. Can you see it?
A passage through the mental health system is an assault on the fundamental personhood of an individual. With the advent of forced outpatient commitment, we’ve made it even more difficult for such travelers to resist the State’s attempt to fundamentally alter the ways they navigate their mental and emotional distress.
Our fellow citizens are exposed to the possibility of forced psychiatric drugging in their homes for what essentially amounts to thoughtcrime, and no place is a safe space to experience extreme thoughts and emotions (however dark they may be). 1984 is the NOW.
More still, when we as a society accept this possibility as just and right for those who “deserve” it (the homeless? the marginalized? the so-called “mentally ill”?), we demonstrate a love for Big Brother hitherto unknown in our society. We say, “yes, take it, own it, all of me – body, mind, soul, and obedience!”
1984 is the NOW, until the day that we say “ENOUGH!”
Not my body.
Not my mind.
Not my soul.
* Or the universal desirability of such an effect, for that matter?
** See also: Robert Whitaker’s Anatomy of an Epidemic
Tags: dissident psychiatrist, mental health, mental illness, moral agency, Nelson Borelli, psychiatry
I am honored to present another guest post from reform-minded (former) psychiatrist Dr. Nelson Borelli. His website and manifesto are well worth reading, and the thoughts he puts forth here about moral agency and psychiatry come at a very important moment in the national dialogue about these topics.
By Nelson Borelli, M.D.
ALT_mentalities kindly invited me to write a critique on the practice of psychiatry. I accepted it with reluctance for several reasons.
First: There is not much original thought I can add to the matter after the monumental contribution of many others, Thomas S. Szasz and Karl Menninger in particular.
Second: Psychiatry,— and I will use that word to include psychiatry and other enterprises such as clinical psychology, social work and all “therapies,” and most respective practitioners — are faith-based organizations, not open to rational thinking and dialogue, let alone change.
Third: History seems to show that critiques to psychiatry are perceived as callous attacks to “science”, to psychiatry practitioners, and to the “mentally ill.” This is usually followed by the hardening of the faith and more closing of the thinking.
Yet I’ll try; the youthful vitality of ALT_mentalities inspires me.
Saving the Underdog
Psychiatry’s tragic course began in the sixteenth century when the political rulers lined up for execution of a woman because she was a “witch.” But a well-connected doctor saved her life by showing she was a sick woman, not a witch. The doctor was Johann Weyer. His deed was certainly good but the reason was bad. That saving-the-underdog became a tragedy of unlimited proportions. After half millennia the tragedy is still with us and it is growing.
The “witches’ law” was wrong then; many social intolerance laws are wrong now. Bad laws should be confronted morally, politically, because that is what they are. They are manmade laws.
Confronting them by “biological-disease” means results in tragedy. The heroic “biological”, medical shortcut is bad. It has built-in badness because it results in bad consequences for the hero (psychiatry) while the moral problems remain unresolved.
Visitors from another planet would be sympathetic to us in learning about our seemingly unsolvable moral problems: When does life begin in the unborn child? Is it permissible to unplug life-supporting equipment from the terminally ill? If so when? Is abortion permissible and if so when and in what circumstances? Should we abolish the death penalty in the USA? Do children have rights? If so what rights, at what age? Do we go for gun control or the Second Amendment? What are the boundaries between Personal and State rights? Et cetera.
Contemporary psychiatry is suffering the bad consequences of the heroic acts of “saving-the-underdog.” Psychiatry is discredited. Self paying patients are fewer and fewer. Third-party payers refuse to pay for “services.” The only thing that keeps the psychiatric industry alive is the state-sponsored/enforced “mental illness/mental treatment” dictum. Nor has the psychiatric industry’s “stigma” cry been working well either.
It is an unnecessary, self- inflicted tragedy, to put it mildly, (for the profit factor cannot be ignored). Psychiatry could be of help to the many folks who suffer from emotional problems. Psychiatry could have room in medicine as a (soft) branch of it. Although the causes and pathology of emotional problems remain obscure, they could continue to be investigated by scientists interested in the field. Emotional problems could be dealt with by professionals who are patient enough to deal (humbly) with diagnoses’ uncertainties by using trial-and-error techniques.
There are already some significant scientific contributions on the relationship between bodily physiology and the perception of emotional reactions. Psychoanalysis and related disciplines have also contributed to the understanding of human emotional conditions. Even the dreadful, drug-pushing, disease-manufacturing pharmaceutical industry has made some contributions. However limited the knowledge of psychiatry at present, there is room within medicine and related disciplines for a respectable Psychiatry specialty.
But that would require present day psychiatry to drop the “mental-illness” ideology.
Psychiatry & Moral Agency
At the core of the “mental illness” ideology is the notion that a person can lose moral agency, this is that the person is no longer able to know what he/she likes or dislikes, or is not able to form and execute (“correct”) personal opinions due to a “biological ill condition.” That is that the person has become “mentally ill.”
That is wrong.
The fact is that humans’ opinions cannot be (biologically) ill. This is a travesty with terrible consequences such as the deprivation of civil rights to citizens who have not committed any crimes.
A court of law may order involuntary psychiatric treatment, known as “Civil Commitment” for a “mentally ill” person. Although the large majority of the “mentally ill” persons are not subjected to involuntary treatment, all “mental Illness” diagnoses suggest possible Civil Commitment, that is, deprivation of personhood.
The fact is that psychiatry is not able to predict criminal behavior on a given person. No legally responsible psychiatrist would publicly state to what percentage of probability a person would act criminally because there is no publication of any scientifically conducted study that objectively demonstrates such a prediction.
Human opinions can be wrong, or right, with respect to a prevailing social code of ethics. A quick look at the history of humans’ opinions shows that even very “important” opinions, come and go. Examples: The learned ones used to sure the Earth was flat. Now the learned ones differ as to whether humans were created or evolved. These are human opinions; they may be errors. But they are not forms of “insanity” or “mental illnesses.” Incidentally, the utterance “sick opinion/belief” is only a pejorative metaphor, an unfortunate metaphor because it is often used literally.
Unfortunately (or fortunately) we humans were born without a God-given “user’s- book.” If we were we might be angels of God like Adam and Eve were before they CHOSE to eat the apple.
Ever since, we are born with the ability to choose. We are born to be on our own stewardship.
One may or may not choose to use the Biblical story, but the fact is that each one of us is ultimately responsible for the management of our lives. We have to manage our lives by the use of science or inspiration and hope for the best. No guarantee of success.
Be aware of false “saviors” such as psychiatry that offer you the “the brain-made-you-do-it” way out as a means of angelic tranquility. If you go for it you become a robot; a Mental Patient Green Card carrier, with entitlements but deprived of personal moral agency.
Personal Moral Agency
Personal moral agency means that one is born with the ability to know, choose and act in accordance to what one thinks is right. Just in case: What you think is right may not be what others think is right.
Psychiatry did not get a “users’ book” from God either. Psychiatrists’ opinions on persons’ life management can be wrong, very wrong! Psychiatrist Egas Moniz won the 1949 Nobel Prize on the “benefits” of lobotomy on “psychotic patients.”
How to manage your life? Simple: Each of us gets information, input, from the world around us and from our own bodies. It’s up to each of us to look, examine, re-examine the information, look for more information and consult with others as needed. Then we reason. Then we act, execute. The more we work on the information, particularly information-that-I-do-not-want-to-know, and do the reasoning, the greater the chance that we would be pleased with our acts or execution at a later date. Of course there is no guarantee that we would be pleased with our acts at a later day. We humans are not perfect, period.
The more one practices on information gathering and reasoning, the greater the chances to be content with our acts at a future date. Unfortunately, just too often people choose to delegate to others the information gathering and reasoning. In so doing, they dull their minds; this is the ability-to-mind. Minding is an inborn ability. However, the quality of minding depends on how much we practice it.
The tragedy of psychiatry will eventually end in the same way other tragedies ended: the death of the hero. In this case, the “mental illness” heroic attempt to “solve” humans’ moral problems.
Good, serious psychiatry is badly needed. But even more needed is for us to get in touch with, to honor and respect our precious minds and humanness.
Where have all the prophets gone? (Part One) 06/18/2012Posted by ALT in Philosophy/Spirituality.
Tags: mental health, prophet, psychiatry, soul healing, spirituality, visionary
I haven’t talked about spirituality much here. In some ways, that’s a glaring omission, given that this blog is concerned mainly with a critique and rethinking of mainstream psychiatry, literally, “soul healing.” The big critique being mainstream psychiatry’s denial of the soul, its insistence on treating only the bodies and the brains, forgetting the spirit that brings them to life.
I’ve avoided it because, well, I didn’t want to offend. Most people (myself most definitely included) are allergic to proselytization — run at the first hint of it.
So, fair warning: I’m going to start talking about spirituality. I may even talk about some of my spiritual beliefs. But with the important caveat that while this evolving faith seems to be true for me, something entirely different may be true for you. And I respect that.
A spiritual battle
I view the struggle for mental rights and freedoms as a battle to secure for the discerning and self-actualizing part of a human being – “soul,” if you will – the right to exist, fully and dynamically. From this perspective, it’s almost inappropriate to approach questions of wellness, of being-in-the-world, from an entirely clinical, secular point of view, because these issues are inextricably tied up with matters of the heart (the seat of spiritual insight).
Again, we’re not robots, not just bodies with a helping of brains on top – there’s a spirit in there that makes us alive! With that spirit we quickly transcend the bare chemical fact of our existence. Carbon atoms bonded to other carbon atoms? That is only the beginning; truly, we are much, much more!
So a person in emotional distress needs more than a chemical intervention, a pharmaceutical or a “natural” vitamin for the body (though a vitamin probably wouldn’t hurt…). This person needs spiritual comfort and guidance. Mind, body, and spirit – I believe that healing requires a balance of all three.
This battle for mental rights and freedoms is fought on several levels: we say forced treatment is a violation of a citizen’s rights (body) and a thinking individual’s free will (mind). But we must not forget the spiritual ramifications – to be restrained, secluded, unwillingly drugged or shocked, is it not a violation of the living spirit?
Anne Woodlen, whose writing I greatly admire, states it starkly:
American medicine treats the body with drugs until it kills the soul. It’s rather like a root canal: the tooth is left in place but the nerve is taken out… More and more people are crying out in spiritual pain, and their cries are being silenced with drugs… You call this caring—this business of silencing the pain of wounded spirits?
- Anne C. Woodlen, “Mind, Spirit, or Soul” [emphasis added]
We live in a society where every spirit, every human being, is systematically assailed. No one escapes entirely. How did this come to pass?
How did we, as a society, come to be so very, very sick?
A related question
I grew up attending Baptist church services every Sunday. In sermons, and in conversations, I would often hear a question that seemed to trouble whoever asked it, and it troubled me, too:
Where have all the prophets gone?
Why doesn’t God send us messengers anymore?
The Old Testament is full of prophets, visionaries, men who saw God, talked with God. If a society was on the path to ruin and evil, God sent someone with a message, a mandate, to make things right. These were real, undeniable miracles, and they happened all the time!
This stuff would be big news, today, right? You just don’t miss a man proclaiming the word of the LORD and then ascending to heaven in a chariot of fire.
Ultimately, I learned to accept that for some mysterious reason, God doesn’t do big, obviously miraculous stuff like that anymore. He answers prayers and works on the small-scale, individual level – but sending messengers with miraculous visionary and prophetic powers to lead a community back to righteousness? That’s a thing of the past; it just doesn’t happen like that anymore. This answer to the question never did sit quite right with me, but it was the best I had.
Until I revisited the church of my childhood a few weeks ago after a long absence, and a resoundingly powerful answer, one that has been building for a while, finally burst into being in my consciousness. There are still spiritual messengers that come to us with a vision of healing, societal change – but they’re silenced. Routinely, as a matter of course. They MUST not be allowed to speak.
This “business of silencing the pain of wounded spirits” and the quelling of revolutionary visions for community-wide healing are one and the same. The practice of biopsychiatry encompasses them both.
I repeat: it is a spiritual battle.
(to be continued…)
Tags: anti-psychiatry, bully, Dr. Allen Frances, mental health activism, Occupy the APA, psychiatry
What does the term “bully” mean?
If you’d asked me that question 10 or even 5 years ago, I probably would’ve answered that a bully is:
- A young person (almost always male)
- In school
- Who uses muscles and aggression to terrorize and manipulate his peers and (more so) his inferiors.
But it doesn’t seem to mean that anymore.
Exhibit A, from my hometown:
Homeless people requesting money, food, or aid on the street (of which I see an increasing number in my city) are apparently bullies, manipulating innocent passers-by into giving them money instead of the city-wide coalition for the homeless [which will, of course, distribute funds in a fair and equitable manner, or so we are told on the other side of The Box]. So we should put our donations in “The Box” and say “NO” to bullies.
[My significant other and I always joke about dumping a big pot of soup in The Box. How long does it take 5 full time, fully educated/certified employees – supported by Box donations – to distribute 5 cups of soup? And will the soup be any good by the time they get around to doing it?]
I myself have been told that what I do with my writing here on ALT_mentalities is akin to “cyber bullying.” Funny. I thought I was critiquing erroneous articles and bad “scientific studies,” and perhaps doing a little musing here and there. I was not aware of the “hurtful nature” of my writing.
It seems that one of the main effects of the bullying public awareness campaign that began more or less a year ago has been to vastly expand the boundaries of the term. The word bully now carries a dizzying array of new connotations – hater, criminal, maybe even dissident, protestor, reformer — we’re at the point now where any person who disagrees with a dominant paradigm can be labeled a “bully,” and promptly booted from the discussion. Or, as in my first example, forced to find a new mode of survival in a field of ever diminishing options. Forced, most likely, to become dependent on that lovely city-wide coalition staffed by certified people who, out of sheer goodness, would help even the despised bullies of the city.
To every critical thinker, every person engaged in the search for mental balance, every activist fighting for mental rights and freedoms, and every soul participating in a healthy critique of the industry that calls itself “psychiatry,” searching for a more human and human alternative:
You’re in danger of being called bully. And it’s total bull.
What does the term “anti-psychiatry” mean?
On the surface, it seems pretty simple. “Anti-psychiatry” = Against psychiatry. “Psychiatry” seems to refers to the Western practice of psychiatrization, including (but not limited to) a biopsychiatric model of mental illness as brain disease, “scientific” diagnosis with the DSM, psychotropic medication as first line treatment, chronicity and decreased lifespan an assumed, prophetic outcome of “treatment.”
That probably describes a lot of folks, myself unabashedly included.
But we must remember the true meanings of the language of mental health. Go to the Greek, and you find that to be “anti-psychiatry” is to be “against soul healing.” Well that’s no good! The major critique of psychiatry [and, again, by psychiatry we mean the Western practice of psychiatrization here] is its complete lack of respect for, failure to even acknowledge the existence of, the soul.
Recently, psychiatrists have been talking amongst themselves, most notably in their trade journal Psychiatric Times, about the “rise” of virulent anti-psychiatry.
Sometimes I wonder if hatred of psychiatrists is one of the few remaining forms of acceptable bigotry. If the vitriol on many anti-psychiatry Web sites is any indication, the answer may be yes.
- Ronald Pies, “Moving Beyond Hatred of Psychiatry: A Brave Voice Speaks Out,” in Psychiatric Times
Those who try to help people with psychological problems also become stigmatized…
Unfortunately, sometimes in a society, those discriminated against will fight internally or compete against one another. So it is in the US at times, especially with gang conflicts. A psychoanalytic explanation for this phenomenon could be “identification with the aggressor.”
Now we may be seeing more and more of that in our field as the antipsychiatry movement of Scientologists seems to be expanding to former patients and their families who felt they were hurt by psychiatry. While some anger and criticism is surely warranted, the vitriol and call for the end of psychiatrists seems to border on hate speech.
- H. Steven Moffic, “Psychism: Defining Discrimination of Psychiatry,” in Psychiatric Times; emphasis added
Aha! Now we’re getting somewhere. Anti-psychiatrists are “aggressors.” They engage in “hate speech.” And the beliefs they espouse, the critiques they publish, their every critical thought about psychiatry likely has its roots in Scientology, whose virulent anti-psychiatry beliefs have “spread” to some non-scientologist psychiatric survivors and their families.
Maybe even a few former professionals, too. Like Alice Keys, a recused psychiatrist who blogs at Mad In America about what reading Robert Whitaker’s books has done and continues to do to her perspective on the Western practice of psychiatrization.
What Moffic is essentially saying is that anyone he describes as “anti-psychiatry” is a bully [remember – aggressive hate speech] and as such should be not be engaged with – not by psychiatrists or any other mental health professionals – because doing so would only instigate a Stockholm Syndrome-like effect where professionals would “identify with the aggressors.”
By which I think he means mental health professionals might actually start to agree with the critique of psychiatrization or at least consider its many salient points.
Presumably this is Alice Keys’ diagnosis.
We’ve got their attention!
I found Moffic’s article about anti-psychiatry especially interesting because almost 5 months ago, he published a Psychiatric Times blog where he claimed that:
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.
- H. Steven Moffic in January Psychiatric Times blog
A lot has changed in 5 months! Moffic and the psychiatric community at large have noticed that they’re under intense public scrutiny. Protestors are coming out to events like the APA conference, inconveniently lifting their voices, sharing their message with an increasingly receptive public. And as much as Allen Frances and his ilk would like to confine scrutiny to the development of the DSM alone – they can’t. Like an ocean wave, critical thought about many of Western psychiatrization’s dehumanizing practices is pushing inexorably towards the shore of the general public’s consciousness.
To my fellow critical thinkers, those who question Western psychiatrization but wholeheartedly support “soul healing,” … I say again, we’ve got their attention!
Now here’s how we keep the positive momentum going, here’s how we sidestep their name-calling, here’s how we rip off the label of anti-psychiatry/bully so that more and more people can hear our message:
1. First, let’s honestly consider psychiatry’s critique. Are we bullies? Are we aggressors? When we tell our stories about what we’ve seen of psychiatry, when we recount scientific studies, research by folks like Robert Whitaker and Loren Mosher, philosophical ideas about the causes and purposes of so-called “mental illness” from John Perry, RD Laing, and Carl Jung, are we engaging in “hate speech”? Are we distorting the truth?
My friends, to the best of my knowledge, we are not.
We are telling the truth as best we can, we are building up a body of experiential, anecdotal, as well as scientific, knowledge as we go, we are engaging in honest and sincere dialogue with anyone who cares to join us, whether they “belong” to our “movement” or not. We want to find balance. We want to find real “soul healers.”
Psychiatry’s label does not describe us.
2. If we’re not bullies, let’s not act like bullies! What I mean by this is: no violence. Let it be, as MindFreedom International’s slogan states, “a united, non-violent revolution to rethink psychiatry.” Psychiatrists, social workers, mental health professionals at large are welcome to be a part of this re-thinking, assuming, of course, that they, too, agree to be non-violent in their engagement with fellow human beings.
PLEASE NOTE: This does not mean that survivor stories containing violence should not be told, that voices speaking with passion or strong emotion should be silenced, that only certain material is now considered legitimate (“non-violent”), a part of this dialogue. It would be foolish address the label of “bully” and “anti-psychiatry” by allowing only politically correct voices of sugary sweetness to be heard!
Rather, let’s follow the basic rules of productive conversation – we stick to the facts. We do not libel anyone. We call a spade a spade, certainly, but we don’t use name-calling for its own sake.
We’ve got a good thing going. Let’s keep it going!
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.
Tags: biopsychiatry, brain disease, diagnosis, DSM-5, New England Journal of Medicine, psychiatry, schizophrenia
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I heard the rumors of a fight, and I came a-running.
This morning, I read [here] that the following inflammatory remarks were published in this week’s New England Journal of Medicine:
… [Only when psychiatrists address] psychiatric disorders in the same way that internists address physical disorders, explaining the clinical manifestations … by the causal processes and generative mechanisms known to provoke them … will psychiatry come of age as a medical discipline and a field guide [the DSM – Diagnostic and Statistical Manual] cease to be its master work.
- Paul McHugh, MD and Phillp Slavney, MD in the NEJM [emphasis added]
Damn, that’s cold. And did I mention it was published in the New England Journal of Medicine (!), which is “one of the world’s most prestigious medical journals… cited in scientific literature more frequently than any other biomedical journal”? All kinds of doctors, clinicians, and practitioners read this thing!
A big deal.
Sounds like the authors are saying mental illness is fundamentally NOT like diabetes, that psychiatry as a discipline will continue to suffer from its immaturity and crippling inferiority complex (“we wanna be scientists, too!”) as long as diagnosis doesn’t rest on a firmly established foundation of physical pathology, and that the DSM is a poor substitute for that kind of a foundation.
Them’s fighting words. Words that might make the NEJM readership think twice before handing out diagnoses and their accompanying pharmacological interventions like the proverbial candy.
Don’t believe every rumor you hear
Having matured a bit from my high school days of running directly to join the ring of kids chanting “fight, fight, fight!”, I decided to get a little context. Who are these guys -– researchers? psychiatrists? some other kind of doctors? — and what does the rest of their NEJM editorial say?
“These guys” are two psychiatrists, professors at the Johns Hopkins School of Medicine. Paul McHugh, the lead author, is a rather famous one. He’s attended Harvard, designed a famous cognitive test often used as a dementia/Alzheimer’s diagnostic tool (a mere 11 questions!), served on the Presidential Council of Bioethics under GW and on a lay panel put together by the Catholic Church to look into the abuse of young boys by priests – none of these things being very high recommendations in my book. The two, together, have written a popular paperback for the general public entitled The Perspectives of Psychiatry which takes the biopsychiatric/disease-based approach to mental health.
And their editorial? It starts off very nicely with a critique of the DSM-delineated “field guide” method of diagnosis – the main problem being that clinicians no longer think too long or hard about causation. This promotes a “rote-driven” method of treating folks, and as the authors so rightly state “identifying a disorder by its symptoms does not translate into understanding it.” Or treating it effectively, if long-term studies of schizophrenia outcomes are any indication.
But things go sour real fast as we get to the “what’s to be done about it” part. We simply must establish causation for psychiatric disorders, and – guess what?—the authors have already done that!
The causes of psychiatric disorders derive from four interrelated but separable families: brain diseases, personality dimensions, motivated behaviors, and life encounters.
-McHugh et al.
They have also helpfully sorted out some common psychiatric disorders into the four families, or “causal perspectives”:
Right there, in the NEJM (remember – prestigious medical journal read by everybody), we’ve got schizophrenia neatly categorized as “brain disease.”
I diagnose thee… Flipfloppers!
Contrast the NEJM editorial with the polite phrasing the authors used in the aforementioned co-authored The Perspectives of Psychiatry, chapter 6:
The continuing failure to identify a particular cerebral pathology or pathophysiology in these disorders [manic depression and schizophrenia] undermines attempts to proclaim them as diseases with complete confidence. They remain mysteries in the sense that a confirmation of their essential nature is lacking…
- authors Paul McHugh, MD and Phillp Slavney, MD in The Perspectives of Psychiatry [emphasis added]
And yet they feel comfortable, only a few years after these words were published, with proclaiming schizophrenia as a “brain disease,” without providing any citations for new, groundbreaking research whatsoever. Clearly this “DSM critique” is not what it seems.
Middle way protestors all the way
As it turns out, these guys are total middle way DSM protestors – the only thing they’d like to fight is the bad public image of the DSM, not the institution of psychiatric diagnoses masquerading as science, and all of the poor treatment that goes along with such posturing (symptom suppression via pharmaceuticals, coercive treatment, et al.).
According to McHugh and Slavney, “no replacement of the criterion-driven diagnoses of the DSM would be acceptable; clinicians are too accustomed to them.” Rather, the only solution is for everyone [clinicians, researchers, families, patients] to embrace their causation groupings – and for that to be coded and billable, too, one can only presume.
In no other field would you continue to reach for an admittedly blunt, ineffective tool simply because it’s “what people are used to.” Surely there are some other possiblities?
I believe that there is another way – instead of fitting people and their “symptoms” into predetermined boxes, we could communicate with each unique individual, offering our support and encouragement (help) when it’s wanted, and offering our respectful non-interventionism and acknowledgement of the humanity of the suffering individual when our “help” is neither helpful nor desired.
I believe there is life after the DSM – and I’d like, as a society and a community, to live it!
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.
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, 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)?